2nd Hour Research Articles

Correlation of Serum Vitamin D Levels to Vascular Access Dysfunction in Prevalent Hemodialysis

Abstract Vascular access dysfunction in hemodialysis patients has been correlated to low serum vitamin D level in previous studies. Vitamin D deficiency and hepatitis C virus infection have been linked to endothelial cell dysfunction, promoting inflammatory cascade.30 negative - & 30 positive - hepatitis C virus patients on prevalent hemodialysis in Ain Shams University Hospitals, were enrolled in the study. All patients had access blood flow < 800 ml/min. For all patients we performed: complete physical examination, complete blood count, serum ferritin, ESR 1st and 2nd hours, CRP, blood urea, serum creatinine, serum albumin, total and direct bilirubin, alanine transferase, aspartate transferase, prothrombin time, International Normalized Ratio, serum calcium and phosphorus, and serum intact parathyroid hormone. Previous laboratory tests were performed using conventional methods within our hospitals laboratories. Serum vitamin Dlevel was measured by Enzyme Linked Immunosorbent Assay. Access blood flow was measured by Duplex Ultrasound. Vitamin D serum level was < 20 ng/ml within negative and positive groups with no significant difference between them. Vascular access flow was significantly lower within positive patients. Parathyroid hormone, Phosphorus, Prothrombin time, International Normalized Ratio, Alanine - and Aspartate - transferase were significantly higher within positive patients. We deduced that Vitamin D level < 20ng/ml was associated with reduced vascular access blood flow < 800 ml/min, with much more reduced access flow within hepatitis C virus positive patients. [Mona Hosny Abdel Salam, Reem Jan Farid, Mostafa Abdelnassier Abdelgawad and Marwa Salim Youssef Ismail. Correlation of Serum Vitamin D Levels to Vascular Access Dysfunction in Prevalent Hemodialysis.

Postoperative Drip-Infusion of Remifentanil Reduces Postoperative Pain—A Retrospective Observative Study

Development of remifentanil-induced hyperalgesia (RIH) postoperatively is an unpleasant experience that requires further treatment. This study assessed the effects of gradual withdrawal combined with drip infusion of remifentanil on postoperative pain and the requirement for rescue analgesics. A total of 559 patients receiving total intravenous anesthesia with propofol and remifentanil were enrolled. All patients either underwent gradual withdrawal of remifentanil (GWR) or gradual withdrawal combined with drip infusion (GWDR) with a dose of 1 mcg·kg−1 for 30 min after extubation. The numeric rating scale (NRS) and the requirement of rescue analgesics were assessed. The requirement for rescue analgesics was significantly lower in the GWDR group than in the GWR group (13.2% vs. 35.7%; p < 0.001). At the post-anesthetic care unit (PACU), patients in the GWDR group had a lower NRS pain score (p < 0.001). In addition, in the postoperative 2nd hour, patients in the GWDR group had a significantly lower NRS than the GWR group (beta, −0.31; p = 0.003). No remifentanil-related adverse effects were observed. We found that gradual withdrawal combined with drip infusion of remifentanil required less rescue analgesics and reduced pain scores. The new way of remifentanil administration may be effective to prevent RIH.

The use of high-flow nasal oxygen vs. standard oxygen therapy in hematological malignancy patients with acute respiratory failure in hematology wards

Background/aimHigh flow nasal cannula (HFNC) was mostly used in intensive care units (ICUs) with few studies in other departments. We hypothesized that HFNC applied at wards is beneficial for acute respiratory failure in hematological malignancy patients.Materials and methodsThe study is a single center, randomized controlled study. Inclusion criteria were hypoxemic respiratory failure and hematological malignancy. Patients were randomized to either venturi mask/nasal cannula oxygen treatment or HFNC.ResultsOne hundred patients were included in the study. Median age was 58.5 (18–86) years and APACHE II score was 17 (5–29). HFNC group was 51 patients and the oxygen treatment group 49 patients. P/F ratios were similar between the groups throughout the study period. Endotracheal intubation was required in 10 (20.0%) patients in oxygen group and 17 (33.0%) patients in HFNC group (p = 0.14). A total of 17 (35.0%) patients in oxygen group and 17 (33.0%) patients in HFNC group received noninvasive mechanical ventilation (p = 0.97). Median VAS comfort scores at the 2nd and 24th hours were not different between groups. The 28-day mortality rate was 36.7% (18 deaths) in the standard group and 45.0% (23 deaths) in the HFNC group (p = 0.39).ConclusionHFNC applied in wards is not superior to standard oxygen treatment for acute respiratory failure in hematological malignancy patients.

Gene expression profile analysis of gallic acid-induced cell death process

Gallic acid is a natural phenolic compound that displays anti-cancer properties in clinically relevant cell culture and rodent models. To date, the molecular mechanism governing the gallic acid-induced cancer cell death process is largely unclear, thus hindering development of novel therapeutics. Therefore, we performed time-course RNA-sequencing to reveal the gene expression profiles at the early (2nd hour), middle (4th and 6th hour), and late (9th hour) stages of the gallic acid-induced cell death process in HeLa cells. By Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses, we found significant changes in transcription of the genes in different types of cell death pathways. This involved the ferroptotic cell death pathway at the early stage, apoptotic pathway at the middle stage, and necroptotic pathway at the late stage. Metabolic pathways were identified at all the stages, indicating that this is an active cell death process. Interestingly, the initiation and execution of gallic acid-induced cell death were mediated by multiple biological processes, including iron and amino acid metabolism, and the biosynthesis of glutathione, as targeting on these pathways suppressed cell death. In summary, our work provides a dataset with differentially expressed genes across different stages of cell death process during the gallic acid induction, which is important for further study on the control of this cell death mechanism.

The comparative evaluation of complex drugs based on fipronil for ectoparasitosis of dogs and cats

The article presents data on the effectiveness of new domestic antiparasitic drug “Insectostop for dogs and cats” in comparison to the reference drugs “Burdi Fipro for dogs” and “Burdi Fipro for cats” that is used for therapeutic and prophylactic purposes against ectoparasitosis of dogs and cats of different breeds. According to the results of the research, the parasitism of fleas of Ctenocephalus canis, C. felis and Pulex irritans species and parasitiform mites of the Ixodes ricinus and Dermacentor reticulatus species and sarcoptiform mites of the species Otodectes cynotis were detected on experimental animals. Clinically, this was inspected by redness, inflammation of the skin, itching reflex, the emergence of papules on the skin, scales. Based on the results, it was found that 8 hours after usage of the experimental drug “Insectostop for dogs and cats” its effectiveness in syphonapterosis of dogs was 87.9 %, and after usage of the reference drug “Bourdie Fipro for dogs” – 86.9 %, and in experiments on cats, the effectiveness of the experimental drug for siphonapterosis in cats was 92.4 %, and the reference drug “Bourdie Fipro for cats” – 90.3 %. Starting from the first and third days after usage of drugs on the fur of dogs and cats of the experimental and control groups, parasitological studies did not reveal fleas of the species Ctenocephalus canis, C. felis and Pulex irritans. So starting from the first day, the experimental and reference drugs showed 100 % effectiveness during the siphonapterosis in dogs and cats. During the ixodidosis of dogs, it was found that at the 8-th hour after usage of the experimental drug “Insectostop for dogs and cats” its effectiveness was 82.9 %, and after usage of the reference drug “Bourdie Fipro for dogs” – 81.3 %. At the 24-th hour after usage of the experimental drug, its effectiveness was 97.6 %, and after usage of the reference drug – 95.9 %. At the 72nd hour of the experiment, no adult representatives of the species Ixodes ricinus and Dermacentor reticulatus were found on the fur of dogs of these groups. Thus, at 72 hours after usage of the experimental and reference drug, they showed 100 % efficiency on adult Ixodes mites. During the Otodectesis of dogs it was found that on the 7th day, effectiveness of the experimental drug was 75.6 %, on the 14th day – 98.1 % and after usage of the reference drug “Bourdi Fipro for dogs” its effectiveness on the 7th day was 73.5 %, and on the 14th – 98.3 %. At 21-st days after treatment of animals with drugs as a result of clinical examination and parasitological examination of dogs mites of the species Otodectes cynotis were not detected. In experiments on cats, on the 7th day after usage of experimental drug, its effectiveness during Otodectesis of cats was 76.9 %, and after usage of reference drug – 77.1 %. As a result of clinical examination and parasitological study of the experimental and control groups of animals on the 14th day after treatment of the auricles of cats with mites of the species Otodectes cynotis was not detected. Thus, usage of both drugs promotes the release of Otodectesis in dogs from parasites on the 21st day of the experiment, and cats – on the 14th day. Tests have shown that the experimental drug “Insectostop for dogs and cats” (100 ml of the drug contains the active substance: fipronil – 10 g) does not cause skin irritation, dermatitis, seborrhea, allergic and other side effects, that the drug is well tolerated by dogs and cats and doesn’t give any side effects and changes of clinical condition of animals.

Assessment on the Effect of Active Management of Third Stage of Labour With and Without Uterine Massage on Maternal Outcome among Postnatal Mothers

The most common cause of maternal death worldwide is postpartum hemorrhage (PPH) and Active Management of Third Stage of Labour (AMTSL) is the most important prophylactic intervention for prevention of PPH. A study was undertaken to assess the effect of AMTSL with and without uterine massage on maternal outcome among postnatal mothers in a selected hospital, WB. In this quasi-experimental study, Total 60 (Experimental Group-30, Control Group-30) postnatal mothers who undergone spontaneous vaginal delivery were selected by non-probability purposive sampling technique followed by randomization. The uterine massage is applied for 1 min immediately after placental delivery to 2 hours of postpartum at every 15 mins interval. The results revealed that there was no statistically significant difference of mean amount of postpartum bleeding between experimental and control group at 1st hour, 2nd hour, 24 hours, and 48 hours [t1= 1.06, t2= 1.52, t3=0.47, t4=0.26 at df (58), p&gt;0.05]. The general condition (BP, Pulse, Respiration) after 1st hour, 2nd hour, 24 hours and 48 hours were comparable and statistically not significant between the two groups. There was no significant association between amount of postpartum bleeding and obstetrical parameters like parity, gravida, POG, presence of episiotomy, birth weight, time of placental delivery, presence of tear and time of initiation of breast feeding etc. for both groups. Based on the results of the current study, it can be concluded that the mothers who received the uterine massage along with AMTSL get no additional benefit as compared to control group. Keywords: Active management of third stage of labour (AMTSL); Uterine massage; Maternal outcome; Postnatal mother.

Pharmacokinetics of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Extreme Obesity

PurposeDirect oral anticoagulants (DOACs) are recommended in preference to vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation (AF) eligible for oral anticoagulation therapy; however, data and clinical experiences supporting the use of DOACs in patients with a body mass index ≥40 kg/m2 or weight >120 kg remain limited. The aim of this study was to evaluate the pharmacokinetic properties of DOACs in patients with AF and extreme obesity. MethodsWe enrolled all consecutive patients with AF and extreme obesity undergoing treatment with DOACs followed up at Monaldi Hospital, Naples, Italy. To determine peak plasma and trough levels of DOACs, plasma samples were collected at 2nd, 4th, 6th, and 12th hours from the last dose intake in patients receiving apixaban and dabigatran and at the 2nd, 4th, 6th, and 24th hours in those receiving edoxaban and rivaroxaban. The DOACs’ peak and trough plasma levels obtained from our study population were compared with those sourced from pharmacokinetic studies among patients without obesity, defined as a normal reference range in the literature. If at least 1 peak or trough plasma level was found ​​below or above the normal reference ranges, the patients were classified as having out-of-range DOAC plasma levels. Study population was then divided into in-range and out-of-range groups. Baseline characteristics, including DOAC treatment, were compared between the 2 groups. Univariate and multivariate logistic regression analysis were performed to identify baseline variables associated with DOACs’ plasma concentration out of the expected range. FindingsA total of 58 patients (mean [SD] age, 70.93 [8.73] years; 40% female) with extreme obesity (mean [SD] body mass index. 44.43 [3.54] kg/m2) and AF while undergoing DOAC treatment were included in the present study. In 9 patients (15.5 %), the DOAC plasma concentrations were out of the expected ranges (out-of-range group);, indicating a greater likelihood of edoxaban 30 mg treatment (33% vs 2%; P < 0.01) and inappropriate DOAC underdosing (56% vs 4%; P < 0.005) compared with the in-range group. According to the multivariate logistic analysis (P = 0.0011), the inappropriate DOAC underdosing (hazard ratio = 29.37; P = 0.0002) was an independent predictor of DOAC plasma levels out of the expected ranges. ImplicationsPatients with extreme obesity and AF who were receiving DOAC therapy had DOAC plasma concentrations in the expected range. The inappropriate DOAC underdosing seems to be the only independent clinical factor associated with a plasma concentration of the drug out of the expected range.

COMPARISON OF BUPIVACAINE–FENTANYL AND BUPIVACAINE-ALFENTANIL USED INTRATHECALLY IN LAPAROSCOPIC APPENDECTOMY SURGERY

OBJECTIVE: Acute appendicitis, which is the most common cause of acute abdominal pain, is an acute inflammation of appendix vermiformis. Spinal anesthesia is one of the most used regional anesthesia technique nowadays, and it is the temporary interruption of nerve conduction by local anesthetic solution injected into the cerebrospinal fluid. In this study we created multimodal analgesia by giving various opioid agent (fentanyl and alfentanil) intrathecally with local anesthetic. The aim of this study is to compare bupivacaine-fentanyl and bupivacaine-alfentanil that are used intrathecally to create motor and sensory block.MATERIAL AND METHODS: This study was planned as a clinical study using the random sampling method in a tertiary care hospital. 50 voluntary patients who were diagnosed with appendicitis by laboratory tests and clinical diagnosis methods in the general surgery clinic were included in the study. The patients were randomly assigned into two group, Group I (10 mg hyperbaric bupivacaine (2cc) and 25 mcg fentanyl (0.5 cc)) and Group II (10 mg hyperbaric bupivacaine (2 cc) and 250 mcg alfentanil (0.5 cc)). The patients were randomly assigned into two group, Group I and Group II. Before the operation, each patient was informed about the use of the patient-controlled analgesia system and visual pain scale (VPS) for pain scoring. It was compared the postoperative analgesic needs of patients who underwent multimodal spinal anesthesia with different opiates. Sensorial block levels were measured by pinprick test every 2 minutes in the first 10 minutes and every 5 minutes in later periods. It was recorded mean arterial pressure at the beginning of the surgery at 0th minute and at 5-10-30th minutes during the surgery. In addition, mean arterial pressure and heart rate were recorded at 1-2-6-12-24th hours postoperatively.RESULTS: Postoperative first analgesic requirement time of Group I was found to be late than Group II. Postoperative 6th, 12th and 24th hours visual pain scales were found to be significantly lower in Group I than Group II. But 2nd and 6th hours heart rates were found higher in Group I than Group II.CONCLUSIONS: It was shown that the duration of analgesia was longer and postoperative first analgesia requirements time were so late in patients who were given bupivacaine–fentanyl than the patients given bupivacaine–alfentanil

Anti-Müllerian Hormone Accelerates Pathological Process of Insulin Resistance in Polycystic Ovary Syndrome Patients.

Insulin resistance (IR) is one of the most common features of polycystic ovary syndrome (PCOS), which is related to obesity. Whether increased anti-Müllerian hormone (AMH) levels in PCOS are involved in the pathogenesis of insulin resistance remains unclear. We investigated serum levels of leptin and AMH along with basic clinical and metabolic parameters in 114 PCOS patients and 181 non-PCOS women. PCOS patients presented higher fasting blood glucose, insulin concentrations and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) in addition to body mass index (BMI), lipids profiles and hormone levels. HOMA-IR showed a positive correlation with BMI, AMH, leptin, and low-density lipoprotein-cholesterol (LDL-c) levels. Interestingly, AMH is strongly positively correlated with HOMA-IR and insulin concentrations for 1st and 2nd hours of glucose treatment after fasting. Among PCOS women with BMI≥25 kg/m2, high AMH level group showed an increased HOMA-IR when compared to normal AMH level. However, among PCOS women with normal BMI, women with high AMH presented an elevated fasting insulin levels but not HOMA-IR when compared to normal AMH group. In vitro treatment of isolated islet cells with high concentration of leptin (200 ng/ml) or high leptin plus high concentration of AMH (1 ng/ml) significantly enhanced insulin secretion. Importantly, co-treatment of AMH plus leptin upregulates the expression of pro-apoptotic proteins, such as Bax, caspase-3, and caspase-8 after incubating with a high level of glucose. These results suggest that AMH may involve in the pathological process of pancreatic β-cells in obese PCOS women.

The antibacterial effect of iron oxide and graphene oxide nanoparticles and their nanocomposites against Escherichia coli and Staphylococcus aureus bacteria

Excessive use of antibiotics in the livestock and poultry industry has led to antibiotic resistance in livestock and humans. The use of metal Nano-oxides and nanocomposites has been considered as a new strategy to combat infectious diseases. In this study, the antibacterial activity of iron oxide and graphene oxide nanoparticles and their nanocomposites were investigated. aureus; S. For this purpose, antibacterial activity of iron oxide (Fe2o3; F), Graphene oxide (GO), 0.018g reduced graphene oxide-Fe2O3 Nanocomposite (FG1), 0.036g reduced graphene oxide-Fe2O3 Nanocomposite (FG2), 0.072g reduced graphene oxide-Fe2O3 Nanocomposite (FG3) against Gram-negative (Escherichia coli; E. coli) and Gram-positive (Staphylococcus aureus) bacteria was screened. The antibacterial activity of the five different nanoparticles was assessed by minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and the time-kill assay methods. The antibacterial results showed that except for FG1, for the rest of the nanoparticles MIC were 60 μL/mL for E. coli and 50 μL/mL for S. aureus. Moreover, the time-kill assay revealed that the growth of both bacteria was inhibited from the 2nd hour onwards for all nanoparticles. In general, the results of this study showed that iron oxide and graphene oxide nanocomposites increase their antibacterial effect.

Role of Standardized Plant Extracts in Controlling Alcohol Withdrawal Syndrome-An Experimental Study.

Patients with alcohol use disorder experience alcohol withdrawal syndrome due to the sudden cessation of alcohol. This study was designed to evaluate the protective effect of Ashwagandha and Brahmi on alcohol withdrawal in rats. Thirty rats of either sex were taken and randomly divided into 6 groups (n = 5). Their normal diet was replaced by a modified liquid diet (MLD). Ethanol was added gradually except in the MLD group for a period of 21 days and withdrawn suddenly. Four treatment groups were administered Ashwagandha (3.75 mg of withanolide glycosides per kg body weight), Brahmi (10 mg of bacosides per kg body weight), Ashwagandha + Brahmi (3.75 mg withanolide glycosides + 10 mg bacosides per kg body weight) orally and diazepam (1 mg/kg body weight, i.p.) 45 min before alcohol withdrawal. Rats were assessed for behavioural changes (agitation score and stereotypic behaviour), anxiety and locomotor activity at 2nd and 6th hours of alcohol withdrawal. Pentylenetetrazol (PTZ) kindling seizures were assessed at 6th hour of alcohol withdrawal. Ashwagandha and Brahmi alone and in combination significantly reduced the behavioural changes in alcohol withdrawal rats at 2nd hour and their combination in 6th hour. Ashwagandha and Brahmi suppressed PTZ kindling seizures effectively and improved locomotory activity at 2nd hour and 6th hour of alcohol withdrawal. Reduction in anxiety was significant among Ashwagandha at 2nd hour and the combination group at 2nd and 6th hour. The results were comparable to diazepam. Ashwagandha and Brahmi have beneficial effects in controlling the behavioural changes, anxiety and seizures in alcohol withdrawal symptoms in rats and improved locomotory activity.

Relationship Between the Serum Levels of Procalcitonin, Lactate, HgA1c and Functional Outcome in Acute Ischemic Stroke Patients

Purpose:Prognostic parameters in stroke management are important for emergency department physicians to reduce mortality and morbidity. No parameters could be determined for prognosis in acute stroke. In this study, we aimed to determine whether serum procalcitonin(PCT), lactate and HgA1c levels at admission and changes of PCT and lactate levels in 2 hours were associated with short-term functional outcome (3rd day) after acute ischemic stroke. Patients and Methods:This was a prospective observational prognostic test study. All consecutive patients admitted to the emergency department and diagnosed as the first episode of acute ischemic stroke were included in the study. On admission and 2nd hour, PCT and lactate levels and admission HgA1c levels were collected from all subjects. We aimed to correlate these values with Modified Rankin Scale (mRs) and mortality on the 3rd day and to determine their predictive value. Results:There was no statistically significant difference in PCT and lactate values and in terms of PCT and lactate clearances between the favorable (mRS <2) and nonfavorable groups. There was a statistically significant difference between two groups in terms of HgA1c value. When the threshold value analysis was performed to determine the non-favorable outcome, the threshold value was determined as 5.7. Conclusion:Our results demonstrate that ischemic stroke patients with higher levels of HgA1c at the time of initial presentation have an increased risk for poor functional neurological outcome at the 3rd day.

A comparison of preincisional and postincisional ultrasound guided transversus abdominis plane block.

Background and Aims:Transversus abdominis plane blocks are part of the multimodal analgesia used for lower abdominal surgeries.Our aim of this study was to compare the analgesic efficacy of preincisional and postincisional TAP blocks in patients undergoing total abdominal hysterectomies.Material and Methods:54 American Society of Anesthesiologists physical status I and II patients aged between 30 and 60 years who underwent a total abdominal hysterectomy under spinal anesthesia in our hospital were chosen for the study. Alternate patients satisfying the inclusion criteria were either given a preincisional or postincisional transversus abdominis plane block bilaterally. Postoperatively, the numeric pain intensity scale was observed, along with nausea, vomiting, and sedation scores.Results:Pain scores were significantly lower (P < 0.05) in the preincisional TAP block group from the 2nd postoperative hour onwards till 12 h, and thereafter it was comparable between both the groups. The total morphine requirement was significantly less in the preincisional TAP group (P-value 0.001). Also, the mean time to the first request for morphine was significantly longer in patients belonging to the preincisional TAP block group (P-value of 0.002). There were no significant differences in the sedation scores postoperatively, except at the 4th hour, where it was significantly higher (P-value of 0.024) in the postincisional TAP group. Post operative nausea and vomiting was significantly higher and so the dose of the antiemetic used was also observed to be more in the postincisional TAP block group.Conclusion:Preincisional TAP blocks are more effective than postincisional ones with better analgesia and lesser side effects, for total abdominal hysterectomies.

BEHAVIOURAL RESPONSES OF AFRICAN CATFISH ( Clarias gariepinus BURCHELL, 1822) JUVENILES EXPOSED TO ACUTE CONCENTRATIONS OF BUTACHLOR (HERBICIDE)

This study examined the behavioral changes induced by butachlor to the juveniles of Clarias gariepinus. The experiment consists of five treatments (0.6, 0.7, 0.8, 0.9 and 1.0 mg/l) and a control. Ten fishes were allotted in each test tank in duplicates. Observations on behavioral responses were made at 0, 12, 24, 48, 72 and 96 hours post-exposure. The opercular movement and tail fin beat rates were observed as counts per minute using a stopwatch. The behavioral patterns of the fish in the control group were normal, whereas in the exposed groups the fish tend to lose equilibrium and swim erratically with vigorous jerky movements. At the 12th and 24th hours the fish in the exposed groups showed hyper-active movement, but became hypoactive at the 48th hour. The mean values of the tail fin beat of the exposed groups were significantly higher (p&lt;0.05) than that of the control at the 12th hour. At the 24th and 48th hour post-exposure the exposed groups showed significant (p&lt;0.05) time-dependent decrease compared to the control. The tail fin beat became significantly higher (P&lt;0.05) in the control group from 72nd hours onward. The decrease of tail fin beats at the 72nd and 96th hours were dose-dependent similar observations were also recorded in the opercular ventilation. At the 12th hour the opercular ventilation of the exposed fish was significantly higher (p&lt;0.05) than the control whereas at the 24th and 48th hours, the opercular ventilation of the exposed groups showed a significant decrease (p&lt;0.05) compared to the control.

Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery

There is asignificant increase in number of obese pregnant women worldwide. Obese parturients undergoing cesarean section have a higher risk for hypotension and require higher doses of vasopressors following spinal anesthesia compared to nonobese parturients. This study aimed to compare the maternal hemodynamic changes when combined spinal-epidural anesthesia (CSEA) is induced in the left lateral decubitus and sitting positions in obese pregnant women undergoing elective cesarean section. In this study, pregnant women with full-term gestation diagnosed as obese undergoing elective cesarean section were included. Two groups were formed: the CSEA was performed in left lateral position in groupI (n = 50) and in sitting position in groupII (n = 50). At the end of the CSEA procedure, patients were placed in the supine position. When the sensory block reached at the upper level of T6 dermatome, surgery was initiated. Hemodynamic, anesthetic and neonatal parameters were recorded. In all patients, CSEA was successful and sufficient anesthesia was provided for surgery. Time to reach T6 dermatome sensory level in groupII was found to be longer than groupI (P = 0.011). At 20 min after spinal injection, the maximum sensory block level was similar in both groups. There were no significant differences between groups in terms of sensory block time and the time to requiring postoperative supplemental analgesics. There were no significant differences in terms of the volume of intravenous fluid administered, ephedrine and atropine requirements between groups. Both groups had similar systolic blood pressure, heart rate and oxygen saturation values during surgery and postoperatively. While both groups had similar diastolic blood pressure (DBP) values during surgery and at the 1st postoperative hour, groupII had lower DBP values at the 2nd postoperative hour compared with groupI (P = 0.04). Left lateral decubitus and sitting positions during performance of CSEA lead to similar maternal hemodynamic changes in obese pregnant women undergoing cesarean section.

Variation of enterohepatic circulation observed with 75SeHCAT images in the first three hours. Scintigraphic patterns and analysis of their association with the diagnosis of bile acid malabsorption

ObjetiveTo evaluate the enterohepatic circulation of 75-Selenium turoselecolic acid (75Se-SeHCAT) during the first 3 h and its correlation with the abdominal retention at the 7th day (AR7), as contribution to the clinical study of biliar acid malabsorption (BAM). Materials and methods38 patients with chronic diarrhea were retrospectively studied. Acquisition protocol included static abdominal images at 1st, 2nd and 3rd hour and the 7th day after oral administration of the radiopharmaceutical. Images of 1–3 h determined 5 patterns of enterohepatic circulation that, due to their location, were characterized as: 1) gallbladder 2−3 h, 2) gallbladder 3 h, 3) gallbladder-abdomen 2−3 h, 4) abdomen, 5) upper left abdomen. The association of these patterns with the AR7 (Fisher, STATA) were investigated. Patients were classified as Non BAM (AR7 > 15%), mild-BAM (AR7 15−10%), moderate-BAM (AR7 10−5%) or severe-BAM (AR7 < 5%). Results19 patients had an AR7 diagnostic of BAM (7 mild-BAM, 5 moderate-BAM, 7 severe-BAM). The pattern “gallbladder at 2−3 h” was statistically associated with Non BAM (p 0,008), while “gallbladder-abdomen at 2−3 h” was correlated with having BAM (p 0,029). ConclusionVariations detected at the abdominal level in images during the first 3 h were associated with changes in intestinal absorption and the incorporation of the radiopharmaceutical into the pool of bile acids, so visual interpretation of the images at 2nd and 3rd hour could be useful in the final assessment of the study.

Chronic Chest Pain Control after Trans-Thoracic Biopsy in Mediastinal Lymphomas.

Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patients with lymphomas. Pathological neuronal mechanisms integrate with an overproduction of IL-6, TNF-α, IL1-β by macrophages and monocytes, which amplifies inflammation and pain. In consideration of this complex pathogenesis, international guidelines recommend diversified analgesia protocols: thoracic epidural, paravertebral block, and systemic administration of opioids. This study reports an attempt to reduce chest pain and prevent chronic pain in 51 patients undergoing trans-thoracic biopsy for mediastinal lymphoma. The entity of pain, measured 72nd hour after biopsy by the Numerical Rating Scale (NRS), was compared with that seen at a 6th month checkpoint in 46 patients. The pain decreased in all cases. At the 6th month checkpoint, among 31 opioid-treated patients, none of the 16 patients with NRS < 6 within the 72nd hour post biopsy had developed chronic chest pain, while 8 of the 15 with higher values did (p < 0.01). Of 10 patients undergoing thoracotomy and treated with opioids, eight had a NRS of no more than 2, of which six had no chronic pain. Of the twenty-one patients who underwent VATS biopsy and were treated with opioids, fifteen had NRS no greater than 2, of which ten had no chronic pain. Subgroups of patients biopsied under mediastinotomy or video-assisted thoracoscopic surgery (VATS) and treated with thoracic epidural analgesia (TEA) or PVB were too small for such analysis.

Post-Cardiac Arrest Hydrocortisone Use Ameliorates Cardiac Mitochondrial Injury in a Male Rat Model of Ventricular Fibrillation Cardiac Arrest.

BackgroundSteroid use after cardiac arrest has been reported to improve survival and neurological outcome in cardiac arrest survivors. The study aimed to evaluate the effect of post‐arrest hydrocortisone use on myocardial damage and cardiac mitochondrial injury in a rat model of ventricular fibrillation cardiac arrest.Methods and ResultsVentricular fibrillation cardiac arrest was induced and left untreated for 5 minutes in adult male Wistar rats. Cardiopulmonary resuscitation and electric shocks were then applied to achieve return of spontaneous circulation (ROSC). Successfully resuscitated animals were randomized into 3 groups: control, low‐dose hydrocortisone (2 mg/kg), and high‐dose hydrocortisone (8 mg/kg). The low‐dose hydrocortisone and high‐dose hydrocortisone (treatment) groups received intravenous hydrocortisone immediately after ROSC and the control group received saline as placebo. Each group consisted of 15 animals. Within 4 hours of ROSC, both treatment groups showed a higher cardiac output than the control group. At the fourth hour following ROSC, histological examination and transmission electron microscopy demonstrated less myocardial damage and mitochondrial injury in the animals treated with hydrocortisone. In the treatment groups, hydrocortisone mitigated the acceleration of Ca2+‐induced mitochondrial swelling and suppression of complex activity observed in the control group. At the 72nd hour after ROSC, a significantly higher proportion of animals treated with hydrocortisone survived and had good neurological recovery compared with those given a placebo.ConclusionsHydrocortisone use after cardiac arrest may mitigate myocardial injury and cardiac mitochondrial damage and thus improve survival, neurological and histological outcomes in a rat model of ventricular fibrillation cardiac arrest.

Effect of additives on short-term storage of ram semen

Bu çalışmanın amacı, kısa süreli saklanan koç spermasının (24 saatlik aralıklarla) 72 saate kadar spermatolojik parametreler üzerine etkilerini araştırmaktı. Çalışmada % motilite, canlılık ve akrozom bütünlüğü verileri değerlendirildi.&#x0D; Çalışmada her koçtan (4 baş Merinos koçu) alınan dört ejakülat kullanıldı. Ejakülatlar pooling yapıldıktan sonra eşit hacimli yedi parçaya bölündü. Çalışma grupları, tris bazlı sulandırıcıya eklenen resveratrol (2 ve 4 mM), troloks (2 ve 4 mM), BSA (3 ve 6 mg/ml) ve kontrol olmak üzere oluşturuldu. Sulandırılan örnekler 72. saate kadar 4°C de muhafaza edildi. Spermatozoa motilitesi, canlılık ve akrozom bütünlüğü 0, 24, 48 ve 72. saatte değerlendirildi. Motilite muayenesi faz kontrast ataçmanlı mikroskopta 400X lük büyütmede, canlılık ve akrozom bütünlüğü ise floresan mikroskop ile değerlendirildi. &#x0D; Çalışmanın 72. saatinde, BSA (3 ve 6mM) grupları motilite (53.75±2.50%; 55.00±4.08%) ve akrozom bütünlüğü (53.70±3.39%; 57.10±4.68%) değerlendirmelerinde kontrol grubu (43.75±2.50%; 46.53±3.58) ile istatistiksel farklılık (p

Anesthetic Preconditioning of the Small Intestine in Hemorrhagic Hypotension

Aim of the study. To investigate the preconditioning effect of sevoflurane on small intestinal mucosa in experimental hemorrhagic hypotension.Material and methods. The study was performed on a cohort of 106 male rats that included two experimental groups: one exposed to ether (Group 1, n=40) and another one exposed to sevoflurane (Group 2, n=40); two control groups included 20 intact animals, of which 10 were anesthetized with ether and 10 with sevoflurane. Six animals were excluded from the study because they died by the 2nd hour of hemorrhagic hypotension under ether anesthesia. The study parameters were measured at 15 min, 30 min, 1 h, and 2 h of hemorrhagic hypotension. Amylolytic activity of the small intestine mucosa was determined by E. A. Zabelinsky, B. W. Smith and I. M. Roe technique modified by A. M. Ugolev. The data were statistically analyzed using the nonparametric Mann-Whitney method.Results. By 15 min of hemorrhagic hypotension, the activity of amylase fractions in all small intestine regions in Group 2 animals was significantly lower vs the Group 1 rats. By 30 min of hemorrhagic hypotension, the activity of the enzyme fractions in all small intestine regions in Group 2 animals remained significantly lower than in Group 1, by an average of 2 to 9 times (P=0.01; P&lt;0.001), and after 1 h of hemorrhagic hypotension, it was 2 and 4 times lower (P=0.02; P&lt;0.001). By the 2nd hour of hemorrhagic hypotension, the activity of nearly all duodenal amylase fractions in the Group 2 animals remained 3-4 times lower compared to Group 1. Meanwhile, a significantly higher activity of slowly desorbing and intracellular amylase fractions vs the control group was observed in jejunum and ileum.Conclusion. In hemorrhagic hypotension under sevoflurane anesthesia, a decrease of the pancreas excretory function, stabilization of the brush border of the mucosa of all small intestine regions, including enterocyte membranes, was found during the first hour of experiment. Two hours after the hemorrhage, the biochemical evidence of brush border damage in the jejunum and ileum was revealed.