Impact of Mediterranean diet in lowering risk of gestational diabetes mellitus: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: The prevalence of gestational diabetes is increasing, and the Mediterranean diet is highly recommended for health. The objective of this study is to determine the relationship between adherence to the Mediterranean diet and gestational diabetes mellitus (GDM). MATERIALS AND METHODS: In this cross-sectional study the presence of GDM is the dependent variable, and socio-demographic and anthropometric characteristics and adherence to the Mediterranean diet are the independent variables in this study, which was carried out in pregnant women who were 24-28 weeks pregnant and had Oral Glucose Tolerance Test (OGTT). Adherence to the Mediterranean diet was evaluated with the Mediterranean Diet Adherence Scale (MEDAS). Data were collected through face-to-face interviews, weight and height measurements of the pregnant women were made, and the diagnosis of GDM was made with OGTT. RESULTS: Two hundred and seven pregnant women participated in the study and 85 of them (41.1%) were diagnosed as GDM. According to Logistic Regression models, age (OR: 1.088, 95% CI: 1.031-1.149) and infertility treatment (OR: 4.570, 95% CI: 1.443-14.474) significantly increased the occurrence of GDM, while adherence to the Mediterranean diet (OR: 0.683, 95% CI: 0.568-0.820) significantly reduced the risk. CONCLUSIONS: Nearly two-fifths of pregnant women were diagnosed with GDM while only one-fourth complied with a Mediterranean diet. The increase in the frequency of GDM should be carefully monitored. It may be useful to detect risky pregnant women at the time of the first diagnosis, to measure their glucose levels, and to give suggestions about the Mediterranean diet in the early period.

A factor that can yield to eating attitude disorders in university students: Self-esteem.

OBJECTIVE: To determine prevalence of eating attitude disorder (EAD) and the effect of self-esteem on EAD in female university students.Study Design: In this cross-sectional study, female university students were included. The dependent variable was EAD determined by Eating Attitude Test-40. Socio-demographic characteristics, body perception, obesity, self-compassion and self-esteem were independent variables. Logistic regression (LR) models have been established to determine the associated factors of EAD. p < 0.05 was considered significant.Results: EAD were found in 3.3% (n = 20) of the participants (n = 600). 44.5% had low and medium self-esteem and %13.4 were overweight (body mass index (BMI) ≥ 25.0). According to LR models, after adjusted for age, increased self-esteem score (decreased self-esteem) (OR:1.8, 95%CI:1.063-3.303) and practicing popular diet (OR:12.6, 95%CI:4.439-35.904) increased the risk of EAD significantly.Conclusion: EAD were less than expected in this group of university students. Self-esteem is an important factor affecting EAD. Students with EAD may be recommended to get psychological support as well as nutritional counseling.

Is Obesity Associated with Lower Mini Mental Test Scores among Elderly? A Cross Sectional Study.

OBJECTIVES: Obesity leads to many chronic diseases and its association with cognitive impairment is controversial. The objective was to investigate the association between obesity, anthropometric measurements and cognitive functions of elderly. METHODS: Planned cross-sectionally, community-dwelling Cypriots (aged ≥ 50 years) without any neurological disorders, were included. Cognitive impairment evaluated by Mini Mental State Examination (MMSE) was the dependent variable. Socio-demographic variables, anthropometric measurements and obesity were the independent variables. The data was collected via face-to-face interview. Logistic regression models were constituted to determine the association of anthropometric measurements, obesity and dementia. RESULTS: The mean age of participants (n = 541) was 60.0 ± 8.7 for women (n = 377) and 61.5 ± 6.0 years for men (n = 164). According to MMSE, 26.0% of women and 11.0% of men had mild-dementia, and the rest scored normal. After adjusted for age and sex, each unit increase in BMI (OR: 1.045, 95%CI: 1.008-1.091), Waist to height ratio (WHtR; OR: 1.030, 95%CI: 1.006-1.055) and Mid upper arm circumference (MUAC; OR: 1.077, 95%CI: 1.016-1.141) increases the risk of mild-dementia. When education, employment and smoking were included in the models, significance of anthropometric measurements was diminished and only sex and education were remained significant for all. CONCLUSION: After controlled for age and sex, increment in anthropometric measurements increased the risk of dementia but when education was taken into consideration, this significant association was diminished showing that sex and education is more predominant in a heterogeneous group in means of education. Thus, for heterogeneous groups it might be better to revise MMSE. To determine the association between obesity and dementia cohort studies with longer follow-up duration with larger samples are needed.

Assisted reproductive treatment outcomes of women with endometriomas: Either with or without previous ovarian surgery.

OBJECTIVE: The present study aimed to evaluate and compare the assisted reproductive technique (ART) outcomes of women with endometriomas either with or without prior endometrioma surgery. MATERIALS AND METHODS: A total of 122 women with endometriomas underwent intracytoplasmic sperm injection-embryo transfer (ICSI-ET) at a tertiary IVF Center, between 2014 and 2019, were included in this retrospective study. Of this group, 38 patients had recurrent endometriomas and 84 patients had primary endometrioma without a previous endometrioma surgery. The outcomes of ART treatment including cancellation rates before ET, numbers of oocytes obtained, implantation, clinical pregnancy and live birth rates were compared between the groups. A logistic regression model including potential confounders as age and presence of male factor infertility was used to evaluate the possible effect of recurrent endometriomas on the live birth. RESULTS: The baseline characteristics of the groups were similar. The poor ovarian response rate, defined as the harvest of fewer than four oocytes, was identified in 35.7% and 42.1% of primary and recurrent endometrioma groups, respectively. The implantation (27.2 ± 42.7% vs 24.1 ± 41.4%, P = .74), clinical pregnancy/ET (30.9% vs 27.6%, P = .93 ) and live birth rates/ET (22.1% vs 17.2%, P = .79) CONCLUSION: The ART outcomes of patients with primary and recurrent endometriomas do not seem different in terms of response to ovarian stimulation and live birth rates after ICSI. These results may indicate that the recurrence of the endometrioma might not have a further detrimental effect on ART outcome than the disease itself.

Evaluation of the nutritional habits of second-year high school students in the Seferihisar region with the ecological framework / Avaliação dos hábitos nutricionais dos alunos do segundo ano do ensino médio na Região de Seferihisar pelo modelo ecológico

ABSTRACT Objective The study aims to identify the nutritional habits of second-year high school students in Seferihisar, Turkey, and the factors associated thereof, based on the Ecological Framework. Methods In this cross-sectional study by a self-reported questionnaire, second-year high school students (n=392) attending public schools in Seferihisar had their nutritional habits measured with the Adolescent Food Habits Checklist scale. The food habit score was calculated and associated factors were evaluated in 4 layers based on the Mary Story's Ecological Framework (individual factors, social, physical and macro-level environments). The data analysis for the association of these layers with the food habits score was executed through multi-level linear regression. Results Students' participation rate was 87.7% (n=344). Of all the layers (from individual factors to the influence of the social environment and macro-level environment: nutritional literacy, the food consumption of their peers at school, availability of fruits-vegetables at home, buying junk food at the school canteen, presence of posters at school, etc.), the option for advertised food items was statistically explanatory based on the linear regression analysis (p<0.05). Conclusions The model derived from the Ecological Framework explained 45% of the nutritional habits with an equivalent contribution from the four layers. Availability of healthy food items where the students lived and higher levels of nutritional literacy led to healthy nutritional habits. Having healthy food items sold at school canteens at affordable prices, using posters to promote a healthy diet, and introducing nutrition-related courses into the curricula would support students in developing healthy nutritional habits.

RESUMO Objetivo O presente estudo almeja determinar os hábitos nutricionais de adolescentes do 2º ano do Ensino Médio em Seferihisar, Turquia, e os fatores associados a esses hábitos no âmbito da Teoria Ecológica. Métodos Neste estudo transversal de questionário autoadministrado, os hábitos nutricionais de alunos do 2º ano do Ensino Médio (n=392) de escolas públicas em Seferihisar foram avaliados através da escala da Lista de Verificação dos Hábitos Alimentares de Adolescentes. A pontuação de hábito alimentar foi calculada e os fatores associados foram avaliados em quatro camadas baseadas no modelo criado no âmbito da Teoria Ecológica de Mary Story (fatores individuais, sociais, físicos e ambientais de nível macro). A análise de dados para a associação dessas camadas com a pontuação dos hábitos alimentares foi executada através de regressão linear multinível. Resultados A taxa de participação dos alunos no estudo foi de 87,7% (n=344). Em relação a cada camada, foram avaliados desde fatores individuais, nível de conhecimento de nutrição, ambiente social, consumo de alimentos pelos colegas na escola, ambiente físico, disponibilidade de frutas e vegetais em casa, compras de comida sem qualidade na cantina da escola, presença de cartazes na escola e ambiente do nível macro. A preferência por alimentos anunciados foi estatisticamente explanatória com base na análise de regressão linear (p<0,05). Conclusão O modelo derivado da Teoria Ecológica explicou 45% dos hábitos nutricionais, com uma contribuição equivalente das quatro camadas. A presença de alimentos saudáveis no ambiente frequentado pelos alunos e um alto nível de conhecimento sobre nutrição trazem estimulam hábitos nutricionais saudáveis. A venda de alimentos saudáveis na cantina e no refeitório das escolas a presença de cartazes encorajando uma dieta saudável e a inclusão de cursos de nutrição no currículo tornarão mais conveniente aos alunos adotar um comportamento nutricional saudável.

Food addiction: A key factor contributing to obesity?

BACKGROUND: People may develop addiction to hyperpalatable foods, which may be a cause of obesity. This study aimed to determine the prevalence of obesity among adolescents and the effect of food addiction on obesity. MATERIALS AND METHODS: In this cross-sectional study, food addiction and obesity status of high school students were investigated. Among 17,000 10th and 11th grade students, assuming the design effect as 2.0, with obesity prevalence of 10%, with 3% error, and 95% confidence interval, at least 752 participants were included. Obesity was the dependent variable, whereas sociodemographic characteristics, body image, eating habits, and food addiction were the independent variables. Food addiction was assessed using the Yale Food Addiction Scale. Obesity was determined by age- and sex-specific body mass index (BMI) percentiles for adolescents < 18 years of age and BMI ≥ 30.0 for those aged ≥ 18. Data were collected through face-to-face interviews. Statistical analyses were performed using SPSS 25.0. After adjustment for age, sex, and other variables, the effect of food addiction on obesity was determined through logistic regression. P <0.05 was deemed statistically significant. RESULTS: Among adolescents (n = 874), 18.9% were food addict, 25.1% were overweight, and 12.1% were obese. After adjusted for age, sex, and other variables, food addiction significantly increased the risk of obesity (odds ratio: 1.9; 95% confidence interval: 1.167-3.335). Having a fragmented family, working mother, overweight father, and participants not knowing their weight correctly significantly increased obesity. CONCLUSION: While quarter of the adolescents had weight problems, one-fifth suffered from food addiction. After adjusting for confounders, food addiction significantly increased obesity. Identifying individuals with food addiction, providing treatment to overcome that, paying special attention to adolescents with obese parents or living in fragmented families, and providing support to both parents and adolescents could be useful in tackling obesity.

Live birth after frozen-thawed embryo transfer: which endometrial preparation protocol is better?

OBJECTIVE: To compare the clinical outcomes of modified natural cycle (mNC) and artificial cycle (AC) protocols for frozen embryo transfers. MATERIAL AND METHODS: A total of 490 frozen-thawed autologous embryo transfer cycles, performed in a single tertiary IVF center, between January 2015 and September 2017, were retrospectively analyzed. Of these, 214 cycles were performed after mNC and 276 cycles were performed after gonadotrophin-releasing hormone (GnRH) agonist plus sequential estrogen and progestin priming protocol. The primary outcome was live birth and secondary outcomes were clinical pregnancy, implantation and miscarriage rates. Multivariate regression analysis was used to adjust covariates on clinical outcome. RESULTS: The rates of live birth (33.6 % vs. 29.3 %, respectively), clinical pregnancy (40.2 % vs. 36.6 %, respectively), implantation (32.3 % vs. 28.5 %, respectively), and miscarriage (5.1 % vs. 6.9 %, respectively) were not different between the mNC and AC groups. Multivariate analysis also showed that the method for endometrial preparation had no significant effect on clinical pregnancy and live birth. The adjusted odds ratios (OR) of live births and clinical pregnancies were 0.97 (95 % CI 0.64-1.48) and 0.98 (95 % CI 0.65-1.46) for the AC compared to mNC group. However, there was a significant difference between mNC and AC in cycles in which double embryo transfer was performed. The live birth (48 % vs. 31.4 %P= 0.01) and clinical pregnancy rates (53.9 % vs. 38.8 %, P= 0.02) were significantly higher in the mNC group than the AC group for double embryo transfers. CONCLUSION: The live birth and clinical pregnancy rates are comparable between mNC and AC with GnRH agonists in frozen thawed embryo transfer cycles. In ovulatory patients with planned double embryo transfer, mNC can be considered. Further well-designed prospective studies are needed to confirm our results.

Prevalence of sarcopenia and related factors in community-dwelling elderly individuals.

OBJECTIVES:  To determine the prevalence of sarcopenia and related factors in individuals aged ≥65 years living in the Bornova district of Izmir, Turkey. Sarcopenia is one of the most serious health problems among elderly individuals. METHODS:  This cross-sectional study was conducted in the Bornova district of Izmir, Turkey, between February-July 2015. This study participants were comprised of 909 individuals aged ≥65 years. The dependent variable was the presence of sarcopenia and the European Working Group on Sarcopenia in Older People (EWGSOP) approach was used for determining sarcopenia. The independent variables were socio-demographic and economic characteristics, healthy life behaviors and health status/condition. Data were collected at home through face-to-face interviews and measurements, analysed using chi-square test, t-test and logistic regression analysis. RESULTS:  The participants' mean age was 72.8±6.2 (range: 65-100) years, and 60.2% were female (n=582). The prevalence of sarcopenia was 5.2% and that of low gait speed was 41.0%, low grip strength was 57.0%, low calf circumference was 6.1% and the combination of low gait speed and low grip strength was 14.3%. Risk factors of sarcopenia included increasing age, physical inactivity, low body mass index and the presence or risk of malnutritionConclusion: The prevalence of sarcopenia was 5.2% in this population and increased with age, physical inactivity, low body mass index and the presence or risk of malnutrition.

Evaluation of sarcopenia, sarcopenic obesity, and phase angle in geriatric gastrointestinal cancer patients: before and after chemotherapy

Background/aim: The purpose of this study was to determine sarcopenia, sarcopenic obesity and phase angle (PA) and the influence of chemotherapy (CT) on anthropometric measurements and and the PA in in geriatric patients with gastrointestinal (GI) cancer. Materials and methods: The anthropometric measurements, calf circumference (CC), upper midarm circumference (UMAC), and hand grip strength (HGS), have been measured to understand muscle function of 153 patients (mean age of 70.5 ± 5.6 years, 28.8% female, 71.2% male). Sarcopenia and PA measurements have been evaluated by bioelectrical impedance analyses. The same evaluations were checked again after 1 cycle of CT (min: 4, max: 6 weeks). Results: Patient population consisted of colorectal (51,6%), gastric (26.8%), pancreas (11.8%), liver (7.2%), and biliary tract cancer (2%). UMAC (28.5 ± 4.4 before, 28.1 ± 4.9, P = 0.034 after CT), and HGS measurements (27.5 ± 8.6 before, 26.8 ± 8.8 after CT, P = 0.007) have significantly decreased after CT. CC measurement < 31 cm at first visit was seen in 13.1% of patients, but the ratio raised to 20.3% after CT (χ², P = 0.003). Severe sarcopenia was determined in 33% of all patients, and 30.0% of them have been considered as sarcopenic obese. Conclusion: Sarcopenia and sarcopenic obesity were prevalent in this group patients. The CT caused a decrease in muscle functions, UMAC, and CC. Patients should be followed up carefully for sarcopenia, sarcopenic obesity, and nutritional aspect and it would be proper to intervene before sarcopenia has not occurred yet.

Association of sarcopenia with depressive symptoms and functional status among ambulatory community-dwelling elderly.

OBJECTIVE: Sarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even mortality. This study aims to determine the association of sarcopenia with depression and functional status among ambulatory community-dwelling elderly aged 65 years and older. MATERIALS AND METHOD: The sample of this cross-sectional study consisted of 28,323 people, aged 65 years and older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However, 966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data were collected by the interviewers at home through face-to-face interview. RESULTS: The mean age was 72.2 ±â€¯5.8 (65-100) years. The prevalence of functional disability, depressive symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/moderate, increased number of chronic diseases, and having at least one physical disability. IADL associated functional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications, and the BMI. CONCLUSION: Sarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional disability and depression. Appropriate interventions should also be implemented.

Is overactive bladder microvasculature disease a component of systemic atheroscleorosis?

AIMS: To evaluate the relationship between overactive bladder (OAB) and systemic atherosclerosis in a cohort of women. METHODS: In this case-control study, we assessed atherosclerosis indicators, such as Framingham risk scores and carotid and femoral artery intima-media thickness, and evaluated possible bladder wall responses to atherosclerosis using endovaginal color Doppler ultrasound and the detection of urinary cytokines in women with OAB and in controls. Quantitative assessment of blood perfusion at the bladder neck was performed using a method that allows for the dynamic monitoring of flow in a predefined region of interest at every point of the cardiac cycle. The independent samples t-test was used to evaluate the relationship between OAB and the atherosclerotic findings when parametric conditions were met, and the Mann-Whitney U test was used when parametric conditions were not met. Kendall's Tau was used to assess the correlation between OAB severity and the atherosclerotic variables. P < 0.05 was considered statistically significant. RESULTS: There were 74 OAB patients and 73 controls; in total, 147 women were evaluated. We found that all atherosclerosis indicators were significantly associated with OAB and that there was a significant relationship between OAB and decreased bladder neck perfusion. Additionally, there were correlations of OAB severity with systemic atherosclerosis and impaired vascular perfusion of the bladder. CONCLUSIONS: Decreased perfusion at the bladder neck, the Framingham scores in severe OAB, and the correlation between them suggest that OAB microvascular disease may be a component of systemic atherosclerosis rather than a separate process.

Reliability and Validity of the Diabetes Eating Problem Survey in Turkish Children and Adolescents with Type 1 Diabetes Mellitus.

OBJECTIVE: The aim of this study was to show the reliability and validity of a Turkish version of Diabetes Eating Problem Survey-Revised (DEPS-R) in children and adolescents with type 1 diabetes mellitus. METHODS: A total of 200 children and adolescents with type 1 diabetes, ages 9-18 years, completed the DEPS-R Turkish version. In addition to tests of validity, confirmatory factor analysis was conducted to investigate the factor structure of the 16-item Turkish version of DEPS-R. RESULTS: The Turkish version of DEPS-R demonstrated satisfactory Cronbach's ∝ (0.847) and was significantly correlated with age (r=0.194; p<0.01), hemoglobin A1c levels (r=0.303; p<0.01), and body mass index-standard deviation score (r=0.412; p<0.01) indicating criterion validity. Median DEPS-R scores of Turkish version for the total samples, females, and males were 11.0, 11.5, and 10.5, respectively. CONCLUSION: Disturbed eating behaviors and insulin restriction were associated with poor metabolic control. A short, self-administered diabetes-specific screening tool for disordered eating behavior can be used routinely in the clinical care of adolescents with type 1 diabetes. The Turkish version of DEPS-R is a valid screening tool for disordered eating behaviors in type 1 diabetes and it is potentially important to early detect disordered eating behaviors.

Systemic atherosclerosis and voiding symptom.

OBJECTIVE: To evaluate the effect of atherosclerosis on the storage and voiding symptoms of the bladder in women with overactive bladder (OAB). STUDY DESIGN: We retrospectively reviewed the charts of women with OAB who were evaluated between 2013 and 2015 in our urogynecology unit. Charts were assessed for history, examination findings, urinary diary, quality of life (QOL) questionnaires, urodynamic studies (UDSs), and four main risk factors for atherosclerosis: hypertension, diabetes mellitus, smoking, and hyperlipidemia. In a previous study, these were defined as vascular risk factors. Cases were excluded for insufficient data, diabetes mellitus with dysregulated blood glucose, or prolapse greater than 1cm to avoid confusing bladder outlet obstruction. We included 167 eligible cases in this study. We evaluated storage and voiding symptoms such as frequency, nocturia, residual urine volume, and voiding difficulties and UDS findings such as maximum bladder capacity, first desire, strong desire, detrusor overactivity, and bladder contractility index. The vascular risk score was categorized as "no risk" if the woman did not have any of the four risk factors and "at risk" if she had any of the factors. Independent sample t-test and chi-square tests were performed for analyses. RESULTS: Among the participants (n=167), 71.9% had at least one vascular risk factor. Those who were at risk were facing significantly more wet-type OAB (p=0.003) and nocturia (p=0.023). Moreover, mean age (p=0.008) and mean gravidity (p=0.020) were significantly higher in the at-risk group, whereas mean total nocturia QOL questionnaire scores (p=0.029) were significantly lower. CONCLUSION: Our findings suggest that aging and atherosclerosis may be associated with severe OAB and poorer QOL. Nocturia and related parameters of poor quality can be explained by impaired bladder neck perfusion. Future trials need to assess vascular and molecular changes in women with OAB.

Renal Ischemia/Reperfusion Injury in Diabetic Rats: The Role of Local Ischemic Preconditioning.

BACKGROUND: The aim of this study was to evaluate the effects of local ischemic preconditioning using biochemical markers and histopathologically in the diabetic rat renal IR injury model. METHODS: DM was induced using streptozotocin. Rats were divided into four groups: Group I, nondiabetic sham group (n = 7), Group II, diabetic sham group (n = 6), Group III, diabetic IR group (diabetic IR group, n = 6), and Group IV, diabetic IR + local ischemic preconditioning group (diabetic IR + LIPC group, n = 6). Ischemic renal injury was induced by clamping the bilateral renal artery for 45 min. 4 h following ischemia, clearance protocols were applied to assess biochemical markers and histopathologically in rat kidneys. RESULTS: The histomorphologic total cell injury scores of the nondiabetic sham group were significantly lower than diabetic sham, diabetic IR, and diabetic IR + LIPC groups. Diabetic IR group scores were not significantly different than the diabetic sham group. But diabetic IR + LIPC group scores were significantly higher than the diabetic sham and diabetic IR groups. CONCLUSION: Local ischemic preconditioning does not reduce the risk of renal injury induced by ischemia/reperfusion in diabetic rat model.

Comparison of the effects of dexmedetomidine administered at two different times on renal ischemia/reperfusion injury in rats.

BACKGROUND AND OBJECTIVES: We investigated the effect of dexmedetomidine on ischemic renal failure in rats. METHODS: In the present study, 26 male adult Wistar albino rats weighting 230-300 g were randomly separated into four groups: sham-operated (n=5), ischemia reperfusion (IR) (IR group, n=7), IR/reperfusion treatment with dexmedetomidine (Dex. R group, n=7) and IR/pre-ischemic treatment with dexmedetomidine (Dex. I group, n=7). In the first group, sham operation was achieved and renal clamps were not applied. For the IR group, renal ischemia was induced by occlusion of the bilateral renal arteries and veins for 60 min followed by reperfusion for 24h. For the Dex. R and Dex. I groups, the same surgical procedure as in the IR group was performed, and dexmedetomidine (100 mcg/kg intraperitoneal) was administrated at the 5th min after reperfusion and before ischemia. At the end of reperfusion, blood samples were drawn, the rats were sacrificed, and the left kidney was processed for histopathology. RESULTS: The blood urea nitrogen (BUN) levels in groups Dex. R and Dex. I were significantly lower than in the IR group (p=0.015, p=0.043), although urine flow was significantly higher in group Dex. R (p=0.003). The renal histopathological score in the IR group was significantly higher than in the other groups. There was no significant difference between the Dex. R and Dex. I groups. CONCLUSIONS: The results were shown that administration of dexmedetomidine reduced the renal IR injury histomorphologically. Administration of dexmedetomidine in the reperfusion period was considered as more effective due to increase in urinary output and decrease in BUN levels.

Comparison of the effects of dexmedetomidine administered at two different times on renal ischemia/reperfusion injury in rats / Comparação dos efeitos de dexmedetomidina administrada em dois momentos diferentes para lesão de isquemia/reperfusão renal em ratos / Comparación de los efectos de la dexmedetomidina administrada en 2 momentos diferentes para lesión de isquemia-reperfusión renal en ratones

Background and objectives: We investigated the effect of dexmedetomidine on ischemic renal failure in rats. Methods: In the present study, 26 male adult Wistar albino rats weighting 230-300 g were randomly separated into four groups: sham-operated (n = 5), ischemia reperfusion (IR) (IR group, n = 7), IR/reperfusion treatment with dexmedetomidine (Dex. R group, n = 7) and IR/pre-ischemic treatment with dexmedetomidine (Dex. I group, n = 7). In the first group, sham operation was achieved and renal clamps were not applied. For the IR group, renal ischemia was induced by occlusion of the bilateral renal arteries and veins for 60 min followed by reperfusion for 24 h. For the Dex. R and Dex. I groups, the same surgical procedure as in the IR group was performed, and dexmedetomidine (100 mcg/kg intraperitoneal) was administrated at the 5th min after reperfusion and before ischemia. At the end of reperfusion, blood samples were drawn, the rats were sacrificed, and the left kidney was processed for histopathology. Results: The blood urea nitrogen (BUN) levels in groups Dex. R and Dex. I were significantly lower than in the IR group (p = 0.015, p = 0.043), although urine flow was significantly higher in group Dex. R (p = 0.003). The renal histopathological score in the IR group was significantly higher than in the other groups. There was no significant difference between the Dex. R and Dex. I groups. Conclusions: The results were shown that administration of dexmedetomidine reduced the renal IR injury histomorphologically. Administration of dexmedetomidine in the reperfusion period was considered as more effective due to increase in urinary output and decrease in BUN levels. .

Justificativa e objetivos: Investigar os efeitos de dexmedetomidina sobre a insuficiência renal isquêmica em ratos. Métodos: No presente estudo, 26 ratos machos adultos, albinos Wistar, com peso 230-300 g, foram randomicamente divididos em quatro grupos: pseudo-operado (n = 5), isquemia-reperfusão (grupo IR, n = 7), IR/tratamento de reperfusão com dexmedetomidina (grupo Dex-R, n = 7) e IR/tratamento pré-isquemia com dexmedetomidina (grupo Dex-I, n = 7). No primeiro grupo, uma pseudo-operação foi feita e clampeamentos renais não foram aplicados. No grupo IR, isquemia renal foi induzida por oclusão das artérias e veias renais bilaterais durante 60minutos seguida por reperfusão durante 24horas. Nos grupos Dex-R e Dex-I, o mesmo procedimento cirúrgico destinado ao grupo IR foi feito e dexmedetomidina (100mcg/kg intraperitoneal) foi administrada cinco minutos após a reperfusão e antes da isquemia. No fim da reperfusão, amostras de sangue foram coletadas, os ratos foram sacrificados e os rins esquerdos processado para histologia. Resultados: Os níveis de nitrogênio ureico no sangue (BUN) dos grupos Dex-R e Dex-I estavam significativamente mais baixos do que os do grupo IR (p = 0,015, p = 0,043), embora o fluxo urinário tenha sido significativamente maior no grupo Dex-R (p = 0,003). O escore histopatológico renal do grupo IR foi significativamente maior do que os dos outros grupos. Não houve diferença significativa entre os grupos Dex-R e Dex-I. Conclusões: Os resultados demonstraram que a administração de dexmedetomidina reduziu histomorfologicamente a lesão de IR renal. A administração de dexmedetomidina durante o período de reperfusão foi considerada como mais eficaz por causa do aumento do débito urinário e da diminuição dos níveis de BUN. .

Justificación y objetivos: investigar los efectos de la dexmedetomidina sobre la insuficiencia renal isquémica en ratones. Métodos: en el presente estudio, 26 ratones machos adultos, albinos Wistar, con un peso de 230-300 g fueron divididos aleatoriamente en 4 grupos: seudooperado (n = 5), isquemia-reperfusión (grupo IR, n = 7), IR/tratamiento de reperfusión con dexmedetomidina (grupo Dex-R, n = 7) e IR/tratamiento preisquemia con dexmedetomidina (grupo Dex-I, n = 7). En el primer grupo, se realizó una seudooperación y no se aplicaron pinzamientos renales. En el grupo IR, la isquemia renal fue inducida por oclusión de las arterias y venas renales bilaterales durante 60 min seguida por reperfusión durante 24 h. En los grupos Dex-R y Dex-I, se llevó a cabo el mismo procedimiento quirúrgico destinado al grupo IR, y la dexmedetomidina (100 µg /kg intraperitoneal) fue administrada 5 min después de la reperfusión y antes de la isquemia. Al final de la reperfusión, fueron recogidas muestras de sangre, los ratones fueron sacrificados y el riñón izquierdo procesado para histología. Resultados: los niveles de nitrógeno ureico en la sangre (BUN) de los grupos Dex-R y Dex-I eran significativamente más bajos que los del grupo IR (p = 0,015; p = 0,043), aunque el flujo urinario era significativamente mayor en el grupo Dex-R (p = 0,003). La puntuación histopatológica renal del grupo IR fue significativamente mayor que la de los otros grupos. No hubo diferencia significativa entre los grupos Dex-R y Dex-I. Conclusiones: los resultados demostraron que la administración de dexmedetomidina redujo histomorfológicamente la lesión de IR renal. La administración de dexmedetomidina durante el período de reperfusión fue considerada más eficaz debido al aumento de producción de orina y a la disminución ...

Waist:height ratio: a superior index in estimating cardiovascular risks in Turkish adults.

OBJECTIVE: To determine the best anthropometric measurement among waist: height ratio (WHtR), BMI, waist:hip ratio (WHR) and waist circumference (WC) associated with high CHD risk in adults and to define the optimal cut-off point for WHtR. DESIGN: Population-based cross-sectional study. SETTING: Balcova, Izmir, Turkey. SUBJECTS: Individuals (n 10 878) who participated in the baseline survey of the Heart of Balcova Project. For each participant, 10-year coronary event risk (Framingham risk score) was calculated using data on age, sex, smoking status, blood pressure, serum lipids and diabetes status. Participants who had risk higher than 10 % were defined as 'medium or high risk'. RESULTS: Among the participants, 67·7% were female, 38·2% were obese, 24·5% had high blood pressure, 9·2% had diabetes, 1·5% had undiagnosed diabetes (≥126 mg/dl), 22·0% had high total cholesterol and 45·9% had low HDL-cholesterol. According to Framingham risk score, 32·7% of them had a risk score higher than 10 %. Those who had medium or high risk had significantly higher mean BMI, WHtR, WHR and WC compared with those at low risk. According to receiver-operating characteristic curves, WHtR was the best and BMI was the worst indicator of CHD risk for both sexes. For both men and women, 0·55 was the optimal cut-off point for WHtR for CHD risk. CONCLUSIONS: BMI should not be used alone for evaluating obesity when estimating cardiometabolic risks. WHtR was found to be a successful measurement for determining cardiovascular risks. A cut-off point of '0·5' can be used for categorizing WHtR in order to target people at high CHD risk for preventive actions.

Evaluation of education, attitude, and practice of the Turkish anesthesiologists in regional block techniques.

BACKGROUND: The demand for regional blocks from both patients and surgeons has significantly increased in anesthesia practice during the last 30 years. Although the studies show that the complications are rare, regional blocks still have serious difficulties which can be prevented by training programs. OBJECTIVES: The purpose of this study was to determine the factors affecting the educational methods, attitude and practice of the Turkish anesthesiologists in regional blocks during and following residency programs. PATIENTS AND METHODS: Anesthesiologists were asked to answer a questionnaire. Educational proficiency was determined by at least 50 spinal, 50 epidural and 50 peripheral block applications during residency. Specialists were asked for the numbers of spinal, epidural and peripheral blocks (PBs) they applied in 2009. The mean and median values were calculated. RESULTS: One hundred and eighty-eight anesthesiologists (84.3 %) agreed to participate in the study. While all participants had made their first attempts in neuraxial blocks (NBs) when they were residents, this ratio was detected as 96.8% for PBs. All participants learned neuraxial and PBs on patients in the operating theater. Education proficiency ratios for spinal, epidural and PBs were 98.1 %, 92.5 % and 62.3 %, respectively. Age, perception of adequate training, nerve block rotation, adequate application in education, following innovations were the factors which significantly affected the number of PBs in practice according to univariate analysis. The participants who consider their applications on NBs were adequate (P = 0.029) and the ones working in state or private hospitals (P = 0.017), applied NBs significantly above the median number. CONCLUSIONS: Anesthesiologists had adequate education and practice of NB applications but a significant proportion of participants (51.8%) lacked both in PBs applications. We believe that NBs are more easily learned than PBs during residency training program.

Effects of blood products on nosocomial infections in liver transplant recipients.

OBJECTIVES: Infection is the most severe complication after an organ transplant. Blood cell transfusion is an independent risk factor for adverse events, including infection in the recipient. This study sought to evaluate the effect of blood product transfusions on nosocomial infections in liver transplant patients. MATERIALS AND METHODS: Patients who underwent a liver transplant at our hospital between 2003 and 2010 were recruited for this study. Exclusion criteria were incomplete records, patients who were hospitalized for more than 48 hours during the 4 weeks before transplant, and pediatric transplants. Incidence of nosocomial infections, which were defined as infections occurring within 30 days after transplant was the primary endpoint. RESULTS: The incidence of nosocomial infections was 28.7%. The number of transfusions of packed red blood cells and fresh frozen plasma was significantly higher in patients with nosocomial infection compared with patients without nosocomial infection (P = .018 and P = .039). Blood products dose-dependently contributed to nosocomial infections. Transfusions of ≥ 7.5 units of red blood cells (odds ratio: 2.8) or ≥ 12.5 units of fresh frozen plasma (odds ratio: 3.27) were associated with nosocomial infections (P = .042 and P = .015). The infection-related mortality rate was 10.3%. CONCLUSIONS: Blood product transfusions are associated with an increased rate of nosocomial infections, which contributes to higher morbidity and mortality.