Serum Levels of Neuropeptides in Epileptic Encephalopathy With Spike-and-Wave Activation in Sleep.

BACKGROUND: Epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS) is a syndrome of childhood, characterized by diffuse or generalized spike-wave activity in electroencephalography during non-rapid eye movement sleep. Neuropeptides have been demonstrated in several studies to function in the sleep-wake cycle and display convulsant and anticonvulsant features. In this study, we aimed to investigate the relationship between EE-SWAS and neuropeptides such as dynorphin, galanin, ghrelin, leptin, melatonin, and orexin. METHODS: This multicenter study was conducted from July 2019 to January 2021. There were three groups: Group 1 contained patients with EE-SWAS. Group 2 consisted of patients with self-limited focal epilepsy of childhood (SeLFE), and group 3 was the control group. Levels of neuropeptides were compared in the sera of these three groups. RESULTS: There were 59 children aged between four and 15 years. Group 1 contained 14 children, group 2 contained 24 children, and group 3 contained 21 children. The level of leptin is higher and the level of melatonin is lower in group 1 than in group 3 (P = 0.01 and P = 0.005, respectively). In group 3, the level of orexin was lower than in both groups 2 and 3 (P = 0.01 and P = 0.01). CONCLUSIONS: These data show that the level of leptin was higher and the level of melatonin was lower in patients with EE-SWAS than in the control group. Furthermore, patients with EE-SWAS had lower orexin levels than both the control group and patients with SeLFE. Further research is required to understand the potential role of these neuropeptides in the pathophysiology of EE-SWAS.

Visfatin levels in hormonally inactive adrenal adenoma and their association with metabolic parameters

Background/aim: In parallel with increased frequency and higher quality of imaging techniques, the prevalence of adrenal adenoma has gradually increased. However, despite the growing incidence, the metabolic and tumorigenesis processes involved in its etiology are still unclear. Although visfatin has been reported to be associated with inflammation and tumorigenesis, its role in adrenal adenoma has not yet been investigated. Therefore, the present study was performed with an aim to evaluate visfatin levels and cardiometabolic risk factors in patients with adrenal adenoma. Materials and methods: Thirty patients recently diagnosed with adrenal adenoma along with 30 healthy participants were studied in a tertiary healthcare center. Twenty-four-hour ambulatory blood pressure monitoring and carotid artery intima-media thickness (CIMT) measurements were performed. Results: The frequencies of diabetes mellitus and hypertension were found to be statistically higher in the adrenal adenoma group. Although the values of mean fasting glucose, insulin, HOMA-IR levels, and the mean, maximum, minimum, delta systolic, and diastolic blood pressures were established to be higher in the adrenal adenoma group, the differences were not found to be statistically significant. Mean high-sensitive C-reactive protein, visfatin levels, and CIMT were seen to be significantly higher in the adenoma group. Conclusion: Cardiometabolic risk factors as well as the visfatin levels were established to be higher in patients with adrenal adenoma. Elevated visfatin levels might play a role in the development and metabolic process of adrenal adenoma.

Effects of different levels of end-expiratory pressure on hemodynamic, respiratory mechanics and systemic stress response during laparoscopic cholecystectomy / Efeitos de diferentes níveis de pressão expiratória final sobre a hemodinâmica, mecânica respiratória e resposta sistêmica ao estresse durante colecistectomia laparoscópica

Abstract Objective: General anesthesia causes reduction of functional residual capacity. And this decrease can lead to atelectasis and intrapulmonary shunting in the lung. In this study we want to evaluate the effects of 5 and 10 cmH2O PEEP levels on gas exchange, hemodynamic, respiratory mechanics and systemic stress response in laparoscopic cholecystectomy. Methods: American Society of Anesthesiologist I-II physical status 43 patients scheduled for laparoscopic cholecystectomy were randomly selected to receive external PEEP of 5 cmH2O (PEEP 5 group) or 10 cmH2O PEEP (PEEP 10 group) during pneumoperitoneum. Basal hemodynamic parameters were recorded, and arterial blood gases (ABG) and blood sampling were done for cortisol, insulin and glucose level estimations to assess the systemic stress response before induction of anesthesia. Thirty minutes after the pneumoperitoneum, the respiratory and hemodynamic parameters were recorded again and ABG and sampling for cortisol, insulin, and glucose levels were repeated. Lastly hemodynamic parameters were recorded; ABG analysis and sampling for stress response levels were taken after 60 minutes from extubation. Results: There were no statistical differences between the two groups about hemodynamic and respiratory parameters except mean airway pressure (P mean). P mean, compliance and PaO2; pH values were higher in 'PEEP 10 group'. Also, PaCO2 values were lower in 'PEEP 10 group'. No differences were observed between insulin and lactic acid levels in the two groups. But postoperative cortisol level was significantly lower in 'PEEP 10 group'. Conclusion: Ventilation with 10 cmH2O PEEP increases compliance and oxygenation, does not cause hemodynamic and respiratory complications and reduces the postoperative stress response.

Resumo Objetivo: A anestesia geral causa a redução da capacidade residual funcional e essa diminuição pode levar à atelectasia pulmonar e ao shunt intrapulmonar. Neste estudo pretendemos avaliar os efeitos de níveis de 5 e 10 cmH2O de pressão expiratória final positiva (PEEP) sobre as trocas gasosas, a hemodinâmica, a mecânica respiratória e a resposta ao estresse sistêmico em colecistectomia laparoscópica. Método: Foram selecionados aleatoriamente 43 pacientes, estado físico ASA I-II, agendados para colecistectomia laparoscópica, para receber PEEP a 5 cmH2O (grupo PEEP-5) ou PEEP de 10 cmH2O (grupo PEEP-10) durante o pneumoperitônio. Os parâmetros hemodinâmicos foram registrados, gasometria arterial e coleta de sangue foram feitas para estimativa dos níveis de cortisol, insulina e glicose para avaliar a resposta ao estresse sistêmico antes da indução anestésica. Trinta minutos após o pneumoperitônio, os parâmetros hemodinâmicos e respiratórios foram registrados novamente e gasometria e amostragem para os níveis de cortisol, insulina e glicose foram repetidos. E os últimos parâmetros hemodinâmicos foram registrados, análise e amostragem de gasometria para os níveis de resposta ao estresse foram feitas após 60 minutos da extubação. Resultados: Não houve diferença estatística entre dois grupos quanto aos parâmetros hemodinâmicos e respiratórios, exceto pressão média das vias aéreas (Pmédia). Os valores de Pmédia, complacência, PaO2 e do pH foram maiores no grupo PEEP-10. Também os valores de PaCO2 foram menores no grupo PEEP-10. Não foram observadas quaisquer diferenças entre os níveis de insulina e de ácido láctico nos dois grupos. Porém, o nível de cortisol no pós-operatório foi significativamente menor no grupo PEEP-10. Conclusão: Ventilação com PEEP de 10 cmH2O aumenta a complacência e a oxigenação, não causa hemodinâmica e complicações respiratórias e reduz a resposta ao estresse no pós-operatório.

[Effects of different levels of end-expiratory pressure on hemodynamic, respiratory mechanics and systemic stress response during laparoscopic cholecystectomy]. / Efeitos de diferentes níveis de pressão expiratória final sobre a hemodinâmica, mecânica respiratória e resposta sistêmica ao estresse durante colecistectomia laparoscópica.

OBJECTIVE: General anesthesia causes reduction of functional residual capacity. And this decrease can lead to atelectasis and intrapulmonary shunting in the lung. In this study we want to evaluate the effects of 5 and 10cmH2O PEEP levels on gas exchange, hemodynamic, respiratory mechanics and systemic stress response in laparoscopic cholecystectomy. METHODS: American Society of Anesthesiologist I-II physical status 43 patients scheduled for laparoscopic cholecystectomy were randomly selected to receive external PEEP of 5cmH2O (PEEP 5 group) or 10cmH2O PEEP (PEEP 10 group) during pneumoperitoneum. Basal hemodynamic parameters were recorded, and arterial blood gases (ABG) and blood sampling were done for cortisol, insulin and glucose level estimations to assess the systemic stress response before induction of anesthesia. Thirty minutes after the pneumoperitoneum, the respiratory and hemodynamic parameters were recorded again and ABG and sampling for cortisol, insulin, and glucose levels were repeated. Lastly hemodynamic parameters were recorded; ABG analysis and sampling for stress response levels were taken after 60minutes from extubation. RESULTS: There were no statistical differences between the two groups about hemodynamic and respiratory parameters except mean airway pressure (Pmean). Pmean, compliance and PaO2; pH values were higher in 'PEEP 10 group'. Also, PaCO2 values were lower in 'PEEP 10 group'. No differences were observed between insulin and lactic acid levels in the two groups. But postoperative cortisol level was significantly lower in 'PEEP 10 group'. CONCLUSION: Ventilation with 10cmH2O PEEP increases compliance and oxygenation, does not cause hemodynamic and respiratory complications and reduces the postoperative stress response.

Effects of different levels of end-expiratory pressure on hemodynamic, respiratory mechanics and systemic stress response during laparoscopic cholecystectomy.

OBJECTIVE: General anesthesia causes reduction of functional residual capacity. And this decrease can lead to atelectasis and intrapulmonary shunting in the lung. In this study we want to evaluate the effects of 5 and 10cmH2O PEEP levels on gas exchange, hemodynamic, respiratory mechanics and systemic stress response in laparoscopic cholecystectomy. METHODS: American Society of Anesthesiologist I-II physical status 43 patients scheduled for laparoscopic cholecystectomy were randomly selected to receive external PEEP of 5cmH2O (PEEP 5 group) or 10cmH2O PEEP (PEEP 10 group) during pneumoperitoneum. Basal hemodynamic parameters were recorded, and arterial blood gases (ABG) and blood sampling were done for cortisol, insulin and glucose level estimations to assess the systemic stress response before induction of anesthesia. Thirty minutes after the pneumoperitoneum, the respiratory and hemodynamic parameters were recorded again and ABG and sampling for cortisol, insulin, and glucose levels were repeated. Lastly hemodynamic parameters were recorded; ABG analysis and sampling for stress response levels were taken after 60minutes from extubation. RESULTS: There were no statistical differences between the two groups about hemodynamic and respiratory parameters except mean airway pressure (Pmean). Pmean, compliance and PaO2; pH values were higher in 'PEEP 10 group'. Also, PaCO2 values were lower in 'PEEP 10 group'. No differences were observed between insulin and lactic acid levels in the two groups. But postoperative cortisol level was significantly lower in 'PEEP 10 group'. CONCLUSION: Ventilation with 10cmH2O PEEP increases compliance and oxygenation, does not cause hemodynamic and respiratory complications and reduces the postoperative stress response.