Wczesne versus opóźnione odżywianie po cięciu cesarskim z różnymi metodami znieczulenia – badanie randomizowane

Objective: The aim of the study was to evaluate the safety and efficacy of early feeding after cesarean delivery under different anesthetic methods. Study design: Two hundred women with elective cesarean delivery were randomly assigned to early oral feeding (EOF) or routine oral feeding (ROF) groups. EOF patients were informed that they could begin taking fluids orally (regime I) as soon as 2 hours after the delivery and then gradually progress to solid foods (regime III), if tolerated. ROF patients were informed that they could start regime I right after bowel sounds were heard on examination and then gradually move on to regime III. Hospitalization time and total time to ambulation (primary outcomes), gasstool discharge time and onset of bowel sounds (secondary outcomes) were compared in groups A [EOF patients after regional anesthesia (n=49)], B [EOF patients after general anesthesia (n=48)], C [ROF patients after regionalanesthesia (n=47)] and D [ROF patients after general anesthesia (n=48)]. Results: There were significant differences in primary and secondary outcomes between group A and the remaining groups, especially group D. The status of patients from group B was not better than group C. In fact, the latter were discharged home sooner and passage of gas, as well as initiation of regime I occurred earlier as compared to the former. Conclusions: Cesarean section under regional anesthesia and encouragement of oral feeding 2 hours after the operation should be recommended in order to achieve postoperative recovery and early hospital discharge. Routine oral feeding (right after bowel sounds are heard on examination) after cesarean section under general anesthesia should be the last choice.Cel: Celem badania była ocena bezpieczeństwa i skuteczności wczesnego włączenia odżywiania po cesarskim wykonanym przy różnych metodach znieczulenia. Do badania włączono 200 kobiet po elektywnym cięciu cesarskim. Po randomizacji pacjentki przydzielano do grupy wczesnego odżywiania dojelitowego (EOF) lub grupy zwykłego włączania jedzenia (ROF). Pacjentkom z grupy EOF pozwolono pić płyny już 2 godziny po porodzie (reżim I) a następnie stopniowo przechodzić do pokarmów stałych (reżim III). Pacjentki z grupy ROF mogły rozpocząć odżywianie wg reżimu I gdy w badaniu osłuchiwaniem obecna była perystaltyka a następnie stopniowo przechodzić do reżimu III. Czas hospitalizacji, całkowity czas do uruchomienia (pierwotny punkt końcowy), czas do oddania gazów i stolca i czas do rozpoczęcia perystaltyki (wtórny punkt końcowy) porównano pomiędzy grupami A [pacjentki EOF ze znieczuleniem przewodowym, n=49], B [EOF ze znieczuleniem ogólnym, n=48], C [ROF ze znieczuleniem przewodowym, n=47] i D [ROF ze znieczuleniem ogólnym, n=48]. Wyniki: Zaobserwowano istotne różnice pomiędzy grupą A a pozostałymi grupami, zwłaszcza grupą D, w odniesieniu do pierwotnego i wtórnego punktu końcowego. Status pacjentek z grupy B nie był lepszy niż z grupy C. W rzeczywistości pacjentki z grupy C były zwalniane do domu wcześniej, również pasaż gazów i włączenie diety wg reżimu I następowały wcześniej niż w grupie B. Wnioski: Cięcie cesarskie ze znieczuleniem przewodowym i włączeniem odżywiania 2 godziny po operacji powinno być zalecane ze względu na szybszą rekonwalescencję oraz wczesny wypis ze szpitala. Jako ostatnie powinno się wybierać cięcie cesarskie ze znieczuleniem ogólnym i rutynowym włączeniem odżywiania po usłyszeniu perystaltyki jelit

COMPARISON OF EPIDURAL AND COMBINED SPINAL-EPIDURAL ANALGESIA IN PARTURIENTS RECEIVING PATIENT CONTROLLED EPIDURAL ANALGESIA DURING LABOR

Amaç: Doğum ağrılarının giderilmesinde Kombine Spinal - Epidural Analjezi (KSEA), Epidural Analjeziye (EA) bir alternatif olarak sunulmaktadır. Bu çalışmada, doğum eyleminin birinci evresinde KSEA veya EA uygulanan gebelerde analjezik yöntemin, doğum eylemi üzerine etkilerini karşılaştırmayı amaçladık. Gereç ve yöntem: Fakülte Etik Kurul onayı alındıktan sonra, ASA I-II'ye uyan 130 nullipar gebe kombine spinal-epidural (n=65) veya epidural (n=65) analjezi uygulanmak üzere çalışmaya alındı. KSEA grubunda, intratekal aralığa 20 μg fentanil + 1 ml %0,25 bupivakain uygulandı; epidural kateter yerleştirildi. Epidural grupta %0,125 bupivakain + 50μg fentanil (toplam 10 ml) epidural aralığa enjekte edilerek analjezi sağlandı. Her iki grupta analjezi idamesinde Hasta Kontrollü Epidural Analjezi (HKEA) (%0,125 bupivakain + 2 μg/ml fentanil-10 ml bolus + 30 dk. kilit süresi) uygulandı. Serviksin dilatasyon ve efasman derecesi, fetus başının seviyesi, oksitosin infüzyon hızı, doğumun I ve II evre süreleri, yeni doğanın Apgar skoru, doğum şekli ve anne memnuniyeti; ayrıca hemodinamik parametreler, ağrı skorları, motor blok ve yan etkiler kaydedildi. Veriler istatistiksel olarak değerlendirildi. Bulgular: Oksitosin infüzyon hızının Grup EA'da 3-8. saatlerde daha yüksek olduğu (p<0,05), serviks dilatasyonunun KSEA grubunda daha hızlı ilerlediği, efasman dereceleri arasında fark olmadığı saptandı. KSEA grubunda fetus başının daha hızlı iniş yaptığı belirlendi (p<0,05). Motor blok görülme oranı, doğum şekli, Apgar Skorları, anne memnuniyeti gruplar arasında farklı değildi. Sonuç: Geleneksel EA ile kıyaslandığında, KSE analjezi uygulanan nullipar gebelerde, serviks dilatasyonu ve fetus başının seviyesinin daha hızlı indiği ve bu yöntemin geleneksel epidural analjeziye bir alternatif olabileceği kanaatına varıldı. Objective: Combined spinal-epidural analgesia (CSEA) technique is proposed as an alternative to conventional epidural analgesia (EA) for pain of labor. In this study we aimed to compare the effects of CSEA with those of epidural analgesia on the progress of labor during the first stage of labor. Material and method: After approval by the local ethics committee, one hundredthirty nulliparous parturients were randomly allocated to receive either CSEA (n=65) combined spinal-epidural analgesia 1 ml of bupivacaine 0.25% with 20 μg fentanyl were injected into the subarachnoid space and the epidural catheter was inserted. The initial dose consisted of 0.125 % bupivacaine+50μg fentanyl in 10 ml of saline in the epidural group. Both groups received epidural top-ups of 10 ml 0.125 % bupivacaine+2μg/ml fentanyl via Patient Controlled Epidural Analgesia (PCEA) pump. Data were collected on cervical dilation, effacement, station, oxytocin infusion rates, length of 1st and 2nd stage of labor, Apgar scores, mode of delivery, mother satisfaction, hemodynamic parameters, side effects, pain and degree of motor block. Results: The mean cervical dilation rates and progress of station were significantly faster in patients receiving CSEA. Oxytocin infusion rates were higher in patients receiving EA. Progress of effacement, the incidence of side effects, and mode of delivery and Apgar scores were similar between groups. Parturients in both groups were equally satisfied. Conclusion: In nulliparous parturients, CSEA is associated with rapid progress of cervical dilation and station when compared to conventional EA; and can be an alternative to EA in our opinion

War in classical Arabic poetry (from the Jahiliyyah to Abbasid period)

Şiir, kendine has bir ritimle tarih boyunca insanların hayal dünyasındaki aşk, sevgi, nefret, hüzün ve intikam gibi düşünceleri dışarıya ahenkle yansıtma ve insanları etki altına alma aracı olmuştur. Sürekli bir değişim, gelişim ve yenilik diyalektiği içinde varlığını sürdüren şiir, Cahiliye'den itibaren Arap toplumunda insanların en çok değer verdiği edebiyat unsuru haline gelmiştir. Zamanla toplumun dinamikleri ve hassasiyetleri değişirken şiir, ehemmiyetini ve etki sahasını daima koruma altında tutmuş ve bir şekilde gelişimini sürdürmeye devam etmiştir. Cahiliye dönemi başta olmak üzere hemen her Arap edebiyatı döneminde şiirde yeni türler varlık göstermiş, şiiri teşvik edici ve geliştirici unsurlar ön plana çıkmıştır. Cahiliye döneminde Arapların yaptığı savaşları ifade etmek için kullanılan Eyyâmu'l-'Arab, şiiri geliştiren bu unsurlardan biridir. Yapılan savaşlarda ölenleri yad etme, kahramanlıklarını övme veya karşı kabileyi yermek için şiir ve şair ihtiyacı hasıl olmuş ve bu vesileyle şiirde gelişmeler vuku bulmuştur. Sadru'l-İslam Döneminde başta şiir olmak üzere değişen edebiyat çehresi, şairleri dini merkeziyetçilik ile medih, hiciv, mersiye gibi temalarla şiir nazmetmeye itmiştir. Bu dönemde savaş içerikli şiir atışmaları, Cahiliye'den beri var olan temaların daha sağlam bir zemine oturmasını sağlayarak sonraki dönemlere intikalini sağlamıştır. İnsanların mezhepsel olarak gruplaştığı, birbirleriyle savaştığı ve kendi içinden bir halife ilan ettiği Emeviler döneminde her grup şaire ve kendi haklılığını ifade edecek şiirlere ihtiyaç duymuştur. Bu dönemde yapılan savaşlar eski şiir türlerinin gelişimine katkıda bulunmuş, yeni şiir türlerinin ortaya çıkmasına zemin hazırlamıştır. Bu çalışmada Cahiliye başta olmak üzere Sadru'l-İslam ve Emevi dönemlerinde meydana gelen savaşların, şiire yansımaları, gelişimine katkıları ve bu şiirlerde işlenen temalar ele alınmıştır.Poetry, with its unique rhythm, has been a means of reflecting the thoughts such as love, hate, sadness and revenge in the imagination of people throughout history and influencing people in harmony. Poetry, which continues to exist in a dialectic of continuous change, development and innovation, has become the most valued literary element of people in Arab society since Jahiliyya. While the dynamics and sensitivities of the society changed over time, poetry has always kept its importance and sphere of influence under protection and has continued to develop in some way. In almost every period of Arabic literature, especially in the Jahiliyya Period, new genres have existed in poetry and elements that encourage and develop poetry have come to the forefront. Eyyâmu'l-'Arab, which was used to express the wars fought by the Arabs during the Jahiliyya Period, is one of these elements that developed poetry. There was a need for poetry and poets to remember those who died in wars, to praise their heroism or to vilify the opposing tribe. On this occasion, developments in poetry have taken place. The changing literary face, especially poetry, in the Sadru'l-İslam Period, pushed poets to write poetry with themes such as praise (medih), satire (hiciv), elegy (mersiye) with religious centralism. In this period, the war content poetry exchanges ensured that the themes that had existed since the Jahiliyya Period were placed on a more solid ground and transferred to the later periods. During the Umayyad Period, when people grouped sectarianly, fought each other and declared a caliph from within, each group needed poets and poems to express their own rightfulness. Inter-sectarian wars contributed to the development of old poetry genres and paved the way for the emergence of new poetry genres. In this study, the reflections of the wars that took place in the Sadru'l-İslam and Umayyad Periods, especially in the Jahiliyya, on the poems, their contributions to its development and the themes dealt with in these poems were discussed

Early versus delayed oral feeding after cesarean delivery under different anesthetic methods – a randomized controlled trial Anesthesia, feeding in cesarean delivery

Objective: The aim of the study was to evaluate the safety and efficacy of early feeding after cesarean delivery under different anesthetic methods

Early versus delayed oral feeding after cesarean delivery under different anesthetic methods - a randomized controlled trial Anesthesia, feeding in cesarean delivery

Objective: The aim of the study was to evaluate the safety and efficacy of early feeding after cesarean delivery under different anesthetic methods

Degradation of Reactive Dyes Using Advanced Oxidation Method

WOS: 000358509300010In this study, the photo-Fenton process was used to identify degradation conditions of Reactive Blue 19 (RB19) and Reactive Red 21 (RR21). The effects of pH, initial H2O2 and FeSO4 concentrations, time, and UV light intensity in determining the degradation rate were studied. The optimal conditions for the degradation of 0.156 mmol L-1 RB19 and 0.036 mmol L-1 RR21 in water were found to be: pH 4, 0.1 mL 30% H2O2 for RB19 and RR21, 0.2 mL 0.5% FeSO4 for RB19 and 0.1 mL 0.5% FeSO4 for RR21, 20 mL volume, and a temperature of 20 degrees C. Optimal conditions were applied to synthetic dye wastewater using small amounts of H2O2 in 1 L for degradation. The degree of degradation efficiency of synthetic wastewater by the photo-Fenton process was found to be > 95% within 10 min.Council of Scientific Research Projects of Marmara University [FEN-BGS-290506-0116]This work was supported by Council of Scientific Research Projects of Marmara University, with FEN-BGS-290506-0116 project number