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Background Although neuropathic pain is a severe and common pain, its pathophysiology has not been elucidated yet. Studies in recent years have focused on the immune system’s role in the pathogenesis of neuropathic pain. The aim of this study was to investigate the role of immunological mechanisms in neuropathic pain and the effect of pregabalin by measuring immunological marker levels in peripheral blood before and after pregabalin treatment in postherpetic neuralgia (PHN) patients with neuropathic pain. Methods Forty patients diagnosed with PHN were included in the study. CD4, T follicular cells (Tfh CD4 + CXCR5 + PD1 + ), Th17 (CD4 + CCR6 + and CD4 + IL17A + ), regulatory T cells (Treg CD4 + CD25 + foxp3 + ), Th1 (CD4 + CXCR3 + and CD4 + IFN-γ + ) and Th2 (CD4 + IL-4 + ) cell ratios were measured in peripheral blood samples before treatment and after 3 months of treatment. Results When immunological marker and inflammation parameter levels were compared before and after treatment, the helper T cell ratio (CD3 + , CD4 + ) was 30.28 ± 12.27% before treatment and 34.93 ± 11.70% after treatment, so there was a statistically significant increase ( P = 0.028). Th17 was 4.75 ± 5.02% before treatment and 5.80 ± 3.13% after treatment, and there was a statistically significant increase ( P = 0.036). Conclusions Immunological mechanisms play an essential role in the pathogenesis of neuropathic pain, immunologically based treatment approach will be the critical point of treatment.

The aim of this study was to compare the efficacy of an intercostal nerve block, which has been used for many years in the treatment of postherpetic neuralgia, and the more recent alternative of an erector spinae plane (ESP) block. Methods: The records of 39 patients who were treated in the algology department for postherpetic neuralgia between May 1, 2015 and May 1, 2018 were evaluated retrospectively. Patients who received an intercostal nerve block constituted Group 1 and those who received an ESP block were categorized as Group 2. The change in numeric rating scale (NRS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores in the short term and in the long term were the primary results of the study. Results: The NRS, LANSS, and sleep interference scale (SIS) scores of the patients in Group 1 and Group 2 were found to be significantly lower at the 24 th hour, week 4, and week 12 compared with the values obtained before block application. In Group 1, the scores recorded at week 4 and week 12 were significantly higher than the 24 th hour values, whereas no difference was observed between these results in Group 2. There was no significant difference between the groups in the week 4 and week 12 scores. Similarly, no significant difference was observed in the NRS, LANSS, or SIS scores before the block application or at the 24 th hour. However, the scores at week 4 and week 12 were significantly lower in Group 2 compared with Group 1. Conclusion: The results indicated that an ESP block significantly decreased neuropathic pain symptoms and the need for additional treatment in postherpetic neuralgia treatment in the long term.

Objectives: The primary objective of this study was to investigate the effects of Pulsed RF application in the genicular nerve on pain and function in patients with osteoarthritis (OA) and its side effects. Methods: This study was conducted between February 2018 and June 2018. Patients who were previously administered diagnostic blocks were evaluated a day later; a drop of at least 50% in numeric pain scores was considered a positive response, and these patients were included in the Pulsed RF neurotomy procedures. Radiofrequency (RF) cannula was advanced towards targeted nerves under the guidance of fluoroscopy. RF lesions were created by applying Pulsed RF treatment to the three genicular nerves three times with five minutes intervals at 42 °C using NT1000 RF Generator. Following the Pulsed RF application, 2 mL 0.5% bupivacaine was injected into each genicular nerve as an anesthetic agent. VAS, pain DETECT scores, WOMAC scores were evaluated preoperative baseline and postprocedure weeks 1, 4, and 12. Patient Global Impression of Change (PGIC) score was evaluated postprocedure weeks 12. Results: This study included 20 patients who were administered genicular nerve Pulsed RF. The mean age was 55.2±3.24 years, and F/M ratio was 12/8. Compared to the pre-procedure period, patients' pain and function evaluation, WOMAC and VAS values decreased by approximately 50% at the end of the 12th week. No side effect was observed in any patients. Conclusion: Our findings suggest that Pulsed RF neurotomy of the genicular nerves is an efficient and safe treatment method for patients with chronic knee osteoarthritis.

Aim: Endoscopy under anesthesia creates stress and anxiety in children and their parents. In this study, we aimed to determine the preoperative anxiety levels of parents and patients who were routinely informed before endoscopy and examine the relationship between children and parents' state and trait anxiety levels. Methods: A cross-sectional study was planned in which pediatric patients and parents were included. The study comprised 104 ASA I-II patients, aged 6-14 years, who were scheduled for endoscopy under deep sedation, and their parents. Immediately after the child patient was taken to the treatment room, parents were asked to fill out the State-Trait Anxiety Inventory. The demographic characteristics of the patients were recorded. The children's anxiety level immediately after separation from parents was evaluated with Modified Yale Preoperative Anxiety Scale (m-YPAS). The patients were divided into two groups according to anxiety levels. Those with m-YPAS >30 were considered the anxiety (+) group, m-YPAS ≤30 were defined as the anxiety (-) group. Results: The mean age of the patients was 11.8 (2.6) years (6-14). Twenty-nine patients had m-YPAS> 30, and 75 patients had m-YPAS ≤30. Parent anxiety levels were not significantly different between the two groups. There was a strong negative correlation (r=-0.589, P<0.001) between child's anxiety and child age, a negative moderate correlation between child's anxiety and parent age (r=-0.259, P=0.008), and weak positive correlation between child's anxiety and complications (r=0.218, P=0.026). Young age was determined as an independent risk factor for increased child anxiety (OR: 0.501, P<0.001, 95% CI: 0.390-0.643). Conclusion: There is no relationship between preoperative anxiety in school-age children and parental anxiety. Young age is an independent risk factor for the development of anxiety in the child.

The clinical picture secondary to amanita phalloides, which began with gastrointestinal complaints, advanced to fulminant hepatic failure in two days. Emergency liver transplantation was decided for the case of a 48-year-old male patient, who at the same time had renal failure and acute pancreatitis. Bridge treatment with plasma diafiltration was applied until the liver transplantation, which was successfully performed on the fifth day of admission to the hospital. Acute pancreatitis and renal failure also resolved and the patient was discharged in a healthy condition on the 30th day of admission. The timing of the transplant in fulminant liver failure and criteria used to select the timing are particularly important. Transplantation should be performed not too early, nor too late. In addition, the development of multiple organ failure during the period until transplantation may result in the death of the patient. Therefore, extra corporeal liver support systems are suggested as an important treatment tool at this stage.

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