Transversus abdominis plane block with different bupivacaine concentrations in children undergoing unilateral inguinal hernia repair: A single-blind randomized clinical trial

BACKGROUND: Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the efficacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair. METHODS: After random allocation, 74 children aged 1-8 were randomized to receive US-guided TAPB by using 1 mg.kg RESULTS: Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6 CONCLUSION: TAPB using 1 mg.kg TRIAL REGISTRATION: This trial was retrospectively registered at Clinicaltrals.gov , NCT04202367

The Impact of Pressure Dressing on Post-Thyroidectomy Hypocalcemia: Prospective Randomized Controlled Clinical Study

Objective:The aim of the study was to evaluate the efficacy of pressure dressing on complications after total thyroidectomy and its correlation with serum calcium levels.Methods:The study involved 112 patients who underwent total thyroidectomy. Patients were randomized into two groups-with and without pressure dressing-and followed prospectively. The calcium levels were measured at 6, 24, and 48 hours postoperatively, respectively. Hypocalcemia was diagnosed when patients were symptomatic or calcium level was below 8.0 mg/dL. Dressing and drain were removed at the 48th hour of postoperatively.Results:No statistically significant difference was found between the two groups in terms of age; gender; thyroid gland weight; calcium concentrations at the 6th, 24th, and 48th hours; total drain liquid; and hypocalcemia rates. Postoperative hematoma developed in 7.1% of the cases and was statistically higher in the without-dressing group compared to with-dressing group. Thyroid gland weight was correlated positively with total drain liquid. There was no correlation between thyroid gland weight and total drain liquid level and 6th-, 24th-, and 48th-hour calcium levels.Conclusion:Pressure dressing after total thyroidectomy significantly reduces postoperative hematoma. Postoperative serum calcium levels were slightly higher in the pressure dressing group but not statistically significant

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Endovasküler Yol ile Tedavi Edilmiş Anevrizmalarda Prosedürel Tromboembolik Sonuçların Öngörülebilirliği

Purpose: Aim of this study was to compare incidental procedurel thromboembolic events occured while beaded stent or flow diverter stent deployment between the first endovascular aneurysm treatment and consecutive endovascular aneurysm treatment based on past medical history, cerebral aneurysm location, thrombocyte reactivity. Materials and Methods: 320 different patients have been treated by flow diverter stent and beaded stent assited coil embolization since February 2013. Overall 386 EVT procedure were carried out. Apart from initial stent assited EVT procedure, a total of 63 consecutive endovascular aneurysm treatments were also performed in 56 patients. Incidental periprocedural thromboembolic events occurred after stent deployment were subclassified as occlusion in stent, partial occlusion or visible thrombus aggregates in stent and side branch transient ischemia or distal cortical branch emboly. Patient group with incidental thrombotic event during EVT procedure was compared with uncomplicated patient group in terms of past medical history (Major cardiovascular event, hyperlipidemia, hypertension, coagulopathy, history of malignancy, smoking) and preprocedural antiagregation profile. Patients were also divided into two groups as having “proximal aneurysm” and “distal aneurysm” according to internal carotid artery bifurcation and origin of superior cerebellar artery. Patient group with proximal and distal aneurysms were distributed by features of past medical history, preprocedural antiaggregation profile and procedural incidental thromboembolic event prevalence. Furthermore, a group of 56 patient with multiple cerebral aneurysms were ordered into two categories as “initial EVT interventions” and “consecutive EVT interventions”. Those dependent groups were compared with each other according to incidental thromboembolic events during procedure. Moreover, considering aneurysm locations, incidental thromboembolic events after stent deployment were also compared between a group treated by flow diverters and a group treated by beaded intravascular stents. Pearson chi-square test, Yates correction in chi square test and Fischer exact test were used for comparison of categorical variables. Mann Whitney U test were also used for comparison of continuous variables. “p<0,05” was accepted as a mean of statistical significance. Results: İncidental thromboembolic events occured in 30 (%7,8) patient after stent deployment. Features of past medical histories and thrombocyte inhibition percentage were not different between the thromboembolic group and uncomplicated group. İn case of clopidogrel resistance, despite the antiaggregation by prasugrel, smoking reduced trombocyte inhibition by %3,1 percent. Thromboembolic event prevalence was higher 4,2 times in distally located aneurysms compared to proximal aneurysm (p=0,001). Distal aneurysms treated by flow diverters experienced 4,9 times more thrombotic event than aneurysm treated by beaded intravascular stent (p=0,001). Three thromboembolic events occured in consecutive stent deployment while no thrombotic event detected in initial stent deployment of similar patients (p=0,287). Conclusion: Repetitive endovascular aneurysm treatments showed no difference in terms of resistance to stent’s intrinsic thrombogenicity effect as compared to inital EVT procedures. İndependent from cardiovascular risks and past medical history, a group of aneurysm located beyond to internal carotid artery bifurcation and basiler apex showed significant risk for occurence of incidental thromboembolic event. Furthermore, using flow diverter stent in aneurysms distal to internal carotid bifurcation and basiler apex exhibited higher incidental thrombotic and ischemic events compared to beaded intravasculer stent.Sponsor mevcut değildir.TEŞEKKÜR, ÖZET, ABSTRACT, İÇİNDEKİLER, SİMGELER VE KISALTMALAR, ŞEKİLLER, TABLOLAR, 1. GİRİŞ ve AMAÇ, 2. GENEL BİLGİLER, 2.1. Tanım ve Sınıflandırma 2.2. Epidemiyoloji ve Risk faktörleri 2.3. Klinik ve Komplikasyonlar 2.4. Tanısal Görüntüleme 2.5. Tedavi 2.6. Perkütan İntraarteriyal GirişimlerdeTrombotik Komplikasyonlar, Risk Faktörleri ve Perioperative Hazırlık 3. GEREÇ ve YÖNTEM, 3.1. Hasta grupları ve demografik veriler 3.2. Endovasküler Anevrizma Tedavisi Öncesi Hazırlık ve Prosedür Detayları 3.3. Veri Analizi-İstatistiksel Yöntemler 4. BULGULAR, 5. TARTIŞMA, 6. SONUÇLAR ve ÖNERİLER, 6.1. Sonuçlar 6.2. Öneriler 7. KAYNAKLAR, EKLER Ek 1. Etik KurulAmaç: Bu çalışmada örgülü stent ya da akım çevirici stent eşliğinde endovasküler yöntem ile anevrizma tedavisi sırasında oluşan insidental trombotik olayları, mükerrer endovasküler anevrizma tedavilerindeki trombotik olaylar ile özgeçmiş özellikleri, anevrizma yerleşimi ve antiagregasyon profilini standardize ederek karşılaştırmayı amaçladık. Gereç ve Yöntem: Şubat 2013 tarihinden itibaren akım çevirici cihaz veya örgülü stent eşliğinde koil embolizasyon yapılarak tedavi edilmiş 320 hastaya 386 adet endovasküler anevrizma tedavisi yapıldı. 56 hastaya ise toplam 63 adet mükerrer endovasküler anevrizma tedavisi yapıldı. EVT sırasında stent açıldıktan sonra meydana gelen trombotik olaylar stent içi oklüzyon, stent içi parsiyel tıkanıklık ya da trombüs agregatları, yan dalın geçici iskemisi veya distal kortikal emboli olacak şeklinde gruplara ayrıldı. Prosedür sırasında insidental trombotik olay gelişen hasta grubu ile komplikasyonsuz hasta grubu özgeçmiş özelliklerine (major kardiyovasküler olay, hiperlipidemi, hipertension, malignite, koagulopati, sigara kullanımı) ve işlem öncesi antiagregasyon profiline göre karşılaştırıldı. Hasta grupları, internal karotid arter bifurkasyon (ICA bif.) ve süperyor serebellar arter orijinine göre “proksimal” ve “distal” anevrizmalar olarak ikiye ayrıldı. Proksimal ve distal yerleşimli anevrizmaların özgeçmiş özellikleri, prosedür öncesi antiagregasyon profili ve EVT sırasında insidental tromboembolik olay gelişiminin prevelansı incelendi. 56 adet multipl intraserebral anevrizması olan hasta grubunda ise birincil EVT ile mükerrer EVT sırasında oluşan trombotik olay prevelansı karşılaştırıldı. Akım çeviri stent ve örgülü stent kullanırken tedavi sırasında gelişen insidental trombotik olayların anevrizma lokasyonuna göre dağılımı araştırıldı. Kategorik değişkenlerin karşılaştırılmasında Pearson ki-kare, Yates düzeltmeli ki-kare ve Fisher’s exact testi kullanıldı. Çalışmadaki sürekli değişkenler ise Mann-Whitney U testi ile karşılaştırıldı. İstatistiksel anlamlılık düzeyi p<0,05 olarak kabul edildi. Bulgular: 30 (%7,8) hastada EVT sırasında stent açıldıktan sonra insidental tromboembolik olay meydana geldi. Trombotik olay gelişen grubun özgeçmiş özellikleri ve trombosit inhibisyon yüzdesi komplikasyonsuz gruptan farklı değildi. Klopidogrel direnci durumunda prasgurel ile antiagregasyona rağmen sigara kullanan hastalarda ortalama trombosit reaktivitesi %3,1 daha azdı. Distal yerleşimli anevrizma tedavisinde trombotik olay prevelansı proksimal yerleşimli anevrizmalara göre 4,2 kat yüksekti (p=0,001). Akım çevirici cihazlar kullanılarak tedavi edilen distal anevrizmalarda tromboembolik ya da iskemik olay prevelansı örgülü stentlere göre 4,9 kat yüksekti (p=0,001). Stent eşliğinde mükerrer defa yapılan EVT sırasında 3 adet trombotik olay yaşanırken, bu hastaların ilk prosedürlerinde trombotik olay yaşanmadı (p=0,287). Sonuç: Mükerrer endovasküler anevrizma tedavisinin stentin trombojenik etkisine karşı direnci, ilk girişimlerden farksızdır. İnternal karotid bifurkasyon ve baziler apeks distalinde yerleşim gösteren anevrizma tedavisinde periprosedürel trombotik olay riski, bu seviyelerin proksimalinde yerleşim gösteren anevrizmalardan belirgin fazla olup kardiyovasküler risk faktörlerinden bağımsızdır. Distal yerleşimli anevrizmalarda akım çevirici cihaza bağlı trombotik ve iskemik olay sıklığı örgülü stentlere göre belirgin yüksektir

Zenginleştirilmiş kafes sisteminde, kafes yönü (duvar – iç), kafes katı ve yumurtlama yaşının yumurtacı hibrit'in yumurta kalitesine etkisi

Bu çalışma zenginleştrilmiş kafes sisteminde, kafes yönü (duvar – iç), kafes katı ve yumurtlama yaşının, yumurtacı hibritte yumurta kalitesi üzerine etkilerini araştırmak amacıyla yapılmıştır. Niğde Ömer Halisdemir Üniversitesi Ayhan Şahenk Tarımsal Uygulama ve Araştırma Merkezınde yetiştirilen Lohman LSL yumurtacı hibridlerden elde edilen 720 adet yumurta kullanılmıştır. Araştırma sonucunda; kafes yönün ak indeksine, Haugh unit'e ve sarı indeksine; yumurtlama yaşının yumurta ağırlığı, şekil indeksi, kırılma mukavemeti, kabuk kalınlığı, ak indeksi, Haugh unit ile sarı rengi skoru ve sarı indeksi skoru üzerine etkisi istatistiksel olarak önemli bulunmuştur. Kafes katının ise yumurta kalitesine anlamlı derecede etkisi gözlemlenmemiştir. Ayrıca birçok kalite kriteri açısından kafes yönü, kafes katı ve yumurtlama yaşı arasındaki interaksiyonlar önemli bulunmuştur.This study investigated the effect of cage direction (wall side- inner side), cage tier, and laying hen age on egg quality in layer hybrid in enriched cage system. A total of 720 egg obtained from Lohman LSL layer hybrids reared in Ayhan Şahenk Agricultural Research and Application Centre were used. Cage direction significantly affected albumen index, Haugh unit, and yolk index. The effect of laying hen age on egg weight, shape index, breaking strength, shell thickness, albumen index, Haugh unit, yolk color score, and yolk index score was found statistically significant. No significant effect of cage tier on egg quality characteristics was observed. In addition, the interactions between cage direction, cage tier, and layer age were found significant for many egg quality parameters