Assessment of sensitivity to the anesthesia in a diabetic rat model.

OBJECTIVE: Diabetes mellitus and glucose regulation are important in deciding on surgical intervention in pre-surgical assessments. In our study, we aimed to investigate the correlations between the induction time of anesthesia, glucose level, and weight in a diabetic rat model. MATERIALS AND METHODS: Weight-matched adult male Wistar rats were grouped as control (n=8) and diabetic (n=8). In the latter group, diabetes was induced with a single intraperitoneal injection of 50 mg/kg streptozotosin. 72 hours after the injection, animals possessing a blood glucose concentration above 300 mg/kg were considered diabetic. The weights and blood glucose levels were observed for 7 days. In the end, 80 mg/kg ketamine and 12 mg/kg xylazine were administered to both groups, and the induction time of anesthesia was recorded. The success of anesthesia was confirmed with toe pinching by using a clamp. The Student's t- and Pearson's correlation tests were used for statistical analyses. RESULTS: The induction time of anesthesia was significantly reduced in the diabetic group compared to the controls (p<0.01). Diabetic animals weighed less than the control group (p<0.01). The correlation analysis in the diabetic group showed that the weight and blood glucose level of animals did not influence the induction time of anesthesia (respectively, p=0.80, r: 0.150; p=0.68, r: -0.300). A negative correlation between blood glucose concentration and weight was found in diabetics (p<0.05, r: -0.828). CONCLUSIONS: The dosage of anesthetic agents is important in the effectiveness of anesthesia, and surgical complications. Since our results indicate the susceptibility of diabetics to anesthesia, we suggest that the dose of anesthetics should be finely adjusted considering the presence of diabetes.

Assessment of atrial fibrillation and ventricular arrhythmia risk in patients with asthma by P wave/corrected QT interval dispersion.

OBJECTIVE: Although the relationship between obesity-asthma, obesity-atrial fibrillation (AF) and obesity-sudden cardiac death is clearly known, the risk of AF and ventricular arrhythmia has not been clearly determined in asthmatic patients. The aim of this study was to investigate whether AF, ventricular arrhythmia, and sudden cardiac death risk were increased in asthmatic patients using P wave dispersion (PWD) and corrected QT interval dispersion (CQTD). PATIENTS AND METHODS: The study was designed as a cross-sectional study. A total of 164 participants (88 patients with asthma and 76 healthy volunteers) were enrolled into the study. PWD and CQTD were measured and recorded in both groups. The statistical difference between the two groups was examined. RESULTS: PWD was higher in the asthma patients than in control subjects (31.53 ± 3.18 vs. 30.33 ± 3.53, p = 0.023). However, there was no statistically difference between the groups in terms of CQTD measurement (43.9 ± 1.84 vs. 43.63 ± 2.06, p = 0.385). In comparison between control group and asthma subgroups (mild, moderate and severe), there was a statistically significant difference among these four groups in terms of PWD (p = 0.017). Subgroup analyses showed that this difference was mainly due to patients with severe asthma. CONCLUSIONS: PWD value was elevated in asthmatic compared to the control group. The CQTD was not statistically significant between the groups. These results indicate that the risk of developing AF in asthmatic patients might be higher than in the normal population. Ventricular arrhythmia and sudden cardiac death risk may not be high in asthmatic patients.

Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography.

BACKGROUND: An understanding of the left main coronary artery (LMCA) anatomy is important for accurate diagnosis and therapy. We aimed to investigate LMCA anatomy via 128-multisliced coronary computed-tomography-angiography (CCTA) in patients with normal LMCA. MATERIALS AND METHODS: A total of 201 CCTA studies were included in this study. Anatomical features of LMCA including cross-sectional areas of the LMCA ostial, LMCA distal, left anterior descending artery (LAD) ostial and left circumflex artery (LCX) ostial, and degree of tapering and LMCA bifurcation angles (BA) in the form of LMCA-LCX BA, LMCA-LAD BA, LAD-LCX BA at end-diastole and end-systole. RESULTS: The mean age was 55 ± 11; 55.7% of patients were males. Right coronary artery was dominant in 173 (86.1%) patients. Mean LMCA length was 10.0 ± 4.5 mm. The mean values of LMCA ostial, LMCA distal, LAD ostial and LCX ostial areas were 18.2 ± 5.1 mm², 13.2 ± 4.0 mm², 9.0 ± 3.2 mm² and 7.6 ± ± 2.8 mm², respectively. LMCA ostial-distal area, LMCA distal-LAD ostial area and LMCA distal-LCX ostial area ratios were ≥ 1.44 - < 1.69 in 47 (23.4%), 53 (26.4%), 47 (23.4%) patients, respectively, and were ≥ 1.69 - < 1.96 in 19 (9.5%), 24 (11.9%), 40 (19.9%) patients respectively. Systolic motion modifies LMCA BAs; systolic motion begets an increment of LMCA-LAD angle in 72.6% of patients and decrement of LAD-LCX angle in 75.6% of patients. Patients with T-shaped LAD-LCX BA was shown to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher diastolic-to-systolic range (DSR) of LAD-LCX BA compared to patients with Y-shaped LAD-LCX BA. CONCLUSIONS: LMCA with T-shaped distal BA was found to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher DSR of distal BA compared to patients with Y-shaped distal BA. These findings may provide useful information for LMCA bifurcation stenting or designing dedicated stents for LMCA.

Vestibular migraine screening in a migraine-diagnosed patient population, and assessment of vestibulocochlear function.

OBJECTIVE: The primary aim of this study is to do a vestibular migraine scan in a population of patients with migraine diagnosis using the most recent standardized diagnosis criterion which is International Classification of Headache Disorders (ICHD) 3 Beta and to identify the epidemiological data. The second part of the study involves performing several vestibulocochlear tests on patients who received vestibular migraine (VM) diagnosis to collect data that may be important for diagnostic purposes by comparing the patients with normal population when necessary. DESIGN: Blind, cross-sectional study. SETTING: Tertiary referral hospital. PARTICIPANTS: One hundred patients were scanned for VM using ICHD 3 Beta guideline. MAIN OUTCOME MEASURES: In order to evaluate the vestibulocochlear functions of the patients with VM diagnosis, audiometry, tympanometry, electrocochleography (EcochG), computerized dynamic posturography (CDP) and video head impulse test (vHIT) were performed; besides in order to evaluate the significance of the results of the tests, second group was formed with migraine patients without any vestibular complaints and control group was formed from healthy population when needed. RESULTS: VM prevalence was determined to be 21% in migraine patients which is much higher than stated in current literature. No significant difference was observed between migraine and VM patients with respect to audiometric and tympanometric measurements. According to the CDP results, balance defects were present in VM patients, even during attack-free periods. EcochG data suggests average SP/AP scores of VM patients are significantly higher than migraine patients. Furthermore, the number of patients who exceeded a limit value of 0.4 or 0.5 in SP/AP scores was significantly higher in VM patients than in migraine patients. Also vHIT results show that nearly half the VM patients, which is a significant ratio, have saccadic movements and this is thought to be compatible with peripheral vestibular involvement. CONCLUSION: Our results suggest VM disease is more common than previously thought. We believe that further EcochG-based studies would shed light on the controversial topic on the intersection and disjunction sets of MD and VM diseases. Although the results of the present study are compatible with peripheral vestibular effects, it is not possible to rule out another central mechanism at some other level.

Assessment of left atrial functions in cardiac syndrome X.

OBJECTIVE: Cardiac syndrome X (CSX) affects left ventricular functions due to myocardial ischaemia. In this study our aim was to determine the changes in left atrial functions in patients with CSX. PATIENTS AND METHODS: One-hundred patients (M/F; 57/43) diagnosed with CSX in whom ischaemia was detected at exercise test and myocardial perfusion scintigrapghy with normal coronary angiogram and control group of 80 subjects (M/F; 40/40) were recruited into the study. In transthoracic echocardiography and tissue doppler echocardiography, left ventricular and atrial functions were recorded. RESULTS: As compared to control group,left ventricular diastolic functions were impaired (E/A; 0.95 ± 0.18 vs 1.11 ± 0.29 p < 0.001), left ventricular end-diastolic pressures were increased (E/Em; 8.1 ± 1.85 vs 6.9 ± 1.74 p < 0.05), and left atrial maximum volume, left atrial pre-A volume,left atrial minimum volume were increased in patients with CSX. Left atrial conduit volume was significantly decreased in patients with cardiac syndrome. Left atrial passive emptying volume (LAPEV), left atrial active emptying volume (LAAEV) and left atrial total emptying volume (LATEV) were significantly increased in patients with cardiac syndrome X. Left atrial passive ejection fration (LAPEF) was found similar between the study groups.Left atrial active ejection fraction (LAAEF) was found significantly increased (37.85 ± 11.89 vs 33.60 ± 9.21; p = 0.009) in patients with CSX. Left atrial total ejection fraction (LATEF) was increased in the group with cardiac syndrome X but it didn't reach statistical significance (60.85 ± 8.73 vs 58.36 ± 8.29; p = 0.054). CONCLUSIONS: Left atrial active contractile pump function increase in response to impaired left ventricular diastolic functions in CSX. Increased left atrial pump function represents a compensatory mechanism in patients with CSX. These results point out the importance of maintaining sinus rythm in patients with CSX.

[Quality of antibiotic (fluoroquinolons, aminosids and amoxicillin-clavulanic acid) prescription in a French teaching hospital]. / Qualité des prescriptions antibiotiques (fluoroquinolones, aminosides et amoxicilline-acide clavulanique); évaluation dans les secteurs de médecine d'un centre hospitalier universitaire.

OBJECTIVES: To assess the quality of prescription of fluoroquinolons, aminosids and amoxicillin-clavulanic acids in medicine departments. METHODS: Data on target antibiotic prescription were collected on a given day and confronted to local recommendations and literature guidelines. Evaluation of antibiotic therapy was done by assessing molecule choice, administration conditions (dosages, route and administration schedule, treatment duration), reassessment of treatments 48-72 h later, dose adaptation of aminosids depending on serum monitoring. RESULTS: Sixty-three patients were included and 67 "target" antibiotics were prescribed. Prevalence of antibiotic-treated patients was 24.4%, and 14.6% for "target" antibiotic-treated patients. Antibiotic choice was appropriate in 67% of prescriptions. Dosages were adequates in 94% of case and administration schedule in 97% of cases. The oral route administration as soon as possible was applied to half of patients. Treatment duration were respected for 94% of prescriptions. Reassessment of antibiotic therapy 48-72 h later was realized in 66% of cases. Dose adaptation of aminosids, when necessary, was realized on one third of cases. For all the quality criteria assessed, the overall frequency of prescription conformity was 44%. CONCLUSION: Large diffusion of protocols, systematic reassessment of treatments at 48-72 h, promotion of training sessions for new prescribers in the institution, reinforcing the function of medical correspondents in antibiotic therapy and infectiologists, periodic evaluation of antibiotic therapy, should improve the quality of antibiotic therapy.

Assessment of the ear and otoacoustic emission findings in fibromyalgia syndrome.

OBJECTIVE: We aimed to assess otoacoustic emission (OAE) findings in fibromyalgia (FM) syndrome. METHODS: Thirty-two ears of 16 female patients with FM syndrome and 30 ears of 15 healthy female controls were also included in the study. Pure tone audiometry, speech discrimination testing, tympanometry and otoacoustic emission testing (both transiently evoked and distortion product) were performed. RESULTS: There was no significant difference between the pure tone hearing results of the patients and controls (p > 0.05). There was no significant difference between the distortion-product-otoacoustic emission results of the patients and controls. Audiologic findings of the patients with and without otologic symptoms were not significantly different than controls (p > 0.05). CONCLUSION: Although FM patients generally have subjective symptoms related to ear, clinical or laboratory assessments usually fail to find out any objective finding related to these subjective symptoms. The otologic functions seem spared in FM syndrome.

Assessment of migraine-related cochleovestibular symptoms.

The objective was to assess the cochleovestibular symptoms in migraine. Therefore, a questionnaire form was prepared to record the data obtained from 20 migraineurs. All patients were assessed with audiometry, bithermal caloric testing and auditory brainstem response testing (ABR) between the migraine attacks, and 8 of them were also assessed during the attacks. Dizziness (30%) was the most common symptom that was followed by vertigo (25%) and tinnitus (20%). All patients had hearing within normal limits. Positional test (Hallpike maneuver) was positive in 2 (10%). Bithermal caloric testing revealed canal paresis in 3 (15%) patients. ABR results were normal in 13 patients. Seven patients (35%) had abnormal ABR results. Four of them (20%) had elongation in the absolute wave latencies (wave I, III and V) and normal IPLs of wave I-III, III-V and I-V. Three (15%) patients had elongation in the absolute wave latencies as well as in the IPLs of wave I-III, III-V and I-V. In conclusion, cochleovestibular symptoms can be seen in migraineurs. The test results between and during attacks are similar. The subjective cochleovestibular symptoms did not correlate with the objective tests performed (audiometry, ABR and caloric testing).

Assessment of DNA strand breakage by comet assay in diabetic patients and the role of antioxidant supplementation.

Diabetes patients often show increased production of reactive oxidative species (ROS) together with vascular complications. The presence of these ROS may lead to increased DNA damage in peripheral blood lymphocytes that may be revealed by the comet assay. To test whether DNA is damaged in diabetes, peripheral blood samples were taken from 30 control individuals and 63 diabetic patients (15 insulin dependent (IDDM) and 48 non-insulin dependent (NIDDM)) and the alkaline comet assay was used to evaluate background levels of DNA damage. Significant differences were detected between control and diabetic patients in terms of frequencies of damaged cells. The extend of DNA migration was greater in NIDDM patients by comparison with IDDM patients which might indicate that IDDM patients are handling more oxidative damage on a regular basis. Smoker individuals had higher frequencies of cells with migration by comparison with the non-smokers in both groups. Also, clear differences between patients on placebo and on Vitamin E supplementation for 12 weeks were observed on the basis of the extend of DNA migration during single cell gel electrophoresis.