Relationship of intensive care scoring systems with neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume values.

OBJECTIVE: We evaluated the relationship between NLR, PLR, and MPV values and scoring systems frequently used in intensive care units in our study. METHODS: In our retrospective study, patients aged 18 years and over who received treatment in the intensive care unit for at least 48 hours were included. Demographic data, such as age, gender, APACHE II, SOFA and GCS scores, expected mortality, and 30-day and 1-year mortality rates were recorded. RESULTS: There was a significant positive correlation between MPV values and APACHE, SOFA, and expected mortality rates, and a significant negative correlation between GCS values. It was also found to be significant that as the P/L ratio increased, APACHE, SOFA scores, and expected mortality rates decreased and GCS increased. In 30-day and 1-year mortalities, MPV values and CRP/albumin ratios were higher, and calcium values were significantly lower. The N/L ratios were also significantly higher in 1-year mortality. CONCLUSION: In our study, a significant correlation was found between APACHE, GCS, SOFA, expected death rates and MPV and P/L rates. In conclusion, we suggest that in addition to intensive care scoring systems, the N/L ratio, P/L ratio, MPV, and CRP/albumin ratios can be used in the prognosis of patients (Tab. 5, Fig. 2, Ref. 18).

When is the Ideal Time to Calculate the Vasoactive Inotropic Score as a Predictor of Mortality and Morbidity in Cardiac Surgery? A Retrospective Study.

INTRODUCTION: The aim of this study was to evaluate the prediction of vasoactive inotropic score (VIS) on early mortality and morbidity after coronary artery bypass grafting (CABG) and to determine the ideal time for score calculation. MATERIALS AND METHODS: The study included patients who underwent isolated on-pump CABG surgery between November 2021 and November 2022. Pre, intra, and postoperative data were obtained by retrospective chart review. The final VIS value in the operating room (VISintra) and the highest VIS value in the first 24 hours in the intensive care unit (VISmax) were calculated. The patients were divided into two groups; Group 1 who developed early postoperative morbidity and mortality and Group 2 who did not. And the data were analyzed by groups. RESULTS: A total of 221 patients with a mean age of 63.49 ± 9.96 years were evaluated and 73 (33%) were in Group 1. The cut-off value for VISintra was determined to be 6.20, VISmax was 6,05. VISintra and VISmax values were significantly higher in the poor outcome group. Multivariate analysis showed that only VISmax value was an independent variable on mortality-morbidity. CONCLUSIONS: Our results imply that the vasoactive inotropic score is an easy and inexpensive score to calculate and can be used as a specific scoring system to predict poor early outcomes in CABG patients. According to statistical analyses, the most predictive time among VIS measurements was VISmax, the highest value calculated in the ICU in the first 24 hours postoperatively.

A novel comparison of erector spinae plane block and paravertebral block in laparoscopic cholecystectomy.

OBJECTIVE: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. METHODS: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. RESULTS: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. CONCLUSION: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.

The effect of an ultrasound-guided sacral erector spinae plane block on the postoperative pain of lumbar discectomy: a randomized controlled trial.

BACKGROUND: Pain management is essential after discectomy, the surgical treatment for lumbar disc herniation. This study evaluated the effect of sacral erector spinae plane block (SESPB) versus standard analgesic methods on postoperative analgesia and opioid consumption in lumbar discectomy operations. METHODS: Over 18 years of age, ASA 1-3 group, 54 patients undergoing elective lumbar discectomy were included in the prospective, randomized, controlled, double-blind, study. They were randomly divided into groups, SESPB and non-block (control). Both groups completed surgery under general anesthesia. At the end of the surgery, group SESPB received a bilateral 20 cc block with 0.25% bupivacaine at the level of the second sacral vertebra. Both groups received tramadol via a patient-controlled analgesia (PCA) device. The primary outcome was total opioid consumption in the first 24 hours after surgery. Pain assessment by Visual Analog Scale (VAS), rescue analgesic requirements, time to first rescue analgesic requirement and adverse effects were recorded 24 hours postoperatively. RESULTS: Total tramadol consumption was 168.8±143 mg (P<0.04) higher in the control group. The first six-hour VAS scores and the number of rescue analgesic users were lower in the SESPB group (P<0.01). The first rescue analgesic use time was 440±140.3 minutes in SESPB group and 47.5±116.1 minutes in control group (P<0.01). Nausea-vomiting was more frequent in the control group (P<0.01) and patient satisfaction was higher in the SESPB group (P<0.01). CONCLUSIONS: In lumbar discectomy surgery, ultrasound-guided SESPB provided adequate analgesia by reducing opioid consumption and pain scores without complications.

Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study.

BACKGROUND: Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. METHODS: Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. RESULTS: CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. CONCLUSIONS: Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.

Extracorporeal membrane oxygenation experience in COVID-19 pandemic: Report of two cases.

The new coronavirus disease, in which 100,000 of people are infected in the world, appears in tables ranging from asymptomatic course to severe acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) is one of the salvage treatments applied in intubated patients due to high mortality. However, since ECMO treatment is a complicated treatment, the gain loss rate should be determined well. We aimed to share two cases that we applied ECMO treatment in our clinic. Although we could not achieve a successful result, we believe that new experiences should be shared in order to better understand the place of ECMO in coronavirus disease 2019 treatment.

Lipoprotein and Metabolic Profiles Indicate Similar Cardiovascular Risk of Liver Steatosis and NASH.

BACKGROUND AND AIM: Nonalcoholic fatty liver disease (NAFLD) affects about 25% of the global population, with no reliable noninvasive tests to diagnose nonalcoholic steatohepatitis (NASH) and to differentiate between NASH and nonalcoholic fatty liver (NAFL) (steatosis alone). It is unclear if NAFL and NASH differ in cardiovascular risk for patients. Here, we compared obese NAFLD patients with a healthy cohort to test whether cholesterol compounds could represent potential noninvasive markers and to estimate associated risks. METHOD: Serum samples of 46 patients with histologically confirmed NAFLD (17 NAFL, 29 NASH) who underwent bariatric surgery were compared to 32 (9 males, 21 females) healthy controls (HCs). We analyzed epidemiological data, liver enzymes, cholesterol and lipid profile, and amino acids. The latter were analyzed by nuclear magnetic resonance spectroscopy. RESULTS: Total serum and high-density lipoprotein (HDL) cholesterol were significantly lower in the NAFLD group than in HCs, with a stronger reduction in NASH. Similar observations were made for sub-specification of HDL-p, HDL-s, SHDL-p, and LHDL-p cholesterols. Low-density lipoprotein (LDL)-s and LLDL-p cholesterol were significantly reduced in NAFLD groups. Interestingly, SLDL-p cholesterol was significantly higher in the NAFL group with a stronger elevation in NASH than in HCs. The amino acids alanine, leucin, and isoleucine were significantly higher in the NAFL and NASH groups than in HCs. CONCLUSION: We show in this study that cholesterol profiles, apolipoproteins, and amino acids could function as a potential noninvasive test to screen for NAFLD or even NASH in larger populations. However, few differences in cholesterol profiles were identified between the NAFL and NASH groups, indicating similar cardiovascular risk profiles.

Traditional and modern practices in wounds and burn injuries in a population of North Western Turkey.

BACKGROUND AND AIM: Recommended first aid approaches on burn injuries and wounds are highly effective to reduce complications and improve positive patient outcomes. However, traditional practices can be harmful for wound healing and increase infection risks. Therefore, the present study is aimed at determining Turkish people's traditional and modern first aid practices in burn injuries and wound. METHODS: This population-based descriptive study included 544 participants. Data was collected via questionnaire form. RESULTS: In this study, the most frequent cases that received first aid were cut wounds (56%) and burn injuries (22%). Most of participants (71.7% for burn injuries, 93.9% for open wound, 53% for closed wound) used modern first aid practices. However, some participants believed in the efficiency of traditional remedies in burn injuries and wounds and learned from family elders. In addition, it was found that educational status influenced belief in the effectiveness of traditional practices and that the conditions receiving first aid varied according to age and gender (p < 0.05). CONCLUSIONS: We believe that more individuals (especially, older and female participants) should be contacted in order to provide first aid training and disseminate recommended practices on first aid. Further comprehensive studies are indicated to improve the quality of healthcare and to determine the needs and reasons to Turkish peoples choose of traditional practices.

Sodium alginate/poly(4-vinylpyridine) polyelectrolyte multilayer films: Preparation, characterization and ciprofloxacin HCl release.

Polyelectrolyte multilayer (PEC) films of sodium alginate (Na-Alg) and poly(4-vinylpyridine) (P4VP) were prepared and were loaded with an antibacterial agent, ciprofloxacin HCl (CIP.HCl) aiming to design new hydrophilic films with controlled physicochemical properties and drug release behaviour that may find application as components of transdermal drug delivery systems. The PEC films were characterized by SEM, XRD, TGA, AFM and FTIR spectroscopy. The hydrophilicity of the PEC films was examined by using contact angle measurement. The number of layers and the nature of the outer layer affect the physicochemical characteristics, CIP.HCl loading and release behaviour of the films. The three layer film PEC-3, which is composed of Na-Alg outer layer deposited on a P4VP/Na-Alg double layer, is characterized by the lowest roughness (Rq = 16.3 nm) and the most hydrophilic surface with a contact angle value of 38.1° among all other films. Its crystallinity index is 0.36, and starts to degrade at 195 °C. It exhibits 130-135% equilibrium swelling capacity in acid buffer and water respectively. PEC-3 is the film with the highest drug loading capacity and drug loading efficiency values of 3.51% and 87% respectively. A cumulative drug release of 65% is obtained from PEC-3 within 24 h in pH = 1.2 buffer solution.

Pullulan modification via poly(N-vinylimidazole) grafting.

A new cationic pullulan derivative was obtained via graft copolymerization of N-vinylimidazole (NVI). Grafting of poly(N-vinylimidazole) (PNVI) onto pullulan has been achieved in aqueous medium using ammonium persulphate (APS) as the initiator. The effect of monomer concentration, pullulan concentration, initiator concentration, time and temperature on the grafting yield has been investigated. The highest grafting yield (513%) of pullulan-graft-PNVI was obtained using 0.016 M pullulan, 0.66 M NVI, 0.18 M APS at 40 °C in aqueous solution for 3 h under nitrogen atmosphere. Water-soluble products were obtained which were further characterized by FTIR, elemental, TGA, SEC and H-1 NMR analyses. Pullulan-graft-PNVI gave soluble and insoluble complexes in aqueous acidic medium with tripolyphosphate and citrate ions due to its cationic nature.

Chitosan-graft-poly(N-hydroxy ethyl acrylamide) copolymers: Synthesis, characterization and preliminary blood compatibility in vitro.

Poly(N-hydroxy ethyl acrylamide) was grafted onto chitosan in aqueous acidic medium using potassium per sulphate initiator to obtain polymer surfaces with blood compatibility for potential biomedical applications. Thermally cross-linked products were obtained upon drying at 60 °C overnight. Chemically cross-linked films were prepared using methylene bis acrylamide (MBA) cross-linker. The products were characterized by FTIR, XRD and SEM analyses. Protein adsorption onto the film surfaces gave, on the average, 30% bovine serum albumin (BSA) and 10% human serum albumin (HSA) removal from aqueous solution, in vitro. Blood compatibility was evaluated with respect to activated prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet adhesion. PT and APTT values remained within normal ranges after blood-polymer contact, with chitosan-graft-polyHEAA films, in vitro. Chitosan-graft-MBA or chitosan-graft-(polyHEAA;MBA), and blank chitosan films produced higher PT and APTT values under similar experimental conditions with chitosan-graft-polyHEAA films, exhibiting blood anticoagulant activity. SEM pictures taken before and after contact with blood sample did not reveal any significant blood component adhesion on the chitosan-graft-(polyHEAA;MBA) film surface contrary to the observation made on the blank chitosan film.

Mono- and Bivalent 14-3-3 Inhibitors for Characterizing Supramolecular "Lysine Wrapping" of Oligoethylene Glycol (OEG) Moieties in Proteins.

Previous studies have indicated the presence of defined interactions between oligo or poly(ethylene glycol) (OEG or PEG) and lysine residues. In these interactions, the OEG or PEG residues "wrap around" the lysine amino group, thereby enabling complexation of the amino group by the ether oxygen residues. The resulting biochemical binding affinity and thus biological relevance of this supramolecular interaction however remains unclear so far. Here, we report that OEG-containing phosphophenol ether inhibitors of 14-3-3 proteins also display such a "lysine-wrapping" binding mode. For better investigating the biochemical relevance of this binding mode, we made use of the dimeric nature of 14-3-3 proteins and designed as well as synthesized a set of bivalent 14-3-3 inhibitors for biochemical and X-ray crystallography-based structural studies. We found that all synthesized derivatives adapted the "lysine-wrapping" binding mode in the crystal structures; in solution, a different binding mode is however observed, most probably as the "lysine-wrapping" binding mode turned out to be a rather weak interaction. Accordingly, our studies demonstrate that structural studies of OEG-lysine interactions are difficult to interpret and their presence in structural studies may not automatically be correlated with a relevant interaction also in solution but requires further biochemical studies.

pH responsive graft copolymers of chitosan.

Grafting suitable polymers onto chitosan can produce cationic or polyampholyte polymers or hydrogels that are potential smart biomedical materials. Chitosan-graft-[poly(diethylamino)ethyl methacrylate] has been prepared in three different physical forms as linear free chains in solution, chemical gels crosslinked with glutaraldehyde, and poly(diethylamino)ethyl methacrylate] grafted onto chitosan tripolyphosphate gel beads. In addition to chemical structure, the graft copolymers were characterized with respect to their dissolution and swelling behavior in aqueous solution. It has been established that solubility of the products is controlled by the grafting yield. While pH sensitive polymers, which collapse at a given pH value are obtained at lower grafting yields, hydrogels form at higher grafting yields with pH responsive swelling behavior. Glutaraldehyde crosslinked chitosan-graft-[poly(diethylamino)ethyl methacrylate] gels and chitosan tripolyphosphate gel beads grafted with poly[(diethylamino)ethyl methacrylate] exhibit pH sensitive swelling with highest equilibrium swelling capacity at pH=1.2.

Effect of CaCO3/HCl pretreatment on the surface modification of chitin gel beads via graft copolymerization of 2-hydroxy ethyl methacrylate and 4-vinylpyridine.

Although chitin, poly(N-acetylglucosamine), possesses considerable potential as a biomaterial, it has not been as thoroughly studied as its derivative chitosan. In this study, the potential of chitin gel beads has been evaluated for surface modification via vinyl polymer grafting. Grafting behavior of two well-established vinyl monomers, namely 2-hydroxyethylmethacrylate (HEMA) and 4-vinylpyridine (4-VP) were investigated using cerium (IV) ammonium nitrate as the redox initiator with the aim of obtaining chemically functionalized more hydrophilic chitin surfaces. The intractable nature of chitin, which is one of its primary drawbacks as a grafting substrate was overcome by applying a CaCO3 treatment during bead preparation. The maximum grafting percentage of poly(HEMA) onto chitin bead without CaCO3 treatment was found to be 65%, while the value for CaCO3 treated chitin beads was 515%. The maximum grafting yield of poly(4-VP) on to CaCO3 treated chitin powder was 380% at optimum conditions. The grafting system was extensively characterized before and after grafting by FT-IR, SEM, C-13 NMR and XRD analyses. Significant improvement on the swelling capacities of chitin based gel beads in aqueous acidic, basic and neutral media was obtained. An account of the pros and cons of the system has been presented.

Comparison of health-related quality of life and exercise capacity according to stages in patients with non-small cell lung cancer.

INTRODUCTION: The aim of this study is to compare the exercise capacity and health-related quality of life parameters according to stages of patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Fifty-two patients (who are able to ambulate independently) with stage I-II (group early-stage, n= 17) and stage IIIA-IV NSCLC (group advanced-stage, n= 35) were included. Exercise capacity (six minute walking test), strength of the peripheral muscle (Back and Leg Dynamometer), performance status (Karnofsky performance status scale), health-related quality of life- HRQOL (European Organization for Research and Treatment of Cancer Quality of life measure and Short Form-36 Health Survey), depression and anxiety (Hospital Anxiety and Depression Scale) were evaluated. RESULTS: No difference was found in age, body mass index, respiratory symptoms and the distribution of disease cell types between two groups (p> 0.05). In advanced-stage group, pulmonary function test values, peripheral muscle strength, walking distance and health-related quality of life scores especially the categories of functional capacity and pain were established significantly lower compared to early-stage group (p ≤ 0.05). Depression and anxiety levels were confirmed to be similar between groups (p> 0.05). CONCLUSION: The exercise capacity of patients with advanced-stage NSCLC is lower due to reduced pulmonary functions and peripheral muscle strength compared to patients with early-stage NSCLC. Therefore, we can conclude that reduced exercise capacity negatively impacts functional categories of health related quality of life of patients with advanced-stage NSCLC.

Drug entrapment in silica microspheres through a single step sol-gel process and in vitro release behavior.

A single step sol-gel process was used to precipitate silica microspheres containing ibuprofen or naproxen for controlled drug delivery applications. The drug release behavior from these systems was analyzed in vitro. Pure ibuprofen and naproxen exhibited linear release with time, while sol-gel silica entrapped drugs were released with a logarithmic time dependence starting with an initial burst effect followed by a gradual decrease. Microscopic analysis combined with gravimety and infrared spectroscopy indicated that some of the drug is entrapped as large crystals attached to silica microspheres while the rest is encapsulated inside the microspheres. Drug-loaded silica microspheres with no open porosity and with a narrow particle size distribution were obtained. Both erosion of the microspheres and diffusion through them contributed to drug release. Sol-gel precipitation of silica microspheres is a promising method for drug entrapment and controlled release.

Desferrioxamine release from gelatin-based systems.

The conventional treatment with regular red-blood-cell transfusions and simultaneous chelation of excess iron with DFO (desferrioxamine) improves quality of life of thalassaemic patients while increasing their rate of survival considerably. Although DFO is the main iron- chelating drug currently utilized, it has various drawbacks, including high cost, poor oral effectiveness, toxicity and short plasma half-life. It has to be administered by slow, subcutaneous infusion during blood transfusion for 8-12 h at night, 5-7 nights a week, and this leads to a very poor patient compliance. In order to avoid frequent and uncomfortable infusions of DFO, application of controlled-release systems might be alternative routes in the supportive treatment of thalassaemia. In the present study, GMs (gelatin microspheres) and GFs (gelatin films) were prepared by coacervation and casting methods respectively to develop controlled DFO-release systems. Cross-linking by glutaraldehyde and carbodi-imide were performed to increase the stability of gelatin matrices. Microspheres and films prepared without the addition of cross-linker degraded completely in 4 h. On the other hand, addition of cross-linker extended this time from hours to weeks depending on the added amount. Therefore the amount of DFO released from microspheres in 7 days was found to be in the range 12-82%, whereas the amount permeated through the films in 5.0 h was found to be in the range 34-67%. GFs were elastic and demonstrated good mechanical properties. Films achieved 0.14-0.69 MPa tensile strength, with 0.12-1.29 MPa elastic modulus and 26.49-109.38% strain values at break point. These studies showed that gelatin-based controlled-release systems could be improved and could be good candidates for the production of long-term DFO-carrying systems.