Does the inhibition of renin-angiotensin system decrease inter-dialytic weight gain in anuric hemodialysis patients?

OBJECTIVE: Knowledge about the inhibition of centrally located angiotensin-I (AT-I) receptors by highly lipophilic AT-I receptor blockers and its' effect are limited with experimental studies. Thus, we aimed to investigate the effect of Telmisartan on Inter-dialytic weight gain (IDWG) % and echocardiographic measurements in anuric hemodialysis (HD) patients. PATIENTS AND METHODS: A total of forty-one anuric HD patients with ≥ 6 months maintenance on HD were included in this prospective, randomized and self-controlled study. Four weeks prior the study, angiotensin converting enzyme blockers and AT-I receptor blocker drugs were stopped. Patients were assessed three times during the study protocol. These are baseline, three months later (without Telmisartan period) and three months after Telmisartan therapy. RESULTS: IDWG % was significantly decreased in the period of with Telmisartan compared to period without Telmisartan (5.6 ± 1.0% vs 5.3 ± 1.0%, p = 0.03). After the administration of Telmisartan left ventricule end-diastolic diameter (LVEDD) (p = 0.001) and inferior vena cava diameter (IVCD) (19.1 ± 3.8 mm vs 17.3 ± 4.2 mm, p = 0.001) were significantly decreased compared to the period of without Telmisartan. Despite of significantly changes observed in IVCD and LVEDD measurements in a period without Telmisartan, there was no significantly difference in left ventricular mass index (LVMI) measurements in this period. However, LVMI was significantly regressed after the administration of Telmisartan (269.3 ± 82.7 g vs 256.3 ± 70.3 g, p = 0.003 respectively). CONCLUSIONS: Treatment of anuric HD patients with Telmisartan at a dose of 40 mg a day reduces IDWG%, LVEDD and IVCD measurements. Further studies investigating the long-term effect of these beneficial effects on clinical outcomes are necessary.

The evaluation of Nesfatin-1 levels in patients with OSAS associated with metabolic syndrome.

PURPOSE: The association of obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS) has been demonstrated in studies and in recent years; the effect of OSAS on insulin resistance independent of the level of obesity is being investigated. Nesfatin-1 is a newly defined 82 amino acid protein with a precursor molecule of NUCB2 (nucleobindin 2). Nesfatin-1 is not only essential in regulation of food ingestion but also important in regulation of some brain functions, autonomic regulation, stress, mental state, and paradoxical sleep. We aimed to evaluate the relationship between OSAS and MS and the MS dependent or independent effect of Nesfatin-1 on this relationship. METHODS: Patients admitted with clinical signs of OSAS are included. Patients are divided into three groups based on Apnea-Hypopnea Index (AHI) on Polysomnography (PSG) as mild, moderate, and severe OSAS. A total of 59 patients were included the control patients. Several OSAS parameters and laboratory findings which are and are not MS dependent are compared. Nesfatin-1 levels are evaluated in all OSAS patients with and without MS. RESULTS: There were significantly more males in all groups (p = 0.007). There was no significant difference between groups in terms of Nesfatin-1 levels. Nesfatin-1 levels were significantly lower in MS group compared to non-MS group (p = 0.021). CONCLUSION: Nesfatin-1 which is known to play a role in the pathophysiology of insulin resistance can be a beneficial target in developing new therapeutic targets for treatment of patients with obesity without any toxic effects in the future.

Fatty Acid Composition of Egg Yolk from Chickens Fed a Diet including Marigold (Tagetes erecta L.).

The objective of this study was to determine the effects of diet supplemented with marigold on egg yolk fatty acid composition and egg quality parameters. Sixty hens were assigned into three groups and fed diets supplemented with 0 (control), 10 g kg(-1), or 20 g kg(-1) marigold for 42 days. Eggs collected at the 6th week of the study were analyzed for fatty acid analysis. Laying performance, egg quality parameters, and feed intake were also evaluated. Yolk color scores in the group fed the 20 g kg(-1) marigold-supplemented diet were found greater than control (10.77 versus 9.77). Inclusion of 20 g kg(-1) marigold in diet influenced egg weights adversely compared to the control. Diet supplemented with 10 g kg(-1) or 20 g kg(-1) marigold increased the levels of C16:0 and C18:0 and decreased levels of C16:1 (n-7) and C18:1 (n-9) in the egg yolk. Also, diet including marigold increased total saturated fatty acids (SFA) and decreased monounsaturated fatty acids (MUFA) in the egg yolk.

The success rates of a glass ionomer cement and a resin-based fissure sealant placed by fifth-year undergraduate dental students.

AIM: To evaluate retention and caries prevention of a glass-ionomer cement (GIC) and a resin-based fissure sealant placed by fifth-year undergraduate dental students. METHODS: The study was conducted according to a split-mouth, randomised clinical trial. Children with at least one pair of caries-free permanent first molars with deep pits and fissures were included in the study. The children were selected from a population that had a high risk for dental caries. Sealant materials were applied by fifth-year undergraduate dental students on 346 fissures of the first permanent molars in 173 children. The ages of the children ranged from 7-15 years (mean 9.4). Two researchers at the clinics supervised all of the procedures. Intra-examiner reproducibility and inter-examiner reproducibility were 0.90 and 0.86, respectively, for the clinical assessment of sealant retention and caries evaluation. RESULTS: GIC sealants were completely lost in 31.9% and resin-based sealants in 16.6% (p<0.05). The total retention rates of GIC sealants and resin-based sealants were 13.8% and 20.8%, respectively. After 24 months, the caries increment was 3.4% for GIC sealants and 4.8% for resin-based sealants (p>0.05). CONCLUSIONS: The retention of GIC sealants was markedly inferior to the retention of resin-based sealants; however, GIC when used as a pit and fissure sealant was slightly more effective in preventing occlusal caries.

Sucralfate for posttonsillectomy analgesia.

Pain is one of the most troublesome complications of tonsillectomy. The pain appears as throat pain, otalgia, or both, and continues until mucosal recovery on the tonsillar fossae is complete. Some surgical and hemostasis techniques may increase pain. Analgesics, antibiotics, steroids, and local and topical anesthetics are used to relieve posttonsillectomy pain, but none has the desired effectiveness. The pain reliever must not increase bleeding and must have minimal side effects. Sucralfate, a basic amino salt of sucrose octasulfate, binds to the matrix protein of a peptic ulcer and produces a protective barrier. Tonsillectomy leaves two large ulcerous wounds, and sucralfate may bind those wounds as it does peptic ulcers. In this controlled study, the efficacy of sucralfate on posttonsillectomy throat pain, otalgia, analgesic requirement, degree of strength, bleeding, body temperature, and mucosal recovery is investigated in 80 patients. Sucralfate is found to significantly reduce throat pain and analgesic requirement after surgery.

Facial nerve paralysis in chronic suppurative otitis media: Ankara Numune Hospital experience.

Although the incidence of facial nerve paralysis (FNP) decreased with the use of contemporary diagnostic tools and the advent of antibiotics, it is still a challenging problem. In this retrospective study, the charts of 1188 patients with chronic suppurative otitis media (CSOM), treated between 1988 and 1996 in the First ENT Clinic of Ankara Numune Hospital, Turkey, were analysed to establish the pre-operative incidence of FNP in CSOM. There were 20 (1.7%) patients with FNP secondary to CSOM. Of these, 14 (70%) had cholesteatoma. There was a defect on the fallopian canal in 14 patients (70%) and it was most commonly located on the tympanic segment of the canal (35.7%). Paralysis was incomplete in all patients. A total of 14 patients had ear drainage more than 3 years. FNP was associated with vertigo in three patients (15%) and tinnitus in one patient (5%).

A new dosage regimen for topical application of ciprofloxacin in the management of chronic suppurative otitis media.

The clinical and bacteriologic efficacy of topically applied ciprofloxacin was studied in 60 patients with chronic suppurative otitis media. Two hundred fifty and 125 microg/ml concentrations of ciprofloxacin solutions were given to two groups of patients. The duration of therapy was determined according to the clinical cure at follow-up. More than 21 days of therapy was not needed in any patient. The clinical cure rate with 250 microg/ml ciprofloxacin was 78.1% at 14 days and with 125 microg/ml it was 83.3%. However, a 100% clinical cure rate and complete bacteriologic eradication was obtained in 21 days in both groups. In each group only one patient had otomycosis by the fourteenth day of therapy, although ear discharge had ceased. It was concluded that 125 microg/ml ciprofloxacin could be applied as successfully as 250 microg/ml, and the duration of therapy had to be at least 14 days. This new dosage regimen can be adopted as an optimal dosage for ototopical application of ciprofloxacin in chronic suppurative otitis media. It will also obviously decrease the expense of therapy.

Susceptibility of microorganisms isolated from chronic suppurative otitis media to ciprofloxacin.

In order to evaluate the susceptibility of the microorganisms isolated from chronic suppurative otitis media to ciprofloxacin, cultures of specimens from 127 patients with chronic suppurative otitis media and their antibiotic sensitivity results were examined. The most common aerobic isolates were Pseudomonas sp., Proteus sp., and Staphylococcus aureus with recovery rates of 40.7%, 21.6% and 19.1% respectively. Sensitivity results showed that 6.2% of Pseudomonas isolates, 2.9% of Proteus isolates, 10% of Staphylococcus aureus isolates and 8.3% of Escherichia coli isolates were resistant to ciprofloxacin.