Challenge Journal Publications (TULPAR Academic Publishing)
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Ultrasound-guided supraclavicular nerve and interscalene block for clavicle surgery in pregnancy: A case report and case-based literature review
Full text linkA 34-year-old woman at 32 weeks of gestation sustained a displaced clavicle fracture following a motor vehicle accident. To avoid the risks of general anesthesia during late pregnancy, ultrasound-guided interscalene and selective supraclavicular nerve blocks were performed with a single skin entry point. Surgery was completed uneventfully, and there was no need for additional analgesics. No maternal or fetal complications observed. This case illustrates the safety and efficacy of regional anesthesia in pregnant trauma patients and highlights the potential of targeted peripheral nerve blocks as a viable alternative to general anesthesia for upper extremity surgeries during pregnancy
Tonsillectomy in a pediatric patient with propionic acidemia: Anesthesia management and potential perioperative challenges
Full text linkPropionic acidemia (PA) is a rare metabolic disorder caused by a deficiency in the propionyl-CoA carboxylase enzyme, leading to the accumulation of toxic metabolites. Surgical procedures pose a risk of metabolic decompensation in patients with PA, requiring careful anesthesia management. A four-year-old male patient with propionic acidemia was scheduled for tonsillectomy due to recurrent upper respiratory tract infections. Midazolam was administered for premedication, and anesthesia induction was achieved with thiopental and rocuronium. Anesthesia maintenance was provided with sevoflurane, and fentanyl was used for analgesia. Postoperative pain management included paracetamol. The procedure was completed without complications, and the patient was transferred to the ward in stable condition. Anesthesia management in PA patients should focus on maintaining metabolic stability. This case demonstrates that with proper preoperative preparation, careful anesthesia management, and close perioperative monitoring, surgical interventions can be safely performed in pediatric patients with PA
Evaluation of quality of life and psychosocial factors in hemodialysis patients: A medical student-led observational survey study from a Turkish university hospital
Full text linkBackground: Other than kidney-related problems, haemodialysis patients often face reduced mobility and the burden of chronic illness, along with other factors that negatively affect their health-related quality of life (HRQoL). Depression, fatigue, and pain are common, yet these issues are often overlooked during routine clinical follow-up. We aimed to assess fatigue, depressive mood, and functional limitations in patients with chronic kidney disease (CKD) undergoing haemodialysis and to examine their associations with demographic, clinical, and psychosocial factors.Materials and Methods: This cross-sectional, observational survey was conducted at a university haemodialysis unit in Türkiye. Sixty-four adult patients completed a modified questionnaire based on the SF-36 Health Survey, incorporating dialysis-specific domains. Data were collected through face-to-face interviews administered by trained medical students. Descriptive statistics and chi-square tests were used to examine associations between symptom domains and patient characteristics.Results: Of the 64 patients included (60.9% male, median age 61–70 years), 75.0% received dialysis three times weekly. Post-dialysis fatigue was reported as moderate (35.9%), severe (29.7%), or mild (25.0%). Clinically relevant depressive symptoms were reported by 18.8% of patients, while 43.8% described at least moderate pain. A strong association was found between pain severity and daily activity limitation (χ² = 58.3, df = 9, p < 0.001). Depression was not significantly associated with age, sex, or dialysis frequency.Conclusions: In this cohort, fatigue, pain, and depressive mood were prominent among haemodialysis patients and more closely related to symptom burden than to demographic or dialysis treatment parameters. Routine patient-reported outcome screening and targeted psychosocial interventions may improve quality of life and daily functioning in this population
Combined effect of rice husk ash and animal bone powder on strength and permeability of concrete
Full text linkConcrete is a key component of construction, and its demand is rising quickly along with infrastructural development. Although cement and aggregates are still essential components for making concrete, the production of cement greatly increases CO2 emissions, necessitating the use of substitute materials to lessen the impact on the environment. As partial cement substitutes, rice husk ash (RHA) and animal bone powder (ABP) are viable alternatives. Animal bones, which are especially common in areas with high cattle populations, and rice husks, a byproduct of paddy production, are frequently discarded despite having useful qualities that can be used to improve concrete. With an emphasis on how they affect the material's permeability and strength, this thesis investigates the addition of RHA and ABP to concrete. Different RHA and ABP replacement amounts are examined through controlled experimentation to ascertain how they affect the properties of concrete following a predetermined curing period. The goal of this research is to determine the ideal combination that strikes a balance between environmental advantages and performance. In addition to improving the qualities of concrete, using RHA and ABP helps with waste management and pollution control. This strategy may help with sustainable building methods, reduce CO2 emissions, and encourage efficient use of resources by lowering dependency on conventional cement
Early detection of acute kidney injury in critically ill burn patients: Evaluating the predictive role of serum and urinary NGAL
Full text linkBackground: Early detection of acute kidney injury (AKI) in critically ill burn patients is crucial for improving outcomes. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising biomarker for early AKI detection. This study aimed to evaluate the efficacy of serum and urinary NGAL levels in predicting AKI in burn patients admitted to the intensive care unit (ICU).Methods: A prospective observational study was conducted on 31 burn patients admitted to the burn ICU. Serum and urinary NGAL levels were measured at admission (0 hours) and at 12, 24, 36, 48, and 72 hours post-admission. AKI was defined using the RIFLE and AKIN criteria. Renal replacement therapy (RRT) requirements, mortality, and other clinical parameters were recorded. Statistical analyses were performed to assess the correlation between NGAL levels and AKI development.Results: Of the 31 patients, 48.4% required RRT, and 45.2% died. Serum NGAL levels at 0 and 12 hours were significantly higher in patients who developed AKI (p<0.05). A serum NGAL cutoff of 251 ng/ml was identified as a significant predictor of AKI (p<0.05). Urinary NGAL levels did not show significant predictive value for AKI. Mortality was significantly associated with higher burn surface area, increased fluid requirements, and higher SOFA and APACHE II scores (p<0.01).Conclusion: Serum NGAL levels are elevated early in burn patients who develop AKI, suggesting its potential as a predictive biomarker. Urinary NGAL did not show significant predictive value. Further studies with larger cohorts are needed to validate these findings and explore the role of NGAL in guiding early interventions in burn patients
Investigation of the effects of re-curing on mechanical properties of basalt-polypropylene hybrid fiber concretes after exposure to high temperature
Full text linkFiber reinforced concretes have attracted significant attention in recent decades due to their superior flexural and toughness properties compared to traditional concrete in civil engineering structures. In addition, cementitious materials can undergo significant mechanical deterioration under high temperature. Therefore, the investigation of the properties of FRC for fire-resistant design has become an important research topic in recent years. On the other hand, there is very little research on the repair of FRCs damaged by fire. In this study, high temperature resistance of mixtures prepared using basalt and polypropylene fibers was investigated. In addition, the ability of FRCs exposed to high temperatures to regain their properties by applying water re-curing process was investigated. In this context, ultrasonic pulse velocity (UPV), compressive and flexural strength of FRC series after different stages were investigated. In the use of water curing single basalt fiber, 18.56% and 13.82% increase in relative compressive strength was obtained after 600 °C and 800 °C, respectively. These increase rates were determined as 22.25% and 22.81% in relative flexural strength. Recovery was more significant in the hybrid mixture formed with 0.2% polypropylene fiber. 29.22% and 15.93% recovery was reported in relative compressive strength after 600 °C and 800 °C, respectively. It was determined that re-curing significantly increased the mechanical properties of FRC mixtures
Seismic performance assessment of timber-framed (hımış) structures with different infill materials
Full text linkThis study investigates the seismic performance of traditional timber-framed (hımış) structures incorporating different types of infill materials through advanced nonlinear finite element modeling. Timber-infilled walls represent a widely used hybrid construction typology in seismic regions, where the interaction between the ductile timber frame and brittle infill materials critically influences structural behavior. Four configurations are analyzed: (1) Timber frame with adobe (mudbrick) infill; (2) Timber frame with fired clay brick infill; (3) Timber frame with natural rubble stone infill; and (4) Bare timber frame. A series of three-dimensional pushover analyses are conducted using ANSYS Workbench, where all materials are modeled using Multilinear Isotropic Hardening plasticity, including contact-based interface definitions and geometric nonlinearity. The mechanical behavior of each wall system is interpreted based on key seismic performance indicators, including initial lateral stiffness, base shear capacity, effective displacement ductility, and energy dissipation. Results show that while infill materials significantly increase the lateral strength and stiffness of the wall systems, they also introduce varying degrees of brittleness and reduced ductility. These findings emphasize the critical role of infill type in the seismic response of timber-framed walls and highlight the importance of understanding frame–infill interaction for the assessment and retrofitting of traditional building stock in earthquake-prone regions
