Abdurrahman Tunay

Acute appendicitis in the elderly often presents with atypical symptoms and is frequently complicated at diagnosis, potentially requiring intensive care unit (ICU) admission. Early risk identification is essential for effective triage. Hematologic biomarkers may provide rapid, accessible tools for predicting disease severity. The objective of this study was to evaluate the predictive value of hematologic parameters-particularly lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and immature granulocyte (IG) indices-for ICU admission and complicated appendicitis in elderly patients. This retrospective observational study included patients aged ≥65 years who underwent appendectomy for suspected acute appendicitis between 2018-2021 and in 2024 at a tertiary emergency department. Patients were grouped by ICU admission status and histopathological diagnosis (complicated vs. non-complicated appendicitis). Preoperative clinical and laboratory data were analyzed using logistic regression and receiver operating characteristic (ROC) analysis. A post hoc power analysis was also performed. Of 143 patients included, 33 (23.1%) required ICU admission. These patients were older and had higher rates of diabetes and coronary artery disease. Lymphocyte counts were significantly lower and NLR values higher in the ICU group. In multivariate analysis, only lymphocyte count independently predicted ICU admission. Complicated appendicitis was associated with age, diabetes, low lymphocyte count, high IG%, and elevated NLR in univariate analysis; however, only age, diabetes, and lymphocyte count remained significant in multivariate modeling. ROC analysis showed moderate diagnostic performance for lymphocyte count (area under the curve=0.669) in identifying complicated cases. Lymphopenia is an independent predictor of ICU admission and complicated appendicitis in elderly patients. Routine blood parameters may support early clinical risk stratification in emergency settings.

Background: Remifentanil, an ultra-short-acting μ-receptor agonist, is used with propofol or thiopental for tracheal intubation without muscle relaxants. While effective with both, its combination with thiopental provides better hemodynamic stability. Thiopental has long been a standard intravenous agent for anaesthesia induction and remains a cost-effective alternative to propofol in resource-limited settings. To date, no study has directly compared the effects of thiopental–remifentanil and propofol–remifentanil combinations on LMA insertion conditions. This study aims to compare the effects of thiopental or propofol with 2 µg·kg⁻¹ remifentanil on laryngeal mask airway (LMA) insertion conditions and success in a prospective, randomised double-blind study. Method: The study included 80 premedicated ASA I-II patients, aged 18–65, randomised into Group P (propofol) and Group T (thiopental). Anaesthesia induction was with 2 μg·kg⁻¹ remifentanil, followed by 5 mg·kg⁻¹ thiopental or 2.5 mg·kg⁻¹ propofol. LMA insertion occurred 90 s post-induction. LMA insertion conditions were evaluated using a six-variable scale. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index monitor (BIS) values were recorded at baseline, 1 min pre-insertion, and at 1, 2, 3, 4, and 5 min after insertion. Apnoea duration, loss of eyelash reflex duration, insertion duration, number of attempts, and perioperative complications were also documented. Results: Demographic data were similar. Group P showed significantly shorter eyelash reflex loss and LMA insertion durations, longer apnoea duration, and higher rates of full mouth opening, excellent LMA insertion condition, and hypotension or bradycardia compared to Group T (p < 0.05). Group P had significantly lower HR, SAP, DAP, and MAP at various time points (p < 0.05). There were no significant differences in blood presence on LMA, sore throat, or dysphagia (p > 0.05). Conclusions: In our study, administration of 2 μg·kg⁻¹ remifentanil before induction along with thiopental or propofol was shown to provide acceptable LMA insertion conditions at comparable levels. As hemodynamic parameters were less affected, we believe the remifentanil–thiopental combination may be a suitable alternative.

Internal Jugular Vein Size and Thrombosis Risk in Central Venous Catheterization - Article abstract #948228

Objective: The field of anesthesiology and reanimation is particularly suited for investigating the relationship between work-related stress and anxiety due to the high demands it places on managing these psychological states. For residents newly exposed to the rigorous working conditions of anesthesiology, the clinical environment can be psychologically challenging. This study was designed based on the hypothesis that anesthesia and reanimation residents, due to their higher exposure to emergency situations and more intense workloads, may exhibit higher levels of stress, anxiety, and distress compared to internal medicine residents. Materials and Methods: Between April 21 and July 6, 2025, a total of 50 medical residents were enrolled in this study from the Departments of Anesthesiology and Reanimation and Internal Medicine at a tertiary education and research hospital. Each participant completed the Visual Analog Scale (VAS), State-Trait Anxiety Inventory (STAI-I and STAI-II), Perceived Stress Scale (PSS-10), and Penn State Worry Questionnaire (PSWQ) during a 24-hour shift. Residents with known cardiovascular or psychiatric disorders were excluded from the study. Results: Regarding psychological assessments, no significant differences were found between the groups for PSS-10 scores. Similarly, PSWQ scores did not differ significantly. VAS scores for anxiety measured before and after shifts showed no significant difference between groups. There was no statistically significant correlation between years of residency and scores on the PSS-10, PSWQ, STAI-I, STAI-II, pre-shift VAS, and post-shift VAS scales. The observed correlation coefficients were weak and negative in direction. The strongest negative correlation was found between years of residency and the PSS-10 score, though this was not statistically significant. These findings suggest that as residency seniority increases, there is no notable change in levels of stress, worry, or anxiety. Conclusion: This study highlights that both anesthesiology and internal medicine residents experience high levels of anxiety, stress, and pathological worry associated with 24-hour shift work, regardless of differences in specialty or seniority.