Conducta Anestésica en Niño con Osteogénesis Imperfecta y Hemorragia Epidural

ResumenLa osteogénesis imperfecta (OI) es el resultado de una mutación genética que causa la formación defectuosa o insuficiente de colágeno. La OI puede causar varias complicaciones anestésicas a causa del manejo difícil de las vías aéreas, de la presencia de deformidad de la columna vertebral, de enfermedades respiratorias, anomalías cardíacas, trastorno de la función plaquetaria, riesgo de hipertermia, invaginación bacilar, deformidades óseas y trastornos metabólicos. El abordaje anestésico de pacientes con OI debe ser hecho con cautela, ya que existe un riesgo de ciertas complicaciones respiratorias. Esos riesgos son causados por deformidad del tórax, fracturas óseas durante el movimiento o el cambio de posición, fracturas mandibulares y cervicales relacionadas con la intubación, intubación difícil e hipertermia maligna. Las técnicas anestésicas con el uso de anestesia venosa total (AVT) y mascarilla laríngea, son adecuadas para el manejo de paciente pediátrico con OI. Sin embargo, esas técnicas todavía no han sido mencionadas como útiles en relatos de casos neuroquirúrgicos. En este estudio, presentamos el uso de AVT y mascarilla laríngea ProSeal (MLP) en un niño con OI y hemorragia epidural. Concluimos que la MLP y la AVT pueden ser usadas con seguridad en el manejo anestésico de pacientes con OI y problemas anestésicos graves

Levels of Organochlorine Pesticides and Heavy Metals in Surface Waters of Konya Closed Basin, Turkey

The concentrations of organochlorine pesticides (OCPs), including α-, β-, γ-, and δ-hexachlorocyclohexane (HCH), heptachlor, heptachlor epoxide, dieldrin, aldrin, endrin, endrin aldehyde, endrin ketone, endosulfan I, endosulfan II, endosulfan sulfate, p,p′-DDE, p,p′-DDD, p,p′-DDT, methoxychlor, chlordane I, chlordane II, and heavy metals, such as As, Cr, Cu, Fe, Mn, and Ni in surface water samples from the Konya closed basin were determined to evaluate the level of contamination. Among all HCH isomers, β-HCH is the main isomer with a concentration range of 0.015–0.065 μg/L. DDE, DDD, and DDT were almost determined in all samples, in which DDE isomer had the highest concentration ranged from not detected to 0.037 μg/L. In all studied OCPs, aldrin showed the highest concentration at 0.220 μg/L. The concentrations of heavy metals in water samples were observed with order: Mn < Cu < Ni < As < Cr < Fe. In some samples, As, Fe, and Cr concentrations exceeded the drinking water quality recommended by EU, US EPA, WHO, and Turkish Regulation, while Cu, Ni, and Mn concentrations are below the guideline values. The levels of both OCPs and heavy metals were also compared with other previously published data

The effect of local anesthesia types on erectile function in TRUS biopsy: A prospective study

Aim: To evaluate the effect of local anesthesia types on erectile function during transrectal ultrasound guided biopsy (TRUS-Bx).Material and Methods: Between February 2014 and February 2015, 50 men who underwent TRUS-Bx at our institution were included in this prospective study. The 50 patients were randomized and divided into two groups according to the type of anesthesia used. All patients were asked to indicate the level of pain experienced on a visual analogue scale (VAS) 10 min after the TRUS biopsy. All patients had to fill in the IIEF standardized questionnaire. Groups were evaluated in terms of pre-biopsy IEFF score (IIEF-1), post-biopsy 1st month IIEF score (IIEF-2) and post-biopsy 2nd month IIEF score (IIEF -3). Patient characteristics, mean VAS score and IIEF score were compared between the two groups.Results: The mean age,IIEF-1,tPSA level, prostate volume and VAS score were 60.86±0.95 years,18.68,6.81±0.54 ng/ml,51.10±3.82 cc and 3.5±0.26 in all patients, respectively. The difference in VAS scores between the groups was statistically significant (p&lt;0.05). In Group 1 the IIEF-1, IIEF-2, and IIEF-3 were different from each other statistically. There was no statistically significant difference between IIEF-1 and IIEF-3 scores in group 2(p=0,136 z=-1,492).So it was observed that the initial IIEF scores were reached at the end of the second month in group 2 administered 12.5 g 2% lidocaine HCl jel.Conclusion: Our study indicates that although local periprostatic anesthesia by injecting 6 ml of 2% lidocaine provides more effective anesthesia for pain relief, intrarectal 12.5g 2% lidocaine HCl jel maintains less impact on erectile dysfunction for TRUS-Bx

Effect of Environmental Tobacco Smoke on Plasma Iron, Zinc and Copper Concentrations in Infants

The deleterious effects of cigarette smoking on trace elements concentrations are well known. Recent studies show that exposure of nonsmokers to environmental tobacco smoke (ETS) results in many biochemical processes and diseases. The aim of this study was to investigate the plasma concentrations of iron (Fe), zinc (Zn) and cooper (Cu) in 29 infants (14 boys and 15 girls, age range: 2-6 months, mean age: 3.6 months) who had been exposed to ETS (range 8-30 cigarettes/day mean 12.4 ± 4.7) for at least two months at home, while the control group included 30 infants (13 male, 17 female, age range: 2-6 months, mean age: 3.3 months) who had never been exposed to ETS. All infants had been breast fed. The plasma iron concentrations were determined by commercial kit, cotinine levels were determined by luminometric method. Cu and Zn concentrations were analyzed by atomic absorption spectrometry. The plasma Fe and Zn concentrations in the study group were significantly lower than in the controls (P &lt; 0.05). However, plasma Cu levels were not different between the two groups (P &gt; 0.05). In conclusion, the plasma Fe and Zn concentration decline in the ETS exposed infants

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

Conduta Anestésica em Criança com Osteogênese Imperfeita e Hemorragia Epidural

Osteogênese imperfeita (OI) é o resultado de uma mutação genética que causa a formação defeituosa ou insuficiente de colágeno. OI pode causar várias complicações anestésicas por causa do manejo difícil das vias aéreas, da presença de deformidade da coluna vertebral, de doenças respiratórias, anomalias cardíacas, distúrbio da função plaquetária, risco de hipertermia, invaginação bacilar, deformidades ósseas e distúrbios metabólicos. A abordagem anestésica de pacientes com OI deve ser feita com cautela, por causa do risco de certas complicações respiratórias. Esses riscos são causados por deformidade do tórax, fraturas ósseas durante o movimento ou mudança de posição, fraturas mandibulares e cervicais relacionadas à intubação, intubação difícil e hipertermia maligna. As técnicas anestésicas com o uso de anestesia venosa total (AVT) e máscara laríngea são adequadas para o manejo de paciente pediátrico com OI. No entanto, essas técnicas ainda não foram mencionadas como úteis em relatos de casos neurocirúrgicos. Neste estudo, apresentamos o uso de AVT e máscara laríngea ProSeal (MLP) em uma criança com OI e hemorragia epidural. Concluímos que a MLP e a AVT podem ser usadas com segurança no manejo anestésico de pacientes com OI e problemas anestésicos graves

Anesthesia Management in a Child with Osteogenesis Imperfecta and Epidural Hemorrhage

Osteogenesis Imperfecta (OI) results from gene mutation that causes defective or insufficient collagen formation. It may cause various anesthetic complications due to the difficulty in airway management, existence of spinal deformity, respiratory disorders, cardiac anomalies, thrombocyte function disorder, risk of hyperthermia, bacillary invagination, bone deformities and metabolic disorders. The anesthesia management of OI patients should be exercised with caution given certain risks of respiratory disorders. These risks are due to thorax deformity, bone fractures during moving or changing position, mandibular and cervical fractures related with intubation, difficult intubation and malignant hyperthermia. The anesthetic technique using Total Intravenous Anesthesia (TIVA) and laryngeal mask airway is suitable for pediatric patient care with OI. However, these techniques have not yet been reported as useful in neurosurgery case reports. In this study, we present the use of TIVA and ProSeal Laringeal Mask in a child with OI and epidural hemorrhage. We came to the conclusion that LMA and TIVA can safely be used in the anesthetic management of OI patients with severe anesthetic problems. Keywords: Anesthesia, Anesthesia, Intravenous, Hematoma, Epidural, Cranial, Laryngeal Masks, Osteogenesis Imperfect