The trial was registered prospectively at clinicaltrials.gov (NCT02715999).

Acute appendicitis (AA) is not uncommon during pregnancy but can be difficult to diagnose. This study evaluated the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in addition to conventional diagnostic indicators of the disease to diagnose AA during pregnancy. Age, gestational age, white blood cell (WBC) count, Alvarado scores, C-reactive protein (CRP), lymphocyte count, NLR and PLR were compared among 28 pregnant women who underwent surgery for AA, 35 pregnant women wrongly suspected as having AA, 29 healthy pregnant women, and 30 nonpregnant healthy women. Mean WBC counts and CRP levels were higher in women with proven AA than in those of control groups (all p < 0.05). Among all the groups, the median NLR and PLR were significantly different in women with proven AA (all p < 0.05). Receiver operating characteristic analysis was used to determine cut-off values for WBC count, CRP, lymphocyte count, NLR and PLR, and multiple logistic regression analysis showed that NLR and PLR used with routine methods could diagnose AA with 90.5% accuracy. Used in addition to routine diagnostic methods, NLR and PLR increased the accuracy of the diagnosis of AA in pregnant women.

Background and objectivesCaudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. In this double-blind prospective randomized trial, we aimed to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries under general anesthesia.Materials and methodsAfter approval was obtained from the ethics committee, in this prospective randomized double-blind trial, 53 patients under general anesthesia undergoing inguinal hernia repair and orchiopexy surgeries randomly received caudal block or QLB. Demographic data, postoperative analgesic requirement, Face, Legs, Activity, Cry, and Consolability (FLACC) scores at 30 min, 1, 2, 4, 6, 12 and 24 hours, parent satisfaction scores and complications were recorded.ResultsThe study included 52 patients, after excluding one patient because of a failed caudal block. There were no significant differences between the groups based on demographic data (p>0.05). The number of patients who required analgesics in the first 24 hours was significantly lower in QLB group (p=0.001). Postoperative 4, 6, 12 hours FLACC scores were significantly lower in the QLB group (p<0.001, p=0.001 and p<0.001, respectively). Parent satisfaction scores were higher in the QLB group (p=0.014).ConclusionAccording to the results of this study, QLB can provide much more effective analgesia than caudal block without adjuvants in multimodal analgesia management of children undergoing inguinal hernia repair and orchiopexy surgeries.Trial registration numberNCT03294291.

The aim of this study is to review the reliability of laparoscopic obesity operations in patients with situs inversus totalis(SIT). A new case of SIT was presented together with a literature review of published English language studies on laparoscopic gastric banding (LAGB), laparoscopic gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic obesity surgery (LOS), and SIT, accessed via PubMed and Google Scholar databases. The case is presented of a 21-year-old female patient who underwent LSG due to SIT. A total of 12 publications in literature matched the search criteria for LAGB, LRYGB, LSG, LOS, and SIT, which reported LAGB in five cases, LRYGB in four cases, and LSG in four cases. In the rare event of SIT, LOS can be safely used following good evaluation.