Should the level of the posterior instrumentation combined with the intermediate screw be a short segment or a long segment in thoracolumbar fractures with fusion to the fractured segment?

PURPOSE: It was aimed to compare the results of long segment posterior instrumentation with intermediate pedicular screw + fusion at the level of the fractured segment including one vertebra above and one below the fractured vertebra (LSPI) and short segment posterior instrumentation with intermediate pedicular screw + fusion at the level of the fractured segment including one vertebra above and one below the fractured vertebra (SSPI) in the surgical treatment of thoracolumbar vertebral fractures. METHODS: Ninety patients with thoracolumbar vertebral (T11-L2) fractures operated between March 2015 and February 2022 were included in this retrospective study. The patients were divided into two groups as those who underwent LSPI (n, 54; age, 40.3) and those who underwent SSPI (n, 36; age, 39.7). Radiological evaluations like vertebral compression angle (VCA), vertebral corpus heights (VCH), intraoperative parameters, and complications were compared between the groups. RESULTS: Correction in early postoperative VCA was statistically significantly better in LSPI (p = 0.003). At 1-year follow-up, postoperative VCA correction was significantly more successful in LSPI (p = 0.001). There was no difference between the two groups in terms of correction loss in VCA measured at 1-year follow-up. There was no statistically significant difference between the two groups in terms of postoperative VCH, VCH at 1-year follow-up, and correction loss in VCH. CONCLUSION: LSPI provides better postoperative kyphosis correction of the fractured vertebra than SSPI. Regarding the segment level of posterior instrumentation, there was no difference between the two groups in terms of the loss of achieved correction of VCA, ABH, and PBH at 1-year follow-up. Operating a thoracolumbar fracture with LSPI will lengthen the operation and increase the number of intraoperative fluoroscopies compared to SSPI.

An investigation into the frequency and risk factors of low back pain following surgical treatment of isolated calcaneal fractures.

OBJECTIVE: This study aimed to determine the frequency of low back pain after calcaneal fractures treated with open reduction internal fixation (ORIF) and the risk factors that cause this condition. METHODS: Thirty-one patients (27 males and 4 females) who underwent surgery for a unilateral calcaneal fracture between 2016 and 2020 and had no complaints of low back pain before fracture surgery were included in the study. The patients were divided into 2 groups: those who developed low back pain after the operation and those who did not. Patients were evaluated with the Life Quality Short Form SF-36, the Oswestry Disability Index (ODI), and American Orthopedic Foot-Ankle Association Score (AOFAS). Sanders' fracture type, joint range of motion (ROM) measurements of injured and uninjured limbs, maximal isometric muscle strength measurements, balance on 1 leg with pedobarographic measurements, and walking time were evaluated. The obtained data were compared among the 2 groups. RESULTS: Low back pain was observed in 71% of the patients and was detected after an average of 6 months from the operation. In ODI, 59.1% of the patients reported that low back pain limited their lives slightly. Patients with low back pain have lower AOFAS scores and worse SF-36 physical functionality than those without low back pain (P < .001, P=.016). Balance time on 1 foot in pedobarographic measurements, foot in ROM, ankle in ankle active, passive plantar flexion, inversion, active hip, passive internal, external rotation, muscle is the foot eversion force. In these measurements, the values of the injured side are intact. It was statistically significantly lower than the other side (interaction P < .1). CONCLUSION: Low back pain may occur after unilateral calcaneal fractures treated by ORIF. This may be caused by decreased angles of ankle dorsi and plantar flexion, foot inversion, hip abduction, and internal and external rotation. In the rehabilitation program, not only the ankle region but also the hip joint of the affected side should be included, and the kinetic chain that describes the interaction mechanism of the human body should not be forgotten. LEVEL OF EVIDENCE: Level IV, Prognostic Study.

The effect of the size of pedicle screw on the long-term radiological and clinical results of short-segment posterior instrumentation in the management of thoracolumbar vertebral fractures.

OBJECTIVE: It was aimed at evaluating the effect of the size of the pedicle screw placed on the fractured vertebra on the long-term radiological and clinical results of short-segment posterior instrumentation applied in the surgical treatment of thoracolumbar vertebral fractures. METHODS: This retrospective study included 36 patients who underwent short-segment posterior instrumentation surgery for a single-level thoracolumbar (T11-L2) fracture between January 2015 and March 2021. The patients included in the study were divided into 2 groups according to the size of the pedicle screw placed in the fractured vertebra (group A: intermediate screw 4.5 mm, ≤35 mm+less than 50% of the vertebral corpus length, m/f: 13/4, n: 17, age: 36.5; group B: intermediate screw 5.5 mm, ≥40 mm+more than 70% of the vertebral corpus length, m/f: 11/8, n: 19, age: 42.6). All patients were periodically evaluated clinically and radiologically. Vertebral compression angle (VCA), anterior and posterior vertebral body height (ABH-PBH), intraoperative parameters (instrumentation time and intraoperative fluoroscopy number), and complications were compared between the 2 groups. RESULTS: Both groups were comparable with respect to age, sex, level of injury, AO classification, mechanism of injury, and American Spinal Cord Injury Association impairment scale. Restoration of VCA and vertebral corpus heights was achieved sufficiently in both groups after operation (P < .0001). There was no significant difference between the 2 groups in terms of early postoperative VCA, VCA measured at final follow-up, or loss of correction in VCA. At the last follow-up, PBH was statistically significantly better preserved in group B (P=.0424). There was no difference between the 2 groups in terms of operation time and the number of intraoperative fluoroscopies. Implant failure was observed in 1 patient in group A. CONCLUSION: This study has revealed that using a long, thick pedicle screw placed in the fractured vertebra can better preserve the PBH at the final follow-up. No correlation was found between the size of the intermediate screw and the preservation of the correction in the postoperative vertebral heights and VCA during the follow-up. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Factors affecting return to work time and functional outcome after low-velocity gunshot injuries related to foot in civilian population.

BACKGROUND: Purpose of this study was to identify factors affecting return to work time and functional outcomes after low-velocity gunshot injuries related to foot. Related complications are also analyzed. METHOD: This study conducted as retrospective cohort study in tertiary care university hospital. Data on 26 patients obtained through retrospective database search. Type of causing weapon, anatomic location of wound, wound type according to Gustilo Anderson classification, extend of damage regarding injured structures, extend of soft tissue damage, duration of hospital stay, need of reconstructive surgery, return-to-work time, follow-up period and functional scores at final follow-up were recorded. Factors affecting functional outcome and return-to-work time were analyzed. RESULTS: Total of 12 patients (46.2 %) experienced complications, with eight being deep soft tissue infections. The mean MFS score for the study group was 77.27 (±11.82). The mean MFS for the pistol group was 83.46 (±6.90), extent of soft tissue damage was an independent risk factor (OR 10.67, 95 % CI 1.70-66.72, p = 0.011) for poor outcomes. On average, patients took 10.12 months (±7.59) to return to work, the type of gun used was an independent variable associated with delayed return to work (OR 144, 95 % CI 8.04-2578.09, p = 0.011). CONCLUSION: Gunshot injuries related to foot can lead to a high rate of complications, loss of workdays, and permanent functional losses. Therefore, it is crucial to develop appropriate treatment plans and manage inevitable complications in these injuries. LEVEL OF EVIDENCE: Level IV, Case series.

Safe Use of Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers: A Multidisciplinary Approach to Minimize Adverse Effects.

Purpose: The purpose of this study is to evaluate the side effects associated with hyperbaric oxygen therapy and provide recommendations to prevent them in patients with diabetic foot ulcers. Introduction: The use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers remains a contentious issue, and minimizing side effects is critical. While the incidence of side effects related to hyperbaric oxygen (HBO2) therapy is low, it is essential to evaluate cases in a multifaceted and interdisciplinary manner to prevent adverse outcomes. Methods: A retrospective cohort study was conducted over the period of 2018-2020, involving a dataset of 100 patients. The primary objective of the study was to examine the frequency and types of side effects experienced by patients who underwent hyperbaric oxygen therapy (HBO) for diabetic foot ulcers (DFUs). In addition, we analyzed various wound characteristics, characteristics of hospitalizations, the surgical or medical interventions received by patients, and laboratory parameters including CRP levels, total blood count, culture results, HbA1c levels, duration of diabetes, treatment received for diabetes, and antibiotic therapy regimens. Results: The percentage of patients who experienced side effects was as low as 6%, and none of them were critical. The most common side effect was discomfort due to the confined space in the chamber. Conclusion: Appropriate patient selection, combined with a multidisciplinary approach to evaluate eligibility, is crucial to avoid adverse side effects. Patient education and early screening for side effects are also essential. Since various treatment protocols exist for HBO2 therapy, pooled data from different protocols may be misleading. Further studies focused on side effects with specific indications are necessary.

Conducting spinal cord injury model with clip compression in rodents: Pearls and pitfalls.

Research on spinal cord injuries is an important and living topic that raises many critical questions that need to be addressed. While numerous articles have compiled and compared various models of spinal cord injuries, there is limited comprehensive guide with clear instructions available for researchers who are unfamiliar with clip compression model. This model creates acute compression damage in spinal cord, which aims to mimic the nature of traumatic spinal cord damage in humans. Purpose of this article is to share our experience on clip compression model, with experience gained from more than 150 animals, and to provide guidance for researchers with lack of experience who wish to design studies with this model. We have defined several key variables, as well as the difficulties that may arise when applying this model.-Proper preparation, good infrastructure and necessary tools and knowledge of anatomy related is essential to the success of this model.-Good exposure with non-bleeding surgical site is key factor for surgical step.-Postoperative care is particularly challenging, and researchers should consider extending their studies over a reasonable time period to ensure that appropriate care could be provided.

Efficacy of telemedicine applications in patients with diabetic foot ulcers: A focus on mortality and major amputation rates.

Amputations related to diabetic foot ulcers (DFU) are associated with high morbidity and mortality rates. Glycaemic control and close follow-up protocols are essential to prevent such ulcers. Coronavirus disease (COVID) related restrictions and regulations might have a negative impact on patients who are with DFU or candidates for DFU. We retrospectively analysed 126 cases that had DFU underwent amputation surgery. Comparative analyses were done between cases that were admitted before COVID restrictions (Group A) and cases admitted after COVID restrictions (Group B). Two groups were homogenic demographically. There was no significant difference between groups in terms of mortality (p = 0.239) and amputation rates (p = 0.461). The number of emergent cases in the pandemic period doubled the number in pre-pandemic period even though this finding was not statistically significant (p = 0.112). Fastly adapted consulting practice and follow-up protocols to compensate for the problems created by COVID-related regulations seem to be effective in terms of mortality and amputation rates.

Predictive Value of Complete Blood Count, Venous Blood Gas Measurements, and Glucose/Potassium Ratio for Delayed Neuropsychiatric Syndrome in Children with Acute Carbon Monoxide Poisoning Due to Coal-Burning Stove.

OBJECTIVE: Delayed neuropsychiatric syndrome may occur after carbon monoxide poisoning has completely healed. The literature on indicators to predict delayed neuropsychiatric syndrome in pediatric patients is limited. The aim of the study is to investigate the effectiveness of complete blood count parameters, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, systemic immune inflammation index, glucose/potassium ratio, venous blood gas parameters, and carboxyhemoglobin in predicting delayed neuropsychiatric syndrome in children with carbon monoxide poisoning due to coal-burning stove. MATERIALS AND METHODS: The patients admitted to the pediatric emergency department with acute carbon monoxide poisoning between 2014 and 2019 were analyzed. The patients were divided into 2 groups as delayed neuropsychiatric syndrome (+) and delayed neuropsychiatric syndrome (-). Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, systemic immune inflammation index (platelet count×neutrophil count/lymphocyte count), and glucose/ potassium ratio were calculated. RESULTS: Of the 137 patients, 46 were diagnosed with delayed neuropsychiatric syndrome within 1 year of carbon monoxide poisoning. A control group was formed from 137 age- and sexmatched children. Glasgow Coma Scale < 15 was found in 11% of patients with delayed neuropsychiatric syndrome (-) and 8.7% of patients with delayed neuropsychiatric syndrome (+) (P = .773). Blood glucose, potassium, glucose/potassium ratio, platelet/lymphocyte ratio, white blood cell, neutrophil count, lymphocyte count, neutrophil/lymphocyte ratio, systemic immune inflammation index, venous partial pressure of carbon dioxide, carboxyhemoglobin, and methemoglobinemia levels were significantly different between control, delayed neuropsychiatric syndrome (+), and delayed neuropsychiatric syndrome (-) groups (P < .05). The most effective predictors for delayed neuropsychiatric syndrome were systemic immune inflammation index (area under the curve = 0.852; cut-off value > 1120; sensitivity = 89.1%; specificity = 75.8%), neutrophil (area under the curve = 0.841; cut-off value > 8000/mm3; sensitivity = 78.2%; specificity = 79.1%), and neutrophil/lymphocyte ratio (area under the curve = 0.828; cut-off value > 4; sensitivity = 78.2%; specificity = 75.5%). CONCLUSION: About one-third of children with carbon monoxide poisoning due to coal-burning stove develop delayed neuropsychiatric syndrome. Systemic immune inflammation index, neutrophil count, and neutrophil/lymphocyte ratio obtained immediately after the poisoning in the pediatric emergency department may be effective predictors for delayed neuropsychiatric syndrome.

Early predictors of high-flow nasal cannula oxygen treatment failure in patients with respiratory distress admitted to the pediatric emergency department.

BACKGROUND: High-flow nasal cannula (HFNC) therapy is a relatively new method used in patients with respiratory distress. The aim of the study was to evaluate the outcomes and to determine the baseline predictors of HFNC treatment failure in children with acute respiratory distress/failure in the pediatric emergency department. METHODS: Children with respiratory distress/failure aged 1 month to 18 years who underwent HFNC therapy with the pre-established protocol were retrospectively analyzed. HFNC therapy was used in respiratory and non-respiratory pathologies. HFNC failure was defined as the need for escalation to non-invasive ventilation or invasive mechanical ventilation. HFNC responders and non-responders were compared based on baseline clinical data. RESULTS: Of the 524 cases (median age:13 months; 292 males / 232 females), 484 (92.4%) had respiratory tract and 40 (7.6%) had non-respiratory tract pathologies. HFNC therapy was unsuccessful in 62 (11.8%) patients. The success rates were 81% and 55% in respiratory and non-respiratory diseases, respectively. In children with respiratory system pathologies, the pre-treatment venous pCO2 level (p: 0.045; OR: 0.958; 95%CI: 0.821-0.990) and the clinically important radiological finding on chest X-ray (lobar infiltration, atelectasis, pleural effusion) (p: 0.045; OR: 3.262; 95%CI: 1.178-9.034) were the most significant parameters in predicting HFNC failure. In children with non-respiratory pathologies, the pre-treatment venous lactate level (p: 0.008; OR: 1.558; 95%CI: 1.125-2.158) was a significant predictor of HFNC failure. There were no cases of pneumothorax or any other reported adverse effects related to HFNC therapy. CONCLUSIONS: HFNC treatment is a safe oxygen therapy in children with respiratory distress/failure due to various etiologies in the emergency department. The lower venous pCO2 level increases and the clinically important radiological finding on chest radiograph decreases the success of HFNC treatment in respiratory pathologies. The higher venous lactate level is a predictor of HFNC treatment failure in non-respiratory pathologies.

Evaluation of Pediatric Delirium Awareness and Management in Pediatric Intensive Care Units in Turkey.

Delirium has been associated with prolonged pediatric intensive care unit (PICU) stay and mechanical ventilation times as well as high hospital costs and mortality rates. This work aimed to examine pediatric delirium awareness and delirium management in Turkey. A total of 19 physicians responsible for their respective PICUs completed the survey. Most of the units (57.9%) did not use any assessment tool. Varying measures were applied in different units to reduce the prevalence of delirium. The number of units that continuously measured noise was very low (15.8%). Eye mask and earpiece usage rates were also very low. In pharmacological treatment, haloperidol, dexmedetomidine, benzodiazepines, and atypical antipsychotics were the most preferred options. Some units have reached a sufficient level of pediatric delirium awareness and management. However, insufficiencies in delirium awareness and management remain in general.

Patient-specific three-dimensional printing spine model for surgical planning in AO spine type-C fracture posterior long-segment fixation.

OBJECTIVE: The aim of this study was to compare duration of surgery, intraoperative fluoroscopy exposure, blood loss and the accuracy of pedicular screw placement between 3D model-assisted surgery and conventional surgery for AO spinal C-type injuries. METHODS: In this study 32 patients who were admitted with thoracolumbar AO spinal C-type injuries were included. These patients were divided randomly into two groups of 16 where one group was operated on using conventional surgery and the other group was operated on using 3D model-assisted surgery. During surgery, instrumentation time, amount of blood loss and intraoperative fluoroscopy exposure were recorded. Moreover, the status of the screws in the pedicles was assessed as described by Learch and Wiesner's and regional sagittal angles (RSA) were measured preop and postoperatively. RESULTS: It was found that there was a statistically significant difference in instrumentation time, blood loss and intraoperative fluoroscopy exposure in the 3D model-assisted surgery group (61.9 ± 4.7 min, 268.4 ± 42.7 ml, 16.3 ± 1.9 times) compared to the conventional surgery group (75.5 ± 11.0 min, 347.8 ± 52.2 mL, 19.7 ± 2.4 times) (t=4.5325, P < 0.0001 and t=4.7109, P < 0.0001 and t=4.4937, P < 0.0001, respectively) Although the screw misplacement rate of the conventional surgery group was higher than that of the 3D model-assisted surgery group, the only statistically significant difference was in the medial axial encroachment (t=5.101 P=0.02) . There was no severe misplacement of pedicle screws in either group. There were no statistically significant differences between postoperative RSA angles and were in both groups restored significantly. CONCLUSION: The results of this study have shown us that the 3D model helps surgeons see patients' pathoanatomy and determine rod lengths, pedicle screw angles and lengths preoperatively and peroparatively, which in turn shortens operative time, reduces blood loss and fluoroscopy exposure. LEVEL OF EVIDENCE: Level I, Therapeutic Study.

Evaluation of the effects of using 3D - patient specific models of displaced intra - articular calcaneal fractures in surgery.

BACKGROUND: It was aimed to compare conventional surgery and three-dimensional (3D) model-assisted surgery used in the treatment of calcaneal fractures. MATERIALS & METHODS: A total of 37 patients with unilateral calcaneal fractures were randomly divided into two groups as a conventional surgery group (n: 19) and a 3D model-assisted surgery group (n: 18). The preoperative, postoperative and last follow up angles of the Bohler and Gissane, calcaneal width and facet height were measured. The duration of the operation, blood loss volume, fluoroscopy usage, instrumentation time for both groups were recorded. Finally, the follow-up AOFAS scores were evaluated. A questionnaire was used to determine the perceptions of the resident doctors about the 3D model. RESULTS: The duration of the operation, blood loss volume, fluoroscopy usage, instrumentation time for 3D model-assisted surgery group were 83.3 ± 4.6 minutes, 83.6 ± 4.6 ml, 6.8 ± 1.4 times and 13.0 ± 0.8 weeks, and as for conventional group they were 130.0 ± 5.8 minutes, 105.1 ± 5.6 minutes, 11.7 ± 1.5 ml, 22.2 ± 2.4 times and 13.3 ± 0.8 weeks, respectively (p < 0.0001). The both groups significantly restored Bohler angle, Gissane angle, calcaneal width and calcaneal facet height after operation (p < 0.0001). The 3D model-assisted group was significantly more succesful in restoration and protection of achieved correction of calcanel facet height (p < 0.0001). The difference was determined among the groups at the final follow-up examination with respect to the amount of change according the values achieved post-op. were significant in Bohler angle (p < 0.001), calcaneal facet height (p < 0.0001) and calcaneal widht (p = 0.017). There was no significant difference between AOFAS scores of the two groups at last follow-up. Resident doctors exhibited high scores of overall satisfaction with the use of a 3D printing model. CONCLUSIONS: Compared to the conventional group, the 3D model-assisted group provide successful intervention and reduce operation, instrumentation time and the fluoroscopy usage with less blood loss. Performing 3D-assisted surgery helps the quality of reduction during the surgery and stability of internal fixation to protect achieved reduction at follow-up more succesfully.

The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey.

AIM OF THE STUDY: Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. METHODS: This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. RESULTS: A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). CONCLUSIONS: The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.

Effects of regional differences on the outcome of cardiopulmonary resuscitation in children: How much different is Gaziantep from Izmir?

OBJECTIVES: We aimed to compare the demographic and clinical characteristics between pediatric cardiac arrest patients treated in Gaziantep at South-eastern Anatolian region and Izmir at Aegean Shore. MATERIALS AND METHODS: We retrospectively reviewed sociodemographic characteristics, laboratory parameters, and clinical outcomes of pediatric patients that underwent cardiopulmonary resuscitation due to prehospital cardiac arrest at two pediatric emergency departments in Izmir Hospital of Health Sciences University and Gaziantep Cengiz Gökçek Kadin Dogum ve Çocuk Hospital of Health Ministry between August 2017 and August 2018. RESULTS: The present study included 188 patients (112 patients from Gaziantep and 76 patients from Izmir). All patients arrived at the hospital through emergency medical services. The median age was lower (14 days vs. 15 months; P < 0.001), and the proportion of Syrian refugees was higher in patients from Gaziantep (78.6% vs. 7.9%; P < 0,001). In both centers, respiratory failure was the most common etiology. In patients from Gaziantep, pH levels were lower (median: 7.10 vs. 7.24), and lactate levels were higher (median: 6 mmol/L vs. 3.6 mmol/L; P < 0.001). The mortality rate was higher among patients from Gaziantep (27.7% vs. 7.9%; P = 0.001). CONCLUSIONS: The rate of Syrian refugees among children who were brought to emergency department due to pre-hospital cardiac arrest was much higher in Gaziantep compared to Izmir. Syrian children were significantly younger and had more severe tissue hypoxia, resulting in a higher mortality rate.

Comparison of direct and video laryngoscope endotracheal intubations by pediatric residents: A study of a child model with normal airway.

OBJECTIVE: This study aimed to compare the efficacy of direct and videolaryngoscopy procedures performed by pediatric residents who had limited experience of direct endotracheal intubation and had not previously used video laryngoscopes in a normal airway child manikin. MATERIAL AND METHODS: The endotracheal intubations performed by pediatric residents with a direct laryngoscope and Storz C-MAC videolaryngoscope on a pediatric manikin with a normal airway were compared. Theoretical and practical training was given before the study. In the first attempt, the success of the intubation procedure, glottis visual duration, and endotracheal tube insertion time were determined. Practitioners grouped the glottis image between 1-4 according to the Cormack-Lehane Staging (Stage 1 ideal image). After the intervention, the participants scored one to ten points on direct and videolaryngoscopy (1 not useful, 10 very useful). RESULTS: The success of direct and videolaryngoscopy of 51 pediatric residents on the same manikin was 48 out of 51 (94%) for each method (P> 0.05). Glottis visual duration was similar in both methods (P>0.05); tube insertion and total intubation time were shorter in the video laryngoscope group (P<0.05); glottis image was better in the video laryngoscope group according to Cormack-Lehane Classification (P<0.05). Participants' rating was higher on videolaryngoscope (P<0.05). CONCLUSION: Users with limited endotracheal intubation experience use Video laryncoscope more effectively than direct laryngoscope in children with normal airway model after training.

Characteristics and outcomes of critically ill children transported by ambulance in a Turkish prehospital system: a multicenter prospective cohort study.

BACKGROUND: The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated. METHODS: This prospective study was conducted at 4 metropolitan cities and 9 tertiary pediatric EDs between August 2014-August 2015. A survey based study evaluated all CIC who were brought by ambulance to the participant EDs. CIC were defined as a patient who requires LSI or needs intensive care admission for any reason. Patient demographics, clinical features, reason for transport, performed procedures in the ambulance or ED were sought. Finally, the short-term outcomes of transported CIC and transport-associated risks were analyzed. RESULTS: During the study period, a total 2094 children were brought by ambulance to all participant EDs. Only 227 (10.8%) of them were critically-ill. Emergency Medical Services (EMS) providers were less likely to perform procedures in CIC if they were staffed with paramedics (p < 0.001). Most procedures were performed on children aged one or older (p < 0.001). No procedure was performed in the ambulance for nearly one fourth of patients who received LSI in the EDs. If the EMS did not have a physician, prehospital providers were less likely to provide immediate LSIs (p < 0.001). CIC were more likely referred from secondary/tertiary care hospitals. The short-term mortality rate was higher if the ambulance was staffed by only paramedics. CONCLUSION: This study demonstrated that Turkish prehospital pediatric emergency care is deficient. We offer a clinical overview of pediatric emergencies to aid EMS directors, policymakers, and ED directors in planning the care of CIC.

The Comparison of Children Who Were Diagnosed with COVID-19 in the First and the Second Waves of the SARS-CoV-2 Pandemic.

OBJECTIVE: To compare the clinical and laboratory findings and short-term outcomes of those children diagnosed with COVID-19 in the first and second waves of the SARS-CoV-2 pandemic. METHODS: A retrospective study was conducted at a suburban community hospital during a 1-year period. All children who were less than 18 years of age and confirmed with COVID-19 were included in the study population. The demographics, clinical features, laboratories, treatments given, hospitalizations, and outcomes were analyzed. RESULTS: A total of 198 patients were enrolled; median age was 9.3 years. One-hundred four patients were diagnosed with COVID-19 disease in the first wave and 94 (47.5%) patients were diagnosed in the second wave of the pandemic. Those patients who were diagnosed with COVID-19 in the first wave of the pandemic were significantly younger than those in the second wave (medians: 2.7 years vs. 15 years respectively, P < .001). Intra-familial contact was detected in 66.4% vs. 33.6% in the first and second waves of the pandemic, respectively (P < .001). Asymptomatic patients were higher in the second wave than in the first wave (P < .001). Additionally, moderate-to-critically ill patients were significantly higher in the first wave than in the second wave (P < .001). The rate of multisystem inflammatory syndrome (MIS-C) cases was 0.32% in this study. CONCLUSION: In children, COVID-19 disease affected older children, there was less intra-familial contact and the severity of the disease was milder in the second wave of the pandemic in comparison to the first wave. MIS-C was encountered in the second wave of the pandemic.

Retrospective evaluation of 377 patients with penetrating foreign body injuries: a university hospital experience (a present case of missed sponge foreign body injury)

Background/aim: This study aimed to retrospectively analyse patients with foreign body (FB) injuries in our hospital and to present a patient with missed penetrating sponge FB injury. Materials and methods: This study lasted 12 years (2008­2020) and reviewed all patients with FB injuries who were admitted to the emergency department (ED) of our hospital. Along with our overall results, we present a case with missed penetrating sponge FB injury in detail. Results: Approximately 377 patients were included in the study (age: 28.3 ± 18.3 years, m/f: 229/148). The foot (n = 148, 39.3%) and the hand (n = 143, 37.9%) were the most frequently injured body parts. Regarding FB types, sewing needles (n = 140, 37.1%), metal pieces (n = 91, 24.1%), and glass (n = 80, 21.2%) were the most frequently observed objects. Most of the patients were injured at home, often by needles or glass. The injury-admission mean time was 7.38 ± 2.5 days. FBs were frequently removed in the ED (n = 176, 46.7%). Plain radiography is the first line in identifying FBs. Soft tissue infection was the most common complication. MRIs were much useful than USGs in detecting the missed penetrating sponge injury of the single patient in the study. Conclusion: For diagnosis of FBs, besides recording the patient's history, obtaining a two-sided radiogram is of great importance. For nonradiolucent or deeply located FBs, further clinical or radiological investigation must be considered to avoid complications. Although most of the FBs can be removed in the ED, patients may require hospitalisation and operation for FB removal, depending upon FB location and age.

Is there a relationship between thyroid hormone levels and suicide attempt in adolescents?

Abstract Background: Thoughts about suicide are quite common in adolescent. While such thoughts can be caused by many reasons, the most well-known of these are mood disorders. There are studies related to coexistence of thyroid pathologies and mood disorders in adult. Objectives: In this study, we aimed to investigate the difference of thyroid hormone levels in between adolescents with suicide attempt history and normal population. Methods: The study was prospective and was designed as a case-control study. Demographic characteristics of the patients were obtained and Serum fT3, fT4 and TSH levels were examined. Results: 222 cases were included in the study, including 101 cases and 121 controls. As for TSH levels, the mean serum levels of the whole group was 1.96 ± 1.08 mU/L, while the mean serum levels of the control group was 2.33 ± 1.5 mU/L and the mean serum levels of the case group was 0.50 ± 0.3 mU/L which revealed that the mean serum levels of the case group was significantly lower (p<0.01). Conclusion: It was found that serum TSH levels were significantly lower in case group than control group and the individuals with subclinical hyperthyroidism had more suicide attempts than the ones in control group.

Three-Dimensional Printed Anatomical Models Help in Correcting Foot Alignment in Hallux Valgus Deformities.

BACKGROUND: Hallux valgus (HV) is the most common pathologic entity affecting the great toe. The goal of corrective surgery is to restore foot mechanics and provide pain relief. The purpose of the study was to create individual angle using life-size foot models with three-dimensional (3D) printing technology to design a section on HV osteotomy. MATERIALS AND METHODS: Ten female patients with a diagnosis of HV were included. Radiologic [HV angle and intermetatarsal (IM) angle] and clinical [American Orthopaedic Foot and Ankle Score (AOFAS)] assessment was done pre- and postoperatively. All the operations were planned together with 3D life-size models generated from computed tomography (CT) scans. Benefits of using the 3D life-size models were noted. The 3D model's perception was evaluated. RESULTS: The mean AOFAS score, mean HV, and IM angles had improved significantly (P < 0.05). The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical planning. At the first tarsometatarsal joint, the HV models showed significantly greater dorsiflexion, inversion, and adduction of the first metatarsal relative to the medial cuneiform. At the first metatarsophalangeal joint, the HV models showed significantly greater eversion and abduction of the first proximal phalanx relative to the first metatarsal. It provided satisfactory results about operation time and blood loss. 3D model's perception was statistically significant (P < 0.05). CONCLUSION: 3D models help to transfer complex anatomical information to clinicians, which provide guidance in the preoperative planning stage, for intraoperative navigation. It helps to create a patient-specific angle section on osteotomy to correct IM angle better and improve postoperative foot function. The 3D personalized model allowed for a better perception of information when compared to the corresponding 3D reconstructed image provided.