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Öğe Association of postoperative airway complications with ultrasonographic measurements in pediatric patients: An exploratory analysis(Wolters Kluwer Medknow Publications, 2025) Sayan, Ozan; Erbas, Mesut; Sayan, MihricanObjective:Postoperative airway complications pose significant risks in pediatric patients and are often multifactorial. Anatomical and physiological differences in children make predicting these complications challenging. This study examines the association between ultrasonographic (USG) measurements and postoperative airway complications, primarily focusing on the subglottic diameter-to-wall thickness difference ratio.Methods:This prospective, double-blind study included pediatric patients aged 1-11 undergoing elective surgery between January and July 2024. Demographic and perioperative data, USG-measured airway diameters, wall thicknesses, and endotracheal tube (ETT) positions were recorded. The subglottic diameter-to-wall thickness difference ratio was the primary ultrasonographic measurement. Airway complications were assessed within the first postoperative hour, including cough, dysphonia, and laryngospasm. The relationship between USG measurements and complications was analyzed.Results:Eighty patients were included, and airway complications were observed in 37.5% (n = 30). Patients with complications had lower height, subglottic diameter, and subglottic diameter-to-wall thickness difference ratio but higher subglottic wall and vocal cord thickness differences. In 70% (n = 20) of these cases, ETT had shifted superiorly from the second tracheal ring. The subglottic diameter-to-wall thickness difference ratio was significantly associated with complications (AUC 0.896, cutoff 32, sensitivity 80%, specificity 92%). ETT positioned above the second tracheal ring was also associated with increased complication risk (OR = 107.747, 95% CI: 5.305-2188.504, P = 0.002).Conclusion:USG appears to be a valuable tool for assessing the association between the subglottic diameter-to-wall thickness difference ratio and postoperative airway complications in pediatric patients. Accurate evaluation of subglottic edema and proper ETT placement using USG may enhance patient safety.Öğe Evaluating the efficacy of serratus posterior superior ıntercostal plane block as an optimal technique in breast cancer surgery: A case series(Wolters Kluwer Medknow Publications, 2025) Sayan, Mihrican; Sayan, Ozan; Erbas, MesutThe wide spread of the serratus posterior superior intercostal plane (SPSIP) block in the hemithorax and axilla suggests it can provide sufficient postoperative analgesia for breast cancer surgery. This case series aims to present the data of five patients who underwent SPSIP block. Patients received preoperative SPSIP block as part of a multimodal analgesia protocol. Our findings indicate that Numeric Rating Scale pain scores remained below 3/10 in all patients, the time to mobilization was shortened, and postoperative opioid requirements were minimal. These data indicate that the SPSIP block might be an efficient choice for pain control in breast cancer surgeries.Öğe Influence of palmar plate injury on outcomes of zone 2 flexor tendon repair(Sage Publications Ltd, 2025) Akyürek, Mustafa; Hafız, Güneş; Sayan, MihricanThis study investigates the impact of proximal interphalangeal joint palmar plate injury on outcomes of flexor tendon repair in zone 2, excluding cases with fractures or dislocations. A retrospective review of 47 digits in 45 patients treated between 2014 and 2022 was conducted, analysing surgical notes, ultrasound images and patient photographs. The palmar plate was injured in 17 digits and intact in 30. Outcomes were assessed using the Strickland criteria for active range of movement 6 months postoperatively. Our analysis revealed that palmar plate injuries significantly affect flexor tendon repair outcomes, with a normal palmar plate increasing the likelihood of excellent recovery by 18 times. Although previous studies indicate no consensus on the impact of flexor digitorum superficialis repair, our findings emphasize the importance of palmar plate integrity. Nerve injury and flexor digitorum superficialis repair did not show significant effects on recovery in this cohort. Our study provides valuable insights into the importance of the injury to the palmar plate.Level of evidence: IIIÖğe Kritik COVID-19 hastalarında kardiyak olayların ve morfolojik EKG özelliklerinin surveyle ilişkisi(2022) Sayan, Mihrican; Altınışık, Hatice BetülAmaç: COVID-19'da yaygın görülmekte olan miyokard hasarı kötü prognoz göstergesi olduğundan kardiyak olayların belirlenmesi ve tedavisi şiddetli hastalığın takibinde oldukça önemlidir. Bu nedenle bu çalışmada COVID-19 enfeksiyonu ile yoğun bakımda tedavi görmüş hastalarda kardiyak olaylarla ilişkili risk faktörlerinin, prognostik biyobelirteçlerin (üre, kreatin, albümin, nötrofil, lenfosit, nötrofil-lenfosit oranı troponin T, laktat dehidrogenaz, D-dimer, ferritin, C-reaktif protein, prokalsitonin), EKG (elektrokardiyografi) bulgularının incelenmesi ve bunların mortalite üzerindeki etkisinin değerlendirilmesi amaçlandı. Yöntem: Çanakkale Onsekiz Mart Üniversitesi Hastanesi Yoğun Bakım Ünitesi'nde COVID-19 pnömonisi nedeniyle tedavi görmüş 193 hasta retrospektif olarak incelendi. Şüpheli kardiyak olay yaşayan (n:111) ve yaşamayan hastalar (n:82) olarak iki grup oluşturuldu. Bu hastalarda kardiyak olaylarla ilişkilendirilebilecek risk faktörleri, laboratuvar ve EKG bulguları incelendi ve mortalite ile ilişkisi araştırıldı. Bulgular: Şüpheli kardiyak olay yaşayan hastaların yoğun bakım ünitesinde yatış süresi daha fazla ve beden kitle indeksleri daha yüksek bulundu. Bu hastalarda; ileri yaş, hipertansiyon varlığı, inotrop kullanımı, sitokin fırtınası varlığı, PaO2-FiO2 oranı düşüklüğü, biyobelirteçlerde bozukluk, mortalite ile ilişkili bulundu. EKG bulgusu olan hastaların mortalitesi yüksek olup bu hastalarda ileri yaş, diyabet, hipertansiyon görülme oranında ve inotrop kullanımı, invaziv mekanik ventilatör ihtiyacında artış görüldü. EKG bulgularından QTc uzaması hastaların %28'inde görülürken mortalite ile ilişkisi saptanmadı. Atriyal fibrilasyonun (AF) ve sağ dal bloğunun (RBB) mortalite ile ilişkili olduğu görüldü. RBB olan hastalarda nötrofil-lenfosit oranı (NLR) yüksekken ST elevasyonu (STE) olan hastalarda NLR düşük gözlendi. Sonuç: COVID-19 hastalarında mortaliteyi öngörmede kardiyovasküler sistem olaylarının önemli bir rolü bulunmaktadır. AF, RBB, STE, sol dal bloğu gibi EKG bulgularıyla birlikte biyobelirteçlerdeki bozukluklar klinisyenleri yüksek riskli hastaya karşı uyarmalıdır.Öğe Neutrophil-platelet ratio as a predictor of acute kidney injury in severe COVID-19(Lippincott Williams & Wilkins, 2024) Sayan, Mihrican; Altınışık, Hatice Betül; Sayan, OzanAcute kidney injury (AKI) is one of the most seen complications of coronavirus-2019 (COVID-19) infection. Patients with AKI caused by COVID-19 likely have higher neutrophil counts and lower platelet and lymphocyte levels. Therefore, the predictive value of many inflammation indexes calculated from the total blood count has been investigated to predict the AKI in COVID-19. According to our clinical experience, we thought that neutrophilia and thrombocytopenia may be more common in the development of AKI. For this reason, this study aimed to evaluate the predictive value of the neutrophil-to-platelet ratio (NPR) for AKI in severe COVID-19 patients. This retrospective study included 334 severe COVID-19 patients followed up in the intensive care unit (ICU). Predictive factors for AKI were analyzed. ROC curve analysis was performed to determine the inflammation indexes' cutoff values for the AKI prediction. Multivariate analyses were performed to determine correlations between the inflammation indexes and AKI. In this study, AKI was determined at the rate of 43% (n:145). Independent risk factors affecting AKI were determined to be age (HR = 1.047, 95% confidence interval [CI]: 1.021-1.072, P < .001), the need for invasive mechanical ventilation (HR = 3.003, 95% CI: 1.645-5.481, P = .001) and the need for vasopressor (HR = 8.111, 95% CI: 3.786-17.375, P < .001). The optimal cutoff values predicting AKI were determined to be 3.9 for the NPR (AUC = 0.679, 95% CI: 0.622-0.737, P < .001) with 71.7% sensitivity and 61.9% specificity, 16.1 for the neutrophil-to-lymphocyte ratio (NLR) (AUC = 0.634, 95% CI: 0.575-0.694, P < .001) with 65.5% sensitivity and 56.1% specificity, and 3872.5 x 10(9)L for the systemic inflammatory index (SII) (AUC = 0.566, 95% CI: 0.504-0.629, P = .038) with 60% sensitivity and 55.6% specificity. In the regression model, only NPR values above the cutoff were related to AKI (HR = 3.817, 95% CI: 1.782-8.177, P = .001). The NPR has more predictive value than the NLPR, NLR, and SII in developing AKI in severe COVID-19 patients in the ICU. NPR is a new helpful index that can help clinicians predict early AKI in critical COVID-19.Öğe Re: Akyurek M et al. Influence of palmar plate injury on outcomes of zone 2 flexor tendon repair. J Hand Surg Eur. 2024, doi:10.1177/17531934241300510 Reply(Sage Publications Ltd, 2025) Akyürek, Mustafa; Hafız, Güneş; Sayan, Mihrican[No abstract available]Öğe Ultrasound-guided serratus posterior superior intercostal plane block for unilateral dorsal thoracic myofascial pain(Edizioni Minerva Medica, 2025) Sayan, Mihrican; Sayan, Ozan; Erbaş, Mesut[No abstract available]
