Correlation Between Sociocultural and Economic Factors in Pediatric Patients' Families and Emergence Delirium.

BACKGROUND: Postoperative delirium is a commonly encountered condition that can arise from multiple factors, and its occurrence varies based on the type of surgery in pediatric patients. This study aimed to investigate the occurrence of delirium during the recovery from anesthesia in children undergoing eye surgery and its association with the sociocultural and economic status of their families. METHODS: This prospective observational study included children aged 2-12 years who underwent eye surgeries. Demographic data, socioeconomic and educational status of parents, parental separation and cooperation scores, Cravero agitation score, and face, legs, activity, cry, and consolability (FLACC) score (at zero, five, 15, and 30 minutes in the postoperative period) were recorded. Patients who scored 5 on the Cravero agitation scale for at least five minutes were considered to have postoperative delirium. The STROBE checklist was followed for reporting. RESULTS: A total of 104 patients were included in the study, of which 65 were male. The mean age of the patients was 6.5±2.9 years, and 42 patients (40.4%) belonged to the preschool age group. The incidence of delirium was found to be 51.9%. Delirium was found to be associated with postoperative pain (p=0.003), age (p=0.001), preoperative anxiety (not cooperative examination score (p=0.047), poor separation score (p=0.006)), presence of a surgical history (p=0.012), and cataract surgery (p=0.007). No evidence was found to demonstrate a link between sociocultural and economic conditions and the development of delirium. CONCLUSIONS: This study identified several factors that influenced the occurrence of delirium, including postoperative pain (FLACC≥4), younger age (<6 years), cataract surgery, presence of surgical history, examination score (score 3, not cooperative), and separation score (scores 3-4, poor).

Correction: Correlation Between Sociocultural and Economic Factors in Pediatric Patients' Families and Emergence Delirium.

[This corrects the article DOI: 10.7759/cureus.46229.].

Temporomandibular Joint Dislocation in a Patient with Keratoconus Under General Anesthesia: A Case Report.

Keratoconus is a common disease in which the central or paracentral cornea undergoes progressive thinning, resulting in a cone-shaped cornea. It has been associated with many systemic disorders such as Down syndrome, osteogenesis imperfecta, and joint hypermobility. Herein, temporomandibular joint dislocation under general anesthesia during supraglottic airway device placement before deep anterior lamellar keratoplasty procedure in a keratoconus patient is reported.

Is Temperature Monitoring Necessary in Pediatric Circumcision?

OBJECTIVE: Perioperative hypothermia occurs in the pediatric age group in the perioperative period at a high rate. In this study, it is aimed to reveal the incidence of perioperative hypothermia and the risk factors that play a role in its development in pediatric circumcision cases that have a brief operation duration. MATERIALS AND METHODS: This prospective observational cohort study included 100 children who underwent circumcision under general anesthesia. All patients were heated with a passive heater and hypothermia was interpreted as a drop in body temperature below <36˚C. The patients were divided into 2 groups: group 1 (patients with body temperature <36˚C) and group 2 (≥36˚C). Demographic data, the American Society of Anesthesiologists' Classification of Physical Health Score, premedication method, operation time, fluid amount, preoperative and postoperative temperature of patients as tympanic were recorded. RESULTS: The average age of the patients was 70 ± 40 months (median: 84) and 93% were ASA I. In 71% of patients, a decrease in body temperature and hypothermia developed in 39% compared to baseline. The duration of operation was longer in the group with hypothermia (30 min [15-70] vs. 25 min [15-60], P < .001). Only the duration of operation was determined as the independent risk factor associated with hypothermia (odds ratio: 1.103 [1.017-1.197], P=.018). CONCLUSION: In this study, it was found that high rates of hypothermia developed even in minor operations such as pediatric circumcision. The risk of hypothermia increases with the prolongation of surgery.

Burnout in Healthcare Professionals During the Covid-19 Pandemic in a Tertiary Care University Hospital: Evaluation of the Need for Psychological Support. / Üçüncü Basamak Bir Üniversite Hastanesinde Covid-19 Pandemisinde Saglik Çalisanlarinda Tükenmislik: Psikolojik Destek Ihtiyacinin Degerlendirilmesi.

OBJECTIVE: Anxiety, stress and burnout are observed in healthcare workers during the Covid-19 pandemic. This study aimed to determine the levels of anxiety and burnout and related risk factors in the healthcare workers and assistant personnel at a tertiary referral university hospital. METHOD: Hospital Anxiety Depression Scale (HADS), Maslach Burnout Inventory (MBI) and a sociodemographic questionnaire were delivered on-line to all employees of our hospital. 683 individuals were to the study who completed and returned the forms between April 15-30, 2020. RESULTS: Stress, depression and anxiety levels were significantly higher in nurses. Emotional burnout and depersonalization symptoms were higher and personal accomplishment scores were lower in resident physicians and nurses in comparison to the other groups. Being single, having a child and living away from home were factors underlying the burnout severity. Frontline work in the Covid-19 clinics did not affect the levels of anxiety, stress and depression. On the basis of the cut off points of the HADS scores; anxiety disorder (OR: 7.19) and depression (OR 3.43) were the most relevant risk factors for emotional exhaustion. Anxiety disorder was also the main risk factor for depersonalization. Depersonalization was 2.7-fold more among the nurses complaining of being overworked. Social support from the work environment and the family was protective against depersonalization. CONCLUSION: Covid-19 pandemic has adversely affected the wellbeing of healthcare workers. The presence of depression and anxiety increased the risk of burnout. Social support can be expected to protect against burnout. It is, therefore, of great importance to implement urgently effective psychosocial and organizational interventions in order to protect the mental health of healthcare workers and to prevent burnout.

The effect of brain death and coma on gastric myoelectrical activity.

BACKGROUND/AIMS: Gastrointestinal motility problems and delayed gastric emptying in patients admitted to intensive care units are important because they can contribute to different problems. Herein we aimed to measure the changes in gastric myoelectrical activity with electrogastrography (EGG) following brain death (BD) and compare the results to those from patients in a deep coma without BD. MATERIALS AND METHODS: Fifteen patients with BD and nine in a deep coma with a Glasgow Coma Score from 3 to 8 were included. An enteral nutrition solution was given via a nasogastric tube between 45 min of fasting and the postprandial periods. The mean dominant frequency (MnDF), normal gastric slow wave ratio (%), tachygastria and bradygastria (%), power ratio (PR: dominant power after test meal/fasting), and dominant frequency instability coefficient were evaluated. RESULTS: The median of MnDF was determined 3.20±0.6 (BD) vs 3.05±0.5 (control), p>0.05. Patients with BD displayed tachygastria, particularly during the fasting state, with this disturbance decreasing during the postprandial period (from 41% to 15%). However, none of the differences between the groups were statistically significant. PR was pathologic in 4/15 (26.7%) patients in the BD group and 4/9 (44.4%) patients in the control group (p=0.288). CONCLUSION: Patients with coma or BD bouth might have gastric myoelectrical activity disturbances. BD does not show more severe disturbance than coma wihouth BD. EGG might be useful as a non-invasive and easy-to-use technology; however, it needs further improvement.

Ventilator-associated pneumonia in critically ill patients with intensive antibiotic usage.

OBJECTIVE: Ventilator-associated pneumonia (VAP) is an infection with high mortality and morbidity that prolongs the length of stay in the intensive care unit (ICU) and hospitalisation. VAP is one of the most common infections in critically ill patients. This study aimed to prospectively determine the VAP rate and associated factors in critically ill patients with intensive antibiotic usage during a one-year period. METHODS: In total, 125 out of 360 patients admitted to the intensive care unit during the one-year study period (September 2010-2011) were included for follow-up for VAP diagnosis. Demographic data, APACHE II scores, diagnoses on admission, clinical pulmonary infection scores (CPIS), CRP, procalcitonin, risk factors for infection, time to VAP diagnosis, and bacteriological culture results were recorded. All data were assessed in terms of ICU, hospital and 28-day mortality. RESULTS: In total, 56 (45%) out of 125 patients were diagnosed with VAP. In addition, 91% of patients diagnosed with VAP were administered antibiotics before diagnosis. In the VAP patients, the mortality rates were 48, 68 and 71% for 28-day, ICU and hospital mortality, respectively. CONCLUSION: The coexistence of clinical and microbiological parameters should not be sought when diagnosing VAP in patients who use antibiotics intensively. VAP can be diagnosed when CPIS≤6 in cases with sufficient microbiological evidence. This strategy may decrease mortality by preventing a delay in therapy.

Severe acute pancreatitis admitted to intensive care unit: SOFA is superior to Ranson's criteria and APACHE II in determining prognosis.

BACKGROUND/AIMS: Severe acute pancreatitis usually requires intensive management of cardiovascular, pulmonary, renal, and septic complications. Many scoring systems are used in determining the outcomes. The aim of the study was to evaluate the role of three scoring systems, i.e. Acute Physiology and Chronic Health Evaluation, Sequential Organ Failure Assessment, and modified Ranson's criteria, in predicting mortality rate in patients with severe acute pancreatitis as well as other factors influencingmortality in patients admitted to intensive care unit. MATERIALS AND METHODS: Charts of 43 patients hospitalized in intensive care unit with severe acute pancreatitis were screened retrospectively. Four patients were excluded. Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment and modified Ranson's scores were calculated on admission, and Sequential Organ Failure Assessment score was recorded on weekly intervals during the intensive care unit stay. RESULTS: Thirty-nine patients were included in the study (65% male, mean age: 61 years). The intensive care unit mortality was 64% and hospital mortality was 71%. Sequential Organ Failure Assessment scores correlated significantly with mortality. All patients with Sequential Organ Failure Assessment score ≥11 at any time during intensive care unit stay had higher mortality (80% sensitivity, 79% specificity, ROC=0,837). Although Acute Physiology and Chronic Health Evaluation II is used to estimate mortality prognosis, we could not find any statistically significant association between Acute Physiology and Chronic Health Evaluation II scores and mortality. CONCLUSION: Various scoring systems are used to determine the prognosis of severe acute pancreatitis. In this group of patients, higher Sequential Organ Failure Assessment scores predict higher intensive care unit/hospital mortality.

Recurrent Spontaneous Pneumothorax during the Recovery Phase of ARDS Due to H1N1 Infection.

The pregnant patients are prone to influenza A (H1N1) virus infection, which may rapidly progress to lower respiratory tract infection and subsequent respiratory failure and acute respiratory distress syndrome (ARDS). Pneumothorax might develop in ARDS under mechanical ventilation. But post-ARDS pneumothorax in spontaneously breathing patient has not been reported in the literature. We report a 31-year old pregnant woman infected with influenza A (H1N1) virus and progressed to ARDS. Mechanical ventilation with high PEEP improved patient's gas exchange parameters within 3 weeks. However spontaneous pneumothorax was developed one week after she weaned off the ventilator. After successful drainage therapy, the patient was discharged. However she re-admitted to the hospital because of a recurrent pneumothorax one week later. She was discharged in good health after being treated with negative continuous pleural aspiration for 10 days. Influenza might cause severe pulmonary infection and death. In addition to diffuse alveolar damage, sub-pleural and intrapulmonary air cysts might occur in influenza-related ARDS and may lead to spontaneous pneumothorax. This complication should always be considered during the recovery period of ARDS and a long-term close follow-up is necessary.

A comparison of analgesic effect of intra-articular levobupivacaine with bupivacaine following knee arthroscopy.

OBJECTIVE: To compare the postoperative analgesic effects of intra-articular levobupivacaine with bupivacaine following knee arthroscopy. METHODS: Forty patients, aged between 20-60 years and undergoing elective knee arthroscopy were enrolled into the study protocol that was carried out in Tepecik Education and Research Hospital, Izmir, Turkey between January and June 2007. General anesthesia protocol was the same in all patients. At the end of surgery, the patients were randomly assigned into 2 groups (n=20 in each group). Group L received 20 ml 0.5% levobupivacaine and Group B received 20 ml 0.5% bupivacaine intra-articularly. We evaluated the level of postoperative pain (by visual analogue scale at 1, 2, 4, 6, 12, and 24 hours after surgery), first analgesic requirement time (period measured from the end of the surgery until further analgesia was demanded), and total analgesic consumption during 24 hours. RESULTS: There were no significant difference in the postoperative pain scores of the patients between groups. The first analgesic requirement times were not statistically different. Twelve patients in Group L (60%) and 9 patients in Group B (45%) needed no additional analgesic during the 24 hours (p>0.05). No complications and side effects were found related to the intra-articular treatment. CONCLUSION: The results of the study show that intra-articular 20 ml 0.5% levobupivacaine provides effective analgesia comparable to that provided by 20 ml 0.5% bupivacaine.

Overlap of symptoms of dyspepsia and gastroesophageal reflux in the community.

BACKGROUND/AIMS: Dyspepsia and gastroesophageal reflux disease are common chronic diseases. In the clinical setting, some patients express both problems together; however, little is known about the real prevalence of the presence of the two symptoms. Turkey is particularly interesting because of differences observed from developed countries. We aimed to derive data from our previous prevalence of gastroesophageal reflux disease study and evaluate the overlap of the two symptoms. METHODS: We used a previously validated and culturally adapted reflux questionnaire, which was translated into Turkish. The questionnaire was applied to 630 randomly selected subjects older than 20 years living in a population of 8857 adults. RESULTS: 28.6% (180/630) of all responders defined dyspepsia within the last 12-month period. When symptom prevalence was considered at least weekly, the prevalence was 10% for heartburn, 15.6% for acid regurgitation, and 20% for either symptom. While the prevalence of gastroesophageal reflux disease was 29.4% in patients with dyspepsia, dyspepsia was found in 43.1% of patients with gastroesophageal reflux disease. Only 21% of symptomatic subjects or 8.4% of the entire study population had both symptoms. Dyspepsia was defined as the most bothersome symptom. 54.3% of all dyspeptic patients and 67.3% with both gastroesophageal reflux disease and dyspepsia used a gastric medication (p>0.05). 29.9% of subjects with dyspeptic symptoms defined antacid consumption and 28.3% acid inhibitor therapy. CONCLUSION: Dyspepsia was defined as the most bothersome symptom compared to gastroesophageal reflux disease symptoms. The prevalence of dyspepsia in patients with gastroesophageal reflux disease is more common than vice versa. However, the overlap of the two symptom groups was lower than expected in this low-income, Caucasian population.

Gastroesophageal reflux disease in a low-income region in Turkey.

OBJECTIVES: Detailed population-based data regarding the prevalence and symptom profile of gastroesophageal reflux disease (GERD) in underdeveloped and developing Caucasian countries are lacking. The aim of this study was to determine the prevalence and clinical spectrum of GERD in a low-income region in Turkey. METHODS: We used a previously validated reflux questionnaire, which was translated into Turkish and culturally adapted. The questionnaire was applied to 630 randomly selected participants greater than 20 yr old living in a population of 8,857 adults, with a low mean income of 75 dollars/person/month. The reliability and reproducibility of the questionnaire were calculated using the kappa statistic (test-retest). Endoscopy and/or 24-h intraesophageal pH monitoring were used to ascertain its validity in identifying patients with reflux. RESULTS: The prevalence of GERD symptoms was 10% for heartburn, 15.6% for regurgitation, and 20% for either symptom experienced at least weekly (95% CI). Heartburn and regurgitation were associated with noncardiac chest pain (37.3%), dysphagia (35.7%), dyspepsia (42.1%), odynophagia (35.7%), globus, hoarseness, cough, hiccup, nausea, vomiting, belching, and NSAID use, but not with body mass index in both frequent and occasional symptom groups. The prevalence of heartburn symptoms, but not regurgitation, increased significantly with age. CONCLUSIONS: The prevalence of GERD in a low-income population in Turkey was similar to that of developed countries, although with a different symptom profile, namely, a lower incidence of heartburn and a higher incidence of regurgitation and dyspepsia. These findings support the contention that there are a large number of patients worldwide in underdeveloped nations with poorly recognized and largely undertreated GERD.

Chloride transport in rabbit esophageal epithelial cells.

We investigated Cl(-) transport pathways in the apical and basolateral membranes of rabbit esophageal epithelial cells (EEC) using conventional and ion-selective microelectrodes. Intact sections of esophageal epithelium were mounted serosal or luminal side up in a modified Ussing chamber, where transepithelial potential difference and transepithelial resistance could be determined. Microelectrodes were used to measure intracellular Cl(-) activity (a), basolateral or apical membrane potentials (V(mBL) or V(mC)), and the voltage divider ratio. When a basal cell was impaled, V(mBL) was -73 +/- 4.3 mV and a(i)(Cl) was 16.4 +/- 2.1 mM, which were similar in presence or absence of bicarbonate. Removal of serosal Cl(-) caused a transient depolarization of V(mBL) and a decrease in a(i)(Cl) of 6.5 +/- 0.9 mM. The depolarization and the rate of decrease of a(i)(Cl) were inhibited by approximately 60% in the presence of the Cl(-)-channel blocker flufenamate. Serosal bumetanide significantly decreased the rate of change of a(i)(Cl) on removal and readdition of serosal Cl(-). When a luminal cell was impaled, V(mC) was -65 +/- 3.6 mV and a was 16.3 +/- 2.2 mM. Removal of luminal Cl(-) depolarized V(mC) and decreased a by only 2.5 +/- 0.9 mM. Subsequent removal of Cl(-) from the serosal bath decreased a(i)(Cl) in the luminal cell by an additional 6.4 +/- 1.0 mM. A plot of V(mBL) measurements vs. log a(i)(Cl)/log a(o)(Cl) (a(o)(Cl) is the activity of Cl(-) in a luminal or serosal bath) yielded a straight line [slope (S) = 67.8 mV/decade of change in a(i)(Cl)/a(o)(Cl)]. In contrast, V(mC) correlated very poorly with log a/a (S = 18.9 mV/decade of change in a/a). These results indicate that 1) in rabbit EEC, a(i)(Cl) is higher than equilibrium across apical and basolateral membranes, and this process is independent of bicarbonate; 2) the basolateral cell membrane possesses a conductive Cl(-) pathway sensitive to flufenamate; and 3) the apical membrane has limited permeability to Cl(-), which is consistent with the limited capacity for transepithelial Cl(-) transport. Transport of Cl(-) at the basolateral membrane is likely the dominant pathway for regulation of intracellular Cl(-).