Cytomegalovirus and Epstein-Barr virus reactivation in the intensive care unit.

AIM: The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation. MATERIALS AND METHODS: In this observational prospective study, 60 adult immunocompetent patients who stayed at least 7 days in an ICU were evaluated. During hospitalization, the viral load was monitored at admission and on day 7 with polymerase chain reaction to detect viral reactivation and weekly thereafter on days 14, 21, and 28 if hospitalization continued. RESULTS: The mean age of patients was 63.3 years (±23.4 years) and 34 (56.7 %) of them were male. Mean APACHE II scores for patients was 25 at admission. Of these patients, 28 were hospitalized in the internal ICU and 32 were hospitalized in the anesthesiology ICU. CMV/EBV reactivation was found in 17 individuals (12 for EBV, 3 for CMV, and 2 for both). The median high-sensitive C-reactive protein value in patients with CMV reactivation was significantly higher than in those patients without CMV reactivation (p = 0.037). EBV reactivation was statistically higher in patients with mechanical ventilation compared to patients without mechanical ventilation (p = 0.023). EBV reactivation in patients with fever was found to be statistically higher than in the patients without fever (p = 0.035). CONCLUSION: There is a need for extended studies with a larger number of patients from specific groups to better understand the reactivation frequency and identify risk factors. EBV and CMV reactivation should be taken into consideration in critically ill patients with fever, without specific symptoms and unresponsive to the treatment.

Comparison of flunixin meglumine and meloxicam influence on postoperative and oxidative stress in ovariohysterectomized bitches.

The aim of this study was to compare the effect of flunixin meglumine (FM) and meloxicam (M) on postoperative and oxidative stress in ovariohysterectomized bitches. Twenty four bitches were divided into three groups (n = 8 in each) and treated during premedication as follows: FM (2.2 mg/kg, iv, Fluvil, Vilsan, Turkey), M (0.2 mg/kg, sc, Maxicam, Sanovel, Turkey) or 0.9% saline (1 ml, iv, IE, Turkey)--control (C) group. The concentrations of serum cortisol, nitric oxide (NO), malondialdehyde (MDA), antioxidant potential (AOP) and glutation (GSH) were measured in blood samples collected during incision (0 h), closure of incision line (0.5 h) and 1, 2.5, 12 and 24 hours after incision. It was observed that cortisol level was higher at 0.5, 1 and 2.5 h in group C (p < 0.05), 0.5 h in group FM (p < 0.001), and 1 and 2.5 h in group M (p < 0.01), as compared to that determine at 0 h. Group C showed higher cortisol level during 0.5 h (p < 0.05) than that found in the other groups. Group FM displayed lower levels during 1 h (p < 0.01) and 2.5 h (p < 0.05) as compared to those observed in other groups. Concentrations of MDA, AOP and GSH between all the groups did not show any significant differences. MDA level was higher at 0.5 and 1 h in group M (p < 0.05) than that found in group C and it was the lowest at 2.5 h in group C (p < 0.05). AOP was higher at 2.5 h in group FM and M (p < 0.05) than that observed in group C, and at 12 and 24 h in group M than that found in group C and FM. GSH did not show any significant differences between the groups. NO level in group FM after 12 h was higher (p < 0.05) than that at 0.5, 1 and 24 h. Moreover, NO level was lower at 0.5 (p < 0.01), 1 (p < 0.05) and 24 h (p < 0.05) in group FM than that observed in group C and M. In conclusion, flunixin meglumine decreases cortisol and NO levels more efficiently than meloxicam. Therefore, it is suggested that postoperative stress following ovariohysterectomy may be prevented by flunixin meglumine in bitches.

Effects of erbium:yttrium-aluminum-garnet and neodymium:yttrium-aluminum-garnet laser hypersensitivity treatment parameters on the bond strength of self-etch adhesives.

This in vitro study evaluated the shear bond strength (SBS) of two self-etch adhesives to coronal and root dentin treated with erbium:yttrium-aluminum-garnet (Er:YAG) or neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers for dentin hypersensitivity. The coronal and root dentin surfaces of 60 extracted human cuspids were divided into three groups (n = 20): (1) control (without treatment); (2) treated with Er:YAG; (3) treated with Nd:YAG laser and a one-step (S3) or two-step self-etch adhesive (SE). A nano-composite was applied and SBS tests were performed. The mean SBS values were calculated, failure modes were determined, and data were subjected to statistical analysis (P = 0.05). Control/SE exhibited higher values than did control/S3 and Nd:YAG/S3 on coronal dentin (P < 0.05). No significant differences were observed between the SE and S3 groups in root dentin (P > 0.05). Comparisons of two dentin substrates did not show any difference except control/SE (P < 0.05). The failure modes were mainly adhesive. The SBSs of self-etch adhesives to Er:YAG or Nd:YAG laser-treated surfaces were comparable with control for both coronal and root dentin.

Treatment of cyanide effluents by oxidation and adsorption in batch and column studies.

In this study the removal of free cyanide from aqueous solutions by air oxidation and adsorption was investigated. Effects of air and pure oxygen, and catalyst on the rate and extent of the removal of cyanide were studied. It was found that the oxidative removal of cyanide by air/oxygen was very limited although it tended to improve in the presence of pure oxygen and catalyst such as activated carbon (AC) and copper sulphate. In the presence of continuous aeration, the non-oxidative removal of cyanide was correlated with a decrease in pH effected apparently by the transfer of carbon dioxide from air phase into the medium. The removal of cyanide by adsorption on activated carbon, nut shell (NS) and rice husk (RH) was also examined. Adsorption capacity of activated carbon was shown to be significantly enhanced via impregnation of activated carbons with metals such as copper (AC-Cu) and silver (AC-Ag). In the column tests, the breakthrough capacity of adsorbents was found to be in an increasing order of RH

Potential use of pyrite cinders as raw material in cement production: results of industrial scale trial operations.

Pyrite cinders, which are the waste products of sulphuric acid manufacturing plants, contain hazardous heavy metals with potential environmental risks for disposal. In this study, the potential use of pyrite cinders (PyCs) as iron source in the production of Portland cement clinker was demonstrated at the industrial scale. The chemical and mineralogical analyses of the PyC sample used in this study have revealed that it is essentially a suitable raw material for use as iron source since it contains >87% Fe(2)O(3) mainly in the form of hematite (Fe(2)O(3)) and magnetite (Fe(3)O(4)). The samples of the clinkers produced from PyC in the industrial scale trial operation of 6 months were tested for the conformity of their chemical composition and the physico-mechanical performance of the resultant cement products. The data were compared with the clinker products of the iron ore, which is used as the raw material for the production Portland cement clinker in the plant. The chemical compositions of all the clinker products of PyC appeared to conform to those of the iron ore clinker, and hence, a Portland cement clinker. The mechanical performance of the mortars prepared from the PyC clinker was found to be consistent with those of the industrial cements e.g. CEM I type cements. It can be inferred from the leachability tests (TCLP and SPLP) that PyC could be a potential source of heavy metal pollution while the mortar samples obtained from the PyC clinkers present no environmental problems. These findings suggest that the waste pyrite cinders can be readily used as iron source for the production of Portland cement. The availability of PyC in large quantities at low cost provides further significant benefits for the management/environmental practices of these wastes and for the reduction of mining and processing costs of cement raw materials.

Medicaid expansions and the crowding out of private health insurance among children.

This paper re-examines the magnitude of crowd out among children. We use longitudinal data that allow us to identify and differentiate groups of children based on whether their eligibility for Medicaid was affected by the program's eligibility expansions. We investigate whether changes in insurance coverage of children affected by the expansions differed from changes in insurance coverage of children unaffected by the expansions. For example, we directly measure whether there was a greater decrease in private insurance coverage among children who became eligible for Medicaid than among children whose eligibility was unaffected. Our results suggest that there was relatively little crowd out among children. We estimate that 18.9% of the recent increase in Medicaid enrollment came from private insurance.

Phosphatidylinositol 3-kinase and protein kinase C contribute to the inhibition by interleukin 6 of phosphoenolpyruvate carboxykinase gene expression in cultured rat hepatocytes.

The participation of phosphatidylinositol 3-kinase (PI3-kinase), protein kinase C, and mitogen-activated protein kinase (MAP-kinase) in the inhibition by interleukin 6 (IL-6) and insulin of phosphoenolpyruvate carboxykinase (PCK) gene expression was investigated in cultured rat hepatocytes. IL-6 or insulin inhibited the glucagon-stimulated increase in PCK messenger RNA (mRNA) by about 70%. In the presence of either the PI3-kinase inhibitor, wortmannin, or the protein kinase C inhibitor, GF109203x, the inhibition by IL-6 was only about 40%, although it was abolished with both inhibitors in combination. Wortmannin alone but not GF109203x prevented the inhibition by insulin of glucagon-stimulated PCK gene expression. The MAP-kinase pathway inhibitor, PD98059, did not affect IL-6 or insulin inhibition of PCK mRNA increase. When chlorophenylthio-cyclic 3',5' adenosine monophosphate (CPT-cAMP) was used instead of glucagon, IL-6 or insulin inhibited the increase in PCK mRNA by 75% and 85%, respectively. The inhibition by IL-6 was only about 50% in the presence of either wortmannin or GF109203x alone but was abolished with the combination of both inhibitors. The inhibition by insulin was only about 50% in the presence of GF109203x and was abolished by wortmannin. The inhibitors did not affect the inhibition by IL-6 or insulin of the glucagon-stimulated increase in cAMP. It is concluded that the inhibition by IL-6 of PCK gene expression involved both PI3-kinase and protein kinase C, whereas the inhibition by insulin required only PI3-kinase. The inhibition occurred downstream from cAMP formation. Hence, IL-6 and insulin may share, in part, common signal transduction pathways in the inhibition of PCK gene expression.

Phenytoin sodium microcapsules: bench scale formulation, process characterization and release kinetics.

The objective of this investigation was to formulate and prepare sustained-action microcapsules of phenytoin sodium (diphenyl hydantoin sodium salt). Using ethylcellulose and methyl acrylic acid copolymers (Eudragit S-100 and L-100) as coating materials, microcapsules of phenytoin sodium were formulated by an organic phase separation and a granule coating method. The phase diagrams were used to study the phase separation in an ethylcellulose-petroleum ether-toluene system, and the effect of temperature and amount of petroleum ether on the ethylcellulose left in the organic solvent mixture was investigated. The phase diagrams showed that increase in temperature did not significantly affect the ethylcellulose residue, and 60 ml of nonsolvent was found adequate for microencapsulation. In vitro release of the formulated microcapsules and the commercially available preparations was performed in CO2-free distilled water using the USP XXIII rotating basket method, and the profiles were evaluated by Higuchi kinetics. Geometric mean diameters of the microparticles prepared by two different methods showed differences due to different core:wall ratios. A 4 x 5 factorial design was utilized and multiple regression was applied to the dependent variables (ethylcellulose content, percent dissolved) against the independent variables (amount of nonsolvent, temperature, core:wall ratio); the optimum phenytoin sodium-to-ethylcellulose ratio was 1:2.3. Utilizing second-order polynomial equations, response-surface graphs and contour plots pointed out the time necessary for 40%, 55%, and 70% release of phenytoin sodium. The desired release profiles were obtained with formulations E-5, ES-2 and ESL-2.