Comparison of the effects of exenatide and insulin glargine on right and left ventricular myocardial deformation as shown by 2D-speckle-tracking echocardiograms.

Background: Exenatide is a glucagon-like peptide-1 (GLP-1) analogs. The effects of GLP-1 analogs on myocardial function are controversial. Aims: The purpose of this study is to compare the effects of exenatide and insulin glargine on subclinical right and left ventricular dysfunction. Methods and Material: In this study, 27 patients with type 2 diabetes were randomized into exenatide and insulin glargine treatment groups. The patients were monitored for six months by conventional echocardiography (ECHO) and 2D-speckle-tracking echocardiography (2D-STE) to evaluate right and left ventricular functions. Results: ECHO parameters did not change significantly pre- and post-treatment, except for the tricuspid annular plane systolic excursion (TAPSE) values. Post-treatment TAPSE values significantly increased in both groups compared to pre-treatment values. In the insulin group, values for 2D-STE parameters of the left ventricular global longitudinal strain (LVGLS) based on apical long-axis (ALA) images increased significantly (p: 0.047) compared to pre-treatment values; however, apical 4-chamber (A4C), apical 2-chamber (A2C), LVGLS, and right ventricular global longitudinal strain (RVGLS) values did not change. In the exenatide group, LVGLS based on A4C values improved (p: 0.048), while ALA, A2C, and LVGLS values did not change. Moreover, the RVGLS values improved significantly after exenatide treatment (p: 0.002). Based on 2D-STE parameters the two treatments did not differ statistically in either pre- or post-treatment periods. Conclusions: Glp-1 treatment can improve left ventricular regional and right ventricular global subclinical dysfunction. Therefore, early GLP-1 treatment may be recommended in diabetic patients with a high risk of cardiac dysfunction.

An analysis of patients in palliative care with pressure injuries.

AIM: The aim of this study was to evaluate the factors that are effective for the treatment, recovery of pressure injury (PI) and costs in palliative care (PC) patients. MATERIALS AND METHODS: From a retrospective review of patient records, the PI localization, the presence of infection, PI stage on admission, discharge and treatment costs were recorded. Patients were grouped according to diagnoses, and PI localizations (sacrum, trochanter, ischium, and heel). The comparison was made of changes in wound stage in the groups. RESULTS: PI was present in all 154 patients during hospitalization and in 94 (61%) on discharge. Full recovery was determined in 52/129 (40.3%) patients with PI in the sacrum, in 23/46 (50%) in the trochanter, in 22/40 (55.0%) in the heel, and in 10/12 (83.3%) in the ischium. Worsening PI stage was observed in 5 (3.9%) in the sacrum, in 1 in the trochanter and in 4 in the heel. Improvement in PI stage was seen in 96 (74.4%) in the sacrum, in 35 (3.9%) in the trochanter, in 27 (50.5%) in the heel, and in 10 (83.3%) in the ischium. Regardless of wound localization, the improvement was observed in 168 (74%) of 227 PI and worsening in 10 (4.4%). The group with no change in the PI stage had prolonged hospital stay and higher costs. The Karnovsky Performance Score and Glasgow Coma Score of fully recovered patients were determined to be higher, and no statistically significant difference was seen in respect of age. CONCLUSIONS: PC patients are prone to PI due to many chronic diseases. The localization of PI and infection are effective factors in the healing of ulcers. The treatment costs for PC patients is higher if they have a pressure ulcer. More comprehensive studies will be useful to clarify the economic and social dimensions of this issue.

The effect of dexketoprofen on ischemia reperfusion injury.

OBJECTIVE: The purpose of this study was to demonstrate the effects of dexketoprofen on experimental ischemia/reperfusion injury induced in rat testicles. METHODS: Twenty-four male Wistar albino-type rats were randomly separated into three groups. To develop testicular torsion, the right testicle was rotated 720° clockwise. After five hours of rotation, reperfusion was applied for 24 hours. The control group rats (Group C) had no procedures or treatments; basal numbers were used. Intraperitoneal 25 mg/kg dexketoprofen (1 cc) (Group D) or the same volume of serum physiologic (Group SP) were given to the Group D and Group SP rats 40 minutes before and 12 hours after detorsion. Twenty-four hours after detorsion, histopathological evaluation was performed by bilateral orchiectomy. Malondialdehyde (MDA) levels were detected in testicular tissue and in serum. RESULTS: Histopathologic changes in the spermatic cells of torsioned testicles in Group D were significantly less than those of Group SP (p < 0.05). MDA levels in both testicles in Group D were similar to those of the control group. Although they were lower than Group SP, the difference was not statistically significant. Serum MDA levels were lower in Group D compared to the other groups (p < 0.05). CONCLUSION: We detected that dexketoprofen decreases I/R injury in both the torsion-formed testicle and the contralateral testicle. Thus, in patients who have urgent surgery for testicular detorsion, dexketoprofen can be preferred as an analgesic to reduce I/R injury. Further study is warranted to demonstrate this effect of dexketoprofen (Tab. 3, Fig. 1, Ref. 30).

Clinical assessment of primary and secondary hypertension in children and adolescents.

The aim of this study was to compare the clinical features of patients with elevated blood pressure and to detect variables associated with the diagnosis of primary hypertension. We identified 383 (69%) hypertensive children (197 [51.5%] with primary hypertension, and 186 [48.5%] with secondary hypertension) out of 553 children referred to our clinic with a history of elevated blood pressure. The primary hypertension group was significantly older and had higher BMI, positive family history of hypertension, and lower prevalence of preterm birth compared with those with secondary hypertension. No difference was found between the two groups in terms of the frequency of target organ damage. Multiple regression analysis showed that a family history of hypertension, obesity, age over 10 years, elevated uric acid, and presence of higher systolic blood pressure values at admission were independent predictors of primary hypertension; therefore, these parameters can be considered important clues for diagnosing primary hypertension.

Comparing tissue coring potentials of hollow needles without stylet and caudal needles with stylet: an experimental study.

BACKGROUND AND OBJECTIVES: Although the association of tissue coring and development of epidermoid tumour has been proposed, the extent and frequency of such coring is still controversial and the viability of carried cells has not been substantiated. In the present study, we used an experimental model without needle removal to investigate the incidence of tissue coring using two different needle types. METHODS: We inserted 22-G caudal (n = 34) or 22-G hollow (n = 25) needles to the tumour-free areas of fresh modified mastectomy specimens. The specimen was stretched and needles were inserted perpendicular to the skin and forced to penetrate the full thickness of the specimen. Without removing the needle, the needle cavity was then washed with 2 mL of RPMI 1640 with L-Glutamine and the washings were collected in a 15-mL falcon tube. The tubes were sealed and labelled and processed to obtain cytologic preparations. The slides were evaluated under a light microscope. RESULTS: A high rate of epithelial cell transportation was noted. All the carried cells were stratum corneum cells with no nucleus. No nucleated cells were seen. The incidence of carried cells was 64.7% and 72.0% in the caudal and hollow needle groups, respectively (P > 0.05). CONCLUSION: Only cells from the outermost layer, stratum corneum, which is made of dead flat skin cells, were transported with needle puncture. The risk of epidermoid tumour development after regional anaesthesia must therefore be low. The incidence of transporting non-nucleated stratum corneum cells was similar between hollow and caudal needles.

Which Factors are Predictive for Presence of Insulin Resistance in Patients with Rheumatoid Arthritis?

ABSTRACT Objective: To investigate obesity and insulin resistance and associated factors in patients with rheumatoid arthritis (RA). Methods: We included a cohort of patients with RA. In the clinical research, duration of disease, existence of clinical remission (disease activity index [DAS] 28 below 2.6) and amount of the relevant disease-modifying anti-rheumatic drugs were derived from clinical datum. Cumulative corticosteroid dose was calculated by duration of corticosteroid usage and ratio of physiologic dose. Insulin resistance was calculated with the homeostasis model of assessment of insulin resistance. Results: A total of 64 patients aged between 22 and 77 with RA were studied. Insulin resistance was detected in 34.4% (n = 22) of patients. There was a statistically significant correlation between body mass index and DAS28 scores (r = 0.469, p = 0.000). We found that the incidence of insulin resistance was lower in patients treated with methotrexate at least 1 year (p = 0.001). As long as we did not detect insulin resistance, none of the patients (n = 7) treated with tumour necrosis factor (TNF) blockers. Cumulative steroid dose, presence of obesity and DAS28 were the best predictors for insulin resistance according to multivariate linear regression analysis (R2c = 0.242, F = 6.39, p < 0.001). In this model R2c for cumulative steroid dose was 0.113 (F = 7.88 p < 0.007) and obesity was 0.147 (F = 10.67, p = 0.02). Conclusion: Obesity and long-standing corticosteroid usage were determinants of insulin resistance in patients with RA. Medications such as methotrexate, TNF blockers may help to reduce insulin resistance.

Effects of granisetron with droperidol or dexamethasone on prevention of postoperative nausea and vomiting after general anesthesia for cesarean section.

This prospective, placebo-controlled, double-blinded, and randomized study was undertaken to compare the efficacy of granisetron, droperidol, and combinations of granisetron with droperidol or dexamethasone on postoperative nausea and vomiting in patients undergoing general anesthesia for cesarean section. Patients (n = 150) who were scheduled for cesarean section under general anesthesia were randomly assigned to one of the five groups: physiological saline 5 ml in Group A, granisetron 40 microg/kg + dexamethasone 8 mg in Group B, granisetron 40 microg/kg + droperidol 1.25 mg in Group C, droperidol 1.25 mg in Group D, and granisetron 40 microg/kg in Group E were administered intravenously after clamping of the fetal umbilical cord. Postoperative nausea and vomiting was observed for 024 h after the anesthesia. Cesarean sections were all performed under general anesthesia. Postoperative nausea and vomiting was more common in placebo group (56.7%) than the others during the 0-24 h after the anesthesia (p < 0.05). All granisetron groups were more effective than placebo and droperidol groups during the postoperative 3-24 h (p < 0.01). Although this trial lacks statistical power, granisetron alone and combinations with droperidol or dexamethasone were effective similarly. All treatment groups, except droperidol during the postoperative 3-24 h, were effective for prevention of postoperative nausea and vomiting during the postoperative 0-24 h.

Resilience at the Transition to Agriculture: The Long-Term Landscape and Resource Development at the Aceramic Neolithic Tell Site of Chogha Golan (Iran).

The evidence for the slow development from gathering and cultivation of wild species to the use of domesticates in the Near East, deriving from a number of Epipalaeolithic and aceramic Neolithic sites with short occupational stratigraphies, cannot explain the reasons for the protracted development of agriculture in the Fertile Crescent. The botanical and faunal remains from the long stratigraphic sequence of Chogha Golan, indicate local changes in environmental conditions and subsistence practices that characterize a site-specific pathway into emerging agriculture. Our multidisciplinary approach demonstrates a long-term subsistence strategy of several hundred years on wild cereals and pulses as well as on hunting a variety of faunal species that were based on relatively favorable and stable environmental conditions. Fluctuations in the availability of resources after around 10.200 cal BP may have been caused by small-scale climatic fluctuations. The temporary depletion of resources was managed through a shift to other species which required minor technological changes to make these resources accessible and by intensification of barley cultivation which approached its domestication. After roughly 200 years, emmer domestication is apparent, accompanied by higher contribution of cattle in the diet, suggesting long-term intensification of resource management.

Comparison of midazolam with or without fentanyl for conscious sedation and hemodynamics in coronary angiography.

OBJECTIVE: To compare the hemodynamic and sedative effects of midazolam - with or without fentanyl combination - with placebo in coronary angiography. DESIGN: Prospective, double-blind, randomized study. SETTING: University medical centre. PATIENTS: All patients undergoing coronary angiography. INTERVENTIONS: Demographic data, hemodynamic variables, sedation and anxiety scores, amnesia, patient and cardiologist satisfaction, and adverse effects were evaluated and compared among coronary angiography patients taking midazolam, midazolam and fentanyl, or placebo before the procedure. MAIN RESULTS: Ninety patients scheduled for coronary angiography were randomly assigned into three groups: a midazolam-placebo group (group MP), a midazolam-fentanyl group (group MF) and a placebo group (group P). Hemodynamic stability was better in each sedation group (groups MP and MF) than in group P. Sedation scores, anxiolysis, and patient and cardiologist satisfaction were not different between the sedation groups. CONCLUSIONS: Both techniques of conscious sedation - midazolam and midazolam with fentanyl - are satisfactory for coronary angiography where hemodynamic stability and patient cooperation are required. In such procedures, local anesthesia without sedation may lead to hypertension and increase overall morbidity.

Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block.

BACKGROUND AND OBJECTIVES: To evaluate the analgesic and anesthetic effects of 40 mL bupivacaine 0.25%, 40 mL bupivacaine 0.25% plus fentanyl 2.5 microg/mL, and 40 mL bupivacaine 0.125% plus fentanyl 2.5 microg/mL for axillary brachial plexus block. METHODS: Sixty patients were randomly allocated to 3 groups and received axillary brachial plexus block with 40 mL bupivacaine 0.25% (group B), 40 mL bupivacaine 0.25% with fentanyl 2.5 microg/mL (group BF), or 40 mL bupivacaine 0.125% with fentanyl 2.5 microg/mL (group DBF). The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events were noted. RESULTS: The mean duration of sensory block and analgesia were longer in group BF (10.1 hours and 20.9 hours) than group B (6.9 hours and 11.6 hours) and DBF (5.9 hours and 12.0 hours) (P < .01, P < .001, respectively). The mean duration of motor block was also longer in group BF (10.7 hours) than group B (4.9 hours) (P < .01). Only 2 patients experienced motor block in group DBF. The frequency of successful block was 35% in group DBF (P < .01). Hemodynamic parameters were similar in all groups. In group B, only 1 patient experienced dizziness. Nausea was observed in 1 patient in each fentanyl group. CONCLUSION: The addition of 100 microg/mL fentanyl to 0.25% bupivacaine almost doubles the duration of analgesia following axillary brachial plexus block when compared with 0.25% bupivacaine alone.

Acute normovolemic hemodilution and nitroglycerin-induced hypotension: comparative effects on tissue oxygenation and allogeneic blood transfusion requirement in total hip arthroplasty.

STUDY OBJECTIVES: To study the comparative effects of acute normovolemic hemodilution and nitroglycerin-induced hypotension on tissue oxygenation and blood transfusion requirement. DESIGN: Prospective, randomized study. PATIENTS: 30 ASA physical status I and II patients scheduled for primary total hip arthroplasty. INTERVENTIONS: Patients were randomized to one of three groups of 10 patients each, to receive acute normovolemic hemodilutin (Group 1) or nitroglycerin-based hypotension (Group 2); Group 3 served as the control group. In Group 1, 2 U of blood was collected and replaced with an equal volume of hydroxyethyl starch (200/0.56%) immediately after anesthesia induction. In Group 2, nitroglycerin was infused at a rate sufficient to reduce mean arterial pressures to 60 to 65 mmHg before initiation of surgery. When hematocrit was reduced to 25%, at first autologous blood and then, if necessary, allogeneic blood was transfused to Group 1, and allogeneic blood was transfused to the other two groups, until hematocrit reached 30% for 5 days postoperatively. MEASUREMENTS AND MAIN RESULTS: Total transfused allogeneic units of blood were determined by the fifth postoperative day. Arterial oxygen content (CaO2), venous oxygen content (CvO2), and oxygen extraction ratios (EO2) were calculated by standard formulas. The mean allogeneic transfusion requirement was significantly lower in Group 1 (1.3 +/- 0.8 U) than in Group 2 (2.3 +/- 0.8 U) or Group 3 (2.7 +/- 1.1 U) (p < 0.05). In Group 1, CaO2 and CvO2 were decreased at all times, but EO2 was significantly increased from 15 +/- 3.9% to 33.3 +/- 5.3% (p < 0.001). As for the other two groups, although CaO2 and CvO2 were decreased, EO2 was not significantly increased. CONCLUSIONS: Acute normovolemic hemodilution is more effective than nitroglycerin-induced hypotension in reducing allogeneic blood transfusion requirement in total hip replacement surgery, without significant metabolic changes.

Brachial plexus injury during subclavian vein catheterization for hemodialysis.

Although the subclavian vein is often used for placement of double-lumen hemodialysis catheters, the risk factors for complications for the patients with chronic renal failure are underestimated. We report a case of a patient with chronic renal failure in whom brachial plexus injury was caused by both a compressive hematoma and direct insertion of a needle resulting from a subclavian vein catheterization attempt for hemodialysis. This case emphasizes the need for determining the coagulation status of the patient especially with chronic renal failure before performing invasive procedures.

Complicated airway management in a child with prune-belly syndrome.

We describe a 15-month-old boy with prune-belly syndrome (PBS) in whom airway management was complicated. Following an inhalation induction using sevoflurane, tracheal intubation by direct laryngoscopy proved impossible after repeated attempts. A laryngeal mask airway (LMAtrade mark) was inserted and the child had an uneventful anaesthetic course.