Comparison of Caudal Block and Sacral Erector Spina Block for Postoperative Analgesia Following Pediatric Circumcision: A Double-Blind, Randomized Controlled Trial.

INTRODUCTION: Caudal block (CB) and erector spina plane block (ESPB) has been shown to provide effective postoperative analgesia following circumcision. Our aim was to compare the analgesic efficacy of sacral ESPB and CB, as well as the time to first analgesic requirement and postoperative complications. METHODS: Patients aged 1-7 years in the ASA I-II group, who were scheduled for circumcision were included in the study. Blocks were performed under general anesthesia before the operation. Postoperative pain was evaluated using the Face, Legs, Activity, Cry and Consolability (FLACC) scores. Analgesic requirements in the first 24 hours postsurgery, the time of first analgesia requirement, and postoperative complications were recorded. RESULTS: A total number of 150 patients were included in the study. In the CB group urinary retention was observed. No side effects were observed in the sacral ESPB group. The 4th and 6th hour postoperative FLACC scores were lower in the ESP group. The number of analgesic consumption in the first 24 hours postsurgery was significantly lower in the ESPB group (p <0.001). CONCLUSION: Based on our results, sacral ESPB performed with ultrasonography is a simple and safe regional anesthesia method that can be used to provide effective postoperative analgesia for circumcision.

Production, characterization and therapeutic efficacy of egg yolk antibodies specific to Nosema ceranae.

Nosema disease, caused by Nosema ceranae, one of the single-celled fungal microsporidian parasites, is one of the most important and common diseases of adult honey bees. Since fumagillin, which has been used for decades in the control of Nosema disease in honey bees (Apis mellifera), poses a toxic threat and its efficacy against N. ceranae is uncertain, there is an urgent need to develop alternative prophylactic and curative strategies for the treatment of this disease. The main aim of this study was to investigate the therapeutic potential of specific egg yolk immunoglobulins (IgY) on Nosema disease. For this purpose, the presence of N. ceranae was determined by microscopic and PCR methods in honey bees collected from Nosema suspicious colonies by conducting a field survey. Layered Ataks chickens, divided into four groups each containing 20 animals, were vaccinated with live and inactivated vaccines prepared from field isolates of N. ceranae. Eggs were collected weekly for 10 weeks following the last vaccination. IgY extraction was performed using the PEG precipitation method from egg yolks collected from each group, and the purity of the antibodies was determined by SDS-PAGE and Western Blot. The presence of N. ceranae-specific IgYs was investigated by Western Blot and indirect ELISA methods. It was determined that specific IgYs showed high therapeutic efficacy on Nosema disease in naturally infected bee colonies. In addition, honey bees collected from infected colonies were brought to the laboratory and placed in cages with 30 bees each, and the effectiveness of IgYs was investigated under controlled conditions. It was detected that specific IgY reduced the Nosema spore load and the number of infected bees significantly in both the field and experimental study groups treated for seven days. It was concluded that chicken IgYs, an innovative and eco-friendly method, had a significant potential for use as an alternative to antifungal drugs.

Exercise Improves Physical Capacity, Cognition, Quality of Life and Promotes Neurotrophic Factors in Patients with Multiple Sclerosis.

Introduction: We aimed to determine the effect of regular exercise on aerobic capacity, strength values, and plasma levels of Nerve Growth Factor (NGF) and Neurotrophin-3 (NT-3) in patients with multiple sclerosis (MS) and investigate its effects on MS symptoms including cognitive impairment, fatigue, balance disorders, and quality of life (QOL). Methods: Forty-three relapsing-remitting MS patients with an Expanded Disability Status Scale (EDSS) score of 4 or less participated in the study. Participants were divided into three groups: aerobic group, strength group, and control group. The patients in the exercise groups had exercise programs three days a week for three months. Aerobic capacity (maximum VO2 value), strength measurements, and balance tests were done, and NGF and NT-3 plasma levels were analyzed in all participants at the beginning and end of the study. Multiple Sclerosis Quality of Life-54 (MSQoL-54), fatigue impact scale, Pittsburgh Sleep Quality Index (PSQI) and, to evaluate cognitive functions, BICAMS scale were applied. Results: Aerobic exercise and strength exercise groups had significant increases in VO2 max, back and leg strength values, and NGF and NT-3 plasma levels (p<0.01). Cognitive functions, fatigue, sleep quality, and QOL significantly improved in the exercise groups (p<0.01). The balance values were also significantly improved in the aerobic group (p<0.01), and althoughimprovement although improvement was observed in the strength group, it was not statistically significant (p>0.05). Conclusions: Our study provides evidence that regular exercise improves quality of life, cognitive functions, fatigue, and sleep quality in MS patients. The levels of NGF and NT-3, which are important factors in neural regeneration and remyelination, were increased post exercise. It can be suggested that exercise may have a potential effect on MS and slow down the disease process with these results.

The modified thoracoabdominal nerve block for post-operative analgesia in paediatric laparoscopic cholecystectomy.

The limited data on post-operative analgesia management after laparoscopic cholecystectomy in the paediatric population make it difficult for clinicians to manage pain in this group. Administration of a modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) has recently been identified as a technique providing effective analgesia on the anterior and lateral thoracoabdominal wall. Unlike thoracoabdominal nerve block through the perichondrial approach block, the local anaesthetic (LA) with M-TAPA block provides effective post-operative analgesia in abdominal surgery by affecting T5-T12 dermatomes, just like when applied to the lower part of the perichondrium. As far as we know, all patients in previous case reports were adults, and we did not come across any study on the effectiveness of M-TAPA in paediatric patients. We present our case who did not need any additional analgesic during the post-operative 24 h after an M-TAPA block was administered before paediatric laparoscopic cholecystectomy.

Knowledge, Attitudes, Practices and Some Characteristic Features of People Recovered from COVID-19 in Turkey.

Background and objectives: The whole world is spending an extraordinary effort by implementing various measures to control and prevent the COVID-19 pandemic. The effectiveness of the preventive measures is greatly influenced by the public's knowledge, attitudes, and practices (KAP) towards the disease. In this study, KAP values and some characteristic features of people recovered from COVID-19 were determined by conducting a questionnaire survey. Materials and Methods: The questionnaire survey was conducted between 1 and 10 January 2021 on people who recovered from COVID-19 in a total of 150 different locations in Turkey. The questionnaire consisted of 46 questions: 14 for determining demographic and some characteristic features of the participants, and 32 for determining their knowledge, attitudes, and practices. The data obtained were evaluated using descriptive statistics, chi-squared tests, t-tests, and one-way analysis of variance (ANOVA). Results: It was determined that 63% of the participants had at least one chronic illness, 3.9% suffered from the disease twice, and 45.2% changed their smoking habits. The average knowledge score of the participants about COVID-19 was calculated as 10.25 (SD = 2.37; range 0-15). The participants were found to have a high level of knowledge about the symptoms and prevention methods in general, and positive changes in post-illness attitudes and behaviors. However, there was a great instability regarding the drugs and vaccines used in the treatment of COVID-19. Conclusions: This was the first study carried out in Turkey to determine knowledge, attitudes, practices, and some characteristic features of people who recovered from COVID-19. It was suggested that health authorities in the country need to develop more effective strategies and policies to find out permanent solutions in order to control and prevent the COVID-19 pandemic by taking into account the concerns of the public, particularly with regards to the drugs used in the treatment and vaccination.

Assessment of Farmers' Knowledge, Attitudes and Practices on Antibiotics and Antimicrobial Resistance.

The aim of this study was to determine knowledge, attitudes, and behaviors of farmers dealing with animal husbandry in eastern Turkey with regard to antibiotic knowledge, use, and resistance. A face to face questionnaire survey, consisting of five sections with 42 questions in total, was applied to 360 farmers located in the region. The questions in the first and fifth sections were closed-ended while those in other sections were prepared using the Likert scale. It was determined that knowledge of the farmers about antibiotic use, duration, storage, and resistance was well below desired levels. This was particularly remarkable in the participants with a low level of education, living in rural areas, and those at 48 years of age or over. In contrast, younger and highly educated participants living in urban areas were more knowledgeable about antibiotic use and they were well aware of the fact that resistance might pose a great risk for public health. Providing appropriate antibiotic use in animals through systematic training of livestock farmers is crucial in tackling the resistance problem.

Acute Kidney Injury After Pediatric Liver Transplantation.

BACKGROUND: The aim of the present study is to assess acute kidney injury (AKI) incidence according to the pRIFLE and AKIN criteria and to evaluate the risk factors for early developing AKI in postoperative intensive care unit after pediatric liver transplantation (LT). MATERIALS: After exclusion of retransplantations, 7 cadaveric and 44 living donors, totaling 51 pediatric LT patients that were performed between 2005 and 2017, were reviewed retrospectively. AKI was defined according to both pediatric RIFLE (Risk for renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal disease) and Acute Kidney Injury Network (AKIN) criteria. Documented data were compared between AKI and non-AKI patients. RESULTS: AKI incidences were 17.6% by AKIN and 37.8% by pRIFLE criteria. AKIN-defined AKI group had statistically lower serum albumin level, higher serum sodium level, higher furosemide dose, and higher rate of red blood cell (RBC) transfusion than the non-AKI group (P = .02, P = .02, P = .01 and P = .04, respectively). AKI patients had significantly prolonged mechanical ventilation (P = .01) and hospital LOS (P = .02). The pRIFLE-defined AKI group had significantly lower serum albumin level, higher blood urea nitrogen (BUN) level, and higher ascites drained and also showed higher requirement for RBC and 20% human albumin transfusions than the non-AKI group (P = .02, P = .04, P: =.007, P = .02 and P = .05, respectively). CONCLUSION: We evaluated that hypoalbuminemia, high requirement for RBC and 20% human albumin transfusions, high serum sodium, high furosemide use, and high flow of ascites are risk factors for AKI and high BUN levels can be predictive for AKI in pediatric LT patients. The effect of AKI on outcome variables were prolonged mechanical ventilation and hospital LOS.

Impact of Cytokine Adsorption Treatment in Liver Failure.

Sepsis causes life-threatening organ dysfunction and is the leading cause of morbidity and mortality in critically ill patients worldwide. Mortality rate of sepsis is close to 30% to 50% despite better understanding of the pathophysiology of sepsis, and advances in antimicrobial therapy, resuscitation strategies, and mechanical ventilation. Liver failure is characterized by accumulation of potentially toxic substances in the systemic circulation of the patient. Toxic effects of these molecules can induce cellular injuries leading to multiorgan dysfunction. Hydrophobic unconjugated bilirubin and bile acids, hydrophilic conjugated bilirubin, and ammonium are the main toxins accumulated in liver failure. We carried out cytokine adsorbtion (CytoSorb) procedure with continuous venovenous hemodialysis in 12-hour sessions. The biochemical values of the patients before and after the use of the filter were recorded. The parameters compared were as follows: total bilirubin, direct bilirubin, C-reactive protein, leukocyte, neutrophil, alanine aminotransferase, aspartate aminotransferase, creatinine, colloid oncotic pressure, ammonia, gamma-glutamyl transferase, alkaline phosphatase, procalcitonin, hematocrit, hemoglobin, pH, albumin, international normalized ratio, fibrinogen, lactate dehydrogenase, platelet, temperature, changes in vasoactive medication requirement, temperature. According to these results, cytokine adsorption systems can be considered as an option to lower bilirubin levels in cases of liver failure. Its inability to lower ammonia level is considered a disadvantage compared with other bilirubin-lowering methods. Although further studies are needed to compare different methods, cytokine adsorption systems may be considered in treatment planning as it contributes to the treatment of sepsis and hyperbilirubinemia in liver failure patients with sepsis.

Scoring Systems and Postoperative Outcomes in Pediatric Liver Transplantation.

PURPOSE: The aim of this study is to investigate the effects of risk scores (Pediatric End-stage Liver Disease [PELD], Child-Turcotte-Pugh [CTP], and Pediatric Risk of Mortality [PRISM-III]) of pediatric liver transplant patients on the postoperative period. METHOD: Seven cadaveric and 45 living donors, totaling 52 pediatric liver transplantation (LT) patients, were reviewed retrospectively. PELD and CTP scores were calculated based on data at hospital admission. PRISM-III score was calculated from data during the first 24 hours of intensive care unit (ICU) admission. Hospital length of stay (LOS), ICU LOS, patients who developed acute kidney injury (AKI), requirement for inotropic-vasopressor therapy, hospital mortality, long-term mortality, duration of mechanical ventilation, metabolic disease, and demographic features were documented.For CTP score, class C was defined as high, and A and B as low. Cutoff values of PELD and PRISM-III scores were detected by using receiver operating characteristic curves. According to these cutoff values, patients were divided into 2 groups as high and low for each score. Documented data was analyzed and compared in groups for each score. RESULTS: Hospital LOS was significantly longer in the high-PELD (P = .01) and high-CTP (P = .01) groups. ICU LOS was significantly longer in the high-PRISM-III group (P = .01). Requirement for inotropic-vasopressor therapy was significantly higher in the high-PELD (P = .04) and high-CTP (P = .04) groups. CONCLUSION: Hemodynamic instability and long hospital LOS can be expected in pediatric post-LT patients with high PELD or CTP scores; there is also the risk that AKI maybe higher for high-PELD score patients. Unexpectedly, the PRISM-III score did not have any correlation with the severity of physiological condition and mortality.

Reevaluation of the Critically Ill Patients With Nonconvulsive Status Epilepticus by Using Salzburg Consensus Criteria.

OBJECTIVE: We aimed to assess the usefulness of the Salzburg Consensus Criteria (SCC) for determining the prognosis of critically ill patients with nonconvulsive status epilepticus (NCSE). METHODS: We retrospectively reviewed consecutive patients with unconsciousness followed up in the intensive care unit (ICU). Three clinical neurophysiologists, one of them blinded to clinical and laboratory data, reevaluated all EEG data independently and determined NCSE according to SCC. The incidence of NCSE and ictal EEG patterns and their relationship to clinical, laboratory, neuroradiological, and prognostic findings were assessed. RESULTS: A total of 107 consecutive patients with mean age 68.2 ± 15.3 years (57 females) were enrolled in the study. Primary neuronal injury was detected in 59 patients (55.7%). Thirty-three patients (30.8%) were diagnosed as NCSE. While authors decided to treat 33 patients (30.8%), 32 patients (29.9%) had been treated in real-life evaluation. Clinical and EEG improvement were detected in 12 patients (11.3%) in real-life treatment group showing correlation with lack of intubation and ICU stay related to postsurgical event. Rate of mortality (45.8%) was high showing association with systemic-metabolic etiology, severity of coma and presence of "plus" modifiers in the EEG. CONCLUSION AND SIGNIFICANCE: Our findings suggest that SCC is highly compatible with clinical practice in the decision for treatment of patients with NCSE. The presence of "plus" modifiers in the EEG was found to be associated with mortality in these patients and was a significant marker for the high mortality rate.

The first experimental research on the pathogenicity of Arcobacter butzleri in zebrafish.

This experimental study was conducted to investigate the pathogenicity and histopathology of Arcobacter butzleri in zebrafish model organism. Firstly, mean infective dose (ID50) of A. butzleri was calculated in zebrafish as 1.3×10(8)CFU/mL and 1×10(5)CFU/mL by immersion and intraperitoneal injection, respectively. For histopathological trials, the ID50 of A. butzleri were given to zebrafish by both immersion and intraperitoneal routes and then, clinical and pathological findings were evaluated on days 1, 3, 5, 7 and 21 of the experiment. During the experimental period, no clinical signs or gross lesions of disease were observed in the zebrafish groups infected with the ID50 of A. butzleri by either method. In the histopathological examination, acute inflammation characterized by neutrophil and plasma cells and local necrosis or congestion were determined in liver, kidney, spleen, gaster and other visceral organs. In addition peritonitis, leukocyte infiltration, villous atrophy and septicemia were observed in the experimental groups. Neither gross nor microscopic lesions were detected in the control groups. This study presented the first report of experimental A. butzleri infection in wild zebrafish. In the light of the findings obtained here, it was concluded that zebrafish could be used as a model organism to investigate pathogenicity and histopathology of arcobacters.

Ketamine versus alfentanil combined with propofol for sedation in colonoscopy procedures: a randomized prospective study.

BACKGROUND/AIMS: Different drug combinations are used for sedation in colonoscopy procedures. A ketamine-propofol (ketofol) mixture provides effective sedation and has minimal adverse effects. Alfentanil also provides anesthesia for short surgical procedures by incremental injection as an adjunct. However, no study has investigated the use of ketofol compared with an opioid-propofol combination in colonoscopic procedures. MATERIALS AND METHODS: A total of 70 patients, ASA physical status I-II, scheduled to undergo elective colonoscopy, were enrolled in this prospective randomized study and allocated to two groups. After premedication, sedation induction was performed with 0.5 mg/kg ketamine +1 mg/kg propofol in Group KP, and 10 mg/kg alfentanil +1 mg/kg propofol in Group AP. Propofol was added when required. Demographic data, colonoscopy duration, recovery time, discharge time, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, Ramsey Sedation Scale values, colonoscopy patients' satisfaction scores, and complications were recorded. RESULTS: The need for additional propofol doses was significantly higher in Group AP than in Group KP. MAP at minute 1 and 5, Ramsey Sedation Scale at minute 5, and discharge time were significantly higher in Group KP than in Group AP. Additional propofol doses and total propofol dose were significantly lower in Group KP than in Group AP. CONCLUSION: Ketofol provided better hemodynamic stability and quality of sedation compared with alfentanil-propofol combination in elective colonoscopy, and required fewer additional propofol; however, it prolonged discharge time. Both combinations can safely be used in colonoscopy sedation.

Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil.

BACKGROUND AND OBJECTIVES: Sedation-analgesia is recommended for comfortable colonoscopy procedures, which are invasive and can be painful. This study aimed to compare the combinations of propofol-alfentanil and propofol-fentanyl for sedation-analgesia in elective colonoscopy patients. METHODS: This prospective and randomized study was planned in ASA I-II groups and included 80 patients between the ages of 18 and 65 years. Sedation-analgesia induction was performed as 1 µg.kg-1 fentanyl, 1 mg.kg-1 propofol in the propofol-fentanyl group (Group PF) and 10 µg.kg-1 alfentanil, 1 mg.kg-1 propofol in the propofol-alfentanil group (Group PA). Patients' scores were limited to 3-4 values on the Ramsey Sedation Scale (RSS) by 0.5 mg.kg-1 bolus additional doses of propofol in sedation-analgesia maintenance. We recorded demographical data, heart rate, mean arterial pressure (MAP), oxygen saturation of hemoglobin (SpO2), RSS value, colonoscopy time, total dose of propofol, complications, recovery time, and discharge time, as well as colonoscopist and patient satisfaction scores. RESULTS: MAP at the 15th minute in Group PA was signifi cantly higher than in Group PF (p = 0.037). Group PA's beginning mean heart rate was higher than the mean heart rate at subsequent readings (p = 0.012, p = 0.002). The mean total propofol dose of Group PA was signifi cantly higher than the total dose of Group PF (p = 0.028). The mean recovery time of Group PA was signifi cantly longer than that of Group PF (p = 0.032). CONCLUSION: Fentanyl provides better operative conditions and reduces the need for additional propofol doses. These advantages cause a shorter recovery time. Therefore, propofol-fentanyl is superior to the propofol-alfentanil for sedation-analgesia in colonoscopy.

Sedação e analgesia em colonoscopia eletiva: propofol-fentanil versus propofol-alfentanil / Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil / Sedación y analgesia en colonoscopia electiva: propofol-fentanilo versus propofol-alfentanilo

JUSTIFICATIVA E OBJETIVO: Sedação e analgesia são recomendadas em colonoscopia para propiciar conforto, pois são procedimentos invasivos e podem ser dolorosos. Este estudo teve como objetivo comparar as combinações de propofol-alfentanil e propofol-fentanil para sedação e analgesia em pacientes submetidos à colonoscopia eletiva. MÉTODOS: Estudo prospectivo e randomizado. Participaram do estudo 80 pacientes, ASA I-II, entre 18 e 65 anos. A indução de sedação e a analgesia foram feitas com propofol (1 mg.kg-1) e fentanil (1 µg.kg-1) no grupo propofol-fentanil (PF) e com propofol (1 mg.kg-1) e alfentanil (10 µg.kg-1) no grupo propofol-alfentanil (PA). Para manutenção, doses adicionais de propofol foram administradas em bolus de 0,5 mg.kg-1 para obter escores de 3-4 na Escala de Sedação de Ramsey (ESR). Registrados os dados demográficos, a frequência cardíaca, a pressão arterial média (PAM), a saturação de oxigênio da hemoglobina (SpO2), os valores da ESR, o tempo de colonoscopia, a dose total de propofol, as complicações, o tempo de recuperação e o tempo para alta, bem como os escores de satisfação do colonoscopista e do paciente. RESULTADOS: A PAM aos 15 minutos no Grupo PA foi significativamente maior do que no Grupo PF (p = 0,037). A frequência cardíaca média do grupo PA foi maior no início do que nas mensurações subsequentes (p = 0,012, p = 0,002). A média da dose total de propofol do Grupo PA foi significativamente maior do que a do Grupo PF (p = 0,028). O tempo médio de recuperação do grupo PA foi significativamente maior do que o do grupo PF (p = 0,032). CONCLUSÃO: Fentanil proporciona melhores condições de operação e reduz a necessidade de doses adicionais de propofol. Essas vantagens diminuem o tempo de recuperação. Portanto, propofol-fentanil é superior ao propofol-alfentanil para sedação e analgesia em colonoscopia.

BACKGROUND AND OBJECTIVES: Sedation-analgesia is recommended for comfortable colonoscopy procedures, which are invasive and can be painful. This study aimed to compare the combinations of propofol-alfentanil and propofol-fentanyl for sedation-analgesia in elective colonoscopy patients. METHODS: This prospective and randomized study was planned in ASA I-II groups and included 80 patients between the ages of 18 and 65 years. Sedation-analgesia induction was performed as 1 µg.kg-1 fentanyl, 1 mg.kg-1 propofol in the propofol-fentanyl group (Group PF) and 10 µg.kg-1 alfentanil, 1 mg.kg-1 propofol in the propofol-alfentanil group (Group PA). Patients' scores were limited to 3-4 values on the Ramsey Sedation Scale (RSS) by 0.5 mg.kg-1 bolus additional doses of propofol in sedation-analgesia maintenance. We recorded demographical data, heart rate, mean arterial pressure (MAP), oxygen saturation of hemoglobin (SpO2), RSS value, colonoscopy time, total dose of propofol, complications, recovery time, and discharge time, as well as colonoscopist and patient satisfaction scores. RESULTS: MAP at the 15th minute in Group PA was significantly higher than in Group PF (p = 0.037). Group PA's beginning mean heart rate was higher than the mean heart rate at subsequent readings (p = 0.012, p = 0.002). The mean total propofol dose of Group PA was significantly higher than the total dose of Group PF (p = 0.028). The mean recovery time of Group PA was significantly longer than that of Group PF (p = 0.032). CONCLUSION: Fentanyl provides better operative conditions and reduces the need for additional propofol doses. These advantages cause a shorter recovery time. Therefore, propofol-fentanyl is superior to the propofol-alfentanil for sedation-analgesia in colonoscopy.

JUSTIFICATIVA Y OBJETIVO: La sedación y la analgesia están recomendadas en la colonoscopia para propiciar la comodidad, porque son procedimientos invasivos y pueden ser dolorosos. Este estudio tuvo el objetivo de comparar las combinaciones de propofol-alfentanilo y propofol-fentanilo para la sedación y la analgesia en pacientes sometidos a la colonoscopia electiva. MÉTODOS: Estudio prospectivo y aleatorio. Participaron en el estudio 80 pacientes, ASA I-II, entre 18 y 65 años. La inducción de sedación y la analgesia fue hecha con propofol (1 mg.kg-1) y fentanilo (1 µg.kg-1) en el grupo propofol-fentanilo (PF) y con propofol (1 mg.kg-1) y alfentanilo (10 µg.kg-1) en el grupo propofol-alfentanilo (PA). Para el mantenimiento, dosis adicionales de propofol se administraron en bolos de 0,5 mg.kg-1 para obtener las puntuaciones de 3-4 en la Escala de Sedación de Ramsey (ESR). Se registraron los datos demográficos, la frecuencia cardíaca, la presión arterial promedio (PAP), la saturación de oxígeno de la hemoglobina (SpO2), los valores de la ESR, el tiempo de colonoscopia, la dosis total de propofol, las complicaciones, el tiempo de recuperación y el tiempo para el alta, como también las puntuaciones de satisfacción del colonoscopista y del paciente. RESULTADOS: La PAP a los 15 minutos en el Grupo PA fue significativamente mayor que en el Grupo PF (p = 0,037). La frecuencia cardíaca promedio del grupo PA fue mayor al inicio que en las mensuraciones posteriores (p = 0,012, p = 0,002). El promedio de la dosis total de propofol del Grupo PA fue significativamente mayor que la del Grupo PF (p = 0,028). El tiempo promedio de recuperación del grupo PA fue significativamente mayor que el del grupo PF (p = 0,032). CONCLUSIONES: El Fentanilo proporciona mejores condiciones de operación y reduce la necesidad de dosis adicionales de propofol. Esas ventajas reducen el tiempo de recuperación. Por tanto, el propofol-fentanilo es superior al propofol-alfentanilo para la sedación y la analgesia en la colonoscopia.

Investigation of virulence and cytolethal distending toxin genes in Campylobacter spp. isolated from sheep in Turkey.

The presence of virulence and cytolethal distending toxin (Cdt) genes was investigated in isolates of Campylobacter jejuni, C. coli, C. lanienae, and C. lari that originated from intestinal contents and gallbladders of clinically healthy sheep. These genes have important roles in the pathogenicity of campylobacters. A total of 363 Campylobacter isolates (221 C. jejuni, 135 C. coli, five C. lanienae, and two C. lari) were used in this study. The frequency of racR, dnaJ, ciaB, pldA, flaA, and cadF virulence genes in all the isolates were determined to be 34.4%, 30%, 24.8%, 30.9%, 95%, and 81.3%, respectively, while the virB11 virulence gene could not be detected in any isolates. CdtA, cdtB, and cdtC genes were detected in 54.5%, 55.9%, and 52.3% of the isolates, respectively. None of the virulence and toxin genes examined here were detected in a total of 19 Campylobacter isolates consisting of 10 C. jejuni and nine C. coli. This is the first study investigating the presence of virulence and toxin genes in a large number of Campylobacter species isolated from clinically healthy sheep by scanning a large area. In addition, this is the first report investigating the presence of virulence and toxin genes in sheep-originated C. lanienae and C. lari isolates.

Sedation-analgesia in elective colonoscopy: propofol-fentanyl versus propofol-alfentanil.

BACKGROUND AND OBJECTIVES: Sedation-analgesia is recommended for comfortable colonoscopy procedures, which are invasive and can be painful. This study aimed to compare the combinations of propofol-alfentanil and propofol-fentanyl for sedation-analgesia in elective colonoscopy patients. METHODS: This prospective and randomized study was planned in ASA I-II groups and included 80 patients between the ages of 18 and 65 years. Sedation-analgesia induction was performed as 1 µg.kg(-1) fentanyl, 1mg.kg(-1) propofol in the propofol-fentanyl group (Group PF) and 10 µg.kg(-1) alfentanil, 1mg.kg(-1) propofol in the propofol-alfentanil group (Group PA). Patients' scores were limited to 3-4 values on the Ramsey Sedation Scale (RSS) by 0.5mg.kg(-1) bolus additional doses of propofol in sedation-analgesia maintenance. We recorded demographical data, heart rate, mean arterial pressure (MAP), oxygen saturation of hemoglobin (SpO2), RSS value, colonoscopy time, total dose of propofol, complications, recovery time, and discharge time, as well as colonoscopist and patient satisfaction scores. RESULTS: MAP at the 15(th) minute in Group PA was significantly higher than in Group PF (p = 0.037). Group PA's beginning mean heart rate was higher than the mean heart rate at subsequent readings (p = 0.012, p = 0.002). The mean total propofol dose of Group PA was significantly higher than the total dose of Group PF (p = 0.028). The mean recovery time of Group PA was significantly longer than that of Group PF (p = 0.032). CONCLUSION: Fentanyl provides better operative conditions and reduces the need for additional propofol doses. These advantages cause a shorter recovery time. Therefore, propofol-fentanyl is superior to the propofol-alfentanil for sedation-analgesia in colonoscopy.

Investigation of toxin genes by polymerase chain reaction in Staphylococcus aureus strains isolated from bovine mastitis in Turkey.

Staphylococcus aureus causes a number of diseases in humans and animals, and it is the most common etiological agent of contagious bovine mastitis. The agent produces several virulence factors such as coagulase (coa), clumping factor, protein A, exfoliative toxins, staphylococcal enterotoxins (SEs), and toxic shock syndrome toxin-1. The aim of the present study was to characterize coa-positive S. aureus strains (n = 92) isolated from bovine subclinical mastitis in Turkey by polymerase chain reaction (PCR) amplification of exfoliative toxin (eta and etb) and toxic shock syndrome toxin-1 (tsst) genes. In addition, a multiplex PCR was employed to investigate the presence of SE genes sea, seb, sec, sed, see, seg, seh, sej, and sei. By PCR amplification, while eta and etb were not detected, only three isolates (3.3%) were positive for tsst. Twenty-seven (29.3%) isolates harbored one or more SE genes, and sei was the most common pattern by multiplex PCR. None of the isolates harbored the genes encoding sea, see, and seh. The application of this multiplex PCR assay could enable more samples to be rapidly characterized for enterotoxin production of S. aureus isolates from milk for epidemiological studies.

Heterogeneity of Campylobacter jejuni and Campylobacter coli strains from healthy sheep.

The objectives of this study were to identify, at species level, thermophilic campylobacters isolated from clinically healthy sheep by a multiplex polymerase chain reaction (mPCR). The heterogeneity among Campylobacter jejuni and C. coli isolates was also investigated using a restriction fragment length polymorphism (RFLP) analysis of the flagellin (flaA) gene. Samples of intestinal contents, gall bladders and faeces were collected from 610 healthy sheep. While gall bladder samples were plated directly onto Preston agar, an enrichment stage was applied for intestinal and faecal samples. Of the 610 samples, 302 (49.5%) were positive for Campylobacter spp. Using a mPCR assay for species identification, 103 (34.1%) were positive with C. jejuni-specific primers, while 100 (33.1%) were positive with C. coli-specific primers. Additionally, 16 (11.9%) of the intestinal content samples were positive for both species by mPCR. All the isolates identified as C. jejuni and C. coli were successfully subtyped by flaA typing. Of 203 isolates tested, 48 different flaA types were found. Twenty-six flaA types were identified among C. jejuni isolates and the remaining 22 from C. coli isolates.

Random amplified polymorphic DNA analysis of Campylobacter jejuni and Campylobacter coli isolated from healthy cattle and sheep.

The genetic heterogeneity among Campylobacter jejuni and Campylobacter coli isolates obtained from apparently healthy cattle and sheep was investigated by random amplified polymorphic DNA (RAPD) analysis. A total of 348 Campylobacter isolates, consisting of C. jejuni (n = 218) and C. coli (n = 130), were analysed. All these isolates were successfully typed by RAPD analysis. The total numbers of band patterns defined by RAPD in cattle and sheep were 42 and 45, respectively. Of the 42 distinct types obtained from cattle, 37 types were observed in C. jejuni isolates (n = 115), and the remaining 5 were in C. coli isolates (n = 30). Of 45 distinct types obtained from sheep, 21 types were observed in C. jejuni isolates (n = 103), and 24 were in C. coli isolates (n = 100). It was concluded that a high degree of heterogeneity existed among the C. jejuni and C. coli isolates of healthy cattle and sheep.