To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies. Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 +/- 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiography All patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients. Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.

Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p < 0.001, r = 0.357; p < 0.001, r = 0.345; p < 0.001, r = 0.360; p < 0.001, r = 0.240; p < 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.

OBJECTIVE: Many laboratory parameters allow to follow up the course of the disease and reveal its clinical severity, particularly in patients with coronavirus disease 2019 (COVID-19) pneumonia. In this study, we aimed to investigate the role of the blood urea nitrogen-to-albumin ratio in predicting the mortality in COVID-19 patients with moderate-to-severe disease who are hospitalized in the intensive care unit. METHODS: A total of 358 patients who were hospitalized in intensive care unit at our hospital between November 1, 2020 and May 15, 2021 were included in this study. During their course of intensive care, surviving patients were included in Group 1 and nonsurviving patients in Group 2. RESULTS: There were no statistically significant differences between the two groups in terms of gender, smoking, and chronic obstructive pulmonary disease rates. In multivariate logistic regression analysis, advanced age (OR 1.038, 95%CI 1.014-1.064, p=0.002), neutrophilto-lymphocyte ratio (OR 1.226, 95%CI 1.020-1.475, p=0.030), blood urea nitrogen-to-albumin ratio (OR 2.693, 95%CI 2.019-3.593, p<0.001), and chest computed tomography severity score (OR 1.163, 95%CI 1.105-1.225, p<0.001) values were determined as independent predictors for in-hospital mortality. CONCLUSION: In this study, we showed that the blood urea nitrogen-to-albumin ratio, which was previously shown as a predictor of mortality in patients with various pneumonia, was an independent predictor of mortality in patients with COVID-19 pneumonia.

Postoperative acute kidney injury is an important problem that can occur after coronary artery bypass graft operations, and it is important to identify risky patient groups preoperatively. This study aimed to investigate the importance of preoperative syndecan-1 levels in predicting acute kidney injury after elective coronary artery bypass graft operations accompanied by cardiopulmonary bypass. Patients who underwent coronary artery bypass graft operation in our clinic between March 1 and May 10, 2022, were included in this prospective study. Patients who did not develop acute kidney injury in the postoperative period were recorded as group 1 and patients who developed it were recorded as group 2. A total of 79 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass were included in the study. There were 55 patients in group 1 and 24 patients in group 2. There was no difference between the groups in terms of age, gender, diabetes mellitus, body mass index, smoking, and hyperlipidemia rates. In multivariate logistic regression analysis, increased blood product use (odds ratio 1.634; 95%CI 1.036-2.579; p=0.035), preoperative high creatinine (odds ratio 59.387; 95%CI 3.034-1162.496; p=0.007), and high syndecan-1 (odds ratio 1.015; 95%CI 1.002-1.028; p=0.025) were independent predictors of acute kidney injury. This study revealed that elevated preoperative syndecan-1 is associated with acute kidney injury after isolated coronary artery bypass graft accompanied by cardiopulmonary bypass and has prognostic utility independent of other recognized risk factors.

COVID-19 önlemleri alınarak elektif cerrahilerin yeniden başlatıldığı pandemi sürecinde elektif cerrahi uygulanacak hastaların preoperatif anksiyete düzeylerinin ve anksiyete seviyelerini etkileyen faktörlerin değerlendirilmesi amaçlandı. 18-75 yaş grubu elektif cerrahi uygulanacak 450 hasta dahil edildi. Yazılı onamları alınan hastalar preoperatif dönemde değerlendirildi. Demografik verileri, eğitim durumu, medikal geçmişi, anestezi ve cerrahi deneyimleri sorgulandı. COVID-19 hakkında soruların olduğu anket formu ile yirmişer maddelik durumluk ve sürekli kaygı ölçeklerinden oluşan Spielberger Durumluk-Sürekli Anksiyete Ölçeği (STAI) hastalar tarafından dolduruldu. Durumluk (STAI-I) ve sürekli (STAI-II) kaygı ölçeklerinde büyük puan yüksek anksiyete seviyesini, küçük puan ise düşük anksiyete seviyesini belirtir. 49.26±15.51 yaş ortalaması olan hastaların ortalama anksiyete düzeyi STAI-I’de 41.46±8.43, STAI-II’de 37.79±9.73 olarak bulundu. Opere edilen kliniklere göre hastaların STAI-I puanları orta düzeyde anksiyete, STAI-II puanları ise hafif düzeyde anksiyete ile uyumluydu. Hastaların yaşı ile STAI-I arasında negatif yönde korelasyon görüldü (r=-0.52, p=0.136), STAI-II’de ise yaş ile pozitif korelasyon saptandı (r=0.22, p=0.321). Cinsiyet, eğitim durumu, geçirilmiş ameliyat öyküsü ve anestezi deneyimi açısından değerlendirildiğinde preoperatif STAI-I ve II puanlarında farklılık saptanmadı. COVID-19 pandemisi hakkında yeterli bilgi sahibi olmadığını düşünen hastaların (%17,6) STAI-I ve STAI-II puanları anlamlı yüksekti (p= 0.000, p= 0.001). Ailesinde geçirilmiş COVID-19 enfeksiyonu bulunan hastaların STAI-I ve II puanları ile diğer hastaların puanları benzerdi (p=0.76, p=0.91). Hastane yatışında COVID-19 ile enfekte olma tedirginliği bulunan hastaların (287 hasta, %63.8) STAI-I puanı hastanede COVID-19’a yakalanmaktan korkmayanlara (163 hasta, %36.2) göre yüksek bulundu (p=0.05). Postoperatif dönemde hastane yatışı sırasında COVID-19 ile enfekte olan hasta olmadı. Elektif cerrahi geçirecek hastalarda COVID-19 pandemisinde preoperatif anksiyete düzeyleri artmıştır. Preoperatif dönemde hastalara COVID-19 ile ilgili rutin bilgilendirme yapılmasının ve alınacak önlemlerden bahsedilmesinin anksiyete düzeyini azaltmada faydalı olacağı düşüncesindeyiz