Evren Buyukfirat

Thymoquinone protects end organs from abdominal aorta ischemia/reperfusion injury in a rat model

Introduction Previous studies have demonstrated that thymoquinone has protective effects against ischemia reperfusion injury to various organs like lungs, kidneys and liver in different experimental models. Objective We aimed to determine whether thymoquinone has favorable effects on lung, renal, heart tissues and oxidative stress in abdominal aorta ischemia-reperfusion injury. Methods Thirty rats were divided into three groups as sham (n=10), control (n=10) and thymoquinone (TQ) treatment group (n=10). Control and TQ-treatment groups underwent abdominal aorta ischemia for 45 minutes followed by a 120-min period of reperfusion. In the TQ-treatment group, thymoquinone was given 5 minutes. before reperfusion at a dose of 20 mg/kg via an intraperitoneal route. Total antioxidant capacity, total oxidative status (TOS), and oxidative stress index (OSI) in blood serum were measured and lung, kidney, and heart tissue histopathology were evaluated with light microscopy. Results Total oxidative status and oxidative stress index activity in blood samples were statistically higher in the control group compared to the sham and TQ-treatment groups (P<0.001 for TOS and OSI). Control group injury scores were statistically higher compared to sham and TQ-treatment groups (P<0.001 for all comparisons). Conclusion Thymoquinone administered intraperitoneally was effective in reducing oxidative stress and histopathologic injury in an acute abdominal aorta ischemia-reperfusion rat model.

Curcumin and dexmedetomidine prevents oxidative stress and renal injury in hind limb ischemia/reperfusion injury in a rat model

Abstract Curcumin and dexmedetomidine have been shown to have protective effects in ischemia–reperfusion injury on various organs. However, their protective effects on kidney tissue against ischemia–reperfusion injury remain unclear. We aimed to determine whether curcumin or dexmedetomidine prevents renal tissue from injury that was induced by hind limb ischemia–reperfusion in rats. Fifty rats were divided into five groups: sham, control, curcumin (CUR) group (200 mg/kg curcumin, n = 10), dexmedetomidine (DEX) group (25 μg/kg dexmedetomidine, n = 10), and curcumin–dexmedetomidine (CUR–DEX) group (200 mg/kg curcumin and 25 μg/kg dexmedetomidine). Curcumin and dexmedetomidine were administered intraperitoneally immediately after the end of 4 h ischemia, just 5 min before reperfusion. The extremity re-perfused for 2 h and then blood samples were taken and total antioxidant capacity (TAC), total oxidative status (TOS) levels, and oxidative stress index (OSI) were measured, and renal tissue samples were histopathologically examined. The TAC activity levels in blood samples were significantly lower in the control than the other groups (p < 0.01 for all comparisons). The TOS activity levels in blood samples were significantly higher in Control group and than the other groups (p <  0.01 for all comparison). The OSI were found to be significantly increased in the control group compared to others groups (p < 0.001 for all comparisons). Histopathological examination revealed less severe lesions in the sham, CUR, DEX, and CUR–DEX groups, compared with the control group (p < 0.01). Rat hind limb ischemia–reperfusion causes histopathological changes in the kidneys. Curcumin and dexmedetomidine administered intraperitoneally was effective in reducing oxidative stress and renal histopathologic injury in an acute hind limb I/R rat model.

Supplemental oxygen in elective cesarean section under spinal anesthesia: Handle the sword with care.

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1(st) and 5(th) minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Acute Respiratory and Renal Failure due to Hypermagnesemia, Induced by Counter Laxatives in an Elderly Man.

Sir, Increased serum magnesium levels are generally iatrogenic and rare clinical situations with significant cardiovascular, neurological and neuromuscular effects. Patients with bowel disorders, renal insufficiency, and patients with old age are especially at high risk for hypermagnesemia. The treatment of hypermagnesemia includes discontinuing the magnesium intake, gastrointestinal decontamination, intravenous calcium gluconate and hemodialysis [1]. Herein, we report a life threating hypermagnesemia situation induced by a magnesium containing product, used for the treatment of chronic constipation. A 70-year-old man presented with constipation, chest tightness and dyspnea. He had a history of chronic obstructive pulmonary disease, chronic kidney failure and diabetes mellitus. Contrast enema was planned on the first hospital day. The patient became lethargic in the second day of hospitalization. Abdominal pain with diminished bowel sounds was observed. The neurological examination showed symmetric decrease in muscle tone and in deep tendon reflexes. Mechanical ventilation was initiated according to arterial blood gas results. Biochemical results were as follows; magnesium, 9.07 (1.5–2.6) mEq/L; calcium, 7.78 (8.4–10.2) mEq/L, sodium, 140 (135–145) mEq/L; potassium, 5.5 (3.5–5.1) mEq/L; creatine, 3.85 (0.2–1.2) mg/dL; blood urine nitrogen, 202.5 (70–105) mg/dL. Calcium gluconate was infused for antagonizing most of the clinical effects of toxicity. A nasogastric and rectal tube were inserted for gastrointestinal decontamination. Emergency continuous veno-venous haemodialysis (CVVHD) for hypermagnesemia was performed and continued during 48 hours. Finally, after a 48 hour CVVHD treatment, the Mg level decreased to 2.0 mEq/L) and the patient was extubated. The follow up period was uneventful. Magnesium is an important intracellular cation that functions as a co-factor in several enzyme pathways. The magnesium plasma value is generally between 1.4 and 2.1 mEq/L and closely regulated through interaction of the gastrointestinal absorption, bone store and kidney excretion [2]. Hypermagnesemia can occur with various processes such as renal failure, Addison disease, milk alkali syndrome, hypothyroidism and with lithium therapy. Decreased elimination, magnesium overdose and increased absorption are the main causes of hypermagnesemia. Our patient had both decreased elimination as a consequence of kidney failure and magnesium overdose due to laxative usage [3]. Clinical manifestations of hypermagnesemia vary according to the serum Mg concentration. Symptomatic hypermagnesemia typically presents with neurological, neuromuscular and cardiac manifestations including hyporeflexia, sedation, muscle weakness and respiratory depression but many physicians are relatively unfamiliar with these conditions [4]. Especially elder patients are at high risk of magnesium toxicity as the kidney function declines with age [5]. Relationship between hypermagnesemia and laxative usage should induce physicians to pay more attention to hypermagnesemia especially in this subgroup of patients and urgent CVVHD is highly effective in preventing significant morbidity and mortality.

Percutaneous nephrolithotomy with different temperature irrigation and effects on surgical complications and anesthesiology applications

OBJECTIVE Percutaneous nephrolithotomy (PCNL) is a widely accepted and frequently performed operation for large kidney stones. However, there is not much information about the effects of irrigation fluid temperature as well as many other factors that affect success and complications during the operation. In this study, we aimed to investigate the surgical and anesthesiological effects of irrigation fluid used in body temperature and room temperature during and after PCNL. MATERIAL AND METHODS A total of 108 PCNL patients were performed between June 2016 and April 2018. The half of these patients (54) were performed with body temperature (37°C) irrigation fluid, hence known as body temperature group (BTG), and the other half with room temperature (22°C) irrigation fluid, called as room temperature group (RTG). For the study, we recorded the body temperature of the patients during and after the operation, the amount of irrigation fluid used, the size and location of the kidney stones, the duration of the operation, postoperative shivering time during the patients wake-up period, pre- and postoperative hemoglobin value, additional blood requirements, postoperative analgesic requirements, and postoperative urinary tract infections. RESULTS The age of patients, gender distribution, height, weight, body mass index, stone size, and postoperative analgesic requirement showed no significant differences in two groups. The postoperative body heat was significantly higher in the BTG than the RTG. The duration of waking was significantly higher in the RTG than the BTG. The amount of hemorrhage was significantly less in the patients who were irrigated in the RTG. CONCLUSION The temperature of the irrigation fluid can affect many parameters in the PCNL. We recommend using irrigation in room temperature especially with patients having bleeding risks and irrigation fluid in body temperature especially with patients having anesthetic risks for easier waking process.