Evaluating the Knowledge, Attitude and Experience of Anesthesiologist About Nasotracheal Intubation: A Questionnaire Study

INTRODUCTION: Although the orotracheal intubation is frequentlyused in the operating room and intensive care, nasotracheal intubation is required for some specific surgeries. In this study, it was aimed to investigate the experience and the level of knowledge on nasotracheal intubation, and the rates of using new methods that facilitate nasotracheal intubation. METHODS: Datas were collected from the questionnaire forms that residents and specialists working in anesthesiology and reanimation clinics answered questions via face-to-face communication or e-mail. The questionnaire included questions regarding demographic data and the knowledge and experience of anesthesiologists about nasotracheal intubation. Number (percent) [n (%)] was used to summarize categorical variables. p<0.05 were considered significant in the study. RESULTS: 204 (93.58%) participants have nasotracheal intubation experience. The number of specialists and residents was equal in the study and the majority of the participants (70.6%, n = 144) were working in the training and research hospitals. The proportion of anesthesiologists who experienced difficult nasal intubation among the participants was 27.9% (n = 57). 21% of the anesthesiologists (n = 12) who with difficult nasotracheal intubations said that ‘I always use the videolaryngoscope'. 69% (49% always, 19.7% rarely) of the participants said that they used midazolam during awake nasotracheal intubation. DISCUSSION AND CONCLUSION: Training programs should be prepared and repeated because of new airway devices and sedative agents in nasal airway management

Peri-operative blood transfusion in elective major surgery: incidence, indications and outcome - an observational multicentre study.

Background: Patients' demographic and epidemiological characteristics, local variations in clinicians' knowledge and experience and types of surgery can influence peri-operative transfusion practices. Sharing data on transfusion practices and recipients may improve patients' care and implementation of Patient Blood Management (PBM). Materials and methods: This was a multicentre, prospective, observational, cross-sectional study that included 61 centres. Clinical and transfusion data of patients undergoing major elective surgery were collected; transfusion predictors and patients' outcomes were analysed. Results: Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion. A total of 5,812 blood components were transfused: red blood cells (RBC), fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88 (1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019 (33%) patients. Half of the RBC units were used by patients in the age group 45-69 years. Specific procedures with the highest RBC use were coronary artery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%). Low haemoglobin concentration was the most common indication for intra-operative RBC transfusion (57%) and plasma and platelet transfusions were mostly initiated for acute bleeding (61.3% and 61.1%, respectively). The RBC transfusion rate in study centres varied from 2% to 72%. RBC transfusion was inappropriate in 99% (n=150/151) of pre-operative, 23% (n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBC transfusion episodes. Pre-operative haemoglobin, increased blood loss, open surgery and duration of surgery were the main independent predictors of intra-operative RBC transfusion. Low pre-operative haemoglobin concentration was independently associated with post-operative pulmonary complications. Conclusions: These findings identified areas for improvement in peri-operative transfusion practice and PBM implementation in Turkey

Evaluation of Postural Parathyroid Hormone Change in Patients with Primary Hyperparathyroidism

Purpose. In the present study, we aimed to investigate postural change of PTH in normal individuals and in patients with primary hyperparathyroidism (PHPT). Methods. Twenty-two patients with PHPT and nine healthy controls were enrolled. Following 12 h of fast, patients stayed in recumbent position for an hour and PTH and total Ca measurements were performed at the 45th and 60th minutes of resting. Afterwards, the patients resumed an upright posture for an hour and again blood samples were taken at the 45th and 60th minutes of standing. Results. In the PHPT group, mean PTH was calculated as 153.9 pg/mL in the recumbent position while it was 206.3 during upright position (Δ change was 47.7) (P<0.001). In the control group mean serum PTH was measured as 41.2 pg/mL in the recumbent position while it was 44.8 pg/mL in the upright position (Δ change was 1.7) (P=0.11). In both groups, serum Ca was higher in the upright position compared to the recumbent position (P<0.001). Conclusion. Postural change of serum PTH is significant only in PHPT group. Postural PTH test may give a clue to the clinician when the diagnosis of PHPT is equivocal

New CagL amino acid polymorphism patterns of helicobacter pylori in peptic ulcer and non-ulcer dyspepsia

Background and Objectives: Helicobacter pylori infection is associated with chronic gastritis, ulcers, and gastric cancer. The H. pylori Type 4 secretion system (T4SS) translocates the CagA protein into host cells and plays an essential role in initiating gastric carcinogenesis. The CagL protein is a component of the T4SS. CagL amino acid polymorphisms are correlated with clinical outcomes. We aimed to study the association between CagL amino acid polymorphisms and peptic ulcer disease (PUD) and non-ulcer dyspepsia (NUD). Materials and Methods: A total of 99 patients (PUD, 46; NUD, 53) were enrolled and screened for H. pylori by qPCR from antrum biopsy samples. The amino acid polymorphisms of CagL were analyzed using DNA sequencing, followed by the MAFFT sequence alignment program to match the amino acid sequences. Results: Antrum biopsy samples from 70 out of 99 (70.7%) patients were found to be H. pylori DNA-positive. A positive band for cagL was detected in 42 out of 70 samples (PUD, 23; NUD, 19), and following this, these 42 samples were sequenced. In total, 27 different polymorphisms were determined. We determined three CagL amino acid polymorphism combinations, which were determined to be associated with PUD and NUD. Pattern 1 (K35/N122/V134/T175/R194/E210) was only detected in PUD patient samples and was related to a 1.35-fold risk (p = 0.02). Patterns 2 (V41/I134) and 3 (V41/K122/A171/I174) were found only in NUD patient samples and were linked to a 1.26-fold increased risk (p = 0.03). Conclusions: We observed three new patterns associated with PUD and NUD. Pattern 1 is related to PUD, and the other two patterns (Patterns 2 and 3) are related to NUD. The patterns that we identified include the remote polymorphisms of the CagL protein, which is a new approach. These patterns may help to understand the course of H. pylori infection.Istanbul Aydin University Scientific Research Projects Uni

Effects of intravenous and mask induction on post-operative emergence delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

peker, kevser/0000-0003-4306-5536WOS:000516134600001PubMed: 32048203Background Emergence delirium occurs in children during recovery from general anesthesia. The aim of the study was to examine the effects of mask and intravenous sevoflurane anesthesia induction on emergence delirium in children undergoing tonsillectomy with or without adenoidectomy. Methods This single-blinded, prospective, randomized clinical trial was conducted in the operating room and the post-operative recovery area at a university hospital. Sixty-seven children (aged 3-12 years) were randomly assigned to receive either mask induction (group M) or intravenous induction (group IV). Vascular access was provided in group M after 8% sevoflurane and 60% nitrous oxide in oxygen were given through a mask. In the IV cohort, an intravenous cannula was inserted prior to induction. The incidence of emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale after arrival in the post-anesthesia care unit. Post-operative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Results PAED scores were significantly higher in group M at 5 min (group M = 12.2 +/- 4.215, group IV = 9.1 +/- 4.0; mean difference = 3.094, 95% CI [1.108; 5.081]; P = 0.003), at 15 min (group M = 8.0 +/- 2.6, group IV = 5.1 +/- 2.3; mean difference = 2.942, 95% CI [1.586-4.301]; P < 0.001), and at 30 min (group M = 5.1 +/- 2.8, group IV = 2.5 +/- 1.8; mean difference = 2.620, 95% CI [1.457; 3.783]; P < 0.001) than in group IV. The FLACC scale scores were similar between the two groups. Conclusion Mask induction for pediatric patients undergoing tonsillectomy with or without adenoidectomy increased Pediatric Anesthesia Emergence Delirium scores more than intravenous induction

Effects of intravenous and mask induction on post-operative emergence delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

peker, kevser/0000-0003-4306-5536WOS: 000516134600001PubMed: 32048203Background Emergence delirium occurs in children during recovery from general anesthesia. The aim of the study was to examine the effects of mask and intravenous sevoflurane anesthesia induction on emergence delirium in children undergoing tonsillectomy with or without adenoidectomy. Methods This single-blinded, prospective, randomized clinical trial was conducted in the operating room and the post-operative recovery area at a university hospital. Sixty-seven children (aged 3-12 years) were randomly assigned to receive either mask induction (group M) or intravenous induction (group IV). Vascular access was provided in group M after 8% sevoflurane and 60% nitrous oxide in oxygen were given through a mask. In the IV cohort, an intravenous cannula was inserted prior to induction. The incidence of emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale after arrival in the post-anesthesia care unit. Post-operative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Results PAED scores were significantly higher in group M at 5 min (group M = 12.2 +/- 4.215, group IV = 9.1 +/- 4.0; mean difference = 3.094, 95% CI [1.108; 5.081]; P = 0.003), at 15 min (group M = 8.0 +/- 2.6, group IV = 5.1 +/- 2.3; mean difference = 2.942, 95% CI [1.586-4.301]; P < 0.001), and at 30 min (group M = 5.1 +/- 2.8, group IV = 2.5 +/- 1.8; mean difference = 2.620, 95% CI [1.457; 3.783]; P < 0.001) than in group IV. The FLACC scale scores were similar between the two groups. Conclusion Mask induction for pediatric patients undergoing tonsillectomy with or without adenoidectomy increased Pediatric Anesthesia Emergence Delirium scores more than intravenous induction

Gynecomastia: Clinical evaluation and management

Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important and patients usually seek medical attention. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both. Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery. The main aim of any intervention is to relieve the symptoms and exclude other etiological factors

Lyme disease (Borreliosis) in a Saint Bernard dog: First clinical case in Turkey

Lyme disease is a zoonotic infection caused by the spirochete Borrelia burgdorferi, which is transmitted by ticks of the Ixodes species. This is the first clinical case report of Lyme disease in Turkey. The subject was a 2-year-old male Saint Bernard with recurrent shifting leg lameness that began at about 6 months of age. In sera samples, B. burgdorferi IgM, IgG, and Western Blot were found to be positive. Chronic borreliosis was diagnosed and a long-term arnoxicillin treatment was recommended. One year after the initial presentation, the dog was asymptomatic according to the owner. A clinical examination performed 2 years after the diagnosis failed to find any evidence of clinical Lyme disease

The Value of Tc-99m Mibi for Differential Diagnosis of Biliary Atresia and Hepatitis in Rats

Cholestatic diseases in neonates which characterized by deterioration of bile passage to intestine. We investigated the usability of Tc-99m MIBI as a hepatobiliary scintigraphy radiopharmaceutical for diferential diagnosis of biliary atresia and hepatitis in experimental model. A total of 20 males Wistar albino rats who had weights ranging from 200-350 g were included in this study. Rats were randomly divided into 4 groups. Control group, sham operated group, biliary atresia group and chemical hepatitis group (with carbon tetrachloride) were created, respectively. Blood flow phases, consantration and early excreation phases was performed after an intravenous injection through the internal jugular vein of 37 MBq Tc-99m MIBI using a gamma camera. Dual late static images were obtained at the same position at 15, 30, 60, 90 and 120 min after injection. In control group, radiopharmaceutical passage into the small intestine was seen between 45 and 60 min and evidently seen between 120 and 150 min as large hyperactive focus on midline or non-linear (snaky) radiopharmaceutical accumulation at the level of kidney. In biliary atresia group, radiopharmaceutical concentration was seen normal in liver but passage into the small intestine was not seen all rats. In carbon tetrachloride group, blood flow, concentration and early excretion scintigraphic images did not differ from control group and radiopharmaceutical passage into the small intestine was seen between 45 and 60 min. Although radiopharmaceuticals passage into the intestine was not shown in all rats of biliary atresia group. We suggest that Tc-99m MIBI as a radiopharmaceutical of hepatobiliary scintigraphy would be the contribution of the differential diagnosis of biliary atresia and hepatitis in humans. [Med-Science 2016; 5(1.000): 134-46