Ultrasound-guided serratus plane block combined with intercostal block for a high-risk patient with pericardial tamponade: A case report

Anesthetic management of patients with pericardial tamponade is challenging. A 65-year-old man diagnosed with small-cell lung carcinoma and bilateral malignant pleural effusion in the lungs and pericardial effusion was scheduled for pericardial-window-opening surgery. The severely compromised lung function of the patient led to an anesthetic plan of ultrasound-guided serratus anterior plane block combined with an intercostal block. Although serratus plane block was initially developed for postoperative analgesia, we have shown here that it can be used under deep sedation in combination with an intercostal block for anesthesia for surgeries involving the hemithorax; the block may be promising in high-risk cases

Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section

Background: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. Aims: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Study Design: Cross-sectional study. Methods: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. Results: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. Conclusion: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women

Competitiveness of forest products industry sector in Turkey: Revealed comparative advantage index

This study, aimed to determine the competitive advantage position of the forest products industry sector in Turkey between 2001-2017 by using the revealed comparative advantage approach. One of the three sub-production structures (wood and articles of wood; wood charcoal-21 sub-product group) of the forest products industry were examined at the level of their sub-product groups. As a result of the study, "the wood and articles of wood;wood charcoal" sector was far from the desired position in terms of competition. When "the wood and articles of wood;wood charcoal" sector was analyzed on sub-group basis, especially the products of 4411, 4413 and 4415 had competitive position. Moreover, it was found that the trend in Turkey's imports of wood and articles of wood sector was not high. However, imports carried out under specified product groups were carried above the level of imports in Turkey

Outcomes for revision total knee replacement after unicompartmental knee replacement

Objective: The aim of this retrospective, observational study was to describe the outcomes of total knee replacement (TKR) after failed Oxford phase 3 medial unicompartmental knee replacement (UKR). Methods: The study included 24 revision TKRs (20 females, 4 males; mean age: 61 years) performed following failed aseptic UKR. Outcomes were assessed using the Knee Society Score (KSS). Results: The most common causes for revision were mobile bearing dislocation and unexplained pain. Mean preoperative KSS was 50.3 (range: 37 to 66) and 82.2 (range: 58 to 97) after TKR. There were 17 excellent, 4 good, 2 fair and 1 poor results. Conclusion: The type of UKR performed (cemented versus uncemented) had no effect on TKR success. Revision for failed UKR with TKR appears to be a technically straightforward procedure with satisfactory early clinical results

A 5-year surveillance of healthcare-associated infections in a university hospital: A retrospective analysis

Objectives: Nosocomial infections or healthcare-associated infections are a significant public health problem around the world. This study aimed to assess the rate of laboratory-confirmed healthcare-associated infections, frequency of nosocomial pathogens, and the antimicrobial resistance patterns of bacterial isolates in a University Hospital. Methods: A retrospective evaluation of healthcare-associated infections in a University Hospital, between the years 2015 and 2019 in Tekirdag, Turkey. Results: During the 5 years, the incidence densities of healthcare-associated infections in intensive care units and clinics were 10.31 and 1.70/1000 patient-days, respectively. The rates of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections in intensive care units were 11.57, 4.02, and 1.99 per 1000 device-days, respectively. The most common healthcare-associated infections according to the primary sites were bloodstream infections (55.3%) and pneumonia (20.4%). 67.5% of the isolated microorganisms as nosocomial agents were Gram-negative bacteria, 24.9% of Gram-positive bacteria, and 7.6% of Candida. The most frequently isolated causative agents were Escherichia coli (16.7%) and Pseudomonas aeruginosa (I 5.7%). The rate of extended-spectrum beta-lactamase production among E. coli isolates was 51.1%. Carbapenem resistance was 29.8% among isolates of P. aeruginosa, 95.1 % among isolates of Acinetobacter baumannii, and 18.2% among isolates of Klebsiella pneumoniae. Colistin resistance was 2.4% among isolates of A. baumannii. Vancomycin resistance was 5.3% among isolates of Enterococci. Conclusion: Our study results demonstrate that healthcare-associated infections are predominantly originated by intensive care units. The microorganisms isolated from intensive care units are highly resistant to many antimicrobial agents. The rising incidence of multidrug-resistant microorganisms indicates that more interventions are urgently needed to reduce healthcare-associated infections in our intensive care units

Predictive Values of Inflammation Indexes in Predicting Mortality in Patients with COVID 19 Hospitalized in General Intensive Care Unit

Objective: Causing a global pandemic, the coronavirus disease 2019 (COVID-19) has caused millions of people to become infected and many more to die. In this study we aimed to investigate whether routinely evaluated clinical and laboratory values ??can predict the mortality of patients with COVID-19 disease.Materials and Methods: In our study, routine laboratory parameters of 89 patients hospitalized in the general intensive care unit with the diagnosis of COVID 19 were retrospectively analyzed. The aggregate index of systemic inflammation (AISI) and other inflamatuar values were calculated from blood tests in patients with positive COVID-19 polymerase chain reaction test and with ground-glass opacity on lung tomography. Patients were divided into two groups as those who died (non-survivors) and those who were discharged (survivors)during the intensive care follow-ups. Results: In our study, in 48 patients who died during follow-up, the indexes of AISI, other inflamatuar paramaters and the biochemical parameters such as troponin I, d-dimer, ferritin and procalcitonin were significantly higher than in discharged patients. Hypertension and higher AISI and ferritin levels were statistically associated with reduced survival in Cox regression analysis (Hazard ration (HR): 3.176; 95% Confident interval (CI): 1.122-8.991, p=0.03, HR: 1.114; 95% CI: 1.060-1.348, p=0.042, HR=1.072;95% CI: 1.014-1.242, p=0.011, respectively.Conclusion: Inflammation indexes derived from blood tests and acute phase reactants such as ferritin can guide us in planning the treatment strategy and risk stratification in patients with COVID-19 in intensive care follow-ups.

Relationship between serum soluble endothelial protein C receptor level and COVID-19 findings

Coronavirus-related disease-2019 (COVID-19)-associated coagulopathy presents predominantly with thrombosis and leads to complications in close association with inflammatory process. Soluble endothelial protein C receptor (sEPCR), which is the soluble form of EPCR, reduces the anticoagulant and anti-inflammatory activity of activated protein C. The purpose of this study is to investigate the relationship between sEPCR and the laboratory parameters and thorax computed tomography (CT) findings in the course of COVID-19. Twenty-five laboratory-confirmed [reverse transcription-quantitative polimerase chain reaction (RT-qPCR) positive] and 24 clinically diagnosed (RT-qPCR negative) COVID-19 patients were enrolled in the study. Blood specimens were collected for sEPCR and haematological and biochemical parameter measurement. Thorax CT was performed to detect COVID-19 findings. These parameters from RT-qPCR positive and negative patients were then compared. Although there was no difference between the groups in terms of symptoms, the time between the onset of symptoms and the admission time was shorter in RT-qPCR positive group (P?=?0.000). sEPCR levels were significantly higher in the RT-qPCR positive group (P?=?0.011). Patients with ground-glass opacity and bilateral involvement on thorax CT have higher serum sEPCR levels (P?=?0.012 and 0.043, respectively). This study has shown for the first time that serum sEPCR levels, which is a member of coagulation cascade and has also been reported to be associated with inflammation, is higher in patients with positive RT-qPCR test and patients with GGO or bilateral involvement on thorax CT regardless of the PCR result. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved

Immunohistochemical expression of E-Cadherin and ?-catenin in prostate adenocarcinoma and benign prostate hyperplasia

Disruption of the E cadherin mediated complex due to loss or depletion of E cadherin results in epithelial abnormalities and serious developmental impairment in varioustissues and organs. The present study aims to determine E cadherin and ? catenin expression in patients diagnosed with benign prostatic hyperplasia (BPH) and prostatecarcinoma (PCa) based on Gleason scores and investigate the association of these proteins with PSA levels and Gleason scoring. Immunohistochemical staining for Ecadherin and ? catenin was performed in 59 patients diagnosed with PCa and 30 patients with BPH. Mean E cadherin expression was 3.00 in patients diagnosed with BPHand 2.38±0.5 in patients with PCa, with a statistically significant difference between these values (p<0.001). Comparison of PCa cases with PSA <10 versus those withPSA ?10 revealed significantly reduced ? catenin expression in the group with PSA levels ?10 (p<0.001). Loss of E cadherin and ? catenin is known to contribute to thepathogenesis of PCa. We believe that future molecular studies on this subject may further elucidate the association between carcinoma development and the expression ofthese molecules, leading to new therapeutic targets in the treatment of PCa

Investigation of occupational accident and fatal occupational accidents in forest products sector at the level of Turkey and the European Union countries

Üretim teknolojilerinde meydana gelen değişim, daha düşük maliyetle daha fazla üretim yapma isteği ve firmaların farklılaşan pazar koşullarında ayakta kalma zorunluluğu çalışma ortamlarında iş sağlığı ve güvenliği açısından sorunları beraberinde getirmektedir. Gelişmiş ve gelişmekte olan ekonomiler iş kazaları ve iş kazalarına bağlı oluşan ölümlerin azaltılması için farklı yasal düzenlemeler yapmakta ve çalışan güvenliğini ön plana çıkarmaya çalışmaktadır. Ülkemizde bu alanda yapılan yasal düzenlemelerin önemli bir kısmı Avrupa Birliğine (AB) adaylık sürecinde oluşturulan uyum yasaları çerçevesinde çıkarılmıştır. Yapılan yasal düzenlemelerin sektörel boyutta nasıl sonuçlar verdiğinin belirlenmesinin amaçlandığı bu çalışmada orman ürünleri sanayi sektörünü oluşturan üç alt sektörel yapının Türkiye ve AB üyeleri ülkeleri düzeyinde karşılaştırılması hedeflenmiştir. 2008-2017 yılları kapsamında ülkemiz ve AB üyesi ülkelerde meydana gelen iş kazası ve ölüm rakamlarının istatistiksel açıdan incelendiği çalışmada özellikle 2013 yılında yürürlüğe giren 6331 sayılı yasanın etkileri sorgulanmıştır. Çalışma sonucunda AB genelinde tüm sektörel boyutlarda iş kazası ve ölüm rakamlarında oluşan azalma karşısında ülkemizde incelenen yıllar düzeyinde sürekli artışların yaşandığı belirlenmiştir. Çıkarılan ve uygulamaya çalışılan yasal düzenlemelerin yeterli olmadığı ve güvenlik kültürünün oluşumuna yönelik çalışmaların yoğunlaştırılmasının zorunlu olduğu tespit edilmiştir.The change in production technologies, the desire to produce more at lower costs and the necessity of firms to survive in different market conditions bring problems in terms of occupational health and safety in working environments. Developed and developing economies regulate different laws to reduce occuptional accidents and occuptional accident deaths and it is trying to highlight employee safety. In our country, a significant part of the legal regulations in this sector has been enacted within the framework of the harmonization laws established in the process of candidacy to the European Union (EU). In this study, which it is aimed to determine how the legal regulations of sectoral scale give results, it was aimed that three sub-sectoral structures of the forest products industry sector were compared in the Turkey and EU countries level. In the study which examined the occuptional accident and death figures that occurred in our country and EU member countries within the period of 2008- 2017, the effects of Law No. 6331, which entered into force in 2013, have been investigated. As a result of the study, it has been determined that there has been a decrease in the number of work accidents and deaths in all sectoral dimensions throughout the EU, while there have been continuous increases in the level of years examined in our country. It has been determined that the legislative regulations adopted and implemented are not sufficient and the efforts for the formation of the security culture should be intensified

Analysis of the coracoid morphology with multiplanar 2D CT and its effects on the graft size in the Latarjet procedure

Purpose: In this study, we aimed to reveal the individual differences regarding the size of the coracoid and their effects on the classical and modified Latarjet procedures. Methods: Computed tomography images of 120 patients (mean age: 41.18 +/- 12.01 years) without shoulder complaints or shoulder instability were evaluated retrospectively. The glenoid width, the surgical graft length, and the coracoid total length, width, and thickness were measured using the multiplanar reconstruction method on the Sectra Picture Archiving and Communications System (PACS) system. Age, gender, side, the dominant hand, and the height of the patients were recorded and the correlations between them were investigated. On the created hypothetical model, the current size of the coracoid was evaluated to determine what size of glenoid defects it could repair by employing the classical and the modified Latarjet techniques. Results: There was no significant difference between the right-hand-dominant group and the left-hand-dominant group in terms of coracoid measurement results (p > 0.05). Again, there was no statistically significant difference between the right and the left side regarding the coracoid size (p > 0.05). A positive correlation could be detected only between age and the coracoid width and thickness (p < 0.05). A positive correlation was also found between the glenoid width and the coracoid width and thickness in both shoulders (p < 0.001). Coracoid thickness could fill in the defects that amounted to 40% of the glenoid width, while the coracoid width could fill in for the defects that were 50% of the glenoid width in both genders. Conclusion: Our study showed that hand dominance and side were not effective on the coracoid dimensions. In addition, it has been shown that the coracoid dimensions did not have a significant effect in the choice of Latarjet technique in terms of defect repair and that repair rates of up to 40% could be achieved in glenoid defects with both techniques