Subcutaneous wound infiltration of ketamine is superior to bupivacaine in terms of pain perception and opioid consumption after cesarean section: a double-blinded randomized placebo-controlled clinical trial.

OBJECTIVE: The aim of the present study was to evaluate the analgesic efficiency of SC ketamine, either alone or in combination with bupivacaine, following CS by means of postoperative pain and opioid need. PATIENTS AND METHODS: One hundred and twenty women were allocated into 4 groups in this prospective, double-blind, placebo-controlled, randomized trial. Group K (Ketamine, n=30) received SC 1 mg/kg ketamine. Group B (Bupivacaine, n=30) received SC 20 mL bupivacaine 0.5%. Group KB (Ketamine+Bupivacaine, n=30) received SC ketamine 1 mg/kg plus SC 20 mL bupivacaine 0.5%. Group P (Placebo, n=30) received SC 30 mL 0.9% saline (placebo). RESULTS: VAS scores at resting and on coughing and analgesic consumptions were compared. Visual analogue scale (VAS) pain scores at rest and coughing, at 15 and 60 minutes, and 2, 6 and 12 hours, and total opioid necessity were measured. VAS scores at rest in Group P were higher than in Group KB at the 6th hour, while lower in Group K and Group KB than in Groups B or P at the 12th hour. Patients receiving placebo had higher coughing VAS scores than those receiving ketamine or ketamine+bupivacaine at 2nd, 6th and 12th hours. Patients in Groups P and B required higher doses of morphine than those in groups K or KB. CONCLUSIONS: Subcutaneous ketamine, either alone or in combination with bupivacaine, provides a better postoperative pain relief and reduces postoperative opioid consumption when compared to use of bupivacaine alone.

The comparison of intraincisional bupivacaine infiltration and intravenous paracetamol administration for pain alleviation after cesarean section: a double-blinded randomized placebo controlled clinical trial.

OBJECTIVE: This study aimed to compare the analgesic effect of subcutaneous (SC) bupivacaine and intravenous (IV) paracetamol on postoperative pain and opioid requisites in patients undergoing cesarean delivery. PATIENTS AND METHODS: One hundred and five women were allocated into 3 groups in this prospective, double-blind, placebo-controlled, randomized trial. Group 1 received SC bupivacaine, Group 2 received IV paracetamol following surgery and every 6 hours for 24 hours in the postoperative period, Group 3 received SC 0.9% saline and IV 0.9% saline at similar periods. Visual analogue scale (VAS) pain scores at rest and coughing, at 15 and 60 minutes, and 2, 6 and 12 hours, and total opioid necessity were measured. RESULTS: VAS scores at rest were higher in placebo group than in bupivacaine and paracetamol groups at 15 minutes (p=0.047) and 2 hours (p=0.004). VAS scores at coughing were higher in placebo group than in bupivacaine and paracetamol groups at 2 hour (p=0.001) and 6 hours (p=0.018). Placebo group needed higher (p<0.001) doses of morphine than paracetamol or bupivacaine groups. CONCLUSIONS: Intravenous paracetamol decreases pain scores similar to SC bupivacaine in the postoperative period compared to placebo. Patients taking bupivacaine or paracetamol need fewer opioids than placebo.

Fetal front-abdominal wall thickness in the second trimester as a predictor of abnormal fetal growth.

OBJECTIVES: Worldwide, approximately 9% of infants have a birth weight ≥4000 g, who are defined as fetal macrosomia, with wide variations between countries. Another form of abnormal fetal growth is fetal growth restriction. Infants with low birth weight (LBW) for their gestational age are primarily categorized as either small for gestational age (SGA) or fetal (intrauterine) growth restriction (FGR). All forms of abnormal fetal growth have high morbidity rates of neonatal. Therefore, diagnosis of abnormal fetal growth as early as possible is crucial for optimal clinical care. The measurement of fetal front-abdominal wall thickness (FAWT) is an easy examination. We conducted this study, wondering whether FAWT can predict birth weight or can determine LGA/macrosomia and/or LBW infants in advance. METHODS: This longitudinal cohort study was done in a tertiary center between September 2016 and September 2019. In total, 768 pregnant women with who attended our clinic for oral glucose tolerance test (OGTT) screening between the 26th and 28th weeks of gestation were included in this study. A total of 768 patients were evaluated in the present study. However, 186 of them were excluded in the follow-up of the study because they met the exclusion criteria or they gave birth in another hospital. Eventually, 582 pregnant women were included, with 57 in the LBW group, 461 in the AGA group, and 64 in the LGA group. In addition, 55 fetuses in the LGA group were determined to be macrosomic (birth weight > 4000 g). The FAWT and classic fetal biometric measurements, such as BPD, AC, FL, and EFW, were compared between the AGA group and the macrosomic infants. Statistical analysis was performed to compare the AGA group and the macrosomic infants group. There were no macrosomic infants in the AGA group, so this was used as the control group. RESULTS: There were no significant differences between the groups for maternal age, gravidity, parity, gestational age on the day of the examination, and gestational age at birth. The mean FAWT was significantly thinner in the SGA group than in the appropriate for gestational age (AGA) group (3.4 versus 3.9 mm, respectively, p < .001), while it was significantly thicker in the LGA group than in the AGA group (4.1 versus 3.9 mm, respectively, p < .001). CONCLUSION: FAWT measurement can provide more information and may be more sensitive toward fetal nutrition and growth than the AC value during the second trimester. Some benefits can be gained through the measurement of FAWT at the end of the second trimester. FAWT measurements can be used in obstetrical practice with a similar performance in predicting the LGA and macrosomic infant like AC and EFW.

The Effects of Oral Isotretinoin in Women with Acne and Polycystic Ovary Syndrome.

INTRODUCTION: Many patients who were diagnosed as polycystic ovary syndrome- (PCOS-) related acne were not capable of sustaining or beginning oral contraceptive pills (OCPs) due to pill scaring, contraindications of OCP use, migraine, or smoking. In this situation, oral isotretinoin treatment may become an important option for PCOS-related acne. The aim of the study was to determine the effects of isotretinoin treatment on PCOS patients who were complicated with severe cystic acne. MATERIALS AND METHODS: This study consisted of 40 female patients diagnosed as PCOS complicated with severe cystic acne. These patients were not eligible candidates for OCP use due to migraine, thrombophilia, heavy smoking, or pill scare. To establish baseline values of hormone levels, on days 2-5 of the menstrual cycle, venous blood samples were obtained. Moreover Modified Ferriman-Gallwey (mFG) score, acne score (AS), follicle count, and bilateral ovarian volumes were evaluated both before and after isotretinoin treatment. RESULTS: Isotretinoin treatment significantly decreased Ferriman-Gallwey score, free testosterone, insulin level, hemoglobin level, acne score, and ovarian volume. Increased triglyceride and cholesterol levels were detected after treatment. CONCLUSION: Isotretinoin treatment may have beneficial effects on free testosterone, insulin, acne score, and Ferriman-Gallwey score. Solely isotretinoin administration may supply adequate healing in PCOS patients' symptoms complicated with severe cystic acne who is not eligible candidates for OCP use. This trial is registered with Clinicaltrials.gov NCT02855138.

Attitudes Toward Organ Donation Among Relatives of the Patients Who Are Being Followed Up in Intensive Care and Dialysis Units.

INTRODUCTION: This study sought to investigate attitudes toward organ donation (OD) among the relatives of patients who are being followed up in intensive care units (ICU) and dialysis units. MATERIALS AND METHODS: This cross-sectional study was conducted with relatives of the patients who were being followed up in hemodialysis (HD) and peritoneal dialysis (PD) units and Neurosurgery, Neurology, Anesthesia, and Reanimation ICUs of Adana Numune Research and Training Hospital. A questionnaire investigating sociodemographic data and knowledge level about OD and an attitude scale about OD was applied with face-to-face interviews. RESULTS: A total of 111 subjects (50 from ICU, 61 from HD and PD units) participated in the study. Mean age was 42.7 ± 13.4 years, 63 (56.8%) were female, 84 (75.7%) were married; education level was low for 49 (44.1%), moderate for 41 (36.9%), and high for 21 (18.9%) subjects; 53 (47.7%) patients were waiting for OD. It was found that sufficient knowledge was low, OD was not unfavorable according to religious beliefs, they knew little about the fact that OD is legally available, and promotions about OD are insufficient in our country. Mean score of Attitudes Toward Organ Donation Scale was 58.6 ± 11.2, and was lower among females (55.7 ± 11.7) compared to males (t = 3.177, P = .002). CONCLUSIONS: Education and promotion activities would decrease the refusal rate, which is the main obstacle against OD from cadavers, a procedure that has quite low rate in our country. Organ transplantations may increase with providing sufficient knowledge about the laws concerned and general considerations.

Interobserver reliability of sonographic fetal biometry in second trimester maternal serum screening.

PURPOSE: To examine the interobserver variability for fetal biometry parameters and to investigate whether this variability affects the second-trimester maternal serum screening test (STMSS) results. MATERIALS AND METHODS: A total of 60 singleton pregnancies who were scheduled for STMSS were investigated. Two experienced sonographers performed all examinations at the same visit. The risk calclations of screening were performed according to the each operator's biometric measurements separately. Interobserver variability in measurements of fetal biometrics and the effect of this interobserver variability on the screening results were assessed. RESULTS: inter-observer reliability for biparietal diameter (BPD) and femur length (FL) were 0.904 and 0.888 (p < 0.00 1), respectively. interobserver reliability coefficients for trisomy 21, trisomy 13/18, and neural tube defect were 0.887, 0.999, and 0.920 (p < 0.0001), respectively. CONCLUSION: The present results demonstrate that the interobserver reliability and agreement of ultrasound measurements of fetal biometry in cases of routine prenatal screening are highly reliable.

Computerized dynamic pupillometry indices mirrors the heart rate variability parameters.

OBJECTIVE: Dynamic pupillometry (DP) is a simple, non-invasive computerized assessment of pupillary light response which provides data concerning both branches of the autonomous nervous system (ANS). Heart rate variability (HRV) analysis assess cardiac health and the ANS modulation on the heart. In this study, we aimed to evaluate the utility of DP as a predictor of cardiac autonomic activity assessed by HRV. PATIENTS AND METHODS: A total of 44 consecutive healthy subjects (mean age = 35.9 ± 7.4 years, 24 males) were enrolled. Pupil diameters (R0, R1, R2 and R%): latency (Lc), amplitude (Ac), velocity (Vc) and duration of pupil contraction (Tc): latency (Ld), velocity (Vd) and duration of pupil dilatation (Td) were measured in DP. Time and frequency domain indices of HRV were obtained from 24-h ambulatory electrocardiographic monitoring. RESULTS: There were strong significant correlations of Vc with LF/HF (r = -0.672, p = 0.001) and a measure of HRV: RMSDD (r = 0.654, p = 0.001). R% significantly correlated with PNN50 (r = -0.432, p = 0.003) and RMSDD (r = -0.422, p = 0.004) and LF/HF (r = 0.340, p = 0.024). Vc (ß = 0.647, p = 0.011) and Ac (ß = 0.320, p = 0.013) were found as independent predictors of RMSSD. Vc (ß = 0.578, p = 0.036) was found to be only significant predictor of PNN50. Vc (ß = -0.617, p = 0.008) and R% (ß = 0.309, p = 0.038) were found to be significant predictors of LF/HF. CONCLUSIONS: Pupillary autonomic functions assessed by DP correlates with cardiac autonomic functions evaluated by HRV. Among the DP parameters analyzed, Vc was a predictor of parasympathetic indices, and R% was a predictor of sympathetic indicators of cardiac autonomic functions.

Assessment of the relationship between dynamic pupillometry and exercise heart rate recovery among healthy subjects.

OBJECTIVE: Dynamic pupillometry (DP) is a simple, non-invasive computerized technique for assessment of pupillary light response which provides data concerning the balance of both branches of the autonomous nervous system (ANS). Heart rate (HR) recovery (HRR) after graded exercise reflects cardiac autonomic activity and predicts cardiovascular events. In this study, we aimed to evaluate the utility of DP as a predictor of cardiac autonomic activity assessed by HRR. PATIENTS AND METHODS: A total of 62 consecutive healthy subjects (mean age = 33.7 ± 8.6 years, 39 males and 23 females) were enrolled. Pupil diameters (R0, R1, R2 and R%): latency (Lc), amplitude (Ac), velocity (Vc) and duration of pupil contraction (Tc): latency (Ld), velocity (Vd) and duration of pupil dilatation (Td) were measured in DP. HRR indices were calculated by subtracting 1st (HRR1), 2nd (HRR2) and 3rd (HRR3) minute HR from the maximal HR during treadmill exercise stress test. RESULTS: HRR1 was 32.9 ± 8.0 bpm, HRR2 was 55.1 ± 11.6 bpm and HRR3 was 58.3 ± 12.7 bpm, respectively. Correlation analysis revealed significant positive correlations of HRR1 with Vc (r = 0.660, p = 0.001), Ac (r = 0.559, p = 0.001) and Vd (r = 0.412, p = 0.001). HRR had significant negative correlations with Lc (r = -0.442, p = 0.001), R% (r = -0.384, p = 0.002) and Ld (r = -0.286, p = 0.025). Vc [ß = 3.995 (1.040 to 6.951, 95% CI, p = 0.009)] and Lc [ß = -0.032 (-0.056 to -0.008, 95% CI, p = 0.01)] were found to be significant independent predictors of HRR1. CONCLUSIONS: Pupillary autonomic functions assessed by DP correlates with cardiac autonomic functions evaluated by HRR. Among the DP parameters analyzed, Vc and Lc were independent predictors of cardiac autonomic functions.

Assessment of cardiac arrhythmias in patients with ankylosing spondylitis by signal-averaged P wave duration and P wave dispersion.

OBJECTIVE: Aortic regurgitation, conduction disturbances, increased myocardial fibrosis and pericarditis could be seen in ankylosing spondylitis (AS). However, less attention has been paid to supraventricular arrhythmias (SVA) and atrial conduction system changes. We aimed to assess SVA and conduction system changes in patients with AS. PATIENTS AND METHODS: Twenty-eight patients (24 men; mean age, 28.7 ± 5.7 years) with AS and 30 healthy volunteers (26 men; mean age, 29.3 ± 5.8 years) were enrolled. All subjects were evaluated by 24-hour ambulatory electrocardiogram, 12 lead standard electrocardiogram (ECG) for P wave dispersion (Pd), and signal-averaged ECG (SAECG) for P wave duration (SAPWD). RESULTS: SVAs were detected in 9 patients with AS (32%) and 3 controls (10%; p =0.02). Mean SAPWD (115.7±28.6 ms vs. 100.2 ± 18.7 ms, p =0.017) and mean Pd (11.9±4.8 ms vs. 9.3±3.6 ms, 0.023) was longer in patients with AS than the control group. When patient with AS were divided into 2 subgroups as patients with or without SVA, the Pd (16.2±5.0 vs. 9.9±3.2, p =0.001), SAPWD (151.4±7.8 vs. 98.7±16.1, p =0.001) and Bath ankylosing spondylitis disease activity index (BASDAI) (5.1±1.6 vs. 3.7±1.0, p =0.014) were significantly greater in the subgroup with arrhythmias compared to the subgroup without arrhythmias. There was a moderate positive correlation between BASDAI and SAPWD (r=0.622, p =0.001). There was also a moderate positive correlation between BASDAI and Pd (r=0.479, p =0.01). CONCLUSIONS: SVA were detected more frequently in AS than control group. SAPWD and Pd were prolonged in patients with AS. Clinical severity assessed with BASDAI had a positive correlation with prolongation of SAPWD and Pd.

Effect of lidocaine spray in pain management during office-based endometrial sampling: A randomised placebo-controlled trial.

Office-based endometrial sampling is the most frequently performed gynaecological procedure. The procedure is usually associated with pain and discomfort. Several anaesthetic and analgesic techniques (e.g., non-steroidal anti-inflammatory drugs, paracervical block, misoprostol and topical anaesthetics) are used for pain management during endometrial sampling. There is no comprehensive study using lidocaine in spray form; we sought to investigate the analgesic efficacy of 10% lidocaine spray in patients undergoing office-based endometrial biopsy. We conducted a prospective, randomised (lidocaine spray (n = 60) and placebo (n = 60), respectively), double-blind study. The mean pain score during procedure was 3.51 ± 1.51 in the lidocaine spray group and 5.11 ± 1.66 in the placebo group. Lidocaine spray treatment significantly lowered the pain scores compared with placebo (p < 0.001). Lidocaine spray can be accepted as a non-invasive, easy to apply and more comfortable anaesthetic method for office-based endometrial sampling.

A comparison of two infiltration models applied to simulation of overland flow over a two-dimensional flume.

At the hillslope scale, where the rill-interrill configuration plays a significant role, infiltration is one of the major hydrologic processes affecting the generation of overland flow. As such, it is important to achieve a good understanding and accurate modelling of this process. Horton's infiltration has been widely used in many hydrologic models, though it has been occasionally found limited in handling adequately the antecedent moisture conditions (AMC) of soil. Holtan's model, conversely, is thought to be able to provide better estimation of infiltration rates as it can directly account for initial soil water content in its formulation. In this study, the Holtan model is coupled to an existing overland flow model, originally using Horton's model to account for infiltration, in an attempt to improve the prediction of runoff. For calibration and validation, experimental data from a two-dimensional flume which is incorporated with hillslope configuration have been used. Calibration and validation results showed that Holtan's model was able to improve the modelling results with better performance statistics than the Horton-coupled model. Holtan's infiltration equation, which allows accounting for AMC, provided an advantage and resulted in better runoff prediction of the model.

Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy: A 2D speckle tracking echocardiography study.

AIM: It is important to diagnose diabetic cardiomyopathy in the early stages to prevent development of evident heart failure in the future. The primary objective of this study was to evaluate the presence of subclinical left ventricular (LV) dysfunction with two-dimensional (2D) speckle tracking echocardiography (STE) and the secondary objective was to compare retinopathy-positive and -negative diabetic patients. PATIENTS AND METHODS: A total of 82 patients with type II diabetes mellitus (DM) and 90 gender-matched healthy controls were included. Retinopathy was present in 55 patients in the study group. All study participants underwent conventional 2D echocardiography and STE. RESULTS: All diabetic patients had preserved LV ejection fraction (LV-EF ≥ 50). Compared with the control group, diabetic patients had a larger left atrium (47.3 ± 19.9 mm vs. 36.9 ± 17.8 mm, p < 0.001) and a higher E/Em ratio (12.0 ± 2.9 vs. 10.5 ± 3.7, p = 0.004). The LV-EF, LV end diastolic and end systolic volumes, E/A ratios, deceleration times, and tissue Doppler parameters were compared between groups. The study group was observed to have statistically significant lower four-chamber (4C; 17.7 ± 3.0 % vs. 19.3 ± 3.5 %, p = 0.002), three-chamber (3C; 17.5 ± 3.0 % vs. 19.2 ± 3.4 %, p = 0.001), and two-chamber (2C; 18.5 ± 3.5 % vs. 20.1 ± 2.4 %, p = 0.001) peak longitudinal strain values compared with the control group. Moreover, LV global strain values were found to be significantly lower in the DM group than in the control group (17.9 ± 2.7 % vs. 21.1 ± 3.2 %, p < 0.001). By contrast, basal rotation (4.9 ± 3.3° vs.2.8 ± 4.5°, p = 0.001), apical rotation (15.3 ± 6.7° vs. 12.1 ± 5.3°, p = 0.001) and LV twist (20.2 ± 7.2° vs. 16.9 ± 6.5°, p = 0.002) in the DM group were significantly increased compared with those of controls. CONCLUSION: The STE procedure can be a useful novel technique in the determination of subclinical LV dysfunction in diabetic patients. Diabetic patients have lower longitudinal myocardial mechanics, and circumferential and rotational mechanics are impaired. There was no significant association between diabetic retinopathy and LV function.

Evaluation of overland flow model for a hillslope using laboratory flume data.

Comprehensive modelling of overland flow requires models for both rill and interrill area overland flow. Evaluation of a physically based mathematical model for simulating overland flow generated on rill and interrill areas of hillslope was done using a data set gathered from a laboratory experimental setup. A rainfall simulator has been constructed together with a 6.50 m × 1.36 m erosion flume that can be given adjustable slopes in both longitudinal and lateral directions. The model was calibrated and validated using the experimental results from the setup of the flume having 5% lateral and 10% longitudinal slopes where rainfall intensities of 105 and 45 mm/hr were induced with the use of nozzles. Results show that for the given slope combination, the model was capable of simulating the flow coming from the rill and interrill areas for the two different rainfall intensities. It was found that significantly more of the flow occurred in the form of the rill flow. The model studied here can be used for the better prediction of overland flow and can also be used as a building block for an associated erosion and sediment transport model.