Posterior reversible encephalopathy syndrome secondary to acute post-streptococcal glomerulonephritis

A previously healthy 11-year-old boy presented to the emergency department with generalized tonic-clonic seizures. One week prior, he had complained of headaches, blurry vision, nausea, and vomiting. Once the seizures were controlled with midazolam and levetiracetam, the patient was admitted to the pediatric intensive care unit

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Idea blok şifreleme sisteminde kullanılan işlemlerin cebirsel özellikleri.

In this thesis we obtain several interesting algebraic properties of the operations used in the block cipher IDEA which are important for cryptographic analyzes. We view each of these operations as a function from $\mathbb Z_{2}^n \times \mathbb Z_{2}^n \to \mathbb Z_{2}^n$. By fixing one of variables $v(z)=\mathbf Z$ in $\mathbb Z_{2}^n \times \mathbb Z_{2}^n$, we define functions $\mathbf {f}_z$ and $\mathbf {g}_z$ from $\mathbb Z_{2}^n$ to $\mathbb Z_{2}^n$ for the addition \BIGboxplus and the multiplication \BIGodot operations, respectively. We first show that the nonlinearity of $\mathbf {g}_z$ remains the same under some transformations of $z$. We give an upper bound for the nonlinearity of $\mathbf {g}_{2^k}$, where $2\leq k < n-1$. We list all linear relations which make the nonlinearity of $\mathbf {f}_z$ and $\mathbf {g}_z$ zero and furthermore, we present all linear relations for $\mathbf {g}_z$ having a high probability. We use these linear relations to derive many more linear relations for 1-round IDEA. We also devise also a new algorithm to find a set of new linear relations for 1-round IDEA based on known linear relations. Moreover, we extend the largest known linear class of weak keys with cardinality $2^{23}$ to two classes with cardinality $2^{24}$ and $2^{27}$. Finally, we obtain several interesting properties of the set \{ ({\mathbf X},{\mathbf X} \BIGoplus {\mathbf A}) \in \mathbb Z_2^n \times \mathbb Z_2^n \,I\, (\mathbf {X}\BJoin {\mathbf Z})\BIGoplus( ({\mathbf X} \BIGoplus {\mathbf A} ) \BJoin \mathbf {Z} ) = {\mathbf B} \} for varying ${\mathbf A}, {\mathbf B}$ and ${\mathbf Z}$ in $\mathbb Z_2^n$, where \BJoin \in \{ \BIGodot,\BIGboxplus \}. By using some of these properties, we present impossible differentials for 1-round IDEA and Pseudo-Hadamard Transform.Ph.D. - Doctoral Progra

Pediatric Fulminant Leptospirosis Complicated by Pericardial Tamponade, Macrophage Activation Syndrome and Sclerosing Cholangitis

Background: Leptospirosis is a zoonotic infectious disease caused by pathogenic spirochetes of the genus Leptospira. Although it is usually asymptomatic and self-limited, severe potentially fatal illness accompanied by multi-organ failure may occur. Case Report: Here we report an unusual case of severe leptospirosis successfully treated with continuous venovenous hemofiltration (CVVHF) and therapeutic plasma exchange (TPE). The patient presented with pericardial tamponade, renal failure and macrophage activation syndrome, and later suffered prolonged jaundice and sclerosing cholangitis during hospitalization in the pediatric intensive care unit (PICU). To the best of our knowledge, sclerosing cholangitis due to leptospirosis has not been reported in the literature. Conclusion: Leptospirosis should be kept in mind in the differential diagnosis of sepsis and septic shock with fever, thrombocytopenia, jaundice and renal failure. TPE and CVVHF should start early after the diagnosis of leptospirosis with multiorgan failure

Elektrik yanıklarında mortaliteye etki eden faktörler

WOS: 000403589400009PubMed ID: 28530776BACKGROUND: The aim of this study was to determine the factors affecting mortality rate among patients with an electrical burn. METHODS: A total of 115 patients admitted to the emergency department and hospitalized in the Burn Treatment Center or Intensive Care Unit (ICU) due to the electrical burn, were included in the study. RESULTS: A total of 115 patients (4 female and 111 male) with a mean age of 32.88 +/- 12.87 years were included in the study. The mean hospitalization period was 25.03 coproduct 20.50 days, and the mean total body surface area burned (% TBSA) was 22.83 +/- 15.54%. Among those patients, 9 (8.5%) expired, and the remaining 106 were discharged after treatment. In a logistic regression analysis, TBSA > 20% (p= 0.02, OR: 11.7, CI: 1.38-99.16); ICU requirement (p= 0.005, OR: 1.28, CI: 1.08-1.58); erythrocyte transfusion requirement (p= 0.02, OR: 12.48, CI: 1.44-107.83); fresh frozen plasma (FFP) requirement (p= 0.03, OR: 10.23, CI: 1.18-88.17); albumin requirement (p= 0.02, OR: 12.60, CI: 1.44-109.85); admission serum albumin level %20 (p=0.02, odds ratio (OR): 11.7, confidence interval (CI): 1.38–99.16), YB gerekenler (p=0.005, OR: 1.28, CI: 1.08–1.58); eritrosit transferi gerekenler (p=0.02, OR: 12.48, CI: 1.44–107.83); Taze donmuş plazma (TDP) gereksinimi olanlar (p=0.03, OR 10.23, CI: 1.18–88.17); albümin gereksinimi olanlar (p=0.02, OR: 12.60, CI: 1.44–109.85); kabulde serum albümin seviyesi <3.5 mg/dL (p=0.04, OR: 7.25, CI: 0.82–63.64); kabul hemoglobin seviyesi <12 mg/dL (p=0.01, OR: 8.29, CI: 1.57–43.61) hastalarda mortaliteyi belirleyen risk faktörleri olarak belirledik. TARTIŞMA: Klinik uygulamada, elektrik yanığı olan hastalarda bu faktörlerin analiz edilmesi mortalite oranını belirlemede yararlı olabilir. Elektrik yanığı olan hastalarda mortalite risk faktörlerini ve uzun dönem morbiditeleri belirlemek için daha geniş çalışmalara gereksinimi vardır

Tiner yanıklarının genel özellikleri: Tek merkezli bir çalışma

WOS: 000396527500009PubMed ID: 28261771BACKGROUND: The aim of the present study was to present characteristic features and risk factors of paint thinner burns in order to raise awareness and help prevent these injuries. METHODS: Records of patients admitted to the burn unit due to paint thinner burns were retrospectively reviewed, and patients with comprehensive data available were included in the study. Total of 48 patients (3 female and 45 male) with mean age of 27.79 +/- 11.49 years (range: 4-58 years) were included in the study. RESULTS: Mean total hospitalization period was 30.25 +/- 27.11 days (range: 3-110 days), and mean total burn surface area was 32.53 +/- 24.06% (range: 3.0-90.0%). In 31 cases (64.6%), intensive care unit admission was required. Among all 48 patients, 9 (18.8%) died in hospital and remaining 38 were discharged after treatment. Primary cause of death was septicemia (n = 7) or respiratory failure (n = 6). Inhalation injury was present in 12 of the patients, 6 of whom died (50%). Statistically significant differences were found between expired and discharged patients when compared for presence of inhalation injury (p = 0.01) and septicemia (p = 0.031). CONCLUSION: Ignition of paint thinner is an important cause of burn injuries that may result in very severe clinical picture. Patients require prompt and careful treatment. Clinicians should be aware that inhalation injury and sepsis are the 2 main factors affecting mortality rate in this group of patients. With increased awareness, preventive measures may be defined. Further studies are warranted to decrease mortality rate in this subgroup of burn patients.AMAÇ: Bu çalışmanın amacı tinere bağlı yanıkları önlemek için bu yanıkların karakteristik özelliklerini incelemek ve risk faktörlerine olan farkındalığı artırmaktır. GEREÇ VE YÖNTEM: Tiner yanığı nedeniyle yanık ünitesine kabul edilen hastalar geriye dönük olarak tarandı, hastaların klinik kayıtları kapsamlı bir şekilde incelendi. Ortalama yaşları 27.79±11.49 (dağılım, 16–58 yaş) olan toplam 48 hasta (3 kadın, 45 erkek) çalışmaya alındı. BULGULAR: Ortalama hastanede kalış süresi 30.25±27.11 (dağılım, 3–110) gündü, ortalama toplam yanık yüzey alanı %32.53±24.06 (dağılım, %3.0–90.0). Toplam 31 hastada yoğun bakım ünitesi ihtiyacı oldu. Tiner yanığı olan hastaların dokuzu kaybedildi (%18.8), geriye kalan 38 hasta tedavileri sonrasında taburcu edildi. Ana ölüm nedeni septisemi (n=7) ve respiratuvar yetersizlikti (n=6). Hastaların 12’sinde inhalasyon yanığı eşlik ediyordu, bunlardan altısı kaybedilmişti (%50). Septisemi (p=0.031) ve inhalasyon hasarı (p=0.01) varlığı açısından karşılaştırıldığında, kaybedilen veya taburcu edilen hastalar arasındaki farklar anlamlı idi. TARTIŞMA: Tinerle temas, hızlı ve dikkatli tedaviler gerektiren çok ciddi klinik tablolara neden olabilen önemli bir yanık nedenidir. Klinisyenlerin bunun bilincinde olmalı, bu hasta grubunda inhalasyon yanığı ve sepsisin mortalitenin iki önemli nedeni olduğunu bilmelidir. Artan bilinçle önleyici tedbirler tanımlanabilir. Bu hasta grubunda mortalitenin azaltılması için daha fazla çalışma yapılmasına ihtiyaç vardır

Peroxisomal disorder characterized with severe cerebral dysgenesis and hypotonia

Very long chain fatty acids accumulate in many tissues and organs in the peroxisomal disorders due to defects in fatty acid metabolism. Although the disease may be manifested as severe symptoms causing early death due to hypotonia, poor feeding, respiratory problems, cerebral dysgenesis, liver and kidney dysfunctions, it may be presented as late onset with mild symptoms. We presented a 4 months-old male infant with peroxisomal disorder diagnosed by dysmorphic facial appearance, hypotonia since birth, feeding difficulties, respiratory distress, severe cerebral dysgenesis and increased very long chain fatty acids due to its rarity

Evaluation of Aflibercept Treatment Responses in Eyes with Bevacizumab/Ranibizumab-resistant Wet Age-related Macular Degeneration

Objectives: To evaluate anatomic and functional results after switching from intravitreal bevacizumab or ranibizumab treatment to aflibercept for wet (neovascular) age-related macular degeneration. Materials and Methods: This retrospective study included 22 eyes of 22 patients resistant to treatment with at least 6 injections of bevacizumab or ranibizumab. The first three injections had been applied monthly, the others pro re nata (PRN). Outcome measures were follow-up period, injection number, best corrected visual acuity (BCVA), central retinal thickness (CRT) and pigment epithelial detachment (PED) height. Dosing regimen of aflibercept was determined PRN. The patients were examined monthly. In all visits, BCVA and optical coherence tomography results were assessed together and injections were applied according to these findings. Patients with at least three months of follow-up were included in the study. Results: Twenty-two eyes of 22 patients treated with bevacizumab or ranibizumab were switched to aflibercept therapy. Seven patients had serous PED and 4 patients had fibrovascular PED. The mean follow-up periods for these groups were 20.59±6.76 months and 8.68±3.79 months, respectively. The mean injection numbers were 10.5±3.61 vs 4.54±1.56. Statistically significant reductions were noted in CRT (533.86±164.06 µm vs 412.04±143.86 µm, p<0.05). BCVA levels were almost equal before and after switching (0.18±0.17 vs 0.18±0.14). Serous and fibrovascular PED heights decreased suboptimally from 460±281.51 µm to 282.42±175.76 µm (p>0.05) for serous PEDs and 251.25±43.85 µm to 225.75±73.09 µm (p>0.05) for fibrovascular PEDs. Conclusion: Switching to aflibercept resulted in significant improvement in CRT, but not in BCVA or PED heights