A rare case: Non-recurrent laryngeal nerve

Non-recurrent inferior laryngeal nerve (NRLN) is a very rare nerve variation seen during thyroidectomy. Identification and preservation of this nerve is crucial for post-operative life of the patient. In this paper, we presented a 55-year old female patient with right NRLN identified during operation performed due to multinodular goiter (MNG). This presented case was intraoperatively identified as NRLN during right lobe dissection and it was preserved through its course until entrance to the larynx with careful dissection. Patient was discharged at first postoperative day without problem during postoperative monitoring. Anatomic variations may cause nerve damage; therefore identification and preservation with careful dissection have utmost importance

Evaluation of Post-cesarean Section Surgical Site Infections Before and During the COVID-19 Pandemic: Retrospective, Tertiary Center Experience

Objective:Surgical site infection (SSI) significantly causes maternal morbidity requiring hospitalization. This study aimed to determine the clinical and laboratory results of patients who developed SSI after cesarean section at the peak of Coronavirus disease-2019 (COVID-19).Method:Sixty patients who developed SSIs after cesarean section were included in the study retrospectively. They were divided into two groups. Thirty patients recruited at the peak of COVID-19 were the “pandemic group” and thirty patients recruited in previous years were the “pre-pandemic group”. Age, parity, presence of comorbidity, emergency or elective cesarean section, use of drain in operation, postoperative hemoglobin, hematocrit and leukocyte values, presence of superficial or deep incisional infection, time from discharge to wound infections, wound growth culture, antibiotic duration, length of hospital stay, and the need for suture performed were analyzed between the two groups.Results:While superficial incisional infection was observed in 71.7% (n=43) of the patients with SSI, deep incisional infection was observed in 28.3% (n=17). It was observed that there was an increase in deep incisional infection rates and the need for suturation in SSIs during the pandemic period, but there was no significant difference (p=0.390). There was no significant difference in hemoglobin, hematocrit, and leukocyte values. However, it was observed that all patients with deep incisional infections were sutured (p<0.001).Conclusion:SSI causes prolonged hospital stays, poor delivery experience, and patient dissatisfaction. Demographic characteristics of patients and surgical factors are essential in determining the risk. This study shows that although there is an increase in the frequency of deep incisional infections during the pandemic, post-cesarean section infections are not affected by the pandemic in terms of clinical and laboratory features

Late perforation of anterior mitral leaflet after surgical resection of the subaortic membrane

AbstractA 54-year-old woman who underwent surgical resection of the subaortic membrane 10 years earlier presented with new onset dyspnea. Cardiovascular examination revealed 3–4/6 pansystolic murmur at the apex. She was found to have severe mitral regurgitation (MR) with transthoracic echocardiography; 2D and real-time-3D transesophageal echocardiography demonstrated severe MR through anterior mitral leaflet perforation with precise localization. The patient was treated with surgery in which the perforated segment was closed by direct suture technique and discharged on postoperative 5th day.<Learning objective: Late anterior mitral leaflet perforation after surgical or interventional procedures has rarely been reported. We present this case to emphasize the role of traumatic injury to weak endothelial surfaces such as a valve leaflet in the development of late leaflet perforation after surgical or interventional procedures.

Evaluation of Birth Satisfaction in Caesarean Section with General Anesthesia and Spinal Anesthesia

Objective:This study aims to investigate the effects of general and spinal anesthesia methods on the birth satisfaction of women in cesarean deliveries with the birth satisfaction scale (BSS) and to determine the factors affecting birth satisfaction.Method:This descriptive cross-sectional study included 350 women who delivered by cesarean section under general and spinal anesthesia in a tertiary healthcare institution between June 2022 and November 2022. The patients were divided into groups S (spinal anesthesia) and G (general anesthesia). The data collection form and the “BSS” were filled in by face-to-face interview technique on the day of discharge to women who had a cesarean section.Results:A total of 350 women who had a cesarean section, 228 (65.1%) in group S and 122 (34.9%) in group G, participated in the study. While 59.7% (n=209) of the women were primary school graduates, 6.9% (n=24) were university graduates. The mean BSS score was significantly higher in group S compared to group G (108±13 vs. 104±12, p=0.005). The preference for spinal anesthesia in university graduates and general anesthesia in illiterate women was significantly higher (p=0.021). When evaluated according to educational status, BSS scores were significantly higher in university graduates (p=0.002).Conclusion:Birth satisfaction scores were high in women with a cesarean section under spinal anesthesia. In addition, preference for spinal anesthesia and BSS scores were high in university graduate sociowomen. Informing women with low educational levels about spinal anesthesia and eliminating any concerns may increase the preference for spinal anesthesia and the satisfaction of delivery

Clinical Characteristics of Patients with Methyl Alcohol Intoxication Followed up in the Intensive Care Unit and Factors Affecting Mortality

Objective:Methyl alcohol is a solvent obtained by the fermentation of wood and used in various fields industrially. Due to its cheap and easy accessibility, it is frequently used to manufacture moonshine and can lead to severe morbidity and mortality. This study aims to evaluate the clinical features of patients with methanol intoxication followed in the tertiary center intensive care unit (ICU) and determine the factors affecting mortality.Method:All patients aged 18 years and older who were followed up in the ICU for methanol intoxication between January 2016 and September 2022 were included in the study. Demographic characteristics, clinical data, and factors affecting mortality were evaluated retrospectively by classifying the patients as discharged and dead.Results:A total of 32 patients, 11 (34.3%) in the discharged group and 21 (65.7%) in the dead group, were included in the study. The mean age of the whole population was 41.5±8.8 years, and all were male. Of the population, 37.5% had central nervous system findings, 34.3% had visual disturbances, and 15.6% had gastrointestinal system complaints. Renal replacement therapy was administered to 93.7% of the patients, ethyl alcohol or fomepizole to 40.6%, and folate to 28.1%. High anion gap metabolic acidosis (pH23.2) and high lactate levels (lactate>5.27) were associated with poor outcomes.Conclusion:Although methanol intoxication is an important public health problem affecting especially young-middle-aged men, it is a significant cause of mortality. We think that developing effective policies can prevent methanol intoxication and related deaths

Effects of Ultrasonography-Guided Transversus Abdominis Plane Block on Postoperative Analgesia, Gastrointestinal Motility, and Mobilization in Patients Delivering Cesarean Delivery Under Spinal Anesthesia: A Retrospective Study

Aim: The aim of this study was to investigate the effect of ultrasonography (USG)-guided transversus abdominis plane (TAP) block on postoperative analgesia, gastrointestinal motility, and mobilization time in patients who had a cesarean section under spinal anesthesia. Material and Methods: The follow-up forms of the total 81 patients who had elective cesarean delivery under spinal anesthesia between March 2022 and June 2022 were reviewed retrospectively. The patients were divided into two groups, 41 patients as the TAP block applied group (group T) and 40 patients as the control group (group C). Demographic data of patients, visual analog scale (VAS) values at postoperative 2nd-, 4th-, 6th-, 12th-, and 24th-hour, tramadol requirements, non-steroidal anti-inflammatory drug (NSAID) and tramadol consumption, postoperative nausea-vomiting (PONV) status, initial gas release times and mobilization times were analyzed. Results: The VAS scores of the patients in group T at the postoperative period 2nd-, 4th-, and 6th-hour were significantly lower than those of group C (

Classical Blind Percutaneous Dilatational Tracheostomy vs Fiberoptic Bronchoscopy Guided Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: Complications, Mortality, and Outcomes

Aim: This study aimed to compare percutaneous dilatational tracheostomy (PDT) procedures performed with fiberoptic bronchoscopy (FOB) guidance and classical blind technique regarding complications, mortality, and patient outcomes. Material and Methods: This study included 62 patients receiving mechanical ventilator support in the intensive care unit (ICU) between October 2022 and June 2023. Patients were randomized into two groups: those who underwent FOB-guided PDT (group FOB, n=31) and those who underwent PDT with the classical blind technique (group C, n=31). Demographic data, clinical characteristics, PDT procedure times, complications, and mortalities were analyzed. Results: The median age was 64 (range, 19-94) years, and 67.7% (n=42) of the patients were male. Demographic data were found similar between groups. The most common primary diagnosis in patients who underwent PDT was intracranial hemorrhages (32.3%, n=20). While the median tracheostomy opening time in the entire study group was 13 (range, 3-31) days, there was no significant difference between the groups (p=0.637). The mean PDT procedure time (9.6±3.8 vs 12.6±5.4 min, p=0.015), median ICU stay (26 vs 37 days, p=0.004), and complication rate (6.4% vs 25.8%, p=0.038) were found to be significantly lower in group FOB. While the 28-day mortality in the entire study group was 17.7% (n=11), there was no significant difference between the groups (p=0.740). Conclusion: In PDT procedures performed under FOB guidance, procedure time, length of stay in the ICU, and procedure-related complication rates were significantly lower, while no significant difference was observed in terms of mortality

Gen verileri üzerinde ilginçlik ölçütleri kullanılarak birliktelik kuralları madenciliğinin uygulanması

Aim: Data mining is the discovery process of beneficial information, not revealed from large-scale data beforehand. One of the fields in which data mining is widely used is health. With data mining, the diagnosis and treatment of the disease and the risk factors affecting the disease can be determined quickly. Association rules are one of the data mining techniques. The aim of this study is to determine patient profiles by obtaining strong association rules with the apriori algorithm, which is one of the association rule algorithms. Material and Method: The data set used in the study consists of 205 acute myocardial infarction (AMI) patients. The patients have also carried the genotype of the FNDC5 (rs3480, rs726344, rs16835198) polymorphisms. Support and confidence measures are used to evaluate the rules obtained in the Apriori algorithm. The rules obtained by these measures are correct but not strong. Therefore, interest measures are used, besides two basic measures, with the aim of obtaining stronger rules. In this study For reaching stronger rules, interest measures lift, conviction, certainty factor, cosine, phi and mutual information are applied. Results: In this study, 108 rules were obtained. The proposed interest measures were implemented to reach stronger rules and as a result 29 of the rules were qualified as strong. Conclusion: As a result, stronger rules have been obtained with the use of interest measures in the clinical decision making process. Thanks to the strong rules obtained, it will facilitate the patient profile determination and clinical decision-making process of AMI patients.Amaç: Veri madenciliği, önceden büyük ölçekli verilerden ortaya çıkarılmayan faydalı bilgilerin keşfedilme sürecidir. Veri madenciliğinin yaygın olarak kullanıldığı alanlardan biri de sağlıktır. Veri madenciliği ile hastalığın tanı ve tedavisi ile hastalığı etkileyen risk faktörleri hızlı bir şekilde belirlenebilmektedir. Birliktelik kuralları, veri madenciliği tekniklerinden biridir. Bu çalışmanın amacı, birliktelik kuralı algoritmalarından biri olan apriori algoritması ile güçlü birliktelik kuralları elde ederek hasta profillerini belirlemektir. Materyal ve Metot: Çalışmada kullanılan veri seti 205 akut miyokard enfarktüsü (AMI) hastasından oluşmaktadır. Hastalar ayrıca FNDC5 polimorfizmlerinin rs3480, rs726344, rs16835198 genotipini de taşımaktadır. Apriori algoritması ile elde edilen kuralları değerlendirmek için destek ve güven ölçüleri kullanılır. Ancak bu ölçütler ile elde edilen kurallar doğrudur ancak güçlü değildir. Bu nedenle, daha güçlü kurallar elde etmek amacıyla iki temel ölçütün yanı sıra ilginçlik ölçütleri kullanılmaktadır. Bu çalışmada daha güçlü kurallara ulaşmak için ilginçlik ölçütlerinden kaldıraç, kanaat, kesinlik faktörü, cosine, korelasyon katsayısı (phi) ve karşılıklı bilgi ölçütleri uygulanmıştır. Bulgular: Çalışmada 108 kural elde edilmiştir. Bu kurallara ilginçlik ölçütlerinin de uygulanması ile elde edilen kural sayısı 29 olmuştur ve bu kurallar güçlü kural olarak nitelendirilmiştir. Sonuç: Sonuç olarak, klinik karar verme sürecinde ilginçlik ölçütlerinin kullanılmasıyla daha güçlü kurallar elde edilmiştir. Elde edilen güçlü kurallar sayesinde AMİ hastalarının hasta profili belirleme ve klinik karar verme sürecini kolaylaştıracaktır

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London