Effect of pentavalent antimony compounds on the inflammatory, hematological and biochemical parameters in patients with cutaneous leishmaniasis.

OBJECTIVE: This study aimed to evaluate how systemic antimony treatment in cutaneous leishmaniasis (CL) patients affects biochemical, hematological, and inflammatory parameters in child and adult patient groups. METHODS: A total of 50 patients (29 adults, 21 children) who received systemic meglumine antimonate (MA) treatment in the skin and venereal diseases clinic between September 2022 and January 2024 and were diagnosed with CL by microscopic examination were included in the study. The medical records of the patients were examined retrospectively. Before and after treatment, neutrophil count, leukocyte count, lymphocyte count, hemoglobin concentration, platelet count, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), amylase, lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen and serum creatinine levels were recorded. RESULTS: In the children group, lymphocyte and platelet values decreased statistically significantly; and lipase value increased statistically significantly after treatment. In the adult group; hemoglobin, neutrophil, lymphocyte and leukocyte values decreased statistically significantly; ALT, AST, amylase, lipase, NLR and PLR values increased statistically significantly after treatment. CONCLUSION: Based on the data in our study, it was stated that systemic meglumine antimonate treatment may lead to an increase in pancreatic enzymes and transaminases and bone marrow suppression. We also think that patients in the adult age group should be followed more closely regarding pancreatic enzymes and kidney function tests than the pediatric age group.

Development of a Neural Network for Target Gas Detection in Interdigitated Electrode Sensor-Based E-Nose Systems.

In this study, a neural network was developed for the detection of acetone, ethanol, chloroform, and air pollutant NO2 gases using an Interdigitated Electrode (IDE) sensor-based e-nose system. A bioimpedance spectroscopy (BIS)-based interface circuit was used to measure sensor responses in the e-nose system. The sensor was fed with a sinusoidal voltage at 10 MHz frequency and 0.707 V amplitude. Sensor responses were sampled at 100 Hz frequency and converted to digital data with 16-bit resolution. The highest change in impedance magnitude obtained in the e-nose system against chloroform gas was recorded as 24.86 Ω over a concentration range of 0-11,720 ppm. The highest gas detection sensitivity of the e-nose system was calculated as 0.7825 Ω/ppm against 6.7 ppm NO2 gas. Before training with the neural network, data were filtered from noise using Kalman filtering. Principal Component Analysis (PCA) was applied to the improved signal data for dimensionality reduction, separating them from noise and outliers with low variance and non-informative characteristics. The neural network model created is multi-layered and employs the backpropagation algorithm. The Xavier initialization method was used for determining the initial weights of neurons. The neural network successfully classified NO2 (6.7 ppm), acetone (1820 ppm), ethanol (1820 ppm), and chloroform (1465 ppm) gases with a test accuracy of 87.16%. The neural network achieved this test accuracy in a training time of 239.54 milliseconds. As sensor sensitivity increases, the detection capability of the neural network also improves.

Effect of adalimumab treatment on inflammatory and hematological parameters in patients with Hidradenitis suppurativa.

OBJECTIVE: Hidradenitis suppurativa (HS), a chronic inflammatory disease that typically manifests after puberty, is characterised by painful nodules, abscesses, draining sinus tracts, and scars in areas rich in apocrine glands such as the axillary and inguinal regions. In recent years, blood-based biomarkers such as the Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR), Monocyte/Lymphocyte Ratio (MLR), Mean Platelet Volume (MPV), Systemic Immune-Inflammation Index (SII) and Pan-Immune-Inflammation Value (PIV) have been used as significant indicators of systemic inflammation. While there are few studies evaluating these biomarkers in HS, the response of these markers to treatment has only been assessed in one study to date. Our study aims to investigate the effect of adalimumab treatment on blood-based systemic inflammation biomarkers in HS, where inflammation plays a significant role. METHODS: The study included 42 adult patients who received adalimumab treatment at our dermatology and venereology clinic between January 2020 and January 2023. Medical records for complete blood count results of the patients were retrospectively reviewed. All systemic inflammation-based biomarkers were calculated from the absolute values of the complete blood count. The SII was calculated with the following formula: (neutrophil count × platelet count/lymphocyte count). The PIV was calculated as follows: (neutrophil count × platelet count × monocyte count/lymphocyte count). Values before the treatment and at the 12th week of treatment were compared. RESULTS: When the changes in the inflammatory parameters of the patients were examined, it was found that NLR (2.13 ± 0.87 vs 2.26 ± 1.12), PLR (111.01 ± 39.89 vs 99.43 ± 35.34), MLR (0.27 ± 0.11 vs 0.28 ± 0.12), MPV (9.59 ± 0.71 vs 9.70 ± 0.79), SII (680.79 ± 330.18 vs 687.89 ± 442.66), and PIV (552.02 ± 330.71 vs 605.05 ± 415.96) values did not change statistically significantly after treatment (p > 0.05). While there was a significant decrease in platelet count compared to before treatment, no statistically significant difference was found in the other evaluated blood cells. CONCLUSION: Adalimumab treatment has not had a significant effect on systemic inflammation markers in HS, an inflammatory disease. More studies are needed to evaluate the effect of adalimumab on these markers in HS.

Sudden developing convulsion during interscalene block: Does propofol anesthesia diminish plasma bupivacaine level?

We aim to review local anesthetic systemic toxicity (LAST) due to suddenly developing convulsion during interscalene block in a 67-year-old patient undergoing shoulder surgery.

Popliteal Sciatic Nerve Block in a Pregnant Patient in the Last Trimester.

Although regional anaesthesia is a commonly preferred anaesthesia technique for pregnant patients undergoing non-obstetric surgery, peripheral nerve blocks are relatively less administered. The use of popliteal sciatic nerve block for foot-ankle surgery has been presented for a nulliparous parturient at 32 weeks of gestation scheduled to undergo surgical exploration of an arterial pseudoaneurysm on her right plantar surface due to a penetrating stab injury. Since surgery did not require pneumatic tourniquet, the sciatic nerve was blocked via the popliteal approach with a single shot injection of 30 mL of 0.375% levobupivacaine. The operation and the anaesthesia course were uneventful. In conclusion, popliteal sciatic nerve block was successful and uneventful for a short foot surgery not requiring tourniquet application in a parturient in the last trimester.

Does hyaluronic acid decrease the apoptotic effect of bupivacaine?

OBJECTIVES: In this study, we aimed to study the anti-apoptotic effects of hyaluronic acid on the apoptotic effects of bupivacaine in cultured rat chondrocytes in a time and dose-dependent manner. MATERIAL AND METHODS: The rat chondrocytes were treated with 7.69 µM, 76.9 µM, and 384.5 µM bupivacaine and 50 µg/ml hyaluronic acid concentrations for six, 24, and 48 hours. At the end of the treatment period, cells were stained with mixture of acridine orange and ethidium bromide. Apoptosis was evaluated using a fluorescence microscope. RESULTS: A significant protective effect of hyaluronic acid on chondrocytes against bupivacaine exposure at 7.69 µM and 76.9 µM concentrations, particularly was observed. There was also a significant protective effect in the exposure time at six and 24 hours for 7.69 µM and 76.9 µM bupivacaine doses. CONCLUSION: Our study results show that hyaluronic acid against chondrotoxicity of bupivacaine may have a protective effect in a time and dose-dependent manner.

Bupivacaine and levobupivacaine induce apoptosis in rat chondrocyte cell cultures at ultra-low doses.

PURPOSE: Osteoarthritis (OA) is characterized by chondrocyte apoptosis and necrosis which play a key role during the progression of OA. Intra-articular administration of bupivacaine is a practical and effective way of postoperative pain control following various joint surgeries. 0.25 % bupivacaine showed to be safe in terms of chondrocyte toxicity. Around 200 nM of bupivacaine was shown to be effective for peripheral nerve block. This study aims to observe the possible cytotoxic effects of bupivacaine and its enantiomer levobupivacaine on chondrocyte cell culture at 7.69, 76.9, and 384.5 µM or at 0.0125, 0.0025, and 0.00025 % concentrations, respectively. METHODS: Chondrocytes were isolated from rat articular cartilage after incubating with collagenase in RPMI-1640 medium. Cells were treated with bupivacaine and levobupivacaine at 7.69, 76.9, and 384.5 µM concentrations for 6, 24, and 48 h. Treated chondrocytes were stained with acridine orange and ethidium bromide and examined under a fluorescence microscope at a 490 nm excitation wavelength for apoptotic changes. RESULTS: Study results suggest that both bupivacaine and levobupivacaine have dose-dependent chondrocyte toxicity, and this is significantly lesser at 7.69 µM dose. There was no significant difference in terms of chondrocyte apoptosis, (p > 0.05). CONCLUSIONS: Clinicians should be skeptic for the serious long-term side effects of bupivacaine and its analogs, even at ultra-low doses.

Acute Phase Reaction after Femur Fracture in a Child with Griscelli Syndrome.

Griscelli syndrome (GS) is an autosomal recessive disorder that is characterized by partial albinism of the skin and hair shaft. Prompt and early diagnosis is a crucial step for the follow up and management of GS, which would otherwise dramatically decrease the life expectancy of the patients. This case report presents the clinical course of a femoral fracture treated with closed reduction and pelvic-pedal cast, and progression of acute phase reaction during the follow up period.

Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study.

BACKGROUND AND OBJECTIVES: Initiation of epidural anesthesia with long-lasting local anesthetics consumes a significant amount of time, which could be problematic in busy obstetric anesthesia suites. We have hypothesized that a combination of articaine and ropivacaine provides faster onset and even an early recovery of sensory-motor block characteristics. METHODS: Sixty term parturients scheduled to have elective cesarean section were randomly allocated into three groups to receive either 20 mL 2% articaine (Group A), 10 mL 2% articaine + 10 mL 0.75% ropivacaine (Group AR) or 20 mL 0.75% ropivacaine (Group R) via lumbar epidural catheter. The onset time of sensory block to T10, T6 and maximum sensory block level, time to two segments regression from maximum sensory block level, onset time and duration of motor block were all recorded. Intraoperative and postoperative additional analgesic requirements were also recorded. RESULTS: Demographic data were similar. The onset times of sensorial block to T10 and T6 were significantly shorter in Groups A and AR in comparison with Group R (p<0.05). The onset times of motor block were similar in all groups, but a more intense motor block was observed in Group R (p<0.05). Two segments regression time and motor block durations were significantly shorter in Groups A and AR in comparison with Group R (p<0.05). Intraoperative supplementary analgesic requirements were higher in Group A than in the other two groups (p<0.05). CONCLUSION: A combination of 2% articaine and 0.75% ropivacaine for epidural anesthesia in a cesarean section should be preferred over epidural 0.75% ropivacaine alone.

Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego / Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study / Ropivacaína, articaína o la combinación de ropivacaína y articaína en la anestesia epidural para cesárea: estudio aleatorio, prospectivo y doble ciego

JUSTIFICATIVA E OBJETIVOS: Iniciar a anestesia peridural com anestésicos locais de longa duração consome uma quantidade significativa de tempo, o que pode ser problemático em centros de anestesia obstétrica muito movimentados. Aventamos a hipótese de que uma combinação de articaína e ropivacaína proporcionaria início mais rápido e mesmo uma recuperação precoce das características do bloqueio sensório-motor. MÉTODOS: Sessenta parturientes a termo agendadas para cesariana eletiva foram randomicamente alocadas em três grupos para receber 20 mL de articaína a 2% (Grupo A), 10 mL de articaína a 2% + 10 mL de ropivacaína a 0,75% (Grupo AR) ou 20 mL de ropivacaína a 0,75% (Grupo R) via cateter peridural. O tempo de início do bloqueio sensorial até T10-T6 e o nível máximo de bloqueio, o tempo para a regressão de dois segmentos do nível máximo de bloqueio sensorial e o tempo de início e duração do bloqueio motor foram todos registrados. A necessidade de analgésicos adicionais, intra- e pós-operatoriamente, também foi registrada. RESULTADOS: Os dados demográficos foram semelhantes. Os tempos de início do bloqueio sensorial até os níveis T10 e T6 foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p < 0,05). Os tempos de início do bloqueio motor foram semelhantes em todos os grupos, mas um bloqueio motor mais profundo foi observado no Grupo R (p < 0,05). O tempo para a regressão de dois segmentos e a duração do bloqueio motor foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p < 0,05). A necessidade de analgésico adicional no período intraoperatório foi maior no Grupo A do que nos outros dois grupos (p < 0,05). CONCLUSÃO: A combinação de 2% articaína e 0,75% ropivacaína para anestesia peridural em cesariana deve ser preferida à administração peridural de ropivacaína a 0,75% sozinha.

BACKGROUND AND OBJECTIVES: Initiation of epidural anesthesia with long-lasting local anesthetics consumes a significant amount of time, which could be problematic in busy obstetric anesthesia suites. We have hypothesized that a combination of articaine and ropivacaine provides faster onset and even an early recovery of sensory-motor block characteristics. METHODS: Sixty term parturients scheduled to have elective cesarean section were randomly allocated into three groups to receive either 20 mL 2% articaine (Group A), 10 mL 2% articaine + 10 mL 0.75% ropivacaine (Group AR) or 20 mL 0.75% ropivacaine (Group R) via lumbar epidural catheter. The onset time of sensory block to T10, T6 and maximum sensory block level, time to two segments regression from maximum sensory block level, onset time and duration of motor block were all recorded. Intraoperative and postoperative additional analgesic requirements were also recorded. RESULTS: Demographic data were similar. The onset times of sensorial block to T10 and T6 were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). The onset times of motor block were similar in all groups, but a more intense motor block was observed in Group R (p < 0.05). Two segments regression time and motor block durations were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05). Intraoperative supplementary analgesic requirements were higher in Group A than in the other two groups (p < 0.05). CONCLUSION: A combination of 2% articaine and 0.75% ropivacaine for epidural anesthesia in a cesarean section should be preferred over epidural 0.75% ropivacaine alone.

JUSTIFICATIVA Y OBJETIVOS: Iniciar la anestesia epidural con anestésicos locales de larga duración consume una cantidad significativa de tiempo, siendo un problema en los centros de anestesia obstétrica que tienen mucho movimiento. Barajamos la hipótesis de que una combinación de articaína y ropivacaína proporcionaría un inicio más rápido e incluso una rápida recuperación de las características del bloqueo sensitivo motor. MÉTODOS: Sesenta parturientes a término que tenían cita para la cesárea electiva se ubicaron aleatoriamente en tres grupos para recibir 20 mL de articaína al 2% (Grupo A), 10 mL de articaína al 2% + 10 mL de ropivacaína al 0,75% (Grupo AR) o 20 mL de ropivacaína al 0,75% (Grupo R) vía catéter epidural. Se registraron el tiempo de inicio del bloqueo sensorial hasta T10-T6 y el nivel máximo de bloqueo; el tiempo para la regresión de los segmentos del nivel máximo de bloqueo sensorial y el tiempo de inicio y duración del bloqueo motor. La necesidad de analgésicos adicionales en el intra y en el postoperatorio, también se registró. RESULTADOS: Los datos demográficos fueron parecidos. Los tiempos de inicio del bloqueo sensorial hasta los niveles T10 y T6 fueron significativamente menores en los grupos A y AR, en comparación con el Grupo R (p < 0,05). Los tiempos de inicio del bloqueo motor fueron similares en todos los grupos, pero un bloqueo motor más profundo se observó en el Grupo R (p < 0,05). El tiempo para la regresión de los segmentos y la duración del bloqueo motor fueron significativamente menores en los grupos A y AR, en comparación con el Grupo R (p < 0,05). La necesidad de analgésico adicional en el período intraoperatorio fue mayor en el Grupo A que en los otros dos grupos (p < 0,05). CONCLUSÓN: La combinación de ropivacaína al 2% y de articaína al 0,75% para la anestesia epidural en cesárea debe ser el método de preferencia en vez de la administración epidural de ropivacaína sola al 0,75%.