The Pediatric Tracheostomy Practice During COVID-19 Pandemic at a PICU

Introduction:To evaluate pediatric tracheostomies performed at a tertiary care pediatric intensive care unit (PICU) before and after the Coronavirus disease-2019 (COVID-19) pandemic.Methods:A total of 57 pediatric tracheostomy patients performed at a tertiary care PICU were included. Prognostic scores including pediatric risk of mortality 2, pediatric index of mortality 2 and pediatric logistic organ dysfunction scores, the family education process and time to home discharge were evaluated according to time of tracheostomy (pre-pandemic vs. after pandemic) and responsible surgeon (pediatric surgeon vs. otolaryngologist). MedCalc® Statistical Software version 19.7.2 (MedCalc Software Ltd, Ostend, Belgium; https: //www.medcalc.org; 2021) was used for statistical analysis.Results:A non-significant tendency for higher rate of pediatric surgery-based tracheostomies was noted after the pandemic (76.0 vs. 24.0%, p=0.134). No significant difference was noted between tracheostomies performed before vs. after the COVID-19 pandemic and those performed by otolaryngologists vs. pediatric surgeons in terms of prognostic scores and time to home discharge.Conclusion:Our findings emphasize the maintenance of high quality patient care for pediatric tracheostomy patients in accordance with standardized tracheostomy protocols and policies during the pandemic period with no significant difference between tracheostomies performed before and after the COVID-19 pandemic and those performed by pediatric surgeons vs. otolaryngologists in terms of prognostic scores and time to home discharge

Left ventricular non-compaction in pregnancy

Left-ventricular non-compaction (LVNC) represents an arrest in the normal process of myocardial compaction, resulting in multiple, prominent, persistant trabeculations and deep inter-trabecular recesses communicating with the ventricular cavity. LVNC is a rarely encountered cardiomyopathy and few cases have been reported in pregnancy. In this case report we present a patient who referred to our clinic with symptoms of heart failure during pregnancy and whose echocardiographic examination revealed prominent trabeculations in the left ventricle

The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction

Background: Glycosylated hemoglobin (HbA1c) level on admission is a prognostic factor for mortality in patients with and without diabetes after myocardial infarction. In the present study, the authors examined the relationship between admission HbA1c level and myocardial perfusion abnormalities in patients with acute myocardial infarction. Methods: One hundred consecutive patients with acute myocardial infarction who were treated with thrombolytic therapy were included in the present prospective study. Blood glucose and HbA1c levels of all patients were measured within 3 h of admission. Patients were divided into three groups according to HbA1c level: 4.5% to 6.4% (n=25), 6.5% to 8.5% (n=28) and higher than 8.5% (n=47). All patients then underwent exercise thallium-201 imaging and coronary angiography to determine ischemic scores and the number of diseased coronary arteries four weeks after admission. Results: Seven patients died within the four-week follow-up period. There was a significant relationship between admission HbA1c level and mortality (P=0.009). Furthermore, there was a significant relationship between HbA1c level and total ischemic scores in patients with acute myocardial infarction (r=0.482; P=0.001). Ischemic scores increased as HbA1c levels increased in patients with acute myocardial infarction. Conclusions: The results demonstrated that admission plasma glucose and HbA1c levels are prognostic factors associated with mortality after acute myocardial infarction. ©2008 Pulsus Group Inc. All rights reserved

Angiographic detection of the left anterior descending and the right coronary artery after fistulas into the pulmonary artery in a patient with rheumatic mitral stenosis

Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult population undergoing coronary angiography. The diagnosis is usually made by aortography and selective coronary angiography. We report here an adult patient with rheumatic mitral stenosis and left anterior descending coronary artery and pulmonary conus branch of right coronary artery-pulmonary artery fistulas detected by coronary angiography. © 2005 Elsevier Ireland Ltd. All rights reserved

İntraperitoneal ve retroperitoneal yaklaşımla endoskopik nefroüreterektomi ve üst kutup nefroüreterektomi deneyimimiz

Aim: Examining the effectiveness of nephroureterectomy and upper pole nephroureterectomy via endoscopy. Material and Methods: The results of 12 patients who underwent retroperitoneoscopic and laparoscopic nephroureterectomy and upper pole nephroureterectomy in the last two years were presented. Results: Eight nephroureterectomies (2 retroperitonoscopic and 6 peritoneoscopic) were performed. Male to female ratio was 3/5, and average age was 9,6 (1-13 years). Minimum two and maximum five ports were used. Cholesistectomy in one, and ovarial cycst aspiration in another patient were applied during the same procedure with laparoscopic nephrectomies. Two open ureteroneocystostomies were added in two patients. Upper pole heminephrectomy was performed in four girls with an average age of 6.1 (8 months-13 years). One of these cases had a unilateral triplex collecting system. Two of the heminephrectomies were retroperitoneoscopic and two were laparoscopic. There was no difference between the durations of surgery and hospitalization of these small groups. Conclusion: Neither laparoscopic nor retroperitoneoscopic nephrectomy is superior to other regarding operating time and hospital stay. However, laparoscopic route was preferred more frequently because of its simplicity for the surgeon, and its large exposure allowing extra interventions for adjacent intraperitoneal pathologies.Amaç: Endoskopik yolla uygulanan nefroüreterektomi ve üst kutup nefroüreterektomi işlemlerinin etkinliğinin irdelenmesi. Gereç ve Yöntem: Kliniğimizde son iki yılda, retroperitoneoskopik ve laparoskopik yolla nefroüreterektomi ve üst kutup nefroüreterektomi uygulanan 12 hastanın sonuçları sunulmuştur. Bulgular: İkisi retroperitoneoskopik 6 tanesi laparoskopik olmak üzere toplam 8 hastaya nefrektomi uygulandı. Olguların beşi kız üçü oğlan, yaş ortalaması 9,6 (1-13 yaş arası)' dır. Kullanılan port sayısı 2 ila 5'dir. Laparoskopik nefroüreterektomi yapılan olguların birinde aynı seansta kolesistektomi, bir diğerinde ise over kistine aspirasyon uygulanmıştır. İki olguda da açık üreteroneosistostomi girişimi eklenmiştir. Yaş ortalaması 6,1 (8 ay - 13 yaş arası) ve hepsi kız olan dört hastaya da üst kutup heminefrektomisi uygulanmıştır. Bu olguların bir tanesinde tripleks sistem bulunmakta idi. Heminefrektomilerin ikisi laparoskopik, ikisi retroperitoneoskopik uygulanmıştır. Uygulamaların cerrahi işlem süresi ve hastanede yatış süreleri arasında belirgin bir fark saptanmamıştır. Sonuç: Nefrektomi ve heminefrektomi girişimleri için retroperitoneal veya laparoskopik yaklaşımların birbirlerine belirgin üstünlükleri saptanmamasına karşın, ek patolojilere girişim yapma gereksinimi olduğu durumlarda ve uygulama kolaylığı açısından laparoskopik girişimler daha fazla tercih edilmiştir