Research Hospital Research Articles

Effects of Postpartum Web-Based Breastmilk and Breastfeeding Education: A Quasi-Experimental Study

Objective: The aim of the study was to examine the effect of web-based breastfeeding education applied to postpartum primiparous women on breastmilk, breastfeeding knowledge and self-efficacy. Methods: This quasi-experimental study was conducted with 73 participants (experimental group=37; control group=36) at the Zeynep Kamil Gynecology and Pediatrics Training and Research Hospital in Istanbul, Türkiye. The study was at postpartum services between June 2018 and October 2019. The participants in the experimental group attended the internet-based breastmilk and breastfeeding education program; where as those in the control group received routine care. Data were collected pre and post training using the demographic information form, Breastmilk and Breastfeeding Knowledge Test and Breastfeeding Self-Efficacy Scale. Results: Our result showed that there was no significant difference found between the experimental and control groups on post-training on Breastmilk and Breastfeeding Knowledge Test (p>.05). On the other hand, there was significant difference between the experimental and control groups on post-training on Breastfeeding Self-Efficacy Scale (p

Evaluation of the satisfaction of relatives of patients being treated in the intensive care unit

Aims: There has been no previous study on the satisfaction of relatives of patients receiving treatment in the intensive care unit of our hospital. Our study was conducted to improve quality and service in our intensive care unit. A survey was conducted to evaluate the satisfaction of the relatives of patients receiving treatment. Methods: The satisfaction of the relatives of the patients who were treated for at least 3 days in the 3rd Step general intensive care unit at Mardin Training and Research Hospital between 01. February 2023 and 01. June 2023 was evaluated in line with the surveys. A questionnaire was given to each patient’s relative by the attending physician to be filled out. Results: 114 patient relatives participated in the study. 12 patient relatives did not agree to fill out the survey. 102 patient relatives filled out the satisfaction survey. Conclusion: Waiting room in intensive care unit conditions need to be improved. In our study, we think that patient relatives have confidence in the treatments applied to their patients and are satisfied with the skills and abilities of doctors and nurses.

Descriptive analysis of road traffic accidents in children aged 0-2 years

Aims: This study aims to investigate road traffic accidents (RTAs) involving infants and toddlers, defined as children from birth to 2 years old, focusing specifically on their epidemiology and outcomes. Methods: A retrospective, single-center, observational, and cross-sectional study was conducted in the Emergency Department of a university-affiliated training and research hospital. Data were collected from July 1, 2019, to January 1, 2024. Results: During the study period, 659 cases involved pediatric RTAs patients (individuals under 17 years old), with 41 cases specifically concerning infants and toddlers. These patients had a mean age of 12.98 ± 5.64 months, and 27 (65.9%) were boys. The median Pediatric Trauma Score for was 9 (range: 5-12) while the median pGCS score was 15 (range: 14-15). Motor vehicle accidents were the leading cause of injuries, accounting for 92.6% of cases, followed by motorcycle accidents (4.8%) and pedestrian-vehicle collisions (2.6%). Hospitalized patients exhibited various injuries, including femur fractures, subdural hematoma, orbital roof fracture, scalp hematomas, and lung contusion. Surgical intervention was required in only one case for a femur shaft fracture. Fortunately, no in-hospital deaths occurred among the study participants. Conclusion: This study underscores the importance of adult supervision to prevent RTAs and emphasizes the critical need for strict enforcement of child passenger safety laws to reduce the incidence of motor vehicle accidents involving infants and toddlers.

Comparison of three methods of greater trochanter fixation in intertrochanteric femur fractures (AO type 31/A2) treated with cementless bipolar hemiarthroplasty

Aim: The aim of this study was to compare the three most commonly used fixation methods for the fractured trochanter major fragment in patients undergoing uncemented bipolar hemiarthroplasty for unstable intertrochanteric fractures. Methods: The medical records of 231 acute hip fracture cases aged 65 years and older with AO classification 31/A2.2 and 31/A2.3 who underwent unilateral primary cementless bipolar hemiarthroplasty at Adana Şehir Training and Research Hospital between January 2021 and January 2023 were retrospectively analyzed. The files were classified into three groups based on the fixation technique used in the operation. Results: There were 231 files, with a mean age of 82.3±7.9. The majority (55.8%) were classified as ASA III. The analysis resulted in no significant differences between the groups in terms of age, number of days between the day of the injury and the day of the surgery, fixation failure, nonunion, number of revision surgeries, hospitalization duration, and HHS recorded at the third and sixth-month follow-up visits. Among the 73 males and 158 females, the ratio of the side in which the fracture occurred showed no difference (p=0.854). The female rate was significantly higher in group 3 compared to other groups (p=0.003). Regarding union success, cases in group 1 had significantly lower trochanter major union rates (p

Efficacy of favipiravir in COVID-19: A retrospective two center comparative study.

Favipiravir (FVP) is an antiviral, targeting RNA-dependent RNA polymerase. We aimed to evaluate the efficacy of FVP as a treatment for COVID-19. We conducted a retrospective study in two centers (San Martino University Hospital in Genova, Italy, and Marmara University Pendik Training and Research Hospital, Turkey). Adult patients (inpatients) diagnosed with COVID-19 between March and June 2020 were included. All patients in the Italian center received the standard of care (SoC) treatment, while in the Turkish center patients received FVP in addition to SoC. Six hundred-nineteen patients were analyzed (225 from Turkey, all treated with FVP, and 394 from Italy, none treated with FVP). Propensity score-matching was done in 142 patients (71 from the SoC group vs. 71 from the SoC + FVP group). A Higher requirement of NIV/CPAP (n = 38; 53.5%) was registered in the SoC group compared to the SoC + FVP group (n = 9; 12.7%). A higher frequency of intubation was registered in the SoC + FVP group (n = 25; 35.2% vs n = 13, 18.3%). There was a trend towards better survival in SoC + FVP treated patients with HR = 0.64 (95% CI 0.30-1.34). At 28 days the OS was, respectively, 70.3% (95% CI: 53.2-82.1) vs 80.3% (95% CI: 69.0-87.8). The addition of FVP to SoC did not show a significant difference in survival and invasive and noninvasive (CPAP/NIMV) mechanical ventilation compared to standard of care in moderate and severe COVID-19-infected patients.

Healthcare-associated infections in patients with COVID-19: is it different from the pre-pandemic period?

Healthcare-associated infections (HAIs) are common in intensive care unit (ICU) patients and may cause devastating consequences. However, the prevalence of HAI and its effects on in-hospital mortality among critically ill COVID-19 patients is ambiguous. We determined the prevalence of HAI and the rate of mortality in critically ill COVID-19 patients and compared it with pre-pandemic ICU patients. This retrospective study was conducted with adult ICU patients admitted to Gazi Yaşargil Training and Research Hospital (Diyarbakir,Turkey) in April-November 2019 (defined as the pre-pandemic period) and in April-November 2020 (defined as the pandemic period). All patients in the pandemic period had COVID-19, while none in the pre-pandemic period did. Patients diagnosed with HAIs during the in-hospital follow-up period were recorded. Of 4596 enrollees, 3386 (73.7%) were pandemic-period patients and 1210 (26.3%) were pre-pandemic-period patients. HAI prevalence was significantly higher at 5.9% (n = 71) in the pandemic-period patients and 2.7% (n = 91) in the pre-pandemic-period patients (p < 0.001). Comorbidities including hypertension (63.4% vs 14.2%, p < 0.001), diabetes mellitus (39.4% vs 8.8%, p < 0.001), and coronary artery disease (30.9% vs 10.9%, p = 0.002) were significantly more frequent in pandemic-period HAI-positive patients. The most common HAI was catheter-related bloodstream infection in both groups, with similar frequency (p = 0.652). In-hospital mortality rate was 85.9% versus 65.9% in pandemic- versus pre-pandemic-period HAI-positive patients (p < 0,05). The prevalence of HAI and the in-hospital mortality rate was significantly higher among pandemic-period patients.

EASIX and m-EASIX predict CRS and ICANS in pediatric and AYA patients after CD19-CAR T-cell therapy

AbstractCytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) are complications of CD19-directed chimeric antigen receptor (CD19-CAR) T-cell therapy. The Endothelial Activation and Stress Index (EASIX) and modified EASIX (m-EASIX) scores have been retrospectively proven to be predictive of CRS and ICANS in adult CAR T-cell recipients. However, these scores have not been evaluated in pediatric cohorts. We retrospectively report on 76 pediatric and adolescent and young adult (AYA) patients with relapsed/refractory B-cell acute lymphoblastic leukemia treated with CD19-CAR T cells at St. Jude Children’s Research Hospital or John’s Hopkins Hospital. Data included patient, disease, and treatment characteristics. EASIX and m-EASIX scores were calculated at days –5 before, 0, and +3 after CAR T-cell infusion. CRS and ICANS occurred in 47 and 17 patients, respectively. At all evaluated time points, the median EASIX scores were higher for patients who developed severe CRS and any grade ICANS, and the median m-EASIX scores were higher in patients who developed severe CRS and severe ICANS than those with no/mild CRS/ICANS. Receiver operating characteristic curve analysis showed that both scores were strong predictors of CRS, especially severe CRS, at all time points. Any grade and severe ICANS were best predicted by both scores at day +3. m-EASIX uniformly outperformed EASIX, except for predicting any grade ICANS. Our results validate the potential utility of EASIX and m-EASIX scores for predicting CAR T-cell–related complications for pediatric and AYA patients.

Comparison of the Results of Different Surgical Techniques in the Treatment of Chronic Subdural Hematoma in a Training and Research Hospital

Background: Chronic subdural hematoma can cause compression of brain tissue followed by neurological deficits. There are several methods for the treatment of chronic subdural hematoma, but the most appropriate treatment is still controversial. we compared 5 different surgical methods applied by five different surgeons in a single center and we suggest the most appropriate treatment method in the literature. Methods: In this study, the files of patients diagnosed with chronic subdural hematoma who underwent surgery at the Neurosurgery Clinic of S.B.U. Bursa City Hospital were retrospectively examined. The patients were evaluated in terms of their complaints, neurological examinations, type of operation, use of subdural drain and postoperative complications. Five different surgical techniques were applied to the patients. Results: We collected data from 185 patients who underwent surgery due to chronic subdural hematoma. Different surgical techniques were used in the treatment of patients. Only one burr hole was opened in 22 of the patients, one burr hole was opened in 40 of them and 1 drain was placed in the subdural space, only two burr holes were opened in 41 of them, two burr holes were opened in 58 of them and 1 drain was placed in the subdural space, and mini craniotomy was performed in 24 patients. Conclusion: Five different surgical methods used in the treatment of chronic subdural hematoma have advantages and disadvantages. We believe that a study conducted by increasing the number of patients, ensuring homogenization of groups, and increasing surgical techniques will shed light on the literature.

Determining the Effects of Nasopharyngeal Suction with Negative and Positive Pressure: Randomised Controlled Trial

Objective: The study aims to determine the effects of nasopharyngeal suction with negative and positive pressure on pain level, respiratory parameters, and mucosal irritation in infants. Methods: This study was conducted as a posttest randomized controlled experimental research. The data was collected at Göztepe Training and Research Hospital between January and November 2020. While the positive pressure suction method was applied to the experimental group, the negative pressure suction method was applied to the control group. Results: It is determined that the pain level mean scores at the 1st and 5th minutes after the suction procedure are lower in the experimental group than in the control group (p

The role of hyperbaric oxygen treatment in the management of spondylodiscitis.

This study analysed treatment outcomes in a patient cohort diagnosed with spondylodiscitis, who received adjunct hyperbaric oxygen treatment (HBOT) in addition to antibiotic therapy at our clinic. Important considerations included the timing of HBOT initiation on treatment success, and recurrence rates. We retrospectively reviewed the records of all patients diagnosed with spondylodiscitis who received HBOT at the Underwater and Hyperbaric Medicine Clinic in Gulhane Training and Research Hospital, between 1 November 2016 and 25 October 2022. The patients received HBOT at 243.2 kPa for a total of 120 minutes per session, once daily for five days a week for a total of 30 sessions. Twenty-five patients with spondylodiscitis were evaluated before and after combination HBOT and targeted antibiotic treatment. After treatment, patients had lower median (range) visual analogue pain scores (8 [4-10] vs 3 [0-7], P < 0.001) and C-reactive protein (22.3 [4.3-79.9] mg·L⁻¹ vs 6.8 [0.1-96.0] mg·L⁻¹, P = 0.002) and lower mean (standard deviation) white blood cell counts (8.8 [3.5] x 109·L⁻¹ vs 6.1 [1.6] x 109·L⁻¹, P = 0.002). When patients were examined (median) 48 months (2-156 months) after the completion of treatment, there were no persistent cases of spondylodiscitis. Combination HBOT with targeted antibiotic therapy effectively managed our cohort of patients diagnosed with spondylodiscitis. Hyperbaric oxygen treatment was safe, with no complications experienced. Moreover, HBOT may have helped to eliminate persistence and recurrence of symptoms with long term follow-up. A randomised controlled study with a larger number of patients is needed for more definitive conclusions.

Anesthesia practices during magnetic resonance imaging in pediatric patients

Aims: The use of magnetic resonance imaging (MRI) is becoming increasingly common for diagnostic and therapeutic purposes in pediatric cases. Among children who are too young to cooperate with the procedure or in those with anxiety, anesthesia may be required to minimize excessive motion and optimize image quality. The aim of this study was to determine the efficacy and associated complications of different anesthesia techniques used during MRI in pediatric patients at our hospital. Methods: Anesthesia follow-up forms and computer records of pediatric patients who had undergone MRI under anesthesia between January 2021 and January 2023 in a training and research hospital in Ankara were retrospectively reviewed. The included patients were categorized into four groups according to their anesthesia maintenance protocols to compare their efficacy and associated complications. Results: Of the 358 included patients, only 2% underwent MRI under general anesthesia with a laryngeal mask airway (LMA), whereas the rest underwent MRI under sedation. In our hospital, the most commonly used technique for MRI under anesthesia in pediatric patients involved sevoflurane inhalation with a simple facemask and airway (54.5%), and the lowest complication rate (0.8%) was observed in those who underwent only anesthesia induction without the administration of an agent for the maintenance of anesthesia. Conclusion: Daily anesthesia is generally considered the most effective and comfortable method for sedation during MRI. The results of this study suggest that anesthesia involving sevoflurane inhalation with a simple face mask applied to preserve spontaneous breathing is an effective and safe method for pediatric patients undergoing MRI.

A retrospective study of anesthesia management in patients operated for neuromuscular scoliosis

Objective: Scoliosis frequently develops as a complication of neuromuscular diseases, often progressing and necessitating surgical intervention. Although complications can arise in spinal fusion surgery for all types of scoliosis, they are more frequent during and after the procedure in cases of neuromuscular scoliosis. This retrospective study aims to explore the preoperative characteristics, anesthesia protocols, as well as intra- and postoperative complications and associated conditions in patients who underwent surgery for neuromuscular scoliosis at our hospital.Material and Methods: After receiving approval from the ethics committee of our hospital, this study conducted a retrospective review of patient files from individuals who underwent surgery for neuromuscular scoliosis at Ankara Training and Research Hospital between 2008 and 2012. A total of 26 patient files were analyzed. Patient parameters including age (years), gender (female (F), male (M)), weight (kg), presence of neuromuscular disease, concomitant cardiovascular and respiratory conditions, as well as other systemic anomalies and diseases, spirometry findings (FEV1, FVC, FEV1/FVC), nutritional status (total protein, albumin), pre-operative hemoglobin (Hg) and hematocrit (Htc) levels, Cobb angle index, angle direction, type of surgical approach (anterior or posterior), muscle relaxants utilized, additional dosage requirements, operation duration, intraoperative bleeding volume (ml), transfusion volume (ml), and intraoperative complications were documented. Results: As the Cobb angle increased, several factors were affected: the duration of the operation was extended (p &lt; 0.05), there was an increase in blood loss (p = 0.012), and more blood transfusions were required (p = 0.32). Furthermore, there was a correlation between increasing age and the amount of blood transfused (p = 0.035). Conclusion: It has been concluded that a comprehensive preoperative assessment is crucial, as it can offer valuable insights into anesthesia management both before and after surgery for scoliosis. Therefore, conducting a detailed preoperative evaluation is essential for patients undergoing these procedures

The Importance of Cited-1 and HIF-1α Immune Activity of Granulosa Cells in IVF Treatment

Aim: The aim of this study was to investigate the Cited-1 and HIF-1α immune activity in granulosa cells in follicular development in patients who underwent IVF for infertility. Materials and Methods: This study was conducted on 40 patients who were admitted to the assisted reproductive program with the complaint of infertility at the Gazi Yaşargil Training and Research Hospital Obstetrics and Gynecology Clinic IVF center between January 2022 and November 2022 and had primary or secondary infertility while starting the Ovum-Pick-Up (OPU) procedure. The fluid containing the granulosa cells was centrifuged at 3000 rpm for 10 min. The samples were fixed and processed for routine paraffine wax tissue embedding protocol. Sections were taken from paraffin blocks and immune stained with Cited-1 and HIF-1α. The preparations were examined under the microscope. Results: HIF-1α expression was positive in membrane of granulosa cells. The nuclei were apoptotic and pyknotic. Cited1 expression was positive in membrane of granulosa cells. the cells were pyknotic. Conclusion: The high level of HIF-1α immunopositivity and negative Cited1 immunoreactivity in the immunohistochemical staining after the granulosa cells around the oocytes collected from female patients admitted to the IVF clinic and diagnosed with infertility showed that granulosa cell viability may be important on oocyte quality.

The Serum 25(OH) Vitamin D, Calcium, and Parathyroid Hormone Levels of The Patients With The Obstructive Sleep Apnea Syndrome

Background: Although there is evidence linking vitamin D to many neurochemical processes involved in sleep, the association between the obstructive sleep apnea and vitamin D, calcium and parathyroid hormone is still unknown, as clinical research have shown inconsistent findings. In this study, we aimed to examine the hypothesis that if there is any relationship between obstructive sleep apnea and serum vitamin D, calcium and parathyroid hormone levels in order to manage treatment. Methods: 56 patients (32 male, 24 female) admitted to the University of Health Sciences Adana City Training and Research Hospital otorhinolaryngology clinic between January 1st, 2022 and January 1st 2023 without any acute and chronic disease were included in the study. The range of participants was 18-70. In this study we examined the serum vitamin D, calcium and parathyroid hormone levels of 32 obstructive sleep apnea patients and compared their serum vitamin D, calcium and parathyroid hormone levels with the serum vitamin D, calcium and parathyroid hormone levels of 24 normal patients in the control group. Results: When the serum vitamin D, calcium and parathyroid hormone levels of obstructive sleep apnea patients and serum vitamin D, calcium and parathyroid hormone levels of normal patients were compared we did not find a statistically significant difference which may be due to our patient density. Conclusion: Vitamin D, calcium and parathyroid hormone levels are not likely related to the presence or absence of obstructive sleep apnea. More intervention studies are needed to better clarify the relation between the obstructive sleep apnea and vitamin D, calcium and parathyroid hormone.

Orthopaedic patients' emergency department attendance behavior in relation to weather conditions: temperature, rain, day and time, and regional thursday effect.

Great variation was noticed in emergency department (ED) afflux in relation to daily weather conditions, including difficulties in arranging the correct number of orthopaedic on-calls on the floor. This study aimed to quantify the association between the number of patients referred to the orthopaedic team from the ED and weather conditions, particularly daily temperature and rain. Data were obtained from a large state research hospital's ED attendance. Weather information for the local area for the year was obtained from the regional meteorological office. Data were evaluated using descriptive statistics, with one-way analysis of variance for the relationship between the day of the week and patient numbers, the Pearson test for correlations between daily ED patient flow and daily temperature and the Spearman correlation test for correlations between daily patient flow and daily rain status. A positive and meaningful correlation existed between daily patient influx and daily temperature, along with a negative correlation between daily patient flow and daily rain. Throughout the year, significantly more patients were referred to the orthopaedic team on Thursdays than on any other day of the week. Patients tended to visit the ED more on warm days and days without rain. These results may help in organising daily, monthly or seasonal on-call orthopaedic team requirements despite the challenges. Incorporating climate forecasts into planning the on-call service might help alleviate the stress on the team.

THROMBOCYTOPENIA IN NEONATES: INCIDENCE, PRESENTATION, AND STUDY OF CORRELATED FACTORS AT A LAHORE TEACHING HOSPITAL

Background: Patients with thrombocytopenia have been observed to experience changes in their coagulation profile and severity of disease. This study aims to see the incidence, presentation, and correlating factors of thrombocytopenia in newborns. Methods: From Jan 2023 to Jan 2024, 200 newborns in the Paediatric and Pathology Departments of Chaudhry Muhammad Akram Teaching and Research Hospital participated in a cross-sectional study. Utilizing SPSS-23, overall data was analysed. Results: In this study 138 (69%) of the 200 newborns were female, and 62 (31%), were male. Seventy-six (38%) neonates had thrombocytopenia, whereas 124 (62%), neonates had normal platelet counts. Of the 76 newborns, 42 (21%) had mild thrombocytopenia, 25 (12.5%) had moderate thrombocytopenia, and 9 (4.5%) had severe thrombocytopenia. Thirty-five percent early-onset neonatal thrombocytopenia (EOT) had early onset thrombocytopenia, while 46 (23%) had thrombocytopenia in the late onset (LOT) phase. There was a strong correlation discovered between thrombocytopenia and anaemia, jaundice asphyxia, low birth weight, preterm and full-term neonatal birth, and neonatal jaundice. The correlation of bleeding in neonates with thrombocytopenia was significant (p&gt;0.05). Conclusion: Moderate to severe thrombocytopenia in newborns often follows mild thrombocytopenia. Thrombocytopenia is highly correlated with bleeding, preterm birth, full-term birth (extensive monitoring during childbirth), anaemia, hypoxia, and sepsis. In sick newborns, severe thrombocytopenia is considered as a prognostic marker. Pak J Physiol 2024;20(3):37–9, DOI: https://doi.org/10.69656/pjp.v20i3.1703

Determination of the effect of the pre-surgery COVID-19 fear level and hygiene behaviours of the patients on the personal protective clinical measures developed after the surgery: Across-sectional study.

This study aims to examine patients' preoperative COVID-19 fear levels, hygiene behaviours, postoperative personal protective clinical measures, and their correlations with each other. This research is a cross-sectional type of study. The study sample consisted of 131 patients hospitalized in the general surgery inpatient ward of a hospital in Turkey. The sample was determined by G-Power analysis. The data were collected in two stages in a research hospital between 1 April 2021 and 1 March 2022. Sociodemographic and Clinical Information Form, COVID-19 Fear Scale, COVID-19 Hygiene Scale were used before surgery; COVID-19 personal protective clinical measures questionnaire was used after surgery. Descriptive statistics, independent t-test, ANOVA test, Wilcoxon test and Spearman correlation analysis were used to evaluate the data. It was determined that preoperative COVID-19 fear levels, hygiene behaviours, and the personal protective clinical measures developed after the surgery were above moderate. A statistically significant and positive correlation was found between the COVID-19 Fear Scale and the preoperative COVID-19 Hygiene Scale and postoperative COVID-19 personal protective clinical prevention questionnaire total score and sub-dimension score averages. Patients' COVID-19 fears, preoperative and postoperative hygiene behaviours are statistically significantly associated with each other at a low level; postoperative clinical precautions and preoperative hygiene behaviours are statistically significantly associated with each other at a high level. The results of this study show that patients are terrified of COVID-19 while they are hospitalized due to surgical intervention during the pandemic process, and they increase their hygiene measures. It is thought that the results of the study will guide the regulation of clinical measures, patient education, and nursing care to be developed for patients during pandemic periods. No patient or public contribution.

Determination of Etiology and Risk Factors in Patients Applying to Our Outpatient Clinic for Weight Loss

Archive information of 100 patients who applied to Ankara University Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital Internal Diseases Polyclinic between 01 December 2016 and 01 June 2017 with a desire to lose weight was examined. Patients who were excluded from exclusion criteria and whose BMI was m2 25 kg / m2 were included in the study. Age, gender, curriculum vitae, blood pressure, anthropometric measurements and laboratory data recorded in patient files were used in the routine functioning of the Internal Diseases Polyclinic. Measurements and blood tests were done in the morning hours after at least 8 hours of fasting. The data of the study were analyzed using Statistical Package for the Social Sciences (SPSS) statistical package program. Size E: 178.00 (165-186), K: 161.00 (150-185) (p

Analysis of the hemogram and biochemistry parameters of patients with trauma

Aims: Trauma-related deaths remain a significant public health concern, with organ complications in over 30% of multitrauma patients leading to high morbidity and mortality. This study aims to understand the changes and reliability of hemoglobin, hematocrit, AST, and ALT levels in trauma cases and their impact on treatment planning. Methods: A retrospective analysis was conducted on 259 multitrauma patients admitted to Ankara Atatürk Training and Research Hospital between July and December 2012. Data on demographic details, trauma types, laboratory parameters, physical and tomographic examinations, treatment modalities, and outcomes were analyzed using SPSS software. Results: The study group predominantly comprised males (74.9%) with a mean age of 42.15 years. Various trauma types were analyzed, including traffic accidents and falls. Significant fluctuations in hemoglobin and hematocrit levels were observed post-fluid resuscitation, regardless of bleeding status. Notably, AST and ALT levels were reliable indicators of hepatic injury. The study also highlighted the effects of fluid hydration volumes on hemoglobin and hematocrit levels. Conclusion: The findings challenge the conventional understanding that drops in hemoglobin and hematocrit levels primarily indicate bleeding in multitrauma patients. Instead, these changes might also result from fluid resuscitation. The study underscores the importance of considering both bleeding and resuscitation efforts when interpreting these laboratory parameters. This study provides new insights into the interpretation of hemoglobin, hematocrit, AST, and ALT levels in trauma patients. It suggests a more nuanced approach in treatment planning, considering the significant impact of fluid resuscitation on these parameters, alongside bleeding.

The effects of prophylactic administration of tranexamic acid on the operative time and the amount of blood transfused during open fixation of pelvis and acetabulum fractures

BackgroundOrthopedic surgeons face challenges regarding perioperative bleeding during the operations of pelvic and acetabular fracture cases. Although the recently popular tranexamic acid (TXA) has proven to be a useful tool, this study primarily aimed to conduct a retrospective comparative analysis of the results of the prophylactic administration of tranexamic acid during open fixation of pelvis and acetabulum fractures, especially regarding operative time and the amount of blood transfused; and in addition, share the results related to other findings including the management of the erythrocyte suspension use and overall cost as secondary aims and thus providing a comprehensive point of view.MethodsThe files of patients with pelvis or acetabulum fractures admitted to the Emergency Clinic of the Adana City Training and Research Hospital between January 1, 2020, and December 31, 2023, were analyzed retrospectively. The inclusion criteria were as follows: patients aged 18 years or older who had undergone open reduction for pelvis or acetabulum fractures.ResultsThere were 78 files identified for analysis. Among the fractures, 27 were located at the pelvis (34.61%) and 51 at the acetabulum (65.38%). The pelvic fracture cases’ age and preoperative hemoglobulin levels were significantly lower (p = 0.019 and p = 0.006, respectively). When all cases were dichotomized into two groups, ones requiring ICU monitoring and the remaining, there were statistically significant differences in terms of the preoperative hemoglobin levels (p = 0.0446), intraoperative bleeding (p = 0.0134), units of erythrocyte suspension used (p = 0.0066), drain output (p = 0.0301), hospitalization duration (p = 0.0008), and the overall cost (p = 0.0002). The comparison regarding TXA use showed that the use of blood products was significantly higher in the pelvic fractures not treated with TXA (6.44 ± 4.42 units, p = 0.0029). The duration of surgery was shorter for pelvic fractures treated with TXA (98.33 ± 21.76 min, p = 0.047).ConclusionAmong the variables, the amount of intraoperative bleeding emerged as the most correlated element, which strongly suggests that in managing open reduction internal fixation surgeries performed for pelvis and acetabulum fractures, intraoperative bleeding should be considered as the crucial factor. Therefore, the administration of TXA, by effectively reducing the amount of intraoperative bleeding, should be considered as an essential tool for orthopedic surgeons.