A Comparison of the Effects of Dexamethasone and Methylprednisolone, Used on Level-3Intensive Care COVID-19 Patients, on Mortality: A Multi-Center Retrospective Study

Background@#Coronavirus disease 2019 (COVID-19) is often a mild disease, usually manifesting with respiratory complaints, and is sometimes mortal due to multiple organ failure. Hyperinflammation is a known COVID-19 component and is associated with organ dysfunction, disease severity and mortality. Controlling hyperinflammatory response is crucial in determining treatment direction. An important agent in providing this control is corticosteroids. This study aimed to determine whether dexamethasone and methylprednisolone, doses, administration time and duration in COVID-19 treatment are associated with improved treatment outcomes. @*Methods@#This retrospective multicenter study was conducted with participation of 6 healthcare centers which collected data by retrospectively examining files of 1,340 patients admitted to intensive care unit due to COVID-19 between March 2020 and September 2021, diagnosed with polymerase chain reaction (+) and/or clinically and radiologically. @*Results@#Mortality in the pulse methylprednisolone group was statistically significantly higher than that in the other 3 groups. Mortality was higher in older patients with comorbidities such as hypertension, diabetes mellitus, chronic kidney failure, coronary artery disease, and dementia. Pulse and mini-pulse steroid doses were less effective than standard methylprednisolone and dexamethasone doses, pulse steroid doses being associated with high mortality. Standard-dose methylprednisolone and dexamethasone led to similar effects, but standard dose methylprednisolone was more effective in severe patients who required mechanical ventilation (MV). Infection development was related to steroid treatment duration, not cumulative steroid dose. @*Conclusion@#Corticosteroids are shown to be beneficial in critical COVID-19, but the role of early corticosteroids in mild COVID-19 patients remains unclear. The anti-inflammatory effects of corticosteroids may have a positive effect by reducing mortality in severe COVID-19 patients. Although dexamethasone was first used for this purpose, methylprednisolone was found to be as effective at standard doses. Methylprednisolone administered at standard doses was associated with greater PaO 2 /FiO 2 ratios than dexamethasone, especially in the severe group requiring MV. High dose pulse steroid doses are closely associated with mortality and standard methylprednisolone dose is recommended.

Decellularization of Trachea With Combined Techniques for Tissue-Engineered Trachea Transplantation

OBJECTIVES: The purpose of this study is to shorten the decellularization time of trachea by using combination of physical, chemical, and enzymatic techniques. METHODS: Approximately 3.5-cm-long tracheal segments from 42 New Zealand rabbits (3.5±0.5 kg) were separated into seven groups according to decellularization protocols. After decellularization, cellular regions, matrix and strength and endurance of the scaffold were followed up. RESULTS: DNA content in all groups was measured under 50 ng/mg and there was no significant difference for the glycosaminoglycan content between group 3 (lyophilization+deoxycholic acid+de-oxyribonuclease method) and control group (P=0.46). None of the decellularized groups was different than the normal trachea in tensile stress values (P>0.05). Glucose consumption and lactic acid levels measured from supernatants of all decellularized groups were close to group with cells only (76 mg/dL and 53 mg/L). CONCLUSION: Using combination methods may reduce exposure to chemicals, prevent the excessive influence of the matrix, and shorten the decellularization time.

Can Propofol Lead to an Increase in Seizure Threshold Over the Course of Electroconvulsive Therapy?

OBJECTIVE: To evaluate the effects of 2 different dose regimens of propofol (low dose: 25 sn) during the course of ECT in higher propofol doses. Although there was an increase in the seizure threshold over the course of ECT in both groups, this increase was found to be much more pronounced in the high-dose propofol group according to the low-dose propofol group. Longer duration of seizures was observed in the low-dose propofol group. CONCLUSION: Higher doses of propofol in induction of anesthesia can lead to a more progressive rise in seizure threshold than lower doses of propofol.

Metabolic syndrome is associated with atrial electrical and mechanical dysfunction

In this study, we aimed to investigate the left atrial [LA] electrical and mechanical functions in patients with metabolic syndrome [MetS]. Subjects and The study population consisted of 87 patients with MetS and 67 controls. Intra-atrial and interatrial electromechanical delays [EDs] were measured with tissue Doppler imaging. P-wave dispersion [Pd] was calculated from the 12-lead electrocardiograms. LA volumes were measured echocardiographically by the biplane area-length method. Intra-atrial and interatrial EDs and Pd were significantly higher in patients with MetS [10.3 +/- 6.3, 21.0 +/- 11.5 and 41.7 +/- 10.8] than in controls [7.4 +/- 5.5, 12.3 +/- 10.4 and 29.2 +/- 7.4; p = 0.003, p < 0.001 and p < 0.001, respectively]. The LA preatrial contraction volume and active emptying volumes were higher in this population, but the LA passive emptying fraction was lower. In the multivariate linear regression analysis, the presence of MetS, LA active emptying volume and left ventricular early diastolic [E] wave velocity/late diastolic [A] wave velocity [E/A] ratios were independent correlates of interatrial ED [p = 0.002, p = 0.001 and p = 0.025, respectively]. This study showed that intra-atrial and interatrial EDs and Pd were prolonged and LA mechanical functions were impaired in patients with MetS

Peritoneal encapsulation in a patient with incomplete situs inversus

Peritoneal encapsulation [PE] is an extremely rare congenital condition in which there is abnormal return of the midgut loop to the abdominal cavity in the early stages of development. It may be present in patients with congenital anomalies like incomplete situs inversus. Pre-operative diagnosis is possible with abdominal CT. A 71-year-old man with incomplete situs inversus was admitted to emergency department with symptoms and signs of peritonitis. Computed tomography [CT] of the abdomen showed characteristic features of the PE syndrome. He had exploratory laparotomy performed and arterial occlusion caused ileocaecal ischaemia and PE was observed. Capsule of PE and ileocaecal excision was done. Postoperative recovery was uneventful

Biological and histopathological investigations of moclobemide on injured ovarian tissue following induction of ischemia-reperfusion in rats

The effects of moclobemide on damaged ovarian tissue induced by is-chemia-reperfusion and damaged contralateral ovarian tissue were investigated in rats, biochemically and histologically. In this experimental study, 40 rats were equally divided into four groups: 10 mg/kg moclobemide, 20 mg/kg moclobemide, ischemia/reperfusion control, and intact control groups. A 2-2.5-cm-long vertical incision was made in the lower abdomen of each rat in order to reach the ovaries, after which a vascular clip was placed on the lower side of the right ovary of each animal in the two treatment groups and the ischemia-reperfusion control group, but not in the healthy [intact control] animal group. The purpose of this procedure was to create ischemia over the course of three hours, then the clips were unclamped to provide reperfusion for the next two hours. At the end of the two hours of reperfusion, all the animals were killed by high-dose anaesthesia and their ovaries were taken and subjected to histological and biochemical [malondialdehyde, nitric oxide, glutathione] studies. The obtained results showed that moclobemide suppressed nitric oxide and malondialdehyde production in the ischemia - reperfusion damage area, and prevented the decrease in endogenous antioxidant levels [glutathione] in the rat ovarian tissue. Moclobemide also prevented infiltration of leukocytes to the ovarian tissue. These results showed that moclobemide protected ovarian tissue against ischemia-reperfusion injury. This study shows that moclobemide represses malondialdehyde and nitric oxide production in the rat ovarian tissue subjected to ischemia-reperfusion injury and keeps the endogenous antioxidant glutathione level from decreasing. Moclobemide also inhibits leukocytic migration into ovarian tissue following ischemia-reperfusion injury. From these results, it is suggested that moclobemide can be used in the treatment of ovarian ischemia-reperfusion injury

gallstone impacting to stomach wall imitating a gastric tumour

Authors describe a case of 78 years old female who presented with the right upper abdominal pain. Ultrasonography showed a gallstone. The patient underwent laparascopic cholecystectomy. The laparoscopic procedure was converted to laparotomy because the adhesions between gallblader and stomach could not be dissected on the correct plane. A gallstone impacted to the stomach antrum wall was observed during dissection. When dense adhesions are noted between the gallbladder and stomach during a routine laparascopic cholecystectomy, one should consider an impacted gallstone on the gastric wall via a cholecystogastric connection

Intravenous regional analgesia in a patient with Glanzmann thrombastenia

Glanzmann thirombastenia [GT] is a rare condition of an inherited autosomal recessive gene characterized with bleeding tendency. The condition is rarely met in the OR and therefore it is essential that anesthesiologist be cognizant of the risk involved and be prepared with all necessary precautionary measures. We present a GT case in a 27 year old male with a mass in the anticubital region of right wrist that was successfully excised using the non-invasive intravenous regional analgesia [IVRA]. The use of platelet transfusion and the recombinant factor VIIa, are stressed