‘‘Near Miss’’ Obstetric Cases: 4 Years Experience of a Tertiary Center

OBJECTIVE: To evaluate the frequency of near miss and the nature of near miss events, and comparatively analyze near miss morbidities among pregnant women managed in our institution over a 4-year period. STUDY DESIGN: The study was conducted in Bakırköy Dr. Sadi Konuk Education and Research Hospital. Cases were identified through a retrospective analysis of hospital records of pregnancy-related complications reported between January 1, 2008 and December 31, 2011. For each case of near miss morbidity and maternal death, data on demographic characteristics were collected, including the patient’s age, parity, previous deliveries, and gestational age at delivery. Data on the nature of obstetric complications, the location where they developed (home, private doctor’s office, maternity center, or hospital), type of delivery, fetal outcomes, and length of stay in the intensive care unit (ICU) were collected. RESULTS: During the study period, 6833 adults required ICU admission; 41 (0.60%) of them were obstetric patients. The total number of births reported during the study period was 9841. The mean age of the patients was 28.5 years (range, 17-52). Six women (14.6%) were admitted before and 35 (85.4%) after childbirth. The most common diagnosis was preeclampsia (41.5%), followed by obstetric hemorrhage (29.2%). CONCLUSION: Maternal health care policies need to be concerned with preventing near miss cases

Evaluation of Block Success in Patients Undergoing Ultrasound-Guided Infraclavicular Brachial Plexus Block with Bilateral Upper Extremity Perfusion Index

Infraclavicular nerve block, frequently preferred in upper extremity surgeries, provides additional advantages, such as reducing opioid consumption by providing an analgesic effect in the postoperative period. The success of peripheral nerve blocks is usually assessed by subjective feedback from the patient, and patient cooperation is needed. This study aims to determine whether the level of the perfusion index, which can be measured non-invasively, can predict the success of the infraclavicular block. Thirty patients who were operated on for carpal tunnel syndrome under infraclavicular brachial plexus block were included in the study. The perfusion index and skin temperature were measured 0-10-20-30 min after blockage and at 2, 4, and 6 h after surgery. The value of the perfusion index in the arm of patients with a successful block was significantly higher (p < 0.05) than in the unblocked arm at 10 min and afterward. The cutoff values for the perfusion index and the perfusion index ratio after local anesthetic injections were 12.55 and 2.175, respectively, at the 20th minute when a significant difference was detected in the sensory block and 14.63 and 2.72 at the 30th minute, when a significant difference occurred in motor block development. The perfusion index can be a reliable and objective method to assess the adequacy of an infraclavicular block. The perfusion index and cutoff values that we determined can be used as an accurate predictive value for the success of infraclavicular block in patients under general anesthesia or in patients whose block success is difficult to evaluate. The study was retrospectively registered on clinicaltrials.gov (trial registration number, NCT04921891; date of registration, 09 June 2021)

Comparison of epidural and intravenous route for acute and chronic postoperative pain control in patients with gynecological malignancy

Objectives: This study compared the effects of patient-controlled epidural and intravenous analgesia on acute and chronic postoperative pain in patients who were operated on for gynecological malignancy

Monitorization of NGAL, Creatinine and Renal Blood Flow in the Follow-up of Acute Kidney Injury in Intensive Care

Objective: Acute Kidney Injury (AKI) and subsequent renal failure are the leading causes of morbidity and mortality in the intensive care unit (ICU). In this study, it was planned to compare Neutrophil Gelatinase-associated Lipocalin (NGAL) and creatinine values in patients diagnosed with AKI and to determine the effect of renal dose dopamine use on renal blood flow, development of chronic renal failure (CRF) and mortality

Is it all about age? Clinical characteristics of Kawasaki disease in the extremely young: PeRA research group experience.

Objectives In the evaluation of children with Kawasaki disease (KD), the age of onset is important and complications may occur if the distinctive features are not assessed accordingly. The objective of the study is to define the clinical and laboratory presentations and treatment outcomes of KD in infants 6 months multicentrically. Methods This retrospective study reviewed the medical records of the patients diagnosed with KD and followed up between January 2009 and January 2019. Results A total of 204 KD patients were enrolled and grouped according to age as Group I (6 months, n = 173). Except for cervical adenopathy (19.3% vs. 47.4%, p = 0.03), the major clinical manifestations of KD were similar between groups I and II. However, the frequency of incomplete and atypical KD was higher in Group I (38.7% vs. 24.8%, p = 0.04, 38.7% vs. 8.1% p < 0.001, respectively). Clinical features such as vomiting/diarrhea (19.3% vs. 1.1% p < 0.001), aseptic meningitis (19.3% vs. 2.3%, p = 0.001) were more common in Group I. Percentage of neutrophils (45.5 vs. 36, p = 0.004) and hemoglobin levels (8 vs. 10.5 gr/dL, p = 0.02) were statistically lower and platelet count (737,000 vs 400,000/mm(3), p = 0.004) was statistically higher in group I. Coronary artery lesions (CALs) were more common in Group I (48% vs. 20%, p < 0.001). Harada and Kobayashi scores appear to be effective in predicting coronary artery lesions (CALs) and IVIG resistance in the entire cohort. There was no diagnostic delay in group I (5.5 vs 6.5 days, p = 0.88). Conclusions Since clinical presentations and laboratory features of KD may vary with age, and the frequency of atypical and incomplete presentations is high, awareness of KD in young children should be raised among pediatricians