Our Unpredicted Difficult Airway Experience in Tracheobronchopathia Osteochondroplastica Patient: A Case Report

Difficult airway is a serious condition that can be fatal and is frequently encountered during general anesthesia applications. Tracheobronkopathy osteochondroplasty (TBO) is a rare benign disease that is one of the causes of unpredictable difficult airway. A 45-year-old male patient with no comorbidities was transferred to the operating room for elective cholecystectomy. He couldn’t be intubated after standard monitoring and induction of anesthesia. The patient, who had papillomatous lesions in the trachea detected by bronchoscopy, was awakened to be scheduled for rigid bronchoscopy. TBO was detected in pathological examination of the samples taken in rigid bronchoscopy. TBO is a rare benign disease. Its etiology is unknown. It may be asymptomatic or may present with persistent dry cough, hemoptysis, dyspnea, recurrent lower respiratory tract infection, atelectasis and difficult intubation. Some patients may be diagnosed for the first time in the operating room due to difficult intubation.In cases with advanced tracheal stenosis, invasive airway intervention may be required or it may have a fatal course. The use of a laryngeal mask in the perioperative period may be an ideal option in a patient known to have TBO before. Unexpected difficult airway management in the operating room is important for anesthesiologists. According to the difficult airway society algorithm, waking the patient from a planned operation is the safest way until the problem is detected. We did not need invasive intervention because our patient also had elective surgery and ventilation was not difficult. In addition, we think that it is an important decision to make a diagnosis using fiberobtic bronchoscopy in operating room conditions and to wake up our patient with sugammadex without repeated attemps of tracheal intubation and delay elective surgery. In coclusion, it should be kept in mind that TBO may be one of the unpredictable causes of difficult intubation in the operating room

COVID-19 pozitif semptomatik çocukların D vitamini düzeyleri

Introduction:Vitamin D is known as a vitamin but also it acts as a prohormone and has many functions. The aim of this study is to investigate the vitamin D levels in pediatric patients with COVID-19. Materials and Methods: A retrospective study was performed in a tertiary education and research hospital in Istanbul, Turkey during the period of Marcht o April 2020. Children diagnosed with symptomatic COVID-19 infection were included in the study. Demographic, clinical and laboratory findings were recorded from patient charts retrospectively. All patients investigated for vitamin D levels. Control group consists of healthy children admitted to pediatric outpatient units for routine check-up in the same season.Thirty children with COVID-19 and 82 healthy children included in this study were compared due to 25-OH vitamin D levels. Results: The median age of COVID-19 positive patients was 11.8 (1.8-17.6) years and the median age of control group was 12.7 (1-16.4) years old. There were 15 (50%) females and 15 (50%) males in infected group and there were 39 (47.5%) females and 43 (52.5%) males control group. Age and gender did not differ among the groups. Median vitamin D level in COVID-19 positive group was 8.9 ng/ml (3- 42 ng/ml) and 18.5 ng/ml (9-40.7 ng/ml) in control group. We detected significantly lower vitamin D values in COVID19(+) group when compared with control group (p<0.001). CT was performed 19 patients in COVID-19 positive group and viral pneumonia was detected in 12(63%) of 19. pneumonia (+) group a 17.4-years-old female patient and a 13.1-years-old male patient had low phosphorus levels by age (2.2 and 2.4 mg/dl). Both of them needed high flow oxygen therapy. None of the other cases needed oxygen therapy. Conclusions: This is the first study to date has measured vitamin D levels in children with COVID-19 in Turkey. We detected significantly lower vitamin D values in COVID-19(+) hospitalized children.Giriş: D vitamini bir vitamin olarak bilinmesine rağmen aynı zamanda bir prohormon görevi görür ve birçok işlevi vardır. Çalışmamızda COVID-19 enfeksiyonu tanısı ile izlenen pediatrik hastalarda D vitamini düzeylerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmamız Mart-Nisan 2020 tarihlerinde İstanbul’da bir 3. basamak eğitim ve araştırma hastanesinde gerçekleştirildi. Semptomatik COVID-19 enfeksiyonu tanısı alan çocuklar çalışmaya dahil edildi. Demografik, klinik ve laboratuvar bulgular retrospektif olarak hasta dosyalarından kaydedildi. Tüm hastaların D vitamini seviyeleri değerlendirildi. Kontrol grubu aynı mevsimde pediatri polikliniğine rutin kontrol için başvuran sağlıklı çocuklardan oluşturuldu. Otuz COVID (+) ve 82 sağlıklı çocuk 25-OH vitamin D düzeyleri açısından karşılaştırıldı.Bulgular: COVID-19 pozitif hastaların ortanca yaşı 11,8 (1,8-17,6), kontrol grubunun ortanca yaşı 12,7 (1-16,4) idi. Enfekte grupta 15 (%50) kız, 15 (%50) erkek, kontrol grubunda 39 (%47,5) kız, 43 (%52,5) erkek vardı. Yaş ve cinsiyet gruplar arasında farklılık göstermiyordu. COVID-19 pozitif grupta medyan D vitamini seviyesi 8,9 ng/ml (3-42 ng / ml), kontrol grubunda 18,5 ng/ml (9- 40,7 ng/ml) idi. COVID19 (+) grupta kontrol grubuna göre istatistiksel olarak anlamlı daha düşük D vitamini düzeyleri saptandı (p<0.001). COVID-19 pozitif grupta 19 hastaya BT yapıldı ve 19 hastanın 12’sinde (%63) viral pnömoni tespit edildi. Pnömoni (+) grupta 17,4 yaşında kız hasta ve 13,1 yaşında erkek hastada yaşa göre düşük fosfor seviyeleri (2,2 ve 2,4 mg/dl) bulundu. Her ikisinin de yüksek akımlı oksijen tedavisine ihtiyacı oldu, diğer vakaların hiçbiri oksijen tedavisine ihtiyaç duymadı. Sonuç: Çalışmamız, Türkiye’de çocuklarda COVID-19 enfeksiyonu ile yatırılarak tedavi edilen olguların D vitamini düzeylerinin araştırıldığı ilk çalışmadır. Yatırılarak tedavi edilen COVID-19 (+) çocuklarda daha düşük D vitamini değerleri tespit ettik

Effects of varying entry points and trendelenburg positioning degrees in internal jugular vein area measurements of newborns

WOS: 000429375500018PubMed ID: 29607867Background: Recent guidelines from the National Institute for Clinical Excellence recommend the use of ultrasonography in the central venous catheterization of children. In this study, we aimed to compare area measurements using ultrasonography and efficiency of varying Trendelenburg degrees on the area measurements, for two different entry points used as internal jugular vein (IJV) cannulation points in newborns. Methods: Fifty-eight healthy newborns, weighing between 3000 and 3500 g, were recruited for this prospective study. Right IJV (RIJV) consecutive measurements were performed in three different Trendelenburg positions at 0 degrees, 15 degrees, and 30 degrees, at two different entry points: The superior approach and an inferior approach. The landmark used in the superior approach was the top of the triangle formed by the two heads of the sternocleidomastoid muscle with the clavicle; while in the inferior approach, it was taken as the midpoint of the clavicle, as measured from the upper edge of the clavicle. Results: The cross-sectional area (CSA) of the RIJV was significantly increased when using the inferior approach, compared to that in the superior approach, in all Trendelenburg degrees, including the neutral position. Both 15 degrees and 30 degrees Trendelenburg positioning resulted in a significant increase in CSA, both in superior and inferior approaches, when compared to neutral positioning. Conclusion: The use of 15 degrees Trendelenburg positioning may have significant advantage for increasing the CSA when used with the inferior approach

Living with schizophrenia: Perspectives of Turkish people with schizophrenia from two Patient Associations on how the illness affects their lives

Background: Schizophrenia is a chronic mental illness affecting the social and occupational lives of the sufferers and posing a considerable burden on the patients and their families. Furthermore, negative societal reactions and the internalization of these attitudes exacerbate the difficulties encountered. This study examines the perspectives of Turkish people with schizophrenia on how they view the impact of the illness on their lives, the societal reactions and attitudes to schizophrenia and whether they agree with these reactions. Methods: Twenty-three adult participants, all members of two schizophrenia associations in Ankara, capital of Turkey, were recruited. Semistructured interviews were used to find out their perspectives on how the illness affected their lives, how the society reacts to them and their views on these reactions. Interviews were recorded, transcribed and thematic analysis was used to capture the general and the subthemes. Results: The findings suggest that causal attributions for the illness, the impact of illness on various life domains, challenges of living with the illness and finally stigmatization are general categories that capture the perspectives of the participants. Conclusion: People diagnosed with schizophrenia experience the impacts and burdens of their illness in various domains of their lives and negative societal reactions heighten these burdens. It seems important to consider the challenges faced by people with schizophrenia in living with their illness and the impacts of negative societal behaviors and attitudes in offering psychosocial interventions programs for supporting this group. Furthermore, combating negative societal attitudes also seems to be necessary

Behçet Disease With Vascular Involvement

Vascular involvement is one of the major causes of mortality and morbidity in Behçet disease (BD). There are no controlled studies for the management of vascular BD (VBD), and according to the EULAR recommendations, only immunosuppressive (IS) agents are recommended. In this study, we aimed to investigate the therapeutic approaches chosen by Turkish physicians during the initial event and relapses of VBD and the association of different treatment options with the relapses retrospectively., Patients with BD (n = 936, female/male: 347/589, mean age: 37.6 ± 10.8) classified according to ISG criteria from 15 rheumatology centers in Turkey were included. The demographic data, clinical characteristics of the first vascular event and relapses, treatment protocols, and data about complications were acquired., VBD was observed in 27.7% (n = 260) of the patients during follow-up. In 57.3% of the VBD patients, vascular involvement was the presenting sign of the disease. After the first vascular event, ISs were given to 88.8% and AC treatment to 59.8% of the patients. Median duration of AC treatment was 13 months (1–204) and ISs, 22 months (1–204). Minor hemorrhage related to AC treatment was observed in 7 (4.7%) patients. A second vascular event developed in 32.9% (n = 86) of the patients. The vascular relapse rate was similar between patients taking only ISs and AC plus IS treatments after the first vascular event (29.1% vs 22.4%, P = 0.28) and was significantly higher in group taking only ACs than taking only ISs (91.6% vs 29.1%, P < 0.001). During follow-up, a third vascular event developed in 17 (n = 6.5%) patients. The relapse rate was also similar between the patients taking only ISs and AC plus IS treatments after second vascular event (25.3% vs 20.8%, P = 0.93). When multivariate analysis was performed, development of vascular relapse negatively correlated with only IS treatments., We did not find any additional positive effect of AC treatment used in combination with ISs in the course of vascular involvement in patients with BD. Severe complications related to AC treatment were also not detected. Our results suggest that short duration of IS treatments and compliance issues of treatment are the major problems in VBD associated with vascular relapses during follow-up.PubMedWoSScopu