Yenidoğan sepsisinde tam kan sayımı parametrelerinin tanısal değeri

Objective: This study was planned to determine whether complete blood count parameters and scores based on complete blood count can be used as a diagnostic marker in neonatal sepsis. Methods: This retrospective study included 70 patients with neonatal sepsis (Group 1) and 65 healthy neonates (Group 2) with similar age, sex, birth weight, and gestational age. The demographic data, blood culture results, clinical and laboratory findings were obtained from the medical records. Scores based on complete blood count such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), eosinophil-to-lymphocyte ratio (ELR), basophil-to-lymphocyte ratio (BLR) and monocyte-to-lymphocyte ratio (MLR) were calculated by dividing the number of neutrophils, platelets, eosinophils, basophils and monocytes by the number of lymphocytes, respectively. Results: There were no significant differences between the groups in terms of demographic characteristics such as age, gender, birth weight, type of delivery and gestational week. C-reactive protein level was significantly higher in the neonatal sepsis group (p 0.05). While NLR was significantly higher (2.19±1.39 vs 1.44±1.07, p<0.001), ELR was significantly lower (0.08±0.07 vs 0.09±0.05, p=0.007) in neonatal sepsis group. NLR was positively correlated while ELR, lymphocyte, platelet, eosinophil and monocyte counts were negatively correlated with CRP (p<0.05). According to the results of ROC curve analysis, CRP, NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts were significant parameters for the diagnosis of neonatal sepsis. Cut-off values were 6.09 mg/L for CRP (sensitivity 88.57%, specificity 100%, AUC: 0.964, p <0.001), 1.01 for NLR (sensitivity 78.57%, specificity 63.08%, AUC: 0.727, p <0.001, 0.079 for ELR (sensitivity 64.29%, specificity 56.92%, AUC: 0.634, p = 0.007), 4.66x109/L for neutrophil count (sensitivity 68.57%, specificity 61.54%, AUC: 0.683, p<0.001), 4.33x109/L for lymphocyte count (sensitivity 65.71%, specificity 60.00%, AUC: 0.668, p=0.001), 259.00x109/L for platelet count (sensitivity 62.86%, specificity 58.46%, AUC: 0.659, p=0.001), 0.27x109/L for neutrophil count (sensitivity 61.42%, specificity 69.23%, AUC: 0.708, p<0.001) and 1.33x109/L for monocyte count (sensitivity 62.86%, specificity 56.92%, AUC: 0.647, p=0.003) Conclusion: Although their sensitivities and specificities lower than CRP; NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts can be accepted as adjunctive data that contribute to the diagnosis of neonatal sepsis. In particular, NLR seems to be the most useful complete blood count parameter in the diagnosis of neonatal sepsis with the highest sensitivity and specificity

The Efficacy of Quadratus Lumborum Block in Children with Laparoscopy-assisted Pyeloplasty

Objective: The quadratus lumborum block (QLB) is a new and effective truncal block used for postoperative analgesia in patients undergoing upper and lower abdominal surgeries. We aimed to evaluate and compare the efficacy of QLB and wound infiltration (WI) using postoperative Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores and total 24-h analgesic consumption in pediatric patients who underwent laparoscopic-assisted pyeloplasty (LAP)

The Knowledge of Eye Physicians on Local Anesthetic Toxicity and Intravenous Lipid Treatment: Questionnaire Study

Objectives: To evaluate the knowledge of ophthalmologists regarding local anesthesia toxicity syndrome (LATS) and intravenous lipid emulsion used in treatment, and to raise awareness of this issue. Materials and Methods: A questionnaire comprising 14 questions about demographics, local anesthesia (LA) use, toxicity, and treatment methods was administered to ophthalmologists at different hospitals. Results: The study included 104 ophthalmologists (25% residents, 67.3% specialists, 7.7% faculty members) with a mean age of 35.71±6.53 years. The highest number of participants was from state hospitals (65.4%), and 34.6% of the physicians had been working in ophthalmology for more than 10 years. Seventy-six percent of the participants reported using LA every day or more than twice a week, but 56.7% had received no specific training on this subject. No statistically significant difference was observed between different education levels and the rates of training (p=0.419). Bupivacaine was the most preferred LA and the majority of respondents (97.1%) did not use a test dose. Allergy (76%) and hypotension (68.3%) were the most common responses for early findings of LATS, while cardiac arrest (57.4%) and hepatotoxicity (56.4%) were given for late findings. The most common responses concerning the prevention of LATS included monitorization (72.4%) and use of appropriate doses (58.2%). Symptomatic treatment was selected by 72.4% of respondents and cardiopulmonary resuscitation and antihistamine treatment by 58.8%. Of the ophthalmologists in the study, 62.5% had never encountered LATS. The use of 20% intravenous lipid emulsion therapy for toxicity was known by 65% of the physicians, but only 1 participant stated having used it previously. Conclusion: The importance of using 20% lipid emulsion in LATS treatment and having it available where LA is administered must be emphasized, and there should be compulsory training programs for ophthalmologists on this subject

The bedside practice of sonographic guided internal jugular vein access in critically ill premature infants

BACKGROUND: Intrahospital transport, general anesthesia, and the prolonged duration of the central venous catheterization (CVC) in unfavorable conditions pose a significant risk to a critically-ill premature infant. We aimed to demonstrate a minimalized and safe manner of CVC in this patient population. METHODS: We worked on a prospective study in 51 critically-ill premature infants in which a 22 Gauge catheter was put in one of the central thoracic veins with the guidance of sonography as a bedside procedure. Of the patients, 27 (53%) were extremely premature, and 21 (41%) were extremely low birth weight infants (ELBW). The mean gestational age was 29±5 weeks, and the mean weight at the time of the procedure was 1655±1028 grams. While no anesthetic and sedative drugs were administered to ELBW infants during procedures, in the remainder of the cohort, procedures were carried out only under sedoanalgesia. RESULTS: Vascular access was achieved in 48 (94%) of the patients after a mean number of 1.47±0.75 attempts. Body heat loss of the patients at the end of the procedures was not statistically significant (P=0.164). However, ELBW infants lost their body heat significantly more than the rest of the cohort (P=0.032). We experienced clinically insignificant common carotid artery puncture in three patients and hemothorax in one patient. CONCLUSIONS: CVC of critically ill premature infants can be safely and successfully achieved in incubators using sonography guidance, protecting them from hypothermia and anesthetic drugs

Retrospective Evaluation of Anesthetic Management in Cesarean Sections of Pregnant Women with Placental Anomaly

Background. In this study, patients who underwent cesarean section and had placenta previa and placenta accreta were examined and compared in terms of haemorrhagic indicators and perioperative anesthetic management. Methods. A retrospective study was conducted in a university hospital in Kahramanmaras, Turkey. It included 95 pregnant women who had placental anomaly and underwent cesarean section between December 15, 2014, and February 15, 2016. Results. The pregnant women were divided into two groups: Group P (previa) (n = 67) and Group A (accreta) (n = 28). The types of anesthesia administered were general anesthesia (GA), which was administered to 50 patients (74.6%) in Group P and 27 patients (96.4%) in Group A, and spinal anesthesia (SA), which was administered to 17 patients (25.4%) in Group P and one patient (3.6%) in Group A.. The mean blood loss was 685.82 ± 262.82 in Group P and 1582.14 ± 790.71 in Group A, and the given amount of crystalloid was higher in Group A with an average of 1628.57 ± 728.19 ml. The use of erythrocyte and fresh frozen plasma solution was higher in Group A than Group P. Eleven patients were intubated and taken to the Intensive Care Unit (ICU) in Group A. Postoperative mechanical ventilation duration was significantly higher in Group A (75.14 ± 43.84 h) (p<0.001). ICU stay was longer in Group A with 2.80 ± 1.13 days. (p<0.001). Conclusion. The intraoperative management and the availability of postoperative ICU conditions are important in placental anomalies cases. The communication between operation team with regard to the development of a standard protocol for these cases will be of great benefit in reducing morbidity and mortality

Diagnostic value of complete blood count parameters in neonatal sepsis

Amaç: Bu çalışma tam kan sayımı parametrelerinin ve tam kan sayımına dayalı skorların yenidoğan sepsisinde tanısal biyo-belirteç olarak kullanılıp kullanılamayacaklarını belirlemek amacıyla planlanmıştır. Yöntemler: Retrospektif olarak planlanan bu çalışmaya, yenidoğan sepsisi tanısı almış 70 hasta (Grup 1) ve hasta grubuyla benzer yaş, cinsiyet, doğum ağırlığı ve doğum haftasında olan 65 sağlıklı yenidoğan (Grup 2) olarak çalışmaya alındı. Demografik veriler, kan kültürü sonuçları, klinik ve laboratuvar bulguları tıbbi kayıtlardan elde edildi. Nötrofil/lenfosit oranı (NLO), trombosit/lenfosit oranı (TLO), eozinofil/lenfosit oranı (ELO), bazofil/lenfosit oranı (BLO) ve monosit/lenfosit oranı (MLO) gibi tam kan sayımına dayalı skorlar, sırasıyla nötrofil, trombosit, eozinofil, bazofil ve monosit sayısının lenfosit sayısına bölünmesiyle hesaplandı. Bulgular: Yaş, cinsiyet, doğum tartısı, doğum şekli ve gebelik haftası gibi demografik özellikler bakımdan gruplar arasında fark yoktu (p>0,05). C-reaktif protein düzeyi yenidoğan sepsisi grubunda anlamlı olarak yüksekti (p0,05). NLO yenidoğan sepsisi grubunda anlamlı olarak yüksek iken (2,19±1,39 vs 1,44±1,07, p 0.05). While NLR was significantly higher (2.19±1.39 vs 1.44±1.07, p<0.001), ELR was significantly lower (0.08±0.07 vs 0.09±0.05, p=0.007) in neonatal sepsis group. NLR was positively correlated while ELR, lymphocyte, platelet, eosinophil and monocyte counts were negatively correlated with CRP (p<0.05). According to the results of ROC curve analysis, CRP, NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts were significant parameters for the diagnosis of neonatal sepsis. Cut-off values were 6.09 mg/L for CRP (sensitivity 88.57%, specificity 100%, AUC: 0.964, p <0.001), 1.01 for NLR (sensitivity 78.57%, specificity 63.08%, AUC: 0.727, p <0.001, 0.079 for ELR (sensitivity 64.29%, specificity 56.92%, AUC: 0.634, p = 0.007), 4.66x109/L for neutrophil count (sensitivity 68.57%, specificity 61.54%, AUC: 0.683, p<0.001), 4.33x109/L for lymphocyte count (sensitivity 65.71%, specificity 60.00%, AUC: 0.668, p=0.001), 259.00x109/L for platelet count (sensitivity 62.86%, specificity 58.46%, AUC: 0.659, p=0.001), 0.27x109/L for neutrophil count (sensitivity 61.42%, specificity 69.23%, AUC: 0.708, p<0.001) and 1.33x109/L for monocyte count (sensitivity 62.86%, specificity 56.92%, AUC: 0.647, p=0.003) Conclusion: Although their sensitivities and specificities lower than CRP; NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts can be accepted as adjunctive data that contribute to the diagnosis of neonatal sepsis. In particular, NLR seems to be the most useful complete blood count parameter in the diagnosis of neonatal sepsis with the highest sensitivity and specificity