COMPARISON OF THE PARASACRAL AND WINNIE APPROACHES TO THE SCIATIC NERVE BLOCK COMBINED WITH THE PSOAS COMPARTMENT BLOCK IN KNEE ARTHROSCOPY

Bu çalışmada diz artroskopisi uygulanacak olgularda; psoas kompartman bloğu (PKB) ile kombine edilerek gerçekleştirilen siyatik sinir bloğunda Winnie ve Mansour yaklaşımlarının klinik etkinliklerinin karşılaştırılması amaçlandı. Araştırma diz artroskopisi uygulanan 18-65 yaşa arası, ASA I-II risk grubunda olan ve araştırmada yer almayı kabul eden 50 olguda gerçekleştirildi. Olgular rasgele iki eşit gruba ayrılarak, Grup I’deki olgularda PKB ile Winnie yaklaşımıyla siyatik sinir bloğu, Grup II’deki olgularda ise PKB ile Mansour yaklaşımıyla parasakral siyatik sinir bloğu kombine edildi. PKB için 20 mL %0,375 levobupivakain ile 20 mL %1,5 lidokain, siyatik sinir blokları için ise 20 mL %0,375 levobupivakain ile 10 mL %1,5 lidokain kullanıldı. Çalışmamızdaki gruplarda; sinir ve pleksus bloklarının uygulanması esnasında ilk motor hareketin gözlenme süresi, uygulama süresi, işlemin gerçekleştirilmesi için gerekli toplam girişim sayısı, komplet duyusal ve motor blok oluşan olguların sıklığı ile bunların oluşma süreleri, turnike veya insizyon ağrısına bağlı genel anestezi uygulanan olguların sıklığı, operasyon için yeterli olan blok başarı oranları ve vücut kitle indeksinin (VKİ) sayılan blok özelliklerine etkileri araştırıldı. Benzer demografik verilere sahip iki grupta uygulanan çalışmamızda Winnie ve Mansour yaklaşımları; sinir stimülasyonuna bağlı ilk motor hareketin gözlenme süresi (sırasıyla 44,9±57,4 ve 51,9±57,1 sn), uygulama süresi (sırasıyla 161,5±61,7 ve 171,5±72,8 sn) ve işlemin gerçekleştirilmesi için gerekli toplam girişim sayısı (sırasıyla 2,5±1,9 ve 2,6±2,2) yönünden değerlendirildiğinde benzer bulunmuştur. Her iki yaklaşım komplet duyusal (sırasıyla %64 ve % 68) ve komplet motor blok (her iki grupta %72) gelişme oranları yönünden benzer bulunmuştur. Ayrıca obturator sinirde duyu (sırasıyla %68 ve %72) ve motor (her ikisinde %72) blok oluşan olgu sayıları yönünden bir farklılık belirlenmemiştir. VKİ ile PKB işlemindeki toplam girişim sayısı, uygulama süresi ve uylukta kas kontraksiyonu gözlenme süresi arasında pozitif yönde bir korelasyon saptanırken, VKİ ile her iki siyatik sinir bloğu arasında aynı veriler yönünden bir ilişki belirlenmemiştir. Turnike veya insizyon ağrısına bağlı genel anestezi uygulanan olgular (sırasıyla % 16 ve % 20) hariç tutulduğunda bu kombinasyonların intraoperatif başarı oranları (sırasıyla %84 ve %80) da benzerdi. PKB’daki yetersizliğe bağlı turnike veya insizyon ağrısı hisseden olgular hariç tutulduğunda da Winnie ve Mansour yaklaşımlarının intraoperatif başarı oranları (sırasıyla %92 ve %88) da benzer bulunmuştur. Sonuç olarak, siyatik sinir bloğu için parasakral ve Winnie yaklaşımlarını uygulayarak PKB ile kombine ettiğimiz bu çalışmada; hem obturator sinirde komplet duyu (sırasıyla %68 ve %72) ve komplet motor (her ikisinde %72) blok oluşan olgu sayıları yönünden parasacral yaklaşımın Winnie yaklaşımına bir üstünlüğü olmadığı hem de araştırdığımız diğer parametreler yönünden bulguların benzer olduğu belirlenmiştir.We aimed to compare the clinical effectiveness of the parasacral and the Winnie approaches to the sciatic nerve block which were combined with the psoas compartment block (PCB) in patients undergoing elective knee arthroscopies. Our research was carried out on 50 patients undergoing unilateral knee arthroscopy who were aged between 18-85 years and belong to ASA I-II risk group and who agreed to take part in the study. Fifty patients were randomized into two groups and in Group 1, patients were applied Winnie aprroach to the sciatic nerve combined with the PCB and; in Group 2, patients were applied parasacral aprroach to the sciatic nerve combined with the PCB. Each group received 20 mL of %0,375 levobupivakain and 20 mL of %1,5 lidokain for the PCB and 20 mL of %0,375 levobupivakain and 10 mL of %1,5 lidokain for the sciatic nerve blocks. We compared the time to first motor response secondary to nerve stimulation, time for the block procedures, number of attempts to elicit the nerve, number of patients in whom sensory and motor blocks developed and the time to onset of sensory and motor blocks, number of patients who received general anesthesia secondary to pain caused by tourniquet or incision and finally block success rates sufficient for the operation. We also determined relation between the body mass index (BMI) and the block procedure properties. 149 Winnie and parasacral approaches which performed in two randomized groups with similar demographic variables were found similar for the time to first motor response secondary to nerve stimulation (Winnie vs parasacral respectively 44,9±57,4 and 51,9±57,1 sec), the time spent for the block procedures (Winnie vs parasacral respectively 161,5±61,7 and 171,5±72,8 sec) and the number of attempts to elicit the nerves (Winnie vs parasacral respectively 2,5±1,9 and 2,6±2,2). Besides no difference was observed between groups for the number of patients in whom complete sensory (Winnie vs parasacral respectively %64 ve % 68) and complete motor blocks (both groups %72) have developed. On the other hand also no difference was observed between groups for the number of patients in whom sensory (Winnie vs parasacral respectively %64 ve % 68) and motor blocks (both groups %72) in obturator nerve have developed. One additional result of our research was that while a positive correlation was found between BMI and the time to first motor response in the thigh secondary to nerve stimulation, the time spent for the block procedure and the number of attempts to elicit the nerves for PCB, no correlation was observed for both of the sciatic nerve blocks with the same determinants. Excluding the patients who have felt pain due to tourniquet or incision and had to be generally anesthetized (Winnie vs parasacral respectively %16 and %20) both groups of combinations were found similar in operative success rate (Winnie vs parasacral respectively %84 and %80). When the patients who have felt pain due to tourniquet or incision secondary to the failure in PCB were excluded, a more objective comparison of the operative success rates of the parasacral and Winnie approaches showed no difference. As a result of our study in which we have combined parasacral and Winnie approaches with the PCB; it is found that parasacral approach is not superior than Winnie approach both for the number of patients in whom sensory (Winnie vs parasacral respectively %64 ve % 68) and motor blocks (both groups %72) in obturator nerve have developed and the the remainder parameters that we have studied

Femoral Nerve Injury Following a Lumbar Plexus Blockade

Background: Lumbar plexus blockade (LPB) combined with sciatic nerve block (SNB) is frequently used for lower extremity surgery. Perioperative nerve injury is a rarely encountered complication of peripheral nerve blocks (PNB). Case Report: Here we report a 44-year-old male patient who developed a partial femoral nerve injury (FNI) following a LPB which was performed before the surgery of a patellar fracture. The clinical and electroneuromyographic findings of the patient were recovered almost completely within the following six months. Conclusion: The presented case demonstrated a FNI despite the absence of any pain or paresthesia sensation, with the disappearance of motor response under 0.3 mA of neurostimulation in the experienced hands

Popliteal Sciatic Nerve Block in a Pregnant Patient in the Last Trimester.

Although regional anaesthesia is a commonly preferred anaesthesia technique for pregnant patients undergoing non-obstetric surgery, peripheral nerve blocks are relatively less administered. The use of popliteal sciatic nerve block for foot-ankle surgery has been presented for a nulliparous parturient at 32 weeks of gestation scheduled to undergo surgical exploration of an arterial pseudoaneurysm on her right plantar surface due to a penetrating stab injury. Since surgery did not require pneumatic tourniquet, the sciatic nerve was blocked via the popliteal approach with a single shot injection of 30 mL of 0.375% levobupivacaine. The operation and the anaesthesia course were uneventful. In conclusion, popliteal sciatic nerve block was successful and uneventful for a short foot surgery not requiring tourniquet application in a parturient in the last trimester

Bacterial Agents Causing Meningitis During 2013-2014 in Turkey: A Multi-Center Hospital-Based Prospective Surveillance Study

This is an observational epidemiological study to describe causes of bacterial meningitis among persons between 1 month and 18 y of age who are hospitalized with suspected bacterial meningitis in 7 Turkish regions. covering 32% of the entire population of Turkey. We present here the results from 2013 and 2014. A clinical case with meningitis was defined according to followings: any sign of meningitis including fever, vomiting, headache, and meningeal irritation in children above one year of age and fever without any documented source, impaired consciousness, prostration and seizures in those < 1 y of age. Single tube multiplex PCR assay was performed for the simultaneous identification of bacterial agents. The specific gene targets were ctrA, bex, and ply for N. meningitidis, Hib, and S. pneumoniae, respectively. PCR positive samples were recorded as laboratory-confirmed acute bacterial meningitis. A total of 665 children were hospitalized for suspected acute meningitis. The annual incidences of acute laboratory-confirmed bacterial meningitis were 0.3 cases / 100,000 population in 2013 and 0.9 cases/100,000 in 2014. Of the 94 diagnosed cases of bacterial meningitis by PCR, 85 (90.4%) were meningococcal and 9 (9.6%) were pneumococcal. Hib was not detected in any of the patients. Among meningococcal meningitis, cases of serogroup Y, A, B and W-135 were 2.4% (n = 2), 3.5% (n = 3), 32.9% (n = 28), and 42.4% (n = 36). No serogroup C was detected among meningococcal cases. Successful vaccination policies for protection from bacterial meningitis are dependent on accurate determination of the etiology of bacterial meningitis. Additionally, the epidemiology of meningococcal disease is dynamic and close monitoring of serogroup distribution is comprehensively needed to assess the benefit of adding meningococcal vaccines to the routine immunization program.Wo

Education of healthcare personnel working with pediatric patients during covid-19 pandemic within the framework of infection control Covid-19 pandemisinde enfeksiyon kontrol çalışmaları çerçevesinde çocuk hastalarla çalışan sağlık personeli eğitimi

© 2020, AVES. All rights reserved.Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic

SARS-CoV-2 seropositivity among pediatric health care personnel just after the first peak of pandemic: A nationwide surveillance.

BACKGROUND: COVID-19 pandemic affected every single person on earth one way or the other. The healthcare personnel were no exception, their responsibilities as well as their risks being immense. METHODS: 4927 healthcare personnel all working in pediatric units at 32 hospitals from seven different regions of Turkey enrolled to the study to determine the seroprevalence of SARS Co-V-2 after the first peak wave. Point of care serologic lateral flow rapid test kit for IgM/IgG was used (Ecotest CE Assure Tech. Co. Ltd.). Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. RESULTS: Nearly 6.1% of healthcare personnel were found to be seropositive for SARS Co-V- 2. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19 co-worker increased the likelihood of infection. The least and the most experienced personnel affected more. Most of the seropositive healthcare personnel (68%) did not have any suspicion that they had COVID-19 previously. CONCLUSIONS: Health surveillance for healthcare personnel involving routine point-of-care nucleic acid testing as well as monitoring PPE adherence would be important strategies to protect healthcare personnel from COVID-19 and to reduce nosocomial SARS-CoV-2 transmission

Evaluation of vaccination status of health care workers for recommended vaccines and their acceptance of SARS-CoV-2 vaccines

© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.Introduction: Health care workers (HCWs) are disproportionately exposed to infectious diseases and play a role in nosocomial transmission, making them a key demographic for vaccination. HCW vaccination rates are not optimal in many countries; hence, compulsory vaccination policies have been implemented in some countries. Although these policies are effective and necessary under certain conditions, resolving HCWs’ hesitancies and misconceptions about vaccines is crucial. HCWs have the advantage of direct contact with patients; hence, they can respond to safety concerns, explain the benefits of vaccination, and counter antivaccine campaigns that escalate during pandemics, as has been observed with COVID-19. Method: A short survey was carried out in May–June 2020 on the vaccination status of HCWs working with pediatric patients with COVID-19. The survey inquired about their vaccination status (mumps/measles/rubella [MMR], varicella, influenza, and diphtheria/tetanus [dT]) and willingness to receive hypothetical future COVID-19 vaccines. The respondents were grouped according to gender, age, occupation, and region. Results: In total, 4927 HCWs responded to the survey. Most were young, healthy adults. The overall vaccination rates were 57.8% for dT in the past 10 years, 44.5% for MMR, 33.2% for varicella, and 13.5% for influenza. Vaccination rates were the highest among physicians. The majority of HCWs (81%) stated that they would be willing to receive COVID-19 vaccines. Conclusion: Although vaccination rates for well-established vaccines were low, a majority of HCWs were willing to receive COVID-19 vaccines when available. Education and administrative trust should be enhanced to increase vaccination rates among HCWs