An analytical approach to determining pethidine: An investigation of 18 patients' urine.

Pethidine (PET) is an opioid pain-relief medicine with high addiction potential, especially among health professionals. Pethidine is commonly prescribed in Turkey as a pain-relieving medication for operative purposes. Due to its accessibility, low cost, user-friendliness, and effectiveness, PET is often misused by both healthcare professionals and patients. For this reason, analytical determination methods for PET abuse are essential in terms of forensic toxicology. In this study, a fast, reliable, and accurate gas chromatography-mass spectrometry method was developed for the first time in Turkey for the simultaneous detection of PET and its main urinary metabolite norpethidine (NPET). The method was validated in terms of selectivity, linearity, the limit of detection (LOD), the limit of quantification (LOQ), trueness, and precision according to the Scientific Working Group for Forensic Toxicology guidelines. The linear range was between 0.125-25.00 µg/mL for PET and 1.00-20.00 µg/mL for NPET. The LOD values for PET and NPET were 0.05 µg/mL and 0.49 µg/mL, while the LOQ values were 0.125 µg/mL and 1.00 µg/mL, respectively. Extraction efficiencies were calculated as 113% for PET and 104% for NPET. The intra-assay and inter-assay precision results were within acceptable limits. In the presented study, the validated method was applied to the urine of 18 patients collected at the 1st and 3rd hours after receiving PET. All samples in the study were collected under patients' consent and in line with ethical guidelines.

Hydroxyzine Dihydrochloride Premedication Is a Necessity for Pediatric Patients Undergoing Strabismus Surgery: An Observational Prospective Clinical Trial.

Objective: In this single-blind, observational prospective clinical trial, we aimed to determine and compare the effects of premedication with hydroxyzine plus midazolam and midazolam alone on the incidence of oculocardiac reflex (OCR). Methods: Forty-five patients were divided into three groups. Group M received 0.5 mg/kg midazolam alone, Group H received 0.5 mg/kg hydroxyzine plus 0.5 mg/kg midazolam, and Group HM received 1 mg/kg hydroxyzine plus 0.5 mg/kg midazolam. The Ramsay Sedation Scale (RSS), the heart rates (HR1: after induction of anesthesia; HR2: before retraction of orbital muscle; and HR3: right after retraction of orbital muscle), the muscles with OCR, and the incidence of OCR (20% decrease of the HR right after the traction) were recorded and compared between the three groups. Results: The mean HR1, HR2, and HR3 values were significantly increased (p=0.002, p < 0.001, p < 0.001) and the incidence of OCR (p=0.004) was significantly decreased in Group H and in Group HM (for all, p < 0.01) compared to Group M. The most common orbital muscle in which OCR occurred was the rectus medialis. Conclusion: Premedication with a combination of 0.5 or 1 mg hydroxyzine with 0.5 mg midazolam significantly reduced the incidence of OCR compared to premedication with midazolam alone. This study was registered on https://clinicaltrials.gov/ with number NCT03806270.

Padded Dressing with Lidocaine HCL for Reducing Pain during Intravenous Cannulation in Adult Patients: A Randomized Controlled Clinical Trial.

Objective: In this study, we aimed to evaluate the effect of administering lidocaine as a local anesthetic at the puncture site prior cannulation on reduction of pain during intravenous cannulation (IVC). Methods: A total of 77 patients were divided into two groups as the patients who received a local anesthetic prior IVC procedure (n = 40) and the control group (n = 37). Patients' demographic data, including age, gender, height, weight and body mass index, IV gauge, IV site, heart rate (HR), and oxygen saturation (SpO2) were recorded and analyzed. Patients in both groups scored the pain they felt during IVC through the visual analog scale (VAS) and the verbal descriptor scale (VDS). Results: No statistically significant difference was found between the two groups in terms of the demographic features. There was no significant difference between the two groups in terms of the cannula gauges and site of IVC. The mean post-IVC HR value was statistically significantly higher compared to pre-IVC in the control group (p = 0.032), while no difference was found between the mean pre- and postprocedure HR in the lidocaine group. The mean VAS score was significantly lower in the lidocaine group compared to the control group (p < 0.001). There was a significant difference between the groups in terms of the current VDSs. The rate of the patients reporting mild pain was statistically significantly higher in the lidocaine group compared to the control subjects (p < 0.001). Conclusion: According to the results of this study, lidocaine HCL-impregnated padded dressing prior IV cannulation significantly reduced pain sensation during IVC.

Assessment of Neuroendocrine Changes and Hypothalamo-Pituitary Autoimmunity in Patients with COVID-19.

SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, in particular, secondary adrenal insufficiency, using a dynamic test and the role of autoimmunity in pituitary dysfunction in patients with COVID-19. The single-center, prospective, case-control study included patients with polymerase chain reaction (PCR)-confirmed COVID-19 and healthy controls. Basal hormone levels were measured, and the adrenocorticotropic hormone (ACTH) stimulation test was performed. Antipituitary (APA) and antihypothalamic antibodies (AHA) were also determined. We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. Patients with COVID-19 had lower free T3, IGF-1, and total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. In conclusion, COVID-19 may result in adrenal insufficiency, thus routine screening of adrenal functions in these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormalities in COVID-19.

The 'Cross-Legged Foetal Sitting Neuraxial Position': Is it Beneficial?-A Prospective Randomised Clinical Trial Via Ultrasonography.

OBJECTIVE: The primary aim of the present study was to compare the 'cross-legged foetal sitting position' (CFSP) with the 'sitting foetal position' (SFP) sonographically. The secondary aim was to compare their comfort. METHODS: A randomised, consecutive controlled, single-blinded trial was performed in Yeditepe University. A total of 50 healthy volunteers were included in the study. Exclusion criteria were body mass index (BMI) >40 kg m-2, lumbar hernia, scoliosis, history of spine surgery, lower back pain or trauma, especially pelvic or knee problems related to arthropathy and not able to do one/both of the two position techniques. The two positioning techniques were evaluated by ultrasonography (USG) and 5-point Numerical Rating Scale (5-NRS) patient satisfaction of comfort questionnaire. Seven outcomes via USG were evaluated, subcutaneous tissue (ST), skin to spinous process (S-SP), transverse diameters of right and left paraspinal muscles (RPM and LPM), interspinous gap opening (ISGO), mean of bilateral paraspinal muscle (MPM) and CFSP-SFP change (CFSP-SFP). Stretcher comfort, position comfort, lumbar comfort (LC) and abdominal comfort (AC) were evaluated by participants with the 5-NRS. RESULTS: In the CFSP, the mean ST and S-SP were significantly (p<0.0001) shorter, and LPM, RPM and MPM were significantly (p<0.0001) wider. The mean ISGO in the CFSP was significantly (p<0.0001) broader. The CFSP was significantly more comfortable than the SFP according to the LC (p=0.02). Only ISGO was found to be significantly broader in the male participant group (p=0.01) and in the BMI ≥25 group (p=0.02) according to CFSP-SFP. CONCLUSION: Considering all ultrasonographic anatomical measurements and according to the 5-NRS related to LC, the CFSP appears to be more advantageous than the SFP as a neuraxial positioning technique.

Myxoglobulosis in the appendix.

Myxoglobulosis is a specific type of mucocele consisting of mucoid material. It is characterized by opaque, transparent globules that resemble "fish eggs" or "frogspawns". It is generally diagnosed incidentally during an appendectomy or an autopsy. In this paper, we aim to present the case of a 58-year-old male patient who was referred to our hospital because of abdominal pain and loss of appetite. The patient underwent an appendectomy. Opaque intraluminal globules were found in the appendectomy material. The globules resembled pearls and they were 2-3 mm in diameter. After histopathological examinations, the patient was diagnosed with myxoglobulosis accompanied with acute appendicitis. According to our research, this is the first case of myxoglobulosis in our country.