Yusuf Akcan

The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study

The aim of the present prospective, randomized study was to investigate and compare the safety and efficacy of dexmedetomidine versus midazolam in providing sedation for gastroscopy. A total of 50 adult patients (25 patients receiving dexmedetomidine and 25 patients receiving midazolam), 18 to 60 years of age, and rated I and II on the American Society of Anesthesiologists physical status classification system were included. A brief questionnaire was used to collect demographic data; patients were asked to rate anxiety, satisfaction with care to date and expected discomfort on a visual analogue scale. The following parameters were measured continuously and recorded every minute: heart rate, mean arterial pressure, hemoglobin oxygen saturation and respiratory rate. The two groups were similar with regard to age, body mass index, sex, education, duration of endoscopy, and ethanol or tobacco use. After the procedure, full recovery time, mean arterial pressure, heart rate, respiratory rate and hemoglobin oxygen saturation levels were similar in both groups. Both groups also had low levels of perceived procedural gagging, discomfort and anxiety scores (P > 0.05), and high satisfaction levels (90.1+/-3.0 for dexmedetomidine versus 84.9+/-4.5 for midazolam; P > 0.05). Retching and endoscopist satisfaction were significantly different in patients receiving dexmedetomidine versus those receiving midazolam (88.8+/-6.5 versus 73.5+/-16.4, P < 0.05; and 20.6+/-4.4 versus 45.2+/-6.0; P < 0.001). In the midazolam group, the number of patients who had adverse effects was higher than the dexmedetomidine group (P < 0.05). As a result, dexmedetomidine performed as effectively and safely as midazolam when used as a sedative in upper gastroscopy; it was superior to midazolam with regard to retching, rate of side effects and endoscopist satisfaction. It was concluded that dexmedetomidine may be a good alternative to midazolam to sedate patients for upper endoscopy.

Evaluation of Risk Factors and Seroprevalence of Hepatitis B and C in Diabetic Patients in Kutahya, Turkey

Aim To assess the prevalence of hepatitis B and C viruses among Turkish patients with type 1 and type 2 diabetes mellitus and to determine the risk factors affecting the prevalence in these patient groups. Methods This study included 630 diabetic and 314 nondiabetic patients. Serologic testing for anti-hepatitis C virus (anti-HCV) and HbsAg was done using a third-generation commercial enzyme-linked immunosorbent assay, and samples positive for anti-HCV and HbsAg were confirmed by a polymerase chain reaction assay. Diabetic patients were classified by HbsAg and anti-HCV status and were evaluated according to demographic features, diabetic characteristics and nondiabetic general risk factors, harmful habits, and aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels. Results HbsAg and anti-HCV seropositivity rates were 5.1% and 3.2% in diabetic patients and were 3.8% and 1.3% in control group, respectively. There was no statistically significant difference between the 2 groups with respect to either marker. Shared risk factors for both hepatitis infections were increased aminotransferase levels and history of hospital admission. In addition, long duration of diabetes mellitus, poor diabetic regulation, and insulin treatment usage were found to relate to HbsAg, whereas a history of blood transfusions and surgical procedures were found to associate with anti-HCV seropositivity. Conclusions We determined that hepatitis B virus and hepatitis C virus infections were slightly but not significantly higher in diabetic patients compared with a normal population. If it is considered that different results might be obtained in various countries or even in various regions of same country, it may be concluded that multicenter and comprehensive studies are needed to elucidate true infection rates and to identify other risk factors affecting the prevalence of these infections.

The transmission of helicobacter pylori via exposure to common sources outweighs the person-to-person contact among spouses in developing countries

evaluated by a self-evaluation scale, from 0 5 nil to 4 5 very good. Statistical testing for significant differences was carried out by Student’st test for between-group comparison and by the Wilcoxon test for within-group comparisons. Results are displayed in Table 1. We observed that both metoclopramide and domperidone similarly decreased the fasting antral area in diabetic gastroparesis ( p , 0.01). Total gastric emptying time was accelerated by domperidone more than by metoclopramide (27% vs 16% shortening of the total gastric emptying time, p , 0.05). Domperidone improved the symptom score more than metoclopramide (evaluation score for symptoms: 2.8 6 1.0vs1.96 0.9,p , 0.05). Both drugs did not influence gastric emptying of healthy controls. No side effects were registered with these doses. We therefore conclude that the effect of domperidone is superior to that of metoclopramide on symptoms of diabetic gastroparesis. This effect is associated with a stronger effect on delayed gastric emptying. Domperidone proved to be superior to metoclopramide also in other conditions, such as chronic dyspepsia (7), pediatric vomiting (9), and nausea and emesis after chemotherapy (9). Because divergent results have been reported with respect to the effectivity of prokinetic drugs in diabetic gastroparesis, a meta-analysis may be welcome, although this will be difficult in view of the largely differing protocols used in the different trials.

Hair Repigmentation in a Hepatitis C Patient Treated with Interferon and Ribavirin

1 Fisher DA, Wright TL: Pruritus as a symptom of hepatitis C. J Am Acad Dermatol 1994; 30: 629–632. 2 Lebovics E, Seif F, Kim D, Elhosseiny A, Dworkin BM, Casellas A, Clark S, Rosenthal W: Pruritus in chronic hepatitis C: Association with high serum bile acids, advanced pathology, and bile duct abnormalities. Dig Dis Sci 1997; 42: 1094–1099. 3 Chia SC, Bergasa NV, Kleiner DE, Goodman Z, Hoofnagle JH, Bisceglie AM: Pruritus as a presenting symptom of chronic hepatitis C. Dig Dis Sci 1998; 43: 2177–2183. 4 Dega H, Frances C, Dupin N: Pruritus and the hepatitis C virus: The MULTIVIRC Unit. Ann Dermatol Vénéréol 1998; 125: 9–12. 5 Cacoub P, Poynard T, Ghillani P, Charlotte F, Olivi M, Piette JC, Opolon P: Extrahepatic manifestations of chronic hepatitis C. Arthritis Rheum 1999; 42: 2204–2212. 6 Cribier B, Santinelli F, Schmitt C, Stoll-Keller F, Grosshans E: Should patients with pruritus be tested for hepatitis C virus infection? A case controlled study. Br J Dermatol 2000; 142: 1249–1250. 7 Paoletti V, Mammarella A, Basili S, Paradiso M, Di Franco M, De Matteis A, Musco A: Prevalence and clinical features of skin diseases in chronic HCV infection: A prospective study in 96 patients. Panminerva Med 2002; 44: 349–352. 8 Kantor GR, Lookingbill DP: Generalized pruritus and systemic disease. J Am Acad Dermatol 1983; 9: 375–382. 9 Cribier B, Samain F, Vetter D, Heid E, Grosshans E: Systemic cutaneous examination in hepatitis C infected patients. Acta Derm Venereol 1998; 78: 355–357. 10 Thomas DL, Mahley RW, Badur S, Palo ğ lu E, Quinn TC: The epidemiology of hepatitis C in Turkey. Infection 1994; 22: 411–414.

Effect of Verapamil Sustained-Release on the Sympathetic Nervous System Response to Isometric Stress in Patients with Essential Hypertension: A Pilot Study in Turkish Patients

Abstract Background: Stress and sympathetic nervous system activation play a major role in the pathogenesis of essential hypertension. Recent data suggest that the calcium channel blocker verapamil, in addition to its antihypertensive effects, can alter the level of norepinephrine released during stress. Objective: The purpose of this study was to examine the effects of verapamil sustained-release (SR) on the sympathetic nervous system response to stress in patients with essential hypertension. Methods: Patients with essential hypertension (diastolic blood pressure > 90 mm Hg and systolic blood pressure > 140 mm Hg) whose blood pressure was inadequately controlled or uncontrolled were enrolled in the study. Secondary hypertension was ruled out by routine biochemical, endocrine, and radiologic tests. After a 15-day washout period during which all previous anti-hypertensive medication was discontinued, blood pressure, heart rate, and serum norepinephrine levels were measured at rest and in response to stress (ie, isometric exercise). Patients began treatment with verapamil SR at dosages recommended in the Sixth Report of the Joint National Committee for the Prevention, Diagnosis, Evaluation, and Treatment of High Blood Pressure (240 mg/d for stage I hypertension and 480 mg/d for stage II and stage III hypertension). After 4 weeks of treatment, blood pressure, heart rate, and norepinephrine levels were measured again at rest and in response to stress. Results: Thirteen patients (9 women and 4 men) were enrolled; 9 patients completed the study. Three patients were lost to follow-up and 1 was noncompliant. Verapamil SR significantly lowered norepinephrine levels both at rest and in response to stress ( P Conclusion: These results suggest that in this small sample of Turkish patients, verapamil SR significantly diminished the sympathetic nervous system response to stress by decreasing norepinephrine levels. This property may make verapamil SR especially useful when there is a need for decreased sympathetic activity (and thereby, a reduction in oxygen consumption) as well as other antihypertensive effects, such as in patients with coronary heart disease.