Tag: nevin manimala

Ulus Travma Acil Cerrahi Derg. 2025 Mar;31(3):242-248. doi: 10.14744/tjtes.2024.77756.

ABSTRACT

BACKGROUND: Effective management of postoperative analgesia following laparoscopic cholecystectomy (LC) is critical to ensure optimal patient comfort and recovery. This study evaluates the effects of erector spinae plane block (ESPB) and rectus sheath block (RSB) on opioid consumption to determine non-inferiority.

METHODS: This retrospective study analyzed 44 patients aged 18 to 75 years who underwent LC at our hospital between December 2022 and March 2023, with American Society of Anesthesiologists (ASA) scores of I-II. Patients were divided into two groups: ESPB (n=24) and RSB (n=20). The ESPB group received a preoperative bilateral injection of 20 mL of 0.25% bupivacaine, while the RSB group received a postoperative bilateral injection of 20 mL of 0.25% bupivacaine. The primary outcome measure was opioid consumption within the first 24 hours postoperatively.

RESULTS: The demographic characteristics of the RSB and ESPB groups were similar. Opioid consumption during the first 24 hours was 6.29+-1.73 mg in the ESPB group and 6.60+-3.41 mg in the RSB group, with no statistically significant difference between the two groups (95% confidence interval [CI]: -1.64 to 1.02; p=0.717). When the equivalence margin was set at -2 mg, opioid consumption in the RSB group was found to be similar to that in the ESPB group. Fentanyl rescue analgesia in the postoperative care unit was required by three patients in the ESPB group and five patients in the RSB group (p=0.400). Visual Analog Scale (VAS) pain scores and the number of patients who developed nausea and vomiting in the first 24 hours postoperatively were similar between the groups (p>0.05).

CONCLUSION: The erector spinae plane block and RSB demonstrated comparable analgesic efficacy. Rectus sheath block was found to be non-inferior to ESPB in LC surgery with respect to 24-hour opioid consumption. The groups were also similar regarding rescue analgesia, VAS scores, shoulder pain, and the frequency of nausea and vomiting.

PMID:40052318 | DOI:10.14744/tjtes.2024.77756

Ulus Travma Acil Cerrahi Derg. 2025 Mar;31(3):226-232. doi: 10.14744/tjtes.2024.73814.

ABSTRACT

BACKGROUND: This study was conducted methodologically to evaluate the Turkish validity and reliability of the Feeling Safe During Surgery Scale and to assess its suitability for the Turkish population.

METHODS: This methodological validity and reliability study collected data from 148 patients who underwent elective surgery with regional anesthesia in the general surgery clinics of a university hospital in Istanbul between December 1, 2021 and June 30, 2022. Data were obtained through face-to-face interviews with patients using the Patient Information Form, developed by the researchers based on the literature, and the Turkish version of the Feeling Safe During Surgery Scale, originally created in Swedish. The Statistical Package for the Social Sciences (SPSS) Amos 26 was used for data analysis.

RESULTS: The content validity index of the scale was determined to be 0.96. Confirmatory factor analysis indicated that the Turkish version of the Feeling Safe During Surgery Scale was acceptably compatible with the original scale. The adapted Turkish version was found to have a comprehensible language structure and appropriate content. Cronbach’s alpha coefficient for the total score was α=0.839, indicating a high level of reliability. Consequently, the Turkish version of the Feeling Safe During Surgery Scale was determined to be valid, reliable, and stable over time.

CONCLUSION: The Turkish version of the Feeling Safe During Surgery Scale is a valid and reliable instrument that can be used in the Turkish population for assessing the sense of safety in patients undergoing elective surgery with regional anesthesia in surgical units.

PMID:40052317 | DOI:10.14744/tjtes.2024.73814

Ulus Travma Acil Cerrahi Derg. 2025 Mar;31(3):233-241. doi: 10.14744/tjtes.2024.40088.

ABSTRACT

BACKGROUND: Explosions are not exclusive to battlefields; they also represent a global security concern that affects all societies worldwide. This study aims to elucidate the effects of injuries caused by explosions with multiple mechanisms, which clinicians may encounter at any time, particularly in the context of military personnel. Furthermore, the clinical characteristics of these injuries were examined.

METHODS: A total of 7,865 patient files evaluated between 2008 and 2017 by the Forensic Medicine Department of Gülhane Medical Faculty, Health Sciences University, were subjected to retrospective review. The study encompassed a total of 906 cases presenting with blast injuries. Medical records and health reports of these cases were reviewed and analyzed in terms of age- and gender-specific incidence, military ranks, type of explosion, origin of explosion, wound types, affected body areas, and sequelae.

RESULTS: The findings of this study indicate that blast injuries predominantly affect young males, particularly those in the military. The most common etiological factor identified was terrorism. Blast injuries were found to occur most frequently in non-vehicular pedestrians and were primarily caused by improvised explosive devices and landmines. Blast injuries most commonly resulted in multiplesite injuries with a shrapnel effect and frequently required surgical intervention. Despite all treatments, 53.4% of explosion-related injuries resulted in long-term sequelae.

CONCLUSION: The results of this study demonstrate that explosion-related injuries present a significant and complex problem. Blasts affect multiple body systems and cause severe injuries. Understanding the impact of explosions on the human body can help develop strategies to minimize or possibly eliminate serious injuries, particularly in explosion incidents encountered by security forces.

PMID:40052314 | DOI:10.14744/tjtes.2024.40088

Ulus Travma Acil Cerrahi Derg. 2025 Mar;31(3):249-258. doi: 10.14744/tjtes.2024.36114.

ABSTRACT

BACKGROUND: The increase in liver cholestasis enzyme and bilirubin levels, especially due to pancreatitis, mimics choledocholithiasis. This study aimed to examine the relationship between demographic and laboratory cut-off values and the presence of choledocholithiasis in patients with acute biliary pancreatitis (ABP).

METHODS: Patients diagnosed with ABP in the Department of General Surgery at Istanbul Faculty of Medicine between January 2010 and December 2022 were retrospectively analyzed. The presence of stones in the common bile duct was determined based on the results of magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Demographic and laboratory values of patients with and without bile duct stones were compared. Cut-off values were determined using receiver operating characteristic (ROC) curve analysis, and logistic regression analysis and modeling was performed for each variable.

RESULTS: A total of 1,026 ABP patients were evaluated. Patients whose enzyme levels were not elevated and those who did not undergo MRCP were excluded. A total of 584 patients were included in the study, and choledocholithiasis was detected in 188 (32.2%) patients. In multivariate analysis, age, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and direct bilirubin (DB) were found to be statistically associated with choledocholithiasis. The cut-off values were determined as 65 years for age, 394 U/L for GGT, 173 U/L for ALP, and 1.42 mg/dL for direct bilirubin. In the group where all four parameters were below these cut-off values, suggesting a clean common bile duct, it was observed that the negative predictive value was 97%.

CONCLUSION: Based on the demographic and laboratory data of patients with ABP, we were able to predict with more than 97% accuracy that the common bile duct was clean. Considering that our study only included patients who underwent MRCP due to elevated enzyme levels and suspicion of choledocholithiasis, the negative predictive value would be even higher if patients with acute biliary pancreatitis with normal enzyme levels were included. Additionally, no complications were observed in any of the patients during follow-up. This finding suggests that patients whose common bile duct is predicted to be clean can initially be monitored and supported with additional imaging methods if necessary. As a result, unnecessary imaging can be avoided, reducing costs and preventing the mortality and morbidity associated with unnecessary procedures.

PMID:40052312 | DOI:10.14744/tjtes.2024.36114

Ulus Travma Acil Cerrahi Derg. 2025 Mar;31(3):214-220. doi: 10.14744/tjtes.2024.23583.

ABSTRACT

BACKGROUND: This study aimed to evaluate the efficacy of thrombopoietin (TPO), a growth factor and acute-phase reactant, as an early prognostic marker for predicting disease severity in patients with acute biliary pancreatitis.

METHODS: A total of 72 patients with acute pancreatitis admitted to the Ankara Numune Training and Research Hospital, General Surgery Department, were included in the study. The severity of acute pancreatitis was classified using the 2012 Revised Atlanta Classification, and blood samples were collected from each patient within the first six hours of hospitalization to measure TPO levels. TPO levels were then compared to C-reactive protein (CRP) levels and other prognostic scoring systems.

RESULTS: According to the Atlanta Classification, TPO levels were found to be statistically significant in distinguishing severe pancreatitis from moderate and mild cases. When evaluating the sensitivity and specificity ratios of serum TPO levels in predicting the severity of acute pancreatitis, a value of 81.61 pg/dL was identified, with a 86.6% sensitivity and 69% specificity. In our study, the accuracy of TPO levels in detecting severe pancreatitis was compared with other scoring systems. The Balthazar scoring system had the highest precision (area under the curve [AUC]: 0.905) in receiver operating characteristic (ROC) curve analysis for severe pancreatitis (95% confidence interval). Serum TPO levels were identified as the second strongest predictors of severe acute pancreatitis (AUC: 0.831).

CONCLUSION: These findings suggest that TPO is a valuable early marker and prognostic indicator for predicting disease severity in patients with acute biliary pancreatitis. However, further randomized studies with larger patient cohorts are still required.

PMID:40052310 | DOI:10.14744/tjtes.2024.23583

Stroke. 2025 Mar 7. doi: 10.1161/STROKEAHA.124.049140. Online ahead of print.

ABSTRACT

BACKGROUND: Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is recommended for secondary prevention in patients with a minor stroke or transient ischemic attack. However, the effectiveness of DAPT can be significantly influenced by genetic variations. This study aimed to estimate the impact of multiple single-nucleotide polymorphisms across various genes on DAPT efficacy using polygenic risk score (PRS).

METHODS: In this post hoc analysis, we included 2905 patients from the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events), which enrolled a total of 5170 patients in China between October 2009 and July 2012. The primary outcome was new stroke within 90 days. Sixteen single-nucleotide polymorphisms across 7 genes involved in clopidogrel metabolism were selected for PRS development. PRS were calculated by summing single-nucleotide polymorphisms from each individual. The Cox proportional-hazards regression model was utilized to estimate the hazard ratio (HR) and 95% CIs of PRS. The predictive value of PRS was estimated by C statistic and compared with a previously validated model.

RESULTS: The elevated PRSs were associated with an increased risk of new stroke within 90 days (P_trend=0.01). The efficacy of DAPT versus aspirin alone in preventing 1-year composite vascular events was significantly different between patients with low (adjusted HR, 0.47 [95% CI, 0.31-0.71]) and high PRSs (adjusted HR, 0.84 [95% CI, 0.60-1.18]; P_interaction=0.03). In patients receiving DAPT, higher PRSs were associated with increased risk of new stroke and composite vascular events at 90 days (adjusted HR per SD increase was 1.51 [95% CI, 1.15-1.99]) and at 1 year (adjusted HR per SD increase was 1.34 [95% CI, 1.08-1.67]). The C statistic for predicting 90-day new stroke using the PRS developed in this study was 0.57 (95% CI, 0.52-0.62), compared with 0.52 (95% CI, 0.48-0.55) for the ABCD-GENE score.

CONCLUSIONS: Using PRS integrating multiple genes may enhance the precision of secondary prevention strategies for patients with minor stroke or transient ischemic attack in the short and long term.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00979589.

PMID:40052280 | DOI:10.1161/STROKEAHA.124.049140

Cancer Rep (Hoboken). 2025 Mar;8(3):e70174. doi: 10.1002/cnr2.70174.

ABSTRACT

BACKGROUND: Robotic surgery has been associated with superior short-term outcomes in patients undergoing total mesorectal excision (TME) for organ-confined rectal cancer. However, whether this approach offers an additional benefit over laparoscopy when performing lateral pelvic lymph node dissection (LPLND) with TME or extended TME (e-TME) in locally advanced rectal cancer (LARC) is not known.

AIMS: This study was conducted to evaluate the outcomes of robotic and laparoscopic LPLND in patients with lateral pelvic node-positive LARC with reference to intraoperative safety, postoperative morbidity, pathological indices including nodal yield and node positivity rates, lateral pelvic recurrence rates, and short term event-free and overall survival.

METHODS AND RESULTS: In this retrospective single-center study, consecutive patients with non-metastatic histologically proven LARC and clinically significant lateral pelvic lymphadenopathy who had undergone laparoscopic or robotic LPLND with TME or e-TME between 2014 and 2023 were included, all procedures having been performed by minimal-access colorectal surgeons who were beyond the learning curve for either surgical approach. Of the 115 patients evaluated, 98.3% received neoadjuvant chemoradiotherapy, following which 27 (23.5%) underwent robotic and 88 (76.5%) laparoscopic LPLND with TME or e-TME. The baseline clinicodemographic features, treatment-related characteristics, and proportion of patients undergoing extended resections for persistent circumferential resection margin-positive rectal cancer (22.7% vs. 18.5%, respectively) were statistically similar in both groups. When comparing robotic with laparoscopic resections, no significant difference was observed in intraoperative parameters including procedure-associated blood loss (median 250 mL vs. 400 mL) and on-table adverse events or conversion rates (none in either group), postoperative outcomes comprising clinically significant early (14.8% vs. 9.1%), intermediate (5.3% vs. 1.9%) and late (5.3% vs. 2.0%) surgical morbidity, re-exploration rates (7.4% vs. 3.4%) and duration of hospital stay (median 6 days in both groups), or the pathological quality indices of margin involvement (7.4% vs. 2.3%), nodal yield (median 4 vs. 7 nodes) and lateral node positivity (22.2% vs. 26.1%), respectively. At a median 11 months follow-up, oncological outcomes in terms of lateral pelvic recurrence rates (3.7% vs. 4.5%), 2-year event-free survival (78.7% vs. 79.3%) and 2-year overall survival (83.1% vs. 93.8%) were also comparable.

CONCLUSION: Surgical competence in laparoscopy may offset the potential benefits extended by robotic platforms. In a high-volume setup with experienced minimal-access surgeons, the clinical, pathological, and short-term oncological outcomes associated with both approaches may be considered equivalent.

PMID:40052270 | DOI:10.1002/cnr2.70174

Stroke. 2025 Mar 7. doi: 10.1161/STROKEAHA.124.047747. Online ahead of print.

ABSTRACT

BACKGROUND: Various measures of abnormal left atrial (LA) structure or function (LA myopathy) are associated with a higher risk of ischemic stroke and dementia, independent of atrial fibrillation. However, limited data exist on their prognostic usefulness. Therefore, we aimed to assess the ability of markers of LA myopathy to improve the prediction of ischemic stroke and dementia.

METHODS: The ARIC study (Atherosclerosis Risk in Communities) is a prospective community-based cohort study. For this analysis, we included participants who attended visit 5 (2011-2013) without a history of stroke or atrial fibrillation and had a 12-lead ECG and a transthoracic echocardiogram. Markers of LA myopathy included P wave abnormalities from 12-lead ECG, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and LA volume and strain parameters from the echocardiogram. The primary composite outcome comprised ischemic stroke and dementia, which were ascertained through hospital surveillance, cohort follow-up, and death registries. To determine improvement in risk prediction of the composite outcome, each marker was individually added to a model that included CHA₂DS₂-VASc variables, and Akaike information criterion, C statistic, and its change were computed. Cox proportional hazards models were used to assess the independent association of LA myopathy markers with the outcome.

RESULTS: Among 4712 participants (59% female; mean age, 74 years), 193 ischemic strokes and 769 dementia cases were ascertained over a median follow-up of 8.3 years. Of LA myopathy markers, only LA reservoir strain and NT-proBNP significantly improved C statistic when added to the CHA₂DS₂-VASc model (base C statistic, 0.677) for the prediction of the composite outcome. Adding the LA reservoir yielded the highest increase in C statistic (0.010 [95% CI, 0.003-0.017]), and the model including the LA reservoir showed the lowest Akaike information criterion. In multivariable regression models, LA volume index, NT-proBNP, and LA strain parameters were significantly associated with the composite outcome.

CONCLUSIONS: Of various LA myopathy markers, LA reservoir yields the greatest improvement in the prediction of ischemic stroke and dementia, supporting its use to identify people at high risk of cerebrovascular events and dementia.

PMID:40052267 | DOI:10.1161/STROKEAHA.124.047747

Otolaryngol Head Neck Surg. 2025 Mar 7. doi: 10.1002/ohn.1184. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to describe and evaluate clinical and polysomnographic outcomes of the preservation palatopharyngoplasty procedure, which preserves pharyngeal mucosa and muscles, in patients with obstructive sleep apnea with high modified Mallampati scores (3 or 4).

STUDY DESIGN: A retrospective chart review.

SETTING: A tertiary medical center.

METHODS: A total of 23 patients who underwent preservation palatopharyngoplasty between November 2022 and May 2024 were included. Outcomes measured were apnea-hypopnea index (AHI), oxygen desaturation index (ODI), Epworth Sleepiness Scale (ESS) scores, and Nasal Obstruction Symptom Evaluation (NOSE) Scale scores pre- and postsurgery. Data were analyzed using unpaired or paired t-tests, and statistical significance was set at P < .05.

RESULTS: The mean age of included patients was 51.74 years. Postoperative results showed a significant 25.48% (standard deviation [SD] = 32.59) decrease in AHI (P = .0011) and 35.25% (SD = 11.00) mean decrease in ODI (P = .0030). REM sleep percentage increased from 12.96% to 21.35% (P = .0106), and REM AHI decreased from 55.49 to 40.02 events/h (P = .0255). Significant improvements were also seen in ESS (P = .0123) and NOSE scores (P = .0134). Among the included patients, 12 out of 23 patients achieved surgical success per Sher’s criteria.

CONCLUSION: The preservation palatopharyngoplasty significantly improved subjective and objective measures in OSA patients with higher Mallampati scores by enhancing upper airway patency and reducing OSA severity.

PMID:40052264 | DOI:10.1002/ohn.1184

Circ Heart Fail. 2025 Mar 7:e012484. doi: 10.1161/CIRCHEARTFAILURE.124.012484. Online ahead of print.

ABSTRACT

BACKGROUND: Heart rate (HR) affects heart failure outcomes, via uncertain mechanisms that may include left ventricular remodeling. However, in human ventricular myocardium, HR change has not been associated with a particular remodeling molecular phenotype.

METHODS: Patients with nonischemic dilated cardiomyopathy (N=22) in sinus rhythm and refractory to β-blockade for both HR lowering and reverse remodeling were randomized 2:1 double-blind to the HCN4 (hyperpolarization-activated cyclic nucleotide-gated potassium channel 4) channel inhibitor ivabradine or placebo for 24 weeks treatment while maintaining target doses of β-blockers. Reverse remodeling was measured by left ventricular ejection fraction (LVEF), and myocardial gene expression by sequencing RNA extracted from endomyocardial biopsies. The primary statistical analysis was between HR change categories divided at the median, which resulted in Decreased HR (N=90) and Unchanged HR (N=8) groups.

RESULTS: Respective HRs at baseline and 24 weeks were as follows: Decreased HR, 82.9±6.8 and 69.7±8.0 beats per minute (P=0.0005) and Unchanged HR, 80.8±5.7 and 79.2±11.6 beats per minute (P=0.58). All completing Decreased HR subjects were treated with ivabradine, whereas in the Unchanged HR group, 3 received ivabradine and 5 placebo. In Decreased HR, LVEF increased from 29.4±8.8% at baseline to 44.2±9.4% at 24 weeks (P=0.0003), compared with respective values of 26.6±11.4% and 29.2±12.0% (P=0.28) in Unchanged HR. HR and LVEF changes were not different from a previously conducted β-blocker nonischemic dilated cardiomyopathy study subdivided into LVEF responders and nonresponders. However, differentially expressed genes (N=151) in the Decreased versus Unchanged HR groups were >99% nonconcordant and therefore individually unique compared with β-blocker HR/LVEF responders versus nonresponders (2 shared differentially expressed genes). Multiple unique differentially expressed genes in Decreased HR including NRG1 upregulation are considered cardioprotective or involved in cardiac development.

CONCLUSIONS: In patients with nonischemic dilated cardiomyopathy in sinus rhythm, HR lowering per se (1) is associated with substantial left ventricular reverse remodeling; (2) its absence can cause β-blocker reverse remodeling nonresponse; and (3) when from HCN4 channel inhibition, results in a unique molecular phenotype.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02973594.

PMID:40052260 | DOI:10.1161/CIRCHEARTFAILURE.124.012484