Upper extremity acute compartment syndrome during tissue plasminogen activator therapy for pulmonary embolism in a morbidly obese patient

AbstractIntroductionDeep vein thrombosis (DVT) and pulmonary embolism (PE) are more frequently observed in morbidly obese patients. Tissue plasminogen activator (tPA) is a thrombolytic agent which dissolves the thrombus more rapidly than conventional heparin therapy and reduces the mortality and morbidity rates associated with PE. Compartment syndrome is a well-known and documented complication of thrombolytic treatment. In awake, oriented and cooperative patients, the diagnosis of compartment syndrome is made based on clinical findings including swelling, tautness, irrational and continuous pain, altered sensation, and severe pain due to passive stretching. These clinical findings may not be able to be adequately assessed in unconscious patients.Presentation of caseIn this case report, we present compartment syndrome observed, for which fasciotomy was performed on the upper right extremity of a 46-year old morbidly obese, conscious female patient who was receiving tPA due to a massive pulmonary embolism.DiscussionCompartment syndrome had occurred due to the damage caused by the repeated unsuccessful catheterisation attempts to the brachial artery and the accompanying tPA treatment. Thus, the bleeding that occurred in the volar compartment of the forearm and the anterior compartment of the arm led to acute compartment syndrome (ACS). After relaxation was brought about in the volar compartment of the forearm and the anterior compartment of the arm, the circulation in the limb was restored.ConclusionAs soon as the diagnosis of compartment syndrome is made, an emergency fasciotomy should be performed. Close follow-up is required to avoid wound healing problems after the fasciotomy

The effect of LPG application on engine performance and exhaust emissions in an air cooled gasoline engine

Bu çalışmada, hava ile soğutmalı ve tek silindirli bir benzin motorunda benzin ve sıvılaştırılmış petrol gazı (LPG) yakıtı ile egzoz emisyon ve motor performans analizi gerçekleştirilmiştir. Deneyler, en yüksek motor torkunun elde edildiği 2600 dev/dk motor devrinde %20-%100 gaz kelebeği açıklığında %20 gaz kelebeği açıklığı aralıklarla gerçekleştirilmiştir. Sonuçlar LPG yakıtından elde edilen değerler benzine oranla ortalama motor torku ve gücünün %4,15, ortalama yakıt tüketimi ve özgül yakıt tüketiminin ise sırasıyla %16,77 ve %16,45 düştüğünü göstermiştir. Buna ek olarak, LPG yakıtı ile benzine oranla ortalama CO, HC ve CO2 emisyonları sırasıyla %35, %35,36 ve %2,5 düşmüş; ortalama NOX emisyonu %88 yükselmiştir.The exhaust emission and engine performance analysis of LPG and gasoline fuel and engine in single cylinder gasoline engine with air cooling were performed in this paper. The experiments were carried out for throttle openings of 20%-100% with %20 intervals at 2600 rpm, where the engine was most stable. The results showed that the mean engine torque and power decreased 4.15%, average fuel consumption and specific fuel consumption decreased 16.77% and 16.45%, respectively, comparing to gasoline and LPG. In addition, average CO, HC and CO2 emissions of LPG fuel and gasoline decreased by 35%, 35.36% and 2.5%, respectively; average NOX emission increased by 88%

Implementation of the New Turkish Primary Education Mathematics Curriculum in the Sixth Grade: A Survey of Teachers' Views

The mathematics education curriculum in Turkey is in the midst of a period of intensive reform. This article investigates the extent to which teachers implement the updated 6th grade mathematics curriculum through their self-reports and if their level of use differs according to the province where the school is located, teachers' gender, level of education, teaching experience and number of students in their classrooms. Furthermore, teachers' opinions about the new curriculum and the difficulties faced by them during the implementation process are also investigated. MANOVA results indicated that teachers' level of use and the factors affecting it varied in different dimensions of the curriculum

Effects of balloon pulmonary angioplasty procedure on electrocardiographic parameters in patients with chronic thromboembolic pulmonary hypertension

Aim: The aim of the present study was to evaluate the value of electrocardiography (ECG) in predicting post-operative hemodynamic improvement in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA).Material and methods: A total of 32 patients were included in the study. During ECG analysis, parameters that have been suggested to be related to right ventricular hypertrophy and/or dilatation were evaluated. The sig-nificance of the change in each parameter obtained at the pre-BPA visit and at the scheduled control visit 6 months after BPA was tested. In addition to ECG analysis, data related to right heart catheterization (RHC) and echocardiography, B-type natriuretic peptide (BNP) levels and World Health Organization (WHO) functional classifications of all patients were also recorded. The relationship between the amount of possible change in ECG parameters and the amount of possible change in hemodynamic parameters was investigated.Results: The Daniel score, which has been suggested to have prognostic value in acute pulmonary embolism, decreased from 8.22 +/- 5.68 to 6.56 +/- 5.55 after the BPA procedure (p: 0.035). Among all parameters studied, only T wave height (V2 t) in V2 derivation changed significantly from-0.77 +/- 2.39 to 1.27 +/- 2.58 mm (p: 0.036). The amount of change in V2 T was found to significantly correlate with the amount of change in systolic right ventricular pressure, mean pulmonary artery pressure, pulmonary vascular resistance, and systemic vascular resistance.Conclusion: Postprocedural T wave changes in lead V2 might serve as a marker of hemodynamic improvement in patients with CTEPH who undergo BPA

Anxiety level in pre-hospital emergency medical services personnel during coronavirus disease-2019 pandemic

Aim: This study aimed to determine the anxiety level in pre-hospital emergency medical services personnel (PHEMSPs) and investigate the factors that potentially affect the anxiety level during the pandemic. Materials and Methods: This cross-sectional survey was conducted with PHEMSPs during the Coronavirus Disease-2019 (COVID-19) pandemic. A 60-item survey, including socio-demographic characteristics, anxiety-related demographic factors, and State-Trait Anxiety Inventory (STAI) scale scores was used. Results: Among 586 PHEMSPs participating in the study, 50.5% were female, with median age of 30 years. The mean STAI-S value was 42.2, and the median STAI-T value was 48. The anxiety levels of female PHEMSPs (STAI-S=51 and STAI-T=44.14) were higher than male (STAI-S=44 and, STAI-T=40.26). The anxiety level of patients with chronic diseases (STAI-S=56 and, STAI-T=45.77) was significantly higher than those without chronic diseases. State anxiety scores in married individuals (STAI-S=49) were higher than those unmarried individuals. Conclusion: Clearly, people who provide this service should be psychologically healthy to efficiently provide healthcare for the benefit of the people. All types of media assume a great responsibility in reducing the unrest or anxiety that may occur in humans, especially because of their potential to reach many parts of the society

Anxiety Levels and Associated Factors Among Emergency Department Personnel Fighting COVID-19

Aim: We aimed to determine anxiety levels of the emergency department (ED) personnel working in close contact with infected patients and potential risk factors associated with this anxiety. Materials and Methods: This cross-sectional, hospital-based study was conducted among healthcare personnel working at the ED of the tertiary healthcare hospital in question, who are directly involved in the diagnosis and treatment of COVID-19 patients. The participants were administered a questionnaire that included items on sociodemographic characteristics; items on health, social, and demographic factors considered to be related with anxiety; and the 40 items of State-Trait Anxiety Inventory (STAI). Results: The study included 138 healthcare professionals. In total, 29.7% of the participants were female and 70.3% were male. The minimum and maximum ages of the participants were 21 and 52 years, respectively, with a median age of 33 (27–40) years. The mean STAI-S and STAI-T scores of healthcare professionals included in the study were 45.4 ± 10.4 and 41.3 ± 7.3, respectively. The effect of women nurses and having children, on anxiety levels was found to be significantly high. Comparing the groups categorized for their compliance with COVID-19-related measures, the state anxiety scores of the “somewhat compliant” group were found to be higher. Participants with the perception that measures taken and institution’s available capacity were insufficient were found to have statistically significantly higher STAI-S scores than the others (p < 0.001) Conclusion: Maintaining mental health of healthcare personnel during a pandemic is vital to better control contagious diseases. Thus, exclusive effort should be made to maintain mental well-being of healthcare professionals being exposed to COVID-19