Bronchoscopy for foreign body aspiration and effects of nebulized albuterol and budesonide combination.

OBJECTIVE: A foreign body aspiration in the tracheobronchial tree is a dangerous medical condition in the childhood period. Although rigid bronchoscopy is a safe procedure, it may cause complications. The aim of this study was to present our bronchoscopy experience and to evaluate the efficacy of pre-operative administration of nebulized albuterol and budesonide combination for reducing intra-operative complications in foreign body aspirated cases. METHODS: In this retrospective study our pediatric cases in which a foreign body was removed from tracheobronchial tree in last 8 years were analyzed. After excluding the patients who needed emergent and negative bronchoscopies, the remaining clinically stable 84 patients were compared for the effects of preoperative administration of nebulized albuterol and budesonide combination on bronchoscopy complications. RESULTS: There were 51 boys (60.3%) and 33 girls (39.7%). There were 38 children in the non-nebulized group and 46 children in the nebulized group. We found that the combined albuterol and budesonide nebulization decrease complications such as arterial oxygen desaturation (p<0.05), and bronchospasm (p<0.05) during the bronchoscopic intervention. CONCLUSION: Preoperative nebulization of albuterol and budesonide combination may decrease perioperative complications of bronchoscopy.

Effect of carboxyhemoglobin on postoperative complications and pain in pediatric tonsillectomy patients.

BACKGROUND: Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high-COHb concentrations are associated with more pain and analgesic use. METHODS: 100 children scheduled for elective tonsillectomy were divided into low and high carbon monoxide (CO) exposure groups: COHb ≤3 or ≥4 g·dl(-1) . We considered a composite of complications during the 7 days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation, re-intubation, hypotension, postoperative bleeding, and reoperation. Pain was evaluated with Wong-Baker Faces pain scales, and supplemental tramadol use recorded for four postoperative hours. RESULTS: There were 36 patients in the low-exposure group COHb [1.8 ± 1.2 g·dl(-1) ], and 64 patients were in the high-exposure group [6.4 ± 2.1 g·dl(-1) ]. Indoor coal-burning stoves were reported more often by families of the high- than low-COHb children (89% vs 72%, P < 0.001). Second-hand cigarette smoke exposure was reported by 54% of the families with children with high COHb, but only by 24% of the families of children with low COHb. Composite complications were more common in patients with high COHb [47% vs 14%, P = 0.0001, OR:7.4 (95% Cl, lower = 2.5-upper = 21.7)], with most occurring in the postanesthesia care unit. Pain scores in postanesthesia care unit and one hour after surgery were statistically significantly lower in the low-exposure group [respectively, P = 0.020 (95%CI, lower = -1.21-upper = -0.80), P = 0.026 (95% CI, lower = -0.03-upper = 0.70)], and tramadol use increased at 4 h (3.5 (interquartile range: 0-8) vs 6 (5-9) mg, P = 0.012) and 24 h (3.5 (0-8) vs 6 (5-9) mg, P = 0.008). CONCLUSION: High preoperative COHb concentrations are associated with increased postoperative complications and pain.

Higher frequency of methicillin resistant bacteria in children with familial mediterranean fever.

OBJECTIVE: To investigate resistant microorganisms in nasal mucosa of children with Familial Mediterranean Fever. METHODS: The study was conducted from March to May 2013 at Mustafa Kemal University, Turkey, and comprised children with Familial Mediterranean Fever and healthy controls. All subjects had no history of antibiotic or local and/or systemic steroid use within the preceding 2 weeks. Nasal swab samples were obtained from all the subjects. Strain identification was done by using standard methods. SPSS 13 was used for statistical analysis. RESULTS: Of the 151 subjects in the study, 73 (48.34%) were cases and 78 (51.65%) were controls. Among the cases, there were 26(35.6%) girls, while among the controls, there were 40(51.3%) girls (p=0.052). The mean age of the cases was 7.78 ± 3.34 years (range: 3-15 years), while it was 8.15 ± 2.71 years (range: 3-16) among the controls (p = 0.208). Methicillin-resistant coagulase-negative staphylococcus and methicillin-resistant staphylococcus aureus were isolated in both the groups. The growth rate of resistant bacteria was 63% (n = 46) in the cases, in the controls (p = 0.003; odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.4-5.2). Among the controls, history of hospitalisation increased the risk for the presence of resistant bacteria by 7.7 fold (OR: 7.7; 95% CI: 1.4-40.4). CONCLUSION: Higher rates of resistant bacteria showed that they were at risk of comorbidities related to antibiotic resistance.

Mean Platelet Volume can Predict Cerebrovascular Events in Patients with Sickle Cell Anemia.

OBJECTIVE: The purpose of this study was to determine the impact of mean platelet volume (MPV) on the frequency and severity of vaso-occlusive and cerebrovascular events in patients with sickle cell anemia (SCA). METHODS: The 238 cases diagnosed with SCA were evaluated retrospectively with respect to the occurrence of painful crisis for the previous year. The incidence, severity and type of the vaso-occlusive crises of the patients with SCA between March 2010 and March 2011 were recorded. The last MPV values in patients who were free of erythrocyte transfusion for the last three months and who had no current vaso-occlusive crises were evaluated. All the patients were grouped according to the frequency of the crises for the previous year preceding the data collection. Group 1: 1 to 3 crises, Group 2: 4 to 5 and Group 3: 6 or more crises annually. RESULTS: In accordance with the results obtained during the evaluation of the cases diagnosed with sickle-cell anemia, MPV value was found to be significantly higher in patients with cerebrovascular events. Also MPV values increased with increasing incidence of the crises (r=0.297) (p=0.001). CONCLUSION: One of the contributing factors for this clinical heterogeneity may be related to the MPV values in patients with sickle cell anemia. The higher MPV values may be an early predictor of future cerebrovascular events in patients with sickle cell anemia and may require close follow-up and additional measures.

Performance of QuantiFERON-TB Gold In-Tube test and Tuberculin Skin Test for diagnosis of latent tuberculosis infection in BCG vaccinated health care workers.

BACKGROUND: Tuberculin skin test (TST) has been used for years as an aid in diagnosing latent tuberculosis infection (LTBI) but it suffers from a number of well-documented performance and logistic problems. Quantiferon-TB Gold In Tube test (QFT-GIT) has been reported to have better sensitivity and specifity than TST. In this study, it was aimed to compare the performance of a commercial IFN-gamma release assay (QFT-GIT) with TST in the diagnosis of HCWs at risk for latent TB infection in BCG vaccinated population. MATERIAL AND METHODS: Hundred healthy volunteer health care workers were enrolled. All were subjected to TST and QFT-GIT. Results were compared among Health Care Workers (HCWs) groups in terms of profession, workplace, working duration. RESULTS: TST is affected by previous BCG vaccinations and number of cases with QFT-GIT positivity is increased in accordance with the TST induration diameter range. QFT-GIT result was negative in 17 of 32 TST positive (≥ 15 mm) cases and positive in 4 of 61 cases whose TST diameters are between 6-14 mm, that is attritutable to previous BCG vaccination(s). It was negative in all cases with TST diameters between 0-5 mm. HCWs with positive QFT-GIT results were significantly older than the ones with negative results. Furthermore duration of work was significantly longer in QFT-GIT positive than in negative HCWs. CONCLUSIONS: There was a moderate concordance between QFT-GIT and TST, when TST result was defined as positive with a ≥ 15 mm diameter of induration. We suggest that QFT-GIT can be used as an alternative to TST for detection of LTBI, especially in groups with high risk of LTBI and in population with routine BCG vaccination program.

Evaluation of the mean platelet volume in children with familial Mediterranean fever.

To evaluate the Mean Platelet Volume (MPV) levels in children diagnosed with familial Mediterranean fever (FMF), during attack and attack-free periods. The records of a total of 117 children with FMF, diagnosed using the Tel-Hashomer criteria, have been scanned. The study consisted of 53 patients during an attack (group 1), 64 patients in attack-free period (group 2), and 57 healthy controls (group 3). Erythrocyte sedimentation rate, C-reactive protein, white blood cell count, platelet count, and MPV levels were retrospectively recorded. The MPV and platelet values in FMF patients during attack (group 1) and FMF patients during attack-free periods (group 2) have been found to be significantly higher than those of the health control group (group 3). Positive correlation has been found between the MPV and platelet values in Group 1 and the disease's severity score (r = 0.224, and r = 0.268, respectively). Positive correlation (r = 0.528, and r = 0.485, respectively) has been also identified between MPV and blood platelet count in patients in Group 1 and 2. No correlation was found between the Colchicine treatment period and MPV (r = -0.005). The MPV values in the complete group of FMF diagnosed children have been found to be much higher compared to those in healthy children. As a consequence, we consider the MPV value as a useful marker that demonstrates the risk of early stage atherosclerosis in children with FMF.

Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey.

OBJECTIVE: This study aims to examine knowledge and attitudes towards Complementary and Alternative Medicine among medical students in Turkey, and find out whether they want to be trained in Complementary and Alternative Medicine (CAM). METHODS: A cross-sectional study was carried out between October and December 2010 among medical students. Data were collected from a total of seven medical schools. FINDINGS: The study included 943 medical students. The most well known methods among the students were herbal treatment (81.2 %), acupuncture (80.8 %), hypnosis (78.8 %), body-based practices including massage (77 %) and meditation (65.2 %), respectively. Acupuncture, aromatherapy, herbal treatment and meditation were better known among female participants compared to males (p < 0.05). Females and first year students, generally had more positive attitudes. A larger proportion of female students compared to male students reported that a doctor should be knowledgeable about CAM (p = 0.001), and this knowledge would be helpful in their future professional lives (p = 0.015). Positive attitudes towards and willingness to receive training declined as the number of years spent in the faculty of medicine increased. CONCLUSIONS: Majority of the medical students were familiar with the CAM methods widely used in Turkey, while most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the medical curriculum, by taking expectations of and feedback from medical students into consideration in setting educational standards.

Psychiatric problems in children and adolescents with sickle cell disease, based on parent and teacher reports.

OBJECTIVE: This study aimed to investigate the occurrence of psychiatric problems in children and adolescents withsickle cell disease (SCD). MATERIAL AND METHODS: The Child Behavior Checklist for ages 4-18 years (CBCL/4-18), Conners' Parent RatingScale (CPRS), Conners' Teacher Rating Scale (CTRS-R), and The Turgay DSM-IV Based Child and Adolescent BehaviorDisorders Screening and Rating Scale, clinician and parent forms (T-DSM-IV-S) were given to the caregivers and teachersof 31 children with SCD aged between 7-18 years and the caregivers and teachers of 34 age matched controls with irondeficiencyanemia. RESULTS: The SCD patients had higher scores on all 4 of scales. Among the subscales, internalizing problems, andattention problems were more prominent in the SCD patients. CONCLUSION: Children and adolescents with SCD appear to have an increased risk for psychiatric problems. Regularpsychological evaluation and referral to child and adolescent psychiatry clinics may facilitate timely diagnosis andeffective treatment of at-risk children and adolescents.

The relationship between vitamin D and disease activity and functional health status in rheumatoid arthritis.

We aimed to establish the relationship between serum vitamin D levels and disease activity and health status in rheumatoid arthritis. Sixty-five patients with RA fulfilling ACR criteria for the classification of rheumatoid arthritis and forty healthy controls were included in this study. Disease activity was assessed according to the Disease Activity Score including 28 joint counts. C-reactive protein (CRP, mg/dl) was determined by the nephelometric method. Erythrocyte sedimentation rate (ESR, mm/h) was determined by the Westergren method. Rheumatoid factor (RF, IU/ml) was also determined by the nephelometric method, and RF > 20 IU/ml was defined as positive. 25-OH Vitamin D EIA Kit was used to measure serum 25-OH Vitamin D levels. We found that the mean of the 25-OH D vitamin levels of the patients with RA was not different than that of controls (P = 0.936). We divided patients with RA into three groups according to DAS28 as low activity group (group 1, n = 25), moderate activity group (group 2, n = 25), and high activity group (group 3, n = 15). 25-OH vitamin D levels of the patients in the high activity group (group 3) were found to be the lowest (P < 0.001), and the patients with moderate disease activity had lower levels than those in the mild group (P = 0.033). Serum 25-OH vitamin D levels were significantly negatively correlated with DAS28, CRP, and HAQ (respectively, r = -0.431, P = 0.000, r = -0.276, P = 0.026, and r = -0.267, P = 0.031). Serum vitamin D levels in patients with RA were similar those in the healthy controls, while it significantly decreases in accordance with the disease activity and decreasing functional capacity.

Effectiveness of Booster Measles-Mumps-Rubella Vaccination in Lower COVID-19 Infection Rates: A Retrospective Cohort Study in Turkish Adults.

OBJECTIVE: The aim of this study was to investigate the effectiveness of booster vaccination of adults with measles-mumps-rubella in the COVID-19 infection rates. METHODS: In order to investigate this hypothesis, we tested COVID-19 positivity rate through PCR assay on the participants (n=245; male), who had to share the same student accommodation together with the same dining hall to provide governmental service. Participants were divided into two groups based on their booster vaccination status with measles-mumps-rubella: the non-vaccinated group (n=207) and the vaccinated group (n=38). The rate of COVID-19 seropositivity, age, body mass index (BMI), active smoking and presence of comorbidity were also measured and recorded. RESULTS: All of the participants were healthy, and age distribution, comorbidity rates, active smoking status and BMI did not vary significantly among the two groups (p=0.305, p=0.594, p=0.280, and p=0.922, respectively). About 36.7% (n=90) of the participants were found to be COVID-19 positive by PCR among which the non-vaccinated cases had higher rates of COVID-19 seropositivity than the vaccinated cases (40.6% vs 15.8%) (OR=3.6, 95%CI: 1.5-9.0, p=0.004). CONCLUSION: Based on these results, we cautiously predict that immunity produced by MMR vaccination boosters may provide some degree of protection against COVID-19 in the adult population.

Effect of coexisting foot deformity on disability in women with knee osteoarthritis.

BACKGROUND: Knee osteoarthritis, a common musculoskeletal disorder, can cause considerable pain and disability. This study investigates the effect of certain foot deformities on the functional status of women with knee osteoarthritis. METHODS: The common foot deformities pes planus and hallux valgus were evaluated in 115 women with knee osteoarthritis and Kellgren-Lawrence grade 2 and 3 osteoarthritis. Anteroposterior and lateral foot-ankle standard radiographs were obtained bilaterally. A lateral talometatarsal angle greater than 4 degrees was defined as pes planus. A hallux valgus angle greater than 21 degrees was defined as hallux valgus. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to objectively assess functional impairment. Knee pain intensity was measured with a visual analog scale. RESULTS: Fifty-nine patients had bilateral pes planus, hallux valgus, or both. The mean visual analog scale value was higher for the deformity group, but the difference was not statistically significant. There was a significant difference in WOMAC scores between the group with foot deformities versus the group without (P = .000). Visual analog scale scores were positively correlated with WOMAC scores (r = 0.499, P = .000). Also, there was a significant correlation between WOMAC scores and lateral talometatarsal angle (r = 0.266, P = .004) and hallux valgus angle (r = 0.362, P = .000) values. CONCLUSIONS: There is a significant correlation between indicators of pain and disability (visual analog scale and WOMAC scores). Also, the presence of foot deformities increased disability levels in women with knee osteoarthritis.

Dermoscopy in the Diagnosis of Cutaneous Leishmaniasis.

BACKGROUND: Cutaneous leishmaniasis (CL) is a protozoan infectious disease. Dermoscopy is a noninvasive diagnostic tool that has been applied to several skin diseases, including infestations. OBJECTIVES: To determine the dermoscopic patterns of CL lesions and to investigate whether a relationship exists between dermoscopic characteristics and the disease duration, localization, and type of CL lesions. METHODS: Seventy-nine patients (48 male, 31 female) from Hatay, Turkey, were enrolled in the study and a dermoscopic evaluation was performed on 139 lesions. Images of CL lesions were taken via polarized light contact dermoscopy. Chi-square and Fisher exact tests were used for statistical analyses and P values <0.05 were considered significant. RESULTS: Generalized erythema was seen in all CL lesions. Vascular structures (94.2%), yellow tears (75.5%), and a white starburst-like pattern (58.3%) were the other most common dermoscopic features. Hyperkeratosis (P = 0.001) and white starburst-like pattern (P < 0.001) were more prevalent in the extremities than elsewhere. Among vascular structures, linear irregular (45.8%), hairpin (43.5%), and comma-shaped (25.9%) patterns were the most common dermoscopic findings. Linear irregular (P = 0.023) and arborizing vessels (P = 0.001) were observed in the head-neck region. Dotted (P = 0.009), hairpin (P < 0.001), and glomerular-like (P = 0.016) morphological findings were more prevalent in the extremities. Statistical significances in disease duration were detected in microarborizing (P = 0.027) and arborizing (P = 0.004) vessels and were most prevalent with a disease duration of >6 months. Hairpin vessels were prevalent in the plaque and nodulo-ulcerative type of lesions. Dotted vessels were most commonly seen in the plaque type (47.4%) of lesions. CONCLUSIONS: Generalized erythema, yellow tears, and starburst-like patterns, as well as linear irregular, hairpin, comma-shaped, and arborizing vessels, were the most commonly detected dermoscopic features of CL lesions. We suggest that the presence of these features can be helpful when diagnosing CL lesions by dermoscopy.

Effects of a fixed-payment method on demand for imaging tests in a university hospital.

BACKGROUND: In 2006, a new medical payment framework such as fixed-payment method was implemented in Turkey and then cancelled 5 months later. The aim of this study was to explore the effects of this payment method on the demand for imaging tests. METHODS: Data were obtained retrospectively from electronic medical records. The main outcome measures were the number of imaging tests, the payment per outpatient and the rate of negative results of imaging tests. RESULTS: The overall mean number of imaging tests per outpatient was 0.75 +/- 0.13. This value decreased significantly after implementation of the fixed-payment method, and then increased after its cancellation (P < 0.01). The overall mean payment per outpatient was $14.1 +/- 2.3. For patients with social security, there was a significant decrease in the mean payment after implementation of the new method, followed by an increase after its cancellation (P = 0.02); in contrast, no significant changes were observed in patients not covered by social security (P > 0.05). No significant differences were observed in the rate of negative results for imaging tests (P > 0.05). CONCLUSIONS: The use of a fixed-payment method reduces the demand for imaging tests when there is a strong financial relationship between the hospital and its personnel.

Positive correlation of CRP and fibrinogen levels as cardiovascular risk factors in early stage of continuous ambulatory peritoneal dialysis patients.

We aimed to study the relationship between the C-reactive protein (CRP), albumin, and fibrinogen as cardiovascular risk factors in continuous ambulatory peritoneal dialysis (CAPD) patients, in the early stage of their therapy. The study included 21 CAPD patients as the study group (SG) and age- and sex-matched 21 healthy patients as the control group (CG). History and physical exam data were obtained for all cases, and demographic baseline characteristics were taken. Twelve-hour fasting serum levels of glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, total protein, albumin, hemoglobin, CRP, and fibrinogen were obtained. There was no statistically significant difference between the SG and CG in baseline characteristics, including age, sex, body mass index (BMI), smoking, and family history of cardiovascular disease. However, diabetes mellitus (DM) and hypertension (HTN) were significantly more common among the study group. The average total protein, albumin, and hemoglobin levels were significantly lower, and the CRP and fibrinogen levels were significantly higher (p < 0.001) in the SG. A positive correlation was seen (r = 0.443, p < 0.05) among CRP and fibrinogen levels in SG. There was no correlation among the other parameters in SG. For CG, there was no correlation seen for any studied parameters. When patients with and without cardiovascular disease (CVD) were compared, no correlation was seen between CRP and other parameters. A positive correlation of CRP and fibrinogen levels as cardiovascular risk factors was shown in early stage of CAPD patients. The CAPD patients with elevated levels of CRP and fibrinogen should receive close follow-up for cardiovascular disease prevention.

Clinical presentation and laboratory findings of organic phosphorus poisoning.

This study was conducted to evaluate the demographic, causative, and biologic characteristics of patients with organophosphate (OP) poisoning who were admitted to tertiary teaching and research hospitals at 2 different universities. All patients admitted to the emergency departments of Cukurova University Hospital in Adana, Turkey, between 2001 and 2003 and the Hospital of Mustafa Kemal University in Hatay, Turkey, between 2004 and 2006 were included. The study group consisted of subjects with a mean age of 28.5+/-14.1 y (range, 14-80 y), and the maximum number of cases in the second decade of life; the female-to-male ratio was 2.2:1. In all, 27 of 43 females and 16 of 20 males were married. Most subjects (n=55) had graduated from primary school; 3 were illiterate and 5 were highly educated. A total of 36 (57.1%) subjects belonged to lower socioeconomic groups. Fifty-three patients intended to commit suicide, and 10 cases were accidental. Mean arrival time of subjects to the hospital after poisoning was 9.9+/-16.1 h (range, 1-96 h); mean Glasgow Coma Scale score was 10.2+/-2.9 (range, 3-15). A total of 19 subjects were intubated, and 4 died. A total of 59 patients recovered completely. The mortality rate (6.3%) depended on various factors such as OP compound consumed, amount ingested, time interval before hospitalization, and patients' general health. Chances for recovery were greater when the patient was hospitalized at the earliest indication. In conclusion, OPs especially affected young single females, and most cases were due to attempted suicide. Because OP poisoning is an important cause of morbidity and mortality, therapy should be started immediately to avoid undesirable consequences.

[Herbal supplement usage in cardiac patients]. / Kardiyoloji hastalarinda bitkisel ürün kullanimi.

OBJECTIVE: Complementary and alternative medicine (CAM) has become more and more widespread around the world. CAM is a broad term that refers to all medical healthcare services, methods, and practices that are not part of standard medical care, as well as the accompanying theories and beliefs. The aim of the present study was to investigate the use of herbal medicinal products in cardiac patients, as well as the methods of administration of the products. METHODS: This descriptive cross-sectional study included 199 patients aged over 18 years who were hospitalized in the Defne Hospital department of cardiology and volunteered to participate in a 20-item survey between April 2016 and June 2016. RESULTS: The study results indicated that 28.6% (n=57) of patients were using herbal products and 71.6% (n=142) said they did not. Only 14.03% (n=8) of those who used herbal products said they used them in consultation with their physician; 85.9% (n=49) had used herbal medicine without consulting their doctor. Of the participants with hypertension, 35.7% of them reported using herbal medicinal products. Of these, 22.5% of them were consuming lemon, 17.5% pomegranate syrup, and 17.5% green tea. Of the participants with cardiovascular diseases, 23.5% of them stated that they were taking herbal products. Of these, 25% were consuming green tea, 25% ginger, and 18.8% sage. CONCLUSION: Herbal medicinal supplements were used by a large portion of the cardiac patients in this study. Furthermore, most of the patients stated that they were using these products without informing their physician, a practice that can have unwanted consequences.

Comparison of sugammadex and conventional reversal on postoperative nausea and vomiting: a randomized, blinded trial.

STUDY OBJECTIVE: To determine whether the new selective binding agent sugammadex causes less postoperative nausea and vomiting (PONV) than the cholinesterase inhibitor neostigmine. DESIGN: Prospective, randomized, double-blinded study. SETTING: University-affiliated hospital. PATIENTS: One hundred American Society of Anesthesiologists physical status 1 and 2 patients scheduled for extremity surgery. INTERVENTIONS: Patients were randomly assigned to neostigmine (70 µg/kg) and atropine (0.4 mg per mg neostigmine) or sugammadex 2 mg/kg for neuromuscular antagonism at the end of anesthesia, when 4 twitches in response to train-of-four stimulation were visible with fade. MEASUREMENTS: We recorded PONV, recovery parameters, antiemetic consumption, and side effects. MAIN RESULTS: Nausea and vomiting scores were lower in the sugammadex patients upon arrival in the postanesthesia care unit (med: 0 [min-max, 0-3] vs med: 0 [min-max, 0-3]; P < .05), but thereafter low and comparable. Postoperative antiemetic and analgesic consumption were similar in each group. Extubation (median [interquartile range], 3 [1-3.25] vs 4 [1-3.25]; P < .001) first eye opening (4 [3-7.25] vs 7 [5-11]; P < .001), and head lift (4 [2-7.25] vs 8 [11-25]; P < .001) in minutes were shorter in patients given sugammadex. Postoperative heart rates were significantly lower in all measured times patients given neostigmine. CONCLUSIONS: Nondepolarizing neuromuscular blocking antagonism with sugammadex speeds recovery of neuromuscular strength but only slightly and transiently reduces PONV compared with neostigmine and atropine.

Use of quality circles among first year medical students and impact on student satisfaction.

Quality circles in the classroom setting are composed of students who meet regularly to identify, analyse and solve problems related to a course, and implement solutions. We recently instituted quality circles (QCs) among preclinical medical students and evaluated their impact on quality of learning and student satisfaction. Included in the study were all 135 first-year medical students of Trakya University School of Medicine in the 2000-2001 academic year. Six students were selected randomly out of 26 volunteers as circle members. Circle participants met once a week for 14 45-minute sessions to discuss educational issues, propose solutions and prepare a report for submission to the dean. A questionnaire was administered to all first-year students and the replies provided the problem pool from which the QC chose the problem to be addressed. A total of 22 problems concerned education and 28 were identified in the fields of accommodation, social activities and other issues. To evaluate the change in the perceived quality of learning, circle members prepared a questionnaire designed to compare satisfaction at the beginning and end of the study period. This questionnaire was composed of 26 items and evaluated various aspects of education. There was a significant increase in student satisfaction after the one-year study period (p = 0.001). In addition to enhancing quality of learning, quality circles improved student satisfaction as well. More studies should be conducted to test the impact of QCs on education in different settings and different classes. Our results show that the use of quality circles in first-year medical students improves quality of learning and student satisfaction.

Daytime sleepiness and sleep habits as risk factors of traffic accidents in a group of Turkish public transport drivers.

AIM: To explore the association of daytime sleepiness, sleep complaints and sleep habits with self-reported car crashes among public transport drivers. METHODS: A cross-sectional descriptive study was carried out on male professional public drivers in two different cities using a validated, self-administered sleep questionnaire which comprised of symptoms suggesting sleep disorders, a subjective report of daytime sleepiness and driving characteristics. The subjects (mean age±SD, 40±11 years) were divided into two groups: (1) accident group and (2) no accident group. RESULTS: Forty nine (15.3%) of the 320 public drivers reported that they had at least one sleepiness related motor vehicle accident and/or near-missed accident (Group 1). The mean age, body mass index and annual distance driven were similar in both groups. Although Group 1 reported less sleep time per night, more witnessed apneas, abnormal sleep, alcohol use and had higher mean Epworth Sleepiness Scale scores than Group 2, multivariate analysis of risk factors revealed that only daytime sleepiness increase the risk of traffic accidents [OR: 1.32 (1.19-1.47)]. CONCLUSION: These results suggest that self-reported sleepiness is a predictive sign of traffic accidents due to driver sleepiness.

Comparison of the Relative Renal Function Calculated with 99mTc-Diethylenetriaminepentaacetic Acid and 99mTc-Dimercaptosuccinic Acid in Children.

The aim was to compare the relative renal functions measured with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) and technetium-99m diethylenetriaminepentaacetic acid (99mTc-DTPA) in children with renal diseases. Relative renal function of 128 children who applied to three hospitals from 2009 to 2011 were analyzed retrospectively. The mean value measured with 99mTc-DTPA and 99mTc-DMSA were 51.58 ± 14.95 and 51.96 ± 14.99 for the right kidney, 47.87 ± 15.27 and 47.94 ± 15.17 for the left kidney, respectively. A significant positive correlation was found between the relative renal functions (r = 0.963, P < 0.001). In Bland-Altman plots, the mean difference between two methods was 0.7 and the correlation limits were between 10.1 and-10.8. As a result, although 99mTc-DMSA is accepted as the most reliable method for the determination of relative renal function, 99mTc-DTPA can be another choice for the calculation of relative renal function without a complementary DMSA scan particularly in pediatric patients who require renogram curve and GFR calculations.