RESUMO
General anesthetics exposure, particularly prolonged or repeated exposure, is a crucial cause of neurological injuries. Notably, isoflurane (ISO), used in pediatric anesthesia practice, is toxic to the developing brain. The relatively weak antioxidant system at early ages needs antioxidant support to protect the brain against anesthesia. Cerium oxide nanoparticles (CeO2-NPs, nanoceria) are nano-antioxidants and stand out due to their unique surface chemistry, high stability, and biocompatibility. Although CeO2-NPs have been shown to exhibit neuroprotective and cognitive function-facilitating effects, there are no reports on their protective effects against anesthesia-induced neurotoxicity and cognitive impairments. Herein, Wistar albino rat pups were exposed to ISO (1.5%, 3-h) at postnatal day (P)7+P9+P11, and the protective properties of CeO2-NP pretreatment (0.5mg/kg, intraperitoneal route) were investigated for the first time. The control group at P7+9+11 received 50% O2 (3-h) instead of ISO. Exposure to nanoceria one-hour before ISO protected hippocampal neurons of the developing rat brain against apoptosis [determined by hematoxylin-eosin (HE) staining, immunohistochemistry (IHC) analysis with caspase-3, and immunoblotting with Bax/Bcl2, cleaved caspase-3 and PARP1] oxidative stress, and inflammation [determined by immunoblotting with 4-hydroxynonenal (4HNE), nuclear factor kappa-B (NF-κB), and tumor necrosis factor-alpha (TNF-α)]. CeO2-NP pretreatment also reduced ISO-induced learning (at P28-32) and memory (at P33) deficits evaluated by Morris Water Maze. However, memory deficits and thigmotactic behaviors were detected in the agent-control group; elimination of these harmful effects will be possible with dose studies, thus providing evidence supporting safer use. Overall, our findings support pretreatment with nanoceria application as a simple strategy that might be used for pediatric anesthesia practice to protect infants and children from ISO-induced cell death and learning and memory deficits.
RESUMO
Introduction: In this study, we aimed to detect anxiety levels of the physicians during the Coronavirus Disease 2019 (COVID-19) pandemic and to assess the knowledge, perspective, and willingness of the physicians about telemedicine. Materials and Methods: This was a survey study of physicians from different specialties who provided patient care during the pandemic in Turkey. A total of 824 physicians responded to questionnaire, which consisted of 5 sections: (1) demographic characteristics; (2) anxiety level; (3) knowledge; (4) perspective; and (5) willingness to use telemedicine. Results: Fifty-six percent of the participants were found to experience mild-to-severe anxiety during the pandemic. It was found that the early career physicians most likely report anxiety about COVID-19 (p = 0.012). Physicians working in training and research hospital settings had higher Beck Anxiety Inventory scores compared to their colleagues working in private health care institutions (p = 0.011). Anxiety levels of physicians were not affected by working experience, existence of comorbidities, or living conditions of the participants (p = 0.138, p = 0.317, and p = 0.123, respectively). The results showed that the participants had a low level of knowledge about telemedicine. Only 61.1% of the physicians stated that they had heard of telemedicine before. The physicians who experienced telemedicine before (N = 76, 9.2% of all the participants) were more likely to find telemedicine beneficial both in pandemic (p < 0.001) and postpandemic period (p = 0.002). Conclusions: About half of our physicians had different levels of anxiety during the pandemic, and this anxiety seemed to be more related to infecting their relatives. Participants thought that providing health care services with telemedicine during the pandemic period would be beneficial and reduce the spread of hospital-acquired COVID-19. However, there was no consensus among the participants regarding the use of telemedicine in the postpandemic period.