Traumatic brain injury and palliative care:a retrospective analysis of 49 patients receiving palliative care during 2013–2016 in Turkey

Traumatic brain injury（TBI）,which is seen more in young adults,affects both patients and their families.The need for palliative care in TBI and the limits of the care requirement are not clear.The aim of this study was to investigate the length of stay in the palliative care center（PCC）,Turkey,the status of patients at discharge,and the need for palliative care in patients with TBI.The medical records of 49 patients with TBI receiving palliative care in PCC during 2013–2016 were retrospectively collected,including age and gender of patients,the length of stay in PCC,the cause of TBI,diagnosis,Glasgow Coma Scale score,Glas gow Outcome Scale score,Karnofsky Performance Status score,mobilization status,nutrition route（oral,percutaneous endoscopic gastrostomy）,pressure ulcers,and discharge status.These patients were aged 45.4 ± 20.2 years.The median length of stay in the PCC was 34.0 days.These included TBI patients had a Glasg ow Coma Scale score ≤ 8,were not mobilized,received tracheostomy and percutaneous endoscopic gastrostomy nutrition,and had pressure ulcers.No difference was found between those who were discharged to their home or other places（rehabilitation centre,intensive care unit and death） in respect of mobilization,percutaneous endoscopic gastrostomy,tracheostomy and pressure ulcers.TBI patients who were followed up in PCC were determined to be relatively young patients（45.4 ± 20.2 years） with mobilization and nutrition problems and pressure ulcer formation.As TBI patients have complex health conditions that require palliative care from the time of admittance to intensive care unit,provision of palliative care services should be integrated with clinical applications.

Metabolic Syndrome and Perioperative Complications during Scheduled Surgeries with Spinal Anesthesia

Background: Metabolic syndrome (MS) is a constellation of factors associated with increased risk of developing cardiovascular diseases and Diabetes Mellitus. Despite of the many studies related to MS, little is known about its impact on scenarios such as surgical anesthesia. Objective: To examine the correlation between demographic and metabolic variables with the occurrence of perioperative complications in patients with MS undergoing scheduled surgeries using a spinal anesthesia technique in the surgery department at the University Clinic San Juan de Dios in Cartagena de Indias, Colombia. Methods: Observational, analytical, cross-sectional, single-center study of 150 subjects with MS and 150 control subjects. Perioperative complications, socio-demographic, hemodynamic and respiratory variables were registered. Groups were compared using t test, Fisher’s exact test or Chi-square, as appropriate. We applied a logistic multiple regression model, adjusted by backward stepwise at 0.25 and forward at 0.05, to find possible incompatible associations. p value < 0.05 was considered significant. Results: There were significant differences between groups in age, American Society of Anesthesiologists physical status classification, frequency of diseases associated to MS and perioperative complications. There were no cases of mortality among patients. There was statistically significant difference between the two groups for intraoperative hypotension and hypertension with p values of <0.0001 and 0.034. Among postoperative complications there was statistically significant difference in pain (13.3% vs 5.3% in patients without MS) and nausea and/or postoperative vomiting (8% vs 2% in patients without MS) with a p value of 0.027 and 0.015 (by Fisher) respectively. Conclusions: Metabolic abnormalities in MS are a risk factor for developing complications in the perioperative period of patients scheduled for surgeries using the subarachnoid anesthesia technique. Accordingly, it is appropriate to implement health intervention strategies by the surgical team, aiming at their prevention and management.

Adipose-derived stem cells in the treatment of hepatobiliary diseases and sepsis

Determination of the mesenchymal stem cells is one of the greatest and most exciting achievements that tissue engineering and regenerative medicine have achieved.Adipose-derived mesenchymal stem cells(AD-MSC)are easily isolated and cultured for a long time before losing their stem cell characteristics,which are self-renewal and pluripotency.AD-MSC are mesenchymal stem cells that have pluripotent lineage characteristics.They are easily accessible,and the fraction of stem cells in the adipose tissue lysates is highest among all other sources of mesenchymal stem cells.It is also HLA-DR negative and can be transplanted allogenically without the need for immunosuppression.These advantages have popularized its use in many fields including plastic reconstructive surgery.However,in the field of hepatology and liver transplantation,the progress is slower.AD-MSC have the potential to modulate inflammation,ameliorate ischemia-reperfusion injury,and support liver and biliary tract regeneration.These are very important for the treatment of various hepatobiliary diseases.Furthermore,the anti-inflammatory potential of these cells has paramount importance in the treatment of sepsis.We need alternative therapeutic approaches to treat end-stage liver failure.AD-MSC can provide a means of therapy to bridge to definitive therapeutic alternatives such as liver transplantation.Here we propose to review theoretic applications of AD-MSC in the treatment of hepatobiliary diseases and sepsis.

Intranasal nerve growth factor for prevention and recovery of the outcomes of traumatic brain injury

Traumatic brain injury is one of the main causes of mortality and disability worldwide.Traumatic brain injury is characterized by a primary injury directly induced by the impact,which progresses into a secondary injury that leads to cellular and metabolic damages,starting in the first few hours and days after primary mechanical injury.To date,traumatic brain injury is not targetable by therapies aimed at preventing and/or limiting the outcomes of secondary damage but only by palliative therapies.Nerve growth factor is a neurotrophin targeting neuronal and non-neuronal cells,potentially useful in preventing/limiting the outcomes of secondary damage in traumatic brain injury.This potential has further increased in the last two decades since the possibility of reaching neurotrophin targets in the brain through its intranasal delivery has been exploited.Indeed,molecules intranasally delivered to the brain parenchyma may easily bypass the blood-brain barrier and reach their therapeutic targets in the brain,with favorable kinetics,dynamics,and safety profile.In the first part of this review,we aimed to report the traumatic brain injury-induced dysfunctional mechanisms that may benefit from nerve growth factor treatment.In the second part,we then exposed the experimental evidence relating to the action of nerve growth factor(both in vitro and in vivo,after administration routes other than intranasal)on some of these mechanisms.In the last part of the work,we,therefore,discussed the few manuscripts that analyze the effects of treatment with nerve growth factor,intranasally delivered to the brain parenchyma,on the outcomes of traumatic brain injury.

Comparison of Nasal and Frontal BIS Monitoring in Neurosurgery: Does the Site of Sensor Placement Affect the BIS Values?

Background and Goal of Study: Intraoperative awareness is a serious but preventable complication of general anaesthesia. Bispectral index (BIS) is the most widely used method monitoring anaesthesia depth. BIS monitoring requires attachment of forehead sensors, which poses a challenge when the surgical field involves the forehead. We aimed to compare the gold standard forehead position of BIS sensors with an alternative position across the nasal dorsum for neurosurgical procedures. Materials and Methods: After ethical committee approval and informed consent were obtained, 62 patients were enrolled in this prospective observational study. Frontal and nasal BIS values were compared in all patients. Results and Discussion: The mean BIS value from frontal versus nasal sensors was 49 ± 22 and 49 ± 21 respectively (n: 62). These values were statistically correlated (ICC 0.78, p < 0.001) indicating that nasal BIS measurement does not present a disadvantage for routine use when needed. Conclusion: Our data reveal that for measuring anesthesia depth, BIS sensor placement on the nasal dorsum shows comparable efficiency in comparison to standard frontal

Plasma Concentrations of Some Trace Element and Heavy Metals in Patients with Metastatic Colon Cancer

Purpose: It is well known that trace elements and heavy metals play a significant role in human health and disease. These elements play an important role in different metabolic pathways of cells and tissues. Trace element deficiency or excess is implicated in the development or progression of some cancers. We present a study which investigates serum/ plasma levels of trace-heavy elements in metastatic colon cancer patients and healthy subjects. Methods: Blood samples were collected from 29 healthy subjects and 40 patients with metastatic colon cancer in Oncology Department of Medical School of Yuzuncu Yil University. In both groups, the serum levels of copper (Cu), magnesium (Mg), lead (Pb), chromium (Cr), zinc (Zn) selenium (Se), manganese (Mn), and cadmium (Cd) were determined. Results: Higher levels of Cu, Mg, Pb, Cr, Zn, Mn and Cd were seen in patients with metastatic colon cancer compared to healthy subjects and these findings were statistically significant (p 0.05). Se levels were noted to be lower in patients with colon cancer in comparison to healthy subjects and this finding was also statistically significant (p 0.05). Conclusions: According to our findings there was significant diffence in trace elements and heavy metals levels between healthy subjects and metastatic colon cancer patients. Therefore heavy metal and trace elements may have prognostic significance in complex disorders including colon cancer. However, further comprehensive studies are needed in order to advance our understanding of the relationship between heavy metal and trace elements and their role in cancers.

Intensive care outcomes of refugee patients in Turkey between 2013 and 2019: A retrospective descriptive study

Objectives:To assess the outcomes of the intensive care of Syrian refugees under temporary protection (SRUTP). Methods: The sample of the study was composed of 110 SRUTP patients who were treated at a tertiary intensive care unit (ICU) between 2013 and 2019 in Istanbul, Turkey. Baseline information and clinical data of the patients were collected by scanning the hospital's electronic database and clinical decision support system. Results:The mean length of ICU stay was 97.6 (36.3-187.8) h. Among the patients, 71 (64.5%) had comorbid diseases, and ICU mortality was 40%. The median cost of health care for each patient was 2144 (1060-4471) USD, and the total health care cost of all patients was 534012USD. Conclusions: Use of vasoactive drug, hemodialysis application, and low Glasgow Coma Scale scores are independent risk factors of the mortality. More researches are needed to clearly reveal the health and cost consequences of war.

Goal-directed fluid therapy in gastrointestinal cancer surgery:A prospective randomized study

Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included.Patients were randomized into 2 groups that received liberal fluid therapy(the LFT group,n=45)and goal-directed fluid therapy(the GDFT group,n=45).Patients’Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity(CR-POSSUM)physiological score,Charlson Comorbidity Index(CCI),perioperative vasopressor and inotrope use,postoperative AKIN classification,postoperative intensive care unit(ICU)hospitalization,hospital stay,and 30-day mortality were recorded.Results:The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group(P<0.05).CR-POSSUM physiological score and CCI were significantly higher in the GDFT group(P<0.05).Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group(P<0.05),postoperative acute kidney injury development was not affected.Postoperative mortality was determined to be similar in both groups(P>0.05).Conclusion:Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery,and it can prevent perioperative fluid overload,and the postoperative results are comparable in the two groups.

Oxidative stress and its complications in human health

Under normal physiological conditions, a homeostatic balance exists between the formation of oxgyen radicals (ROS) and their removal by endogenous scavenging antioxidants. An imbalance between oxidants and antioxidants that is in favor of the oxidants potentially leading to damage is termed “oxidative stress”. Mitochondria are a major producer of ROS, which mainly consists of superoxide anion, hydrogen peroxide, and hydroxyl radical. Especially, during systemic inflammatory response syndrome, sepsis, septic shock, there is an overproduction of ROS while the natural antioxidant mechanisms are weakened, mainly because of endothelial cell damage. General anesthesia can impair the immunological defense mechanisms while inducing an inflammatory reaction in alveolar macrophages. In chronic diseases and high mortality situations like sepsis, oxidative/antioxidative equilibrium shifts to the direction of oxidative stress. When elderly patients with chronic diseases and patients with sepsis undergo surgical operations, anesthesia and anesthetic agents used increases the oxidative stress in addition to the surgical trauma. Thence many studies are ongoing on the antioxidant drugs and enzymes. We must never forget to take the oxidative stress of our patients into account while planning their treatments.

Female infertility and laparoscopic surgery: A series of 415 operations at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon

Objective: To describe the practice of laparoscopic surgery in the treatment of infertility at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital. Materials and Methods: This was an observational study with retrolective data collection. All patients who underwent laparoscopy for infertility with a complete file were recruited. Data were collected on a pre-established form and analyzed with Microsoft Excel 2007 software. Results: Six hundred and thirty-three women, representing 6.9% of gynecologic operations, underwent laparoscopic surgery during the study period. Infertility accounted for 69.8% (442 cases) of the indications. Four hundred and fifteen files were analyzed. The commonest intraoperative findings were: tubo-peritoneal adhesions (71.6%), hydrosalpinx with distal tubal occlusion (41.5%), peri-hepatic adhesions (22.4%), uterine fibroids (20.2%) and tubal phimosis (14.0%). Adhesiolysis, neosalpingostomy and fimbrioplasty were the commonest surgical gestures. At the end of the procedure, the best tube was staged as favorable in 57.6% of our patients. A complication rate of 4.3% was observed. Conclusion: Infertility is the main indication for laparoscopic surgery in our setting. The main operative findings are tubo-peritoneal adhesions and hydrosalpinx. The most practiced tubal surgical gesture is neosalpingostomy. Half of the recruited women have a favorable stage for the best tube. The complication rate is low.

<i>Raoultella planticola</i>Bacteremia-Induced Fatal Septic Shock and Sepsis-Induced Coagulopathy in a Patient with Pancreatic Cancer: A Case Report and Literature Review

Background: Raoultella planticola is a gram-negative rod-shaped bacterium commonly found in water and soil and considered to be a rare and possibly underestimated cause of severe human infection. Its presence should be suspected in older patients with a history of cancer, immune suppression and recent exposure to traumatic injuries or invasive medical procedures. Case presentation: A 78-year-old male with a history of hypertension was diagnosed with pancreatic adenocarcinoma. Whipple procedure (pancreaticoduodenectomy) was performed afterwards. On the 8th day of surgery, the patient was admitted to our tertiary ICU with septic shock. His initial Sequential Organ Failure Assessment (SOFA) score was 12 with predicted mortality 95.7%. Empirical antibiotic therapy with colymicin, meropenem and teikoplanin was administered immediately and two sets of blood cultures were obtained. Patient developed refractory septic shock despite the addition of vasopressin and the patient’s condition continued to deteriorate. Patient died on the third day of sepsis. His blood culture was positive for R. planticola, which was identified using the VITEK-2 biochemical identification system. Conclusions: Clinicians should be aware of fatal unusual infections in immunocompromised patients.

Comparison between intrathecal hyperbaric bupivacaine and levobupivacaine for ambulatory knee arthroscopy

AIM: To compare the effect of hyperbaric levobupivacaine and bupivacaine on the quality of the block, patient satisfaction, and discharge time in patients undergoing arthroscopic knee surgery under unilateral spinal anesthesia.METHODS: One hundred and thirty-two patients, American Society of Anaesthesiologists Ⅰ or Ⅱ, scheduled for elective ambulatory knee arthroscopy were randomly assigned to four double-blind groups. To achieve a unilateral spinal block, Group BF received 5 mg of hyperbaric bupivacaine plus 20 μg of fentanyl intrathecally, Group LF received 5 mg of hyperbaric levobupivacaine plus 20 μg of fentanyl intrathecally, Group B received 5 mg of hyperbaric bupivacaine intrathecally, and Group L received 5 mg of hyperbaric levobupivacaine intrathecally. The level and duration of the sensory block, the intensity and duration of the motor block, the time to first analgesic requirement, and the time elapsed until the patient's discharge were recorded. Hemodynamic values and adverse effects were also recorded. RESULTS: The duration of time needed to reach the T12 dermatome level was significantly longer in Group L [7(3-20) min] than in Group B [6(3-12) min](P = 0.006). The maximum sensory level reached on the side undergoing the operation was significantly higher in Group BF than in Group B(P < 0.05). The intensity of the motor blockade was greater in Group BF than in Group LF and L. Complete recovery from motor blockade occurred earlier in Groups LF [75(45-165) min] and L [63(35-120) min] than in Group BF [115(60-180) min](P < 0.05). The length of time needed for the sensory block to regress to the level of S2 was shorter in Group L(154 ± 50) than in Group BF(192 ± 66)(P < 0.05). The quality of the block was significantly lower in Group L than in Groups BF, LF and B(P = 0.012, P = 0.003, and P < 0.001, respectively). The time elapsed until Visual Analog Scale ≥ 4 was significantly shorter in Group L(110 ± 48) than in Groups BF(200 ± 60), LF(156 ± 61) and B(162 ± 52)(P < 0.05). The time elapsed until the patient's discharge was shorter in Groups B(244 ± 54) and L(229 ± 55) than in Group BF(288 ± 64)(P = 0.021 and P = 0.001, respectively). There were no differences among the groups regarding hemodynamic parameters and adverse events, except for pruritus. The occurrence of pruritus was significantly more frequent in Groups BF and LF than in other groups. CONCLUSION: In conclusion, 5 mg of hyperbaric bupivacaine and 5 mg of hyperbaric levobupivacaine plus 20 μg of fentanyl provided a better spinal anesthesia than 5 mg of hyperbaric levobupivacaine alone.

Rare Side Effects of Propofol Administration Case Report and a Brief Literature Review

Introduction： Propofol is an intravenous general anesthetic and sedation drug for use in the induction and maintenance of anesthesia or sedation. It is included in WHO Model List of Essential medicines and approved by the FDA （food and drug administration） in 1989. The side effects of Propofol have been studied widely in the last 25 years. They can be easily managed and that is why Propofol has become a fn＇st choice drug for the most of the anesthesiologists worldwide. This paper presents a case report of Propofol induced pulmonary edema and also a review of some of the rarest and unusual manifestations of Propofol side effects. Some of them are urine discoloration, tissue necrosis, rhabdomyolysis and postoperative panereatitis. Methods and materials： A case summary of 18-years old woman with unusual postoperative pulmonary reaction was considered along with other documented cases. Several full-text articles were briefly analyzed for estimating the role of Propofol for a number of strange and potentially life threatening conditions. Results： Despite the low incidence rate, the presented case could be determined as a pulmonary edema due to its clinical features. Furthermore, rare drug reactions such as rhabdomyolysis, tissue necrosis, postoperative pancreatitis etc. may remain unrecognized and create diagnostic and therapeutic issues. Conclusions： Although the officially reported dangerous reaction, Propofol remains one of the best hypnotic and sedative agents. The better knowledge of the full list of drug reactions considered as rare and very rare is a guarantee of an adequate and a better therapeutic behavior.

Effect of age on computed tomography findings:Specificity and sensitivity in coronavirus disease 2019 infection

BACKGROUND Coronavirus disease 2019(COVID-19)is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019.Although the real-time reverse transcription PCR test for viral nucleic acids is the gold standard for COVID-19 diagnosis,computed tomography(CT)has grown in importance.AIM To evaluate the sensitivity and specificity of thoracic CT findings of COVID-19 pneumonia according to age groups.METHODS PCR and CT results from 411 patients were reviewed.The diagnosis of COVID-19 pneumonia was made by three radiologists.Lymphadenopathy,pericardial effusion,pleurisy,pleural thickening,pleural effusion,location features of the lesions,ground glass,consolidation,air bronchogram,vascular enlargement,bronchial dilatation,halo finding,inverted halo sign,nodularity,air bubble,subpleural band(curvilinear density),reticular density,crazy paving pattern,and fibrosis findings were recorded.The patients were divided into nine groups by decades while calculating the sensitivity,specificity,and diagnostic efficacy for CT positivity.RESULTS The mean age of the cases was 48.1±22.7 years.The CT finding with the highest diagnostic power was ground glass.Vascular enlargement and bronchial dilatation followed ground glass.Pericardial effusion was the finding with the lowest diagnostic accuracy.The incidence of lymphadenopathy,pleurisy,pleural thickening,peripheral localization,bilateral,ground glass,vascular enlargement,bronchial dilatation,subpleural band,reticular density,crazy paving appearance,and fibrosis all increased increase significantly with age in patients with positive real-time reverse transcription PCR test.CONCLUSION There are few publications comparing sensitivity and specificity of thoracic CT findings according to age.In cases of COVID-19 pneumonia,there is an increase in the variety and frequency of CT findings with age,and parallel to this the sensitivity and specificity of the findings increase.COVID-19 cases in the pediatric age group have fewer lung findings than adults,and this situation decreases the diagnostic value of CT in pediatric patients.

The Association between Preoperative Parental Anxiety and Emergence Agitation in Preschoolers

Introduction: The preoperative distress and anxiety experienced by preschoolers are associated with an increased incidence of troubled recovery from anesthesia. However, influences of parental anxiety on children at different stages of the surgical processes are not clear. The aim of this study was to evaluate any existing association between preoperative parental anxiety and emergence agitation in a pediatric surgery population. Materials and Methods: A total of 60 children ASA class I or II, aged 3 - 12 years old, undergoing adenotonsillectomy with sevoflurane, were included in the study. Before surgery, we used State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety. Emergence agitation of the children was assessed with Watcha scale and recorded every 10 min of first 30 min of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate their satisfaction, post operative pain and any side effect observed in the children. Results: Preoperatively, the mean STAI-S scores of mothers were significantly higher than those of fathers (p 0.05). The children had the highest agitation scores at 10th postoperative minutes with an incidence of 73.9%. There was no correlation between parental anxiety and emergence agitation. Logistic regression analysis showed that low educational level of the parent was the only independent factor for state anxiety (OR: 8.96, 95% CI: 1.50 - 40.35, p = 0.030). Discussion: In this study, we observed that education level of the parents might affect their preoperative anxiety. The factors influential in parental anxiety were not correlated with pediatric emergence agitation in this study.

Predictive Factors for the Occurrence of Pharyngostoma after Laryngectomy and Total Pharyngo-Laryngectomy in Yaounde and Douala

Introduction and Aims: Pharyngostoma or pharyngo-cutaneous fistula is a frequent complication of totals laryngectomies and pharyngo-laryngectomies. Its incidence varies from one series to another from 13% to 58%. Multiple risk factors are known. The data from our environment concerning this condition are few. Thus, in order to contribute to the study of this complication in our environment, we proposed to carry out this study, whose objective was to determine the predictive factors for the occurrence of pharyngo-cutaneous fistula or pharyngostoma after total laryngectomy and total pharyngo-laryngectomy in Yaounde and Douala. Patients and Methods: This was a retrospective, cross-sectional, descriptive study conducted in the 5 Ear-Nose-Throat (ENT) department of hospital in the city of Yaounde and Douala. The study took place between January 2009 and December 2020. All patients who underwent total laryngectomy or total pharyngo-laryngectomy with a follow-up of at least one month were included in the study. Incomplete records were excluded, as well as those of patients who died before one month of postoperative follow-up. Results: We selected 48 cases of total laryngectomies (TL) and total pharyngo-laryngectomies (TPL), and identified 37 cases of pharyngostoma. 45 men (93.8%) and 3 women (6.3%). The mean age was 56.4 years with extremes ranging from 37 to 86 years. Smoking and alcoholism were noted in 75% and 79.2% of our patients respectively. A tracheotomy before TL and TPL was found in 41.7%. 100% of the tumours found were T3 or T4. The surgery was in 34 cases (70.8%) TL and in 14 cases (29.2%) TPL. Pharyngostomas were observed in 37 cases among 48 patients operated on, i.e. a frequency of 77.1%. The average delay of appearance was 7 to 14 days. We had spontaneous healing with pressure dressing and nasogastric tube feeding in 35 patients (77.8%) and two patients benefited from pectoralis major flap treatment;the healing time was 21 to 30 days. We did not find any correlation between gender, age, tumour site of origin and locoregional extension and the occurrence of pharyngostoma. Preoperative tracheotomy and radiotherapy were not significant risk factors for the occurrence of pharyngostoma. However, preoperative anaemia (p = 0.02), LTP (p = 0.02), early complications (p 0.001) and lack of continuous saliva aspiration postoperatively (p = 0.03) were statistically significant predictors of pharyngostoma in univariate analysis. Conclusion: Pharyngostoma is the most common postoperative complication after TL and TPL. In our setting, the main associated risk factors identified were: preoperative anaemia, LTP, early complications and failure to continuously aspirate saliva postoperatively.

Postoperative delirium:A tragedy for elderly cancer patients

In this editorial,we comment on the article by Hu et al entitled“Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”.We wanted to draw attention to the general features of postoperative delirium(POD)as well as the areas where there are uncertainties and contradictions.POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery.It is a severe postoperative complication,especially for elderly oncology patients.Although the underlying pathophysiological mechanism is not fully understood,various neuroinflammatory mechanisms and neurotransmitters are thought to be involved.Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD.As delirium is considered a preventable clinical entity in about half of the cases,various early prediction models developed with the support of machine learning have recently become a hot scientific topic.Unfortunately,a model with high sensitivity and specificity for the prediction of POD has not yet been reported.This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.

Effect of pH,lactate,electrolyte,and strong ion difference variability on prediction of intensive care unit mortality:A retrospective study

Objective:To investigate the effect of the variability of Nas,Cls,Ks,lactate values and sodium effect(NaEffect),chloride effect(ClEffect),non-lactate strong ion difference(SIDnl)values calculated according to Stewart’s approach on predicting intensive care unit(ICU)mortality.Methods:The study was conducted on 1539 patients,retrospectively.Serum Na(Nas),serum Cl(Cls),serum K(Ks),serum Ca(Cas),serum Mg(Mgs),lactate,pH values and SIDnl,NaEffect,ClEffect,APACHEⅡ(first,last),and SOFA(first,last)scores were recorded.Radiometer ABL 800(Denmark)was used for blood gas analysis.The variability of each parameter was calculated.The effect of variability of each parameter on 30-day ICU mortality was analyzed.Results:The variability of lactate(P<0.001,OR=0.580,95%CI=0.505-0.652),pH(P=0.001,OR=0.004,95%CI=0.000-0.104),NaEffect(P<0.001,OR=0.550,95%CI=0.378-0.592),Ks(P<0.001,OR=0.385,95%CI=0.244-0.565)values were protective factors of ICU mortality and Cls value was a risk factor(P=0.004,OR=1.095,95%CI=1.024-1.164).Variability of ClEffect,SIDnl values did not affect ICU mortality.Conclusions:The variability of electrolytes is important.Electrolyte,effects,and lactate variability can guide treatment and fluid applications in ICU.

Endovascular treatment of carotid cavernous sinus fistula: A systematic review

Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial workup of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.

Acute right lower abdominal pain in women of reproductive age:Clinical clues

AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age.