Pub Date : 2024-09-01DOI: 10.14744/tjtes.2024.69547
Sabahattin Destek, Osman Cemil Akdemir, Ceren Gonultas, Vahit Onur Gul
Intra-abdominal abscesses usually originate from the gastrointestinal tract, with 70% occurring in the postoperative period. The mortality rate can reach 50%. These abscesses most commonly develop in the subphrenic and subhepatic spaces. Treatments include percutaneous drainage or surgical drainage. In this report, we present a minimally invasive video-assisted trans-diaphragmatic drainage (MIVTD) method through a simple incision using a right intercostal approach. This method was successfully performed on a patient who underwent Graham patch repair with laparotomy due to a diagnosis of peptic ulcer perforation and subsequently developed a right subphrenic multiloculated collection after unsuccessful percutaneous drainage.
{"title":"Minimally invasive video-assisted trans-diaphragmatic drainage of a subphrenic complicated abscess.","authors":"Sabahattin Destek, Osman Cemil Akdemir, Ceren Gonultas, Vahit Onur Gul","doi":"10.14744/tjtes.2024.69547","DOIUrl":"https://doi.org/10.14744/tjtes.2024.69547","url":null,"abstract":"<p><p>Intra-abdominal abscesses usually originate from the gastrointestinal tract, with 70% occurring in the postoperative period. The mortality rate can reach 50%. These abscesses most commonly develop in the subphrenic and subhepatic spaces. Treatments include percutaneous drainage or surgical drainage. In this report, we present a minimally invasive video-assisted trans-diaphragmatic drainage (MIVTD) method through a simple incision using a right intercostal approach. This method was successfully performed on a patient who underwent Graham patch repair with laparotomy due to a diagnosis of peptic ulcer perforation and subsequently developed a right subphrenic multiloculated collection after unsuccessful percutaneous drainage.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.14744/tjtes.2024.78241
İzzet Ustaalioglu, Gülbin Aydoğdu Umaç
Background: Aortic dissection (AD) is a serious cardiovascular condition associated with high mortality rates. The systemic inflammatory response can influence the prognosis of AD, and in this context, the neutrophil-to-lymphocyte ratio (NLR) emerges as a simple and rapid inflammatory biomarker.
Methods: This retrospective cohort study included 103 patients diagnosed with AD and treated in the emergency department between 2018 and 2023. Patient demographics, clinical features, and laboratory results were evaluated. Multivariate logistic regression analysis was performed to adjust for potential confounders such as age, mean systolic blood pressure, oxygen saturation, hemoglobin, lactate values, and the presence of coronary artery disease. The ability of NLR to predict mortality was analyzed using receiver operating characteristic (ROC) analysis.
Results: The study population was divided into two groups: non-survivors (68% mortality rate) and survivors (32% survival rate). The non-survivor group had significantly higher NLR values compared to the survivor group (median NLR 7.66 vs. 2.5, p<0.001). Multivariate logistic regression analysis identified NLR as an independent predictor of in-hospital mortality (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.42-3.82, p<0.001). ROC analysis for NLR demonstrated high discriminative power with an area under the ROC curve (AUROC) of 0.851 (95% CI 0.768-0.914). The determined cut-off point was >5.08 with a sensitivity of 77.14% and specificity of 81.82%.
Conclusion: The findings indicate that high NLR is strongly associated with increased mortality risk in patients with AD and can be used in emergency clinical settings to predict mortality.
背景:主动脉夹层(AD主动脉夹层(AD)是一种严重的心血管疾病,死亡率很高。全身炎症反应可影响 AD 的预后,在此背景下,中性粒细胞与淋巴细胞比值(NLR)成为一种简单、快速的炎症生物标志物:这项回顾性队列研究纳入了2018年至2023年期间在急诊科确诊并接受治疗的103名AD患者。对患者的人口统计学特征、临床特征和实验室结果进行了评估。进行了多变量逻辑回归分析,以调整潜在的混杂因素,如年龄、平均收缩压、血氧饱和度、血红蛋白、乳酸值和是否存在冠状动脉疾病。使用接收器操作特征(ROC)分析方法分析了 NLR 预测死亡率的能力:研究对象分为两组:非存活者组(死亡率为 68%)和存活者组(存活率为 32%)。与幸存者组相比,非幸存者组的 NLR 值明显更高(NLR 中位数为 7.66 vs. 2.5,P5.08,敏感性为 77.14%,特异性为 81.82%):研究结果表明,高 NLR 与 AD 患者死亡风险增加密切相关,可用于临床急诊预测死亡率。
{"title":"Neutrophil/lymphocyte ratio as a predictor of mortality among aortic dissection patients in the emergency department.","authors":"İzzet Ustaalioglu, Gülbin Aydoğdu Umaç","doi":"10.14744/tjtes.2024.78241","DOIUrl":"https://doi.org/10.14744/tjtes.2024.78241","url":null,"abstract":"<p><strong>Background: </strong>Aortic dissection (AD) is a serious cardiovascular condition associated with high mortality rates. The systemic inflammatory response can influence the prognosis of AD, and in this context, the neutrophil-to-lymphocyte ratio (NLR) emerges as a simple and rapid inflammatory biomarker.</p><p><strong>Methods: </strong>This retrospective cohort study included 103 patients diagnosed with AD and treated in the emergency department between 2018 and 2023. Patient demographics, clinical features, and laboratory results were evaluated. Multivariate logistic regression analysis was performed to adjust for potential confounders such as age, mean systolic blood pressure, oxygen saturation, hemoglobin, lactate values, and the presence of coronary artery disease. The ability of NLR to predict mortality was analyzed using receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>The study population was divided into two groups: non-survivors (68% mortality rate) and survivors (32% survival rate). The non-survivor group had significantly higher NLR values compared to the survivor group (median NLR 7.66 vs. 2.5, p<0.001). Multivariate logistic regression analysis identified NLR as an independent predictor of in-hospital mortality (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.42-3.82, p<0.001). ROC analysis for NLR demonstrated high discriminative power with an area under the ROC curve (AUROC) of 0.851 (95% CI 0.768-0.914). The determined cut-off point was >5.08 with a sensitivity of 77.14% and specificity of 81.82%.</p><p><strong>Conclusion: </strong>The findings indicate that high NLR is strongly associated with increased mortality risk in patients with AD and can be used in emergency clinical settings to predict mortality.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.14744/tjtes.2024.77415
Fatih Ceran, Salih Onur Basat, İdris Ersin, Deniz Filinte, Özgür Pilancı, Mehmet Bozkurt
Background: Ischemia-reperfusion injury (IRI) is a phenomenon that affects transplant survival. The aim of our study was to examine the effects of IRI in isogenic and allogeneic muscle and skin transplantation models exposed to prolonged warm ischemia.
Methods: Forty-eight Lewis rats and 16 Brown-Norway rats were used to create four groups: Isogenic Inguinal Flap Transplantation (IST), Isogenic Gastrocnemius Muscle Flap Transplantation (IMT), Allogeneic Inguinal Flap Transplantation (AST), and Allogeneic Gastrocnemius Muscle Flap Transplantation (AMT). Malonyldialdehyde (MDA) and superoxide dismutase (SOD) levels were measured on postoperative days 1, 7, 21, 35, 63, 100, and 120 in all groups. Donor-specific chimerism (DSC) in peripheral blood was evaluated in the allogeneic groups on postoperative days 7, 21, 35, 63, 100, and 120. The microRNA-21 and microRNA-205 levels were evaluated on postoperative days 1, 7, and 120 in all groups. At the end of the study, a histopathological examination was performed.
Results: A statistically significant difference was found between the groups in terms of MDA and SOD levels. DSC was detected in the AMT group. A significant increase in microRNA-205 was observed, especially in the AMT group. There was no significant difference in the number of functional muscle units between the muscle transplantation groups.
Conclusion: The presence of DSC in the AMT group and the lack of a significant difference in the number of functional muscle units in the IMT and AMT groups are noteworthy findings.
{"title":"Evaluation of the effects of ischemia-reperfusion injury in rat isogenic and allogeneic muscle and skin transplant models.","authors":"Fatih Ceran, Salih Onur Basat, İdris Ersin, Deniz Filinte, Özgür Pilancı, Mehmet Bozkurt","doi":"10.14744/tjtes.2024.77415","DOIUrl":"https://doi.org/10.14744/tjtes.2024.77415","url":null,"abstract":"<p><strong>Background: </strong>Ischemia-reperfusion injury (IRI) is a phenomenon that affects transplant survival. The aim of our study was to examine the effects of IRI in isogenic and allogeneic muscle and skin transplantation models exposed to prolonged warm ischemia.</p><p><strong>Methods: </strong>Forty-eight Lewis rats and 16 Brown-Norway rats were used to create four groups: Isogenic Inguinal Flap Transplantation (IST), Isogenic Gastrocnemius Muscle Flap Transplantation (IMT), Allogeneic Inguinal Flap Transplantation (AST), and Allogeneic Gastrocnemius Muscle Flap Transplantation (AMT). Malonyldialdehyde (MDA) and superoxide dismutase (SOD) levels were measured on postoperative days 1, 7, 21, 35, 63, 100, and 120 in all groups. Donor-specific chimerism (DSC) in peripheral blood was evaluated in the allogeneic groups on postoperative days 7, 21, 35, 63, 100, and 120. The microRNA-21 and microRNA-205 levels were evaluated on postoperative days 1, 7, and 120 in all groups. At the end of the study, a histopathological examination was performed.</p><p><strong>Results: </strong>A statistically significant difference was found between the groups in terms of MDA and SOD levels. DSC was detected in the AMT group. A significant increase in microRNA-205 was observed, especially in the AMT group. There was no significant difference in the number of functional muscle units between the muscle transplantation groups.</p><p><strong>Conclusion: </strong>The presence of DSC in the AMT group and the lack of a significant difference in the number of functional muscle units in the IMT and AMT groups are noteworthy findings.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.14744/tjtes.2024.52932
Furkan Adem Canbaz, Gonca Gerçel, Sefa Sag
Background: This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline.
Methods: A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023.
Results: Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle.
Conclusion: While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.
{"title":"The management of testicular torsion: A survey of Turkish pediatric surgeons and pediatric urologists.","authors":"Furkan Adem Canbaz, Gonca Gerçel, Sefa Sag","doi":"10.14744/tjtes.2024.52932","DOIUrl":"https://doi.org/10.14744/tjtes.2024.52932","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline.</p><p><strong>Methods: </strong>A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023.</p><p><strong>Results: </strong>Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle.</p><p><strong>Conclusion: </strong>While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.14744/tjtes.2024.07834
Ramiz Yazici, Hüseyin Mutlu, Cengizhan Kilicaslan, Ekrem Taha Sert, Kamil Kokulu, Halil Kara, Murat Kilicaslan, Mustafa Ekici, Bensu Bulut
Background: This study aims to determine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) symptoms and the associated risk factors in children admitted to the Emergency Department (ED) due to traumas.
Methods: EChildren aged 3-16 years admitted to the ED for traumas were included in the study. The control group consisted of children aged between 3-16, who visited the pediatric ED for non-traumatic reasons. The Revised Conners Parent Rating Scale (CPRS-R) was administered to parents who agreed to participate following initial intervention and stabilization. Trauma patients were divided into two groups: those diagnosed with ADHD and those without ADHD. Risk factors likely to increase the identification of ADHD were assessed.
Results: The study included 917 children, with both groups showing similar characteristics regarding age, sex, demographic, and cultural factors. The most common reason for ED visits was extremity traumas, accounting for 296 (35.2%) cases. The majority of trauma patients (95.9%) were discharged from the ED after outpatient interventions. All subscale scores of the CPRS-R, except for the social problems subscale, were significantly higher in the study group compared to the control group. Factors that increased the risk of ADHD included admission with extremity traumas (p<0.001), previous ED admissions due to traumas (p<0.001), and having a family member previously diagnosed with ADHD (p<0.001).
Conclusion: The prevalence of ADHD symptoms may be higher in children admitted to the ED due to traumas. Furthermore, extremity traumas, previous trauma-related ED-admissions, and a family history of ADHD increase the risk of ADHD.
{"title":"Prevalence and risk factors of attention deficit hyperactivity disorder in children admitted to the emergency department due to traumas.","authors":"Ramiz Yazici, Hüseyin Mutlu, Cengizhan Kilicaslan, Ekrem Taha Sert, Kamil Kokulu, Halil Kara, Murat Kilicaslan, Mustafa Ekici, Bensu Bulut","doi":"10.14744/tjtes.2024.07834","DOIUrl":"https://doi.org/10.14744/tjtes.2024.07834","url":null,"abstract":"<p><strong>Background: </strong>This study aims to determine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) symptoms and the associated risk factors in children admitted to the Emergency Department (ED) due to traumas.</p><p><strong>Methods: </strong>EChildren aged 3-16 years admitted to the ED for traumas were included in the study. The control group consisted of children aged between 3-16, who visited the pediatric ED for non-traumatic reasons. The Revised Conners Parent Rating Scale (CPRS-R) was administered to parents who agreed to participate following initial intervention and stabilization. Trauma patients were divided into two groups: those diagnosed with ADHD and those without ADHD. Risk factors likely to increase the identification of ADHD were assessed.</p><p><strong>Results: </strong>The study included 917 children, with both groups showing similar characteristics regarding age, sex, demographic, and cultural factors. The most common reason for ED visits was extremity traumas, accounting for 296 (35.2%) cases. The majority of trauma patients (95.9%) were discharged from the ED after outpatient interventions. All subscale scores of the CPRS-R, except for the social problems subscale, were significantly higher in the study group compared to the control group. Factors that increased the risk of ADHD included admission with extremity traumas (p<0.001), previous ED admissions due to traumas (p<0.001), and having a family member previously diagnosed with ADHD (p<0.001).</p><p><strong>Conclusion: </strong>The prevalence of ADHD symptoms may be higher in children admitted to the ED due to traumas. Furthermore, extremity traumas, previous trauma-related ED-admissions, and a family history of ADHD increase the risk of ADHD.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.14744/tjtes.2024.67996
Metin Yığman, Hale Çolakoğlu Er
Background: The use of ureteral access sheaths (UAS), which offer advantages in flexible ureteroscopic lithotripsy (fURL), may lead to undesirable conditions such as ureteral injury, ischemia, and prolonged ureteral stenosis. The aim of this study was to investigate the effect of the distal ureteral lateralization angle on successful UAS placement.
Methods: We analyzed the data of patients who underwent fURL for kidney and/or proximal ureteral stones retrospectively. Based on the preoperative computed tomographic examinations of the patients, the bladder outlet was considered the zero point. We calculated the angle values between the horizontal axis passing through this point and the most lateralized point of the distal ureter. The patients were divided into two groups: those to whom UAS was successfully placed and those to whom UAS placement failed.
Results: No significant difference was detected between the groups with successful UAS placement (n=36) and those without UAS placement (n=12) in terms of sex, laterality, localization, number of stones, stone burden, and bladder volumes evaluated with preoperative computed tomography (p>0.05). However, a significant difference was found between the two groups regarding age and distal ureteral lateralization angle (p<0.001, p=0.013).
Conclusion: The distal ureteral lateralization angle is considered to be an effective factor in the placement of UAS in patients scheduled for fURS.
{"title":"The effect of distal ureteral lateralization angle on ureteral trauma avoidance and successful ureteral access sheath placement.","authors":"Metin Yığman, Hale Çolakoğlu Er","doi":"10.14744/tjtes.2024.67996","DOIUrl":"https://doi.org/10.14744/tjtes.2024.67996","url":null,"abstract":"<p><strong>Background: </strong>The use of ureteral access sheaths (UAS), which offer advantages in flexible ureteroscopic lithotripsy (fURL), may lead to undesirable conditions such as ureteral injury, ischemia, and prolonged ureteral stenosis. The aim of this study was to investigate the effect of the distal ureteral lateralization angle on successful UAS placement.</p><p><strong>Methods: </strong>We analyzed the data of patients who underwent fURL for kidney and/or proximal ureteral stones retrospectively. Based on the preoperative computed tomographic examinations of the patients, the bladder outlet was considered the zero point. We calculated the angle values between the horizontal axis passing through this point and the most lateralized point of the distal ureter. The patients were divided into two groups: those to whom UAS was successfully placed and those to whom UAS placement failed.</p><p><strong>Results: </strong>No significant difference was detected between the groups with successful UAS placement (n=36) and those without UAS placement (n=12) in terms of sex, laterality, localization, number of stones, stone burden, and bladder volumes evaluated with preoperative computed tomography (p>0.05). However, a significant difference was found between the two groups regarding age and distal ureteral lateralization angle (p<0.001, p=0.013).</p><p><strong>Conclusion: </strong>The distal ureteral lateralization angle is considered to be an effective factor in the placement of UAS in patients scheduled for fURS.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.14744/tjtes.2024.87099
Hale Kefeli Çelik, Gökçen Başaranoğlu, Ahmet Haydar Peçe, Gökhan Ünver, Serkan Tulgar, Mustafa Süren
Background: The Modified Early Obstetric Warning System (MEOWS) is a score-based or color-coded system that detects changes in physiological parameters and enables earlier diagnosis and care of worsening obstetric patients. The aim of this study is to evaluate the tool's performance and contribute to its use in Türkiye by translating MEOWS into Turkish.
Methods: This prospective and descriptive study, approved by the local ethics committee, included 350 obstetric in-patients who gave birth at Samsun Training and Research Hospital, Gynecology and Children's Hospital between April and August 2022. The study involved patients with a gestational week greater than 28 weeks and up to six weeks postpartum.
Results: The average age of the patients was 28.9±5.9 (18-40) years, with trigger values occurring in 34.6% (n=121) and morbidity occurring in 30.9% (n=108) of the cases. The most common trigger among the individual physiological indicators was high systolic blood pressure (28.3%). When the performance of MEOWS was evaluated, a statistically significant correlation was found between trigger and morbidity (Kappa=0.605; p<0.001). The sensitivity of MEOWS in estimating morbidity was 77.78% (95% confidence interval [CI]: 68.76-85.21%), specificity was 84.71% (95% CI: 79.55-89.00%), Positive Predictive Value (PPV) was 69.42% (95% CI: 62.40-75.64%), Negative Predictive Value (NPV) was 89.52% (95% CI: 85.67-92.43%), and accuracy was 82.57% (95% CI: 78.18-86.40%).
Conclusion: MEOWS was found to be an effective screening tool for predicting morbidity in this study and performs well in Turkish with sufficient sensitivity, specificity, and accuracy. However, the inclusion of long-term results would provide a more comprehensive understanding of the effectiveness of MEOWS.
{"title":"Validation of the Turkish version of the Modified Early Obstetric Warning System (MEOWS) chart.","authors":"Hale Kefeli Çelik, Gökçen Başaranoğlu, Ahmet Haydar Peçe, Gökhan Ünver, Serkan Tulgar, Mustafa Süren","doi":"10.14744/tjtes.2024.87099","DOIUrl":"https://doi.org/10.14744/tjtes.2024.87099","url":null,"abstract":"<p><strong>Background: </strong>The Modified Early Obstetric Warning System (MEOWS) is a score-based or color-coded system that detects changes in physiological parameters and enables earlier diagnosis and care of worsening obstetric patients. The aim of this study is to evaluate the tool's performance and contribute to its use in Türkiye by translating MEOWS into Turkish.</p><p><strong>Methods: </strong>This prospective and descriptive study, approved by the local ethics committee, included 350 obstetric in-patients who gave birth at Samsun Training and Research Hospital, Gynecology and Children's Hospital between April and August 2022. The study involved patients with a gestational week greater than 28 weeks and up to six weeks postpartum.</p><p><strong>Results: </strong>The average age of the patients was 28.9±5.9 (18-40) years, with trigger values occurring in 34.6% (n=121) and morbidity occurring in 30.9% (n=108) of the cases. The most common trigger among the individual physiological indicators was high systolic blood pressure (28.3%). When the performance of MEOWS was evaluated, a statistically significant correlation was found between trigger and morbidity (Kappa=0.605; p<0.001). The sensitivity of MEOWS in estimating morbidity was 77.78% (95% confidence interval [CI]: 68.76-85.21%), specificity was 84.71% (95% CI: 79.55-89.00%), Positive Predictive Value (PPV) was 69.42% (95% CI: 62.40-75.64%), Negative Predictive Value (NPV) was 89.52% (95% CI: 85.67-92.43%), and accuracy was 82.57% (95% CI: 78.18-86.40%).</p><p><strong>Conclusion: </strong>MEOWS was found to be an effective screening tool for predicting morbidity in this study and performs well in Turkish with sufficient sensitivity, specificity, and accuracy. However, the inclusion of long-term results would provide a more comprehensive understanding of the effectiveness of MEOWS.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Maxillofacial injuries, due to their diverse etiological causes, are often considered a component of multi-trauma and constitute a significant portion of trauma. This study aims to elucidate the incidence of maxillofacial traumas, particularly among military personnel, various clinical courses, and characteristics, thereby contributing to the literature.
Methods: Forensic reports, primarily related to military personnel and organized between 2011 and 2016 at the Forensic Medicine Department of Gülhane Medical Faculty, Health Sciences University, were retrospectively examined. The study involved a detailed analysis of cases with maxillofacial injuries resulting from trauma, focusing on aspects such as age, gender, the origin of the trauma, degree of injury, the presence of bone and dental fractures, and the occurrence of psychiatric disorders as a result of the trauma.
Results: This study demonstrated that maxillofacial traumas predominantly occurred in young male individuals, particularly among military personnel. The most common etiological factor identified was interpersonal violence. The majority of injuries were soft tissue damages, with the nasal bone being the most frequently fractured area. Injuries to the head and upper extremities were also detected in some of the cases, showing that multiple injuries are common in such cases. Post-traumatic psychological disorders developed in some cases, with anxiety disorders being the most commonly observed.
Conclusion: It has been determined that maxillofacial injuries can affect multiple body regions, necessitating a multidisciplinary approach. This study underscores the importance of developing comprehensive strategies and policies for understanding and managing maxillofacial traumas, providing a fundamental reference for future studies in this field.
{"title":"Comprehensive examination of etiological factors and clinical manifestations of maxillofacial traumas in forensic cases: A five-year retrospective study.","authors":"Hüseyin Balandız, Halit Canberk Aydogan, Burak Kaya, Semih Özsever, Sait Özsoy","doi":"10.14744/tjtes.2024.70045","DOIUrl":"https://doi.org/10.14744/tjtes.2024.70045","url":null,"abstract":"<p><strong>Background: </strong>Maxillofacial injuries, due to their diverse etiological causes, are often considered a component of multi-trauma and constitute a significant portion of trauma. This study aims to elucidate the incidence of maxillofacial traumas, particularly among military personnel, various clinical courses, and characteristics, thereby contributing to the literature.</p><p><strong>Methods: </strong>Forensic reports, primarily related to military personnel and organized between 2011 and 2016 at the Forensic Medicine Department of Gülhane Medical Faculty, Health Sciences University, were retrospectively examined. The study involved a detailed analysis of cases with maxillofacial injuries resulting from trauma, focusing on aspects such as age, gender, the origin of the trauma, degree of injury, the presence of bone and dental fractures, and the occurrence of psychiatric disorders as a result of the trauma.</p><p><strong>Results: </strong>This study demonstrated that maxillofacial traumas predominantly occurred in young male individuals, particularly among military personnel. The most common etiological factor identified was interpersonal violence. The majority of injuries were soft tissue damages, with the nasal bone being the most frequently fractured area. Injuries to the head and upper extremities were also detected in some of the cases, showing that multiple injuries are common in such cases. Post-traumatic psychological disorders developed in some cases, with anxiety disorders being the most commonly observed.</p><p><strong>Conclusion: </strong>It has been determined that maxillofacial injuries can affect multiple body regions, necessitating a multidisciplinary approach. This study underscores the importance of developing comprehensive strategies and policies for understanding and managing maxillofacial traumas, providing a fundamental reference for future studies in this field.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.14744/tjtes.2024.24189
Metin Yalcin, Mehmet Tercan, Erhan Ozyurt, Aysen Baysan
Background: Gallbladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. Despite advancements in imaging technology and biochemical analysis, perforations are still diagnosed intraoperatively in some cases. This situation has revealed the need for new markers in the diagnosis of perforation. In this study, we aimed to analyze the role of biomarkers in the diagnosis of perforated cholecystitis cases.
Methods: In this retrospective study, blood samples (white blood cells (WBC), hemoglobin, platelet count, C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), urea, creatinine, glucose, amylase, lipase, aspartate ami-notransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin) were analyzed in patients who were diagnosed with acute cholecystitis in the emergency department.
Results: One hundred seventy patients were divided into two groups according to the presence or absence of gallbladder perforation. Sixty-three (37.1%) patients had perforation. Transition from laparoscopy to open operation, intensive care unit admission, length of hospital stay, and mortality were higher in the perforated group compared to the non-perforated group. When we analyzed the patients according to laboratory findings, there was a difference in WBC, NLR, CRP, albumin, and CAR parameters in the perforation group. In regression analysis, CRP and CAR performed better.
Conclusion: Our study showed that CRP and CAR may be diagnostic biomarkers with low specificity and sensitivity in predicting GBP in patients with acute cholecystitis. This marker is a low-cost and easily accessible parameter that may help clinicians make an early diagnosis and plan appropriate treatment for this condition with high morbidity and mortality.
背景:胆囊穿孔(GBP)是急性胆囊炎的一种罕见并发症,但会危及生命。尽管成像技术和生化分析取得了进步,但在一些病例中,穿孔仍然是在术中诊断出来的。这种情况表明,诊断穿孔需要新的标记物。本研究旨在分析生物标志物在胆囊穿孔病例诊断中的作用:在这项回顾性研究中,我们采集了血液样本(白细胞(WBC)、血红蛋白、血小板计数、C反应蛋白(CRP)、白蛋白、CRP/白蛋白比值(CAR)、中性粒细胞-淋巴细胞比值(NLR)、尿素、肌酐、葡萄糖、淀粉酶、脂肪酶、天门冬氨酸氨基转移酶、淀粉酶、脂肪酶)、对急诊科确诊为急性胆囊炎的患者的天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)、总胆红素、直接胆红素进行了分析。结果根据是否存在胆囊穿孔将 170 名患者分为两组。63名患者(37.1%)有胆囊穿孔。与无穿孔组相比,穿孔组患者从腹腔镜手术转为开腹手术、入住重症监护室、住院时间和死亡率均较高。根据化验结果对患者进行分析后发现,穿孔组患者的白细胞、NLR、CRP、白蛋白和CAR参数存在差异。在回归分析中,CRP和CAR的表现更好:我们的研究表明,在预测急性胆囊炎患者的 GBP 方面,CRP 和 CAR 可能是特异性和敏感性较低的诊断生物标志物。该标记物是一种低成本、易获得的参数,可帮助临床医生对这种发病率和死亡率较高的疾病进行早期诊断并制定适当的治疗计划。
{"title":"The role of biomarkers in predicting perforated cholecystitis cases: Can the c-reactive protein albumin ratio be a guide?","authors":"Metin Yalcin, Mehmet Tercan, Erhan Ozyurt, Aysen Baysan","doi":"10.14744/tjtes.2024.24189","DOIUrl":"10.14744/tjtes.2024.24189","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. Despite advancements in imaging technology and biochemical analysis, perforations are still diagnosed intraoperatively in some cases. This situation has revealed the need for new markers in the diagnosis of perforation. In this study, we aimed to analyze the role of biomarkers in the diagnosis of perforated cholecystitis cases.</p><p><strong>Methods: </strong>In this retrospective study, blood samples (white blood cells (WBC), hemoglobin, platelet count, C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), urea, creatinine, glucose, amylase, lipase, aspartate ami-notransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin) were analyzed in patients who were diagnosed with acute cholecystitis in the emergency department.</p><p><strong>Results: </strong>One hundred seventy patients were divided into two groups according to the presence or absence of gallbladder perforation. Sixty-three (37.1%) patients had perforation. Transition from laparoscopy to open operation, intensive care unit admission, length of hospital stay, and mortality were higher in the perforated group compared to the non-perforated group. When we analyzed the patients according to laboratory findings, there was a difference in WBC, NLR, CRP, albumin, and CAR parameters in the perforation group. In regression analysis, CRP and CAR performed better.</p><p><strong>Conclusion: </strong>Our study showed that CRP and CAR may be diagnostic biomarkers with low specificity and sensitivity in predicting GBP in patients with acute cholecystitis. This marker is a low-cost and easily accessible parameter that may help clinicians make an early diagnosis and plan appropriate treatment for this condition with high morbidity and mortality.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Ischemia/reperfusion injury is one of the most challenging postoperative situations in vascular surgery, both in elective procedures with prolonged clamping time and in delayed emergency cases with vascular occlusion. The inflammatory response that develops during ischemia and the oxygen-free radicals that proliferate during reperfusion have detrimental effects on the brain, heart, and kidneys. In this study, we aimed to compare the effects of vanillic and rosmarinic acid in preventing ischemia/reperfusion injury in a lower limb ischemia-reperfusion model in rats.
Methods: Thirty-two female Sprague-Dawley rats weighing 185-240 g were randomly divided into four groups of eight animals each. Group 1 was designated as the control, Group 2 as ischemia/reperfusion (I/R), Group 3 as ischemia/reperfusion + vanillic acid (I/R + VA), and Group 4 as ischemia/reperfusion + rosmarinic acid (I/R + RA). In all groups except the control, the infrarenal abdominal aorta was clamped, and 60 minutes of ischemia followed by 120 minutes of reperfusion was performed. Vanillic acid was administered intra-abdominally 15 minutes before the start of reperfusion in Group 3, and rosmarinic acid in Group 4. At the end of the reperfusion phase, blood samples and hearts were collected, and the rats were euthanized. Histopathologically, myofibrillar edema, myocytolysis, focal hemorrhages, and infiltration of polymorphonuclear leukocytes (PMNL) in cardiac tissue were examined. Total antioxidant capacity (TAC), total oxidative status (TOS), oxidative stress index (OSI), 8-OH-deoxyguanosine, lactonase, and arylesterase activity were measured in blood samples.
Results: Myofibrillar edema was most pronounced in the I/R group and less pronounced in the I/R + VA and I/R + RA groups (p=0.005 and p=0.066, respectively). There was no difference between the ischemia/reperfusion groups regarding myocytolysis, focal hemorrhage, and PMNL infiltration (p>0.99). Among all groups, TOS and OSI were lowest in the control group, while TAC was highest. TAC was similar in the I/R + VA and I/R + RA groups but was significantly higher in these two groups than in the I/R group. The lactonase activity in the I/R + VA group was similar to that in the control group but was significantly higher compared to the I/R and I/R + RA groups.
Conclusion: Our study shows that vanillic and rosmarinic acids reduce myofibrillar edema in the heart after lower limb ischemia and increase TAC. However, vanillic acid increases the activity of lactonase, an enzyme known for its antioxidant effect, more than rosmarinic acid.
背景:缺血/再灌注损伤是血管外科手术中最具挑战性的术后情况之一,无论是在钳夹时间较长的择期手术中,还是在血管闭塞的延迟急诊病例中都是如此。缺血时产生的炎症反应和再灌注时增殖的无氧自由基会对大脑、心脏和肾脏产生不利影响。本研究旨在比较香草酸和迷迭香酸在大鼠下肢缺血再灌注模型中预防缺血再灌注损伤的效果:将 32 只体重为 185-240 克的雌性 Sprague-Dawley 大鼠随机分为 4 组,每组 8 只。第一组为对照组,第二组为缺血再灌注组(I/R),第三组为缺血再灌注+香草酸组(I/R + VA),第四组为缺血再灌注+迷迭香酸组(I/R + RA)。除对照组外,其他各组均夹闭肾下腹主动脉,缺血 60 分钟,再灌注 120 分钟。再灌注开始前 15 分钟,第 3 组大鼠腹腔注射香草酸,第 4 组大鼠腹腔注射迷迭香酸。 再灌注阶段结束后,收集血液样本和心脏,对大鼠实施安乐术。组织病理学检查心肌组织中的肌纤维水肿、肌溶解、局灶性出血和多形核白细胞(PMNL)浸润。对血液样本中的总抗氧化能力(TAC)、总氧化状态(TOS)、氧化应激指数(OSI)、8-OH-脱氧鸟苷、内酯酶和芳基酯酶活性进行了测定:结果:肌纤维水肿在I/R组最为明显,而在I/R + VA组和I/R + RA组则不明显(分别为p=0.005和p=0.066)。缺血/再灌注组之间在肌溶解、局灶出血和 PMNL 浸润方面没有差异(P>0.99)。在所有组别中,对照组的 TOS 和 OSI 最低,而 TAC 最高。I/R + VA 组和 I/R + RA 组的 TAC 相似,但这两组的 TAC 明显高于 I/R 组。I/R + VA 组的内酯酶活性与对照组相似,但明显高于 I/R 组和 I/R + RA 组:我们的研究表明,香草酸和迷迭香酸能减轻下肢缺血后的心脏肌纤维水肿,并增加TAC。然而,香草酸比迷迭香酸更能提高内酯酶的活性,而内酯酶具有抗氧化作用。
{"title":"Comparison of the protective effects of vanillic and rosmarinic acid on cardiac tissue: Lower limb ischemia-reperfusion model in rats.","authors":"Serhat Huseyin, Adem Reyhancan, Umit Halici, Orkut Guclu, Salih Tuysuz, Burcak Oztorun, Suat Canbaz","doi":"10.14744/tjtes.2024.12359","DOIUrl":"https://doi.org/10.14744/tjtes.2024.12359","url":null,"abstract":"<p><strong>Background: </strong>Ischemia/reperfusion injury is one of the most challenging postoperative situations in vascular surgery, both in elective procedures with prolonged clamping time and in delayed emergency cases with vascular occlusion. The inflammatory response that develops during ischemia and the oxygen-free radicals that proliferate during reperfusion have detrimental effects on the brain, heart, and kidneys. In this study, we aimed to compare the effects of vanillic and rosmarinic acid in preventing ischemia/reperfusion injury in a lower limb ischemia-reperfusion model in rats.</p><p><strong>Methods: </strong>Thirty-two female Sprague-Dawley rats weighing 185-240 g were randomly divided into four groups of eight animals each. Group 1 was designated as the control, Group 2 as ischemia/reperfusion (I/R), Group 3 as ischemia/reperfusion + vanillic acid (I/R + VA), and Group 4 as ischemia/reperfusion + rosmarinic acid (I/R + RA). In all groups except the control, the infrarenal abdominal aorta was clamped, and 60 minutes of ischemia followed by 120 minutes of reperfusion was performed. Vanillic acid was administered intra-abdominally 15 minutes before the start of reperfusion in Group 3, and rosmarinic acid in Group 4. At the end of the reperfusion phase, blood samples and hearts were collected, and the rats were euthanized. Histopathologically, myofibrillar edema, myocytolysis, focal hemorrhages, and infiltration of polymorphonuclear leukocytes (PMNL) in cardiac tissue were examined. Total antioxidant capacity (TAC), total oxidative status (TOS), oxidative stress index (OSI), 8-OH-deoxyguanosine, lactonase, and arylesterase activity were measured in blood samples.</p><p><strong>Results: </strong>Myofibrillar edema was most pronounced in the I/R group and less pronounced in the I/R + VA and I/R + RA groups (p=0.005 and p=0.066, respectively). There was no difference between the ischemia/reperfusion groups regarding myocytolysis, focal hemorrhage, and PMNL infiltration (p>0.99). Among all groups, TOS and OSI were lowest in the control group, while TAC was highest. TAC was similar in the I/R + VA and I/R + RA groups but was significantly higher in these two groups than in the I/R group. The lactonase activity in the I/R + VA group was similar to that in the control group but was significantly higher compared to the I/R and I/R + RA groups.</p><p><strong>Conclusion: </strong>Our study shows that vanillic and rosmarinic acids reduce myofibrillar edema in the heart after lower limb ischemia and increase TAC. However, vanillic acid increases the activity of lactonase, an enzyme known for its antioxidant effect, more than rosmarinic acid.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}