The effects of on-pump and off-pump coronary artery bypass surgery on oxidative stress and cerebral oxygenation: a prospective observational study.

Background/aim: In this prospective observational study, our goal was to investigate the relationship between serum levels of oxidative stress (OS) parameters and regional cerebral oxygen saturation (rSO2) in addition to evaluating postoperative clinical outcomes among patients undergoing coronary artery bypass graft surgery (CABG). Materials and methods: This study comprised 64 adult patients undergoing elective CABG (on-pump [n = 48] and off-pump [n = 16]) procedures. Serum OS levels and rSO2 values were measured intraoperatively at three specific time points: T1 (after induction), T2 (15 min before aortic cross-clamp removal or the final distal anastomosis), and T3 (15 min after aortic cross-clamp removal or the last distal anastomosis). Results: Serum OS and lactate values demonstrated higher levels at T2 and T3 (p < 0.001), while rSO2 values were lower at T2 (p = 0.024) in the on-pump CABG group compared to the off-pump CABG group. The rSO2 values at T2 exhibited a negative correlation with OS parameters, lactate levels at T2 and T3, aortic clamp time, postoperative mechanical ventilation time, and intensive care unit stay length. In the multivariate linear regression analysis (R2 = 0.181, p = 0.001), lactate values at T2 emerged as the sole factor affecting the OS index at T2 (t = 2.843, p = 0.006). Conclusion: In our study, we observed elevated OS values and relatively low rSO2 values during on-pump CABG procedures, with rSO2 showing an association with increased OS parameters. Close monitoring of the OS response level and rSO2 during CABG could potentially enhance postoperative clinical outcomes.

Early and Mid-Term Outcomes of Delayed Sternum Closure Strategy in Adult Cardiac Surgery: A Single-Center Experience.

BACKGROUND: Delayed sternum closure is a crucial strategy in the management of hemodynamic instability after weaning from cardiopulmonary bypass. This study aimed to evaluate our outcomes with this technique in light of the literature. METHODS: We retrospectively reviewed the data of all the patients who developed postcardiotomy hemodynamic compromise and intraaotic balloon pump was inserted between November 2014 to January 2022. Patients were divided into two groups: primary sternal closure group, and delayed sternum closure group. Patients' demographic data, hemodynamic parameters, and postoperative morbidities were recorded. RESULTS: Delayed sternum closure was performed in 16 patients with an incidence of 3.6%. The most common indication was hemodynamic instability in 14 patients (82%), followed by arrhythmia in 2 patients (12%) and diffuse bleeding in 1 patient (6%). The mean time to sternum closure was 21 (±7) hours. Three patients died (19%), p > 0.999. The median follow-up period was 25 months. Survival analysis revealed that the survival rate was 92%, p = 0.921. Deep sternal infection was observed in one patient with (6%), p > 0.999. multivariate logistic regression analysis revealed that end-diastolic diameter [odds ratio (OR) 4.5, 95% CI (1.19-17), p = 0.027], right ventricle diameter [OR 3.9, 95% CI (1.3-10.7), p = 0.012] and aortic clamp time [OR 1.16, 95% CI (1.02-1.12), p = 0.008] were independent risk factors for delayed sternum closure. CONCLUSIONS: Elective delayed sternal closure is a safe and effective method for treating postcardiotomy hemodynamic instability. It can be performed with a low incidence of mortality and sternal infections.

Serum vitamin D le Serum vitamin D levels are associated with acute post e associated with acute postoperative pain and opioid analgesic consumption after laparoscopic cholecystect cholecystectomy: a str omy: a strobe compliant pr obe compliant prospectiv ospective obser e observational ational study.

BACKGROUND: In this prospective observational study, we aimed to evaluate the relationship between serum levels of vitamin D and acute postoperative pain scores, as well as opioid analgesic consumption in patients undergoing laparoscopic cholecystectomy. METHODS: : The study was performed in the Medical Faculty Hospital, from April 2020 to April 2021. Postoperative visual analog scale (VAS) pain scores, total tramadol consumption, number of requests on patient-controlled analgesia (PCA) were compared between the vitamin D deficient (≤20 ng/mL; n = 25) and vitamin D nondeficient (>20 ng/mL; n = 55) groups at five time points (T0: in the recovery room, T1: 1st hour in the ward, T2: 6th hour, T3: 12th hour, and T4: 24th hour). RESULTS: Postoperative VAS pain scores were similar in the vitamin D deficient group at all time points (T0-4), but differed significantly only at the T-0 time point (p = 0.020). The mean cumulative tramadol consumption was significantly higher in the vitamin D deficiency group than in the nondeficiency group (p = 0.005). Vitamin D levels were lower in patients with VAS ≥ 4 at the postoperative T-0 time point (p = 0.009). In the multivariate linear regression analysis, 15.7% of cumulative tramadol consumption was due to vitamin D deficiency (ß = -0.188). DISCUSSION: : Our study shows that preoperative low vitamin D level was associated with an increase in acute postoperative pain scores and consumption of opioid analgesics in patients undergoing laparoscopic cholecystectomy. Our findings may be useful for postoperative pain management in patients with vitamin D deficiency.

Evaluation of suicide probability in children and adolescents with epilepsy.

BACKGROUND: We aimed to examine suicide probability, factors affecting suicide, and personality traits of children and adolescents diagnosed with epilepsy, and to compare their results with those of children without epilepsy. METHODS: Fifty-six children diagnosed with epilepsy and 56 control children, aged 11-16 years, were evaluated by using the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria, the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, the Child Depression Inventory, the Suicide Probability Scale (SPS), and the Personality Inventory for DSM-5 - Brief Form - Children (PID-5-BF) scales. Factors predicting suicide risk in children with epilepsy were analyzed. RESULTS: The mean age, SPS total score, and hopelessness subscale score, PID-5-BF total score as well as disinhibition and psychoticism subscale scores of the epilepsy group were significantly higher than those of the control group (P < 0.05). There was no significant difference between the groups in terms of the Child Depression Inventory, and other subscales of the Suicide Probability Scales and PID-5-BF scales. The SPS total score was higher in patients with comorbid psychiatric diseases, those using psychiatric drugs, and girls (P < 0.05). An ANCOVA analysis indicated that the most important factor that predicted the probability of suicide and its subscale scores was the level of depression, and the presence of epilepsy was not predictive. CONCLUSIONS: We found a high probability of suicide and personality pathology in children with epilepsy but the main predictor of suicide probability was the level of depression, not the presence of epilepsy.

The Effect of Preoperative Anxiety on Fetal Cord Blood Tumor Necrosis Factor-Alpha, Interleukin-6, and Neonatal Outcomes in Pregnant Women.

BACKGROUNDS: In this study, we aimed to investigate the relationship in pregnant women who undergo elective cesarean section between the preoperative anxiety (POA) levels and neonatal results and TNF-α, IL-6 and IL-8 levels, the pro-inflammatory cytokines in cord blood. SUBJECTS AND METHODS: Sixty-six volunteer patients, aged 18 to 40, who underwent elective cesarean surgery were included in the study. Trait Anxiety Inventory (TAI) was evaluated at the anesthesia outpatient clinic and State Anxiety Inventory (SAI) was determined one hour before cesarean section. Plasma levels of TNF-α, IL-6 and IL-8 in the umbilical cord blood were determined using the ELISA method. Fetal cord blood gas, birth weight, and APGAR scores at the 1st and 5th minutes after birth were recorded. RESULTS: The mean preoperative maternal SAI and TAI scores were 46.6±10.9 and 41.4±7.8, respectively. There was a significant correlation between POA and fetal birth weight and fetal cord blood TNF-α, IL-6 and IL-8 parameters. The inflammatory marker levels in the cord blood of fetuses in the high anxiety groups were significantly higher (p<0.001). Fetal birth weight was significantly lower in the high anxiety groups (p<0.05), whereas there was no significant difference in cord blood gas values. CONCLUSIONS: Our results show that an increase in the levels of TNF-α, IL-6, and IL-8 cytokines in fetal cord blood in pregnant women with high anxiety levels and this situation causes negative effects on the newborn.

Serum levels of mu-opioid receptor according to menstrual cycle phases are associated with postoperative pain and opioid consumption in laparoscopic gynecological surgeries: a prospective observational study.

AIMS: In this prospective observational clinical study, we aimed to evaluate the relationship between serum mu-opioid receptor (MOR) levels according to menstrual cycle phases on postoperative pain scores and analgesic requirements. METHODS: A total of 80 female patients undergoing laparoscopic surgery were divided into two groups according to the phases of the menstrual cycle as follicular and luteal. Postoperative pain scores, total tramadol consumptions, and numbers of demands on patient-controlled analgesia (PCA) of the patients were recorded at 5 time points (T0: in the recovery room, T1: 1st hour in the ward, T2: 6th hour in the ward, T3: 12th hour in the ward, T4: 24th hour in the ward). Serum MOR concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: The mean serum MOR levels were significantly higher in the follicular group (275 ± 32 pg/ml) compared to the luteal group (254 ± 28 pg/ml) (p = 0.003). Total tramadol consumption (T0, T2, and T3) was significantly higher in the luteal group (p = 0.031, p = 0.012, p = 0.017, respectively). Postoperative pain scores did not differ significantly between the groups. With the exception of T4 (p = 0.057), the number of demands on PCA was significantly higher in the luteal group. However, multivariate logistic regression analysis showed that serum MOR levels were affected by the menstrual cycle phase (follicular) (ß = 0.361) (p = 0.001). CONCLUSIONS: Our study revealed that patients during the follicular phase with higher serum MOR levels consumed less opioid analgesic postoperatively. More comprehensive studies are needed to determine the relationship between serum MOR levels and menstrual cycle phases as well as postoperative pain. (Trial registration number: NCT04690491 www. CLINICALTRIALS: gov ).

The Effect of Drug Use, Body Mass Index and Blood Pressure on Oxidative Stress Levels in Children and Adolescents with Attention Deficit and Hyperactivity Disorder.

Objective: The aim of this study was to determine the correlation between clinical variables such as body mass index, blood pressure, drug use and oxidative stress level in children and adolescents with attention deficit and hyperactivity disorder (ADHD). Methods: Total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), malondialdehyde (MDA) and superoxide dismutase (SOD) activity were measured in the serum of 51 patients (38 male, 13 female) diagnosed with ADHD according to DSM-5 diagnostic criteria and 32 control subjects (12 male, 20 female). The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version was applied to all participants. Results: The mean TOS, OSI, MDA values were determined to be significantly higher (p < 0.001) and the mean SOD value was lower in the ADHD group (p < 0.001). Multivariate regression analysis indicated significantly lower SOD and diastolic blood pressure values and significantly higher MDA in the ADHD group compared to the control group (p < 0.01). Low SOD (sensitivity 90.2%, specificity 78.0%) and high MDA (sensitivity 86.3%, specificity 81.2%) were determined to be predictive parameters for diagnosing ADHD. In univariate analysis, the mean TOS, OSI and SOD values were higher in ADHD patients under medication, while the mean TAS was higher in patients not using medication (p < 0.01). Only TOS was significant in multivariate logistic regression analysis (p < 0.01). Conclusion: The results of this study demonstrate that impaired oxidative balance may play a role in the etiology of ADHD.

Two-Point Discrimination in Feet with Ankle Sprains.

BACKGROUND: This study aimed to compare two-point discrimination in feet with ankle sprains and feet without ankle problems, and to determine whether there was a change in the two-point discrimination values in ankle sprains. METHODS: A total of 108 people were included in the study. These subjects were aged between 18 and 40 years and visited the Medical Faculty of Yozgat Bozok University for various reasons in July and September of 2022. These people were divided into two groups: subjects with an ankle sprain and subjects with no ankle problems. Two-point discrimination values measured in mm were recorded for both groups using a caliper (esthesiometer) used in six regions of 216 feet. The two-point discrimination threshold values of the feet were compared statistically according to feet with ankle sprains and feet without ankle problems, as well as in right and left feet. RESULTS: The study determined that the two-point discrimination threshold values measured at the 1st toe tip, heel, 3rd plantar metatarsal head, medial malleolus, and lateral malleolus in subjects with an ankle sprain was higher than in subjects with no ankle problems. When comparing both feet of the subjects with an ankle sprain, the two-point discrimination threshold value in the heel of the foot with an ankle sprain was higher than in the heel of the foot without ankle problems. CONCLUSIONS: The two-point discrimination threshold value was higher in subjects with an ankle sprain than in subjects with no ankle problems. The data suggest that the two-point discrimination threshold may be higher in people with an ankle sprain. Further studies are needed to better understand the two-point discrimination threshold in ankle sprains.

Effectiveness of Different Doses of Tenoxicam in Preventing Propofol Injection Pain.

OBJECTIVE: In this study, we aimed to investigate the effect of 2 different dosages of tenoxicam in the prevention of propofol injection pain. METHODS: A total of 120 patients between the ages of 20-50 years who were scheduled for elective surgery were included in this prospective. Patients were randomly divided into 3 groups. Group 1 received 5 mL saline, group 2 received 10 mg tenoxicam in 5 mL saline, and group 3 received 20 mg tenoxicam in 5 mL saline intravenously as a pretreatment. Venous occlusion was applied for 60 seconds with a rubber tourniquet after the injection was completed. After injecting propofol, the pain at the injection site of the patient was questioned according to the Verbal Rating Scale. RESULTS: The overall pain incidence during propofol injection was 85% in group 1, 75% in group 2, and 60% in group 3 (P = .039). While there was no significant difference between groups 1 and 2 (P=.264), there was a significant difference between groups 1 and 3 (P=.012). Moreover, there was a significant decrease in the level of severe pain in group 3 compared to group 1 (P=.008). There was no significant difference between the groups in terms of mild and moderate pain levels (P > .05). CONCLUSIONS: We found that 20 mg of tenoxicam pretreatment was effective in reducing the incidence and severity of propofol injection pain compared to the control saline group, but the 10 mg dose did not significantly reduce the injection pain.

Effects of preoperative anxiety levels and the D-type personality on propolol injection pain.

Objective: Propofol injection pain (PIP) is a common condition in anesthesia practice and can be detrimental for patients. In this study, we aimed to investigate the effects of preoperative anxiety, depression levels, and D-type personality trait on PIP and to determine predictive factors. Methods: Sixty-eight patients who underwent elective septorhinoplasty under general anesthesia were analyzed. The effects of various factors (preoperative anxiety, depression, D-type personality, venous cannulation pain, gender, and age) on the incidence of PIP were assessed. To identify risk factors associated with PIP, multivariate logistic regression analysis was performed. Results: The incidence of PIP was significantly higher in patients who had preoperative anxiety and venous cannulation pain and who are Type D personality and female. Preoperative anxiety (ß, 2.914; p=<0.001), Type D personality (ß, 2.225; p=0.022) and venous cannulation pain (ß, 1.590; p=0.043) were identified as independent risk factors for development of PIP. Depression, general anesthesia history, marital status, smoking, education status, and age were not significant as risk factors for the PIP. Conclusion: In addition to the physical factors that can predict PIP in anesthesia application, we believe that the presence of preoperative anxiety, Type D personality, and venous cannulation pain is significant, and it will be useful to apply preventive treatments for injection pain.

Decreased brain-derived neurotrophic factor levels may predict early perioperative neurocognitive disorder in patients undergoing coronary artery bypass surgery: A prospective observational pilot study.

STUDY OBJECTIVE: To determine the prognostic value of the change in intraoperative BDNF (Brain-derived neurotrophic factor) levels during cardiac surgery with cardiopulmonary bypass (CPB) on early perioperative neurocognitive disorder (PND). DESIGN: Prospective observational pilot study. SETTING: The study was performed in the Medical Faculty Hospital, from January 2020 to August 2020. PATIENTS: 45 adult patients undergoing elective coronary artery bypass surgery (CABG) with CPB. INTERVENTIONS: None. MEASUREMENTS: Cognitive function was evaluated 1 day before and 4 days after the surgery. Serum BDNF levels were measured at four time points (T1: after induction; T2: with aortic cross-clamp; T3: without aortic cross-clamp; T4: 4 days after surgery) by enzyme-linked immunosorbent assay. MAIN RESULTS: The incidence of PND was 37.8% four days after surgery. Serum BDNF (T2 and T4) levels were significantly lower in PND group compared to non- PND group (p = 0.003 and p = 0.016, respectively). Moreover, lactate, rSO2 (regional cerebral oxygen saturation), aortic cross-clamp time, CPB duration, and the amount of blood transfusion differed between the groups. Logistic regression analysis identified serum BDNF-T2, age, cross-clamp time, and rSO2-T2 as independent risk factors for PND. Based on the ROC analysis, the area under curve (AUC) of BDNF-T2 concentration for prediction of PND was 0.759 with sensitivity of 71.4% and specificity of 64.7% (p < 0.01). CONCLUSION: Intraoperative BDNF serum levels may be a useful biomarker in predicting PND in patients undergoing CABG surgery. More comprehensive studies is needed in order to confirm the effect of decreasing intraoperative BDNF serum levels on the development of PND. TRIAL REGISTRATION NUMBER: NCT04250935 www.clinicaltrials.gov.

Knowledge, attitudes, and behaviors of mosque imams regarding organ donation.

BACKGROUND: In this study we aimed to determine knowledge, attitudes, and behaviors of mosque imams regarding organ donation. MATERIAL/METHODS: This study involved 322 mosque imams working in Kahramanmaras, a city in the Mediterranean region of Turkey. A questionnaire was used to determine participants' sociodemographic characteristics, knowledge, attitudes, and behaviors regarding organ donation. RESULTS: Out of a total of 322 participants, 253 (78.6%) stated that organ donation is allowed in Islam, while 5 (1.6%) expressed that it is religiously forbidden, and 64 (19.9%) stated that they have no idea about the issue. Only 2 (0.6%) participants were registered organ/tissue donors, wile 320 (99.4%) were not. Out of all participants, 72 (22.4%) imams were willing to donate organs. Forty-six (14.3%) imams had previously received basic training about organ donation, and 166 (51.6%) were willing to attend a related training. Television programs and healthcare professionals were the most common means of learning about organ donation. Educational programs by healthcare professionals for imams and the public were proposed to be effective in increasing the number of organ donations. CONCLUSIONS: This study revealed that the knowledge of mosque imams regarding organ donation is poor and they had little willingness to donate their organs. Interestingly, many imams had no knowledge about organ donation under Islam. Collaboration of media, healthcare professionals, and mosque imams regarding organ donation might help increase organ donation.