1,554 research outputs found

    Lumbar Puncture of the Newborn

    Get PDF
    Heinrich Irenäus Quincke was the first person in medical history to perform lumbar puncture (LP). Indications of lumbar puncture include suspected meningitis, suspected subarachnoid hemorrhage, administration of chemotherapeutic agents, instillation of contrast media for imaging of the spinal cord, and the evaluation of various neurologic conditions including normal pressure hydrocephalus and Guillain-Barré syndrome, and the treatment of idiopathic intracranial hypertension. Contraindications of lumbar puncture include findings of increased intracranial pressure, bleeding diathesis, cardiopulmonary instability, soft tissue infection at the puncture site, shock, respiratory insufficiency, and suspected meningococcal septicemia with extensive or spreading purpura. Altered mental status, focal neurologic signs, papilledema, focal seizure, and risk for brain abscess are indications for cranial imaging before performing LP. Lack of local anesthetic use and advancement of the spinal needle with the stylet in place were most prominent risk factors for a traumatic LP. Ultrasound may minimize the number of LP attempts and decrease patient and parent anxiety by easily identifying an insertion site. Infection, spinal hematoma, epidermoid tumor, and cerebral herniation are the main complications of LP. When LP is traumatic, the wisest approach is to assume the patient is having meningitis and start empirical therapy

    Environmental security: Conflict resolution samples for German East Africa in the postcolonial era

    Get PDF
    Çevresel sorunların ve çevresel bozulmaların ozon tabakasının seyrelmesiyle beraber 1980'li yıllarda insan hayatını etkilemeye başlaması sonucunda çevre faktörü Soğuk Savaş'ın ardından başlayan güvenlik tartışmalarında yer edinmeye başlamıştır. Güvenlik kavramının genişletilmesi ve güvenlikleştirmeyle birlikte hızla küreselleşen dünyada çevre meselesi önemli bir güvenlik unsuru olarak görülmeye başlamıştır. Çevresel güvenlik kavramının güvenlik çalışmalarında ayrı bir alan olarak yer tutmasıyla birlikte çatışmaların, özellikle şiddetli ülke içi çatışmaların ardında yatan çevresel nedenler ihtiyaç ve kaynak temelli çatışmalar açsından çeşitli çalışma gruplarında irdelenmeye başlamıştır. Bu çalışma, çevresel güvenliğin kavramsal gelişimine ışık tutarak Ruanda ve Burundi'nin tarihsel sürecini çevresel güvenlik kaygıları açısından değerlendirmekte ve bu analiz üzerinden ihtiyaç ve kaynak temelli çatışmalara dair çatışma çözümleme örnekleri sunmaktadır.The environmental factor started to take its place in security debates introduced right after the Cold War as environmental problems and environmental derogation start to have a negative effect on human life with the depletion of ozone layer in the 1980s. The environmental factor became an important security issue in a very globalizing world with the extension of security concept and securitization. Environmental causes underlying conflicts especially the violent internal ones started to be studied among different study groups in terms of needs-based and resource-based conflicts since the concept of environmental security was introduced as a separate field in security studies. This study highlights the conceptual development of environmental security and evaluates the historical context in Rwanda and Burundi in terms of environmental security concerns. It also offers conflict resolution samples for needs-based and resource based conflicts with this analysis

    Neonatal Meningitis

    Get PDF
    Neonatal meningitis continues to be a problematic issue of neonatology and pediatric infectious diseases with its incidence of 0.8–6.1 in 1000 live births, high case fatality rate, and neurological sequelae. Major risk factors for contracting meningitis in the newborn period include maternal peripartum infection, premature rupture of membranes, premature birth, fetal hypoxia, septic or traumatic birth, low birth weight, and galactosemia. The leading causative agent is group B streptococci (in almost half of the cases), and a quarter of cases are due to Escherichia coli. Vertical transmission from the mother is often the route of infection. Neonatal meningitis may not be distinguishable clinically from neonatal sepsis without meningitis. Meticulous care should be taken to perform lumbar puncture whenever the patient’s status permits since it is an indispensable tool for diagnosis. Initial empirical therapy may consist of ampicillin and cefotaxime, ampicillin and gentamicin, or ampicillin + gentamicin + cefotaxime during the first week of life. Ampicillin + gentamicin + cefotaxime for nonhospitalized infants and the same combination with the replacement of ampicillin with vancomycin for infants still in hospital are suitable options after the first week

    Sepsis in Children

    Get PDF
    Sepsis is systemic inflammatory response syndrome due to a documented or suspected infection. Causative agents of sepsis include group B streptococcus, Escherichia coli, and Listeria monocytogenes in infants younger than 2 months, and community‐acquired organisms. Bacteremia may ensue in patients whose defense mechanisms have become vulnerable due to many factors. Sepsis and septic shock can be viewed as clinical pictures, which develop as consequences of proinflammatory processes/cytokines leading to a state that cannot be restrained by anti‐inflammatory processes/cytokines. As yet, a cytokine, which is uniquely associated with severe sepsis and septic shock and can be used as a biomarker, has not been discovered. Sepsis is a cytokine storm, which may adversely affect almost any organ system. Whether there is an association between the severity of sepsis or septic shock and cytokine gene polymorphisms is an important field of study. Mottled skin and prolongation of capillary refill time may help the physician recognize septic shock before hypotension emerges. The management of severe sepsis and septic shock involves (1) the hemodynamic support, (2) inotropes, vasopressors, and vasodilators, (3) antimicrobial therapy, (4) transfusions, and (5) corticosteroids as indicated. Hospital mortality of pediatric sepsis is 2–10%

    Prof. Dr. Bedđ N Sehsuvaroglu (1914-1977) , A famous turkish historian of medicine and pharmacy and eczacilik tarđhđ derslerđ (lectures on the history of pharmacy), his book

    Get PDF
    Reason for this study is to study an important book of Sehsuvaroğlu , a famous Turkish historian of medicine and pharmacy from the point of history of medicine and pharmacy.As method , Sehsuvaroğlu’s biography is given as chronological and his book’s parts are commented .Here, the main aim is to comment on this book. Prof.Dr.Bedi.N.Sehsuvaroglu who was born in Đstanbul in I914 completed his primary and high school education in Kabatas and Kadiköy in Đstanbul and graduated from Đstanbul Faculty of Medicine in 1939. He served as a physician in various places of Turkey . Afterwards , he also became professor of history of medicine in 1962. Sehsuvaroğlu who died in 1977 was the director of the department of deontology , Đstanbul Faculty of Medicine. Eczacılık Tarihi Dersleri (Lectures on History of Pharmacy) is one of the most important books of Sehsuvaroğlu.It is in Turkish and with the date of 1970.This book which is 423 pages gives the development of the pharmacy from the ancient ages to today .In this book ,both Western pharmacy and Turkish pharmacy are present .Moreover, many knowledge on Turkish medical manuscripts are present .In this book , this famous author specifies uses and effects of drugs in these manuscripts. As a result, Prof.Dr.Bedi. N Sehsuvaroğlu is an important Turkish author and his books mention many important topics on history of medicine and pharmacy . One of these books is Eczacılık Tarihi Dersleri( Lectures on History of Pharmacy)

    Nüks kolorektal kanserde cerrahi tedavi: Kısa ve uzun dönem sonuçlar

    Get PDF
    Aim: The aim of this study was to investigate the effect of surgical margin positivity on short- and long-term outcomes in patients undergoing recurrent colorectal cancer surgery. Method: Demographics, parameters related to primary tumor and previous surgery, recurrent tumor characteristics and perioperative features and long-term outcomes were compared between groups (R0 vs. R1) according to surgical margin positivity. Results: Of 57 patients who underwent surgery for recurrent colorectal cancer, 49 patients (86%) in whom curative resection was achieved were included in the study. Eleven (22.4%) cases had surgical margin positivity (R1) on pathological examination. Demographics, primary tumor localization, tumor stage, time to recurrence, adjuvant oncological treatments were comparable between R0 and R1 groups. Although the surgical procedures performed differed according to the location of the recurrent lesion, they were proportionally similar between the groups. The operative time, the amount of intraoperative bleeding, the need for transfusion, and the length of hospital stay were similar (p>0.05 for each variable). There were 17 (44.7%) and four (36.4%) postoperative complications in the R0 and R1 groups, respectively, but no difference was observed between the groups. Regional recurrence rate was 18.9% (n=7) in R0 group and 27.3% (n=3) in R1 group, respectively (p=0.675). Overall survival rates of R0 and R1 patients at 1, 3 and 5 years were 78.4% vs. 81.8%, (p=0.754), 43.2% vs. 36.4%, (p=0.720) and 27.0% vs. 27.3% (p=0.866), respectively. Conclusion: Complications are higher after recurrent colorectal cancer surgery. This study emphasizes that microscopic surgical margin positivity (R1) may not adversely affect short- and long-term outcomes in patients operated for recurrent colorectal cancer, and that local recurrence rates of these cases may be similar to those with complete resection (R0).Amaç: Nüks kolorektal kanser cerrahisi uygulanan hastalarda cerrahi sınır pozitifliğinin erken ve geç dönem sonuçlarını üzerine etkisini incelemektir. Yöntem: Nüks kolorektal kanser tanısıyla ameliyat edilen hastalarda cerrahi sınır pozitifliği durumuna göre demografik veriler, ilk hastalık ve operasyon bilgileri, nüks hastalık ve tedavi verileri ile uzun dönem sonuçları kıyaslandı. Bulgular: Nüks kolorektal kanser nedeniyle ameliyat edilen 57 hastanın küratif amaçlı rezeksiyonun başarıldığı 49’u (%86) çalışmaya dahil edildi. Bu olguların 11’inde (%22,4) patoloji raporlarında cerrahi sınır pozitifliği (R1) saptandı. R0 ve R1 grupları demografik veriler, ilk tümörün yerleşim ve evresi ile nükse kadar geçen süre, uygulanan onkolojik tedaviler açılarından istatistiki farklılık göstermiyordu. Uygulanan cerrahi işlemler nüks lezyonun yerleşimine göre farklılık göstermekle beraber oransal olarak gruplar arasında benzerdi. Operasyon süresi, ameliyat sırasında kanama miktarı, transfüzyon ihtiyacı ve miktarı ile hastanede kalış süreleri benzerdi (her bir değişken için p>0,05). R0 ve R1 gruplarında %44,7 (n=17) ve %36,4 (n=4) oranlarında postoperatif komplikasyon izlendi, ancak gruplar arasında farklılık gözlenmedi. R0 ve R1 gruplarında yer alan hastalarda yeniden bölgesel tekrarlama oranları %18,9 (n=7) ve %27,3 (n=3) idi (p=0,675). Hastaların 1, 3 ve 5 yıllık genel sağkalım oranları (%78,4 vs. %81,8, p=0,754; %43,2 vs. %36,4, p=0,720 ve %27,0 vs. %27,3, p=0,866) idi. Sonuç: Nüks kolorektal kanser ameliyatı sonrası komplikasyon oranları yüksektir. Bu çalışma nüks kolorektal kanser tanısı ile ameliyat edilen hastalarda mikroskobik cerrahi sınır pozitifliğinin (R1) erken ve geç dönem sonuçları olumsuz olarak etkilemeyebileceğini ve bu olguların lokal tekrarlama oranlarının tam rezeksiyon başarılan (R0) olgulara benzer olabileceğinin altını çizmektedir

    Correlation of seismotectonic variables and GPS strain measurements in western Turkey

    Get PDF
    ABSTRACT Interrelationships between the multifractal properties of epicenter distribution (D q ), the Gutenberg-Richter b value, and GPS derived strain (shear and dilatation) fo

    The Impact of COVID-19 Pandemic on Distress Intolerance: Among Panic Buyers in Turkey

    Get PDF
    In this study, the factors affecting levels of distress intolerance during the Covid-19 pandemic are statistically analyzed among panic buyers in Turkey. Distress intolerance also increased as health status deteriorates. Construct consistency was achieved in measuring distress intolerance during the Covid-19 period. Confirmatory factor analysis (CFA) was performed for participants who engage in panic buying behavior. CFA showed that the reliability and consisteny of this scale was ensured. It was seen that enduring uncomfortable emotions was the condition that affected distress intolerance the most. Doing everything to avoid feeling distressed or sad was found to be the least affecting distress intolerance in the Covid-19 period. When all of the fit criteria were considered, it was evident that the proposed model was valid for sample. Consequently, it is recommended that public health services develop health strategies with respect to the stated risk factors and to provide interventions that increase psychological flexibility to reduce Covid-19 related intolerance to distress

    Cerebral hemodynamics in patients with cirrhosis

    Get PDF
    Background/Aims: Cirrhosis causes a decrease in cerebral blood flow because of a hyperdynamic circulatory state. We aimed to study the cerebral hemodynamic parameters in patients with decompensated cirrhosis and their relationship to the Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. Materials and Methods: We used transcranial Doppler to investigate the cerebral hemodynamic parameters, namely the mean flow velocity of the middle cerebral artery, pulsatility index (PI), and resistive index (RI), in 50 patients who had decompensated cirrhosis and in a control group of 50 healthy people. We also investigated their relationship to the Child-Pugh and MELD scores. Results: Patients with cirrhosis had a lower mean flow velocity than those in the control group. Further, patients with cirrhosis had higher PI and RI values. There was a positive correlation between PI and the Child-Pugh score. In addition, there was a positive correlation among PI, RI, and the MELD score. The RI values of patients with ascites were higher than those of patients without ascites. Conclusion: Cerebral autoregulation might be impaired in patients with cirrhosis. Cerebral resistance proportionally increases to disease severity. There was a positive correlation among PI, RI, and MELD scores, which means that transcranial Doppler might be useful not only in the follow-up of the severity of the disease but also in determining the survival of these patients. © Copyright 2016 by The Turkish Society of Gastroenterology
    corecore