Valor predictivo de los test preoperatorios para estimar la intubación difícil en pacientes sometidos a la laringoscopia directa para la cirugía de oído, nariz y garganta

ResumenJustificación y objetivosEl valor predictivo de los test preoperatorios para estimar la intubación difícil puede ser diferente en afecciones laríngeas. Se hizo una revisión de las historias clínicas de los pacientes sometidos a laringoscopia directa y una investigación del valor predictivo de los exámenes preoperatorios para estimar la intubación difícil.MétodosSelección de historias clínicas de los períodos preoperatorio e intraoperatorio y del sistema informatizado del hospital.ResultadosSe evaluaron 2.611 pacientes. En un 7,4% se detectaron intubaciones difíciles. Las intubaciones difíciles fueron constatadas en pacientes con una puntuación de Mallampati (escala de Mallampati [EM]) clase 4 (50%); clasificación de Cormack-Lehane grado 4 (95,7%); conocimiento previo de la vía aérea difícil (86,2%); restricción de la amplitud de movimientos del cuello (amplitud de movimientos cervical) (75,8%); distancia tiromentoniana corta (81,6%); y masa en las cuerdas vocales (849,5%) (p<0,0001). La EM tuvo una sensibilidad baja, mientras que la amplitud de movimientos cervical, tuvo la presencia de masa en las cuerdas vocales, distancia tiromentoniana corta y EM con un valor predictivo positivo relativamente mayor. La incidencia de intubaciones difíciles se incrementó 6.159 y 1.736 veces en cada nivel de aumento de los grados de la clasificación de Cormack-Lehane y de la clase de la EM, respectivamente. Cuando todos los test fueron considerados en su conjunto, la intubación difícil pudo ser clasificada con exactitud en un 96,3% de los casos.ConclusiónLos resultados de los test que prevén intubaciones difíciles en casos con laringoscopia directa coincidieron claramente con los resultados previstos en la literatura para las poblaciones de pacientes en general. Las diferencias en algunos resultados de los test, cuando se les comparó con los de la población en general, pueden ser debidas a las condiciones patológicas subyacentes de la laringe en las poblaciones de pacientes con intubación difícil.AbstractBackground and objectivesPredictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated.MethodsPreoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened.ResultsA total of 2.611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system class 4 (50%), Cormack–Lehane classification grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical range of motion) (75.8%), short thyromental distance (81.6%), vocal cord mass (849.5%) as indicated in parentheses (P<.0001). MS had a low sensitivity, while restricted cervical range of motion, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in Cormack–Lehane classification grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases.ConclusionTest results predicting difficult intubations in cases with direct laryngoscopy had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation

Bazı Organik Materyallerin ve Toprak Düzenleyicilerin Organik Fındık Yetiştiriciliğinde Verim ve Toprak Özellikleri Üzerine Etkileri

Bu çalışma, yöresel organik artık olan fındık zurufunun (taze ve kompost hali) organik tarımda yaygın olarak kullanılan organik ticari gübrelerin yerine kullanılma durumunu ve kullanılan miktarın azaltılıp azaltılamayacağı, verim ve bazı toprak özellikleri üzerine etkilerinin belirlenmesi amacıyla 2008 yılında yürütülmüştür. Araştırma, Samsun İli Ağcagüney Beldesi organik sertifikalı fındık bahçesinde Tombul fındık çeşidinde kurulmuştur. Toprak düzenleyici olarak klinoptilolit ve leonardit, organik ticari gübre (biofarm), yöresel atık olan fındık zurufunun iki farklı kullanım şekli (taze ve kompost) araştırmanın materyalini oluşturmaktadır. Araştırma tesadüf bloklarında bölünmüş parseller deneme desenine göre 3 tekrarlamalı olarak yürütülmüştür. Yapılan istatistik analiz sonucunda organik gübrelerin etkisi önemli bulunmuştur. En yüksek meyve verimi fındık zurufu (taze) ve organik ticari gübrenin (Biofarm) tek başına uygulandığı parsellerden belirlenmiştir. Hasat sonrası 0-20 cm derinlikten alınan toprak örneklerinde bazı toprak özellikleri incelenmiştir

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients

Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack-Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p < 0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation

Bioactivities of Ethanolic Extract and its Fractions of Cistus laurifolius L. (Cistaceae) and Salvia wiedemannii Boiss. (Lamiaceae) Species.

Cistus laurifolius L. (Cistaceae) and Salvia wiedemannii Boiss. (Lamiaceae) have been used for treatment of some illnesses in Turkish folk medicine. In the present study, the ethanolic extract and its fractions obtained using re-extraction by hexane (Hx), chloroform (CHCl3), butanol, and remaining-water (r-H2O) of C. laurifolius were screened for their in vitro bioactivities