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Objective: This study aimed to investigate the role of neuromuscular electrical stimulation (NMES) in increasing femoral venous blood flow after total hip prosthesis and to evaluate its potential effects on preventing postoperative deep vein thrombosis (DVT).Materials and methods: A total of 64 patients who underwent total hip prosthesis were randomly separated into two groups. The NMES group (n=32) received low-molecular-weight heparin+NMES. And the non-NMES group (n=32) received a low-molecular-weight heparin+compression bandage.Results: There was no difference between the groups in terms of the presence of preoperative and postoperative leg edema. The calf diameter was significantly lower in the NMES group than in the non-NMES group in both the preoperative (p=0.003) and postoperative (p=0.008) period. Although the femoral vein peak velocity (VPV) was similar between the groups in the preoperative period, it was significantly higher in the NMES group than in the non-NMES group postoperatively (p=0.001). The femoral VPV after total hip prosthesis increased more in the NMES group (43.2%) compared with the non-NMES group (16.3%). In the non-NMES group, the D-dimer value in the preoperative period was lower than on postoperative days one and five (p<0.05). There was no significant difference between the D-dimer values on postoperative days one and five. In the NMES group, a statistically significant difference was determined between the preoperative and postoperative test results (F(2.93)=20.86, p=0.001). The preoperative D-dimer values were compared to the postoperative values on the first and fifth day, and according to the post hoc test results, the D-dimer values were significantly lower on the fifth postoperative day than on the first postoperative day, and the preoperative value was significantly lower than the fifth postoperative day value (p<0.05). Conclusion: Although the two groups were similar in terms of leg edema, there was a significant increase in femoral VPV in the NMES group. This could indicate a potential effect of NMES in preventing postoperative DVT and needs to be confirmed with further studies.

Introduction: The increasing prevalence of Gram-negative bloodstream infections in pediatric patients poses significant treatment challenges, particularly from multi-drug resistant (MDR) strains. Despite advances in medical care, mortality from bloodstream infections remains a concern. Our study aims to understand pediatric patients` demographics, clinical conditions, and microorganisms causing Gram-negative infections, as well as identify factors affecting treatment outcomes and mortality. Methodology: A retrospective, observational study of Gram-negative bacteremia, including all patients < 18 years of age, hospitalized during 2022, with documented bacteremia caused by Enterobacteriaceae or non-fermentative bacteria. Results: In total 123 blood cultures from 102 patients were included study. The median age of patients was 22 months, with 85.3% having an underlying medical condition. Common strains were Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, with 73.2% hospital-acquired infections. Among the isolated species, 28.5% were multidrug-resistant (MDR). The mortality rate was 10.5%. Mortality among patients with antibiotic-resistant isolates was 17.1%. Patients with sepsis had a markedly elevated mortality rate. Additionally, mortality was increased among patients reliant on mechanical ventilation and those with urinary catheters. Furthermore, central venous catheterization was found to be an independent predictor for sepsis (odds ratio: 2.463, 95% confidence interval: 1.095–5.53), while the presence of a urinary catheter was identified as an independent predictor of mortality (odds ratio: 5.681, 95% confidence interval: 1.142–28.249). Conclusions: The study findings highlight a critical need for strategies to reduce MDR Gram-negative infections in children, emphasizing the importance of timely removal of invasive devices and rational antibiotic use to improve patient outcomes.

Date of submission: 06 Aug. 2020, Date of acceptance: 31 Oct. 2020 In the presence of aortoiliac occlusive peripheral artery disease (AIOPAD), which can cause significant mortality and morbidity when untreated, critical leg ischemia symptoms such as absence of peripheral pulses and intermittent claudication or ulcer-gangrene in the feet can be observed; it was described by Rene Leriche as pain in gluteal muscles, cold lower extremities with plain color and cyanosis, severe claudication in lower extremities, and presence of impotence in men.1,2 The treatment of the disease, whose diagnosis is based on physical examination findings on symptomatic patients and the results of imaging methods such as conventional angiography or computed tomography angiography (CTA),2 can be provided by peripheral bypass surgery or endovascular revascularization,2 and sometimes the disease is also seen observed to be well-tolerated with development of collateral arterial pathways.1 Two main collateral arterial pathways, being systemic or visceral artery originating pathways, have been identified for the disease;1,3 and the most common systemic collateral pathway has been reported to be the pathway where the blood flow of external iliac arteries is provided, which is linked with deep circumflex iliac arteries originating from the lumbar, iliolumbar, and inferior epigastric arteries.3,4 Identifying and knowing the existing collateral arterial pathways during the preoperative preparations of patients is not only important for the viability of the extremities, but also for surgical planning,1,3 and that CTA and magnetic resonance angiography (MRA) are reported to be successful for imaging and maintaining these collateral pathways.1,4 Although the symptoms of clinically significant AIOPAD vary from intermittent claudication (IK) to critical leg ischemia, it is reported in literature that the symptoms of patients are not directly related to the severity of the disease due to the physical activity status and existence of collateral arterial pathways.1 In our presentation, we tried to present die collateral blood flow patterns diat ensure the viability of the lower extremities in our patient with AIOPAD, and discuss die case in the light of literature. In our patient, total occlusion was detected by СТА in abdominal aorta and bilaterally iliac arteries from die level of distal renal arteries (Figure la), and it was observed diat the distal external iliac arteries were filled widi collateral pathways of connections between intercostal arteries and deep circumflex arteries, and internal mammary artery and left external iliac artery were detected (Figure lb and lc). Since the patient did not accept surgical bypass treatment for aortoiliac occlusive disease, he was followed up for optimal medical treatment and die control of risk factors. [...]identifying and maintaining the collateral arterial pathway formations is of critical importance in AIOPAD, for which the symptoms are reported to be not directly associated with the severity of the disease, as the collateral arterial pathways play an important role in ensuring the viability of extremities by providing blood flow to the distal of the lesion; so that any threat to the extremity and morbidities can be prevented.

Introduction:Even though it has been reported that femoropopliteal artery endovascular revascularization is often performed with antegrade femoral artery interventions, which are technically relatively challenging, having the advantage of better control, it has also been reported that recanalization failure may occur in approximately 20% of patients and some materials have been developed for this reason.Aim:To evaluate the safety of retrograde popliteal artery intervention and our procedural success rate for symptomatic femoropopliteal artery occlusive disease.Material and methods:A total of 95 endovascular revascularization procedures were performed for treating symptomatic occlusive peripheral artery disease in the study period. Inclusion criteria were defined as patients who underwent endovascular revascularization procedures for symptomatic femoropopliteal artery occlusive disease. Patients who underwent a percutaneous endovascular procedure for iliac artery or below-knee arterial occlusive disease in the same session and patients who had previously undergone peripheral arterial bypass grafting or endovascular treatment for existing femoropopliteal artery disease were excluded.Results:We evaluated 45 peripheral endovascular procedures performed on 39 patients with a mean age of 62.49 ±11.38 years in our hospital for chronic femoropopliteal artery occlusive disease. Twelve (26.7%) of the endovascular treatment procedures were performed with retrograde access through the popliteal artery (Group 2). In neither group were any complications of arterial rupture, distal embolism, early thrombosis, or pseudoaneurysms observed.Conclusions:We are of the opinion that the retrograde popliteal artery technique is an effective and safe intervention option in endovascular revascularization, particularly in the revascularization of the long segment and complex femoropopliteal artery occlusions.

Patients with severely calcified aorta have high risk of atheroemboli and bleeding during cardiac surgery. Clamping the ascending aorta to initiate cardiac arrest or to perform proximal anastomosis is a challenging problem. Beating heart coronary artery bypass grafting without aortic clamping is usually accepted as the best solution. Herein, we present a feasible and inexpensive proximal anastomosis technique without using aortic clamps for patients with severely atherosclerotic aorta.

There are some clinical conditions described in literature which limit the application of full endovascular aneurysm repair, and the most important of these limitations are inappropriately short and angled aneurysm neck, narrow terminal aorta, and curved and very small diameter or highly calcified iliac arteries that make access difficult, and unilateral iliac artery occlusion is another one of these limitations, which is less frequently observed. In our case report, we present a patient whose abdominal aortic aneurysm was considered to be high risk for classical open surgical repair. Our patient has a unilateral iliac artery occlusion co-existing with abdominal aortic aneurysm and the occluded left common iliac artery and severely stenotic external iliac artery segment was applied percutaneous transluminal balloon dilatation and after which abdominal aortic aneurysm was successfully treated with standard endovascular aneurysm repair. A standard successful endovascular aneurysm repair procedure was applied for the patient who did not develop any intraoperative complications. The left iliac artery blood flow was also ensured by the dilatation of occluded iliac artery segment, simultaneously. When there are such limitations related to the iliac artery as iliac artery occlusion, the standard endovascular aneurysm repair procedure combined with invasive techniques for iliac artery revascularization is a practical and safe treatment option which reduces the procedural morbidity and mortality compared to the other treatment options.

Although there are publications in the literature stating that parameters related to the nutritional status of patients are associated with the clinical outcomes of those with coronary artery disease, it is also stated that there is insufficient data on the relationship between nutritional indices and long-term outcomes and major adverse cardiovascular events in patients undergoing isolated coronary artery bypass grafting. This retrospective study was conducted with patients who underwent isolated elective on-pump coronary artery bypass grafting in our hospital. Patients who underwent emergency coronary artery bypass grafting or those with known atrial fibrillation in the preoperative period were excluded. Patients were analyzed and compared in two groups according to the development of postoperative atrial fibrillation. The data of 93 coronary artery bypass grafting patients (71 [76%] males) with a mean age of 62.86 ± 9.53 years included in the study were evaluated. Both groups had similar preoperative ejection fraction value, hemoglobin level, age, number of distal bypasses, and postoperative mortality rates. Although the mean cardiopulmonary bypass and aortic cross-clamping times were higher in Group 1, they were not statistically significant. In our study, the mean prognostic nutrition index value was 51.76 ± 3002. According to our study results, there was no statistically significant difference between prognostic nutrition index values and the development of atrial fibrillation after coronary artery bypass grafting, which is similar to some publications in the literature. We think that it would be beneficial to conduct randomized studies involving more patients on this subject.

Previous studies suggest that the location of coronary artery disease cannot independently predict atrial fibrillation after coronary artery bypass grafting, but with little information, it has also been thought that simultaneous right coronary endarterectomy may cause this rhythm problem. In this study, we aimed to evaluate the effect of right coronary artery bypass grafting on early postoperative atrial fibrillation. Patients who underwent elective on-pump coronary artery bypass grafting operations in our hospital were included in the study, and patients who underwent a different open-heart surgery or those who had previously undergone open-heart surgery were not included. Patients included in the study were divided into Group 1 (patients who developed postoperative atrial fibrillation) and Group 2 (patients who did not develop postoperative atrial fibrillation) and compared in terms of right coronary artery bypass grafting and other follow-up parameters. The mean age of a total of 158 patients included in the study was determined as 63.25 ± 10.07 years (range 44 - 85 years), 120 were male, and 96% of them had hypertension. Postoperative atrial fibrillation developed in 43 patients, and right coronary artery bypass grafting was performed in 123 patients. We think that the frequency of postoperative atrial fibrillation development may be higher in cases where right coronary artery bypass grafting is performed, as it may play a role in processes related to the conduction system and right ventricular dysfunction, and multicenter studies with a large number of patients would be beneficial on this subject.

Background. The term ‘pseudo-outbreak’ refers to a condition in which a microorganism is found in cultures at a greater rate than expected due to contamination of materials that would normally be sterile. This situation cannot be clinically correlated with the infection suggested by the culture results. This can be confusing depending on the patient’s clinical condition, especially in intensive care units (ICU). The pseudo-outbreak with Escherichia coli in patients in ICUs will be discussed in this study to emphasize the importance of strict adherence to microbiology policies and procedures. Methods. In September 2022, growths of Escherichia coli were found in the endotracheal aspirate cultures of six children and eighteen adults in the ICU. Results. The identification of the same microbial agent in 24 patients prompted an investigation into a potential outbreak. The infection control committee compiled a comprehensive patient list to facilitate the assessment. Given that the healthcare personnel and infrastructure of each ICU were distinct and functioned independently, the possibility of cross-contamination within these units was deemed unlikely. Consequently, attention was directed toward the microbiology laboratory as a potential source of the outbreak. A thorough review of culture processing steps and laboratory equipment was conducted. This investigation revealed that the saline solution used for the passage of endotracheal aspiration cultures was contaminated, suggesting a laboratory-associated contamination event as the probable cause. Conclusions. By strictly adhering to the latest protocols, the disinfection and sterilization chain can ensure the safe use of both invasive and non-invasive medical equipment. This manuscript aims to raise awareness among pediatricians and pediatric infectious disease specialists regarding the occurrence of pseudo-outbreaks. A pseudo-outbreak is indicative of a disruption in the sterilization chain.

Cat scratch disease (CSD) is an infection caused by Bartonella henselae, presents with non-specific symptoms like lymphadenopathy, fever, and fatigue. It can progress to disseminated disease, leading to complications such as liver and splenic micro abscesses, osteomyelitis, encephalitis, and uveitis. Diagnosis is challenging due to varied presentations and limited tests. Treatment involves supportive care, with severe cases requiring antimicrobial therapy. In this report, we present a case of Cat scratch disease characterized by an atypical clinical manifestation, hepatosplenic and paravertebral involvement.