Effects Of Different Anesthesia Applications On Mood, Depression, And Anxiety Levels In Burn Patients.

Adequate and effective pain management and prevention of depression are essential in burn patients. This study aims to explore the effects of ketamine sedation in burn patients in terms of mood disorders, depression, anxiety, and suicidality during postoperative follow-up in the intensive care unit. This study targeted subjects aged 18 to 65 years, in the ASA I-II class, with basic communication skills, no history of diagnosed mental illness, and no history of neuropsychiatric or cognitive disorders or related treatment. The study was conducted on 67 patients. After preoxygenation, anesthesia induction was practiced with 2 mg/kg IV propofol and 1 mcg/kg IV fentanyl in the general anesthesia group. Anesthesia was continued with a mixture of 0.3-0.5 mcg/kg/min remifentanil, 2% sevoflurane, 50% air, 50% oxygen. In the sedation group, 1 mcg/kg IV fentanyl and 1 mg/kg IV ketamine were administered at induction; anesthesia was maintained by adding 30-50 mg IV propofol if necessary. The Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and Beck Scale for Suicidal Ideation (BSSI) have been administered via way of means of a psychiatrist preoperatively and on the primary postoperative day. In intragroup evaluations, MADRS values for the sedation anesthesia group decreased statistically significantly after the anesthesia (11.63±5.49) compared to the pre-anesthesia period (14.44±7.22) (p < 0.001). HAM-A scores of both anesthesia groups decreased statistically significantly after anesthesia. No patient was found to have suicidal ideation in all evaluations in which BSSI was used. Burn patients may have a high potential for depression, anxiety disorders, and suicidal tendencies due to the trauma they have experienced. In these patients, sedation anesthesia with ketamine may reduce negative mood, depression, anxiety, and suicidal tendencies in the postoperative period.

Postoperative residual curarisation in geriatric patients: a prospective, observational cohort study.

Objective: To evaluate the occurrence and potential risk factors of residual curarisation after surgery and the subsequent acute respiratory events in elderly patients. METHODS: The prospective, cohort study was conducted at Ankara City Hospital from July to December 2021, and comprised data of geriatric patients undergoing elective surgery under general anaesthesia using moderate-acting nondepolarising muscle relaxants. Postoperative acute respiratory events in the post-anaesthesia care unit were subsequently noted. Data was analysed using SPSS 25. RESULTS: Of the 185 patients aged >65 years evaluated, 174(94%) were included; 88(50.6%) females and 86(49.4%) males. The incidence of residual curarisation was in 6(3.4%) patients. Postoperative residual curarisation was significantly associated with smooth recovery process (p<0.05). The recovery was associated with intraoperative bleeding, total dose of neuromuscular blocker, and the length of time from the last dose of neuromuscular blocker to antagonist administration (p<0.05). Postoperative critical respiratory events were more common in patients with postoperative residual curarisation (p< 0.001). The length of stay in post-anaesthesia care unit was 1.57 times longer in such patients (p=0.001). Conclusion: Postoperative residual curarisation increased length of hospital stay and respiratory complications.

Comparing the biological properties and chemical profiling of chestnut bee pollen and bee bread collected from Anatolia.

Bee bread (BB) and bee pollen (BP) are accepted as functional food and considered in medical properties due to its important bioactive components. These bee products show different biological properties, but researches on these aspects have not been clear yet. In present study, Anatolian BB and BP extracts were analyzed for the first time for their pollen type, total phenolic (TPC) and flavonoid content (TFC), and antimicrobial and antioxidant properties. Samples were analyzed for their antimicrobial efficacy by the agar well diffusion and MIC methods. HPLC analysis was used to identify the compounds in the BB and BP samples. Antioxidant activity was measured by the FRAP and DPPH methods. As a result of microscopy for pollen identification, Fagaceae family was dominant. Phenolic compound analysis showed that the amounts of p-coumaric acid and rutin were found to be the highest in BB and BP, respectively. Stronger antioxidant activity was obtained from BP. MIC values of BB were range from 250 to 12.5 µg/mL. The most susceptible bacterium was Mycobacterium smegmatis. The extract of BP was effective on all gram-negative bacteria with doses range from 250 µg/mL to 500 µg/mL. The lowest MIC value was detected with the concentration of 12.5 µg/mL against M. smegmatis. Anatolian BB and BP could be considered as a functional foods due to antioxidant activity and may be beneficial in the management and treatment of pathogenic bacteria because of high antimicrobial activity.

Chemical profiling and antimicrobial effect of Anatolian honey bee venom.

Due to increasing antibiotic resistance, there is an urgent need to find new antibiotic alternatives or supporters for the treatment of disease-causing pathogens. For this reason the aim of the study was examine the antimicrobial and antifungal activity of Anatolian (Anadolu) honey bee venom (HBV) against Gram-positive and Gram-negative bacteria and yeast-like fungi. At first step chemical analyses of HBV was performed by HPLC method. According to the results of HPLC analysis, we obtained a good separation of apamine, phospholipase A2 and melittin with the ratio of 1.83%, 20.60% and 57.62% respectively. The antimicrobial and antifungal activity of the Anatolian HBV was tested against 9 Gram (+), 7 Gram (-), 1 acid-alcohol-resistant and 3 yeast fungi. First, the activity of the Anatolian HBV sample against these microorganisms was determined by the agar well diffusion method, then their zones were measured. The microdilution method was used to determine the minimum inhibitory concentration (MIC) for the antimicrobial activity tests. The results of MIC values were varied from 3.06 µg/mL to 50 µg/mL for the tested microorganisms. It was found that Mycobacterium smegmatis and Streptococcus pyogenes were the most susceptible bacteria (3.06 µg/mL), followed by Vibrio sp., Aeromonas sobria, Enterococcus faecalis, Listeria monocytogenes, Staphylococcus aureus (MRSA) and B. subtilis with a MIC concentration of 6.125 µg/mL. These findings strongly suggest that Anatolian HBV will be developed as a new antibacterial-antifungal drug against Gram-positive, Gram negative and antibiotic-resistant bacteria and yeast-like fungi. However, further research is required to evaluate their in vivo efficacy and safe and effective delivery methods for their therapeutic use.

Screening of Antimicrobial Resistance Genes and Epidemiological Features in Hospital and Community-Associated Carbapenem-Resistant Pseudomonas aeruginosa Infections.

INTRODUCTION: Researching carbapenem-resistant isolates enables the identification of carbapenemase-producing bacteria and prevents their spread. METHODS: P. aeruginosa isolates were recovered from Medicine Faculty of Recep Tayyip Erdogan University and identified by conventional methods and the automated Vitek 2 Compact system. Antimicrobial susceptibility experiments were performed in accordance with CLSI criteria and the automated Vitek 2 Compact system. The PCR method was investigated for the presence of ß-lactamase resistance genes. PFGE typing was performed to show clonal relation among samples. RESULTS: Seventy P. aeruginosa isolates were isolated from seventy patients. Of the patients, 67.1% had contact with the health service in the last 90 days and 75.7% of the patients had received antimicrobial therapy in the previous 90 days. Twenty-four isolates were carbapenem resistant, 2 isolates were multidrug-resistant except colistin, and none of the samples had colistin resistance. The gene encoding ß-lactamase or metallo-ß-lactamase was found in a total of 36 isolates. The bla VEB and bla PER genes were identified in 1 and 5 isolates alone or 17 and 13 isolates in combination with other resistance genes, respectively. The bla NDM was the most detected metallo-ß-lactamase encoding gene (n=18), followed by bla KPC (n=12). bla IMP and bla VIM were detected in 5 and 1 isolates, respectively. Also, the association of bla VEB-bla PER and bla VEB-bla KPC-bla NDM was found to be very high. Much more resistance genes and co-occurrence were detected in hospital-acquired samples than community-acquired samples. No difference was found between the community and hospital-associated isolates according to PFGE results. Simultaneously from 6 patients, other microorganisms were also isolated and 5 of them died. CONCLUSION: The average length of stay (days) was found to be significantly higher in HAI group than CAI group. The death of 5 patients with fewer or no resistance genes showed that the co-existence of other microorganisms in addition to resistance genes was important on death.

Counteraction of Apoptotic and Inflammatory Effects of Adriamycin in the Liver Cell Culture by Clinopitolite.

Growing evidence has been reported on adriamycin (ADR) hepatotoxicity in literature. Hepatotoxicity caused by the use of drugs has a serious undesirable effect in the cure of cancer patients that needs to be eliminated. The exact mechanism of ADR on non-cancerous tissue still remains to be a mystery. The zeolite (clinoptilolite) minerals form a complex group of aluminosilicates that often occur as accessory minerals in intermediate and basic rocks. In light of this information, we investigated the possible anti-inflammatory and anti-apoptotic effects of clinoptilolite in ADR that is inducing the toxicity in primary liver cell culture. Primary liver cell culture from rat was used in the study. We had three experiment groups including the following: (1) cells treated only with 50 µM ADR for 24 h, (2) cells treated with the 50 µM ADR for 24 h and then treated with 10(-4) M zeolite for 1 h, and (3) cells were incubated with 50 µM ADR for 24 h and then incubated with 10(-4) M zeolite for 24 h to test its long-term effects. After that, western blotting was performed in order to evaluate protein expression levels of several inflammation markers including IL-1ß, tumor necrosis factor (TNF)-α, and nuclear factor kappa B (NF-κB), and immunohistochemistry was carried out to detect apoptosis in liver cell culture. Also, TdT-dUTP Terminal Nick-End Labeling (TUNEL) method was used for detecting apoptosis. We found elevated levels of inflammatory protein and apoptotic markers in ADR-administered cells (p < 0.05). Inflammatory and apoptotic markers decreased significantly after treated with zeolite (p < 0.05). The present study was pointed out that ADR causes hepatotoxicity via apoptosis and/or inflammation processes resulting from initiator NF-κB and TNF which causes proinflammatory mediators such as IL-1ß. Elevation of inflammation might give rise to trigger apoptosis. Clinoptilolite counteracted the apoptosis and inflammation induced by ADR arising from the decrease in NF-κB, TNF-α, and IL-1ß protein levels.

Evaluation of carbapenem resistance using phenotypic and genotypic techniques in Enterobacteriaceae isolates.

BACKGROUND: Bacterial resistance to antibiotics is increasing worldwide. Antibiotic-resistant strains can lead to serious problems regarding treatment of infection. Carbapenem antibiotics are the final treatment option for infections caused by serious and life-threatening multidrug-resistant gram-negative bacteria. Therefore, an understanding of carbapenem resistance is important for infection control. In the study described herein, the phenotypic and genotypic features of carbapenem-resistant Enterobacteriaceae strains isolated in our hospital were evaluated. METHODS: In total, 43 carbapenem-resistant strains were included in this study. Sensitivity to antibiotics was determined using the VITEK(®)2 system. The modified Hodge test (MHT) and metallo-ß-lactamase (MBL) antimicrobial gradient test were performed for phenotypic identification. Resistance genes IMP, VIM, KPC, NDM-1, and OXA-48 were amplified by multiplex PCR. RESULTS: The OXA-48 gene was detected in seven strains, and the NDM-1 gene in one strain. No resistance genes were detected in the remainder of strains. A significant correlation was observed between the MHT test and OXA-48 positivity, and between the MBL antimicrobial gradient test and positivity for resistance genes (p < 0.05). CONCLUSION: The finding of one NDM-1-positive isolate in this study indicates that carbapenem resistance is spreading in Turkey. Carbapenem resistance spreads rapidly and causes challenges in treatment, and results in high mortality/morbidity rates. Therefore, is necessary to determine carbapenem resistance in Enterobacteriaceae isolates and to take essential infection control precautions to avoid spread of this resistance.

Extrapulmonary tuberculosis: 7 year-experience of a tertiary center in Istanbul.

BACKGROUND: Although a decreasing trend of tuberculosis (TB) was reported in Turkey, higher proportion of extrapulmonary tuberculosis (EPT) was revealed. MATERIAL AND METHODS: In this retrospective study, clinical and laboratory data of 141 EPT patients were evaluated for a seven-year period by using descriptive statistics, and parametric and non-parametric tests where appropriate. RESULTS: The most frequent types of EPT were meningeal TB (23%) and TB lymphadenitis (21%), respectively. Other types of EPT were skeletal, miliary, peritoneal, abscess, genitourinarial, cutaneous and gastrointestinal involvement which ranged between 18% and 1%. Mean age was 42 and female/male ratio was almost equal. All patients were born in Turkey. Although all of them were permanent residents of Istanbul, 73% of the patients came from East and Southeast Region of Turkey. For the patients, being older than 40 years old (p<0.01), having miliary TB (p<0.05) and high CRP levels (p<0.05) were found to be associated with mortality. CONCLUSIONS: EPT still remains as a significant morbidity and mortality reason in lower income populations and developing countries. In our study, although all patients were residents of Istanbul approximately two thirds of them have migrated from East and Southeast parts of the country. The relatively high prevalence of tuberculosis cases in Istanbul may be due to the permanent migration from other parts of the country. Early diagnosis and initiation of appropriate treatment are the keys for reducing morbidity and mortality in patients with EPT, particularly in the cases of older ages.

QT dispersion and cardiac involvement in children with Familial Mediterranean fever.

Familial Mediterranean fever is a hereditary disease characterised by recurrent and self-terminated attacks of fever and polyserositis. An earlier study found that adult patients of Familial Mediterranean fever had an abnormally longer QT dispersion and corrected QT dispersion, markers for ventricular arrhythmogenicity. QT dispersion is a simple non-invasive arrhythmogenic marker that can be used to assess homogeneity of cardiac repolarisation; however, it has not been studied in children with Familial Mediterranean fever before. The aim of this study was to assess QT dispersion and corrected QT dispersion, and their relationship with systolic and diastolic function of the left ventricle in a group of children with Familial Mediterranean fever. We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum QT, minimum QT, QT dispersion, corrected QT, maximum corrected QT, minimum corrected QT, and corrected QT dispersion intervals were measured from standard 12-lead electrocardiography. No statistically significant differences were found between the groups in QT dispersion, corrected QT dispersion, and systolic-diastolic function of the left ventricle parameters. During the 12 months of follow-up, no ventricular arrhythmias were documented in either group.

Can screening Chlamydia trachomatis by serological tests predict tubal damage in infertile patients?

Effectiveness of screening Chlamydia trachomatis (CT) antibody to predict tubal damage was assessed in this prospective study which was performed in a teaching hospital between September 2003 and September 2004. The study group consisted of 152 patients who underwent laparoscopy for infertility and the control group consisted of 80 fertile women who gave birth in the same hospital. CT antibody levels were measured by IFA (Indirect Fluorescence Assay for CT). Adhesions were defined by Gomel's classification system. Rate of seropositivity of CT was 34.6% in the study group and 22.5% in the control group (p>0.05). In the study group, the sensitivity, specifity, positive predictive and negative predictive values of CT positivity for tubal damage were 40%, 69.5%, 50% and 60.2% respectively. In the infertile group, the rate of tubal adhesion in the CT positive group was 50% and in the CT negative group it was 39.7% (p>0.05). However, there was a positive correlation between the severity of tubo-peritoneal adhesions and seropositivity for CT. In this study, we found out that tubo-peritoneal adhesions could not be predicted by the presence of CT inserum. There was a positive correlation between high CT seropositivity and high degree of adhesions.

Comparison of three different combination therapies in the treatment of human brucellosis.

The efficacy and tolerability of three different combination treatment regimens in human brucellosis were compared in 118 uncomplicated patients enrolled in a prospective study between May 1997 and December 2002. Brucellosis was diagnosed using standard clinical and microbiological findings. Patients with central nervous system involvement, spondylitis, endocarditis or children under 16 years of age were excluded from the study. Patients were randomly assigned to receive 400 mg of ofloxacin plus 600 mg of rifampicin (OR, n = 41), 200 mg of doxycycline plus 600 mg of rifampicin (DR, n = 45) or 1g intramuscularly streptomycin (administered for three weeks) plus 200 mg doxycycline (DS, n = 32) daily for 6 weeks. All patients were followed up at least 6 months after cessation of therapy. There was no statistical difference between the groups on relapse rates and clinical response to the treatment (P>0.05). Five patients in OR (12.8%), six patients in DR (14.3%) and three patients in DS groups (9.7%) suffered relapse. The side-effects were seen in eight (19.5%), 21 (46.7%) and eight (25.0%) patients of OR, DR and DS groups, respectively. The use of combination therapy of ofloxacin plus rifampicin for 6 weeks was found to be as effective as DR and DS. The side-effects of therapy in OR and DS groups was less severe than in the DR group.

Effect of the treatment of brucellosis on leukocyte superoxide dismutase activity and plasma nitric oxide level.

BACKGROUND: The mechanisms by which brucellae evade intracellular killing by polymorphonuclear leukocytes are incompletely understood. In this study, we evaluated changes of leukocyte superoxide dismutase (SOD) activity and plasma total nitrite as an indicator of nitric oxide (NO) levels during brucellosis therapy. METHODS: Thirty-two patients with acute brucellosis, 27 patients with chronic brucellosis and 30 healthy controls were included in the study. Patients with acute brucellosis were tested for leukocyte SOD activity and plasma total nitrite levels before, during (21st day), and at the end (45th day) of the combined therapy of rifampicin and doxycycline. The same parameters were also investigated in chronic cases and controls. RESULTS: The SOD activities were lower in patients with acute brucellosis before therapy compared with those 21 and 45 days after starting therapy (P < 0.001). In contrast, total nitrite levels did not change significantly (P > 0.05). CONCLUSIONS: In the present study, leukocyte SOD activity was found to be decreased in patients with acute brucellosis. Enzyme activity was increased by treatment, finally reaching the activity of healthy controls. Using an antioxidant agent in addition to classical antimicrobial therapy for acute brucellosis might be a therapeutic approach.

Antihepatitis B response to hepatitis B vaccine administered simultaneously with tetanus toxoid in nonresponder individuals.

In this prospective study, our aim was to test the effect of simultaneous administration of preS2 and S containing recombinant hepatitis B vaccine (S2SRHB) with tetanus toxoid (TT) to the individuals who did not respond after three doses of hepatitis B vaccine previously. There were three groups (healthy individuals, pregnant women, hemodialysis patients), each was divided into two subgroups as groups A and B. Group A received S2SRHB+TT and group B received only S2SRHB. We found that in groups receiving both vaccines, both seroconversion rate and antibody titer level were significantly higher (P<0.05). In conclusion, simultaneous administration of S2SRHB+TT is more effective than administration of S2SRHB alone.