The accurate identification of the percutaneous tracheostomy insertion site using digital palpation in children.

BACKGROUND: Percutaneous tracheostomy (PT) may be required frequently in long-term ventilated intensive care patients. Although the overall risks are low, serious complications may occur, especially in children. Hence, this study aimed to assess physician accuracy in identifying PT insertion sites by digital palpation in children aged between 5 and 13 years. METHODS: Participants were asked to identify the needle entry point (interspace between 2nd and 3rd or 3rd and 4th tracheal rings) for PT using digital palpation. Then, a single operator scanned the neck of each child with a linear high-frequency transducer. An accurate estimation was defined as a mark made between the upper and lower borders of the tracheal rings within the midline. RESULTS: In the study including 104 patients, the PT insertion site was accurately identified with digital palpation in a total of 50.9% of patients, compared with sonographic findings. The time required to determine the PT entry point by USG was longer than the palpation technique (114.7 vs. 43.8 s, P<0.001). The mean distance between the entry points of both methods was 4.53±2.03 mm. The majority of inaccurate assessments (45%) was above the 2nd tracheal ring. The lower the skin-to-air-mucosal interface distance, the higher the success of the PT entry point detection with the digital palpation method. A one-unit increase in body mass index was related to increasing the risk of failure by 1.1 times (P=0.030). CONCLUSION: Significant physician inaccuracy exists in PT insertion sites in children aged between 5 and 13 years, especially as BMI increases. Pre-procedural USG may help identify the landmarks for PT.

Acute Appendicitis During Pregnancy: A Case Series of 42 Pregnant Women.

Introduction It is difficult to diagnose the symptoms of acute appendicitis in pregnant women due to its similarities with pregnancy physiology. In this study, we examined the diagnostic value of laboratory parameters in the diagnosis of acute appendicitis in pregnant women. Material and methods Forty-two patients who underwent appendectomy during pregnancy were evaluated. The demographic characteristics, laboratory parameters and imaging methods of the patients were examined. According to the pathology results, the patients were evaluated in two groups as normal appendix and acute appendicitis. In addition, a non-pregnant control group was formed to compare the results between the pregnant and control groups. Results The mean age of the 42 patients was 30±6 years, and the pathology results were evaluated as normal in 16 (38.1%) of the patients. As imaging methods, ultrasonography was undertaken in all patients, with MRI being additionally performed in two patients. When the normal appendix and acute appendicitis groups were compared, no significant difference was observed in terms of laboratory parameters (neutrophil, lymphocyte, white blood cell and platelet counts, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, mean thrombocyte volume, red cell distribution width, and pregnancy trimesters (P>0.05). The group that had undergone appendectomy had a significantly higher rate of negative appendectomy compared to the control group (P=0.001). Conclusion Laboratory parameters alone cannot be sufficient for the diagnosis of acute appendicitis in pregnant patients. If clinical examination, laboratory parameters and USG are not sufficient for diagnosis, MRI is the imaging method that should be considered to reduce negative appendectomy rate.

The Comparative Clinical Performance of Four SARS-CoV-2 Rapid Antigen Tests and Their Correlation to Infectivity In Vitro.

Due to globally rising numbers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, resources for real-time reverse-transcription polymerase chain reaction (rRT-PCR)-based testing have been exhausted. In order to meet the demands of testing and reduce transmission, SARS-CoV-2 antigen-detecting rapid diagnostic tests (Ag-RDTs) are being considered. These tests are fast, inexpensive, and simple to use, but whether they detect potentially infectious cases has not been well studied. We evaluated three lateral flow assays (RIDA®QUICK SARS-CoV-2 Antigen (R-Biopharm), SARS-CoV-2 Rapid Antigen Test (Roche)), and NADAL® COVID-19 Ag Test (Nal von Minden GmbH, Regensburg, Germany) and one microfluidic immunofluorescence assay (SARS-CoV-2 Ag Test (LumiraDx GmbH, Cologne, Germany)) using 100 clinical samples. Diagnostic rRT-PCR and cell culture testing as a marker for infectivity were performed in parallel. The overall Ag-RDT sensitivity for rRT-PCR-positive samples ranged from 24.3% to 50%. However, for samples with a viral load of more than 6 log10 RNA copies/mL (22/100), typically seen in infectious individuals, Ag-RDT positivity was between 81.8% and 100%. Only 51.6% (33/64) of the rRT-PCR-positive samples were infectious in cell culture. In contrast, three Ag-RDTs demonstrated a more significant correlation with cell culture infectivity (61.8-82.4%). Our findings suggest that large-scale SARS-CoV-2 Ag-RDT-based testing can be considered for detecting potentially infective individuals and reducing the virus spread.

[A bibliometric analysis of the field of anesthesia during 2009-2018]. / Análise bibliométrica no campo da anestesiologia no período de 2009­2018.

OBJECTIVE: The limited number of bibliometric studies in the literature have generally focused on the top-cited studies in the field of anesthesia, however, there is a lack of studies that made a holistic bibliometric evaluation of these works. The purpose of this study is to make a contemporary summary of the articles published in the field of anesthesia within the last 10 years through detailed bibliometric methods. METHODS: The articles published between the years 2009 and 2018 were downloaded from the Web of Science (WoS) database and analyzed using bibliometric methods. The literature review was conducted using the keyword "Anesthesiology" in the "Research Area" category via the advanced search option available in WoS. The relation between the number of publications of the countries and the Gross Domestic Products and Human Development Index values were analyzed using Spearman's correlation coefficient. The number of articles between the years 2019 and 2021 was estimated through linear regression analysis. RESULTS: A review of the literature indicated 41,003 articles in the Web of Science database. Estimations included 4,910 (3,971-5,849) articles for the year 2019. There was a high-level, positive significant correlation between the number of publications and Gross Domestic Product (r=0.776, p<0.001). CONCLUSION: The findings show that countries with high income are effective in the field of anesthesia, which indicates a strong association between research productivity and economic development. Undeveloped and developing countries should be encouraged to conduct research in the field of anesthesia.

Can Neutrophil-to-Lymphocyte or Platelet-to-Lymphocyte Ratio Be Used to Predict Postoperative Nausea and Vomiting in Breast Reduction?

Background/Objective Postoperative nausea and vomiting (PONV) is one of the most frequently seen complications in the postoperative period. In several studies, the neutrophil-lymphocyte ratio (NLR) or the thrombocyte-lymphocyte ratio (PLR) has been suggested as a parameter to be used in the diagnosis of inflammatory diseases. However, the literature provides no information about this relationship for breast reduction. This study aims to investigate whether preoperative NLR or PLR was an indicator of PONV and identify its relationship with antiemetic use. Methods In this study, hemogram values and antiemetic amounts taken within 24 hours were obtained retrospectively by scanning the files of the patients received breast reduction diagnosis and operation. The confounder effect was controlled using the Propensity Score Matching analysis to distribute the case-control groups similarly. The Receiver Operating Characteristic (ROC) analysis was used to determine whether NLR and PLR could be a prognostic indicator for PONV prediction. Sensitivity and specificity values were calculated after the ROC analysis to determine the success of the cut-off points. Results The success of NLR and PLR in discriminating PONV was found to be statistically significant (cut-off: 1.97, area under the curve (AUC)=0.697, p=0.001, cut-off: 137.2, AUC=0.743; p<0.001, respectively). In addition, the sensitivity of PLR (77.8%) in discriminating PONV was found to be higher in comparison to NLR (73.3%). Conclusions One of the factors decreasing patient care quality and satisfaction is PONV. The results of this study showed that preoperative NLR and PLR could be taken into consideration in antiemetic use required for the prevention of postoperative nausea-vomiting in breast-reduction operations.

A bibliometric analysis of the field of anesthesia during 2009-2018 / Análise bibliométrica no campo da anestesiologia no período de 2009-2018

Abstract Objective The limited number of bibliometric studies in the literature have generally focused on the top-cited studies in the field of anesthesia, however, there is a lack of studies that made a holistic bibliometric evaluation of these works. The purpose of this study is to make a contemporary summary of the articles published in the field of anesthesia within the last 10 years through detailed bibliometric methods. Methods The articles published between the years 2009 and 2018 were downloaded from the Web of Science (WoS) database and analyzed using bibliometric methods. The literature review was conducted using the keyword "Anesthesiology" in the "Research Area" category via the advanced search option available in WoS. The relation between the number of publications of the countries and the Gross Domestic Products and Human Development Index values were analyzed using Spearman's correlation coefficient. The number of articles between the years 2019 and 2021 was estimated through linear regression analysis. Results A review of the literature indicated 41,003 articles in the Web of Science database. Estimations included 4,910 (3,971-5,849) articles for the year 2019. There was a high-level, positive significant correlation between the number of publications and Gross Domestic Product (r = 0.776, p < 0.001). Conclusion The findings show that countries with high income are effective in the field of anesthesia, which indicates a strong association between research productivity and economic development. Undeveloped and developing countries should be encouraged to conduct research in the field of anesthesia.

Resumo Objetivo Existe um número limitado de estudos bibliométricos na literatura, e no campo da anestesiologia concentram-se de forma geral nos estudos mais citados. Entretanto, existem poucos estudos de avaliação bibliométrica holística dessas publicações. O objetivo do presente estudo foi fazer um resumo contemporâneo dos artigos publicados no campo da anestesiologia nos últimos 10 anos usando métodos bibliométricos detalhados. Método Os artigos publicados entre 2009 e 2018 foram extraídos do banco de dados Web of Science (WoS) e analisados usando métodos bibliométricos. A revisão da literatura foi conduzida usando o unitermo "Anesthesiology" (Anestesiologia) na categoria "Research Area" (Área de Pesquisa) usando a opção de busca avançada disponível no WoS. A relação entre o número de publicações de cada país e os valores do Produto Interno Bruto e Índice de Desenvolvimento Humano foi analisada usando o coeficiente de correlação de Spearman. O número de artigos para os anos de 2019 a 2021 foi estimado por meio de análise de regressão linear. Resultados A revisão da literatura encontrou 41.003 artigos no banco de dados Web of Science. As estimativas incluíram 4.910 (3.971-5.849) artigos para o ano de 2019. Houve correlação de alto grau, positiva, significante entre o número de publicações e Produto Interno Bruto (r = 0,776; p< 0,001). Conclusões Os achados mostram que países de alta renda são efetivos no campo da anestesiologia, indicando uma forte associação entre a produtividade em pesquisa e desenvolvimento econômico. Países não desenvolvidos ou em desenvolvimento devem ser estimulados a conduzir pesquisa no campo da anestesiologia.

Epidemiology of Self-poisoning with Drug in the Central Anatolian Region in Turkey.

AIM: Deliberate self-poisoning (DSP) is a common cause of intensive care hospitalization among young adults and a serious health problem worldwide. Demographic data vary according to geographical and sociocultural characteristics of the regions. In recent years, studies investigating epidemiological features and prognosis of these patients have increased. In our study, we retrospectively examined patients who committed suicide with drugs and were treated in the ICU of our hospital. MATERIALS AND METHODS: The files of 148 patients who took drugs or substances for committing suicide and who were hospitalized in the ICU of Aksaray Training and Research Hospital between 2015 and 2019 were examined. Demographic data of the patients, type of the agent used in the suicide, time to reach hospital, treatment methods applied, length of hospital stay, vital signs, complications, need for intubation, and mortality rates were recorded. RESULTS: Mean age of the 148 patients who took drugs for suicide was 26.7. Female rate was 73%. The most frequently used drug for suicide was paracetamol (34.4%). Antidepressants took the second place and were followed by drugs in the NSAID group. The duration of admission in the hospital after taking the medicine ranged from 1 to 6 h, while it was less than 3 h in 68.2% of the patients. In most suicide patients, the treatment method was in the form of intravenous fluid and supportive therapy (95%). N-acetyl cysteine (paracetamol intoxication) was used in 7% of the patients, an intubation requirement developed in 2.7%, and three patients taking organophosphate died. CONCLUSION: In studies conducted in developing countries such as Turkey, female sex (63%-71%) and 25 years of age have been found to be the proportion of the patients (56%-63%), whereas our study found even higher ratios compared to those (73%-66%). In studies conducted in developed countries, most commonly used agents for suicide were benzodiazepines and tricyclic antidepressants, while the most common suicide agent was paracetamol in our study. We believe that the reason for this could be the possibility of accessing the agent without a prescription.

A bibliometric analysis of publications on trauma in critical care medicine during 1980-2018: A holistic view.

BACKGROUND: There is not a holistic bibliometric study evaluating the publications in the literature even though trauma is a paramount subject in the field of critical care. This study aimed to investigate the important articles and journals receiving the most citations and publishing the most articles, revealing international cooperation and uncovering trend topics in this subject as a consequence of analyzing articles on trauma in the field of critical care published between 1980 and 2018 using bibliometric analysis methods. METHODS: Publication scan in this study was performed using Web of Science (WoS) database. Literature review was limited to only publications indexed in the field of Critical Care. "Trauma" was used as the keyword to reach relevant publications. Linear regression analysis was performed to predict the number of articles foreseen to be published in the upcoming years in the subject of trauma. RESULTS: As a result of the literature review, a total of 10851 publications were found. Six thousand four hundred and eighty-nine (59.8%) of these publications were under the category of article. First three countries with the most publications were respectively as the United States of America (4096) (63.1%), Canada (401) and Germany (380). Turkey ranked 21 with 41 publications. The article titled "Evaluating trauma care - the triss method" published in 1987 had received the most citations. The journal with the most publications and citations was "Journal of Trauma Injury Infection and Critical Care". CONCLUSION: This study will be a useful guide to all scientists and clinicians conducting research on trauma in critical care.

N-methyl-D-aspartate Receptor Antagonists may Ameliorate Spinal Cord Injury by Inhibiting Oxidative Stress: An Experimental Study in Rats.

AIM: To investigate the neuroprotective effect of a N-methyl-D-aspartate (NMDA) receptor antagonist (amantadine) in an experimental spinal cord injury (SCI) model. MATERIAL AND METHODS: Thirty male Spragueâ€"Dawley rats were divided into three groups: control (I), SCI (II), and SCI + amantadine (III). SCI was created using clip compression technique. At the end of day 7, blood samples were obtained from the rats and analyzed using various biochemical markers. Histological examination was also performed. MDA, GSH, and MPO assays were done. VEGF, TNF-α, and Baxexpressions were also analyzed. RESULTS: The group III had several inflammatory cells in the gray and white matter, with mildly degenerated multipolar and bipolar cells. Some bipolar and multipolar neurons showed TNF-α expression; however, TNF-α was found to be weak in small groups of inflammatory cells around the blood vessels in the substantia grisea and alba. Positive Bax expression was observed in the substantia grisea layer, particularly in the membrane of some bipolar neurons and glial cells; however, negative Bax expression was observed in neuron and glial cells and showed positive VEGF expression in the vascular endothelium in the group III. CONCLUSION: NMDA receptor antagonists, especially amantadine, may ameliorate SCI by inducing angiogenesis, affecting inflammation and apoptosis. It inhibits oxidative stress and the signaling pathways following SCI in rats.

Evaluation of Neuroprotective Effect of Sevoflurane in Acute Traumatic Brain Injury: An Experimental Study in Rats.

AIM: To examine the effect of sevoflurane, a halogenated anesthetic used in clinical applications, on oxidative stress and inflammation after an acute traumatic brain injury (TBI) in rats. MATERIAL AND METHODS: Thirty male Spragueâ€"Dawley rats were divided into three groups: control (Group 1), trauma (Group 2), and trauma+sevoflurane (Group 3). A diffuse TBI model was created for Groups 2 and 3. Sevoflurane anesthesia was applied 6 hours a day after induced trauma in Group 3. Glutathione (GSH), malondialdehyde (MDA), and tissue myeloperoxidase (MPO) activities were measured in the blood. Tumor necrosis factor alpha (TNF-±), vascular endothelial growth factor (VEGF), and Bax primary antibodies were used to determine the effects of TBI. RESULTS: MDA was significantly higher in Group 2 than in Group 1. There was a significant increase in tissue MPO levels in Groups 2 and 3 compared with those in Group 1. GSH levels decreased in Groups 2 and 3. Group 3 revealed degenerative changes in neurons and glial cells, vascular enlargement and congestion, and inflammatory cell infiltration around blood vessels. In Group 3, VEGF expression was positive in endothelial and inflammatory cells around blood vessels. Group 3 had positive TNF-± expression in neurons, small granular cells, and glial cells around blood vessels. CONCLUSION: Sevoflurane administration in acute TBI did not prevent the development of oxidative stress and inflammation.

Acupuncture Treatment in Patients with Chronic Subjective Tinnitus: A Prospective, Randomized Study.

Objective: This study investigated the effect, onset, duration of action, and short-term outcomes of acupuncture therapy for treating patients with severe chronic subjective tinnitus. Materials and Methods: This randomized controlled trial evaluated patients with chronic, idiopathic, and severe tinnitus. A total of 105 participants were divided into 2 groups using a randomization method: a study group who received verum acupuncture therapy (n = 53) and a sham acupuncture group (n = 52). Ten acupuncture sessions were given over 5 weeks. After treatment, each participant was monitored for up to 3 months according to changes on a visual analogue Scale (VAS), and Tinnitus Handicap Inventory (THI), and Pure-Tone Audiometry and Speech Discrimination (Interacoustics AC-40, Denmark) scores. Results: The VAS and THI scores were evaluated. A statistically significant difference was noted between the sham and verum acupuncture groups at post-treatment follow-up (P < 0.001). Decreases in the THI and VAS scores became significant in the second week of treatment (P < 0.001 and P < 0.001, respectively), but these scores increased again in the third month post-treatment (P < 0.001 and P < 0.001, respectively). Conclusions: Acupuncture is an effective treatment for patients with severe chronic subjective tinnitus. Patient complaints, decreased beginning at the second treatment week; however, in the third post-treatment month, the complaints reappeared. Maintenance acupuncture therapy is necessary for patients with tinnitus; this approach should be investigated in future studies.

The effects of dexmedetomidine in increased intestinal permeability after traumatic brain injury: An experimental study.

BACKGROUND: This study aims to investigate whether or not dexmedetomidine (DEX) application affects inflammation, increased intestinal mucosa damage and intestinal permeability in traumatic brain injury (TBI). METHODS: The rats included in our study were randomized into three groups as the control group (Group 1, n=10), trauma group (Group 2, n=10) and the trauma+dexmedetomidine group (Group 3, n=10). While trauma was not induced in the control group, head trauma was induced in all rats in Groups 2 and 3 with the same method. The rats in Group 3 additionally received the DEX application. Intestinal THF-a, serum TNF-a, IL-6, IL-1b and D-lactate levels were measured six hours post-trauma to assess systemic and local infection. Histopathological evaluation of the terminal ileum was performed at the 6th hour to assess mucosal damage. Intestinal permeability was evaluated by measuring the level of dextran injected into the 5-cm ileum segment adhered to the proximal and distal edges at the 30th minute in the blood taken by cardiac puncture. RESULTS: Intestinal TNF-a (p=0.003), serum TNF-a (p=0.009), IL-6 (p=0.002), IL-1b (p=0.001), and D-lactate levels measured in Group 3 (p=0.046) were significantly lower than those measured in Group 2. Dextran level measured in blood in Group 3 was observed significantly lower than that of Group 2 (p<0.001). Histopathological evaluation of the intestines revealed no injuries in the ileum of the rats in Group 1, injury in the ileum, villus atrophy and mucosal damage in the rats in Group 2, and a significant recovery was observed in Group 3 in comparison to Group 2. CONCLUSION: It was seen in our study that DEX reduced TBI-induced increased inflammation, intestinal mucosa damage and intestinal permeability. These results suggest that DEX may ameliorate the damage done to the intestinal tissue by modulating post-TBI inflammatory responses.

Effects of Modic Type 1 Changes in the Vertebrae on Low Back Pain.

OBJECTIVE: The present study examined the physical extent of Modic type 1 (MT1) changes and other phenotypic magnetic resonance imaging (MRI) findings in the vertebrae of patients with low back pain (LBP) and MT1 changes. We also identified any correlations of these findings with the severity of pain and the Oswestry Disability Index (ODI). The relationship between the presence of pain and MT1 changes has been examined in several studies. However, to the best of our knowledge, no study has assessed the relationships between pain severity and ODI and the total vertebral area of MT1 involvement. METHODS: After excluding any patient with MT2 or MT3 changes, 49 patients with a diagnosis of LBP and MT1 changes demonstrated on MRI were included. MT1 involvement area, disc height, number of Schmorl's nodes, disc degeneration (Pfirrmann grade), and cross-sectional area of the lumbar muscles were obtained via MRI. Additionally, patient demographic data, body mass index, physical activity level, and disability (ODI) scores were assessed. RESULTS: The total vertebral area of MT1 involvement correlated significantly and positively with the ODI (P = 0.001). In the multivariate linear regression model, with ODI as the dependent variable and age, mean Pfirrmann grade, total vertebral area of MT1 involvement, and sex as independent variables, only the total vertebral area of MT1 involvement was significantly associated with the ODI. CONCLUSIONS: A significant positive correlation was noted between the vertebral MT1 involvement extent and changes in the ODI. Other MRI features of patients with LBP were not related to pain severity or ODI.

Comparison of the airway access skills of prehospital staff in moving and stationary ambulance simulation: A randomized crossover study.

OBJECTIVES: We aimed to compare the procedural success and intervention durations regarding various airway access skills in moving and stationary ambulance simulations. MATERIAL AND METHODS: An ambulance simulator was used to simulate the moving ambulance environment, and a standard manikin was used for airway simulation. The study included 38 paramedics and paramedic students. In stationary and moving environments, a classical endotracheal intubation with a stylet, an intubation with a gum elastic bougie (GEB), a laryngeal mask airway (LMA), and a laryngeal tube (LT) were applied randomly. The cuff inflation duration, the duration until the first ventilation, and the intubation success were assessed. RESULTS: There was no difference in terms of success and intubation durations of the four methods in moving and stationary environments. In both environments, the LT and LMA were inserted most rapidly (p < 0.001). There was no difference in the intubation duration and the success among the supraglottic methods. In moving and stationary environments, the intubation with a classic stylet was faster than the intubation with a GEB. The use of a GEB did not increase the intubation success. CONCLUSIONS: In this simulation study, the moving environment did not affect the duration or success of the endotracheal intubation. Supraglottic methods were applied more quickly in both moving and stationary environments. A GEB was used successfully by practioners with no previous experience; however, the duration of the intubation was longer.

Diphenylhydantoin Induced DRESS Syndrome: A Case Report.

Drug Rash with Eosinophilia and Systemic Symptoms" (DRESS) syndrome is a severe adverse drug reaction. The drugs most often implicated are anti-convulsants, bupropion, sulfonamides, sulfasalazine, allopurinol, minocycline, abacavir and neviparine. There are also immune and infectious causes that can lead to DRESS syndrome. A 70-year-old female patient had undergone endovascular coil embolization for intracranial aneurysm and experienced a generalised seizure postoperatively. She had been given diphenylhidantoin (DPH). Six days after DPH therapy, the patient had complained of widespread skin rash. Although DPH was replaced with levetiracetam afterwards, the skin rash deteriorated, causing facial oedema and swelling of the tongue. She had severe facial oedema with swelling of the tongue, causing disturbance of breathing. On the second day in the critical care unit, the patient's breathing deteriorated, leading successively to intubation and mechanical ventilation. The patient's rash was still persistent and the results of a punch biopsy taken from the lesions revealed superficial perivascular dermatitis involving spongiotic eosinophils compatible with spongiotic drug eruption. As a result, it is important to realise that medications we use can be the cause of a range of reactions ranging from simple rash to life threatening syndromes.