Purpose: This prospective, randomized, double-blind study was designed to assess whether intraoperative infusion of dexmedetomidine provides effective postoperative analgesia. Postoperative pain scores and morphine consumption were compared in a treated group and a placebo group, both of which received patient-controlled morphine after total abdominal hysterectomy.Methods: Fifty women were randomly assigned to two groups. Group D (n = 25) received a loading dose of dexmedetomidine 1 µg·kg -1 iv during induction of anesthesia, followed by a continuous infusion at a rate of 0.5 µg·kg -1 ·hr -1 throughout the operation. Group P (n = 25) received a volume-matched bolus and infusion of placebo (0.9% saline). For each case, heart rate, peripheral oxygen saturation, and systolic and diastolic blood pressure were recorded intraoperatively and for 48 hr postoperatively. Patients used a patient-controlled analgesia device to receive bolus doses of morphine after surgery. Total morphine consumption, pain scores, and sedation scores were recorded for the first 48 hr (two hours in the postanesthesia care unit and 46 hr on the ward). Results:The groups were similar with respect to mean times to extubation of the trachea. Pain and sedation scores were also similar between groups at all corresponding times throughout the 48-hr period of observation. Group D patients consumed significantly less morphine in the postanesthesia care unit and on the ward (P < 0.05 and P < 0.01, respectively). Fewer patients in Group D experienced itching or nausea/vomiting (P < 0.05). Conclusion:Continuous iv dexmedetomidine during abdominal surgery provides effective postoperative analgesia, and reduces postoperative morphine requirements without increasing the incidence of side effects. Objectif
Coronavirus disease 2019 (COVID-19) pandemic caused infection in a season when influenza is still prevalent. Both viruses have similar transmission characteristics and common clinical manifestations. Influenza has been described to cause respiratory infection with some other respiratory pathogens. However, the information of COVID-19 and influenza coinfection is limited. In this study, we reported our coinfected cases and reviewed the literature. We included all COVID-19 diagnosed patients. All patients with a presumed diagnosis of COVID-19 were routinely screened for influenza. Their thorax radiology was reviewed for COVID-19-influenza differentiation. During the study period, 1103 patients have been diagnosed with COVID-19. Among them, six patients (0.54%) were diagnosed coinfected with influenza. There have been 28 more coinfected patients reported. Laboratory-based
OBJECTIVESTo compare the landmark-guided technique versus the ultrasound-guided technique for internal jugular vein cannulation in spontaneously breathing patients.METHODSA total of 380 patients who required internal jugular vein cannulation were randomly assigned to receive internal jugular vein cannulation using either the landmark- or ultrasound-guided technique in Bursa, Uludag University Faculty of Medicine, between April and November, 2008. Failed catheter placement, risk of complications from placement, risk of failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization and the demographics of each patient were recorded.RESULTSThe overall complication rate was higher in the landmark group than in the ultrasound-guided group (p < 0.01). Carotid puncture rate and hematoma were more frequent in the landmark group than in the ultrasound-guided group (p < 0.05). The number of attempts for successful placement was significantly higher in the landmark group than in the ultrasound-guided group, which was accompanied by a significantly increased access time observed in the landmark group (p < 0.05 and p < 0.01, respectively). Although there were a higher number of attempts, longer access time, and a more frequent complication rate in the landmark group, the success rate was found to be comparable between the two groups.CONCLUSIONThe findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of immediate complications.
We have read the case report of Kutlu and Metin with great interest. 1 They have reported a patient with psoriasis and Covid-19 treated with hydroxychloroquine and oseltamivir. The patient developed exacerbation of psoriasis at fourth day of this treatment. They suggested that the exacerbation of psoriasis was due to the use of hydroxychloroquine, while they briefly discussed the possibility that Covid-19 disease might trigger the exacerbation of psoriasis. We have recently seen a patient with psoriasis and Covid-19 who may contribute to psoriasis and Covid-19 interaction. A 48-year-old female was admitted with fever, cough, shortness of breath, and exacerbation of psoriatic lesions. She had a diagnosis of psoriasis for 30 years given several systemic and topical drugs: She used acitretin, 30 mg/day, for 5 weeks 3 years ago, and methotrexate (first oral 15 mg/week, 6 weeks, then subcutaneous 25 mg/week, 8 weeks) with folic acid, 1.5 years ago. Her last treatment was topical:
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