Evaluation of the deaths secondary to entrapment under the debris in the Van earthquake

AbstractIntroductionAn earthquake occurred on October 23, 2011 at 13:41 in the Van city of Turkey. According to the Kandilli Observatory and Earthquake Research Institute, the magnitude of this earthquake was measured as 7.2 on the Richter scale. The earthquake caused deaths and injuries due to entrapment under the debris. This study has been planned in order to evaluate the features of these deaths and to discuss the obtained data comparatively with the literature.Materials and methodsExternal examination of the corpses and autopsy reports drawn up for Van Attorney Generalship in the city center were evaluated retrospectively.ResultsTotally 51 deaths secondary to the entrapment under the debris were analyzed. Twenty-seven cases (52.9%) were females and 24 cases (47.1%) were males. All the deaths occurred in houses or workplaces. The causes of deaths were as follows: head trauma together with visceral organ laceration in 30 cases (58.8%), mechanic asphyxia in 14 cases (27.5%) and the crush syndrome in seven cases (13.7%). Deaths due to the crush syndrome occurred after victims’ were rescued alive after having been under the debris.ConclusionTraumatic findings are usually generalized and extensive in deaths related with earthquakes. Multiple fractures of cranial bones, ribs, extremities and injuries of visceral organs and major vessels are determined in the external examination. On the other hand, forensic pathologists should not disregard the diagnosis of the crush syndrome in traumatic deaths, especially if the trauma is secondary to the entrapment under the debris following an earthquake

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Coronary Artery and Mitral Valve Surgery in Takayasu's Arteritis: A Case Report

Concomitant coronary artery disease and mitral valve disease are rare in Takayasu's Arteritis. Our patient had Takayasu's Arteritis diagnosed 9 years ago. She had an inferior myocardial infarction and double stent implantation 8 months ago. She was admitted to the hospital for chest pain, and 3 vessel diseases were diagnosed with significant mitral regurgitation due to anterior leaflet prolapse. In this report, we present perioperative management of our patient who underwent coronary artery bypass grafting and mitral valve replacement

Dynamic analysis of doubly curved composite panels using lamination parameters and spectral-Tchebychev method

Efficient modeling and optimization techniques are required to overcome the high design complexity and computational costs concerning the engineering of composite structures. In this paper, a modeling framework for the dynamic analysis of doubly curved composite panels is developed. Lamination parameters are used to characterize the stiffness properties of the laminate, and the responses are calculated through the two-dimensional spectral-Tchebychev method. The proposed framework combines the computational efficiency advantages of both lamination parameters formulation and spectral-Tchebychev method which is extended for dynamic analysis of curved composite laminates. Compared to the finite element method, the developed model significantly decreases the computation duration, thereby leading to analysis speed-ups up to 40 folds. In the case studies, fundamental frequency contours for the doubly curved composite panels are obtained in lamination parameters space for the first time. The results show that, unlike flat or singly curved laminates, the maximum frequency design points for doubly curved panels can be inside the feasible region of lamination parameters requiring multiple layer angles. The fundamental mode shapes for the maximum frequency designs are also computed to investigate the influence of panel curvatures on the vibration patterns, which can exhibit mode switching phenomenon

USING TOPSIS METHOD WITH LAPLACE CRITERION TO SELECT OPTIMUM AIRLINE

In this study, for evaluating subjective features that provides preference of airline companies to others the method TOPSIS has been used. Whilst calculating the weights of the criteria Laplace Criterion had been used. The importance of the study is that this is a unique application in air cargo industry

A useful cannulation strategy to facilitate re-warming during total arch replacement

"Distal-first" surgical technique with antegrade cerebral perfusion and early re-warming is a secure and comfortable method for aortic arch replacement. By using this technique, we can minimize total circulatory arrest and hypothermic periods. Cerebral morbidities can be reduced by antegrade cerebral perfusion which is achieved via both axillary cannulation and balloon-catheters. Distal organ, cerebral, and renal morbidities can be minimized by early femoral arterial perfusion and early re-warming that is re-started immediately after distal anastomosis is performed

The dose-related effects of Dexmedetomidine on renal functions and serum neutrophil gelatinase-associated lipocalin values after coronary artery bypass grafting: a randomized, triple-blind, placebo-controlled study

OBJECTIVES: Acute kidney failure after coronary artery bypass grafting (CABG) is a serious complication that increases morbidity and mortality rates. Early detection and prevention of this complication are very important. A novel biomarker named neutrophil gelatinaseassociated lipocalin (NGAL) can play an important role in early diagnosis of acute kidney injury. Recent studies on the favourable effects of Dexmedetomidine on cardiac surgery have been published. The aim of this study is to investigate whether there is a dose-dependent positive effect of Dexmedetomidine on neutrophil gelatinase-associated lipocalin levels and renal functions when used after CABG

The Reliability of the Use of Serum Neutrophil Gelatinase-Associated Lipocalin Levels in the Assessment of Renal Functions after Coronary Artery Bypass Grafting

Objective. Evaluation of perioperative renal function is very important for early diagnosis and treatment of acute kidney injury after coronary artery bypass grafting. Serum creatinine levels, creatinine clearance, and estimated glomerular filtration rates used in determination of postoperative kidney injury can lead to late detection. Therefore, it is necessary to make a diagnosis earlier in clinical practice and to search for a reliable method. The reliability of the use of serum neutrophil gelatinase-associated lipocalin levels in close follow-up of renal function was evaluated in patients with coronary artery bypass grafting under cardiopulmonary bypass in our study. Patients and Methods. A total of 40 patients who underwent coronary artery bypass grafting under cardiopulmonary bypass between September 2009 and February 2010 were included in the study. The reliability of the postoperative 1st day plasma neutrophil gelatinase-associated lipocalin (Triage (R) NGAL Device; Biosite Inc.) measurements was evaluated in kidney injury developed in the first 5 days after operation that was detected using the Risk-Injury-Failure-Loss-End stage criteria. Results. Ten (25%) women and 30 (75%) male patients were included in the study. The average age is 59 +/- 8.6 years. Kidney injury according to Risk-Injury-Failure-Loss-End stage criteria developed in 8 patients (20%). For 150 ng/mL cutoff value of postoperative plasma neutrophil gelatinase-associated lipocalin levels, the area under the receiver-operating characteristic curve was 0.965. Neutrophil gelatinase-associated lipocalins sensitivity, specificity, and negative and positive predictive values were 100%, 93.8%, 100%, and 80%, respectively. Conclusion. It has been determined that plasma neutrophil gelatinase-associated lipocalin levels can be reliably used for early diagnosis of kidney dysfunction in patients undergoing coronary artery bypass grafting