Effect of Spirituality on Psychological Resilience and Hope in Patient-Family Caregiver Dyads Experiencing Gynecological Cancer: An Actor-Partner Interdependence Analysis.

BACKGROUND: Women experiencing gynecological cancer (GCPs) and family caregivers (FCGs) use spirituality to cope with cancer. However, the dual relationship between the impact of spirituality on psychological resilience and hope among both GCPs and FCGs has not yet been explored. OBJECTIVE: To examine the interdependent relationship between spirituality, psychological resilience, and hope of women with gynecological cancer and their FCGs at the dyadic level. METHODS: In this cross-sectional study, 107 dyads were recruited from the gynecological oncology departments of 2 university hospitals in Ankara, Turkey. The GCPs and FCGs completed a Patient/Family Caregiver Information Form, Spiritual Well-being Scale, Connor-Davidson Resilience Scale, and Dispositional Hope Scale. Data were analyzed using descriptive statistics and Pearson's correlations. This study used the Actor-Partner Interdependence Model. RESULTS: Spirituality of both GCPs and FCGs had a significant positive effect on their psychological resilience ( B = 0.918, P < .001; B = 0.435, P < .001, respectively) and hope ( B = 0.350, P < .001; B = 0.246, P < .001, respectively). However, the spirituality of GCPs and FCGs did not have a partner effect on psychological resilience ( B = -0.150, P < .052; B = -0.150, P = .052, respectively) and hope ( B = -0.012, P = .810; B = 0.073, P = .157, respectively). CONCLUSIONS: Spirituality of GCPs and their FCGs positively affected their psychological resilience and hope, but the effect on each other was limited. IMPLICATIONS FOR PRACTICE: Health professionals, especially nurses, should focus on tailoring spiritual care interventions to the unique needs of each individual within the GCP and FCG dyads. Personalized approaches that recognize and address the specific spiritual concerns of patients and caregivers may be more effective in promoting psychological resilience and hope.

Intramolecular Friedel-Crafts Reaction with Trifluoroacetic Acid: Synthesizing Some New Functionalized 9-Aryl/Alkyl Thioxanthenes.

In this study, a series of halogen-substituted thioxanthenes were synthesized because the most important and biologically active derivatives of xanthenes are thioxanthenes. In order to obtain new thioxanthene derivatives, first, the starting molecules were synthesized by the appropriate reaction methods in two steps. The intramolecular Friedel-Crafts alkylation (FCA) method was used to convert the prepared three aromatic substituted starting alcohol compounds to their corresponding thioxanthenes by cyclization. For the intramolecular FCA reaction of secondary alcohols, which are the starting compounds (1a-1t), organic BroÌ·nsted acids, which require more innovative, easier, and suitable reaction conditions, were used instead of halide reagents with corrosive effects as classical FCA catalysts. Trifluoroacetic acid was determined to be the organocatalyst with the best yield. Therefore, some original 9-aryl/alkyl thioxanthene derivatives (2a-2t) were synthesized using the optimized FCA method. In addition, a new sulfone derivative of thioxanthene 3i was prepared by performing the oxidation reaction with one of the obtained new thioxanthene 2i. Thioxanthenes and their derivatives are important heterocyclic structures that contain pharmacologically valuable sulfur and are used in the treatment of psychotic diseases such as Alzheimer's or schizophrenia, as well as a number of potent biological activities.

New Strategy for the Synthesis of Some Valuable Chiral 1,3-Diols with High Enantiomeric Purity: New Organocatalyst, Asymmetric Aldol Reaction, and Reduction.

Chiral 1,3-diols are highly valuable molecules used in industries such as pharmaceuticals, cosmetics, and agriculture. Therefore, in this study, a new strategy was developed to synthesize enantiomerically pure (>99% ee) 1,3-diols. New chiral 1,3-diols (5a-5q) with high enantiomeric purity were synthesized from aldol products chiral 1,3-keto alcohols (4a-4q), which are aldol products with different structures. Chiral 1,3-keto alcohols (4a-4q) were synthesized by a new asymmetric aldol method in the first step. This method was developed using a new proline-derived organocatalyst (3g) and Cu(OTf)2 as an additive in DMSO-H2O for the first time. Almost >99% ee was obtained using our developed aldol procedure. In the second step, original chiral diols (5a-5q) of high enantiomeric purity were obtained by asymmetric reduction of chiral keto alcohols with chiral oxazaborolidine reagents. In this way, a two-step asymmetric reaction was developed for chiral 1,3-diol enantiomers with high enantiomeric purity. The structures of all the original chiral compounds obtained were elucidated by infrared and nuclear magnetic resonance spectroscopy, mass spectrometry, and elemental analysis methods. Their enantiomeric excesses were determined by the chiral high-performance liquid chromatography method. Both keto alcohols and their corresponding chiral diols synthesized can be used as chiral starting materials and chiral source materials or intermediates in the synthesis of many biologically active molecules, or they can be used as chiral ligands in asymmetric synthesis, serving as organocatalysts.

Synthesis of Novel 1,4-Diketone Derivatives and Their Further Cyclization.

One of the important reactions to obtain a new carbon-carbon bond is the Stetter reaction, which is generally via a nucleophilic catalyst like cyanide or thiazolium-NHC catalysts. In particular, 1,4-diketones with very functional properties are obtained by the Stetter reaction with the intermolecular reaction of an aldehyde and an α,ß-unsaturated ketone. In this study, we synthesized new derivatives (substituted arenoxy) of 1,4-diketone compounds (2a-2n) with useful features by a new version of the Stetter reaction method. In our work, arenoxy benzaldehyde derivatives with different structures as the Michael donor and methyl vinyl ketone as the Michael acceptor were used for the intermolecular Stetter reaction. The reaction was catalyzed by 3-benzyl-5-(2-hydroxyethyl)-4-methylthiazolium chloride (3b), using triethylamine for the basic medium and dimethyl sulfoxide as the solvent. As a result, some novel arenoxy-substituted 1,4-diketones were gained with good yields at room temperature within 24 h through an intermolecular Stetter reaction. In addition, new furan and pyrrole derivatives were prepared by performing the cyclization reaction with one of the obtained new diketone compounds.

Transition-metal-free intramolecular Friedel-Crafts reaction by alkene activation: A method for the synthesis of some novel xanthene derivatives.

In this work, new derivatives (substituted 9-methyl-9-arylxanthenes) of xanthene compounds (5a-l) of possible biological significance were synthesized by developing a new synthesis method. In order to obtain xanthene derivatives, the original alkene compounds to be used as the starting materials were synthesized in four steps using appropriate reactions. A cyclization reaction by intramolecular Friedel-Crafts alkylation was carried out in order to synthesize the desired xanthene derivatives using the alkenes as starting compounds. The intramolecular Friedel-Crafts reaction was catalyzed by trifluoroacetic acid (TFA) and provided some novel substituted 9-methyl-9-arylxanthenes with good yields at room temperature within 6-24 hours. As a result, an alkene compound was used for activation with TFA in the synthesis of xanthene through intramolecular Friedel-Crafts alkylation for the first time.

Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy.

OBJECTIVE: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. MATERIAL AND METHODS: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. RESULTS: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH2O; P-LMA, 27.0±4.7 cmH2O; p=0.42) and did not change during the induction of and throughout pneumoperitoneum. The first attempt success rates were 93% with both S-LMA and P-LMA. Mean airway device insertion time was significantly shorter with S-LMA than with P-LMA (12.5±4.1 seconds versus 15.6±6.0 seconds; p=0.02). The first attempt success rates for the drainage tube insertion were similar (P-LMA, 93%; S-LMA 100%); however, drainage tubes were inserted more quickly with S-LMA than with P-LMA (9.0±3.2 seconds versus 14.7±6.6 seconds; p=0.001). In the PACU, vomiting was observed in five patients (three females and two males) in the S-LMA group and in one female patient in the P-LMA group (p=0.10). CONCLUSION: Both airway devices can be used safely in laparoscopic cholecystectomies with suitable patients and experienced users. However, further studies are required not only for comparing both airway devices in terms of postoperative nausea and vomiting but also for yielding definitive results.

The LMA CTrach™ in morbidly obese and lean patients undergoing gynecological procedures: a comparative study.

PURPOSE: The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. The aim of this study was to compare the airway management quality in morbidly obese and lean patients with use of the LMA CTrach. METHODS: After Ethics Committee approval, 60 adult patients (30 morbidly obese patients with body mass index >40 kg/m² and 30 lean patients with body mass index <30 kg/m²) scheduled to undergo gynecological surgery were enrolled in this prospective study. The induction of anesthesia was standardized using propofol, fentanyl, and rocuronium. Ventilation and intubation success rates, time taken to achieve successful ventilation, and intubation through the CTrach and airway complications were recorded. RESULTS: The CTrach was successfully inserted and adequate ventilation through the CTrach was achieved in 59 patients (98%). Only 1 patient in the lean group was not able to ventilate through the CTrach. We were successful in endotracheal intubation, either under vision or blind, in 56 patients (93%). We were able to view the larynx in 51 patients (85%). Total intubation time was significantly longer in morbidly obese patients, 69 (311) s, than in lean patients, 33 (107) s [median (range)] (P < 0.001). CONCLUSIONS: We concluded that the time to intubate the trachea in obese patients was significantly longer than in lean patients when the LMA CTrach was used.

Levobupivacaine-tramadol combination for caudal block in children: a randomized, double-blinded, prospective study.

BACKGROUND: The aim of this prospective study was to compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.125% or caudal tramadol 1.5 mg.kg(-1) and mixture of both in children undergoing day-case surgery. METHODS: Sixty-three American Society of Anesthesiologists (ASA) I or II children between 1 and 7 years old scheduled for inguinal hernia repair under sevoflurane anesthesia were randomized to receive caudal levobupivacaine 0.125% (group L), caudal tramadol 1.5 mg.kg(-1) (group T) or mixture of both (group LT) (total volume of caudal solution was 1 ml.kg(-1)). Duration of analgesia and requirement for additional analgesics were noted. Postoperative pain was evaluated using the Children's and Infants' Postoperative Pain Scale (CHIPPS) every 15 min for the first hour, and after 2, 3, 4, 6, 12, and 24 h. Analgesia was supplemented whenever pain score was > or =4. RESULTS: No patient experienced significant intraoperative hemodynamic response to surgical incision. Duration of analgesia was significantly longer in group LT than in group L and group T (545 +/- 160 min vs 322 +/- 183 min and 248 +/- 188 min, respectively) (P < 0.01). There were no significant differences between the group L and group T for duration of analgesia (P > 0.05). There were no significant differences among the groups in the number of patients requiring analgesia after operation (P = 0.7). No signs of motor block were observed after the first postoperative hour in any of the patients. CONCLUSION: Addition of tramadol increased the duration of analgesia produced by caudal levobupivacaine in children.

Hearing loss after spinal anesthesia: the effect of different infusion solutions.

OBJECTIVE: We speculate that the preoperative volume replacement with a convenient solution may protect the inner ear function after spinal anesthesia. METHODS: The patients were randomized in a single-blind fashion into two groups: group LR (n = 40) received lactated Ringer's and group GF (n = 40) received gelatin polysuccinate 4% (Gelofusine). Spinal anesthesia was performed with a 25 G Quincke needle and was given bupivacaine 0.5% 10 mg and fentanyl 25 microg. Audiograms were performed preoperatively and 2 days postoperatively. RESULTS: The overall incidence of hearing loss was 7.5%. The hearing loss was unilateral in two and bilateral in four patients. Hearing loss occurred within the low-frequency range and the hearing thresholds returned to normal by the fifth postoperative day. CONCLUSIONS: Although the incidence of hearing loss for the lactated Ringer's group was higher than the Gelofusine group, there was no statistically significant difference between the groups. For medicolegal and ethical reasons, patients should be informed about the possibility of hearing loss after spinal anesthesia.

Survival of an eight-year-old child with a very severe high-tension electrical burn injury: a case report.

We present the management and survival of an eight-year-old boy with a severe high-tension electrical burn injury of 68% of total body surface area in a surgical intensive care unit, as a result of a well-planned and applied treatment strategy. Subsequent to escharotomy and fasciotomy operations under general anesthesia, the patient was taken into the surgical intensive care unit. In addition, patient underwent nine more operations including right femur disarticulation and split-thickness skin graftings with homografts from his brother and autografts. The patient was connected to mechanical ventilator for 59 days. By the time the patient was transferred to plastic and reconstructive surgery ward, he was fully conscious, cooperated and hemodynamically stable.

Continuous venovenous hemodiafiltration to treat controlled-release carbamazepine overdose in a pediatric patient.

Carbamazepine (CBZ) intoxication is an important issue in acute poisoning practice. Highly protein-bound, CBZ is not removed efficiently through conventional hemodialysis. We describe the use of continuous venovenous hemodiafiltration (CVVHDF) in a 2-year-old boy who developed general tonic clonic seizure and respiratory depression due to controlled-release formula of CBZ overdose (peak drug level of > 20 microg.ml(-1), therapeutic range: 5-10 microg.ml(-1)). Serum CBZ concentrations fell to 0.25 microg.ml(-1) at the end of hemodiafiltration. The patient recovered rapidly and was discharged from hospital 4 days from the time of ingestion with no complications or neurologic impairment.

The incidence and risk factors of difficult mask ventilation.

PURPOSE: The ability to ventilate and oxygenate a patient using a bag-mask breathing system may be lifesaving in the case of failure of the initial intubation attempt. In this study, we aimed to determine the incidence of difficult mask ventilation (DMV) and to find preoperative risk factors for this procedure. METHODS: Based on methods used for overcoming some difficulties with bag-mask ventilation (MV), classification has been made into four categories: easy MV, awkward MV, difficult MV, and impossible MV. A univariate analysis was performed to identify potential risk factors predicting DMV, followed by a stepwise forward binary logistic regression, and the odds ratio and 95% confidence interval were calculated. RESULTS: A total of 576 patients were studied. Incidence of easy MV, awkward MV, and difficult MV were found to be 75.5% (n = 435), 16.7% (n = 96), and 7.8% (n = 45), respectively. Height, weight, age, male gender, increased Mallampati class, history of snoring, lack of teeth, and beard were found to be DMV risk factors (P < 0.05). Using a multivariate analysis, Mallampati class 4, male, history of snoring, age, and weight were found to be significantly associated with DMV. Although the incidence of DMV in general was 7.8% (n = 45), the incidence of DMV among patients with difficult intubation (n = 123) was found to be 15.5% (n = 19). CONCLUSIONS: Mallampati class 4, male patients, history of snoring, increasing age, and increasing weight were found to be risk factors for DMV in our study.

[Therapeutic bronchoscopic treatment of postintubation tracheal stenosis: 5 cases]. / Terapötik bronkoskopi ile tedavi edilen postentübasyon trakea stenozlari: Bes olgu sunumu.

Benign airway obstruction is known as curable by therapeutic bronchoscopic methods. Compared by surgical therapies it is comfortable and has no risks for the patients. For five patients who applied our clinic after tracheostomy and endotracheal intubation stenosis we used therapeutic bronchoscopic methods; "laser-stenotic silicon stent". In two patients after vaporization of membranous stricture by Neodimum Yttrium Aliminum Pevroskite Laser (Nd-YAP laser) who were seen posttracheostomy and postentubation; stenotic stent was implanted mechanically and/or by means of baloon dilatation. Membranous stricture area was coagulated by Nd-YAP-laser in other three cases and anatomic airway diameter was achieved mechanically and by baloon dilatation. In the follow up period we applied stenotic silicon stent implantation after second laser resection in whom restenosis observed. In conclusion; patients who had stenotic silicon stent implantation and having no problems in the follow up this therapeutic method is found to be curative.