Curcumin as a Potential Therapeutic Agent for Mitigating Carbon Monoxide Poisoning: Evidence from an Experimental Rat Study.

BACKGROUND Carbon monoxide (CO) is a poisonous gas and causes tissue damage through oxidative stress. We aimed to investigate the protective value of curcumin in CO poisoning. MATERIAL AND METHODS Twenty-four female Spraque Dawley rats were divided into 4 subgroups: controls (n=6), curcumin group (n=6), CO group (n=6), and curcumin+CO group (n=6). The experimental group was exposed to 3 L/min of CO gas at 3000 ppm. Curcumin was administered intraperitoneally at a dosage of 50 mg/kg. Hippocampal tissues were removed and separated for biochemical and immunohistochemical analysis. Tissue malondialdehyde (MDA) levels, nitric oxide (NO) levels, and superoxide dismutase (SOD) and catalase (CAT) activities were assayed spectrophotometrically, and serum asymmetric dimethylarginine (ADMA) were measured using the ELISA technique. Tissue Bcl-2 levels were detected by the immunohistochemistry method. RESULTS Tissue CAT and SOD activities and NO levels were significantly lower, and MDA and serum ADMA levels were higher in the CO group than in the control group (P<0.001). The curcumin+CO group had higher CAT activities (P=0.007) and lower MDA than the CO group (P<0.001) and higher ADMA levels than the control group (P=0.023). However, there was no significant difference observed for tissue SOD activity or NO levels between these 2 groups. In the curcumin+CO group, the Bcl-2 level was higher than that in the CO group (P=0.017). CONCLUSIONS The positive effect of curcumin on CAT activities, together with suppression of MDA levels, has shown that curcumin may have a protective effect against CO poisoning.

Comparison of the Effects of Neostigmine and Sugammadex on Colonic Anastomotic Strength in Rats.

BACKGROUND: After colorectal surgery, anastomotic leakage is a major cause of mortality and morbidity. There are many factors affecting anastomotic leakage. It is known that agents such as neostigmine that is used to reverse neuromuscular blockade have certain effects on anastomosis. In our study, in which we planned to test this hypothesis, we aimed to compare the possible effects of different doses of sugammadex and neostigmine on colon anastomosis strength in a colonic resection anastomosis model in rats. MATERIALS AND METHODS: Forty adult Wistar albino male rats were divided into five groups as control (group C), Sugammadex 16 mg/kg (group SL), sugammadex 96 mg/kg (group SH), neostigmine 0.3 µmol/kg (group NL), and neostigmine 1.5 µmol/kg (group NH). The transverse colons of all rats were resected, and colonic anastomosis was performed. Appropriate drug doses according to the groups were given on the postoperative seventh day, and tissue hydroxyproline (TH) level and anastomotic bursting pressure were measured. RESULTS: Anastomotic bursting pressure values were statistically significantly different between the groups (P = 0.001). The bursting pressure in group SH was significantly higher compared with group C, group NL, and group NH. The hydroxyproline values were statistically significantly different between the groups (P = 0.015). According to the post hoc test results, the difference was between group SH and group C (P = 0.007). There were no significant differences between the other groups (P > 0.05). There was no significant difference in terms of intra-abdominal adhesion rates between the groups. CONCLUSIONS: In our study, we found that low and high doses of neostigmine had no variable effect on anastomosis, but high dose of sugammadex (96 mg/kg) had an increasing effect on intestinal anastomosis strength.

Importance of the National Early Warning Score (NEWS) at the time of discharge from the intensive care unit

Backround/aim: To identify, at an early stage of intensive care, patients who will require readmission to the intensive care unit (ICU) based on their National Early Warning Score (NEWS-d) at discharge. Materials and methods: Overall, 536 patients aged >18 years who stayed at a tertiary ICU for >24 h were included. Patients who readmitted and not readmitted to the intensive care within 48 h after discharge were compared. Results: Mean patient age was 64.26 ± 18.50 years and 252 (44.7%) patients were male. Mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 21.86 ± 8.74; mean NEWS-d was 4.48 ± 2.53. Forty-nine (9.1%) were readmitted to ICU. The reasons for initial admission, age, and NEWS-d vvalues were significantly different between the 2 groups. The NEWS-d values of the readmitted group were significantly higher (9.16 ± 1.05) than nonreadmitted group (4.01 ± 2.13). Based on receiver operation curve analysis, sensitivity and specificity were 98% and 95%, respectively, considering a NEWS-d cut-off value of 7.5 as the limit value for estimating readmission. Conclusion: A NEWS-d value of >7.5 demonstrated high sensitivity and specificity in identifying the risk of readmission for patients being discharged from ICU.

Global Scientific Outputs of Brain Death Publications and Evaluation According to the Religions of Countries.

In 1950s, the concept of brain death, which began to be discussed primarily in terms of medicine and then in terms of religion, law, and ethics, became a central topic in all world countries as it was an early diagnosis of death. Despite the fact that brain death (BD) diagnosis is of importance for benefitting from organ and tissue transplantation of patients in the world, the literature still involves no bibliometric studies that made a holistic evaluation of the publications about this issue. The present study aims to investigate the top-cited articles about BD published between 1980 and 2018, identify the citation collaboration of the journals, demonstrate the collaboration between the countries, define the relationship between organ transplantation and BD, and reveal the latest developments and trend topics about this issue. In addition, this study aims to investigate the relationship between religions of countries and brain death publication productivity. Documents for bibliometric analysis were downloaded from Web of Science. The literature search was performed using the keywords "brain death/dead" during 1980-2018. The correlations between gross domestic product (GDP), Human Development Index (HDI) and publication productivity of the countries on BD were investigated with Spearman's correlation coefficient. There was a high-level, statistically significant correlation between the number of publications and GDP, and HDI and the number of publications about BD (r = 0.761, p < 0.001; r = 0.703, p < 0.001). The USA was the top country in terms of publication productivity, which was followed by developed countries such as Germany, Japan, France, and Spain. However, the contribution of the undeveloped or developing countries such as China, Brazil, Turkey, Iran, and South Africa was found to be considerably important. While many people in the world die with undamaged organs, many other people die needing those organs. Therefore, it is considered that the collaborations and thus multidisciplinary studies about BD should be increased in the world countries, and the countries should be involved in bigger collaborations instead of little clusters. Especially, Muslim countries should be encouraged to do research and publish studies about the issues of brain death and organ transplantation.

The Effect of Different Types of Laryngeal Mask Airways on Sound Quality: A Prospective Randomized Study.

Background Although the deterioration in sound quality is not as much as endotracheal intubation, it can also be seen after the use of laryngeal mask airway (LMA). The aim of this study is to investigate the effects of different LMA types on voice performance. Methods This study included 88 patients aged 18-80 years, whose surgical procedure was not planned to take longer than 120 minutes. In the acoustic voice analysis, F0, jitter%, and shimmer% were examined. In addition, the Voice Handicap Index (VHI)-30 questionnaire has completed an evaluation of voice quality. The patients were randomly divided into two groups (I-gel LMA [n=44]; Classic LMA [n=44]) according to the closed envelope method. Results A total of 88 patients were included in the study. Demographic data of the patients were statistically similar between the groups (p > 0.05). The changes in the preoperative and postoperative F0, jitter, and VHI-30 values in the I-gel group were statistically significant (p: 0.002, p: 0.001, p < 0.001). Shimmer values were not significantly different (p: 0.762). In the classical LMA group, preoperative and postoperative F0, jitter, shimmer, and VHI-30 values were statistically significantly different (p: 0.001, p: 0.012, p: 0.036, p < 0.001). Conclusion I-gel LMA and classic LMA negatively affect voice performance in the preoperative and postoperative periods. This situation was also observed in the VHI-30 index test. However, when this situation was evaluated in terms of shimmer analysis, the decrease in voice quality in the early postoperative period was more limited in the I-gel group.

N-methyl-D-aspartate Receptor Antagonists may Ameliorate Spinal Cord Injury by Inhibiting Oxidative Stress: An Experimental Study in Rats.

AIM: To investigate the neuroprotective effect of a N-methyl-D-aspartate (NMDA) receptor antagonist (amantadine) in an experimental spinal cord injury (SCI) model. MATERIAL AND METHODS: Thirty male Spragueâ€"Dawley rats were divided into three groups: control (I), SCI (II), and SCI + amantadine (III). SCI was created using clip compression technique. At the end of day 7, blood samples were obtained from the rats and analyzed using various biochemical markers. Histological examination was also performed. MDA, GSH, and MPO assays were done. VEGF, TNF-α, and Baxexpressions were also analyzed. RESULTS: The group III had several inflammatory cells in the gray and white matter, with mildly degenerated multipolar and bipolar cells. Some bipolar and multipolar neurons showed TNF-α expression; however, TNF-α was found to be weak in small groups of inflammatory cells around the blood vessels in the substantia grisea and alba. Positive Bax expression was observed in the substantia grisea layer, particularly in the membrane of some bipolar neurons and glial cells; however, negative Bax expression was observed in neuron and glial cells and showed positive VEGF expression in the vascular endothelium in the group III. CONCLUSION: NMDA receptor antagonists, especially amantadine, may ameliorate SCI by inducing angiogenesis, affecting inflammation and apoptosis. It inhibits oxidative stress and the signaling pathways following SCI in rats.

Evaluation of Neuroprotective Effect of Sevoflurane in Acute Traumatic Brain Injury: An Experimental Study in Rats.

AIM: To examine the effect of sevoflurane, a halogenated anesthetic used in clinical applications, on oxidative stress and inflammation after an acute traumatic brain injury (TBI) in rats. MATERIAL AND METHODS: Thirty male Spragueâ€"Dawley rats were divided into three groups: control (Group 1), trauma (Group 2), and trauma+sevoflurane (Group 3). A diffuse TBI model was created for Groups 2 and 3. Sevoflurane anesthesia was applied 6 hours a day after induced trauma in Group 3. Glutathione (GSH), malondialdehyde (MDA), and tissue myeloperoxidase (MPO) activities were measured in the blood. Tumor necrosis factor alpha (TNF-±), vascular endothelial growth factor (VEGF), and Bax primary antibodies were used to determine the effects of TBI. RESULTS: MDA was significantly higher in Group 2 than in Group 1. There was a significant increase in tissue MPO levels in Groups 2 and 3 compared with those in Group 1. GSH levels decreased in Groups 2 and 3. Group 3 revealed degenerative changes in neurons and glial cells, vascular enlargement and congestion, and inflammatory cell infiltration around blood vessels. In Group 3, VEGF expression was positive in endothelial and inflammatory cells around blood vessels. Group 3 had positive TNF-± expression in neurons, small granular cells, and glial cells around blood vessels. CONCLUSION: Sevoflurane administration in acute TBI did not prevent the development of oxidative stress and inflammation.

Can Neutrophil-to-Lymphocyte or Platelet-to-Lymphocyte Ratio Be Used to Predict Postoperative Nausea and Vomiting in Breast Reduction?

Background/Objective Postoperative nausea and vomiting (PONV) is one of the most frequently seen complications in the postoperative period. In several studies, the neutrophil-lymphocyte ratio (NLR) or the thrombocyte-lymphocyte ratio (PLR) has been suggested as a parameter to be used in the diagnosis of inflammatory diseases. However, the literature provides no information about this relationship for breast reduction. This study aims to investigate whether preoperative NLR or PLR was an indicator of PONV and identify its relationship with antiemetic use. Methods In this study, hemogram values and antiemetic amounts taken within 24 hours were obtained retrospectively by scanning the files of the patients received breast reduction diagnosis and operation. The confounder effect was controlled using the Propensity Score Matching analysis to distribute the case-control groups similarly. The Receiver Operating Characteristic (ROC) analysis was used to determine whether NLR and PLR could be a prognostic indicator for PONV prediction. Sensitivity and specificity values were calculated after the ROC analysis to determine the success of the cut-off points. Results The success of NLR and PLR in discriminating PONV was found to be statistically significant (cut-off: 1.97, area under the curve (AUC)=0.697, p=0.001, cut-off: 137.2, AUC=0.743; p<0.001, respectively). In addition, the sensitivity of PLR (77.8%) in discriminating PONV was found to be higher in comparison to NLR (73.3%). Conclusions One of the factors decreasing patient care quality and satisfaction is PONV. The results of this study showed that preoperative NLR and PLR could be taken into consideration in antiemetic use required for the prevention of postoperative nausea-vomiting in breast-reduction operations.

The effects of dexmedetomidine in increased intestinal permeability after traumatic brain injury: An experimental study.

BACKGROUND: This study aims to investigate whether or not dexmedetomidine (DEX) application affects inflammation, increased intestinal mucosa damage and intestinal permeability in traumatic brain injury (TBI). METHODS: The rats included in our study were randomized into three groups as the control group (Group 1, n=10), trauma group (Group 2, n=10) and the trauma+dexmedetomidine group (Group 3, n=10). While trauma was not induced in the control group, head trauma was induced in all rats in Groups 2 and 3 with the same method. The rats in Group 3 additionally received the DEX application. Intestinal THF-a, serum TNF-a, IL-6, IL-1b and D-lactate levels were measured six hours post-trauma to assess systemic and local infection. Histopathological evaluation of the terminal ileum was performed at the 6th hour to assess mucosal damage. Intestinal permeability was evaluated by measuring the level of dextran injected into the 5-cm ileum segment adhered to the proximal and distal edges at the 30th minute in the blood taken by cardiac puncture. RESULTS: Intestinal TNF-a (p=0.003), serum TNF-a (p=0.009), IL-6 (p=0.002), IL-1b (p=0.001), and D-lactate levels measured in Group 3 (p=0.046) were significantly lower than those measured in Group 2. Dextran level measured in blood in Group 3 was observed significantly lower than that of Group 2 (p<0.001). Histopathological evaluation of the intestines revealed no injuries in the ileum of the rats in Group 1, injury in the ileum, villus atrophy and mucosal damage in the rats in Group 2, and a significant recovery was observed in Group 3 in comparison to Group 2. CONCLUSION: It was seen in our study that DEX reduced TBI-induced increased inflammation, intestinal mucosa damage and intestinal permeability. These results suggest that DEX may ameliorate the damage done to the intestinal tissue by modulating post-TBI inflammatory responses.

[A bibliometric analysis of the field of anesthesia during 2009-2018]. / Análise bibliométrica no campo da anestesiologia no período de 2009­2018.

OBJECTIVE: The limited number of bibliometric studies in the literature have generally focused on the top-cited studies in the field of anesthesia, however, there is a lack of studies that made a holistic bibliometric evaluation of these works. The purpose of this study is to make a contemporary summary of the articles published in the field of anesthesia within the last 10 years through detailed bibliometric methods. METHODS: The articles published between the years 2009 and 2018 were downloaded from the Web of Science (WoS) database and analyzed using bibliometric methods. The literature review was conducted using the keyword "Anesthesiology" in the "Research Area" category via the advanced search option available in WoS. The relation between the number of publications of the countries and the Gross Domestic Products and Human Development Index values were analyzed using Spearman's correlation coefficient. The number of articles between the years 2019 and 2021 was estimated through linear regression analysis. RESULTS: A review of the literature indicated 41,003 articles in the Web of Science database. Estimations included 4,910 (3,971-5,849) articles for the year 2019. There was a high-level, positive significant correlation between the number of publications and Gross Domestic Product (r=0.776, p<0.001). CONCLUSION: The findings show that countries with high income are effective in the field of anesthesia, which indicates a strong association between research productivity and economic development. Undeveloped and developing countries should be encouraged to conduct research in the field of anesthesia.

Objective and Subjective Evaluations of the Effects of Different Types of Intubation Tube Applications on Voice Performance in the Early Postoperative Period.

Objective Changes in voice performance in the postoperative period due to trauma suffered during endotracheal intubation or edema occurring in the postoperative period are often observed. The present study aimed to evaluate the effects of different types of intubation tube applications on voice performance in the early postoperative period using objective and subjective voice analysis methods. Materials and Methods A total of 88 patients who underwent endotracheal intubation either using a cuffed endotracheal (n = 44) or spiral-embedded cuffed endotracheal (n = 44) tube were included in this study. An endotracheal tube of 7.5 mm was used for female patients and that of 8 mm was used for male patients. Preoperative acoustic voice analysis was performed, and fundamental frequency (F0), jitter%, and shimmer% values were recorded. In addition, the voice handicap index-30 (VHI-30) questionnaire was completed by the patients for subjective evaluation. The same procedure was repeated in the first 48 hours postoperatively. The preoperative and postoperative data were statistically compared. In addition, the effect of the type of endotracheal intubation tube on acoustic voice analysis parameters and VHI-30 scores was statistically evaluated. Results In the early postoperative period, a significant decrease in the F0 value and a significant increase in jitter% and shimmer% values were detected. The VHI-30 score was also found to be significantly higher in the early postoperative period than in the preoperative period. The effects of both the intubation tubes on voice performance were found to be similar. Conclusion Objective and subjective evaluations revealed that voice performance was declined in the early postoperative period after orotracheal intubation.

Experimental study on prophylactic effects of vardenafil in ischemia-reperfusion model with intestinal volvulus injury in rats.

AIM: An experimental study was performed to evaluate the effects of Vardenafil on ischemia-reperfusion (I/R) injury in an experimental volvulus model by histochemical and biochemical methods. MATERIALS AND METHODS: Thirty-five male Wistar rats were divided in five groups (n = 7). In Group 1, a 5 cm segment of small intestine 2 cm proximal to cecum was excised to have a control group. In the second group, 5 cm segment of small intestine 2 cm proximal to cecum was rotated 360° clockwise direction and sutured with 4/0 polyglactin to generate an experimental model of volvulus. At the end of 2 h of ischemia, the same intestinal segment was sampled. In group 3, after achieving ischemia similar to group 2, two hours of reperfusion injury was obtained by removing the sutures. Rats in Group 4 received vardenafil after 1.5 h of ischemia and then 2 h of reperfusion. And finally, in Group 5, vardenafil was administered 2 h before laparotomy and 5 cm of intestine was removed without I/R injury. Intestinal segments were evaluated for total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) with biochemical and histopathological analysis. RESULTS: Serum TOS levels and OSI were not significantly different between groups (p = 0.910, P = 0,43 respectively). The serum TAS level was decreased in group 3 as compared to vardenafil groups 4 and 5, without a statistical significance (p = 0.428). In histopathologic analysis, we found that vardenafil, partially reduced I/R injury. The villus structure was preserved but, congestion and inflammation were moderate. CONCLUSION: Vardenafil partially reduced I/R injury histopathologically on intestine. Our study shows that it does not have statistically antioxidant effect on intestinal I/R injury in experimental model of volvulus. However, effects of vardenafil in I/R injury of liver, kidney, heart, testis, over and brain which were cited in literature were not confirmed with I/R injury on intestine.

Internal Jugular Vein Catheterization: The Landmark Technique versus Ultrasonography Guidance in Cardiac Surgery.

Background Central venous catheterization is an invasive procedure that must be performed during cardiovascular surgery. The addition of ultrasound guidance to the catheterization technique has shown effectiveness in reducing complications because it allows for the visualization of anatomical variations prior to intervention and the continual visualization of the needle during the placement. The purpose of this study was to evaluate the effectiveness of needle-guiding ultrasound for internal jugular venous cannulation. Method Patients undergoing coronary bypass surgery at Hitit University, department of cardiovascular surgery, from January 2014 to June 2018, were included in the study. The patients were divided into two groups: those with catheterization with ultrasound guidance (Group U) and those with catheterization performed with the anatomic landmark technique (Group L). Results A total of 584 cases were investigated. The success of the procedure and complication rates for both methods were compared. Central vein catheterization with ultrasonography produced success and complication rates significantly better than those for catheterization using the landmark technique (p=0.04 and p=0.00001, respectively). Conclusion This study demonstrated that the use of ultrasonography for internal jugular vein catheterization for patients undergoing coronary bypass surgery significantly reduced the complication rates as compared to those of patients where the landmark technique was used for catheterization.

The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients.

Background/aims Sedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients. Material and methods We made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013. Patients were divided into two groups, including Group P (continuous infusion of sedative agent) and Group D (daily sedation interruptions - daily recovery). Demographics, mechanical ventilation time, stay at intensive care unit, hospitalization period, time of first weaning, success of weaning, ventilator-related pneumonia (VRP), total doses of drugs, re-intubation frequency, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores and mortality rates of patients were compared. Ramsay Sedation Score (RSS) was used to evaluate the level of sedation. Considering that ideal sedation level is "3" with RSS, RSS < 3 is considered as mild sedation, while RSS > 3 is considered as deep sedation. Results There was no difference between demographics of patients. Mechanical ventilation period was significantly longer in Group P than Group D (p < 0.001). When stay at ICU unit was considered, ICU stay was significantly longer in Group P than Group D (p < 0.001). No statistically significant difference was found between two groups with respect to hospitalization period. In inter-group comparison, time to start first weaning was significantly late in Group P than Group D (p < 0.05). There was no difference between groups in terms of frequency of success of weaning and mortality rate (p > 0.05). In inter-group comparison the frequency of reintubation viewed in Group D was significantly less than in Group P (p < 0.05). Considering development of VRP, it was significantly more common in Group P in comparison with Group D (p < 0.05). No statistically significant difference was found between groups in terms of doses of sedative agents (p > 0.05). Considering doses of opioid analgesics, the total dose of fentanyl was significantly higher in Group P than Group D (p = 0.04), while no difference was found for doses of morphine (p > 0.05). Again, no statistical difference was found in doses of muscle relaxant agents (p > 0.05). Conclusion It was observed that the sedation technique with daily interruption is superior to continuous infusion of sedatives. Accordingly, we believe that daily weaning will make positive contributions to patients who are mechanically ventilated at intensive care unit.