Department of anesthesiology and reanimation, school of medicine, Marmara University, Istanbul, turkey

Objective: The aim of this prospective and randomized study was to compare the methods used for the assessment of the nasoduodenal tube position in critically ill patients according to the success rate, time spent on successful placement and cost effectivity. Methods: Sixty critically ill patients for whom enteral feeding with nasoduodenal tube (ND) was planned, were allocated randomly into 3 groups. The assessment of the location of the ND tube was done by auscultation of the loudest sound location over the right flank in group A, pH determination of the duodenal aspirate in group PH and fluoroscopic view in group F. The failure criteria was the placement of a ND tube in the stomach in all groups, the necessity of having more than two flat abdominal radiographs in group A and PH, the duration of fluoroscopy for more than 10 minutes in group F. The success rate, the time of successful placement and the total cost were determined and compared statistically by using analysis of variance and Fisher’s Exact Test. Results: The success rate was significantly higher in group F (95%). The time of successful placement was significantly shorter in group F (75.15 ± 5.32 min versus 147.95 ± 77.05 min in group A and 177.75 ± 154.84 min in group PH). There was no difference between groups regarding the total cost. A 25% false positive result was found in the PH group i.e. the tube was found to be in the stomach after the radiological evaluation although pH values were > 4. Conclusion: For critically ill patients in whom enteral feeding is planned with ND, fluoroscopy should be preferred whenever possible for the placement of the ND tube because the success rate is higher, the placement is quicker and it is more cost-effective than the conventional methods

Yaşlıların Sağlık Durumlarının Değerlendirilmesi

Giriş: Dünyada ve ülkemizde genel nüfus yaşlandıkça bu grubun sağlık bakı- mına olan gereksinimleri arttığından yaşlı bireylerin bakım gereksinimlerinin belirlenmesinde sağlık durumunun değerlendirilmesi önemlidir. Amaç: Çalışma yaşlıların sağlık durumlarını değerlendirmek amacıyla yapılmıştır. Yöntem: Aralık 2010 tarihinde, iletişim problemi olmayan, bağımsız veya yarı bağımlı olan, 65 yaş üstü toplam 212 yaşlı bireyde tanımlayıcı olarak yapılmıştır. Yaşlı sağlığını değerlendirmek amacıyla araştırmacılar tarafından geliştirilen sosyodemografik özellikler, fiziksel yeterlilik durumu ve sistemlere özgü fiziksel muayene bulgularını içeren “Yaşlı değerlendirme Formu” kullanılmıştır. Bağımlılık durumu, yaşam bulguları, beden kitle indeksi hesaplanmış, sistemlere özgü değerlendirilmesinde baştan-ayağa ve sistemlerin fiziksel muayenesi yapılmıştır. Bulgular: Çalışmada değerlendirmeye alınan bireylerin 65-95 yaş arasında (70.74+7.07), %55,7’sinin erkek, %28.3’ünün ilkokul mezunu, %10.8’inin alerjisi olduğu, %54.7’sinin sigara kullandığı, %42.5’inin barsak alışkanlıklarında sorun yaşadığı, %26.4 ’ünün de uyku sorunu olduğu belirlenmiştir. Yaş- lıların %63.2’sinin en az bir ameliyat geçirdiği, %61.8’inin hipertansiyon başta olmak üzere diyabet ve kalp yetersizliği gibi kronik bir hastalığı, %50.9 ’unun ağrı yakınması olduğu bu nedenlerle %84,9’unun sürekli kullandığı ilaçlarının olduğu saptanmıştır. Yaşlıların %58.5’inin bağımsız olarak fiziksel gereksinimlerini karşıladığı, %80.7’sinin açık ve anlaşılır bir konuşmasının olduğu, %72.6 ’sının baston, gözlük, tekerlekli sandalye, diş protezi kullandığı, sistemleri ile ilgili fiziksel muayenesinde en yoğun kas zayıflığı, yürüme güçlüğü (%71.2), ödem, noktüri, yorgunluk, çarpıntı (%65.6) öksürük, dispne, balgam çıkarma (%61.8), halsizlik, baş ağrısı, baş dönmesi (%59.4) sık idrar yapma, idrar kaçırma (%47.6) sorunu belirlenmiştir. Elde edilen sonuçlar yaşa bağlı anatomik ve fizyolojik değişkenlerin yansıması olarak değerlendirilmiştir. Sonuç: Yaşlıların bağımsızlıklarını etkileyen sağlık sorunları görüşme, gözlem ve ayrıntılı fizik muayene ile belirlendiğinden hemşirelerin etkinliği önemlidir

Impact of nutrients and water level changes on submerged macrophytes along a temperature gradient: A pan-European mesocosm experiment

Submerged macrophytes are of key importance for the structure and functioning of shallow lakes and can be decisive for maintaining them in a clear water state. The ongoing climate change affects the macrophytes through changes in temperature and precipitation, causing variations in nutrient load, water level and light availability. To investigate how these factors jointly determine macrophyte dominance and growth, we conducted a highly standardized pan-European experiment involving the installation of mesocosms in lakes. The experimental design consisted of mesotrophic and eutrophic nutrient conditions at 1 m (shallow) and 2 m (deep) depth along a latitudinal temperature gradient with average water temperatures ranging from 14.9 to 23.9 degrees C (Sweden to Greece) and a natural drop in water levels in the warmest countries (Greece and Turkey). We determined percent plant volume inhabited (PVI) of submerged macrophytes on a monthly basis for 5 months and dry weight at the end of the experiment. Over the temperature gradient, PVI was highest in the shallow mesotrophic mesocosms followed by intermediate levels in the shallow eutrophic and deep mesotrophic mesocosms, and lowest levels in the deep eutrophic mesocosms. We identified three pathways along which water temperature likely affected PVI, exhibiting (a) a direct positive effect if light was not limiting; (b) an indirect positive effect due to an evaporation-driven water level reduction, causing a nonlinear increase in mean available light; and (c) an indirect negative effect through algal growth and, thus, high light attenuation under eutrophic conditions. We conclude that high temperatures combined with a temperature-mediated water level decrease can counterbalance the negative effects of eutrophic conditions on macrophytes by enhancing the light availability. While a water level reduction can promote macrophyte dominance, an extreme reduction will likely decrease macrophyte biomass and, consequently, their capacity to function as a carbon store and food source

Total ıntravenous anesthesıa wıth spontaneous breathıng for transvagınal oocyte retrıeval

Objective: The aim of this study was to compare the adequacy of spontaneous breathing and assisted ventilation with laryngeal mask airway (LMA) during total intravenous anesthesia for transvaginal oocyte retrieval. Methods: One hundred patients, undergoing transvaginal oocyte retrieval under propofol - alfentanil anesthesia were randomly assigned into two groups. Anesthesia was induced with 2 mg.kg-1 propofol and 10 pg.kg-1 alfentanil i.v. in all patients . The ventilation was assisted with LMA in group I and was spontaneous in group II. One mg.kg-1 propofol and 5 pg.kg-1 alfentanil i.v. were administered when needed. Systolic and diastolic blood pressure, heart rate, oxygen saturation (Sp02) and end-tidal C02 pressure (ETC02), total drug doses administered, side effects and Aldrete recovery score were recorded. Results: Blood pressure and heart rate decreased significantly in all patients after induction (p<0.001). Sp02 increased and ETC02 decreased significantly at the 5th min in group I. Sp02 in group I and ETC02 in group II was found significantly higher (p<0.001) but remained within normal range during the operation. There were no differences in the time to achieve an Aldrete recovery score of 10 and the incidence of side effects. Conclusion: We concluded that propofol- alfentanil anesthesia with spontaneous breathing is an effective and safe anesthetic technique for transvaginal oocyte retrieval