Behcet Al

Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia.

OBJECTIVE Ultrasonography has been suggested as a useful noninvasive tool for the detection and follow-up for hypovolemia. Two possible sonographic markers as a surrogate for hypovolemia are the diameters of the inferior vena cava (dIVC) and the right ventricle (dRV). The goal of this study was to evaluate IVC and RV diameters and diameter changes in patients treated for hypovolemia and compare these findings with healthy volunteers. METHODS Fifty healthy volunteers and 50 consecutive hypovolemic patients were enrolled in the study. The dIVC, both during inspiration (IVCi) and expiration (IVCe), was measured in hypovolemic patients both before and after fluid resuscitation, and they were also measured in healthy volunteers during the time they participated in the study. The dIVC, in hypovolemic patients both before and after fluid resuscitation, was measured ultrasonographically by M-mode in the subxiphoid area. The dRV was measured ultrasonographically by B-mode in the third and fourth intercostals spaces. RESULTS The average diameters of the IVCe, IVCi, and dRV in hypovolemic patients upon arrival were significantly lower compared with healthy volunteers (P = .001). After fluid resuscitation, there was a significant increase in the mean diameters of the IVCe, IVCi, and RV in hypovolemic patients (P = .001). CONCLUSIONS The results indicate that the dIVC and dRV are consistently low in hypovolemic subjects when compared with euvolemic subjects. Bedside serial measurements of dIVC and dRV could be a useful noninvasive tool for the detection and follow-up of patients with hypovolemia and evaluation of the response to the treatment.

Melatonin reduces oxidative stress in the rat lens due to radiation-induced oxidative injury

Purpose: The aim of this study was to evaluate the antioxidant role of melatonin against radiation-induced cataract in the rat lens after total cranial irradiation with a single 5 Gray (Gy) dose of gamma irradiation. Materials and methods: Twenty-eight Sprague-Dawley rats were used for the experiment.The rats were randomly divided into four equal groups. The control group did not receive melatonin or irradiation but received both 0.1 ml physiological saline intraperitoneally and sham irradiation. The irradiation (IR) group received 5 Gy gamma irradiation to the total cranium as a single dose plus 0.1 ml physiological saline intraperitoneally. The melatonin plus IR group received irradiation to the total cranium plus 5 mg/kg/day melatonin intraperitoneally. The melatonin group received only 5 mg/kg/day melatonin plus sham-irradiation. Biochemical parameters measured in murine lenses were carried out using spectrophotometric techniques. Results: Lens antioxidant capacity, as measured by levels of total superoxide scavenger activity (TSSA), non-enzymatic superoxide scavenger activity (NSSA) and glutathione reductase (GRD) activity, significantly increased in melatonin, control and melatonin plus IR groups when compared with the IR group. Lens glutathione-S-transferase (GST) activity significantly increased in control and melatonin groups when compared with the IR group. Lens malondialdehyde (MDA) levels significantly increased in the IR group when compared with control, melatonin and melatonin plus IR groups. Lens TSSA and NSSA activities significantly decreased in control and melatonin plus IR groups when compared with the melatonin group. Lens GST activity significantly increased in the control group when compared with melatonin plus IR group. Lens GRD activity significantly increased in melatonin and melatonin plus IR groups when compared with control group. Conclusions: Melatonin reduces oxidative stress markers and augments anti-oxidant capacity in the rat lens.

Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure

BACKGROUND Patients scheduled to invasive medical procedures experience high levels of anxiety, which may lead to increased perceptions of pain and vital sign instability throughout. AIMS To examine the effect of a music intervention (MI) on stress hormones, physiologic parameters, pain, and anxiety state before and during port catheter placement procedures (PCPPs). METHODS We conducted a prospective, randomized, controlled study in 100 oncology patients, who were randomly assigned to an MI group (n=50) or a control group (n=50). The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone (ACTH) levels, heart and respiratory rate (HR, RR) and systolic and diastolic blood pressure (SBP, DBP), on arrival in the surgical intervention room, as well as immediately prior to and immediately after the PCPP, in both groups. Furthermore, pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales. RESULTS On arrival, there were no differences between the patients in terms of serum cortisol and ACTH levels, HR, RR, SBP, DBP and anxiety levels. There were significant reductions in hormone levels (p<0.05 for all), HR (p<0.001), RR (p<0.001), SBP (p<0.05) and DBP (p<0.05), immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group. Furthermore, music led to a significant reduction in pain (p<0.05) and anxiety scores (p<0.05) in the MI group compared to control group. CONCLUSION During invasive medical procedures, MI significantly decreases stress hormone levels, physiological parameters, acute procedural pain and anxiety.

The effect of caffeic acid phenethyl ester (CAPE) against cholestatic liver injury in rats.

OBJECTIVES Caffeic acid phenethyl ester (CAPE) has been subjected to considerable investigations that have revealed its antioxidant and anti-inflammatory activities in different conditions. But there is not a previous investigation about its effect on cholestatic liver injury. The aim of this study was to investigate the effect of CAPE in rat liver against cholestatic liver injury induced by bile duct ligation. METHODS Swiss-albino rats were recruited in the study as follows; Group 1 rats subjected to simple laparotomy known as the sham group; Group 2 rats subjected to bile duct ligation (BDL); Group 3 bile duct ligated rats treated with CAPE. The third group received CAPE (10 micromol/kg) intraperitoneally daily throughout 14 d. RESULTS Data showed a decrease in gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase levels (ALT) of the CAPE treated rats, compared with BDL group (P < 0.001, P < 0.01, and P < 0.02, respectively). In the CAPE treated rats, tissue levels of malondialdehyde (MDA) and myeloperoxidase (MPO) were significantly lower than that of the BDL group (P < 0.001). The levels of glutathione (GSH) in CAPE treated rats were significantly higher than that of BDL group (P < 0.001). In CAPE treated group, the levels of interleukin-1alpha (IL-1alpha) and interleukin-6 (IL-6) were significantly lower than that of BDL group (P < 0.03, P < 0.02, respectively). Administration of CAPE in the rats with biliary obstruction resulted in inhibition of necro-inflammation. CONCLUSION These results suggest that treatment of CAPE maintains antioxidant defenses, reduces oxidative liver injury, cytokine damage, and necro-inflammation in bile duct ligated rats. Thus, CAPE seems to be a promising agent for the attenuation of cholestatic liver injury.

The effects of oral Ginkgo biloba supplementation on radiation-induced oxidative injury in the lens of rat.

Background: The aim of this study was to evaluate the antioxidant role of Ginkgo biloba (GB) against radiation-induced cataract in the rat lens after total cranial irradiation with a single 5 Gray (Gy) dose of gamma irradiation. Materials and Methods: Twenty-four Sprague-Dawley rats were used for the experiment. The rats were randomly divided into three equal groups. Group 1 did not receive GB or irradiation (control group) but received 1-ml saline orally plus sham-irradiation. Group 2 received total cranium 5 Gy of gamma irradiation as a single dose (IR group) plus 1-ml saline orally. Group 3 received total cranium irradiation plus 40 mg/kg/day GBE (IR plus GBE group). Biochemical parameters measured in murine lenses were carried out using spectrophotometric techniques. Results: Lens total (enzymatic plus non-enzymatic) superoxide scavenger activity (TSSA), non-enzymatic superoxide scavenger activity (NSSA), glutathione reductase (GRD), and glutathione-S- transferase (GST) activities significantly increased in the IR plus GBE groups when compared with the IR group. However, TSSA, GRD and GST activities were significantly lower in the IR group when compared with the control group. Lens xanthine oxidase (XO) activity in the IR group significantly increased compared to that of both the control and IR plus GBE groups. Conclusion: GBE has clear antioxidant properties and is likely to be a valuable drug for protection against gamma-irradiation and/or be used as an antioxidant against oxidative stress.

Antioxidative status and lipid peroxidation in kidney tissue of rats fed with vitamin B(6)-deficient diet.

Introduction: The aim of this study was to evaluate lipid peroxidation (LP) and free radical scavenging enzyme activities in kidney tissue of vitamin B6-deficient rats. Material and Methods: The rats were divided into control and vitamin B6-deficient groups. After 4 weeks of feeding, animals in all groups were anesthetized by thiopental sodium (50 mg/kg). Thoraces were opened, 2 mL blood samples were taken from aortas, then the rats were killed by cervical dislocation, and kidney tissues were removed. Biochemical measurements in kidney tissue were carried out using a spectrophotometer. Results: Total superoxide scavenger activity (TSSA), nonenzymatic superoxide scavenger activity (NSSA), superoxide dismutase (SOD) activities, and antioxidant potential (AOP) values in the vitamin B6-deficient group were significantly lower than those of the control group, whereas glutathione peroxidase (GSH-Px), glutathione reductase (GRD), glutathione-S-transferase (GST) activities, and malondialdehyde (MDA) level were significantly higher than those of the control group (p < 0.05). Discussion: The results show that vitamin B6 deficiency causes an attenuation in antioxidant defense system and an increase in oxidative stress in kidney tissue of rats.

Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest.

UNLABELLED The purpose of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained non-expert sonographers integrated into the advanced cardiac life support (ACLS). MATERIAL AND METHODS This study was prospectively performed in 179 patients (104 males and 75 females) who underwent cardiopulmonary resuscitation (CPR) in an emergency department (ED) during two calendar years (2013 and 2014). Two senior doctors, who had received emergency cardiac ultrasonography training, performed cardiac ultrasound through the apical, subxiphoid, or parasternal windows. Ultrasound evaluation and pulse controls were performed simultaneously. SPSS 18.0 was used for statistical analysis. RESULTS A total of 63.7% (114) of the cardiopulmonary arrest incidents occurred out of the hospital. Only 13 patients had a femoral pulse during the initial evaluation, while 166 showed no femoral pulse. Initial monitoring showed a regular rhythm in 53 patients, ventricular fibrillation in 18 patients, and no rhythms in 108 patients. The first evaluation with ultrasound detected an effective heart rate in 26 patients and ventricular fibrillation in 14 patients, while no effective heart rate was observed in 139 patients. In addition, ultrasound revealed pericardial tamponade in seven patients and right ventricular enlargement in four cases. Global hypokinesia was detected in four patients and hypovolemia was observed in another four patients. CONCLUSION The use of real-time ultrasonography during resuscitation with real-time femoral pulse check can help facilitate the distinguishing of pea-type arrest, ascertain the cause of the arrest, infer a suitable treatment, and optimize medical management decisions regarding CPR termination.

Relationship between renal stone formation, mitral annular calcification and bone resorption markers.

Background and Objectives : Mitral annular calcification (MAC) is associated with osteoporosis and there is evidence of reduced bone mineral density (BMD) in patients with renal stone formation (RSF). Therefore, we designed this study to test if RSF was associated with MAC and if this association could be linked to bone resorption. Methods : Fifty-nine patients (mean age, 41.5 years) with RSF and 40 healthy subjects (mean age, 44.2 years) underwent screening for MAC and BMD, and measuurements were taken of serum and urine electrolytes, parathyroid hormone, alkaline phosphatase and urine dypyridoline. Results : MAC was diagnosed in 11 (18%) patients with RSF compared with 1 (2.5%) control (P=.01). Urine phosphorus, magnesium, sodium, potassium and chloride levels were lower (P < .001, P=.02, P < .001, P < .001 and P < .001, respectively), but serum alkaline phosphatase, calcium and potassium levels were higher (P=.008, P=.007 and P=.001, respectively) in patients with RSF versus those without RSF. None of these abnormalities were found in patients or subjects with MAC. Urine pyridoline levels were higher and T-scores were more negative (more osteopenic) in patients and subjects with MAC than in those without MAC (P=.01 and P=.004, respectively). In a multivariate analysis, only T-scores and urine dipyridoline level were predictive of MAC (P=.03 and P=.04, respectively). Conclusions : Screening for MAC and bone resorption markers in patients with RSF demonstrated a high incidence of MAC in these patients. The presence of MAC in patients with RSF was associated with bone resorption markers. This seemingly complex interrelationship between RSF, MAC and bone loss needs to be clarified in further studies.

Patient and relative complaints in a hospital emergency department: a 4-year analysis

Bulgular Sonuclar, dort yilda tibbi bakim, personel tutumu, bekleme suresi ve mali sebeplerle ilgili acil servise karsi yapilmis 54 sikâyetin oldugunu ortaya cikardi. Şikâyetcilerin, %75.9’u (n=41) erkek, %24.1’i (n=13) kadindi. Şikâyetlerin buyuk bir kismi (%29.7-%20.4) tibbi bakim ve davranis problemlerine bagliydi. Cogu sikâyet yesil kodlu hastalar icin yapilmisti (%55.6). Şikâyetlerin cogu acil doktorlari hakkindaydi (%38.9). Şikâyet sikligi; her 1.000 basvuruya 0.18 idi.

An assessment of oxidant/antioxidant status in patients with snake envenomation

Objective The aim of this study is to investigate the antioxidant status (TAS), oxidant status (TOS) and oxidative stress index (OSI) in patients with snake envenomation and to learn more about the pathophysiology of snake envenomation. Method Between May 2009 and October 2010, 47 patients were admitted to our emergency department with snake bites, and as a control group 20 healthy volunteers were enrolled in this study. Serum, plasma, and erythrocyte components were prepared for all patients on admission and at the control after 1 month. Serum TOS/TAS levels were measured. Results No correlation was observed among age, gender and the levels of TAS, TOS and OSI. TAS, TOS and OSI levels were higher in snake envenomation patients upon arrival at the emergency department than in the healthy control group. Upon admission, all levels of patients with snake envenomation were higher than the control levels taken after 1 month. Conclusions Serum TAS, TOS and OSI levels increase in snake envenomation patients. The results obtained in this study indicate that the snake bite was associated with a shift to an oxidative state, and oxidative stress plays an important role in the pathophysiology of snake envenomation.