Successful Use of Early Therapeutic Hypothermia in an MDMA and Amphetamine Intoxication-Induced Out-of-Hospital Cardiac Arrest: A Case Report.

BACKGROUND: Deaths caused by recreational drug abuse have increased considerably in recent years. Therapeutic hypothermia offers the potential to improve neurological outcomes in post-resuscitation patients. CASE REPORT: A 19-year-old man was brought to our emergency department after suffering out-of-hospital ventricular fibrillation (VF) cardiac arrest. He was resuscitated at our emergency department again due to VF. Urine analysis showed high levels of amphetamine and 3,4 methylenedioxymethamphetamine (MDMA) (ecstasy). The patient was intubated, sedated, and ventilated. Within 1 h after the return of spontaneous circulation and hemodynamic stabilization, therapeutic hypothermia was initiated for neurologic protection. An external-cooling device was used for cooling. He was maintained at 33oC for 72 h. The patient was weaned from the ventilator and extubated on day 5. He was discharged from the hospital on the day 10 with good cerebral performance. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Initiation of early therapeutic hypothermia within 1 h after return of spontaneous circulation might contribute to better neurologic outcome in patients who suffer VF cardiac arrest. We suggest that early therapeutic hypothermia may be considered in patients who suffer out-of-hospital cardiac arrest due to MDMA and amphetamine intoxications.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

Gait characteristics of patients with bilateral club feet following posteromedial release procedure.

In this study we intended to evaluate the gait characteristics of children who had bilateral operated clubfeet, and to compare the results with gait parameters of children without clubfeet or lower extremity abnormalities. Fifteen children with bilateral plantigrade and asymptomatic clubfeet, operated bilaterally with posteromedial release method, were included in group P. Means+/-SD of age and follow-up time were 8.5+/-2.6 years (range, 4-14 years) and 7.7+/-2.8 years (range, 3-10 years), respectively. Age, sex, height-and weight-matched 24 children without clubfeet or lower extremity abnormalities were included in the control group (group C). Three-dimensional computerized gait analysis was performed for all subjects, and time-distance, kinematic and kinetic gait characteristics of the groups were compared. Time-distance characteristics of the groups were identical. Ankle plantar flexion angles, plantar flexor moment and generated power were significantly decreased in group P (P<0.05). Knee hyperextension during midstance was observed in 17 of 30 (57%) knees in the P group. Kinetic analysis revealed excessive knee valgus and flexion moments, as well as decreased second peak values of vertical ground reaction forces for group P. This study shows that even successfully operated, plantigrade and clinically asymptomatic children with bilateral clubfeet have significant gait deviations involving all lower limb joints. Future studies are needed to investigate the accountable factors of gait deviations and possible long-term musculoskeletal morbidity of operated children with bilateral clubfeet.

[Recurrent traumatic hip dislocation in a child]. / Cocukta tekrarlayan travmatik kalça çikigi: Olgu sunumu.

Recurrent traumatic hip dislocation is rarely seen in childhood. We presented a case of traumatic hip dislocation which was treated by conservative methods. A two-year-old girl was treated with closed reduction and a hip spica cast for posterior traumatic dislocation in the right hip. Two years later, a recurrent dislocation occurred following a minor trauma on the same side. She was again treated with closed reduction and immobilization with a hip spica cast for three weeks followed by a three-week load bearing restriction. Early follow-up examinations showed an increased internal rotation of the hip compared to the left side, suggesting increased posterior capsular laxity. It then disappeared on her final follow-up at age six and magnetic resonance imaging showed no evidence for avascular necrosis or capsular laxity. She was asymptomatic and her physical examination was within normal limits. Of note, several members in her family had developmental dysplasia of the hip.

A novel electrospun nano-fabric graft allows early cannulation access and reduces exposure to central venous catheters.

PURPOSE: The use of tunneled central venous catheters (CVC) as vascular access for hemodialysis treatment is increasing worldwide. We present a novel polycarbonate urethane nano-fabric graft, produced by electrospinning technology, which has self-sealing features that avoid seroma formation and allow puncturing within 48 hours. The aim of this study was to assess its advantages in a setting where late referral is common. 
 METHODS: A retrospective single center study assessed 24 implanted grafts in 24 patients with maximal follow-up of 18 months; patency rates, time to first cannulation and post-operative complications were assessed. 
 RESULTS: Successful access was achieved in all 24 patients within 48 hours. In 50% of the patients cannulation was performed within 24 hours without increasing the complication rate. Twelve month primary and secondary patencies were 50% and 70.8%, respectively. Excluding early failures (within 30 days) because of surgical problems, 12 month primary and secondary patencies were 75% and 81.2% respectively. Complication and infection rates were 10.94 and 0.49/1000 dialysis procedures, respectively. No pseudoaneurysms or seromas were documented at 18 months.
 CONCLUSIONS: Early cannulation was successful in all patients with good 12-month primary and secondary patency rates, compared to data reported by others on polytetrafluoroethylene (PTFE) grafts. The infection rate was substantially lower than in tunneled CVCs. Therefore, the AVflo graft may improve the clinical status of dialysis patients by decreasing the exposure to CVCs.