Investigation of the efficacy of systemic N-Acetyl Cysteine therapy preventing nasal mucositis following radiotherapy.

BACKGROUND: Radiotherapy (RT) is one of the main methods used in the treatment of head and neck cancers but may cause mucosal side effects in the tumor area and surrounding structures. These include nasal mucosal disorders and chronic rhinosinusitis due to disruption of the mucociliary system. This situation seriously affects the quality of life of the patients and there is no accepted effective method for its treatment yet. In our study, we aimed to examine the side effects of RT on the nasal mucosa and mucociliary system and to investigate histopathologically and immunohistochemically the effectiveness of N-acetyl cysteine (NAC) in preventing these side effects of RT. METHODOLOGY: The study was carried out with 30 female Sprague Dawley rats devided in three groups. No intervention was made in the control group. On the second day of the experiment, 30 Gy radiotherapy was applied to the head area in the RT group. NAC was administered intraperitoneally at a dose of 1 g/kg/day for 14 days from the first day of the study to the RT+ NAC group. On the second day, 30 Gy of radiotherapy was applied to the head area 1 hour after the NAC application. On the 14th day, 1 hour after NAC was applied to the RT+NAC group, all animals were sacrificed. The nasal mucosa samples were stained with hematoxylin-eosin, and the intensity and extent of staining sentan in the nasopharyngeal tissue samples were evaluated by immunohistochemical staining using anti-SNTN antibody. RESULTS: The loss of cilia in the nasal tissue was lower in the RT+NAC group than in the RT group. The intensity and extent of staining in the nasopharyngeal tissue of Sentan was higher in the RT+NAC group than in the RT group. Mucosal neutrophil and mononuclear inflammatory cell infiltration in the nasal tissue, vascular dilatation, hyperemia and hemorrhage, erosion and shedding of the mucosal epithelium, mucosal ulceration were found to be similar in the RT+NAC group and the control group. It was milder in the RT+NAC group than in the RT group, but not statistically significant. CONCLUSIONS: Radiotherapy caused pathological changes in the nasal mucosa, caused loss of cilia and a decrease in the level of Sentan, the cilia apical protein. The results of our study showed that NAC treatment can reduce the side effects of RT on the nasal mucosa. It also showed that NAC was effective in preventing the loss of cilia, which is the building block of the mucociliary system, and improving the expression of Sentan.

Indoor radon measurements in Turkey dwellings.

In this work, indoor radon radioactivity concentration levels have been measured in dwellings of Turkey within the frame of the National Radon Monitoring Programme. The (222)Rn concentrations were measured with time-integrating passive nuclear etched track detectors in 7293 dwellings in 153 residential units of 81 provinces, and the radon map of Turkey was prepared. Indoor radon concentrations were distributed in the range of 1-1400 Bq m(-3). The arithmetic mean of the radon gas concentration was found to be 81 Bq m(-3); the geometric mean was 57 Bq m(-3) with a geometric standard deviation of 2.3.

Acute fetal distress following tooth extraction and abscess drainage in a pregnant patient with maxillofacial infection.

Oral infections have been implicated in adverse pregnancy outcomes such as pre-eclampsia, premature delivery and growth retardation. A 28-year-old and 9 months pregnant otherwise healthy woman with a complaint of facial swelling and dental pain was referred to the Department of Oral and Maxillofacial Surgery. Oral examination revealed perimandibular and masticator space infection related to the left mandibular third molar tooth. Eight hours after surgical intervention, fetal distress developed. The patient was immediately taken into surgery and a male baby delivered by Caesarean section. The baby was then admitted to the intensive care unit. On the twelfth day of his admission, the baby was discharged in good health. Severe maxillofacial infection in pregnancy is a medically complicated situation which should be treated by an oral and maxillofacial surgeon in consultation with an obstetric and gynaecology service.

[Renal failure after gastrointestinal hemorrhage: case 10/2012]. / Akutes Nierenversagen nach gastrointestinaler Blutung - Fall 10/2012.

HISTORY AND ADMISSION FINDINGS: We report on a 78-year-old female patient, who presented to the emergency department with nausea and vomiting. INVESTIGATIONS: Endoscopy of the upper gastrointestinal tract revealed gastric erosions and duodenal ulcers. The patient had iron deficiency anemia. DIAGNOSIS, TREATMENT AND COURSE: Following treatment with a proton pump inhibitor (PPI) the patient developed fever, signs of inflammation and oliguric renal failure. In the urine-dipstick there was minimal hematuria and leukocyturia. Urinary protein-differentiation revealed tubular proteinuria with excretion of α1-microglobulin. Renal biopsy showed interstitial nephritis with infiltration of eosinophilic granulocytes. After stopping treatment with PPI and commencing glucocorticoid therapy, the patient recovered fully from renal failure. CONCLUSIONS: Allergic interstitial nephritis following PPI treatment is an important differential diagnosis of renal failure of unknown cause and has a good prognosis when promptly diagnosed and treated.

A study of environmental radioactivity measurements in the Samsun province, Turkey.

This study was concerned with the measurement of natural and artificial radionuclides in soil samples and indoor radon concentrations in the Samsun province, Turkey. In soil samples, the values of individual mean activity of (226)Ra, (232)Th, (40)K and (137)Cs radionuclides were found to be 31, 22, 341 and 16 Bq kg(-1), respectively. The radiological parameters, such as the absorbed dose rate in air, the annual effective dose (AED) and excess lifetime cancer risk, were calculated. Indoor radon measurements were carried out with CR-39-based radon dosemeters at 127 dwellings in the Samsun province. The mean annual (222)Rn activity was found to be 106 Bq m(-3) (equivalent to an AED of 1.88 mSv). The seasonal variation of (222)Rn activity shows that maximum levels are observed in the winter, while minimum levels are observed in the summer. The mean lifetime fatality risk for the studied area was estimated at 1.45×10(-4). The results obtained did not significantly differ from those obtained in other parts of the country.

[Triage systems in the emergency department]. / Triagesysteme in der Notaufnahme.

Emergency department (ED) triage systems facilitate the categorization of emergency patients according to their disease severity and determine both treatment priority and treatment location. Four different five-level triage systems are internationally accepted. The Australasian Triage Scale (ATS, Australasia) allows categorization based on symptoms using specific descriptors. The Manchester Triage System (MTS, UK) uses defined presentational flow charts combined with indicators. The Canadian Triage and Acuity Scale (CTAS, Canada) is based on the ATS, but also includes diagnoses. The Emergency Severity Index (ESI, USA) first excludes life-threatening and severe disease before stratification according to estimated resource utilization. The goal of all triage systems is to reduce the in-hospital mortality and to minimize time to treatment, length of stay, and resource utilization.

Student tutors are able to teach basic sonographic anatomy effectively - a prospective randomized controlled trial.

PURPOSE: Ultrasound is a widely used diagnostic tool. In medical education, it can be used to teach sonographic anatomy as well as the basics of ultrasound diagnostics. Some medical schools have begun implementing student tutor-led teaching sessions in sonographic abdominal anatomy in order to meet the growing demand in ultrasound teaching. However, while this teaching concept has proven to be feasible and well accepted, there is limited data regarding its effectiveness. We investigated whether student tutors teach sonographic anatomy as effectively as faculty staff sonographers. MATERIALS AND METHODS: 50 medical students were randomly assigned to one of two groups. 46 of these could be included in the analysis. One group was taught by student tutors (ST) and the other by a faculty staff sonographer (FS). Using a pre/post-test design, students were required to locate and label 15 different abdominal structures. They printed out three pictures in three minutes and subsequently labeled the structures they were able to identify. The pictures were then rated by two blinded faculty staff sonographers. A mean difference of one point in the improvement of correctly identified abdominal structures between the pre-test and post-test among the two groups was regarded as equivalent. RESULTS: In the pre-test, the ST (FS) correctly identified 1.6 ± 1.0 (2.0 ± 1.1) structures. Both the ST and FS group showed improvement in the post-test, correctly identifying 7.8 ± 2.8 vs. 8.9 ± 2.9 structures, respectively (p < .0001 each). Comparing the improvement of the ST (6.2 ± 2.8 structures) versus the FS (6.9 ± 3.2) showed equivalent results between the two groups (p < .05 testing for equivalence). CONCLUSION: Basic abdominal sonographic anatomy can be taught effectively by student tutors.

Radon level and indoor gamma doses in dwellings of Trabzon, Turkey.

The seasonal variations of the indoor radon activity concentrations were determined in the 97 dwellings of Trabzon, Turkey. The annual average indoor radon activity concentration varied from 8 to 583 Bq/m³. The average winter/summer ratio of radon activity concentrations was 3.62. The gamma activity concentrations in the soil samples were determined as 41, 38, 443 and 25 Bq/kg for ²²6Ra, ²³²Th, 4°K and ¹³7Cs, respectively. The average gamma dose rate in air and the annual effective dose equivalent for outdoor occupancy were calculated as 63 nGy/h and 77 µSv/y, respectively.

Radiological characterisation of Artvin and Ardahan provinces of Turkey.

Indoor radon concentration measurements were carried out and corresponding annual effective doses due to exposure to indoor radon were determined in Artvin and Ardahan provinces located in the eastern part of Turkey. The measurements were performed for four seasons in order to determine the seasonal fluctuations mostly observed in indoor environments. Indoor radon concentration values were observed to range from 21 to 321 Bq m⁻³ for the Artvin province and from 53 to 736 Bq m⁻³ for the Ardahan province. It was observed that minimum indoor radon concentration values were obtained in summer, while the highest ones were observed in winter. Indoor radon concentration values of the current study were compared with those of other provinces in Turkey. As elevated indoor radon concentrations are mostly correlated with high ²³8U activity concentrations in soil, a total of 57 and 33 soil samples were collected from the Artvin and Ardahan provinces, respectively, to determine ²³8U activity concentration as well as the concentration of ²³²Th and 4°K--naturally occurring radionuclides. It was also observed that soil samples collected from the study areas contained ¹³7Cs as an artificial radionuclide.

Medical clerkships do not reduce common prescription errors among medical students.

Prescribing correctly represents one of the most essential skills of a doctor when it comes to patient safety. Unfortunately, prescribing errors still account for a large proportion of avoidable drug-related problems (DRP). Despite this shortcoming, many medical schools do not provide specific prescribing training and assume that students acquire sufficient prescribing skills during regular medical clerkships. We therefore investigated whether there is an association between the individual time spent by students in internal-medicine clerkships and the number of prescription errors committed in a standardized prescribing test for common drug-related problems in a medical inpatient setting. Seventy-four fifth-year medical students (25 +/- 3 yrs, 24 m, 50 f) who had completed their formal pharmacology training filled in prescription charts for two standardized patient paper cases. The charts were rated by two blinded consultants from the field of internal medicine using a checklist for common prescription errors. Students were divided into three groups according to the number of weeks previously spent in internal-medicine clerkships. Group differences in the number of prescription errors made were subsequently examined. Students committed 69% +/- 12% of all possible prescription mistakes. There was no significant difference between the group without clerkships in internal medicine (G1) (71 +/- 9%), the group with one to four weeks (G2) (67 +/- 15%), and the group with more than five weeks of clerkships (G3) (71 +/- 10%), p = .76. Medical students do not seem to acquire the necessary skills to avoid common prescription errors during regular clerkships in internal medicine. This study provides evidence to suggest that specific prescription training within medical education is warranted in order to prevent DRP.

Radon concentrations in three underground lignite mines in Turkey.

Monitoring of radon in underground mines is important in order to assess the radiological hazards to occupational workers. Radon concentration levels in three underground lignite mines (Tunçbilek, Omerler and Eynez) of Turkey were obtained in this study. For this reason, atmospheric radon level measurements were carried out in mines using CR-39 track detectors. Chemical etching of the detector tracks and subsequent counting were performed at Cekmece Nuclear Research and Training Center. The obtained results were evaluated according to the International Commission of Radiation Protection and the Turkish Atomic Energy Authority whose radon action levels for workplaces are 500-1500 and 1000 Bq(-3), respectively. The radon gas concentrations in the lignite mines were determined to be between 50 +/- 7 and 587 +/- 16 Bq m(-3). The results obtained in these experiments are far under the action levels. The computed radon doses for the mine workers of Tunçbilek, Omerler and Eynez lignite mines are 1.23, 2.44 and 1.47 mSv y(-1), respectively.

Environmental radioactivity assessment for Bayburt, Turkey.

This study assesses the results of environmental radioactivity measurements for Bayburt Province in the Eastern Black Sea area of Turkey. Using gamma-ray spectrometry, activity concentrations of the natural radionuclides (226)Ra, (232)Th and (40)K and a fission product (137)Cs were investigated in soil samples. The activity concentrations of (226)Ra, (232)Th and (40)K in various building materials such as sand, cement and marble and in drinking waters were determined. The activity concentrations vary from 16 to 54 Bq kg(-1) for (226)Ra, from 10 to 21 Bq kg(-1) for (232)Th and from 113 to 542 Bq kg(-1) for (40)K in building materials. The mean specific activity concentrations of (226)Ra, (232)Th and (40)K in drinking waters were 93, 30 and 504 mBq l(-1), respectively. The concentrations of gross alpha and beta radioactivity in drinking water samples collected from four different sampling stations have been determined. The results show that the gross alpha and beta activities are lower than the screening levels given by the World Health Organization (WHO), which are a maximum contaminant level of 0.5 Bq l(-1) and 1.0 Bq l(-1) gross alpha and beta radioactivity, respectively, in drinking water. Indoor radon measurements were made in 44 dwellings in Bayburt by using Cr-39 detectors. Radon concentrations in dwellings in Bayburt varied from 17 to 125 Bq m(-3) and the average value was 56 Bq m(-3). The results obtained in this study indicate that the region has a background radiation level that is within the typical natural range and shows no significant departures from other parts of the country.

Transport evaluation of alendronate across Caco-2 cell monolayers.

The transport of alendronate through Caco-2 monolayers in the absence and presence of absorption enhancers (sodium taurocholate-STC and dimethyl-beta-cyclodextrin-DM-beta-CD) was studied. The viability of Caco-2 cells was determined by MTT assay. The effects of the experiment period and serum existence in Dubelco's Modified Eagle's Medium (DMEM) on cell viability were examined. The least toxic concentrations of alendronate, STC and DM-beta-CD were found as 0.2% (w/v), 5 mM and 0.3% (w/v), respectively. Transport experiments were performed with these concentrations in DMEM supplemented with serum for an 8 h period. DM-beta-CD increased the transport of alendronate through Caco-2 monolayers significantly. No significance was observed with STC. Cell integrity was determined by measuring the electrical resistance values at the end of the transport experiments and found to be decreased to a greater extent with DM-beta-CD. These results indicate that DM-beta-CD is a promising agent for improving the transport of alendronate.

A study of indoor radon levels in rural dwellings of Ezine (Canakkale, Turkey) using solid-state nuclear track detectors.

Indoor radon activity level and radon effective dose (ED) rate have been carried out in the rural dwellings of Ezine (Canakkale) during the summer season using Radosys-2000, a complete set suitable to radon concentration measurements with CR-39 plastic alpha track detectors. The range of radon concentration varied between 9 and 300 Bq m(-3), with an average of 67.9 (39.9 SD) Bq m(-3). Assuming an indoor occupancy factor of 0.8 and 0.4 for the equilibrium factor of radon indoors, it has been found that the 222Rn ED rate in the dwellings studied ranges from 0.4 to 5.2 mSv y(-1), with an average value of 1.7 (1.0) mSv y(-1). There is a possibility that low radon concentrations exist indoors during the summer season in the study area because of relatively high ventilation rates in the dwellings. A winter survey will be needed for future estimation of the annual ED.

Indoor radon concentrations in Adana, Turkey.

The indoor radon concentration in Adana, Turkey was measured in living rooms of 52 houses during winter 2005 and 57 houses during summer 2005. Forty-four houses were selected for both winter and summer researches for estimating seasonal variations. Indoor radon concentrations were measured seasonally over hotter and colder 2 months over the whole year, using CR-39 passive nuclear track radon detectors. The radon concentrations were ranged from 15 to 97 Bq m(-3) on January-February 2005 for 60 d and from 5 to 70 Bq m(-3) on June-July 2005 for 60 d. The average summer concentration measured was 25.8 Bq m(-3) and the average winter concentration was 48.9 Bq m(-3) in 44 houses that observed seasonal variations. The differences between winter and summer periods were ranged from 1 to 77 Bq m(-3). The average value in both winter and summer periods is 37 Bq m(-3) in 44 houses that observed seasonal variations. This value is below the worldwide indoor radon concentration distribution of 46 Bq m(-3). The annual effective dose equivalent from (222)Rn was 0.9 mSv y(-1).

Comparison of dexmedetomidine-propofol vs. fentanyl-propofol for laryngeal mask insertion.

BACKGROUND AND OBJECTIVES: There have been many studies to find the optimum anaesthetics to provide excellent conditions for laryngeal mask insertion. We compared the effects of dexmedetomidine administered before propofol, on laryngeal mask insertion with fentanyl combined with propofol. METHODS: In all, 52 patients, ASA I-II, scheduled to have minor urological procedures were randomized into two groups. Group F received 1 microg kg(-1) fentanyl (in 10 mL normal saline) and Group D received 1 microg kg(-1) dexmedetomidine (in 10 mL normal saline). We used 1.5 mg kg(-1) propofol for induction and 50% N2O and 1.5% sevoflurane in oxygen for maintenance. We observed jaw mobility (1: fully relaxed; 2: mild resistance; 3: tight but opens; 4: closed), coughing or movement (1: none; 2: one or two coughs; 3: three or more coughs; 4: bucking/movement) and other events such as spontaneous ventilation, breath holding, expiratory stridor and lacrimation. In each category, scores <2 were acceptable for laryngeal mask insertion. RESULTS: More patients developed apnoea and their apnoea times were longer in Group F than Group D (P < 0.001). Respiratory rates increased in Group D (P < 0.001). Adverse events during laryngeal mask insertion were similar. The reductions in systolic and mean blood pressures were greater in Group F (systolic: P < 0.05, mean: P < 0.01). Emergence times were shorter in Group F than in Group D (P < 0.001). CONCLUSION: Dexmedetomidine, when used before propofol induction provides successful laryngeal mask insertion comparable to fentanyl, while preserving respiratory functions more than fentanyl.

Ketamine gargle for attenuating postoperative sore throat.

BACKGROUND: Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sore throat (POST) with reported incidences of 21-65%. We compared the effectiveness of ketamine gargles with placebo in preventing POST after endotracheal intubation. METHODS: Forty-six, ASA I-II, patients undergoing elective surgery for septorhinoplasty under general anaesthesia were enrolled in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly allocated into two groups of 23 subjects each: Group C, saline 30 ml; Group K, ketamine 40 mg in saline 30 ml. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anaesthesia. POST was graded at 0, 2, 4, and 24 h after operation on a four-point scale (0-3). RESULTS: POST occurred more frequently in Group C, when compared with Group K, at 0, 2, and 24 h and significantly more patients suffered severe POST in Group C at 4 and 24 h compared with Group K (P<0.05). CONCLUSIONS: Ketamine gargle significantly reduced the incidence and severity of POST.

Topical ketamine and morphine for post-tonsillectomy pain.

BACKGROUND AND OBJECTIVES: Tonsillectomy is frequently associated with postoperative pain of considerable duration, which is usually accompanied by the substantial consumption of both opioid and non-opioid analgesics. Despite the use of different surgical and anaesthetic techniques in the search for safe and effective post-tonsillectomy pain relief, this problem remains a clinical dilemma. The aim of the current study was to evaluate the potential effects of topically administered ketamine and morphine by an oral rinse into the tonsillar fossae. METHODS: In all, 60 children, 15 for each group, aged between 3 and 12 yr scheduled for tonsillectomy were randomly assigned to one of four groups. Study drugs were administered to both tonsillar fossae for 5 min. Group K received 0.4 mL (20 mg) ketamine in 10 mL artificial saliva, Group KM received 0.4 mL (20 mg) ketamine + 5 mL (20 mg) 4 per thousand morphine aqueous solution in 5 mL artificial saliva, Group M received 5 mL (20 mg) 4 per thousand morphine aqueous solution in 5 mL artificial saliva, Group C received only 10 mL artificial saliva. Postoperative pain, nausea, vomiting, sedation and bleeding were evaluated. RESULTS: Pain scores were higher in the control group at arrival in the recovery ward (P < 0.05). Morphine and ketamine groups had longer effective analgesia time than the morphine + ketamine and control groups. The 24-h analgesic consumption was significantly higher in the control group. CONCLUSION: Topical ketamine and morphine seems to be a safe and easy analgesic approach for decreasing adenotonsillectomy pain.

Radon measurements in the Catalagzi Thermal Power Plant, Turkey.

The Catalagzi Thermal Power Plant (CTPP) (41(0)30'48.4('')N and 0.31(0)53'41.5('')E) is located at nearly 13 km North-east of Zonguldak city, which is located at the West Black Sea coast in Turkey. The middling products with high ash content of bituminous coals are used in this plant. Seasonal radon concentration measurements have been carried out by using CR-39 plastic track detectors in and around the CTPP. The annual average radon concentration has been found to vary from a minimum of 39.8 +/- 28.9 Bq m(-3) in the ash area to a maximum of approximately 75.0 +/- 15.7 Bq m(-3) in the service building of the power plant. The annual average radon concentration in the dwellings of the thermal power plant colony of the plant is 71.0 +/- 33.4 Bq m(-3). The effective dose has been found to vary from 0.38 to 0.71 mSv y(-1) with a mean value of 0.56 mSv y(-1), which is lower than the effective dose values 3-10 mSv given as the range of action levels recommended by International Commission on Radiological Protection: Protection against radon-222 at home and at work, ICRP Publication 65 (1993).