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Bismuth salts are widely used to treat peptic ulcers. Acute toxicity with colloidal bismuth subcitrate overdose causes nephrotoxicity. There have been numerous reports of encephalopathy after long-term consumption of bismuth salts, but only a few cases of nephrotoxicity (adult and pediatric) have been documented to date. This report presents a case of acute renal failure due to colloidal bismuth subcitrate overdose in adolescent. A 16-year-old girl presented with complaints of nausea, vomiting, and facial paresthesia. Ten days earlier she had tried to commit suicide by taking 60 tablets of De-nol (colloidal bismuth subcitrate 18 g). The physical examination findings on admission indicated minimal fluid overload but no signs of encephalopathy. Laboratory tests on admission showed blood urea nitrogen 102 mg/dl, serum creatinine 19.9 mg/dl, and serum bismuth level 495 microg/l. The patient was started on appropriate fluid therapy and penicillamine as a chelating agent and then began hemodialysis on alternate days. The patient's renal function gradually returned to normal over 9 weeks and by 64 days after the overdose her serum bismuth level had fallen to almost half the level detected 2 days after admission. The patient made a complete recovery. The case demonstrates that acute renal failure can develop as a manifestation of acute toxicity from colloidal bismuth ingestion, and that the prognosis may be favorable if the patient receives appropriate supportive treatment and dialysis.

Background This study aimed to reveal the experiences of nurses in robotic surgery and their adaptation to this method. Methods This research was planned within the framework of qualitative research methods. The study population consisted of robotic surgery nurses in Turkey. Focus group interviews were conducted after the flow process was developed, and the interviews were supported using a semistructured interview form. Two focus interviews were conducted with 15 participants. Results As a result of the content analysis, 11 themes were created in four categories. The categories of the study were designed as follows: (1) Training in Robotic Surgery Nursing, (2) Adaptation to Technology in Robotic Surgery Nursing, (3) Changing Roles and Adaptation Process in Robotic Surgery Nursing, and (4) Future of Robotic Surgery. Conclusions The lack of clarity regarding the roles and responsibilities of robotic surgery nurses and the lack of arrangements for working conditions are thought to cause professional dissatisfaction and disengagement from work.

The aim of the study evaluates cultural sensitivity in healthcare services among senior nursing students to patients with different cultural backgrounds. The study had a one-group pre-posttest model descriptive study design. Thirty-four nursing students taking the courses Emergency Care and Diabetes were included into the study. Standardized patients were used as a simulation technique. The difference between intercultural sensitivity scores before the simulation and those after the simulation was not statistically significant (p>0.05). Even though there were no differences between intercultural sensitivity scores before the simulation and the scores after the simulation, simulation based education is an effective teaching method in enhancement of cultural sensitivity.

DTI findings correlate well with conventional Doppler echocardiography findings. Children with ESRD show, after dialysis, echocardiographic signs of LV diastolic dysfunction.

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We describe the case of a 30-month-old boy who developed acute disseminated encephalomyelitis (ADEM) after hepatitis A virus (HAV) infection and ultimately died. As far as we know, this is only the second case of HAV-associated ADEM to be reported in the literature. The child was brought to hospital with fever, lethargy and weakness of 2 days duration. He had developed jaundice, abdominal pain and malaise 2 weeks beforehand and these problems had resolved within 2 days. Neurological examination revealed lethargy, generalised weakness and positive Babinski's signs bilaterally. Cerebrospinal fluid examination showed mild lymphocytic pleocytosis, increased protein and elevated anti-HAV IgM and IgG titres. Serum HAV IgM and IgG titres were also elevated. Despite aggressive treatment with ceftriaxone, acyclovir and anti-oedema measures, he developed papilloedema and coma within 24 hours of admission. Magnetic resonance imaging of the brain revealed diffuse cerebral oedema and multifocal hyperintensities on T2-weighted images, with most lesions in the white matter of both cerebral hemispheres. The diagnosis of ADEM was established and high-dose steroids and intravenous immunoglobulin were added to the treatment regimen. However, his clinical condition continued to deteriorate and he died on the 20th day in hospital. This case shows that HAV infection can be linked with ADEM. Patients with HAV infection should be examined carefully for central nervous system symptoms during follow-up. Likewise, the possibility of HAV infection should be investigated in cases of ADEM.

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