Nurzen Sezgin

Protective effect of melatonin on random pattern skin flap necrosis in pinealectomized rat

Abstract: Random pattern skin flaps are still widely used in plastic surgery. However, necrosis in the distal portion resulting from ischemia is a serious problem, increasing the cost of treatment and hospitalization. Free oxygen radicals and increased neutrophil accumulation play an important role in tissue injury and may lead to partial or complete flap necrosis. To enhance skin flap viability, a variety of pharmacological agents have been intensively investigated. The aim of this study is to test the effects of melatonin, the chief secretory product of the pineal gland and a highly effective antioxidant, on random pattern skin flap survival in rats. Herein, to investigate the physiological and pharmacological role of melatonin on dorsal skin flap survival. Pharmacological (0.4, 4 and 40 mg/kg) levels of melatonin were given intraperitoneally (i.p.). For this, pinealectomized (Px) and sham operated (non‐Px) rats were used. The effects of melatonin on levels of malondialdehyde (MDA), nitric oxide (NO), glutathione (GSH) and the activities of glutathione peroxidase (GSH‐Px) and superoxide dismutase (SOD) were measured in the skin flap. The ratio of skin flap necrosis was compared among the experimental groups by using planimetry. MDA and NO levels were found to be higher in Px than non‐Px rats; while GSH levels and GSH‐Px, and SOD activities were reduced. Melatonin administration to Px rats reduced MDA and NO levels and increased GSH, GSH‐Px, SOD levels. Melatonin also reduced the ratio of flap necrosis determined by using planimetry and supported through the photography. In conclusion, these results show that both physiological and pharmacological concentrations of melatonin improve skin flap viability.

Increased High Sensitive CRP Level and Its Significance in Pathogenesis of Slow Coronary Flow

Previous studies have suggested that microvascular abnormalities cause slow coronary flow (SCF). The role of inflammation has not been investigated, to date. The purpose of this study was to determine the role of inflammation in pathogenesis of SCF. The study included 32 patients with angiographically proven SCF (mean age 49 ±9 years) (group I) and 30 subjects with normal coronary flow (mean age 48 ±8 years) (group II). Blood samples were collected for high sensitive CRP (hs-CRP) measurements. Thrombolysis in myocardial infarction frame count (TFC) was compared in both groups. Distribution of sex, age, body mass index (BMI), arterial blood pressure, and ejection fraction were similar in the 2 groups. TFC was significantly higher in group I than in group II for each artery including left anterior descending coronary artery (LAD), left circumflex artery (Cx), and right coronary artery (RCA) (38.9 ±6.6 vs 22.1 ±1.8 frames, p = 0.0001; 39.6 ±4.9 vs 22.3 ±1.8 frames, p = 0.001 ; 39.0 ±3.8 vs 22.0 ±1.8 frames, p = 0.001, respectively). In group I, serum hs-CRP concentration was significantly higher than that of group II (0.6 ±0.58 vs 0.24 ±0.1 mg/dL p = 0.03). Correlation analysis showed a positive correlation between hs-CRP level and TFC for each artery (for CTFCLAD, r = 0.36 p = 0.004; for TFCCx, r = 0.42 p = 0.003; and for TFCRCA, r = 0.42, p = 0.0001 respectively). Increased hs-CRP level suggests that inflammation may be associated with pathogenesis of SCF or at least in part contributes to its pathogenesis. Increased hs-CRP level may also be an early marker of impaired coronary blood flow.

Is low blood magnesium level associated with hemodialysis headache

Objective.—The aim of this study was to evaluate the prevalence, demographic, clinical features, and possible risk factors for hemodialysis headache (HDH).

Efficacy of allopurinol pretreatment for prevention of contrast-induced nephropathy: a randomized controlled trial

BACKGROUND Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Radiocontrast agents can cause a reduction in renal function that may be due to reactive oxygen species. Conflicting evidence suggests that administration of antioxidants prevents CIN. METHODS We assessed the efficacy of allopurinol in preventing CIN. We prospectively randomized 159 patients with a serum creatinine concentration >1.1mg/dL undergoing cardiac catheterization/interventions to receive allopurinol (300 mg, p.o.) 24h before administration of radiocontrast agent and hydration (1mg/kg/hN/saline for 12h pre- and post-contrast, n=79), or hydration alone (1mg/kg/hN/saline for 12h pre- and post-contrast, n=80). RESULTS CIN occurred in 6 of 80 patients (7.5%) in the control group and no subjects in the allopurinol group (p=0.013). In the allopurinol group, median serum creatinine concentration decreased significantly from 1.43 mg/dL [1.1-4.15 mg/dL] to 1.35 mg/dL [0.7-4.15 mg/dl] at 48 h and to 1.27 mg/dL [0.66-4.37 mg/dL] at 4 days after radiocontrast administration (p<0.0001 and p<0.0001 compared with baseline, respectively). In the control group, median serum creatinine concentration decreased non-significantly from 1.48 mg/dL [1.1-2.96 mg/dL] to 1.43 mg/dL [0.73-3.02 mg/dL] and to 1.45 mg/dL [0.86-3.71 mg/dL] (p=0.045 and p=0.57, respectively) 48 h and 4 days after radiocontrast administration. CONCLUSIONS Prophylactic oral administration of allopurinol, along with hydration, may protect against CIN in high-risk patients undergoing coronary procedures.

Elevated plasma homocysteine levels in gestational diabetes mellitus

Objective.  This prospective study investigated the occurrence of hyperhomocysteinemia in a population of patients with gestational diabetes. The aim was to determine whether elevated plasma homocysteine is associated with gestational diabetes in Turkish women.

Bone loss during the acute stage following burn injury.

The aim of this study was to investigate the effect of burn injury on bone metabolism and bone densitometry in the early period. Twenty-one patients with >25% total body surface area (TBSA) burns and 20 healthy controls participated. TBSA burned, ambulation, and functional status were recorded. After 30 days, we measured bone mineral densities of the L1–L4 vertebrae, the left distal forearm, and the left proximal femur in the patients. At 1 and 4 weeks after the burn, changes in bone turnover were assessed in patients by changes in deoxypyridinoline levels in the urine and osteocalcin in the serum and compared with the values of control group. In patients, Z-scores < −1 were found in 71.42% of left distal forearm, 23.80% of left proximal femur, and in 42.85% of L1–L4 vertebrae measurements. No significant correlations existed between Z-scores and TBSA, Functional Ambulation Scale, or Functional Independent Measure. When compared with controls, there was no statistically significant decrease of osteocalcin (a marker of bone formation) levels in patients 1 and 4 weeks after burn injury. However, when compared with controls, a statistically significant difference was found regarding deoxypyridinoline (a marker for bone resorption) in patients 1 and 4 weeks after burn injury (P < .001 and P < .001, respectively). Decreases in bone mineral density occurred during the first month following burn injury, which seemed to be linked with increases in bone resorption during this period. No correlation existed between reduction in bone mineral density and functional status.

Effect of caffeic acid phenethyl ester on survival of axial pattern flaps in rats with ischaemia–reperfusion injuries

Oxygen–derived free radicals have been implicated in the pathogenesis of tissue injury after ischaemia–reperfusion. Caffeic acid phenethyl ester (CAPE), an active ingredient of honeybee propolis, has been identified as having potent antioxidant and anti-inflammatory properties. We evaluated the ability of CAPE applied intraperitoneally in reducing tissue injury after ischaemia–reperfusion. To investigate whether treatment with CAPE modifies the concentrations of the endogenous indices of oxidant stress, we examined its effects on a model of flap ischaemia–reperfusion injury in rats. CAPE (10 µmol/kg) was given through the peritoneum before reperfusion. CAPE given intraperitoneally had an inhibitory effect on tissue injury after ischaemia–reperfusion comparable to that of a control group. The anti-inflammatory and antioxidant properties of CAPE may contribute to its suppression of tissue injury.

Relation of serum cortisol to delirium occurring after acute coronary syndromes

BACKGROUND Delirium can be associated with cardiac system disorders. Stress plays an important role in the pathogenesis of postoperative delirium. Cortisol is one of the most important stress hormones in humans. We aimed to investigate whether a relation exists between serum cortisol and the degree of delirium after acute coronary syndromes (ACS). METHODS We enrolled 52 consecutive patients who presented with ACS and were hospitalized in the coronary care unit. Patients were examined daily by a single psychiatrist, and delirium was diagnosed by using the Delirium Rating Scale (DSR). Blood samples were obtained at 6:00 am of the next morning after admission. RESULTS The mean age was 66 years (SD, ±6 years), and 52% were men. Delirium occurred in 25 patients (48%). The median score on the DRS was 17 for the delirious patients and 5 for the nondelirious. Median cortisol levels were significantly different between the delirium and nondelirium groups (13.9 vs 6.2 μg/dL; P < .01). There were significant correlations between the cortisol levels and the severity of the delirium based on DRS scores as well as between the cortisol levels and the presence of delirium (r = 0.65 and 0.74, respectively; P = .01). In a linear logistic regression model, cortisol predicted the occurrence of delirium (β = .81; P < .01). In receiver operating characteristics analysis, the optimal cutoff value of cortisol to predict delirium was 10.8 μg/dL, with 96% sensitivity and 89% specificity. CONCLUSION Delirium was common after ACS, and serum cortisol levels correlated with the degree of delirium and the risk of delirium.

Are amniotic fluid C-reactive protein and glucose levels, and white blood cell counts at the time of genetic amniocentesis related with preterm delivery?

Abstract Objective: To compare women with spontaneous preterm delivery before 37 weeks and women who delivered at term with respect to amniotic fluid C-reactive protein (CRP), glucose levels, and white blood cell counts at the time of genetic amniocentesis. Study design: The study was conducted on 216 pregnant women who underwent genetic amniocentesis between the 15th and 18th weeks of gestation at Baskent University Obstetrics and Gynecology Department. All patients were followed until delivery for the occurrence of pregnancy complication. Indications for amniocentesis included abnormal triple test results showing increased risk for Downs syndrome, advanced maternal age and sonographic findings indicative for chromosomal abnormalities. The samples were carried immediately to the laboratory for cytogenetic and biochemical examination. Women with spontaneous preterm delivery before 37 weeks (n=20) and those who delivered at term (n=196) were compared with respect to some maternal and infant characteristics, amniotic fluid C-reactive protein, glucose levels, and amniotic fluid white blood cell counts. Results: During the study period 244 patients underwent amniocentesis. A chromosomal abnormality was present in 11 patients. 1 patient had a spontaneous pregnancy loss within 3 weeks after the procedure and 16 patients were delivered for fetal or maternal indications (preeclampsia, fetal growth restriction, placenta previa). The remaining 216 women were included in the study and investigated for the risk of preterm delivery. The prevalence of spontaneous preterm delivery before 37 weeks was 9.3% (20/216). There were no significant differences between the preterm delivery and the term delivery groups with respect to C-reactive protein levels and white blood cell counts. Mean amniotic glucose levels were significantly lower in the preterm delivery group (P<0.05). Amniotic fluid glucose levels of ≤46 mg/dL had a sensitivity of 100% and NPV of 100%. Conclusion: Amniotic fluid glucose levels at the time of genetic amniocentesis are lower in women with spontaneous preterm delivery before 37 weeks compared to those who delivered at term. Amniotic fluid glucose levels of ≤46 mg/dL at the time of genetic amniocentesis may be more sensitive, cheaper and have higher negative predictive value than C-reactive protein levels and white blood cell counts for the prediction of patients in spontaneous preterm labor. The greatest benefit of amniotic fluid glucose testing might be when the physician judges the patient to be at low risk for preterm delivery.

Impact of early versus late enteral nutrition on cell mediated immunity and its relationship with glucagon like peptide-1 in intensive care unit patients: a prospective study

IntroductionGlucagon-like peptide-1 (GLP-1) originates from the gastrointestinal system in response to the presence of nutrition in the intestinal lumen and potentiates postprandial insulin secretion. Also, it acts as an immune-modulator which has influences on cell-mediated immunity.The aim of this study was to determine the impact of early enteral nutrition versus late enteral nutrition on plasma GLP-1 levels and the relationship between GLP-1 changes and cell-mediated immunity.Materials and methodsThe study was designed as a prospective, single-blinded study and carried out in the neurology intensive care unit (ICU) of a university hospital. Twenty-four naive patients with acute thromboembolic cerebrovascular events, with National Institute of Health (NIH) stroke scores between 12 and 16, were included. Any condition interfering with GLP-1 and immunity was regarded as exclusion criterion. Two patients died, and two dropped out of the study due to complicating conditions.Patients were randomly subjected to early enteral feeding within the first 24 hours (Group 1), or late enteral feeding, beginning 48 hours after admission (Group 2) via a nasogastric tube. Calculated daily energy requirement was supplemented with parenteral nutrition, starting on the first study day for both groups. Blood samples were obtained before, and at 5, 15, 30, 60 and 120 minutes after the first enteral feeding for GLP-1 assays; this procedure was repeated on the third day. Before and 24 hours after the first enteral feeding, samples were also taken for immunological analysis. Clinical observations were recorded.Pre- and post-feeding plasma GLP-1 changes between the two groups and within groups were evaluated. Lymphocyte subgroup changes before and 24 hours after the first enteral feeding in relation to GLP-1 changes were sought as well.ResultsGroup 1 and Group 2 exhibited similar GLP-1 levels in the pre-feeding and post-feeding periods for both the first time and the third day of enteral feeding. Also, no significant change in pre-/post-feeding GLP-1 levels was observed within groups. T-helper and T-regulatory cells increased, T-cytotoxic cells decreased significantly in Group 1 (P = 0.02; P = 0.036; P = 0.0019), but remained the same in Group 2 after enteral feeding. Positive but statistically insignificant clinical effects in terms of predisposition to infections (10% vs 40%) and median time of ICU stay (10 vs 15 days) were observed in Group 1.ConclusionsDepending on our findings, we propose that early enteral feeding may cause amelioration in cell-mediated immunity via factors other than GLP-1 in ICU patients with acute thromboembolic stroke. However, the possible deleterious effects of parenteral nutrition cannot be ruled out.