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Healthcare workers' cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P = 0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P > 0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P < 0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians. [ABSTRACT FROM AUTHOR]

Objective: The New Delirium Rating Scale (NDRS) makes use of verbal assessments to evaluate the cardinal features of delirium and is an observer-rated, 10-item symptom rating scale based on both DSM-IV and the findings of the previous clinical research. In this study, we tested the validity of the NDRS for measuring the severity of delirium in intensive care units. Methods: Thirty consecutive non-intubated patients admitted to the ICU for more than 24 hours were included in the study. Two intensivists were trained to rate delirium according to NDRS and they daily carried out structured interviews to evaluate the patients. All patients were interviewed by a psychiatrist for rating according to NDRS, and the data collected by the psychiatrist and the intensivists were compared. Results: The cut-off score for NDRS was 11.3 patients (10%), who were rated as delirious. The inter-rater reliability of the intensivists and the psychiatrist was found to be 0.84 and 0.90, respectively (p<0.0001). Conclusion: Intensivists easily used NDRS, a detailed delirium assessing scale, and rated delirium successfully. [ABSTRACT FROM AUTHOR]

Pediatric regional anesthesia is widely used to relieve postoperative pain after abdominal surgery. Commonly used techniques of regional anesthesia include lumbar epidural and caudal block. However, the use of central neuraxial blockade has limitations. It is contraindicated in patients with clotting abnormalities, spinal dysraphism with tethered cord syndrome, meningomyelocele, and following spinal surgery with instrumentation. Ultrasound guided transversus abdominis plane block is a new method of regional anesthesia that can be used in settings where central neuraxial blockade is contraindicated. In this study, we present 5 pediatric cases in which major abdominal surgery was performed but central neuraxial blockade could not be carried out due to spinal abnormalities.

Background/aim: Factors affecting neurological outcome and the usefulness of neuron-specific enolase (NSE), S-100B, glial fibrillary acidic protein (GFAP), and procalcitonin (PCT) in predicting neurological outcomes were assessed in patients who survived at least 24 h after cardiopulmonary resuscitation (CPR)., Materials and Methods: Thirty successfully resuscitated cardiac arrest patients were included in this prospective clinical study. The initial cardiac arrest rhythm, duration of CPR, return of spontaneous circulation time, administered doses of adrenaline, base excess, blood sugar, and hemodynamic parameters were recorded. Patients with Glasgow Outcome Scale (GOS) scores of 1-3 were defined as Group I and patients with GOS scores of 4-5 were defined as Group II. Serum NSE, GFAP, S-100B, and PCT levels were compared between the two groups shortly after CPR (hour 0) and at hours 12 and 24 of the postresuscitation period., Results: Serum S-100B was significantly higher (P = 0.009) in Group II immediately after CPR. Serum S-100B and NSE after CPR at hours 0, 12, and 24 were significantly lower in patients who survived to hospital discharge. Serum PCT at hours 12 and 24 and serum S-100B after CPR at 0, 12, and 24 h reached 94.7% sensitivity. Serum NSE, GFAP, S-100B, and PCT specificities were lower than 50%., Conclusion: In predicting neurological outcomes, serum S-100B has high sensitivity and low specificity immediately after CPR.

Objectives: To compare the time interval of the procedure, possible complications, post-operative pain levels, additional analgesics, and nurse satisfaction in ultrasonography-guided and standard caudal block applications. , Methods: This retrospective study was conducted in Celal Bayar University Hospital, Manisa, Turkey, between January and December 2014, included 78 pediatric patients. Caudal block was applied to 2 different groups; one with ultrasound guide, and the other using the standard method. , Results: The time interval of the procedure was significantly shorter in the standard application group compared with ultrasound-guided group (p=0.020). Wong-Baker FACES Pain Rating Scale values obtained at the 90th minute was statistically lower in the standard application group compared with ultrasound-guided group (p=0.035). No statistically significant difference was found on the other parameters between the 2 groups. The shorter time interval of the procedure at standard application group should not be considered as a distinctive mark by the pediatric anesthesiologists, because this time difference was as short as seconds.  , Conclusion: Ultrasound guidance for caudal block applications would neither increase nor decrease the success of the treatment. However, ultrasound guidance should be needed in cases where the detection of sacral anatomy is difficult, especially by palpations.

Objective: Postpartum period is physically, socially and emotionally a difficult time for the parents and the baby to become a family. We tried to investigate how the anaesthesia method affects patients who underwent cesarean delivery, as a factor which also affects this period., Methods: Two hundred and six parturients, who underwent elective cesarean delivery in Celal Bayar University Hafsa Sultan Hospital were recruited for our study. After demographic data and anaesthesia methods were noted, an EQ-5D health survey and Katz ADL scale were evaluated face to face 24 hours postoperatively, and by telephone on the 5th postoperative day., Results: The percentage of patients who had general anaesthesia was 35.2% (n=71), while 19.8% (n=40) had epidural anaesthesia and 45% (n=91) had spinal anaesthesia. Among -these three methods, the EQ-5D health survey revealed that the outcome at postoperative 24 hours was best in epidural anaesthesia and that general anaesthesia outcome was the worst (p=0.007). The Katz ADL scale at postoperative 24. hours showed that epidural anaesthesia was better than the other methods for regaining daily life activities (p<0.05)., Conclusion: Our study showed that epidural anaesthesia had the most effective role among the methods in regaining daily life activities after elective cesarean delivery, which was demonstrated using the EQ-5D health survey and Katz ADL scale.

Background: This prospective, controlled experimental study was planned to investigate the effects of levosimendan on transforming growth factor (TGF)-beta3 and Smad1, Smad2 and Smad3 expression in the early stages of sepsis., Methods: Twenty-four rats were randomized into four groups: (1) sham-operated controls, (2) dobutamine group--subjected to abdominal hypertension and peritonitis-induced sepsis using cecal ligation and puncture (CLP), then treated with 10 microg x kg(-1) min(-1) intravenous (IV) dobutamine infusion, (3) levosimendan group--as in 2, then treated with levosimendan IV bolus 200 microg x kg(-1) followed by 200 microg x kq(-1) min(-1) IV infusion, and (4) a control group as in 2, with no treatment. All rats were killed 8 hours after CLP. Aorta tissue samples were analyzed by immunohistochemical staining., Results: CLP caused mild interleukin (IL)-1 immunostaining in both control and dobutamine groups. Immunoreactivity of tumor necrosis factor (TNF)-alpha was mild in both sham and control groups. TGF-beta3 immunostaining was mildly increased in groups sham, control and dobutamine, whereas it was found moderate in group levosimendan. Smad1, Smad2 and Smad3 were found moderately increased only in group levosimendan., Conclusion: Beneficial effects of levosimendan on hemodynamics and global oxygen transport were reported in experimental and clinical trials. Besides its potency on C++ ion sensitivity, it should influence inflammatory cytokine production by diminishing TGF-beta3 and Smad1, Smad2 and Smad3 expression.

Objectives: The main purpose of this study was to investigate pain perception of the professional volleyball players at rest and maximal cardiovascular stresses during different phases of menstruation., Methods: Thirteen volleyball players from Celal Bayar University were used as the participants of the study. At rest, anthropometric measurements, systolic and diastolic blood pressures were determined. Then, pain tolerance and pain threshold were measured by sphygmomanometer that placed upper part of the arm. Visual Analog Scales (VAS) was used to grade the pain. At the 2nd (menstrual phase) and 14th (ovulation phase) days of menstrual cycle, oxygen consumption (VO(2)), heart rate (KA), blood lactate (KL) pain perception and rate of perceived exertion (RPE) were taken during two incremental maximal exercises testing., Results: Statistical analysis of this study indicated that at rest pain tolerance and threshold values of the volleyball players were significantly higher during menstruation phase compared to ovulation phase. Also, VO(2) and KL measurements taken at the high intensities during 2nd day of mensturation were statistically higher than that of measurements were done at 14th day of mensturation. Moreover, pain perception of the participants that was measured during 2nd day of menstruation was significantly lower than that of measurements during the 14th days of menstruation (p<0.05). According to results of regression analysis, RPE and KL were two dependent variables that were statistically related to pain perception during two different phases of menstruation., Conclusion: As a conclusion due to the decrease in pain perception, the intensity of the training could be increased during menstruation period.

The effects of levosimendan on acute lung injury induced by peritonitis and abdominal hypertension in the early stages of sepsis in rats were investigated. Twenty-four adult male Wistar rats were randomized into: (1) sham, (2) subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture, then treated by dobutamine, (3) subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture, then treated by levosimendan, and (4) controls subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture with no treatment. In the control and levosimendan groups, cecal ligation and puncture resulted in moderate IL-1beta immunolabelling in lung tissue; marked IL-1beta immunolabelling was demonstrated in the dobutamine group. TNF-alpha immunolabelling was negative in both the sham and levosimendan groups, but moderate and weak immunoreactivities were observed in the dobutamine and control groups, respectively. There were almost no TUNEL positive cells in the sham, but they were prominent in the control. TUNEL positive cells were significantly less in the levosimendan treated lungs when compared to control and dobutamine groups. Immunoreactivity of eNOS was stronger in the dobutamine group when compared with the levosimendan group. In addition, iNOS immunoreactivity was strongly detected in the control group; this immunoreactivity was less in the levosimendan group than the dobutamine group. In this experimental sepsis model, treatment with levosimendan had a marked effect on attenuating or decreasing apoptosis and inflammation in the lung.