Religious Identity and its Relation to Health-Related Quality of Life and COVID-Related Stress of Refugee Children and Adolescents in Germany.

Research shows that religious identity is associated with health. The aim of this study was to understand the role of religious identity for refugee minors' health in greater detail. Middle Eastern refugee minors resettled in Germany and aged 8-18 years completed questionnaires at baseline (T1, n = 246) and follow-up (T2, n = 122) measurement between 2019 and 2022. Religious identity was assessed with a 4-item measure (Cronbach's α = .89). Associations of religious identity at T1 with health-related quality of life (HRQoL) at T1, change in HRQoL from T1 to T2, and perceived COVID-related stress at T2, as well as the mediating role of resources were examined. The results showed a positive association between religious identity and HRQoL, which was partially mediated by integration into peer group, but not by ethnic identity, sense of coherence or religious practice. No significant associations between religious identity and change in HRQoL or COVID-related stress occurred. Therefore, cross-sectional analyses support the beneficial role of religious identity for HRQoL and the crucial mediating role of integration into peer group, suggesting the promotion of religious identity or peer group integration. However, the absence of significant effects on change in HRQoL from T1 to T2 and COVID-related stress at T2 do not allow drawing any long-term conclusions.

ERAS in Cardiac Surgery: Wishful Thinking or Reality.

Enhanced recovery after cardiac surgery (ERACS) is a multi-disciplinary approach to improve patient outcomes and reduce complications following cardiac surgery. The aim of ERACS protocol is to optimize pre-operative preparation, reduce surgical trauma, and minimize post-operative stress.The protocol has been shown to improve patient outcomes, including shorter hospital stays, lower rates of complications, and faster return to normal activities. It is important to note that ERACS is a multi-disciplinary approach, and requires close collaboration between surgeons, anaesthesiologists, nurses, and other healthcare professionals to ensure successful implementation. Anaesthesiologists play a crucial role in the ERACS protocol, as they are responsible for the management of the patient's anaesthesia and pain management during and after surgery. In this paper provide an overview of the ERACS protocol from the perspective of an anaesthesiologist.

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study.

PURPOSE: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. METHODS: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. RESULTS: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. CONCLUSION: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide.

Quantification of beta-lactam antibiotics cefuroxime and flucloxacillin in human synovial fluid, using ultra-performance convergence chromatography-tandem mass spectrometry.

Total hip- and knee arthroplasty generally result in successful outcomes. A small percentage of patients however suffer from periprosthetic joint infections (PJI) postoperatively, often with severe consequences. The standard treatment of chronic PJIs consists of a staged arthroplasty exchange during which antibiotic therapy plays a crucial role. For successful antibiotic treatment, adequate concentrations at the infection site are a prerequisite. Regarding the treatment of PJIs, knowledge is lacking with respect to the relationship between administered dosages and plasma- and infection site concentrations of the antibiotics. To gain insight into the antibiotic exposure at the infection site, validated analytical methods for analysis of the antibiotics in matrices at the site of the PJI are essential. We describe a validated ultra-performance convergence chromatography-tandem mass spectrometry (UPC2-MS/MS) method for quantification of the beta-lactam antibiotics cefuroxime and flucloxacillin in synovial fluid. This method was successfully validated for antibiotic quantification in synovial fluids according to the EMA guidelines and consists of a simple sample preparation. For both antibiotics, the accuracy and precision were within requirements (RSD < 15%). In addition, matrix effects and recovery were within the range of 80-120%. Carry over was less than 20% and stability in -80 °C was at least 2 months for standards and quality controls. The limits of quantification were adequate (1-100 mg/L) to cover potential cefuroxime and flucloxacillin concentrations in synovial fluid as described in literature (r > 0.995). The method has a run time of 4.5 min and 50 µL synovial fluid is needed and the validated method will be applied during a PK/PD study to determine the exposure of the study antibiotics in synovial fluid at the site of PJIs.

Population Pharmacokinetics of Intravenous Ganciclovir and Oral Valganciclovir in a Pediatric Population To Optimize Dosing Regimens.

Ganciclovir is indicated for curative or preventive treatment of cytomegalovirus (CMV) infections. This study aimed to characterize ganciclovir pharmacokinetics, following intravenous ganciclovir and oral valganciclovir administration, to optimize dosing schemes. All children aged <18 years receiving ganciclovir or valganciclovir were included in this study. Pharmacokinetics were described using nonlinear mixed-effect modeling. Monte Carlo simulations were used to optimize the dosing regimen to maintain the area under the concentration-time curve (AUC) in the preventive or therapeutic target. Among the 105 children (374 concentration-time observations) included, 78 received intravenous (i.v.) ganciclovir, 19 received oral valganciclovir, and 6 received both drugs. A two-compartment model with first-order absorption for valganciclovir and first-order elimination best described the data. An allometric model was used to describe the bodyweight (BW) effect. Estimated glomerular filtration rate (eGFR) and medical status of critically ill children were significantly associated with ganciclovir elimination. Recommended doses were adapted for prophylactic treatment. To obtain a therapeutic exposure, doses should be increased to 40 mg/kg of body weight/day oral or 15 to 20 mg/kg/day i.v. in children with normal eGFR and to 56 mg/kg/day oral or 20 to 25 mg/kg/day i.v. in children with augmented eGFR. These doses should be prospectively confirmed, and therapeutic drug monitoring could be used to refine them individually. (This study has been registered at ClinicalTrials.gov under identifier NCT02539407.).

Population Pharmacokinetics of Intravenous and Oral Acyclovir and Oral Valacyclovir in Pediatric Population To Optimize Dosing Regimens.

Acyclovir is an antiviral currently used for the prevention and treatment of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections. This study aimed to characterize the pharmacokinetics (PK) of acyclovir and its oral prodrug valacyclovir to optimize dosing in children. Children receiving acyclovir or valacyclovir were included in this study. PK were described using nonlinear mixed-effect modeling. Dosing simulations were used to obtain trough concentrations above a 50% inhibitory concentration for HSV or VZV (0.56 mg/liter and 1.125 mg/liter, respectively) and maximal peak concentrations below 25 mg/liter. A total of 79 children (212 concentration-time observations) were included: 50 were taking intravenous (i.v.) acyclovir, 22 were taking oral acyclovir, and 7 were taking both i.v. and oral acyclovir, 57 for preventive and 22 for curative purposes. A one-compartment model with first-order elimination best described the data. An allometric model was used to describe body weight effect, and the estimated glomerular filtration rate (eGFR) was significantly associated with acyclovir elimination. To obtain target maximal and trough concentrations, the more suitable initial acyclovir i.v. dose was 10 mg/kg of body weight/6 h for children with normal renal function (eGFR ≤ 250 ml/min/1.73 m2) and 15 to 20 mg/kg/6 h for children with augmented renal clearance (ARC) (eGFR > 250 ml/min/1.73 m2). The 20-mg/kg/8 h dose for oral acyclovir and valacyclovir produced effective concentrations in more than 75% of children; however, a 15-mg/kg/6 h dose, if possible, is preferred. These doses should be prospectively confirmed, and therapeutic drug monitoring could be used to refine them individually. (This study has been registered at ClinicalTrials.gov under identifier NCT02539407.).

The association of severe encephalopathy and question mark ear is highly suggestive of loss of MEF2C function.

Auriculocondylar syndrome and isolated question mark ear result from dysregulation of the endothelin 1-endothelin receptor type A signaling pathway. Animal models have highlighted the role of the transcription factor MEF2C as an effector of this pathway. We report heterozygous MEF2C loss-of-function as a possible cause of question mark ear associated with intellectual deficiency.

Intraoperative left atrium inversion after implantation of HeartMate III ventricular assist device.

We report here a case of left atrium inversion after implanting HeartMate III LVAD, which is known to be the first in literature. LVAD can be functional only if there is adequate inflow to the device. Parameters and filling of left ventricle can be assessed by TEE. In our case, initial examination with TEE showed thrombus like images. HeartMate III has a reliable algorithm that automatically reduces pump speed if 'suction effect' is detected. HeartMate III demonstrates clean flow properties and good surface wash. Despite these positive features of the HeartMate III, left atrium inversion can still be seen with it, so users should be alert in this regard.

Vaccinations, response, and controls before and after intestinal transplantation in children.

Vaccination is an effective strategy to decrease infections in transplant recipients. Children after intestinal transplantation carry a high risk of infection due to increased immunosuppression. In a series of 22 children after intestinal transplantation, we studied the vaccination schedules and the antibodies against vaccine-preventable diseases before transplantation, and at one and five yr after transplantation. We reviewed whether the vaccination schedules were complete, and we analysed the factors that may influence serological immunity and the incidence of disease in patients with deficient immunity. All patients completed the recommended vaccination schedules for DTaP-IPV and HBV. After transplantation, the negative antibodies against vaccine-preventable diseases were mostly related to an antirejection therapy: for DTaP-IPV: four of four patients with no antibody had been treated for rejection, for HBV: two of five, HAV: three of four, MMR: three of seven, and VZV: three of four. A post-transplantation varicella infection was followed by acute rejection, with probability for a relationship between both events. We observed 50% of varicella cases in unvaccinated children, highlighting the importance of pretransplant vaccination. Waning immunogenicity mediated by antibodies against vaccine-preventable disease after transplantation indicated a need for boosters. The recommendations should be regularly enforced, as the reliance on routine immunizations schedules is not adequate in immunocompromised patients.

Systemic vasculitis in a patient with rhupus syndrome.

Rhupus is a rare syndrome characterized by overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Previous reports mentioned that rhupus patients have prominent RA associated clinical manifestations and only mild organic damage related to SLE. Progressive or life-threatening manifestations are rare in rhupus patients. Our patient diagnosed as rhupus was a young women, presented with multi-organ involvement of systemic vasculitis. Rheumatologists should be aware of possibility that rhupus may be accompanied by progressive or life-threatening conditions such as vasculitis.

USE OF COVER CROPS FOR WEED SUPPRESSION IN HAZELNUT (CORYLUS AVELLANA L.) IN TURKEY.

Weed management is critical in hazelnut (Corylus avellana) production. Weeds reduce nutrient availability, interfere with tree growth, and reduce hand-harvesting efficiency. Field experiments were conducted to test effects of cover crops as alternative weed management strategies in hazelnut. The cover crop treatments consisted of Trifolium repens L., Festuca rubra subsp. rubra L., Festuca arundinacea Schreb., Vicia villosa Roth. And Trifolium meneghinianum Celmand fallow with no cover crop. Control plots such as weedy control, herbicide control and mechanical control were added as reference plots. The lowest weed dry biomass was obtained from Vicia villosa plots, and there were no significant differences among all other cover crop treatments. The highest cover crop dry biomass was measured in the Trifolium meneghinianum plots. Regarding the effect of cover crops on hazelnut yields, the lowest yield was ob- tained from weedy control plots, while the highest yield was obtained from F. arundinacea plots. This research indicated that cover crops could be used as living mulch in integrated weed management programs to manage weeds in the hazelnut orchards.

Oxidative stress of intracameral lidocaine and levobupivacaine on ocular tissues.

BACKGROUND: To investigate the biochemical changes on the oxidant/antioxidant balance in corneal and lens tissues in rabbits, and to determine the relative corneal endothelial toxicities following the injection of intracameral anaesthetic agents: levobupivacaine 0.5% or lidocaine 2%. METHODS: The experiment was conducted using New Zealand rabbits. The rabbits were randomly divided into three experimental groups. Twenty eyes received injections of 0.2 ml of one of the two anaesthetic preparations and 10 control eyes received injections of 0.2 ml balanced salt solution. Corneal thickness and clarity were measured before and 3 and 6 h after surgery. Anterior chamber reaction was evaluated 1, 3 and 6 h after surgery. In corneal and lens tissues, malondialdehyde and total thiol levels were measured using spectrophotometric methods. RESULTS: Levobupivacaine 0.5% caused corneal thickening, oedema and anterior chamber reaction (p<0.001). There were no biochemical changes in the levobupivacaine group (p>0.05). No change was observed in the corneal thickness, oedema and anterior chamber reactions, whereas the level of malondialdehyde significantly increased in corneal and lens tissues (p<0.001, p=0.015, respectively), and the level of total thiol significantly decreased in the lens tissue in the lidocaine 2% group (p<0.001). CONCLUSIONS: The results of this study suggest that levobupivacaine 0.5% has an immediate toxicity on corneal endothelium. Lidocaine 2% causes oxidative damage on corneal and lens tissues. Surgeons should not use repetitive and high doses of intracameral lidocaine in the presence of corneal pathology during cataract surgery.

Preserved costal cartilage homograft application for the treatment of temporomandibular joint ankylosis.

Ankylosis of the temporomandibular joint has been a daunting problem in oral and maxillofacial surgery. Condylectomy with gap arthroplasty is the basic technique for treatment of the fully grown patient. In the past, reconstruction has primarily been accomplished with alloplastic materials or with autogenous tissue harvested from the patient. Joints reconstructed with alloplastic materials have been subject to complications such as acute infection and chronic inflammatory problems as a result of foreign-body reaction with the immune system. Biologic reconstruction with autogenous materials does expose the patient to the risk of complications at the donor site. In the last 4 years, we have treated seven patients between the ages of 20 and 42 years who had complete temporomandibular joint ankylosis. In each patient, the affected joint was exposed through an extended preauricular incision. The ankylosed mandibular condyle with the surrounding abnormal bone, together with the coronoid process, was resected and removed. The ankylosed area was resected until an improvement of at least 15 mm in the interincisal opening distance was obtained. A solvent-preserved homologous cartilage graft was sculpted according to the size and shape of the gap and was then placed in it as interpositional material. Physical therapy, including active and passive mouth-opening exercises, began on the second postoperative day and continued for 6 months. Patients were observed for 6 months to 4 years. During this period, no major complications were noted, and satisfactory results were obtained. The initial mean interincisal opening distance was 15.2 mm after surgery, and the final mean interincisal opening distance was 32 mm after completion of physiotherapy. No recurrence was seen during the 4 years of follow-up. This technique seems to be an effective, time-saving, and simple alternative to other methods of joint reconstruction in adults who have fairly extensive ankylosis of the temporomandibular joint. In this article, a description of the surgical technique, a review of all cases, and recommendations for the use of this type of graft material are discussed. Our clinical experience over the past 4 years with the use of preserved homologous costal cartilage grafts as interpositional material has been encouraging.

Effect of coronary sinus diastolic balloon pulsation on ischemic myocardium.

OBJECTIVES: To evaluate the effect of coronary sinus diastolic balloon pulsation (CSDBP) on acute myocardial ischemia and infarction. It was hypothesized that this procedure would improve retrograde flow to ischemic areas and allow for more complete oxygen exchange and venous washout of metabolites, with elevated coronary sinus pressure and retrograde pulsation. ANIMALS AND METHODS: This two-part study was done on 10 dogs. First, CSDBP was applied to normal myocardium by a balloon catheter and a pump system at beat to beat cardiac cycles of 1:1, 2:1 and 3:1. Then coronary ischemia was obtained by coronary artery ligation and the procedure was repeated. Electrocardiographic (ECG), arterial and coronary sinus pressure alterations were monitored continuously, and arterial, mixed venous and coronary sinus blood lactate concentrations were measured at each stage of the study. RESULTS: In the first stage no hemodynamic deterioration was observed. In the second stage, mean ECG-ST segment elevation was 6.30+/-0.95 mm (P<0.01) and coronary sinus blood lactate concentration increased to 5.37+/-0.37 mmol/L from 1.95+/-0.31 mmol/L (P<0.01). ECG-ST segment elevation decreased to 3.73+/-0.64 mm and coronary sinus blood lactate concentration decreased to 4.79+/-0.28 mmol/L (P<0.05) with 1:1 beat to beat CSDBP. ECG-ST segment elevation decreased to 2.95+/-0.73 mm and coronary sinus blood lactate concentration decreased to 4.4+/-0.22 mmol/L with 2:1 CSDBP. ECG-ST segment elevation decreased to 3.6+/-0.42 mm and coronary sinus blood lactate concentration decreased to 4.17+/-0.22 mmol/L with 3:1 CSDBP as well. DISCUSSION: Results showed that CSDBP technique lowered the increased ECG-ST segment elevation and myocardial lactate production.

Sternal closure with resorbable synthetic loop suture material in children.

PURPOSE: The reliability of poly-p-dioxanone (PDS) suture for sternal closure was tested on 264 consecutive sternotomies in the authors' department from April 1987 to May 1998. METHODS: The reason for sternotomy was tetralogy of Fallot in 65 cases (24.6%), ventricular septal defect (VSD) in 38 cases (14.4%), atrial septal defect (ASD) in 77 cases (29.2%), ASD + VSD in 23 (8.7%), mitral valve replacement in 22 cases (8.3%), aortic valve replacement in 10 cases (3.8%), and other cardiac disorders in 29 cases (11.0%). RESULTS: Sternal wound infection, sternal dehiscence, and mediastinitis occurred in 1.5% of patients (4 of 264). The overall hospital mortality rate related to the mediastinitis was 1.1% (3 of 264) in the early postoperative period. CONCLUSION: This absorbable suture and our different technique are a safe alternative to standard sternotomy closure after pediatric open cardiac surgery.

Reverse neurofasciocutaneous flaps for soft-tissue coverage of the lower leg.

The evolution of neurocutaneous flaps has created a new concept in reconstructive surgery. These flaps, based on the arterial network around the superficial sensory nerves, are gaining popularity in soft-tissue coverage. Various flaps can be planned based on the neurocutaneous perforators. These kinds of flaps are available for extremity reconstruction. In the lower leg, reverse neurocutaneous flaps have been used successfully. Although these flaps in the lower leg are called neurocutaneous, they have been elevated with the underlying fascia like fasciocutaneous flaps, and thus the authors call these flaps neurofasciocutaneous flaps. They have used 11 reverse neurofasciocutaneous flaps (6 saphenous and 5 sural) since 1995. All flaps survived completely, and stable coverage of soft-tissue defects of the lower leg was achieved in all patients.

An unusual case of hypoglossia-hypodactyly syndrome.

Hypoglossia-hypodactyly syndrome is seen very rarely and its appearance is sporadic. Different degrees of tongue hypoplasia and transverse deficiencies in the upper extremities are seen. In the patient presented there was a sulcuslike deformity at the midline of the lower lip, and the continuity of the orbicularis oris muscle was disturbed at this location, in addition to the classic findings of hypoglossia-hypodactyly syndrome. A description of this variant and its treatment are described.

Uncommon Klinefelter's variant (49,XXXXY) with cleft palate.

The karyotype 49,XXXXY is a rare form of Klinefelter's syndrome. Various anomalies can be found in this variant--more than other variants of Klinefelter's syndrome. Cleft palate is rarely seen among these anomalies. A cleft palate deformity can be diagnosed early and easily. This deformity should cause one to suspect an uncommon variant of Klinefelter's syndrome. Here we present a patient with an uncommon variant of Klinefelter's syndrome who was diagnosed with the help of the presence of an incomplete cleft palate deformity.

Extensive bilateral eyelid ptosis caused by xanthoma palpebrarum.

Xanthoma palpebrarum is the most common form of xanthoma that appears in the eyelids. Usually there is no functional loss in the eyelids and plaque formation is typical. In this article, we present a patient who had xanthomatic masses that covered the whole upper eyelids. The masses caused a serious degree of ptosis in both upper eyelids. This patient was searched for systemic disease. After removal of the xanthoma palpebrarum, extensive ptosis has been relieved.