A green approach for metoclopramide quantification in pharmaceutical products: new HPLC and spectrophotometric methods.

Green spectrophotometric and HPLC methods have been developed for the quantification of metoclopramide. In the spectrophotometric method, it was determined by direct absorbance measurement at 273 nm wavelength using ultrapure water as solvent. The Extend C18 column was used for the HPLC method. The mobile phase system consisted of a combination of ethanol and formic acid solution (pH 2.0; 30:70 v/v). Isocratic elution was applied and the flow rate was set at 1.0 mL min-1. Metoclopramide was detected at 273 nm. The methods performed were economical, rapid, environmentally friendly, and simple, providing metoclopramide analysis within 5 min. The methods have been successfully applied in pharmaceutical products without matrix interference. The results of the application of the developed methods to pharmaceutical products were statistically compared and no significant difference was observed between the methods. In addition, the greenness assessment of the developed methods was performed using AGREE software. Our developed methods, based on the use of solvents such as ethanol and water, are proposed as a more environmentally and analyst-friendly option for the quantification of metoclopramide in pharmaceutical products than other methods currently in use.

Evaluation of the demographic characteristics and general health status of earthquake survivors affected by the 2023 Kahramanmaras earthquake; a section from Gaziantep Nurdagi district.

BACKGROUND: An earthquake with a magnitude of 7.7 occurred in Pazarcik District of Turkey at 04.17 on February 6, 2023 and another earthquake of 7.6 occurred at 13.24 on the same day. This is the second largest earthquake to have occurred in Turkey. The aim of this study is to investigate the earthquake-related level of knowledge, attitudes and behaviours, general health and psychological status of survivors who were affected by the 2023 Kahramanmaras Earthquake and who were living in Nurdagi District of Gaziantep after the earthquake. METHODS: Data of 2317 individuals older than 18 years of age who were living in earthquake neighbourhoods, tents and containers in Nurdagi District of Gaziantep were examined. Variables were evaluated to find out the demographic characteristics and general health status of earthquake victims. General Health Questionnaire (GHQ-12) was used to find out psychological states of earthquake victims. RESULTS: The rate of injuries was 14.2% and leg and foot injuries were the most common with 44.2%. The relationship between injury status; and age, marital status, and being trapped under debris was revealed (p < 0.05). Mean GHQ-12 score of the survivors was 3.81 ± 2.81 and 51.9% experienced psychological distress. In the evaluation with logistic regression, it was found that female gender, being injured in the earthquake, loss of first degree and second degree relatives (with a higher rate in loss of first degree relative), having a severely damaged -to be demolished house and having a completely destroyed house were correlated with higher level of psychological distress (p < 0.05). CONCLUSION: General characteristics, injury prevalence and affecting factors of earthquake survivors were evaluated in the present study. Psychological distress was found in victims. For this reason, providing protective and assistive services to fight the destructive effects of earthquake is vital. Accordingly, increasing the awareness of people residing in earthquake zones regarding earthquakes is exceptionally important.

The Lifesaving Impact of Transcatheter Interventions in the Early Post-Fontan Palliation Period.

Despite advancements in postoperative outcomes after Fontan surgery, there remains a risk of suboptimal outcomes and significant morbidity in the early postoperative period. Anatomical obstructions in the Fontan pathway can lead to prolonged pleural effusion or ascites, cyanosis, and low cardiac output syndrome (LCOS). Transcatheter interventions offer an alternative to early re-surgery for treating these complications. Over a 13-year period, early catheter angiography, performed within 30 days post-index procedure, was administered to 41 patients, identifying anatomical issues that necessitated re-intervention in 39 cases. This led to transcatheter interventions in 37 (10.4%) of the 344 Fontan surgery patients. The median age was 4.8 years (IQR: 4-9.4), and the median weight was 16.5 kg (IQR: 15-25.2), with females comprising 51.4% (19/37) of this group. The primary indications for the procedures were persistent pleural effusion or ascites in 27 patients (66%), LCOS in 8 patients (20%), and cyanosis in 6 patients (14%). Among the 37 undergoing transcatheter intervention, 30 were treated solely with this method and discharged, three died in ICU follow-up, and four required early re-surgery. No procedural mortality was observed. Our findings demonstrate that transcatheter interventions, including stent implantation, balloon angioplasty, and fenestration dilation, are safe and effective in the early post-Fontan period. Therefore, they should be considered an integral part of the management strategy for this patient group.

Gaussian Bayesian network model of healthcare, food and energy sectors in the pandemic: Türkiye case.

Healthcare, food, and energy are the basic needs of life in the globalizing world. Humankind's quest to maintain a healthy life and find ways to meet its needs has continued since its existence. The causal relations between the healthcare, food, and energy sectors are explored using data from the pandemic when COVID-19 was a global risk, and human health sustainability underwent a complicated process. It aims to examine the interaction between the healthcare, food, and energy sectors and model the causal relationship within the framework of probabilistic dependencies. For this purpose, the relationships between these sectors during the pandemic are modeled via Bayesian Networks (BNs). This highly successful inference method makes the complex structure of causal relationships graphically understandable. The data consists of stock returns at the end of the business day between March 11, 2020, when the pandemic was declared, and December 26, 2022. Data on 13 stocks actively traded on the Istanbul Stock Exchange (BIST) during the 700 days were obtained from tr.investing.com. Causal modeling uses Gaussian Bayesian Networks (GBNs) for continuous variables. To make the inferences drawn from the data more successful and minimize the loss of information, the GBN model is built with continuous variables. The posterior Probability Density Functions (PDFs) of the stocks in the network are constructed over the structure of the Directed Acyclic Graphs (DAG) of the BNs, and inferences are made by querying possible cases (tips). Markov Chain Monte Carlo (MCMC) simulations are performed with the posterior PDFs, and measures of the central tendency of the stocks are calculated. GBNs are used to generate daily return estimates for ULKER with the lowest MSE (1.06e-03) and RMSE (3.22e-02) values and ULUUN with the highest MSE (3.43e-03) and RMSE (5.83e-02) values.

Utility of Balloon Occlusion Testing in Determining Fontan Suitability Among Patients with Elevated Pulmonary Artery Pressure and Additional Antegrade Pulmonary Blood Flow.

In individuals with a single ventricle undergoing evaluation before Fontan surgery, the presence of excessive pulmonary blood flow can contribute to increased pulmonary artery pressure, notably in those who had a Glenn procedure with antegrade pulmonary flow. 28 patients who had previously undergone Glenn anastomosis with antegrade pulmonary blood flow (APBF) and with elevated mean pulmonary artery (mPAP) pressure > 15 mmHg in diagnostic catheter angiography were included in the study. After addressing other anatomical factors that could affect pulmonary artery pressure, APBF was occluded with semi-compliant, Wedge or sizing balloons to measure pulmonary artery pressure accurately. 23 patients (82% of the cohort) advanced to Fontan completion. In this group, median mPAP dropped from 20.5 (IQR 19-22) mmHg to 13 (IQR 12-14) mmHg post-test (p < 0.001). Median PVR post-test was 1.8 (IQR 1.5-2.1) WU m2. SpO2 levels decreased from a median of 88% (IQR 86%-93%) pre-test to 80% (IQR 75%-84%) post-test (p < 0.001). In five patients, elevated mPAP post-test occlusion on diagnostic catheter angiography led to non-completion of Fontan circulation. In this group, median pre- and post-test mPAP were 23 mmHg (IQR 21.5-23.5) and 19 mmHg (IQR 18.5-20), respectively (p = 0.038). Median post-test PVR was 3.8 (IQR 3.6-4.5) WU m2. SpO2 levels decreased from a median of 79% (IQR 76%-81%) pre-test to 77% (IQR 73.5%-80%) post-test (p = 0.039). Our study presents a specialized approach for patients initially deemed unsuitable for Fontan due to elevated pulmonary artery pressures. We were able to successfully complete the Fontan procedure in the majority of these high-risk cases after temporary balloon occlusion test.

Mortal condition in an unusual localization, analysis of isolated tongue and tongue base abscesses.

BACKGROUND: Tongue abscess (TA) is a very rare clinical condition and its treatment is very important. Surgical drainage is at the forefront in the treatment. Our study includes patients with tongue and tongue base abscesses. AIM: To discuss the clinical and laboratory findings of these patients emphasizing the underlying causes and treatment options with the largest patient series in the English literature. METHODS: We included patients with isolated TA who applied to our clinic between January 1, 2020 and January 1, 2023. Those who lack the recorded data, those who are not between the ages of 18-66, those who have not undergone surgery-interventional procedure, and those who have infection and/or abscess in another place were excluded from the study. RESULTS: There were two female (18%) and nine male (82%) patients in our series consisting of 11 patients. Their ages ranged from 18 to 66, and the mean ± SD was 48.63 ± 16.3. Considering the localization of the abscess, three anterior abscesses (27%), two lateral abscesses (18%), and six abscesses at the base of the tongue (54%) were detected. CONCLUSION: Tongue abscesses can cause acute upper airway obstruction and respiratory collapse. It may be necessary to act quickly for the tracheotomy procedure and this procedure can usually be performed under local anesthesia as intubation cannot be achieved. When we encounter an abscess in an unexpected organ, difficulties may be encountered in the management of the patient.

Fistulized Pseudoaneurysm Associated with Hypothenar Hammer Syndrome to the Skin in a 12-Year-Old Patient: A Case Report.

In this case, we present a condition where the extension of the hamate hook in the Guyon canal can damage the ulnar artery or its branches, leading to the development of an aneurysm or pseudoaneurysm. The patient, a 12-year-old female, presented to our clinic with a complaint of an uncontrolled palm lump that has been growing for several months and began to bleed in a pulsatile manner after trauma. She was an amateur volleyball player who trained twice weekly for two hours. Color Doppler ultrasound examination revealed a 1.1×0.8 cm pseudoaneurysm in a branch of the ulnar artery. Aneurysmectomy and primary repair were performed. Timely diagnosis and treatment planning are crucial for ulnar artery pseudoaneurysms or aneurysms to prevent ischemic events in a later period.

Patients with developmental dysplasia of the hip shows higher digit ratio (2D:4D).

BACKGROUND: Developmental dysplasia of the hip (DDH) encompasses a range of hip disorders, from dysplasia to dislocation. One key factor is sex, with women being four to eight times more susceptible to DDH than men. However, there have been no studies investigating the second-to-fourth digit ratio (2D:4D), a biomarker of prenatal sex steroid exposure, in DDH patients. This study aimed to explore whether there is an association between the 2D:4D ratio and DDH. METHODS: Digital calipers were used to measure the second and fourth finger lengths of 250 patients treated for DDH and 200 patients in the healthy control group between January 2020 and January 2023. The Mann-Whitney U test was used for non-normally distributed variables and two-way analysis of variance to assess differences in measurements between DDH patients based on sex, side, and the interaction of sex and side. The intraclass correlation coefficient (ICC) was used to assess measurement repeatability. RESULTS: The median (min-max) age was 10.00 (6-16) years in the DDH group, 12.00 (6-16) years in the control group, and 10 (6-16) years for the whole cohort. There was no significant difference in terms of age between the patient and control groups (p = 0.083). When comparing the DDH group with controls the former showed higher right 2D:4D and Δ2D:4D and these differences were significant in both males and females. Among the patients, controlling for side of dysplasia did not affect right 2D:4D, left 2D:4D or Δ2D:4D. CONCLUSION: There was a significant association between higher 2D:4D ratios (both right and left hands) and DDH in both men and women. This indicates that the 2D:4D ratio, a marker of intrauterine estrogen/testosterone balance, is associated with DDH.

Non-structural flood mitigation optimization at community scale: Middle Cedar Case Study.

Flooding is the leading natural hazard in Iowa and has resulted in billions of dollars of damage to properties and critical infrastructure over the past couple of decades. Land alterations, urbanization, and changing precipitation regimes increase the magnitude and frequency of flood events. Considering the increasing risk, flood mitigation efforts are significant to reduce future losses. In this study, we present a comprehensive flood mitigation assessment for the cities of Cedar Falls, Cedar Rapids, and Waterloo in Iowa, utilizing various datasets such as property information, flood inundation maps, mitigation costs, and depth-damage functions. The research revealed that flooding has a minimal impact on Waterloo below the 200-year return period flood scenario, but Cedar Falls and Cedar Rapids are significantly vulnerable, requiring more mitigation investments and planning. The study conducted a benefit-cost analysis, indicating that dry floodproofing is the most feasible option to reduce flood impacts in all studied communities. Moreover, the research conducted a climate data-driven analysis, which found that elevating structures significantly increases the number of feasible mitigation options, regardless of various long-term climate projections. The study also analyzed predetermined mitigation budgets, revealing potential avoided losses and benefit-cost ratios for properties with the highest BCRs and prioritizing them to maximize the total benefit to the communities. The study findings offer crucial insights and recommendations to guide decision-makers in the community on prioritizing cost-effective flood mitigation strategies and minimizing flood impact in the studied regions.

A Challenging Interventional Procedure: Transcatheter Closure of Tubular Patent Ductus Arteriosus in Patients with Pulmonary Hypertension.

Transcatheter closure of the tubular ducts remains the most challenging procedure, with higher complication rates than other types. This study evaluates the characteristics of transcatheter closure of tubular ducts with pulmonary hypertension. 73 patients with tubular ducts who underwent cardiac catheterization for transcatheter PDA closure were analyzed. The mean age and weight were 1.93 ± 2.68 years and 8.83 ± 6.14 kg, respectively. Transcatheter closure was attempted in 72 patients. Four cases (5.5%) were referred to surgery, while the procedure was completed in the remaining (94.5%). Amplatzer duct occluder (ADO) I or Cardiofix duct occluder (CDO) was the most commonly used devices. However, the use of Amplatzer vascular plug (AVP) II raised in recent years. The most common concern was aortic protrusion/stenosis in ADO I/CDO devices, but most regressed during follow-up. Iatrogenic coarctation of the aorta was observed in two with ADO I/CDO. Embolization of the device to the pulmonary artery was observed in three with CDO, AVP II, and AVP I. Significant left pulmonary artery stenosis requiring stenting developed in one after closure with an MVSDO device. Tubular ducts are highly associated with pulmonary arterial hypertension, and transcatheter closure of them is still challenging despite the developing device armamentarium. Although ADO I or similar devices are widely used, off-label devices are usually needed at increasing rates. The AVP II device is unsuitable for short tubular ducts but seems the best option for long ones.

Environmental Factors for the Advancement of Teachers' Self-Efficacy in Professional Development.

There is a shifting paradigm in gifted education from person-based approaches (i.e., identifying giftedness) to process-based approaches (i.e., transacting giftedness). This new framework is centered on enriching educational opportunities that will make the process meaningful (i.e., gifted) to everyone in a setting. However, little is known about how this renewed perspective can be applied in teacher professional development. In line with the socio-ecological models, our study aims to identify the best appropriate model to describe teacher self-efficacy (i.e., the dependent variable in the study) as professional development from an ecological perspective and to propose an ecologically intelligent school (EIS) for the advancement of self-efficacy. Structural equation modeling (SEM) was performed to create a model using TALIS 2018 dataset. Afterward, indices of goodness-of-fit criteria were examined for each model. The results indicate that there is a complex ecological background, in that various factors affect the dependent variable. Model 3 was determined as the most suitable model that can be proposed as an ecologically intelligent school (EIS) for the advancement of self-efficacy. The factors within the three layers of the socio-ecological model-communication with teachers, communication with students, school climate, and feeling valued by the national level-altogether created an appropriate model explaining teacher professional development, regarding self-efficacy.

How reliable is the asset score in measuring socioeconomic status? Comparing asset ownership reported by male and female heads of households.

Asset scores are widely used as the preferred method of measuring socioeconomic wellbeing of households in developing countries. We examine the degree of discrepancies in reporting asset ownership by male and female heads of the same household. Household asset scores were estimated separately for male and female responses, using Principal Component Analysis, the method widely used in the literature, and households were categorized into wealth quintiles. The results indicate that only half of the households belonged to the same quintile groups for both male and female response-based asset scores. In addition, the two estimates of asset scores within the same quintile deviate by more than 20% for 71% of households in the top three quintiles and for 18% in the poorest two quintiles. Inter-individual (male/female) variability in reporting the asset ownership was high enough to raise concerns about the validity and reliability of asset scores as a metric of household socioeconomic status. Although the study did not try to ascertain underlying reasons for differential reporting, possible explanations could be a lack of awareness among household members on asset ownership or differential propensity to demonstrate relatively better social status of the household by male and female respondents. To improve reliability of asset scores, methodology for collecting asset ownership information should define who in the household may or may not be used as a respondent. Visual verification of reported ownership of assets will reduce male-female discrepancies but the verification process is time-consuming and intrusive, thus negating the advantages of collecting asset data. Alternatives to asset-based scoring need to be considered and one approach could be to solicit subjective opinions from male and female heads on the location of households in the social hierarchy.

Talking about the Vaccine after the Pandemic: A Cross-Sectional Study among Youth in Turkey and Ethical Issues.

Examining the factors that affect the vaccination rate among young people in an ethical frame can support vaccination promotion. Therefore, this study will elaborate, through an ethical lens, on young people's hesitation about and decisions regarding getting vaccinated. The cross-sectional study was conducted with 2428 people aged 15-30 in Turkey in June 2022. The questionnaire included the following subtitles: psycho-social situation, health services and health policies, COVID-19 vaccine, and predictions about life and health after the pandemic. The average age was 22.9 years. In the study sample, 80% were vaccinated, while 20% were not. Vaccinated participants acted more cautiously to protect their health. Receiving accurate and sufficient information on proposed vaccines affects vaccination status. The primary reason for getting vaccinated was "to protect their health, families, and relatives", and the primary reason for not getting vaccinated was "not trusting the vaccine content or the country where the vaccine was produced". Specifically, those vaccinated felt more relaxed physically, psychologically, and socially. In addition, the expectations for the future of those vaccinated were significantly higher. Accurate and adequate information is essential for reducing vaccine hesitancy. In addition, promoting prosocial behaviors in young people and highlighting related values will support vaccination.

U-net-based semantic classification for flood extent extraction using SAR imagery and GEE platform: A case study for 2019 central US flooding.

Data-driven models for water body extraction have experienced accelerated growth in recent years, thanks to advances in processing techniques and computational resources, as well as improved data availability. In this study, we modified the standard U-Net, a convolutional neural network (CNN) method, to extract water bodies from scenes captured from Sentinel-1 satellites of selected areas during the 2019 Central US flooding. We compared the results to several benchmark models, including the standard U-Net and ResNet50, an advanced thresholding method, Bmax Otsu, and a recently introduced flood inundation map archive. Then, we looked at how data input types, input resolution, and using pre-trained weights affect the model performance. We adopted a three-category classification frame to test whether and how permanent water and flood pixels behave differently. Most of the data in this study were gathered and pre-processed utilizing the open access Google Earth Engine (GEE) cloud platform. According to the results, the adjusted U-Net outperformed all other benchmark models and datasets. Adding a slope layer enhances model performance with the 30 m input data compared to training the model on only VV and VH bands of SAR images. Adding DEM and Height Above Nearest Drainage (HAND) model data layer improved performance for models trained on 10 m datasets. The results also suggested that CNN-based semantic segmentation may fail to correctly classify pixels around narrow river channels. Furthermore, our findings revealed that it is necessary to differentiate permanent water and flood pixels because they behave differently. Finally, the results indicated that using pre-trained weights from a coarse dataset can significantly minimize initial training loss on finer datasets and speed up convergence.

Using artificial intelligence to improve pain assessment and pain management: a scoping review.

CONTEXT: Over 20% of US adults report they experience pain on most days or every day. Uncontrolled pain has led to increased healthcare utilization, hospitalization, emergency visits, and financial burden. Recognizing, assessing, understanding, and treating pain using artificial intelligence (AI) approaches may improve patient outcomes and healthcare resource utilization. A comprehensive synthesis of the current use and outcomes of AI-based interventions focused on pain assessment and management will guide the development of future research. OBJECTIVES: This review aims to investigate the state of the research on AI-based interventions designed to improve pain assessment and management for adult patients. We also ascertain the actual outcomes of Al-based interventions for adult patients. METHODS: The electronic databases searched include Web of Science, CINAHL, PsycINFO, Cochrane CENTRAL, Scopus, IEEE Xplore, and ACM Digital Library. The search initially identified 6946 studies. After screening, 30 studies met the inclusion criteria. The Critical Appraisals Skills Programme was used to assess study quality. RESULTS: This review provides evidence that machine learning, data mining, and natural language processing were used to improve efficient pain recognition and pain assessment, analyze self-reported pain data, predict pain, and help clinicians and patients to manage chronic pain more effectively. CONCLUSIONS: Findings from this review suggest that using AI-based interventions has a positive effect on pain recognition, pain prediction, and pain self-management; however, most reports are only pilot studies. More pilot studies with physiological pain measures are required before these approaches are ready for large clinical trial.

Embolización de cuerpo extraño por la raíz aórtica por lesión por arma de fuego: caso clínico de una paciente asintomática de diez años.

Foreign body embolies that origin arterial system have mostly seen symptomatic and that's why they require emergency surgery. However, asymptomatic cases are followed conservatively, they can cause vascular-related end-organ pathologies as time passes. Foreign body migration from the ascending aorta to the end-organ artery is a very rare in literature after a fire gun injury. In symptomatic cases, emergency surgery should be planned immediately. In asymptomatic cases, the risks and benefits should first be considered before any surgical approach.

Las embolias de cuerpo extraño que tienen origen en el sistema arterial se han presentado en su mayoría sintomáticas y por eso requieren cirugía de emergencia. Sin embargo, los casos asintomáticos se siguen de manera conservadora, pueden causar patologías vasculares relacionadas con los órganos diana a medida que pasa el tiempo. La migración de cuerpos extraños desde la aorta ascendente hasta la arteria del órgano blanco es muy rara en la literatura después de una lesión por arma de fuego. Casos sintomáticos, la cirugía de emergencia debe planificarse de inmediato. En casos asintomáticos, primero se deben considerar los riesgos y beneficios antes de cualquier abordaje quirúrgico.

Management of Nonocclusive Mesenteric Ischemia in Patients with Cardiac Failure.

AIM: This study aimed to evaluate the surgical procedures, outcomes, and prognostic factors in patients with ischemic heart disease who were operated on due to nonocclusive mesenteric ischemia (NOMI). MATERIAL AND METHODS: This research contains all patients diagnosed with congestive heart failure and NOMI between January 2011 to January 2020. The patients who had angiography or CT that showed occlusion of more than 50% in any of the main branches of the mesenteric artery or patients who presented with symptoms in correlation with a total occlusion were excluded from the study. Patients who underwent coronary heart surgery but were not diagnosed with congestive heart failure and those with atrial fibrillation also were excluded from the study. Patients divided into two groups, according to a medical database. RESULTS: A significant difference was found between the surviving and non-survivor groups in minutes, in terms of median time to segmenter intestinal resection (P = 0.042). CONCLUSION: An early diagnosis and surgical segmental intestinal resection before peritonitis worsens can be the key to better prognosis for NOMI patients.

Upper extremity arterial aneurysms: Etiology, management, and outcome.

BACKGROUND: Upper extremity arterial aneurysms are not common clinical conditions. It may causes ischemic gangrene or limb losses as a result of thromboembolic events due to endothelial damage. In this study, we aimed to investigate the etiology, management, and long-term outcome. METHODS: A total of 55 upper extremity aneurysms between January 2009 and April 2018 were retrospectively investigated. The mean age was 41 ± 13 years, and the women and men were 13 (23.6%) and 42 (76.4%). The mean follow-up was 43 ± 18 months. RESULTS: The incidence of pseudoaneurysm was higher than the true aneurysm (64.5% vs. 35.5%). 30 (84%) patients who had pseudoaneurysm repaired primerely and 6 (16%) patients had patchplasty. About 58% of the true aneurysm caused by blunt trauma. 4 (21%) true brachial aneurysm patients were required emergency intervention due to distal ischemia. 16 (84.2%) patients operated using by saphenous vein graft. The primary and secondary patency was 87.5% and 93.8%. No limb or life loss occurred during follow-up. CONCLUSION: Pseudoaneurysms are more common among upper limb aneurysms and they occur mostly by iatrogenic causes. Blunt trauma can be main cause of the true aneurysm. Surgical resection of the aneurysm and interposition of saphenous vein graft provides excellent results in the long-term.

ANTECEDENTES: los aneurismas arteriales de las extremidades superiores no son condiciones clínicas frecuentes. Puede causar gangrena isquémica o pérdida de extremidades como resultado de eventos tromboembólicos por daño endotelial. En este estudio, nuestro objetivo fue investigar la etiología, el tratamiento y el resultado a largo plazo. MÉTODOS: Se investigaron retrospectivamente un total de 55 aneurismas de las extremidades superiores sometidos a reparación quirúrgica entre enero de 2009 y abril de 2018. La edad media fue de 41 ± 13 años, y las mujeres y los hombres tenían 13 (23.6%) y 42 (76,4%). El seguimiento medio fue de 43 ± 18 meses. RESULTADO: La incidencia de pseudoaneurisma fue mayor que el aneurisma verdadero (64.5% frente a 35.5%) y fue causado por un traumatismo iatrogénico. 30 (84%) de los pseudoaneurismas reparados con cualquier injerto, 6 (16%) pacientes requirieron plastia con parche. 58% del aneurisma verdadero causado por traumatismo cerrado. 4 (21%) pacientes con aneurisma braquial verdadero requirieron intervención de emergencia debido a isquemia distal. 16 (84,2%) pacientes fueron sometidos a operación de reparación de aneurisma mediante injerto de vena safena. La permeabilidad primaria y secundaria fue del 87.5% y 93.8%. No se produjeron pérdidas de miembros ni de la vida durante el seguimiento. CONCLUSIÓN: Los pseudoaneurismas son más comunes entre los aneurismas de miembros superiores y ocurren principalmente por causas iatrogénicas. El traumatismo cerrado es la principal causa del verdadero aneurisma. La resección quirúrgica del aneurisma y la interposición con injerto de vena safena proporciona excelentes resultados a largo plazo.

How does tranexamic acid affect blood transfusion and bleeding amount in pelvis-acetabulum fractures treated with open reduction and internal fixation?

BACKGROUND: This study aimed to investigate intravenous tranexamic acid's (TA) effect on blood loss and transfusion ratios in pelvis-acetabulum fractures treated with open reduction and internal fixation. METHODS: Patients who underwent open reduction and internal fixation due to pelvis-acetabulum fractures between January 2017 and January 2019 constituted this study's target population. After applying inclusion and exclusion criteria, patients were divided into two groups: Those who were perioperatively given 15 mg/kg TA (i.e., Group 1) and those who were not (i.e., Group 2). Data including age, gender, mechanism of injury, fracture type, presence or absence of additional injuries, the time interval between admission and surgery, incision site, pre-operative and post-operative hemoglobin levels, intraoperative estimated blood loss (EBL), number of blood units transfused, and complications were recorded. Two groups were compared regarding these parameters. RESULTS: The study cohort included 58 patients. There were 30 patients in Group 1 and 28 patients in Group 2. Our analysis revealed that the number of blood units transfused was significantly higher in Group 2 than Group 1 (p=0.016). However, there was no significant difference between the two groups regarding intraoperative EBL, pre-operative and post-operative hemoglobin levels, and the time interval between admission and surgery. CONCLUSION: Administration of intravenous TA reduces blood transfusion requirement in patients with pelvis-acetabulum fractures treated with open reduction and internal fixation. This approach can prevent potential blood transfusion-related complications.

Fermatean fuzzy ELECTRE multi-criteria group decision-making and most suitable biomedical material selection.

ELECTRE is a family of multi-criteria decision analysis techniques, which has the ability to provide as much as possible precise and suitable set of actions or alternatives to the underlying problem by eliminating the alternatives, which are outranked by others. Group decision-making is an effective process to provide the most appropriate solution to real-world decision-making scenarios by considering and merging the expert opinions of multiple individuals on the problem. The aim of this study is to present an extended version of the ELECTRE I model called the Fermatean fuzzy ELECTRE I method for of multi-criteria group decision-making with Fermatean fuzzy human assessments. The method proposed in this study has the possibility to solve multi-criteria group decision-making problems by using the Fermatean fuzzy decision matrix obtained in Fermatean fuzzy number form in the evaluations made with the available alternatives based on expert opinions. First, the mathematical description of the multi-criteria group decision-making problem with Fermatean fuzzy information has been given. Then, the proposed Fermatean fuzzy ELECTRE I method to deal with the problem has been presented. After the determination of the relative importance degree of experts, the Fermatean fuzzy aggregated averaging operator is employed to merge the individual Fermatean fuzzy decision matrices produced by the experts into the aggregated Fermatean fuzzy decision matrix. Next, for pairwise comparison of available alternatives with respect to considered criteria, the concepts of Fermatean fuzzy strong, midrange, and weak concordance and discordance sets are based on the approach of score function and accuracy function defined for Fermatean fuzzy numbers. Afterward, Fermatean fuzzy concordance and discordance matrices are defined, constructed by concordance and discordance indices. Finally, Fermatean fuzzy effective concordance and discordance matrices are computed to obtain Fermatean fuzzy aggregated outranking matrix, indicating abstract information on dominations of suitable alternatives to the others. The proposed method will be used in material selection in distinct implementations, exclusively in biomedical applications where the prosthesis materials should have similar characteristics to human tissues. Since biomedical materials are used in various parts of the human body for many different purposes, in this study, material selection will be made using the method presented for the femoral component of the hip joint prosthesis for orthopedists and practitioners who will choose biomaterials.