Using high-performance liquid chromatography (HPLC) and 2,4-dinitrophenylhydrazine (2,4-DNPH) as a derivatizing reagent, an analytical method was developed for the quantitative determination of acetone in human blood. The determination was carried out at 365 nm using an ultraviolet-visible (UV-Vis) diode array detector (DAD). For acetone as its 2,4-dinitrophenylhydrazone derivative, a good separation was achieved with a ThermoAcclaim C18 column (15 cm × 4.6 mm × 3 μm) at retention time (t R) 12.10 min and flowrate of 1 mL min−1 using a (methanol/acetonitrile) water elution gradient. The methodology is simple, rapid, sensitive, and of low cost, exhibits good reproducibility, and allows the analysis of acetone in biological fluids. A calibration curve was obtained for acetone using its standard solutions in acetonitrile. Quantitative analysis of acetone in human blood was successfully carried out using this calibration graph. The applied method was validated in parameters of linearity, limit of detection and quantification, accuracy, and precision. We also present acetone as a useful tool for the HPLC-based metabolomic investigation of endogenous metabolism and quantitative clinical diagnostic analysis.
Informed consent is linked to the principle of patient autonomy and has an important place in common medical codes of conduct and legislative regulations. The aim of this study is to determine the judgments and reviews of the high court (Yargıtay) related to informed consent and to discuss them from a medicolegal aspect within Turkish jurisprudence. In the search engine of the website publishing high court decisions, the keywords "informed consent", "information", "consent" and "assent" were used without any date limitation. In this study, N=32 high court judgments were investigated. The data obtained were analyzed in light of the literature and guidelines. In 23 of the cases (71.9%) surgical interventions requiring general anesthesia were performed. In the other 9 cases (28.1%) surgical interventions not requiring general anesthesia and medical interventions with diagnostic and/or treatment purposes were performed. There was a statistically significant difference between the groups with informed consent and without informed consent for "surgical interventions not requiring general anesthesia and medical interventions with diagnostic and/or treatment purposes". The high court identified that in 17 of the cases (53.1%) informed consent was not present while in 15 (46.9%) informed consent was obtained. The court could not prove that informed consent was obtained in 15/17 cases in the group without consent, while in 7/15 cases in the consent group inadequate informed consent was obtained. The high court interrogated the extent and adequacy of informed consent for all types of surgical interventions both requiring and not requiring general anesthesia and medical interventions with diagnostic and/or treatment purposes. The types of surgical and medical interventions that require written informed consent and the aims of informed consent should be re-evaluated.
ÖzetAmaç: Bu çalışmada, pediatrik adli olgularda meydana gelen yaralanmaların önlenmesine yönelik olarak; travma profilini ve istemli yaralanmaların özellik-lerini ortaya çıkarmak amaçlandı. Gereç ve Yöntem: Acil servise 01.01.2014-31.12.2014 tarihlerinde başvuran, 18 yaş ve altı çocuk adli olguların dijital ortamdaki kayıtları retrospektif olarak yaş, cinsiyet, yaralanma tipi, travmanın etiyolojisi ve etkileri açısından incelendi. Bulgular: İncelenen 148 olgunun 62'si (%41,9) kadın, 86'sı (%58,1) erkek cinsiyette ve yaş ortalaması 11,2±0,4 idi. Yaralanma nedenleri ilk sırada, trafik kazaları (n=69, %46,6), ikinci sıra-da istemli yaralanmalar (32 olgu, %21,6) idi. İstemli yaralanmalardan 20 olgu (%13,5) darp, 7 olgu (%4,7) kesici-delici alet yaralanması, 3 olgu (%2) intihar girişimi, 1 olgu (%0,7) ateşli silah yaralanması ve 1 olgu (%0,7) cinsel istismar idi. Toplam; 11 (%7,4) olguda yaşamsal tehlike mevcuttu. Tartışma: Olguların çoğu trafik kazasına bağlı önlenebilir nitelikte yaralanmalardır. İs-temli yaralanmalar, okul çağı ve adolesan döneminde daha sıktır. Bu özel-likler, yaralanma kontrol programlarının geliştirilmesi ve çocuk güvenliğinin sağlanması açısından çok önemlidir. Anahtar KelimelerAcil Servis; Adli Pediatrik Olgular; İstemsiz Yaralanmalar; Çocuk Güvenliği Abstract Aim: In this study, we aim to reveal the characteristics of intentional injuries and the trauma profiles in order to prevent injuries in pediatric forensic cases. Material and Method: Forensic cases of patients aged 18 or younger who were admitted into emergency service were analyzed retrospectively in terms of age, gender, type of injury, and etiology of trauma between January 1, 2014 and December 31, 2014. Results: Of the 148 cases, 62(41.9%) were female and 86(58.1%) male; the mean age was 11.2±0.4. The most common cause of injury was traffic accident (46.6%). The second most common type of injury was intentional injuries (21.6%). The distribution of intentional injury is: beating in 20 cases (13.5%), stab wounds in 7 cases (4.7%), gunshot wounds in 1 case (0.7%), sexual abuse in 1 case (0.7%), and attempted suicide in 3 cases (2%). Eleven (7.4%) cases had life-threatening injuries. Discussion: Most injuries are preventable because they are due to traffic accidents. Intentional injuries were more frequent during school age and adolescence. Understanding these findings is very important in developing child safety programs to reduce injuries.
Physical abuse is defined as non-accidental injury. For 0-3 years of age children, evaluated in the emergency department, the possibility of physical abuse should be considered. The purpose of this study is to discuss the role of radiological findings in the assessment of physical abuse suspicion. Children in 0-3 years of age, admitted with fall to the emergency department of a university hospital in 2018, were retrospectively evaluated on hospital automation system. Data was obtained from electronic health records. The cases were examined in terms of age, gender, falling features, physical and radiological findings related to trauma and suspicion of abuse. Data was analyzed in SPSS program. In 100 cases, 52 (52.0%) were male and the mean age was 28.7±10.6 months. The clinical diagnoses of the cases were 51 (51.0%) falling from the same level, 11 (11.0%) falling from one level to another, and 38 (38.0%) 'only' falling. Posttraumatic radiological findings were as follows: 19 (19.0%) cases had soft tissue injury with bone fracture and/or joint dislocation; 17 (17.0%) cases had isolated soft tissue injury and 1 (1.0%) had temporal bone fracture and intracranial traumatic changes. In 11 (11.0%) cases had long bone fractures, 9 (9.0%) were diaphyseal fractures. Two (2.0%) cases had hand-finger, 1 (1.0%) clavicle, 1 (1.0%) calvarial and 1 (1.0%) facial bone fractures. The case with clavicle fracture could not be evaluated in terms of physical abuse suspicion, because of unknown condition of walking. The suspicion of physical abuse was considered in 1 (1.0%) case due to delay in hospital admission. Long bone diaphyseal fractures were most common in children aged 0-3 years. Since this finding showed low specificity to physical abuse, no suspicion of physical abuse was radiologically considered. The delay in hospital admission reveals the importance of evaluating cases from a multidisciplinary point of view in terms of suspicion of physical abuse.
Nötrofil lenfosit oranı (NLO) ve trombosit lenfosit oranı (TLO) sistemik inflamasyonu gösteren biyobelirteçlerdir. Bu çalışmanın amacı, adli travmatolojik açıdan yaralanmanın ağırlığının belirlenmesinde, NLO ve TLO'nın rolünü tartışmaktır. Gereç ve yöntem: Bir üniversite hastanesi tıbbi biyokimya laboratuarında, 01.06.2015-01.11.2015 tarihlerinde etanol analizi yapılmış olan olgular, hastane otomasyon sistemi üzerinden retrospektif olarak belirlendi. Veriler, hastaların elektronik dosyalarından elde edildi. Olguların, sosyodemografik özellikleri, yaralanmanın ağırlığı/derecesi, etanol düzeyi, NLO ve TLO değerleri incelendi. Veriler SPSS programında analiz edildi. Bulgular: İncelenen 155 hastanın 133'ü (%85,8) erkek olup yaş ortalaması 36,6± 15,4 yıldı. YT olan olgularda NLO ortalaması 9,4±10,9, YT olmayan olgularda 5,1±5,1 saptandı, bu fark istatistiksel anlamlı değildi (p>0,05). Basit tıbbi müdahale (BTM) ile giderilemeyen olguların NLO ortalaması 8,6±8,6 olup, BTM ile giderilebilir ve travmatik değişim olmayan gruplara göre daha yüksekti ve Bonferroni düzeltmeli Mann Witney U testine göre bu farklar anlamlıydı (p=0,0001). Kırık saptanan olgularda NLO ortalaması 8,9±9,4 iken, kırık saptanmayan olgulara göre daha yüksekti ve bu fark istatistiksel olarak anlamlıydı (p=0,002). TLO ortalama değerleri ile gruplar arasında, istatistiksel anlamlı fark saptanmadı (p>0,05). Sonuç: Yüksek NLO değerleri ile yaralanmanın ağırlığı arasında anlamlı bir ilişki mevcuttur. TLO'na göre NLO, adli travmatolojik açıdan yaralanmanın ağırlığını belirlemede yardımcı bir biyobelirteç olarak kullanılabilir. Bu ilişkinin patofizyolojisinin anlaşılması için, daha fazla araştırma yapılması gereklidir.
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