Alterations in the spinal cord, trigeminal nerve ganglion, and infraorbital nerve through inducing compression of the dorsal horn region at the upper cervical cord in trigeminal neuralgia.

BACKGROUND: Idiopathic trigeminal neuralgia (TN) cases encountered frequently in daily practice indicate significant gaps that still need to be illuminated in the etiopathogenesis. In this study, a novel TN animal model was developed by compressing the dorsal horn (DH) of the upper cervical spinal cord. METHODS: Eighteen rabbits were equally divided into three groups, namely control (CG), sham (SG), and spinal cord compression (SCC) groups. External pressure was applied to the left side at the C3 level in the SCC group. Dorsal hemilaminectomy was performed in the SG, and the operative side was closed without compression. No procedure was implemented in the control group. Samples from the SC, TG, and ION were taken after seven days. For the histochemical staining, damage and axons with myelin were scored using Hematoxylin and Eosin and Toluidine Blue, respectively. Immunohistochemistry, nuclei, apoptotic index, astrocyte activity, microglial labeling, and CD11b were evaluated. RESULTS: Mechanical allodynia was observed on the ipsilateral side in the SCC group. In addition, both the TG and ION were partially damaged from SC compression, which resulted in significant histopathological changes and increased the expression of all markers in both the SG and SCC groups compared to that in the CG. There was a notable increase in tissue damage, an increase in the number of apoptotic nuclei, an increase in the apoptotic index, an indication of astrocytic gliosis, and an upsurge in microglial cells. Significant increases were noted in the SG group, whereas more pronounced significant increases were observed in the SCC group. Transmission electron microscopy revealed myelin damage, mitochondrial disruption, and increased anchoring particles. Similar changes were observed to a lesser extent in the contralateral spinal cord. CONCLUSION: Ipsilateral trigeminal neuropathic pain was developed due to upper cervical SCC. The clinical finding is supported by immunohistochemical and ultrastructural changes. Thus, alterations in the DH due to compression of the upper cervical region should be considered as a potential cause of idiopathic TN.

Headache related to mask use of healthcare workers in COVID-19 pandemic.

BACKGROUND: It has been reported that a new type of headache may develop as a result of face mask use during the COVID-19 pandemic. The aim of this study is to investigate the clinical features of face mask-related headache during the COVID-19 pandemic. METHODS: This is a cross-sectional study carried out on healthcare workers at the Afyonkarahisar Health Sciences University. The number of workers at our university was established. Sample size was calculated using the G*Power program. A questionnaire consisting of questions relating to pre-existing headache, an aggravation in headache, and de-novo headache was filled out by 3 neurologists with all participants. RESULTS: Data was collected from a total of 375 participants, after the exclusion of 5 individuals who refused to participate. Out of all participants, 26 (6.9%) used a filtering mask, 274 (73.1%) used a surgical mask, 75 (20.0%) participants used a combination of both masks. The number of participants with preexisting headache was 114 (30.4%) had pre-existing headache. Of those with pre-existing headache, 77 (67.5%) healthcare workers had reported an aggravation in their headache after mask use. De-novo headache was observed in 116 (30.9%) of participants. De-novo headache characteristics included throbbing in 17 (14.7%) participants and pressing in 99 (85.3%) participants. In addition, symptoms such as tachypnea, sleep disturbance, and fatigue were found to be significantly higher. CONCLUSIONS: This study indicates that healthcare workers develop headaches due to use of masks during the COVID-19 outbreak.

The effect of burn severity on functional capacity in patients with burn injury.

BACKGROUND: Burns are traumatic injuries that result in severe tissue damage. A reduction in exercise capacity is the most common functional impairment, although it is not clear to what extent the severity of the burn injury affects the exercise capacity. OBJECTIVE: The aim of this study was to examine the physiological responses to exercise and to evaluate exercise capacity according to burn severity. METHODS: The study included a total of 64 burn patients, comprising 33 with moderate injuries (Total body surface area: 9.93 ± 4.73%; mean age: 37 ± 11.93 years) and 31 with major injuries (Total body surface area: 39.03 ± 10.36%; mean age: 41.09 ± 14.96 years). Heart rate, systolic blood pressure, diastolic blood pressure, double product, dyspnea level, oxygen saturation and leg fatigue before and after the shuttle walk test were recorded. Walking distances were measured after the shuttle walk test. RESULTS: A significant difference was determined between patients with major and moderate burn injuries in respect of the cardiovascular responses to the shuttle walk test. Major burn injury patients had a significantly shorter walking distance than the moderate burn injury patients (p< 0.05). CONCLUSIONS: Burn injury severity was seen to affect the functional capacity and cardiovascular responses to the shuttle walk test. Shuttle walk test can be preferred to evaluate moderate and major burn injury patients' functional capacity in the acute period of injury.

Clinical evaluation of negative-pressure wound therapy in the management of electrical burns.

BACKGROUND: In this study, we aimed to evaluate the clinical efficacy and safety of negative-pressure wound therapy (NPWT) in the treatment of the patients with electrical burns. METHODS: This study was retrospectively performed using a database placed prospectively in the burn center of our hospital. All consecutive patients with electrical burns treated using NPWT at our center between August 2008 and December 2012 were included. The treatment results in our study were grouped as successful or unsuccessful considering the treatment objectives in accordance with therapy indications. RESULTS: In total, 39 patients were included in our study; of them, 36 (92.3%) were men. The average age was 34.9±9.8 years (range, 17-63 years). The majority of the patients in our study (92.3%) had been exposed to high voltage electricity. The mean total burned body surface area (TBSA) was 19.3±9.8 (range, 4-44). Six patients (15.4%) had TBSAs ≥30%, 31 (79.5%) had third degree burns, and 8 (20.5%) had fourth degree burns. In our study, indications of NPWT included bone and/or tendon exposed deep wounds that are not suitable for early grafting or flap applications owing to the lack of supporting tissue in 27 (69.2%) patients, graft fixation in 8 (20.5%) patients, and secondary grafting following graft loss in 4 (10.3%) patients. The general success rate of NPWT was 90.7% according to indications and treatment objectives in our study. CONCLUSION: In the light of our results, NPWT may contribute to the present conventional treatments used in severe electrical burns.

Can we make an early 'do not resuscitate' decision in severe burn patients?

BACKGROUND: The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. METHODS: Between January 2009 and December 2014, 29 patients (3.44%) with very severe burns were admitted to burn unit. Average total burn surface area (TBSA) was 94.24% (range: 85-100%), and in 10 patients, TBSA was 100%. Additional inhalation burns were present in 26 of the patients (89.65%). All of the patients died, despite every medical intervention. Mean survival was 4.75 days (range: 1-24 days). Total of 17 patients died within 72 hours. Lethal dose 50 (% TBSA at which certain group has 50% chance of survival) rate of our burn center is 62%. Baux indices were used for prognostic evaluation of the patients; mean total Baux score of the patients was 154.13 (range: 117-183). RESULTS: It is well known that numerous problems may be encountered during triage of severely burned patients in Turkey. These patients are referred to burn centers and are frequently transferred via air ambulance between cities, and even countries. They are intubated and mechanical ventilation is initiated at burn center. Many interventions are performed to treat these patients, such as escharotomy, fasciotomy, tangential or fascial excision, central venous catheterization and tracheostomy, or hemodialysis. Yet despite such interventions, these patients die, typically within 48 to 96 hours. Integrity of the body is often lost as result of aggressive intervention with no real benefit, and there are also economic costs to hospital related to use of materials, bed occupancy, and distribution of workforce. For these reasons, as well as patient comfort, early do-not-resuscitate or do-not-intubate protocol for these patients is suggested. Resources could then be directed to other patients with high expectancy of life and patients with burns that are beyond treatment can experience more comfortable end of life. CONCLUSION: At present in Turkey, it is not possible to give DNR order for patient with severe burns that are incompatible with survival due to legal interdiction. This subject should be discussed at high-level meetings with participation of doctors, legal experts, economists, and theologians.

Retrospective analysis of patients with burn injury treated in a burn center in Turkey during the Syrian civil war.

OBJECTIVES: To report the management of burn injuries that occured in the Syria civil war, which were referred to our burn center. Methods: Forty-three patients with burns, injured in the civil war in Syria and whom were referred to Dr. Lütfi Kirdar Kartal Educating and Training Hospital Burn Centre of Istanbul, Turkey between 2011-2015 were analyzed in a retrospective study. Results: Most of our patients were in major burn classification (93%; 40/43) and most of them had burns greater than 15% total on body surface area. Most of them were admitted to our center late after first management at centers with improper conditions and in cultures of these patients unusual and resistant strains specific to the battlefield were produced. Conclusion: Immediate transfer of the patients from the scene of incidence to burn centers ensures early treatment, this factor may be effective on the outcome of these patients.

Opposition to organ donation and transplant by midwifery, nursing, and social work students.

OBJECTIVES: This study sought to determine the individual and social factors of students enrolled in undergraduate programs of midwifery, nursing, and social work, regarding their negative attitudes on organ donation and transplant. MATERIALS AND METHODS: This was descriptive research, consisting of 29 first- and second-year students from the departments of midwifery, nursing, and social work at the Kocaeli School of Health, Kocaeli University, in Kocaeli, Turkey, who expressed that they were opposed to organ donation and transplant. Data were collected in June 2012 during focus group discussions with a semistructured questionnaire and analyzed by thematic content analysis. RESULTS: Regarding negative attitudes toward organ donation and transplant, 7 themes were identified: fear, lack of knowledge, religious belief, loss of bodily integrity, the degree of recipient relationship, the decision 's effect on the family, and fulfilment of certain criteria for a recipient. CONCLUSIONS: The study shows that the most important determinants of students' negative attitudes regarding organ donation and transplant are fear, lack of knowledge, and religious beliefs. Adding courses to the undergraduate curricula of midwifery, nursing, and social work programs about organ donation and transplant would increase these students ' knowledge.

Does acupuncture have a positive effect on school success in children?

OBJECTIVE: To evaluate school success in pediatric patients undergoing acupuncture treatment for various indications. METHODS: The grades achieved during both school terms by children undergoing acupuncture treatment for various indications at the pediatric outpatient clinic of Ulus State Hospital were analyzed. Exam grades in mathematics, social studies, and Turkish was compared between the first and the second terms. Forty children were included in the study, with 22 male and 18 female, and their average age was 11.1 years. These patients were undergoing acupuncture treatment for attention deficit-hyperactivity disorder (ADHD), enuresis nocturna, migraine, obesity, atopic dermatitis, alopecia areata, and Tourette's syndrome. Treatments were done at the beginning of the second term. Four of the 25 patients with ADHD had borderline intelligence quotients. The report cards of all 40 patients were examined, and their grades in the first and the second school term were compared. RESULTS: There was a statistically significant increase in the grades obtained in mathematics, social studies, and Turkish (P < 0.005) by the students from the first to the second school term. When 4 ADHD patients with borderline deficiency in intelligence were excluded, and the grades among the 21 patients with ADHD were compared for both terms, there was also a statistically significant increase in mathematics, social studies, and Turkish grades (P < 0.05). CONCLUSION: Acupuncture contributed to the academic success of the children who underwent acupuncture treatment for their primary symptoms.

[Clinical, radiological and bronchoscopic evaluation of inhalation injury cases treated at a burn center]. / Yanik merkezimizde takip edilen inhalasyon yanigi olgularinda, klinik, radyolojik ve bronkoskopik degerlendirme.

BACKGROUND: We aimed to introduce inhalation injury, pulmonary complications and mortality-related factors on the basis of clinical, radiological and bronchoscopic findings in patients with inhalation burns. METHODS: Between January 2009 and January 2010, patients hospitalized in the intensive care unit (ICU) of a burn center who were diagnosed as inhalation burn and underwent bronchoscopy were included in the study. Demographic findings, burn type, burn percentage, clinical-laboratory features, chest Xray findings on the first and fifth days, and bronchoscopic lesions were obtained from patient files. Bronchoscopic findings were classified, and bronchoscopic score for each patient was calculated. Clinical, laboratory and radiological findings, length of stay in the ICU, and bronchoscopic scores of patients who were discharged versus of those who died were compared, and mortality-related factors were investigated. RESULTS: Twenty-nine patients (25 male, 4 female; mean age 40.1 +/- 3.4 years) were included. Radiological abnormalities were found in 41.3% and 65.5% of patients on the first and fifth days of hospitalization, respectively. There were no complications related to bronchoscopy. Percentage of burn and duration of stay in the ICU were higher in patients who died than in discharged patients (20.4%-48.5%, p = 0.003; mean: 7.0-13.7 days, p = 0.037, respectively). Of patients who died, 79.1% showed radiological abnormality and 50% had acute respiratory distress syndrome (ARDS) on the fifth day of hospitalization. There were no pathologic findings on chest X-ray and no ARDS was seen on the fifth day in patients who were discharged (p < 0.05). CONCLUSION: Inhalation burns in patients with cutaneous burns cause a high percentage of pulmonary complications and increase mortality. Bronchoscopy must be performed early for diagnosis, and close follow-up of these patients is necessary.

Clinical evaluation of a temporary fecal containment device for non-surgical fecal diversion in perineal burns.

BACKGROUND: The aim of this study was to evaluate the clinical results of a temporary fecal containment device (Flexi-Seal® FMS) in our burn center. METHODS: All patients in whom temporary fecal containment devices were applied for perineal burns between August 2008 and August 2009 in our institution were reviewed. Demographics, etiology of burns, total body surface area (TBSA) burned, intensive care unit (ICU) need, early mortality, and post-application data were obtained from a prospectively designed database. In addition, some variables were investigated as potential risks factors for fecal leakage. RESULTS: The mean age of patients (n=15) was 43.1±22.1 years, and 66.7% of the patients were male. The mean %TBSA burned was 40.7±16.6. Fecal leakage was seen in 6 patients. Local infection in the perineum was observed in 6 patients, including 4 of the 6 patients with fecal leakage. The mortality rate was 33% (5 deaths). All exitus patients had 50% or more TBSA burned. Electrical burn injury was found as a significant risk factor for fecal leakage in surviving patients (p<0.05). Autologous split-thickness grafting was performed in 8 patients without complication. The mean duration of catheterization was 22.5±5.7 days. Except for superficial mucosal erosion in the distal rectum in 2 cases, no complication was observed. The mean hospitalization time was 46.7±12.7 days. CONCLUSION: If the safety of these devices is proven in further prospective, high-volume studies, they may reduce the necessity of diverting stoma operation in burn patients.