Diş çürükleri çocuklarda oldukça yaygın görülen ve genel sağlığı olumsuz yönde etkileyebilen kronik bir hastalıktır. Çocuklarda ağrıya, beslenme problemleri gibi genel sağlık sorunlarına ve psikolojik problemlere yol açabilmektedir; bu nedenle tedavi edilmeleri gerekmektedir. Her çocuk, rutin bir şekilde klinik ortamında tedavi edilemeyebilmekte ve ekstra davranış yönlendirme tekniklerine ihtiyaç duyulabilmektedir. Koopere olmayan ve engelli çocukların dental tedavileri uygun ve gerekli endikasyon değerlendirmesi yapıldıktan ve oluşabilecek komplikasyonlar ile yarar-zarar ilişkisi değerlendirildikten sonra ileri davranış yönlendirme tekniklerinden olan genel anestezi ile tedavi edilebilmektedir. Genel anestezi altında dental tedavinin yapılması kararının verilmesinden önce sedasyon dahil olmak üzere tüm olası alternatif tedavi yolları değerlendirilmeli ve aile bu konu hakkında detaylı şekilde bilgilendirilmelidir. Diş hekimleri genel anestezi uygulamasının endikasyonları, kontraendikasyonları ve komplikasyonları hakkında detaylı bilgiye sahip olmalıdır; anestezi uzmanları ile işbirliği içerisinde olmalıdır. Hastaların tedavi öncesinde detaylı bir şekilde genel sağlık durumunun ve ağız sağlığının değerlendirilmesi, hastaların tedavi planlamasının yapılması gerekmektedir. Böylece hastaya özel tedavi yaklaşımı ile oluşabilecek komplikasyonların ve ileride tekrarlayabilecek tedavi gereksinimlerinin önüne geçilebilmesi mümkün olabilmektedir. Genel anestezi altında gerçekleştirilen dental tedavilerin başarı oranı uygulanan tedavi prosedürüne, tercih edilen restoratif materyale, tedavi sonrasındaki oral hijyen alışkanlıklarına ve hastanın diyet özelliklerine bağlı olabilmektedir. Önemli olan hastaya kalıcı oral hijyen alışkanlığının kazandırılması ve geleceğe yönelik olumlu davranışların oluşmasını sağlayabilmektir.

Objectives: Sex-based disparities in COVID-19 outcomes are well-documented, with men experiencing greater acute severity and women showing increased vulnerability to post-viral syndromes. However, longitudinal immunometabolic trajectories in vaccinated individuals remain underexplored. In this study, sex-based differences in long-term metabolic, endocrine, renal, cardiovascular, and inflammatory responses were investigated among vaccinated individuals recovering from SARS-CoV-2 infection. Methods: This retrospective single-center cohort study included 426 adults (199 females, 227 males) with PCR-confirmed symptomatic COVID-19 and at least two vaccine doses. Serial assessments were conducted at baseline, 18-, 24-, and 30-month post-infection. Parameters included fasting glucose, HbA1c, lipid profile, thyroid function, renal markers, CRP, D-dimer, fibrinogen, troponin, and hematologic indices. Statistical analyses assessed longitudinal changes and sex-stratified correlations. Results: Fasting glucose and HbA1c levels significantly declined over time, more prominently in males. Glucose correlated with age and BMI only in females. Lipid levels remained largely unchanged, although males had higher baseline triglycerides. Females showed rising TSH levels and persistently lower free T3; males exhibited higher creatinine, urea, and troponin levels throughout. Inflammatory markers declined significantly in both sexes, with males displaying higher CRP and troponin, and females showing sustained fibrinogen elevation and a temporary lymphocyte surge. D-dimer was elevated in females at the 30-month point. Conclusions: Sex-specific physiological recovery patterns were evident among vaccinated COVID-19 survivors. Males exhibited earlier metabolic and cardiac alterations, while females had more persistent endocrine and inflammatory shifts. These findings underscore the need for sex-tailored long-term monitoring strategies prioritizing early metabolic and cardiac screening in men and prolonged immunoendocrine surveillance in women.

Background/Objectives: Totally implantable venous access ports (TIVAPs) are commonly used in oncology for long-term venous access, but catheter tip malpositioning can lead to complications. Intracavitary electrocardiography (IC-ECG) provides real-time tip guidance, although data on clinical outcomes and patient satisfaction remain limited. This study evaluates postoperative complications, catheter function, and patient comfort and satisfaction after TIVAP implantation using ultrasound and IC-ECG guidance. Methods: This retrospective single-center study included adults with solid cancers who received TIVAP implants for chemotherapy from June 2021 to September 2024. Procedures used the right internal jugular vein, with ultrasound guidance and the Seldinger technique; catheter tip placement was guided by IC-ECG. Chest X-rays were obtained to assess for early complications and tip position. Primary outcomes were comfort and satisfaction; secondary outcomes included catheter tip position, catheter complications, and usability. Results: Among 213 screened patients, 192 were included (79 females, 113 males; mean age 60.83 ± 12.19 years). The catheter tip was located within the target zone in 149 patients (77.6%). Success rates were 98.44% (n = 189/192) for blood aspiration, 97.90% (n = 186/190) for port ease of use, 98.95% (n = 189/191) for overall satisfaction, and 98.43% (n = 188/191) for willingness to recommend. Discomfort occurred in 6.25% (n = 12/192) of patients. Comfort improved significantly from day1 to day7 (p < 0.001). Complication rates included hematoma (1.56%, n = 3), pneumothorax (0.52%, n = 1), venous thrombosis (1.56%, n = 3), local infection (2.08%, n = 4), systemic infection (0.52%, n = 1), and catheter occlusion (2.08%, n = 4). Catheter blood aspiration success was 93.75% (n = 180/192). Conclusions: In this retrospective cohort, TIVAP implantation via the right internal jugular vein under ultrasound and IC-ECG guidance was associated with low complication rates, favorable catheter function, and high patient satisfaction. Prospective, multicenter, and comparative studies are needed to determine whether ECG-guided tip positioning improves long-term clinical and patient-centered outcomes.

Retrospective Analysis of Totally Implantable Venous Access Ports which was Performed using the Patient’s Height as a Guide, and the Effect of Catheter Tip Position on Complications - Turkish Journal of Anaesthesiology and Reanimation

Background and Objectives: Acute normovolemic hemodilution (ANH) is commonly used to minimize perioperative blood loss and transfusion requirements. While it is considered safe, the molecular effects of ANH on vital organs remain unclear. Aquaporins (AQPs), the principal cellular water transporters, may play a role in tissue adaptation or injury under hemodilution stress. This study aimed to evaluate the impact of ANH on AQP1, AQP3, and AQP4 expression profiles and their association with apoptotic and inflammatory markers in the aorta, heart, kidney, and liver. Materials and Methods: Male Hannover–Sprague Dawley rats (6 months old) were assigned to control (no procedure), sham (anesthesia only), and hemodilution (anesthesia and ANH) groups. ANH was induced using balanced crystalloid infusion. Physiological parameters, blood gases, electrolytes, and metabolic profiles were monitored. At 24 h post-ANH, tissues were harvested for immunoblot analysis of AQPs, as well as apoptotic and inflammatory markers. Results: At 24 h post-ANH, changes in potassium, calcium, and glucose levels, decreased hematocrit, increased lactate, decreased pH, base excess, and PaCO₂ were detected, indicating mild metabolic acidosis due to tissue hypoxia and impaired oxygen delivery. Apoptotic and inflammatory responses were observed across all tissues, but AQP alterations were organ-specific. In the heart, AQP1 downregulation correlated inversely with NF-κB and TNF-α levels, while AQP3 upregulation positively correlated with apoptosis. The aorta showed the opposite pattern. In the kidney, AQP4 downregulation was strongly associated with apoptosis and inflammation. Furthermore, ANH selectively increased the AQP3 expression without affecting AQP1 or AQP4 in the liver. Conclusion: ANH induces differential aquaporin expression patterns in major organs, with tissue-specific associations with apoptosis and inflammation. These findings highlight a potential mechanistic role for AQPs, particularly AQP1 and AQP3, in modulating tissue response to hemodilution. These molecular adaptations may serve as early indicators of tissue stress, suggesting clinical relevance for perioperative fluid strategies.

Hearing loss after spinal anesthesia is one of the rare complications. It has been suggested that low frequent hearing loss develops after the development of endolymphatic hydrops in the cochlea due to CSF escape after dural puncture. Hearing loss after nonotologic surgical procedures is very rare and usually can only be determined by audiometric evaluation. We aimed to present the sudden unilateral hearing loss and healing process in a patient who underwent spinal anesthesia for elective anterior cruciate ligament surgery in this postoperative period.