The impact of Treosulfan-based conditioning for inborn errors of immunity: Is dose monitoring crucial?

INTRODUCTION: In children with inborn errors of immunity (IEI) who will receive a hematopoietic stem cell transplant (HSCT) treosulfan-based conditioning is currently preferred. The aim of this study was to investigate early and late outcomes in pediatric IEI patients receiving pre-HSCT treosulfan and to examine the effect of treosulfan dose monitoring on outcomes. METHODS: Seventy-three pediatric patients receiving this management between 2015 and 2022 were included. RESULTS: Overall survival rate was 80%, and event-free survival was 67.8%. A larger treosulfan dose AUC after first application increased the rate of early toxicity (p = .034) and slowed lymphocyte engraftment (r = .290; p = .030). Underlying disease, treosulfan AUC, donor type, stem cell type, number of immunosuppressive agents, the dose of anti-thymocyte globulin, and post-transplantation cyclophosphamide did not to increase risk of acute graft-versus-host disease. The risk of mixed chimerism (MC) in patients with autoimmune lymphoproliferative syndrome and leukocyte adhesion deficiency were higher than those with severe combined immunodeficiency (p = .021 and p = .014, respectively). The risk of MC was lower in those receiving peripheral blood stem cells (SC) compared with bone marrow derived SC (OR = .204, p = .022). CONCLUSION: The AUC of the treosulfan dose was not associated with poorer late outcomes. Treosulfan is an agent that can be used safely in the IEI patient group,  level measurement appears essential to identify early toxicities. Prospective studies with more extended follow-up periods are needed.

Highly Enantioselective Binaphthyl-Based Chiral Phosphoramidite Stabilized-Palladium Nanoparticles for Asymmetric Suzuki C-C Coupling Reactions.

The optically pure binaphthyl-based phosphoramidite ligands and their perfluorinated analogs have been first used for the preparation of chiral palladium nanoparticles (PdNPs). These PdNPs have been extensively characterized by X-ray diffraction, X-ray photoelectron spectroscopy, transmission electron microscopy, 31P NMR, and thermogravimetric analysis techniques. The circular dichroism(CD) analysis of chiral PdNPs exhibited negative cotton effects. Perfluorinated phosphoramidite ligands provided smaller (2.32-3.45 nm) and well-defined nanoparticles, in comparison with the nonfluorinated analog (4.12 nm). The catalytic behavior of binaphthyl-based phosphoramidite stabilized chiral PdNPs has been investigated in the asymmetric Suzuki C-C coupling reactions for the formation of sterically hindered binaphthalene units, and high isolated yields (up to 85%) were achieved with excellent enantiomeric excesses (>99% ee). Recycling studies revealed that chiral PdNPs could be reused over 12 times without significant loss in activity and enantioselectivity (>99% ee). The nature of the active species was also investigated with a combination of poisoning and hot filtration tests and found that catalytically active species is the heterogeneous nanoparticles. These results indicate that the use of phosphoramidite ligands as a stabilizer for developing efficient and unique chiral nanoparticles could open up a field for many other asymmetric organic transformations promoted by chiral catalysts.

Evaluation of the risk factors for BK virus-associated hemorrhagic cystitis in pediatric bone marrow transplantation patients: Does post-transplantation cyclophosphamide increase the frequency?

BACKGROUND: BKV-HC is one of the most significant complications of HSCT. This retrospective study aimed to determine the frequency of BKV-HC in pediatric patients undergoing HSCT, detect the associated risk factors for the development of BKV-HC, and explore the effects of post-transplantation Cy use. METHODS: Three hundred twenty-seven patients (girls: 121, boys: 206) were analyzed according to sex, conditioning regimen, transplantation type, donor relatedness, stem cell source, the presence and grade of aGVHD, CMV co-existence, and Cy use. RESULTS: Multivariate analysis confirmed the prognostic importance of age (OR: 4.865), TBI use, the presence of aGVHD (OR: 2.794), CMV coinfection (OR: 2.261), and Cy use (OR: 27.353). A statistically significant difference was found between the mean BKV-HC follow-up times compared with post-transplantation Cy intake (p < .001). The BKV-HC rate increased as the number of risk factors of the patient increased. CONCLUSION: BKV-HC is an essential complication of HSCT primarily associated with Cy use, the presence of aGVHD, and donor relatedness. The present study shows that the use of Cy in the post-transplantation period further increases BKV-HC risk in pediatric patients, regardless of dose.

Are the Anxiety Levels of Pediatric Hematology-Oncology Patients Different From Healthy Peers During the COVID-19 Outbreak?

The COVID-19 outbreak has caused anxiety among children with hematology-oncology disease and their families, as it has in every segment of society. In this study, we aimed to detect the anxiety levels of children with hematologic or oncologic disease and of their parents after the COVID-19 outbreak. The sample consisted of 15 patients 12 to 18 years of age receiving treatment in the Pediatric Hematology and Oncology Unit in Altinbas University Medical Faculty Bahçelievler Medikalpark Hospital and 33 parents of the same unit patients between 6 and 18 years of age, and their 35 healthy peers and their parents. The State-Trait Anxiety Inventory was applied to participant children and their parents to evaluate their general anxiety and pandemic-related anxiety levels. Children with a hematology-oncology disease and their families were compared with healthy peers and their families. No significant difference was observed for pandemic-related anxiety levels (P>0.05). Both parent groups exhibited higher anxiety levels with regard to the pandemic than did their children (P<0.05). Children with hematology-oncology disease reported significantly higher trait anxiety levels when compared with healthy peers (P=0.01). The families of children who had not received stem cell transplantation had higher state and trait anxiety scores than the families of children who had received the transplantation (P<0.05). Even though they were in the high-risk group, children with a hematology-oncology disease and their families had pandemic-related anxiety levels comparable with those of healthy peers and their families.

HAX-1 deficiency: Characteristics of five cases including an asymptomatic patient.

BACKGROUND: Mutations in the HAX-1 gene cause an autosomal recessive form of severe congenital neutropenia (SCN), which particularly manifests with recurrent skin, lung and deep tissue infections from the first few months of life. OBJECTIVE: We retrospectively evaluated the clinical and laboratory findings of the patients diagnosed with SCN carrying HAX1 gene mutations. METHODS: A total of five patients with SCN, carrying a HAX1 gene mutation, were evaluated in terms of clinical and laboratory findings. Mutation analysis of the candidate genes (HAX1, ELANE and CSF3R) was performed. RESULTS: All of the patients lived in Turkey; four of them were of Kurdish origin and one was Turkish. Of the five patients, three were girls and two were boys, and the mean age of the patients was 8.8 years old (range 4-15 years). The mean age of diagnosis was 25.8 months (range 2 months-5 years). The infections diagnosed included recurrent gingivitis, stomatitis, and skin and soft tissue abscesses. Developmental retardation and epilepsy were present in only one patient, whereas speech retardation was present in two. All of our patients had a HAX1 mutation, and are still alive and none of them has shown malignant transformation yet. CONCLUSION: Complete blood count should be performed and absolute neutrophil count should be evaluated in patients with recurrent severe infections. In the event that neutropenia is detected, they should be investigated in terms of SCN and mutation analysis should be performed.

Subconjunctival bevacizumab in the impending recurrent pterygia.

The aim of this study is to evaluate the efficacy and safety of subconjunctival bevacizumab injection(s) in the treatment of impending recurrent pterygia. Twenty-three eyes of 23 patients who developed impending recurrence after pterygium surgery with conjunctival autografting and were treated with subconjunctival bevacizumab injection(s) (2.5 mg/0.1 mL) were included in the study. Anterior segment photographs were taken prior to and at 1 week, 1, 3 and 6 months after the injection, and at the end of the follow-up period. Image analysis was performed using an image processing and analysis software program. Recurrence rate and complications were recorded. The mean age and follow-up time of the patients were 51.2 ± 6.2 (31-60 years) and 16.8 ± 3.1 (12-22 months), respectively. The average number of injections was 2 ± 0.78 (1-3). Sixteen eyes required re-injection (two injections in nine eyes, three injections in seven eyes), due to progression of vascularization. There were significant differences between size percentage of lesions before injection and at 1 week, 1, 3 and 6 months after the injection (p < 0.05 for all). Corneal recurrence developed in only one patient and no ocular or systemic side-effects of bevacizumab were observed. Repeated injections of bevacizumab may help to prevent the high recurrence rate of residual impending pterygium, due to its adjuvant role in decreasing lesion size, especially in the first year after surgery.

The effect of amantadine treatment on neurological outcome and mortality in mechanically ventilated severe head trauma patients in intensive care unit.

This study aims to investigate the effect of amantadine use on neurological outcomes and mortality in patients with severe traumatic brain injury (TBI) (Glasgow coma score [GCS] between 3 and 8) who have been followed up on mechanical ventilators in the intensive care unit (ICU). Data from the hospital's electronic records were retrospectively searched. Patients over 18 years of age, with severe brain trauma (GCS between 3-8), who were treated with endotracheal intubation and invasive mechanical ventilation at admission to the ICU, and who were treated with Amantadine hydrochloride at least once in the first week of follow-up were included in the study. To evaluate the patients' neurological outcomes, the GCS and FOUR scores were used. GCS and FOUR scores were recorded on the 1st, 3rd, and 7th days of the first week. In addition, the score difference between the 1st and 7th day was calculated for both scores. The patients were divided into 2 groups: those receiving amantadine treatment (Group A, n = 44) and the control group (Group C, n = 47). The median age of all patients was 39 (18-81) (P = .425). When Group A and Group C were compared, no statistically significant results were found between the 1st, 3rd, and 7th day GCS values (P = .474, P = .483, and P = 329, respectively). However, the difference in GCS values between day 1 and day 7 (∆ GCS 7-1) was statistically significant (P = .012). Similarly, when Group A and Group C were compared, no statistically significant results were found between the 1st, 3rd, and 7th day FOUR score values (P = .948, P = .471, and P = .057, respectively). However, the FOUR score values between day 1 and day 7 (∆ FOUR score 7-1) were statistically significant (P = .004). There was no statistically significant difference among the groups in terms of ICU length of stay, duration of non-ICU hospital stay, and length of hospital stay (P = .222, P = .175, and P = .067, respectively). Amantadine hydrochloride may help improve neurological outcomes in patients with severe TBI. However, further research is needed to investigate this topic.

Epidemiologic and microbiologic evaluation of catheter-line bloodstream infection in a pediatric hematopoietic stem cell transplant center.

BACKGROUND: Children who underwent hematopoietic stem cell transplant (HSCT) transplants are at high risk of developing central-line-associated bloodstream infections (CLABSIs). The present study aimed to identify possible risk factors for mortality by analyzing the clinical and laboratory characteristics of patients diagnosed with CLABSI in our pediatric hematopoietic stem cell transplant unit. METHODS: The initial CLABSI episodes of 102 children were analyzed. Medical records of the patients were evaluated by preformed standardized surveys. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for mortality. RESULTS: Thirty-five patients (34.3%) were female. The median age was 48 months (3-204). The median time to onset of CLABSI was 19 days (4-150). The gram-negative and gram-positive bacteria ratio among the causative agents was 57.8% to 34.3%. The mortality rate was 12.6%. The presence of severe neutropenia, initiation of inappropriate empirical antibiotic therapy, the presence of hypotension, persistent bacteremia, pediatric intensive care unit admission, growth of carbapenemase-positive gram-negative microorganism and multidrug-resistant bacteria were significantly high in the mortality group when compared to survivors. The presence of hypotension, inappropriate empirical antibiotic therapy, and persistent bacteremia were found to be independent risk factors for mortality. CONCLUSIONS: Rational use of antibiotics, active surveillance and screening of patients together with improved infection control practices may reduce the incidence and the consequences of CLABSIs.

The Relationship between Gynecological Cancer Awareness and Self-Care Agency in Married Women.

Nursel Alp DalObjective This study was conducted to determine the relationship between gynecological cancer awareness and self-care agency among married women. Materials and Methods This descriptive and cross-sectional study was performed with 819 women who presented to the obstetrics polyclinic of a hospital located in the west of Turkey between December 15, 2020 and April 15, 2021. The data of the study were collected by using the Exercise of Self-Care Agency Scale (ESCA) and the Gynecological Cancers Awareness Scale (GCAS). Results The mean age of the participants was 37.62 ± 9.181 years. The mean ESCA score of the women who participated in this study was 95.89 ± 25.060, which indicated moderate levels of self-care agency. The mean total GCAS score of the participants of this study was 156.57 ± 32.930, which indicated high levels of gynecological cancer awareness among the women. As the self-care agency of the women increased, their awareness of gynecological cancers also increased. Conclusion Midwives and nurses who provide preventive and supportive healthcare services may affect the self-care agency of women positively by gynecological cancer awareness they will raise in these women.

A bibliometric analysis of obstructive sleep apnea and anesthesia.

To conduct a bibliographic analysis of obstructive sleep apnea (OSA) which has reached epidemic proportions and is a frequent, unknown, and important cause of perioperative morbidity and mortality, by examining the internationally most cited articles. For OSA, the most cited articles in the field of anesthesiology and reanimation, appropriate access terms were compiled and combined, and related publications were searched using the Thompson Reuters Web of Science Citation Indexing search engine. A total of 79 journal publications were found on OSA and anesthesia, with an average of 14.86 citations per article. The most cited publication was the "Society for Ambulatory Anesthesia Consensus Statement on Preoperative Selection of Adult Patients with Obstructive Sleep Apnea Scheduled for Ambulatory Surgery" published in the journal Anesthesia and Analgesia and was conducted by Joshi et al. It was found that 38 of the 79 studies reached as a result of the search were articles, and the average number of citations was 21.13. The Hirsch index of these articles, which were cited 803 times in total, was 15. A total of 31 articles (81.57%) were cited at least once, while the remaining 7 articles (18.43%) were not cited at all. The majority of the articles obtained are from the research fields of anesthesiology (n = 20; 52.63%), followed by otorhinolaryngology (n = 5; 13.15%), pediatrics (n = 5; 13.15%), respiratory system (n = 5; 13.15%), internal medicine (n = 4; 10.52%), and the rest were in various fields. Publications on "Obstructive Sleep Apnea" and "Anesthesia" have increased rapidly in the last decade. Anesthesia management and airway safety, patient management, including pain control in the postoperative period, and noninvasive mechanical ventilation treatment methods, such as continuous positive airway pressure, are hot topics.

The relationship between bi-spectral index and VOTE score in evaluation of drug-induced sleep endoscopy: A systematic meta-analysis.

OBJECTIVE: The aim of this study was to investigate both the presence and severity of collapse in anatomical regions defined by the VOTE score (velum, orofarinx, tongue, and epiglottis), during drug induced sleep endoscopy (DISE) in patients diagnosed with obstructive sleep apnea, based on the bi-spectral index (BIS) sedation level. METHODS: In order to conduct a meta-analysis of articles examining the relationship between the VOTE score and BIS sedation level in determining the presence and severity of upper airway collapse during DISE, a literature review was performed. RESULTS: As a result of the search made in the specified databases, a total of 1864 articles were reached. Five articles included in this review that had sufficient statistical data to be included in the meta-analysis were found. A statistically significant correlation was found between the BIS sedation level and the areas of obstruction in the VOTE score. The strongest association is at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively (CC: 0.639, CC: 0.53, CC: 0.49, and CC: 0.346, P < .001). In the subgroup analysis of publications with BIS sedation levels in the range of 60 to 65, the distribution in the epiglottis region was heterogeneous, and it was found to be statistically significant according to the random effect model (P < .001). The distribution in the tongue was homogeneous, and it was found to be statistically significant according to the fixed effect model (P < .001). When the publications in which the BIS sedation level is in the range of 65 to 75 are examined according to the areas of obstruction; the distribution in 4 anatomical regions was homogeneous and statistically significant according to the fixed effect model (P < .001). CONCLUSION: It was found that BIS sedation levels during DISE application in obstructive sleep apnea patients were associated with obstruction of the anatomical regions of the upper airway. The strongest association was found at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively. It is helpful to monitor the sedation level with BIS in order to better define the collapsed areas during DISE application. However, more studies are needed to better understand the relationship between BIS sedation values and sleep stages.

Investigation of high flow nasal cannule efficiency with electric impedance tomography based parameters in COVID-19 adults patients: a retrospective study.

Background/Aim: This study aimed to investigate the effects of oxygen therapy using a high flow nasal cannula (HFNC) on patients diagnosed with COVID-19 Acute Respiratory Distress Syndrome (C-ARDS) by utilizing electrical impedance tomography (EIT)-based parameters. Materials and Methods: Oxygen therapy was administered to the patients at two different flow rates and two different positions: T0-baseline measurements were taken in the supine position before any therapy was initiated. T1-HFNC was administered in the supine position with a flow rate of 30 L/min. T2-HFNC was administered in the supine position with a flow rate of 50 L/min. T3-HFNC was administered in the prone position with a flow rate of 30 L/min. T4-HFNC was administered in the prone position with a flow rate of 50 L/min. EIT-based parameters (global inhomogeneity index (GI index), center of ventilation (CoV), regional ventilation delay index (RVD index), region of interest ratio (ROI ratio)), as well as respiratory and hemodynamic parameters of the patients, were recorded from the database. Results: A total of twenty patients were included in this retrospective observational study. The mean age of the included patients was 64.3 ± 10.6 years. Statistically significant differences were observed in the measurements of GI index, CoV, RVD index, ROI ratio, PaO2/FiO2 ratio, respiratory rate, and mean arterial pressure parameters across different time intervals (p < 0.005). Pairwise comparisons of EIT parameters and measurements of respiratory and hemodynamic parameters at five different time points revealed statistically significant differences. For the GI index, significant differences were observed between the mean measurements taken at T0-T1, T0-T2, T0-T3, T0-T4, T1-T3, T1-T4, T2-T3, T2-T4, and T3-T4 time intervals (p < 0.05). Regarding CoV, significant differences were found between the mean measurements taken at T0-T3, T1-T3, T2-T3, and T3-T4 time intervals (p < 0.05). Additionally, for the ROI ratio, significant differences were observed between the measurement averages taken at each time interval (p < 0.05). Conclusion: Our findings suggest that prone positioning during the management of C-ARDS patients leads to improved lung homogeneity, as indicated by EIT parameters. However, further research is required to enhance the visualization of ventilation using EIT.

Self-disclosure, empathy and anxiety in nurses.

PURPOSE: This study aimed to examine the relationship between self-disclosure, empathy, and anxiety in nurses. DESIGN AND METHODS: The study was conducted with 255 nurses working in hospitals in Turkey. Data were collected using a Sociodemographic Form, the Self-Disclosure Scale (SDS), the Basic Empathy Scale (BES), and the Spielberger State-Trait Anxiety Inventory (STAI). FINDINGS: A statistically significant positive relationship was found among the SDS, BES, and Spielberger STAI. PRACTICE IMPLICATIONS: Psychiatric nurses should ensure the reduction of nurses' anxiety levels by planning different interventions such as psychotherapy, counseling, and training. They may determine nurses' self-disclosure and empathy skills as well as their needs.

Is serum magnesium level associated with atrial fibrillation in the mixed medical/surgical intensive care unit setting?

Background: Although low serum magnesium level is a a relatively common problem in mixed medical/surgical intensive care units (ICUs), its association with new-onset atrial fibrillation (NOAF) has been studied to a lesser extent. We aimed to investigate the effect of magnesium levels on the development of NOAF in critically ill patients admitted to the mixed medical/surgical ICU. Methods: A total of 110 eligible patients (45 female, 65 male) were included in this case-control study. The age and sex-matched control group (n = 110) included patients with no atrial fibrillation from admission to discharge or death. Results: The incidence of NOAF was 2.4% (n = 110) between January 2013 and June 2020. At NOAF onset or the matched time point, median serum magnesium levels were lower in the NOAF group than in the control group (0.84 [0.73-0.93] vs. 0.86 [0.79-0.97] mmol/L; p = 0.025). At NOAF onset or the matched time point, 24.5% (n = 27) in the NOAF group and 12.7% (n = 14) in the control group had hypomagnesemia (p = 0.037). Based on Model 1, multivariable analysis demonstrated magnesium level at NOAF onset or the matched time point (OR: 0.07; 95%CI: 0.01-0.44; p = 0.004), acute kidney injury (OR: 1.88; 95%CI: 1.03-3.40; p = 0.039), and APACHE II (OR: 1.04; 95% CI: 1.01-1.09; p = 0.046) as factors independently associated with an increased risk of NOAF. Based on Model 2, multivariable analysis demonstrated hypomagnesemia at NOAF onset or the matched time point (OR: 2.52; 95% CI: 1.19-5.36; p = 0.016) and APACHE II (OR: 1.04; 95%CI: 1.01-1.09; p = 0.043) as factors independently associated with an increased risk of NOAF. In multivariate analysis for hospital mortality, NOAF was an independent risk factor for hospital mortality (OR: 3.22; 95% CI: 1.69-6.13, p<0.001). Conclusion: The development of NOAF in critically ill patients increases mortality. Critically ill patients with hypermagnesemia should be carefully evaluated for risk of NOAF.

Needs of family members of patients admitted to a university hospital critical care unit, Izmir Turkey: comparison of nurse and family perceptions.

PURPOSE: This study aims to compare the perceptions of nurses and families on the needs of the relatives of the patients in Intensive Care Unit (ICU). METHODS: This cross-sectional study was conducted in the ICU of a university hospital. The study comprised 213 critical care patients' relatives and 54 nurses working in the same ICU. Data were collected using the Turkish version of Critical Care Family Needs Inventory (CCFNI) and a questionnaire on the characteristics of the participants. The difference between the perceptions of families and nurses was analyzed using Student t-test. Results: CCFNI's assurance/proximity subscale mean scores ranked first among bothpatients and nurses. The item "To be assured the best care possible is being given to the patient" was the top priority for both groups. Mean assurance/proximity and information dimensions of relatives were significantly higher compared to nurses (p < 0.001). No significant difference was found between the perception of patient relatives and nurses related to support and comfort dimensions (p < 0.05). CONCLUSION: The needs of the relatives of patients are underestimated by nurses. This inhibited the performance of ICU nurses in line with the holistic care approach. Educational objectives that include the needs of ICU patients' relatives should be incorporated into the undergraduate and in-service training of nurses. Policies should be established to create space and time for effective relative-nurse communication.

Evaluation of clinical and laboratory characteristics of childhood tuberculosis.

AIM: Tuberculosis is one of the oldest and most contagious diseases of human history. One- quarter of the world's population is infected with the tuberculosis bacillus. Childhood tuberculosis does not have a standard clinical and radiologic description. Herein, we aimed to evaluate the clinical, laboratory, and radiologic findings of childhood tuberculosis. MATERIAL AND METHODS: The medical records of 216 patients hospitalized and treated with a diagnosis of TB between January 2015 and July 2019 in the Division of Pediatric Infectious Diseases in our hospital, were examined retrospectively. RESULTS: One hundred twenty-nine (59.7%) of 216 patients who were diagnosed as having TB were female and 87 (40.3%) were male. The age distribution of the patients was 12.3 (range, 0.33-18) years. One hundred sixty-nine patients (78.2%) had pulmonary, 34 (15.7%) had extrapulmonary, 13 had (6%) both pulmonary and extrapulmonary. One hundred forty-three (66.2%) patients had tuberculin skin test positivity. Acid-resistant bacteria were observed in 46 (21.3%) body fluid samples, and culture positivity was observed in 42 (19.4%) samples. The association of pulmonary tuberculosis and extrapulmonary tuberculosis was found with a higher rate in individuals who lived on minimum wage and in patients who had growth and developmental retardation (p=0.001, p<0.001). The hospitalization time was longer in these patients (p=0.027). The hemoglobin and sodium levels were significantly lower in patients who had extrapulmonary tuberculosis (p=0.044, p=0.002). CONCLUSION: Although the diagnosis of childhood tuberculosis is difficult due to the nonspecific signs and symptoms, it is a preventable and treatable disease.

Nutrition assessment in critically ill patients.

BACKGROUND: The aim of this study was to assess whether subjective global assessment (SGA) is useful in identifying malnutrition and outcomes in the intensive care unit (ICU). METHODS: After obtaining institutional approval, 124 consenting patients were enrolled in this study. Patients were evaluated at admission using clinical data, SGA, height, weight, triceps skinfold thickness (TSF), mid-arm circumference (MAC), Acute Physiology and Chronic Health Evaluation (APACHE II), and Simplified Acute Physiologic Score (SAPS). Patients were classified as well nourished, moderately malnourished, or severely malnourished with SGA. RESULTS: According to SGA, 62% (n = 77) of the patients were classified as well nourished, 26% (n = 33) as moderately malnourished, and 11% (n = 14) as severely malnourished. Body weight, body mass index (BMI), MAC, TSF, and mid-arm muscle circumference (MAMC) were lower, whereas APACHE II and SAPS II scores and mortality were higher in the malnourished groups compared with the well-nourished group. The SGA rating correlated significantly with age, body weight, percentage of weight loss, serum albumin level, APACHE II and SAPS II scores, and mortality. Anthropometrics data were correlated with SGA. Mortality rate was correlated with high APACHE II score, SAPS II score, days in the ICU and low BMI, MAMC, and serum albumin level. CONCLUSIONS: The results support that SGA is simple and may predict the patient's outcomes in the ICU.

Perioperative antibiotic prophylaxis and cost in a Turkish University Hospital.

Although surgical site infections have decreased with the use of prophylactic antibiotics, inappropriate surgical antibiotic prophylaxis is still a world-wide problem. In this retrospective study, perioperative antibiotic prophylaxis was evaluated in a university hospital. All surgical procedures (total 2038) performed in the year 2002 were included. The study setting was the Anesthesiology and Reanimation unit in Pamukkale University Medicine Faculty Hospital. A total of 1902 patients received antibiotic prophylaxis. Ninety-two percent of all procedures were elective, 8% emergencies. Approximately 85.7% were clean surgery, 8.5% clean-contaminated, 5.3% contaminated, and 0.5% dirty. Approximately 93.3% of patients received antibiotic prophylaxis. Although timing of prophylaxis was appropriate in all procedures, duration was optimal in only 29.0% of all cases. Sulbactam/ampicillin (33.2%), cefepime (23.4%), ceftriaxone (15.1%), ciprofloxacin (12.6%) and cefazolin (11%) were the most commonly used antibiotics. Instead of an estimated optimal cost of perioperative antibiotic prophylaxis ranging between US$2.6 and 7.8 according to guidelines, the average cost was US$62 per patient. We believe that compliance regarding the optimal choice, frequency and duration of perioperative antibiotic prophylaxis is inadequate, thereby making additional efforts necessary.

Contrast Sensitivity in Microtropic and Anisometropic Eyes of Successfully Treated Amblyopes.

OBJECTIVES: To assess and compare contrast sensitivity function in the previously amblyopic and non-amblyopic "normal" eyes of patients with microtropia and anisometropia who achieved 20/20 visual acuity after occlusion therapy. MATERIALS AND METHODS: Contrast sensitivity was tested monocularly on both eyes of 34 successfully treated microtropic and 15 anisometropic subjects (visual acuity 20/20 in both eyes). Contrast sensitivity function was evaluated by CSV-1000E and age-matched nomograms were used (spatial frequencies of 3, 6, 12, and 18 cycles per degree [cpd]) for comparison. RESULTS: The mean age of subjects was 11.2±1.3 years in the microtropic group, 9.8±1.7 years in the anisometropic group (7-12 years); the mean follow-up time was 16.4±3.2 months (12 to 92) in the microtropic group and 27.7±1.8 months (12-84) in the anisometropic group. Statistical comparison of the microtropic amblyopic eyes versus non-microtropic eyes showed significant differences at spatial frequencies of 3, 12 and 18 cpd (3 cpd, t=2.8, p=0.007; 6 cpd, t=1.1 p=0.261; 12 cpd, t=2.2, p=0.033; 18 cpd, t=2.2, p=0.030). When anisometropic eyes were compared with non-anisometropic eyes, there was a significant difference only at 12 cpd (t=2.1 p=0.049). The comparison of non-amblyopic eyes versus age-matched nomograms revealed no differences at any of the spatial frequencies (p>0.05 for all). CONCLUSION: Contrast sensitivity was decreased in patients with amblyopia, especially in the microtropic group. The assessment of contrast sensitivity function may serve as a new parameter for termination of occlusion therapy.

Evaluation of choroidal and retinal thickness measurements in adult hemodialysis patients using spectral-domain optical coherence tomography.

PURPOSE: To assess the effect of hemodialysis on retinal and choroidal thicknesses using spectral-domain optical coherence tomography (SD-OCT). METHODS: In this prospective interventional study, 25 hemodialysis patients (17 male, 8 female) were enrolled. All participants underwent high-speed, high-resolution SD-OCT (λ=840 mm; 26.000 A-scans/s; 5 µm resolution) before and after hemodialysis. Choroidal thickness was measured perpendicularly from the outer edge of the retinal pigment epithelium to the choroid-sclera boundary at the fovea and at five additional points: 500 µm and 1000 µm nasal to the fovea and 500 µm, 1000 µm, and 1500 µm temporal to the fovea. Two masked physicians performed the measurements. Choroidal and retinal thicknesses before and after hemodialysis were compared. RESULTS: The median choroidal thicknesses before and after hemodialysis were 182 µm (range, 103-374 µm) and 161 µm (range, 90-353 µm), respectively (P<0.001). The median retinal thicknesses were 246 µm (range, 179-296 µm) before and 248 µm (range, 141-299 µm) after hemodialysis (P>0.05). Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, and ocular perfusion pressure significantly decreased after hemodialysis (P<0.001). Intraocular pressure did not vary significantly (P=0.540). CONCLUSION: Hemodialysis seems to cause a significant decrease in choroidal thickness, whereas it has no effect on retinal thickness. This significant decrease in choroidal thickness might be due to the extensive fluid absorption in hemodialysis, which could result in decreased ocular blood flow.