Exploring Invisible Part of The Iceberg: Compartment Syndrome in Orthopaedic Patients and Nursing Approaches

Kompartman sendromu, erken tanılanamadığında bireylerin yaşam kalitesini bozabilen ciddi bir durumdur. Genellikle travma, ameliyat, immobilizasyon ve enfeksiyon nedeniyle meydana gelen kompartman sendromunun akut, kronik ve crush olarak üç tipi vardır. Özellikle ortopedik cerrahi geçiren ve travmaya maruz kalan kişilerde görülme sıklığı daha fazla olduğundan, kompartman sendromunun önlenmesinde, erken tanılanmasında ve gerekli girişimlerin başlatılmasında ortopedi hemşirelerine büyük sorumluluklar düşmektedir. Son derece önemli olan bu sorun erken saptanamadığında amputasyon ile sonuçlanabilmektedir. Önemi büyük olmasına rağmen ülkemizde hemşirelik literatüründe bu konuya yeterince yer verilmemiştir. Bu gereksinim doğrultusunda yazılan bu derleme makalede kompartman sendromunun tanımı, insidansı, etyolojisi, fizyopatolojik süreci, belirti ve bulguları, önlenmesi, erken tanılanması, tedavisi ve hemşirelik bakımına ilişkin bilgiler sunulmuştur Compartment syndrome is a serious condition, if it can not be early diagnosis that may impair the quality of life of individuals. Generally trauma, surgery, immobilization, and infections are caused by compartment syndrome that included three types as acute, chronic and crush. Because of the incidence of compartment syndrome is higher in individuals especially who is exposed to trauma and orthopedic surgery, orthopedic nurses have great responsibilities related compartment syndrome prevention, early diagnosis, and initiation of necessary interventions. This problem is extremely important when if it can not early diagnosis, so it can be result in amputation. Despite of compartment syndrome has great importance, this subject has not been given enough in nursing literature in our country. Through with the requirements of this review article written and it was provided the knowledge on description of compartment syndrome, incidence, etiology, pathophysiological process, signs and symptoms, prevention, early diagnosis, treatment and nursing car

The effectiveness of BD Vacutainer® Plus Urinalysis Preservative Tubes in preservation of urine for chemical strip analysis and particle counting.

Introduction: The aim of this study was to evaluate the stability of urine collected in preservative tubes for chemistry strip analyses and particle counting to determine whether the transport of urine samples with all of their constituents is possible. Materials and methods: 275 pathologic urine specimens were included. Each urine sample was evaluated after 4, 8, 12, 24, and 48 hours of storage in BD Vacutainer® Plus Urinalysis Preservative (BD UAP) tubes and compared with refrigeration at 4 °C. All analyses were peformed on H-800 and FUS-200 automatic modular urine analyzers (Dirui Industry, Changchun, China). The kappa coefficients (?), false positive (FP) and false negative (FN) rates were evaluated. ? > 0.8 was accepted as good agreement. Results: Haemoglobin (Hb), leucocyte esterase (LE), and protein (Pro) analyses should be performed within 4 hours, whereas glucose (Glc) was stable until the end of 48 hours in both storage conditions. Nitrite (Nit) was well preserved in BD UAP tubes for 24 hours but was stable only up to 8 hours at 4 °C. Bilirubin (Bil) had very high FN rates even at 4 hours in both conditions. The particle counting showed high FN rates for white blood cells (WBC) and red blood cells (RBC), whereas squamous epithelial cells (EC) were stable up to 8 hours in both conditions. Conclusions: Preanalytical requirements for both urine chemical strip analyses and particle counting in a unique sample were not met in either condition. Thus, the transfer of urine samples for centralization of urinalysis is not yet feasible

The relationship between thyroid autoimmunity and poor response to ovarian stimulation in in vitro fertilization women with infertility

Introduction: Thyroid autoimmunity (TAI) is the most common autoimmune disorder. Patients with TAI are usually euthyroid, and the presence of anti-thyroid peroxidase (anti-TPO) in patients with or without thyroid dysfunction is associated with infertility, recurrent embryo implantation failure, and early pregnancy loss. We aimed to investigate the relationship between low ovarian reserve, pregnancy outcomes, and TAI. Material and methods: This retrospective cohort study was conducted in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients between 2010 and 2018. All patients (n = 1400) for whom thyroid autoantibody testing was requested were detected. A study group was formed from patients with anti-TPO positivity (n = 363). The control group (n = 555) comprised euthyroid anti-TPO negative patients matched to the study group regarding age and body mass index (BMI). Results: Mean serum TSH value was 2.35 ± 1.70 mIU/mL in anti-TPO-positive patients and 1.81 ± 1.2 mIU/mL in controls, and the difference was significant (p < 0.05). Total dose of gonadotropins used in ovulation induction in anti-TPO-positive and control patients were 3000 IU and 2700 IU, respectively, and the difference was statistically significant (p < 0.05). The number of metaphase 2 oocytes was significantly lower in the anti-TPO-positive group (p < 0.05). Embryo transfer number and embryo grade were significantly lower in the anti-TPO-positive group (p < 0.01). Poor ovarian response was significantly higher in anti-TPO-positive patients (40%) as compared to anti-TPO-negative controls (30%) (p < 0.01). Clinical pregnancy rate was significantly lower in the anti-TPO-positive group (29.2%), as compared to the antibody-negative group (38.4%) (p < 0.01). Conclusions: There are controversial data regarding the impact of antithyroid antibodies on ovarian reserve and pregnancy outcome after IVF treatment. The results of this study indicate that there was a relationship between TAI and poor ovarian response, and that TAI adversely affects IVF outcomes. Further investigations are required to explore the mechanism behind these effects

Karotis Endarterektomilerinde Ultrasonografi Eşliğinde İntermediate Servikal Pleksus Blok Uygulaması (Olgu Serisi)

Giriş : Karotis endarterektomide (KE) rejyonal yöntemler nörolojik izleme izin verdiği ve daha iyi bir postoperatif süreç sağladığı için tercih edilmektedir (1). Bu amaçla akla ilk gelen seçenek derin ve yüzeyel servikal blok kombinasyonudur; ancak derin blok seyrek de olsa ciddi komplikasyonlara yol açabilmektedir (2). Ultrasonografi (USG) eşliğinde intermediate blok, KE için düşük komplikasyon sıklığı ve etkin anestezi için önerilmektedir (3).Amaç : Karotis endarterektomilerinde USG eşliğinde intermediate servikal pleksus blok uyguladığımız olgularımızı paylaştık.Gereç ve Yöntem : Karotis endarterektomi planlanan, onamı alınmış 5 hastaya standart monitorizasyon sonrası USG eşliğinde intermediate servikal pleksus bloğu uygulandı. (resim 1) Boyun anterolateral bölgesinin dermatomal innervasyonuna uygun pinprick testi yapıldı. Yeterli anestezi sağlanan hastalar cerrahiye verildi. Perioperatif sedasyon 0,02 mcg/kg/dk remifentanil ile sağlandı. Sözel ve motor uyaran ile nörolojik izlemi yapılan hastaların dakika solunum sayısı, Ramsey sedasyon skalası (RSS) ile sedasyon düzeyleri ve vizüel analog skala (VAS) ile ağrı düzeyleri takip edildi. İntraoperatif VAS ?4 hastalarda cerrahi alana %1 lidokain 4ml verilmesi; 1,5mg/kg lidokain dozunun yeterli gelmediği hastalarda remifentanil infüzyonunun 0,02 mcg/kg/dk arttırılması planlandı. Perioperatif komplikasyonlar ile birlikte hasta ve cerrah memnuniyeti kaydedildi.Bulgular : Demografik ve operatif veriler tablo-1’de özetlenmiştir. Beş hastanın 2’sine cerrahi alandan 1 kez ek lokal anestezik uygulandı. Bir hastada insizyon mandibulaya doğru genişletildiğinde VAS 5, diğerinde ise kas diseksiyonu esnasında VAS 4 ağrı bildirimi üzerine 5’er ml %1 lidokain uygulandı. Hastaların dakika solunum sayıları >10 ve RSS 2 olarak gözlendi. Hastalarda komplikasyon gelişmedi. Hastalar ve cerrahlar gelecekte bu blok yöntemiyle operasyonun yapılmasını tercih edebileceklerini söylediler.Tartışma /Sonuç : Servikal bloklar KE’de uygulanan anestezi yöntemlerindendir. Uyguladığımız intermediate servikal blok 5 hastamızda cerrahi için yeterli anestezi sağlamıştır. Genişleyen insizyon nedeniyle oluşan hafif ağrı, literatür ile uyumlu şekilde düşük doz lokal anestezik ile giderilebilmiştir (3). Intermediate blok KE için iyi bir seçenek gibi durmaktadır

Investigation of patterns of t helper-1, t helper-2 and t helper-17 associated cytokines in pregnant patients with hashimoto thyroiditis

Giriş ve Amaç: Otoimmün Tiroid Hastalıkları doğurganlık çağındaki kadınlarda sık görülmektedir. Tiroid antikor pozitifliğinin ve hipotiroidinin; tekrarlayan gebelik kayıpları ve infertilite ile ilişkisi gösterilmiştir. Tiroid otoimmünitesi olan olgularda T helper -1 (Th1) ve T helper-2 (Th2) arasındaki dengenin Th1 lehine bozulduğu ve aktive T lenfositlerin uterusta başarılı gebeliği engellediği düşünülmektedir. Bu çalışmadaki amaçlarımız da Hashimoto Tiroiditi (HT) olan gebelerde Th1/Th2 ve Th17 ile ilişkili sitokin düzeylerinin sağlıklı gebelerden farklı olup olmadığını incelemek, gebelik seyrinin bu sitokin düzeylerine etkisini değerlendirmek ve L-Tiroksin (LT4) tedavisinin bu seyire katkısı olup olmadığını araştırmaktır. Ayrıca bu sitokin düzeylerini infertil HT olan olgularda da inceleyerek infertilite patogenezinde tiroid otoimmünitesinin rolü olup olmadığını araştırmaktır. Gereç ve Yöntem: Çalışmaya gebeliğin başında HT tanısı alan ve LT4 tedavisi almayan 20 gebe, gebelikten önce bilinen HT olan 15 gebe ve kontrol grubu olarak , bilinen otoimmün tiroid hastalığı olmayan 19 gebe dahil edildi. Gebe olguların ilk ve ikinci trimestirde tiroid fonksiyon testleri, tiroid otoantikor düzeyleri, Th1/Th2 ve Th17 ile ilişkili sitokin düzeyleri ölçüldü tiroid ultrasonografileri yapıldı. Çalışmaya ayrıca HT olan infertilite nedeni açıklanamayan 21 kadın ve HT olan fertil 18 olgu alınmıştır. Bu olguların tiroid fonksiyon testleri, tiroid otoantikor düzeyleri, Th1/Th2 ve Th17 ile ilişkili sitokin düzeyleri ölçüldü ve tiroid ultrasonografileri yapıldı. Bulgular: HT tanısını ilk trimestirde alan gebelerde Th1 ilişkili sitokin olan IL-2 düzeyi kontrol grubundan anlamlı yüksek bulundu [7,29 (0,88-24,05) e karşılık 2,07 (0-9,19), p<0,05]. Bu grupta benzer şekilde Th17 ile ilişkili sitokin olan IL-17 düzeyi kontrol grubundan anlamlı yüksek bulundu [ 4,53 (0,94-8,19) e karşılık 1,79 (0,84-5,75), p<0,05]. Gruplar arasında ilk trimestirde Th2 ile ilişkili sitokin olan IL-4 ve IL-10 düzeyleri açısından anlamlı farklılık saptanmadı. İkinci tirmestirde ölçülen Th1, Th2 ve Th17 ile ilişkili sitokin düzeyleri açısından anlamlı fark bulunmadı. HT i olan infertil ve fertil olgular arasında Th1, Th2 ve Th17 ile ilişkili sitokin düzeyleri açısından anlamlı fark bulunmadı. Sonuç: HT I olan gebelerde Th1 ve Th17 ile ilişkili sitokin düzeyleri ilk trimestirde kontrol grubuna göre yüksekken ikinci trimestirde kontrol grubu ile fark göstermemiştir. Bu patolojik artışın ikinci trimestirde düzelmesi LT4 tedavisinin olumlu katkısı sonucu olmuş olabilir. HT i olan infertil ve fertil olgular arasında Th1, Th2 ve Th17 ile ilişkili sitokin düzeyleri açısından anlamlı fark bulunmamış olması açıklanamayan infertilitenin patogenezinde immün sistem dengesizliği dışında başka nedenlerin rol oynayabileceğini düşündürmektedir.Introduction: Thyroid autoimmunity is common in women during the reproductive years of their lives. There is a relationship between thyroid autommunity and recurrent pregnancy loss and infertility. In pregnant patients with thyroid autoimmunity T helper-1 (Th1)/T helper-2 (Th2) ratio may shift to Th1 type response and these activated T lymphocytes may lead to implantation failure. Aims of this study are to investigate Th1, Th2 and T helper-17 (Th17) associated cytokines such as IL-2, IL-4, IL-6, IL-10, IL-12 and IL-17 in pregnant patients with Hashimoto Thyroiditis (HT), to evaluate the changes of this cytokines with L-thyroxin (LT4) treatment in pregnant state. We also examine these cytokines in patients with infertility and HT to investigate the possible role of thyroid autoimmunity in infertility. Material and method: Twenty pregnant women whom HT was diagnosed in first timester of pregnancy and were not on LT4 treatment, fifteen pregnant women whom HT was known before pregancy and were on LT4 treatmet already and nineteen pregnant patients without thyroid autoimmunity were included in this study. Thyroid funciton tests, thyroid autoantibodies and cytokine levels of pregnant patients were measured at first and second trimester. Twenty one women with HT and infertility of unknown etiology and eighteen fertile women with HT were also included in this study. Thyroid funciton tests, thyroid autoantibodies and cytokine levels of this patients were measured. Serum-free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), autoantibodies against thyroid peroxidase (anti-TPO), autoantibodies against thyroglobulin (anti-Tg) levels were measured using a chemiluminecent, immunometric method, and cytokine levels were measured using ELISA. Results: In pregnant patients, whom was diagnosed HT in first trimester of pregnacy,serum IL-2 level was significantly higher than control group. [7,29 (0,88-24,05) vs 2,07 (0-9,19), p<0,05]. In this group, serum IL-17 was significantly higher than control group [4,53 (0,94-8,19) vs 1,79 (0,84-5,75), p<0,05]. There was no significant difference between groups for serum IL-4 and IL-10 levels. In second trimester no significant difference was found between groups for all cytokines measured. There was no significant difference between infertile and fertile patients with HT for all cytokines measured. Conclusion: In first trimester we found a significant difference for Th1 and Th17 associated cytokines between HT and control group. There was no difference between groups for these cytokines in second trimester. This action, which correlates with a reduction in thyroid peroxidase antibody titers, may be associated with clinical benefits of LT4 treatment

kaynaklı API 5L x70 boru hattı çeliğinin yorulma davranışı

In this study, fatigue failure behavior of welded X70 pipeline steel was investigated by rotating bar bending fatigue tests performed at room temperature. S-N curves of base metal, weld and heat-affected zone (HAZ) were plotted. Tension tests, hardness measurements and Charpy V notched impact tests were carried out for mechanical characterization. Microstructural examination was conducted by optical microscope and scanning electron microscope (SEM). Fracture surfaces were examined with SEM. In addition to fractographic analysis, striation spacing was used to estimate the crack growth rate of base metal, weld and HAZ. Stress intensity factor (∆K) ranges were also calculated. Tensile properties and hardness values of base metal and weld were found to be almost the same. Charpy impact test results show that base material has approximately twice impact energy than weld and HAZ at room temperature. However, Charpy impact energies of HAZ and weld decreased noticeably at −30 ℃ while very slight decrease was observed for base metal. The comparison of high cycle fatigue and crack growth behaviors shows that base metal has a better fatigue behavior than weld and HAZ from the point of crack initiation and propagation. Moreover, our findings also support the idea that striation spacing can be used as a fractographic approach in order to estimate the crack growth behavior of materials.Thesis (M.S.) -- Graduate School of Natural and Applied Sciences. Metallurgical and Materials Engineering

Chronic Lyme disease presented with gastroparesis

We present a case of a 54-year-old White man who was admitted to our clinic for evaluation of gastroparesis. His gastroparesis was severe and unresponsive to previous treatments. Darkfield microscopy revealed the presence of spirochetes and corkscrew-shaped bacteria; although Lyme immunoglobulin M (IgM) and immunoglobulin G (IgG) Western Blot testings were negative. The patient was diagnosed with Chronic Lyme disease and recovered with antibiotherapy. We outline a rare case of dysmotility syndrome; a unique presentation of cChronic Lyme disease and emphasize the limitation of tools necessary in diagnosing Lyme diseas

Optimal damper placement to prevent pounding of adjacent structures

Bu çalışmada, dinamik özellikleri farklı olan bitişik nizam yapıların deprem etkisi altında çarpışmalarının engellenmesi için viskoz sönümleyiciler kullanılmıştır. Sönümleyicilerin optimum yerleşimleri araştırılmıştır. Yapılar arasındaki rölatif deplasman minimize edilmiştir. Toplam sönüm katsayısının farklı değerleri için optimizasyon yapılmış ve her bir durum için, yapı davranış transfer fonksiyonları ve zaman davranışları açısından incelenmiştir. Ayrıca yapılarda rijitlik ve kütle dağılımlarının etkisi de incelenmiştir. Optimum tasarımlar üniform tasarımlar ile karşılaştırılmış ve etkinliği gösterilmiştir.In this study, viscous dampers to prevent pounding of adjacent structures subjected the earthquakes, which are different dynamic properties, are used. Optimal damper placement is investigated. Relative displacement between adjacent structures is minimized. The optimization is satisfied for different total damping, for each situations, the structural response is investigated in terms of transfer functions and time response. Moreover, the effect of stiffness and mass distribution are investigated. Optimal designs are compared with the uniform designs and the effectiveness of optimal desings is shown

Logistic and Its Importance in Turkish Food Sector and an Analysis of the Logistics Sector in Turkey

Permanence in the international markets for many global companies is about being known as having effective logistics which targets customer satisfaction management and lower costs. Under competitive conditions, the necessity of providing the products to customers quickly and on time for the companies which constantly aim to improve their profitability increased the strategic importance of the logistics concept. Food logistic is one of the most difficult areas in logistics. In the process from manufacturer to final consumer, quality and hygiene standards must be provided constantly. In food logistics, reliable and extensive service network has great importance and on time delivery is the target. Developing logistics industry provide the supply of foods in the country and the development of export markets more quickly and has an important role in providing added value to the country's economy. Turkey that creates a bridge between the east and the west is an attractive market for logistics companies. In this study, by examining both the place and the importance of logistics in Turkish food sector, recommendations will be made for the food industry