The Effect of Intra-abdominal Pressure on Heart Rate Variability and Hemodynamics During Laparoscopic Cholecystectomy: A Prospective Observational Study.

Introduction This study aimed to evaluate hemodynamic changes using heart rate variability (HRV) measurements in diabetic and nondiabetic patients who will undergo laparoscopic cholecystectomy and to provide our preoperative measurements to guide us for better perioperative anesthesia management. Materials and methods The study included 143 patients aged 40 years and older who would undergo elective laparoscopic surgery, did not have any comorbidities other than diabetes mellitus (DM) type II, and were in the American Society of Anesthesiologists (ASA) class I-III risk group. Patients were divided into two groups: the control group (n = 77) and the DM group (n = 66). The preoperative glycated hemoglobin (HbA1C) level was measured. Peripheral oxygen saturation (SpO2) and hemodynamic parameters such as systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and HRV parameters were measured preoperatively, perioperatively, and postoperatively. Intra-abdominal pressure (IAP) was administered at 10-12 mmHg. Results Even though SAP, DAP, MAP, and HR decreased with induction, they increased with insufflation, and an overall decrease was seen at the postoperative 24th hour for all parameters. When the groups were evaluated, no difference was observed except that the DAP was significantly lower in the DM group (p = 0.029) at insufflation and the HR was higher in the DM group at induction, and the difference was significant (p = 0.001). Preoperative HRV parameters were significantly lower in the DM group. According to the HRV parameters, although a decrease was observed after induction and insufflation, conversely, an increase was observed postoperatively. When the postoperative and preoperative values were compared, the standard deviation of the NN (R-R) intervals (SDNN), SDNN index, high frequency (HF), low frequency (LF), and LF/HF parameters were found to be significantly lower in the DM group than in the control group. Conclusion Diabetic patients are more sensitive to increased intra-abdominal pressure (IAP) in laparoscopic surgery, and the effects on cardiac autonomic functions can be determined by HRV measurements without clinically reflecting on hemodynamic data. Additionally, in diabetic patients with preoperative LF and/or HF values less than 100, we believe that careful follow-up in terms of autonomic neuropathy complications and anesthesia management should be done more meticulously in these patients.

Effects of taxifolin on tramadol-induced oxidative and inflammatory liver injury in rats: an experimental study.

In this experimental study we aimed to investigate the biochemical and histopathological effects of concomitantly administered taxifolin on tramadol-induced liver damage in rats. The rats were divided into three groups; control group (CG), tramadol alone (TRG), and taxifolin + tramadol given (TTRG) groups. Malondialdehyde (MDA), total glutathione (tGSH), total oxidant status (TOS), total antioxidant status (TAS), nuclear factor-kappa beta (NF-kB), tumor necrosis factor-α (TNF-α), and interleukin-1ß (IL-1ß) levels were measured in liver tissues. Liver tissues were also examined histopathologically. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities were determined in blood samples. In tissue analyses, determinants of oxidative stress and inflammation, all were significantly higher in the TRG group compared with the control and TTRG groups. In the TTRG group, all oxidative stress and inflammation markers were significantly lower than in the TRG group. In addition, there was not any significant difference between the control and TTRG groups regarding the TOS and TAS status. Serum liver enzymes were also significantly higher in the TRG group than in the other two groups. In histopathological examinations, the control group had a normal histological appearance. Degenerative-necrotic hepatocytes and hemorrhage, which were seen at a severe level in the TRG group, were found to be moderate in the treated TTRG group. In addition, mononuclear cell infiltrations were found to be severe in the TRG group and mild in the treated TTRG group. Finally it was concluded that Taxifolin alleviated the toxic effects of tramadol on the liver including the histopathological and biochemical changes as well as the oxidative damage.

The effects of sugammadex on gastric ischemia-reperfusion injury in rats: Biochemical and histopathological evaluation.

The primary sources of reactive oxygen species (ROS) that cause ischemia-reperfusion (I/R) injuries are enzymes xanthine oxidase (XO) and nicotinamide adenine dinucleotide phosphate oxidases (NOXs) in the literature, whereby one of the main ROS producing cells via NOX activity are polymophonuclear leukocytes (PNL). Sugammadex, the effect of which we plan to research against gastric I/R damage, is a modified gamma-cyclodextrin that antagonizes the action of steroidal neuromuscular blocking drugs. Previous studies have reported that sugammadex inhibits PNL infiltration. However, it is unknown whether an inhibitory effect on XO is present. We aimed to biochemically and histopathologically investigate the effects of sugammadex on I/R-induced stomach damage in rats. The animals were divided into groups that underwent gastric ischemia-reperfusion (GIR), 4 mg/kg sugammadex + gastric ischemia-reperfusion (SGIR), and a sham operation group (SG). The effect of sugammadex was evaluated by measuring oxidant-antioxidant and PNL parameters. There was no significant difference in XO levels between the SGIR and GIR groups. In the SGIR group, sugammadex inhibited the increase in myeloperoxidase (MPO) and malondialdehyde (MDA) levels (p < 0.001). The amount of MDA and MPO in the SGIR group was similar as in the SG group. Sugammadex significantly suppressed the decrease in tGSH levels in the SGIR group (p < 0.001). The difference between tGSH levels in the SG and SGIR groups was slight. In the SGIR group, sugammadex significantly suppressed the increase in tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL1-ß) levels compared to the GIR group (p < 0.001). Additionally, sugammadex corrected histopathological modifications as much as sham group. In conclusion, sugammadex may be beneficial in preventing oxidative stress.

Evaluation of the effects of total intravenous anesthesia and inhalation anesthesia on postoperative cognitive recovery.

OBJECTIVE: To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels. MATERIAL AND METHODS: The study sample consisted of 80 patients aged 18-65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively. RESULTS: The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038). CONCLUSION: The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.

Effect of age on computed tomography findings: Specificity and sensitivity in coronavirus disease 2019 infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019. Although the real-time reverse tr-anscription PCR test for viral nucleic acids is the gold standard for COVID-19 diagnosis, computed tomography (CT) has grown in importance. AIM: To evaluate the sensitivity and specificity of thoracic CT findings of COVID-19 pneumonia according to age groups. METHODS: PCR and CT results from 411 patients were reviewed. The diagnosis of COVID-19 pneumonia was made by three radiologists. Lymphadenopathy, pericardial effusion, pleurisy, pleural thickening, pleural effusion, location features of the lesions, ground glass, consolidation, air bronchogram, vascular enlargement, bronchial dilatation, halo finding, inverted halo sign, nodularity, air bubble, subpleural band (curvilinear density), reticular density, crazy paving pattern, and fibrosis findings were recorded. The patients were divided into nine groups by decades while calculating the sensitivity, specificity, and diagnostic efficacy for CT positivity. RESULTS: The mean age of the cases was 48.1 ± 22.7 years. The CT finding with the highest diagnostic power was ground glass. Vascular enlargement and bronchial dilatation followed ground glass. Peri-cardial effusion was the finding with the lowest diagnostic accuracy. The incidence of lymphadenopathy, pleurisy, pleural thickening, peripheral localization, bilateral, ground glass, vascular enlargement, bronchial dilatation, subpleural band, reticular density, crazy paving appearance, and fibrosis all increased increase significantly with age in patients with positive real-time reverse transcription PCR test. CONCLUSION: There are few publications comparing sensitivity and specificity of thoracic CT findings according to age. In cases of COVID-19 pneumonia, there is an increase in the variety and frequency of CT findings with age, and parallel to this the sensitivity and specificity of the findings increase. COVID-19 cases in the pediatric age group have fewer lung findings than adults, and this situation decreases the diagnostic value of CT in pediatric patients.

Healthcare workers' socio-psychological status after a year with COVID-19 pandemic: a cross-sectional face-to-face survey in Erzincan, Turkey.

Introduction: on January 7th 2020, SARS-CoV-2 was identified in Wuhan, China, and on March 11th, 2020, the World Health Organization declared it a "Pandemic". The aim of this research is to assess depression, anxiety, work, and social status in healthcare workers during the COVID-19 pandemic. Methods: the research was designed to be a cross-sectional face-to-face survey. The study included 111 healthcare employees and 222 non-healthcare workers between the ages of 18 and 65 who applied to the hospital. For some reason, no one was excluded from the research. Socio-demographic and lifestyle-related questions, depression, anxiety, work-social adjustment scores, and pandemic-social status-operation connections were all assessed using a self-report questionnaire containing psychometric measures. Results: the mean age of the participants in the study was 33.67±10.01 and 59% of the participants were female. PHQ9: 11.67±6.41, GAD7: 9.06±5.81, and W&SAS: 17.55±10.98 were the scores of the healthcare professional groups. PHQ9: 10.25±6.21, GAD7: 7.59±5.65, and W&SAS: 14.75±10.27 were the non-healthcare professional groups' results. When the PHQ9, GAD7, and W&SAS scores of both groups were compared, there was no statistically significant difference in the PHQ9 depression score between the two groups (p=0.107), the GAD7 (p<0.05) and W&SAS (p<0.05) scores of the healthcare professionals were statistically significantly higher. Conclusion: in comparison to the non-healthcare worker group, healthcare professionals had the same level of depression, greater levels of moderate and high anxiety, and higher levels of work-social adjustment disorder. Unlike the literature, we found that the degree of depression fell to the same level as the non-health professional group in our study, but it was still disadvantaged in terms of anxiety and work-social adjustment.

Effect of tocilizumab on ischemia-reperfusion-induced oxido-inflammatory renal damage and dysfunction in rats.

Ischemia-reperfusion-induced (I/R) renal damage is a pathogenic process that starts with ischemia, then progresses through oxidative stress and inflammation. Tocilizumab (TCZ), a recombinant human monoclonal antibody produced against the IL-6 receptor, will be tested against renal I/R injury. TCZ is known to lower the levels of proinflammatory cytokines and oxidant mediators while raising the amounts of antioxidant molecules. Our purpose is to evaluate the biochemical and histological effects of TCZ against I/R-induced oxido-inflammatory kidney damage and dysfunction in rats. Animals were divided into 3 groups as renal I/R (RIR), I/R+ TCZ (IRT), and healthy group (HG). TCZ was administered at a dose of 8 mg/kg to the IRT group (n=6) of the animals, and distilled water as a solvent was administered intraperitoneally (ip) to the RIR (n=6) and HG (n=6) groups. Then, two hours of ischemia and six hours of reperfusion were applied to the left kidneys of IRT and RIR animals. TCZ significantly inhibited the increase in the levels of malondialdehyde (MDA), nuclear kappa B (NF-κB), tumour necrosis factor alpha (TNF-α), interleukin 1-ß (IL-1ß), IL-6, creatinine (Cr) and blood urea nitrogen (BUN) and decrease in total glutathione (tGSH) with I/R in renal tissue. TCZ also attenuated severe histopathological damage due to I/R in renal tissue. TCZ protected renal tissue from I/R-induced oxidative and inflammatory damage. These results indicate that TCZ may be useful in the treatment of renal I/R injury.

Negative-pressure pulmonary edema after mammoplasty: a case report.

Negative-pressure pulmonary edema (NPPE) is a rare but life-threatening postoperative complication that occurs due to the acute obstruction of the upper airway. In our case report, we present a 25-year-old female patient who underwent elective mammoplasty under general anesthesia and developed NPPE 4 hours after extubation. The patient had a preoperative mallampati score of 3. After routine anesthesia induction, the patient was intubated with an endotracheal tube with a guide wire. Aspiration wasn't observed during extubation. The patient was followed in the post-anesthesia care unit (PACU) for 30 minutes with a saturation of 95% and was subsequently transferred to the service. Four hours after the operation, the patient was re-examined due to dyspnea and shortness of breath. Due to oxygen saturation of 88% and pO2of 56mmHg despite mask ventilation, the patient was admitted to the intensive care unit (ICU). A computed tomography (CT) scan revealed extensive diffuse ground-glass opacities and consolidations in both lungs. She did not respond to mask ventilation and was given non-invasive ventilation with continuous positive airway pressure (CPAP). Forced diuresis was induced with furosemide. Tachypnea resolved within 2 hours after CPAP was initiated, the patient did not require oxygen support and COVID-19 polymerase chain reaction (PCR) testing was negative. Subsequently, the patient was discharged to the clinical ward on postoperative day 1. When considering NPPE, early diagnosis and respiratory support are associated with reduced mortality and rapid recovery. Patients who develop laryngospasm during extubation must be closely monitored, and in the case of pulmonary edema, NPPE should be considered in the differential diagnosis.

The effects of thiamine pyrophosphate on propofol-induced oxidative liver injury and effect on dysfunction.

Propofol may cause an increase in reactive oxygen species in the body. In this study, we tested the effect of antioxidant thiamine pyrophosphate (TPP) on propofol-induced liver damage. The eighteen rats were split into three groups: HG, healthy; PP, propofol-treated (50 mg/kg) and PT, treated with propofol (50 mg/kg) and TPP (25 mg/kg). Total glutathione (tGSH), total oxidant (TOS), and total antioxidant (TAS) levels were tested together with aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and malondialdehyde (MDA). Histopathological examination of the tissues was performed. We have found that levels of MDA, TOS, ALT, AST, and LDH were all higher in PP group than in HG and PT groups (p < 0.05). In PP group, the TAS and tGSH levels were statistically substantially lower. The PT for oxidants levels showed a statistically significant reduction. In PT group, the levels of antioxidants were found to be considerably higher. The epitheliums, glands, and vascular structures of the PTs were histologically close to normal. By boosting antioxidants, TPP may help to reduce propofolinduced liver damage.

Case report: cerebral thromboembolism in an unconscious COVID-19 patient in intensive care.

Although the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. Acute respiratory distress syndrome due to SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus 2) often requires intensive care follow-up. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement. The pandemic has raised many challenges in managing critically ill older adults, a population preferentially killed by COVID-19. The mortality and morbidity rates are extremely high in critically ill patients with COVID-19. Recent studies have reported the potential development of a hypercoagulable state in COVID-19. Viral infections and hypoxia may cause these state. It is increasingly reported that thromboembolic events are associated with a poor prognosis. Due to these thromboembolic complications, COVID-19 patients often have neurological symptoms. These symptoms may not be observed in intensive care patients who are sedated. We report one case who was sedated COVID-19 pneumonia and who was later diagnosed with cerebral venous thrombosis with cranial imaging when he could not awaken even though sedation was discontinued. Since COVID-19 causes intense thrombotic susceptibility due to cytokine storm, cerebrovascular thromboembolic complications associated with COVID-19 infection should be considered first and foremost for unconsciousness ventilated patients. Severe and potentially cerebral thrombosis may prolong the patient´s stay in intensive care.

The effect of dexmedetomidine on gastric ischemia reperfusion injury in rats. Biochemical and histopathological evaluation.

PURPOSE: To evaluate the protective effect of dexmedetomidine on gastric injury induced by ischemia reperfusion (I/R) in rats. METHODS: A total of 18 male albino Wistar rats were divided groups as: gastric ischemia reperfusion (GIR), gastric ischemia reperfusion and 50 µg/kg dexmedetomidine (DGIR) and sham operation (HG) group. After the third hour of reperfusion, the biochemical and histopathological examinations were performed on the removed stomach tissue. RESULTS: Malondialdehyde (MDA) and myeloperoxidase (MPO) levels were found to be significantly higher in GIR compared to HG (p < 0.05). A statistically significant decrease was observed at the DGIR compared to the GIR for oxidants levels. Total glutathione (tGSH) and superoxide dismutase (SOD) levels were statistically significantly decreased at the GIR, and antioxidants levels were found to be significantly higher in the DGIR (p < 0.05) There was no significant difference between HG and DGIR in terms of SOD (p = 0.097). The DGIRs' epitheliums, glands and vascular structures were close to normal histological formation. CONCLUSIONS: Dexmedetomidine is found to prevent oxidative damage on the stomach by increasing the antioxidant effect. These results indicate that dexmedetomidine may be useful in the treatment of ischemia-reperfusion-related gastric damage.

The effect of adenosine triphosphate on propofol-induced myopathy in rats: a biochemical and histopathological evaluation.

Propofol infusion syndrome characterized by rhabdomyolysis, metabolic acidosis, kidney, and heart failure has been reported in long-term propofol use for sedation. It has been reported that intracellular adenosine triphosphate (ATP) is reduced in rhabdomyolysis. The study aims to investigate the protective effect of ATP against possible skeletal muscle damage of propofol in albino Wistar male rats biochemically and histopathologically. PA-50 (n = 6) and PA-100 (n = 6) groups of animals was injected intraperitoneally to 4 mg/kg ATP. An equal volume (0.5 ml) of distilled water was administered intraperitoneally to the P-50, P-100, and HG groups. One hour after the administration of ATP and distilled water, 50 mg/kg propofol was injected intraperitoneally to the P-50 and PA-50 groups. This procedure was repeated once a day for 30 days. The dose of 100 mg/kg propofol was injected intraperitoneally to the P-100 and PA-100 groups. This procedure was performed three times with an interval of 1 days. Our experimental results showed that propofol increased serum CK, CK-MB, creatinine, BUN, TP I, ALT, AST levels, and muscle tissue MDA levels at 100 mg/kg compared to 50 mg/kg and decreased tGSH levels. At a dose of 100 mg/ kg, propofol caused more severe histopathological damage compared to 50 mg/ kg. It was found that ATP prevented propofol-induced muscle damage and organ dysfunction at a dose of 50 mg/kg at a higher level compared to 100 mg/kg. ATP may be useful in the treatment of propofol-induced rhabdomyolysis and multiple organ damage.

The effect of dexmedetomidine on gastric ischemia reperfusion injury in rats. Biochemical and histopathological evaluation

ABSTRACT Purpose: To evaluate the protective effect of dexmedetomidine on gastric injury induced by ischemia reperfusion (I/R) in rats. Methods: A total of 18 male albino Wistar rats were divided groups as: gastric ischemia reperfusion (GIR), gastric ischemia reperfusion and 50 μg/kg dexmedetomidine (DGIR) and sham operation (HG) group. After the third hour of reperfusion, the biochemical and histopathological examinations were performed on the removed stomach tissue. Results: Malondialdehyde (MDA) and myeloperoxidase (MPO) levels were found to be significantly higher in GIR compared to HG (p < 0.05). A statistically significant decrease was observed at the DGIR compared to the GIR for oxidants levels. Total glutathione (tGSH) and superoxide dismutase (SOD) levels were statistically significantly decreased at the GIR, and antioxidants levels were found to be significantly higher in the DGIR (p < 0.05) There was no significant difference between HG and DGIR in terms of SOD (p = 0.097). The DGIRs' epitheliums, glands and vascular structures were close to normal histological formation. Conclusions: Dexmedetomidine is found to prevent oxidative damage on the stomach by increasing the antioxidant effect. These results indicate that dexmedetomidine may be useful in the treatment of ischemia-reperfusion-related gastric damage.

Can endocan be a new biomarker in ventilator-associated pneumonia?

Ventilator-Associated Pneumonia (VAP) is a hospital-acquired bacterial infection with high incidence and mortality rate. The aim of this study is to investigate the correlation between the Endocan level and development of VAP and whether or not this correlation was correlated with the clinical findings. Demographic data, white blood cell (WBC) count, procalcitonin (PCT), c-reactive protein (CRP), and fever levels of 60 patients were recorded in serial measurements for 5 days. When there was the presence of fever or elevated Endocan, alveolar lavage culture was taken and chest radiographies were taken. Correlations of the Endocan levels with the culture results and laboratory values were examined. The rate of VAP was found as 10.4/1000 mechanical ventilator days. Endocan levels were significantly higher in patients with VAP (p < 0.05). However, there was no significant difference among PCT, WBC, CRP measurements (p > 0.05). No correlation was found between Endocan levels and PCT, WBC and CRP levels in those with VAP (p > 0.05). A significant correlation was found between the Endocan level and the elevated fever 24 h later (p:0.001). The serum Endocan level on the day 3 had a specificity of 73.3%, a sensitivity of 68.9%, positive predictive value of 44%, and negative predictive value of 88.5% at the cut off level of 9.17 ng/mL. In this study, it was determined that high Endocan levels were associated with the development of VAP. The present study suggested that Endocan can be used as a screening tool for the development of VAP. CLINICAL TRIALS.GOV ID: NCT02916277.

Use of sugammadex in Rett syndrome: A case report.

Rett syndrome (RS) is a neurodevelopmental disorder characterized by loss of cognitive, motor, and social skills, epilepsy, autistic behavior, abnormal airway patterns, gastroesophageal reflux, nutritional problems, and severe scoliosis. Although girls with RS show normal or near-normal growth until 6-8 months, they lose their skills after that. The anesthetic management of these patients requires care because of all these clinical features. Especially in the postoperative period, prolonged apnea is common and extubation is delayed. In this case report, the effect of using sugammadex was presented in a 16-year-old girl with RS. The patient's all bimaxillary teeth and 4 wisdom teeth were extracted under general anesthesia in one session with minimal surgical trauma and moderate bleeding. Sugammadex can be a rapid and reliable agent for the reversal of the neuromuscular block in neurodegenerative patients.

The effects of ketamine and thiopental used alone or in combination on the brain, heart, and bronchial tissues of rats.

INTRODUCTION: We compared the side effects of ketamine and thiopental used alone and of a ketamine/thiopental combination dose on the brain,heart, and bronchial tissues of rats. MATERIAL AND METHODS: Three groups received intraperitoneal injections of 30 mg/kg ketamine (K-30); 15 mg/kg thiopental (T-15); or of both in combination (KTSA). These doses were doubled in another set of study groups (K-60, T-30, and KTA groups, respectively). Optimal anesthesia duration was examined in all groups. RESULTS: Anesthesia did not occur with 30 mg/kg ketamine or 15 mg/kg thiopental. However, when used alone ketamine and thiopental led to oxidative stress in the striatum, heart, and bronchial tissues. Conversely, combined administration of anesthetics and subanesthetic doses were found not to create oxidative stress in any of these areas. The highest level of adrenaline in blood samples collected from the tail veins was measured in the KTA-60, and the lowest amount in the T-30. Creatine kinase activity was highest in the KTA-60 group (p < 0.001). When we compared for all 5 groups to untreated control group; the creatine kinase-MB activities were significiantly different in K-30, T-15 and T-30 (p < 0.001). CONCLUSIONS: The studied doses of ketamine led to oxidative stress by increasing the amount of adrenaline. Thiopental increased oxidative stress with decreases in adrenaline. A longer anesthetic effect with minimal adverse events may be achieved by ketamine and thiopental in combination.

Effect of melatonin on antioxidant capacity, inflammation and apoptotic cell death in lung tissue of diabetic rats.

PURPOSE: To investigate the effects of melatonin on antioxidant capacity, inflammation and apoptotic cell death (through expression of cleaved-caspase 3) in lung tissue samples of diabetic rats. METHODS: Thirty male Sprague-Dawley rats were randomly divided into three groups. Group 1 (control group) was made up of healthy rats. Group 2 (diabetes group) received streptozotocin at a dose of 50 mg/kg/day for 5 days.Group 3 (diabetes plus melatonin group) received streptozotocin at a dose of 50 mg/kg/day for 5 days and then they received melatonin at a dose of 20 mg/kg/day between 28thand 35thdays of the study. RESULTS: Tissue MDA and MPO levels were found to be significantly higher in diabetes group compared to control group (p<0.05) whilst administration of melatonin was found to significantly lower this increase down to normal levels (p<0.05). Bronchus associated lymphoid tissue (BALT) was more severe in diabetics whereas administration of melatonin alleviated this hyperplasia. Cleaved caspase 3 activity was severe in hyperplastic BALT in diabetic rats however in lowered down to moderate level when melatonin was administered. CONCLUSION: The melatonin caused an increase in antioxidant capacity and decreased the expression of cleaved-caspase 3.

The effect of desflurane and propofol protocols on preconditioning.

BACKGROUND: Preconditioning is one of the most powerful mechanisms preventing the myocardial ischemic damage that occurs during coronary artery bypass grafting. OBJECTIVES: We aimed to investigate the effects of different propofol and/or desflurane administration protocols in terms of the prevention of ischaemia-reperfusion damage. MATERIAL AND METHODS: Ninety patients, aged > 18 years, American Society of Anesthesiologists (ASA) category III, scheduled to undergo primary elective coronary artery bypass grafting (CABG), were included in the study. During maintenance, the patients in group 1 (n = 30) received a propofol infusion (5-6 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h); the patients in group 2 (n = 30) also received a propofol infusion (5-6 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h), but they were also given 6% desflurane inhalation for 15 min both before cross-clamping of the aorta and after removal of the clamp; the patients in group 3 (n = 30) received a propofol infusion (2-3 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h) and received the continuous 6% desflurane inhalation. Blood samples were drawn in the preoperative period (S1), during cardiopulmonary bypass, before cross-clamping the aorta (S2), after removal of the cross-clamp (S3) and 24 h after the operation (S4). RESULTS: All groups were similar in terms of age and BMI (p > 0.05). TNF-α levels were higher at S3 compared to S1, S2 and S4 (p > 0.001). The TNF-α levels at S4 were lower in group 3 than those in group 1 and group 2 (p < 0.05). In all groups, h-FABP levels showed an increase in S3 but were significantly lower at S4 (p < 0.05). In group 3, h-FABP levels at S2 and S3 were significantly lower than those in group 1 (p < 0.05). There was a moderate correlation between h-FABP and TNF-α levels (Spearman's rho = 0.472, p < 0.001). CONCLUSIONS: On the basis of the measurement of h-FABP and TNF-α, low-dose propofol and continuous desflurane inhalation provide more effective preconditioning than propofol alone or a short course of desflurane in patients undergoing CABG.

Neutrophil-to-lymphocyte ratio as a possible indicator of epicardial adipose tissue in patients undergoing hemodialysis.

INTRODUCTION: Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. MATERIAL AND METHODS: Forty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. RESULTS: Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. CONCLUSIONS: Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.

What Is the Best Pulmonary Physiotherapy Method in ICU?

Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n = 15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n = 15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p = 0.001). The lung collapse index decreased in study group at 48th (p = 0.003) and 72nd hours (p < 0.001). The PO2 levels increased in the study group at 72nd hour (p = 0.015). The culture positivity at 72nd hour was decreased to 20%. The days of ventilation and staying in ICU did not differ between the groups. Conclusions. Although HFCWO is very expensive equipment, combined technique may prevent the development of lung atelectasis or hospital-acquired pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU.