Mortality in Behçet's syndrome.

Behçet's syndrome significantly increases mortality especially when seen in the young male, while it is less severe among females and the aged. In many patients, the condition abates with the passage of time. The main cause of mortality is large vessel disease, especially bleeding pulmonary artery aneurysms (PAA), almost exclusively seen among men. Central nervous system disease comes second. Interestingly, not much increased atherosclerosis is seen in Behçet's syndrome when compared to other inflammatory diseases. In controlled studies, there has been no increase in history of increased angina or myocardial infarction. Similarly, atherosclerotic plaque formation is not increased by ultrasound. On the other hand, intermittent claudication can be seen. However, this is not due to arterial involvement but due to venous disease of the lower extremities. Recently there has been a substantial decrease in mortality due to PAA thanks to prompt disease recognition and treatment.

Corneal sensitivity and subjective complaints of ocular pain in patients with fibromyalgia.

PurposeFibromyalgia (FM) is a chronic pain disorder associated with pain and hypersensitivity in various parts of the body. The aim of this study was to understand whether changes in corneal sensitivity were associated with the subjective complaints of these patients.Patients and methodsIn this study, we included 36 patients with FM (30 female, 6 male, mean age: 46.7±9.2 years) and 39 healthy control subjects (33 females, 6 males, mean age: 44.3±7.6 years). We performed a detailed ophthalmological examination, measured tear film breakup time (TBUT), and performed Schirmer I test without anesthetic (SIT). Only patients that did not have any eye disease were included in this study. Subjective complaints of the patients were evaluated with ocular surface disease index (OSDI) scores and the corneal sensation was evaluated with Cochet-Bonnet esthesiometer.ResultsThere was no significant difference between the groups for age, sex, and visual acuity. Both SIT (16.1 mm vs 15.3 mm, P=0.36) and TBUT results (17.8 s vs 18.8 s, P=0.40) were similar in FM group and the controls subjects. However, corneal sensations in central (60.0 mm vs 55.0 mm, P=0.03), superior (57.5 mm vs 50.0 mm, P=0.005), and inferior (53.89 mm vs 46.03 mm, P<0.001) regions were significantly increased in FM patients. There was a significant positive correlation between corneal sensation and OSDI scores.ConclusionIn this study, we have demonstrated that the patients with FM have increased corneal sensitivity and have related ocular surface complaints similar to dry eye disease in the absence of it.

The effects of breeding systems and stocking density on some blood parameters of rock partridges (Alectoris graeca).

In this study, the effects of breeding systems and stocking density on some blood parameters of rock partridges [total protein, total cholesterol, triglyceride, urea, glucose, calcium, phosphorus, alkaline phosphatase (ALP), sodium, chlorine, potassium, aspartate amino transferase (AST), and alanine amino transferase (ALT)] were investigated. For this purpose, blood samples of 18-wk-old male rock partridges, which were bred on the ground and in cages with 3 different stocking densities (group I: 15 partridges/m(2); group II: 20 partridges/m(2); and group III: 25 partridges/m(2)) were examined. Breeding method of rock partridges was found to have significant effects on blood total protein, (P < 0.05), total cholesterol (P < 0.05), triglyceride (P < 0.01), urea (P < 0.01), glucose (P < 0.05), calcium (P < 0.05), phosphorus (P < 0.01), ALP (P < 0.05), sodium (P < 0.01), chlorine (P < 0.05), and potassium (P < 0.01) levels, whereas it was found to have no significant effect on blood AST and ALT levels (P > 0.05). Stocking density of rock partridges was also found to affect significantly the levels of blood total protein, total cholesterol, triglyceride, urea, glucose, calcium, phosphorus, ALP, sodium, chlorine, and potassium (P < 0.05), whereas it did not have a significant effect on blood AST and ALT levels (P > 0.05). When the breeding method of the partridges was changed from the ground to the cages and the stocking density was increased, it was observed that the levels of blood total cholesterol, triglyceride, urea, glucose, sodium, and chlorine increased, whereas total protein, calcium, phosphorus, ALP, and potassium levels decreased. It was understood that the reactions of partridges toward breeding systems and stocking density were different and passing from ground system to cage system, and the increase in stocking density caused significant changes in blood parameters.

The effects of different breeding systems on egg productivity and egg quality characteristics of Rock Partridges.

This study was carried out to investigate the effects of different breeding systems (breeding on the ground and in the cage) on the egg production and egg characteristics of Rock Partridges. Egg production values of the ground and cage system groups were determined as 41.30 and 49.40%, respectively, and this difference was found to be significant (P < 0.05). The weight values of the eggs were 23.86 g in the ground system and 22.08 g in the cage system (P < 0.05). The difference between the shape index values, which were determined as 75.39 in the ground system and as 77.65 in the cage system, was statistically significant (P < 0.05). In addition, the values for yolk index (48.42 and 44.11), albumen index (1.45 and 1.66), Haugh unit (83.24 and 86.78), shell weight (2.39 and 2.86), yolk weight (8.55 and 7.89), and albumen weight (12.46 and 11.78) obtained in the ground and cage system, respectively, were obtained to be statistically different (P < 0.05). It was observed that the Rock Partridges could be bred in ground and cage systems during the egg production period, and although the investment cost and equipment expenditure increase in cage breeding, the egg quality, shape index, albumen index, and Haugh unit of Rock Partridges decrease dramatically in ground breeding.

Detrended fluctuation analysis of laser Doppler flowmetry time series: the effect of extrinsic and intrinsic factors on the fractal scaling of microvascular blood flow.

The relative contribution of extrinsic (central) and intrinsic (local) oscillatory mechanisms to the fractal scaling of blood flow in forearm cutaneous microcirculation is unclear. The aim of this study was to investigate the contributions of these mechanisms to the fractal properties of the blood flow signal by using their frequency spectrum in the analyses. To evoke local oscillatory components, acetylcholine (ACh) was iontophoresed into the forearm and cutaneous perfusion was measured by a laser Doppler flowmeter (LDF) at rest. Depending on the involved factors in ACh-induced vasodilatation, central, cardiac and respiratory, signals have also increasingly appeared in LDF. The detrended fluctuation analysis (DFA) of filtered LDF time series demonstrated that the LDF was fractal with three distinct scaling regions. Furthermore, the findings of the present study indicated that these regions are related to the frequency bands of well-known control systems of blood flow and were called cardiac, cardio-respiratory and local regions. The mean scaling exponent increased with vasodilatation in the cardiac region but decreased and even changed its sign in the cardio-respiratory region. Inhibition of a local vasodilator mechanism not only decreased the scaling exponent of the local region but also eliminated the effect of respiratory coupling on fractal scaling. These findings suggest that the scaling exponents might have a diagnostic value for detecting pathological dynamics in vascular beds.

Exogenous zinc improves blood fluidity but has no effect on the mechanisms of vascular response to acetylcholine iontophoresis in humans.

Recent findings in cellular signaling function of zinc through the mobilization intracellular calcium or by inducing ATP release suggest that extracellular zinc plays an important role in many physiological functions. However, such an extracellular signaling action of zinc for most cells is not known. Therefore, we investigated whether zinc plays any role in endothelium- dependent acetylcholine (ACh)-induced vasodilatation in microvascular beds. Transdermal iontophoresis was used to transport ACh through the forearm skin and cutaneous perfusion was measured using a laser Doppler flowmeter (LDF). Experiments were repeated using (1) zinc instead of ACh to test the effect of zinc ions alone and (2) concomitant iontophoresis of ACh and zinc to explore the effect of zinc on ACh-induced vasodilatation. Although zinc augments blood flow, curve-fitting to LDF signals indicate that zinc has no effect on the neural and endothelial component of ACh-induced vasodilatation. Additionally, no effect of Zn2+ on blood flow was found during its iontophoresis alone. Therefore, it is suggested from the Fourier analysis of LDF signals that the Zn+ might influence blood fluidity by its action on red blood cells deformability/ aggregability during a high-blood-flow condition, which might, in turn, decrease blood viscosity and improve blood flow in vivo.

Time required for partial pressure of arterial oxygen equilibration during mechanical ventilation after a step change in fractional inspired oxygen concentration.

OBJECTIVE: To determine the time required for the partial pressure of arterial oxygen (PaO2) to reach equilibrium after a 0.20 increment or decrement in fractional inspired oxygen concentration (FIO2) during mechanical ventilation. SETTING: A multi-disciplinary ICU in a university hospital. PATIENTS AND METHODS: Twenty-five adult, non-COPD patients with stable blood gas values (PaO2/FIO2 > or = 180 on the day of the study) on pressure-controlled ventilation (PCV). Following a baseline PaO2 (PaO2b) measurement at FIO2 = 0.35, the FIO2 was increased to 0.55 for 30 min and then decreased to 0.35 without any other change in ventilatory parameters. Sequential blood gas measurements were performed at 3, 5, 7, 9, 11, 15, 20, 25 and 30 min in both periods. The PaO2 values measured at the 30th min after a step change in FIO2 (FIO2 = 0.55, PaO2[55] and FIO2 = 0.35, PaO2[35]) were accepted as representative of the equilibrium values for PaO2. Each patient's rise and fall in PaO2 over time, PaO2(t), were fitted to the following respective exponential equations: PaO2b + (PaO2[55]-PaO2b)(1-e-kt) and PaO2[55] + (PaO2[35]-PaO2[55])(e-kt) where "t" refers to time, PaO2[55] and PaO2[35] are the final PaO2 values obtained at a new FIO2 of 0.55 and 0.35, after a 0.20 increment and decrement in FIO2, respectively. Time constant "k" was determined by a non-linear fitting curve and 90% oxygenation times were defined as the time required to reach 90% of the final equilibrated PaO2 calculated by using the non-linear fitting curves. RESULTS: Time constant values for the rise and fall periods were 1.01 +/- 0.71 min-1, 0.69 +/- 0.42 min-1, respectively, and 90% oxygenation times for rises and falls in PaO2 periods were 4.2 +/- 4.1 min-1 and 5.5 +/- 4.8 min-1, respectively. There was no significant difference between the rise and fall periods for the two parameters (p > 0.05). CONCLUSION: We conclude that in stable patients ventilated with PCV, after a step change in FIO2 of 0.20, 5-10 min will be adequate for obtaining a blood gas sample to measure a PaO2 that will be representative of the equilibrium PaO2 value.

Handwashing frequencies in an intensive care unit.

As most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered the single most important intervention to prevent nosocomial infections. However, previous studies have shown that handwashing practices are poor, especially among medical personnel. The objective of this study was to assess the rate of handwashing among intensive care unit (ICU) healthcare personnel, and then to propose realistic suggestions so that hand hygiene' could be performed at an optimal level. To achieve this, each healthcare worker in the ICU of Istanbul Medical Faculty was observed directly, and, a comprehensive microbiological investigation was carried out among personnel and of the inanimate environment. The frequency of handwashing was low; 12.9% among medical personnel. Moreover, there was a widespread contamination in the ICU and 28.1% of the healthcare workers were carriers for methicillin-resistant Staphylococcus aureus (MRSA). The factors that contributed to low compliance of handwashing protocols were: a low staff to patient ratio, excessive use of gloves and deficiencies in the infra-structure of ICU. In heavy workload conditions, alcoholic handrub solutions for quick hand decontamination can be considered as an alternative to handwashing.

No additive effects of inhaled iloprost and prone positioning on pulmonary hypertension and oxygenation in acute respiratory distress syndrome.

BACKGROUND: In acute respiratory distress syndrome (ARDS), pulmonary hypertension is associated with a poor prognosis. Prone position is effective to improve oxygenation whereas inhaled iloprost can treat pulmonary hypertension. However, combination of these interventions has not been examined before. The hypothesis was that this combination had additive effects on oxygenation and pulmonary hemodynamics as compared with each intervention alone. METHODS: In a prospective, randomized cross-over study, ten pigs were anesthetized, intubated and ventilated with volume controlled ventilation. Carotid, jugular venous and pulmonary artery catheters were inserted. ARDS was induced with oleic acid (0.20 mL/kg). Measurements were repeated in randomized different sequences of prone or supine positions with or without iloprost inhalation (220 ng/kg/min) (four combinations). Systemic and pulmonary arterial pressures; arterial and mixed venous blood gases; and Qs/Qt and the resistances were recorded. RESULTS: Iloprost decreased pulmonary artery pressures (for MPAP: P=0.034) in both supine (37±10 vs. 31±8 mmHg; P<0.05) and prone positions (38±9 vs. 29±8 mmHg; P<0.05); but did not obtain a significant improvement in oxygenation in both positions. Prone position improved the oxygenation (p<0.0001) compared to supine position in both with (361±140 vs. 183±158 mmHg, P<0.05) or without iloprost application (331±112 vs. 167±117 mmHg, P<0.05); but did not achieve a significant decrease in MPAP. CONCLUSION: Although iloprost reduced pulmonary arterial pressures, and prone positioning improved oxygenation; there are no additive effects of the combination of both interventions on both parameters. To treat both pulmonary hypertension and hypoxemia, application of iloprost in prone position is suggested.