Chrononutrition in Critical Illness.

Circadian rhythms in humans are biological rhythms that regulate various physiological processes within a 24-hour time frame. Critical illness can disrupt the circadian rhythm, as can environmental and clinical factors, including altered light exposure, organ replacement therapies, disrupted sleep-wake cycles, noise, continuous enteral feeding, immobility, and therapeutic interventions. Nonpharmacological interventions, controlling the ICU environment, and pharmacological treatments are among the treatment strategies for circadian disruption. Nutrition establishes biological rhythms in metabolically active peripheral tissues and organs through appropriate synchronization with endocrine signals. Therefore, adhering to a feeding schedule based on the biological clock, a concept known as "chrononutrition," appears to be vitally important for regulating peripheral clocks. Chrononutritional approaches, such as intermittent enteral feeding that includes overnight fasting and consideration of macronutrient composition in enteral solutions, could potentially restore circadian health by resetting peripheral clocks. However, due to the lack of evidence, further studies on the effect of chrononutrition on clinical outcomes in critical illness are needed. The purpose of this review was to discuss the role of chrononutrition in regulating biological rhythms in critical illness, and its impact on clinical outcomes.

Quinoa (Chenopodium quinoa Willd.) supplemented cafeteria diet ameliorates glucose intolerance in rats.

Quinoa (Chenopodium quinoa Willd.) is a pseudocereal with rich nutritional composition, gluten free, and organoleptic. The primary aim of this study was to elucidate the possible protective roles of quinoa in glucose homeostasis in a model of cafeteria diet-induced obesity. Male Wistar rats (3 weeks of age) were randomly allocated to be fed by; control chow (CON; n = 6), quinoa (QUI; n = 6), cafeteria (CAF; n = 6), or quinoa and cafeteria (CAFQ; n = 6) for 15 weeks. CAFQ resulted in decreased saturated fat, sugar, and sodium intake in comparison with CAF. Compared to CON, CAF increased body weight gain, plasma insulin, plasma glucose, decreased liver IRS-1, AMPK mRNA expressions, and pancreatic ß-cell insulin immunoreactivity, and developed hepatocyte degeneration and microvesicular steatosis. Compared to CAF, QUI lowered body weight, plasma glucose, and plasma insulin, increased liver IRS-1 and AMPK mRNA expressions, and pancreatic ß-cell insulin immunoreactivity. Compared to CAF, CAFQ lowered plasma glucose, increased liver IRS-1 mRNA expressions, increased pancreatic ß-cell insulin immunoreactivity, and lowered hepatocyte degeneration and microvesicular steatosis. Dietary treatments did not influence IRS-2, AKT2, and INSR mRNA expressions. HOMA-IR, HOMA-ß, and QUICKI were also similar between groups. Restoration of insulin in CAFQ islets was as well as that of CON and QUI groups. In conclusion, as a functional food, quinoa may be useful in the prevention of obesity and associated metabolic outcomes such as glucose intolerance, disrupted pancreatic ß-cell function, hepatic insulin resistance, and lipid accumulation.

Taurine supplementation reduces adiposity and hepatic lipid metabolic activity in adult offspring following maternal cafeteria diet.

Maternal taurine supplementation has been shown to exert protective effects following a maternal obesogenic diet on offspring growth and metabolism. However, the long-term effects of maternal cafeteria diet on adiposity, metabolic profile, and hepatic gene expression patterns following supplementation of taurine in adult offspring remains unclear. In this study, we hypothesized that exposure to maternal taurine supplementation would modulate the effects of maternal cafeteria diet by reducing adiposity and hepatic gene expression patterns involved in lipid metabolism in adult offspring. Female Wistar rats were fed a control diet, control diet supplemented with 1.5% taurine in drinking water, cafeteria diet (CAF) or CAF supplemented with taurine (CAFT) from weaning. After 8 weeks, all animals were mated and maintained on the same diets during pregnancy and lactation. After weaning, all offspring were fed with control chow diet until the age of 20 weeks. Despite similar body weights, CAFT offspring had significantly lower fat deposition and body fat when compared with CAF offspring. Microarray analysis revealed that genes (Akr1c3, Cyp7a1, Hsd17b6, Cd36, Acsm3, and Aldh1b1) related to steroid hormone biosynthesis, cholesterol metabolism, peroxisome proliferator-activated receptor signaling pathway, butanoate metabolism, and fatty acid degradation were down-regulated in CAFT offspring. The current study shows that exposure to maternal cafeteria diet promoted adiposity and taurine supplementation reduced lipid deposition and in both male and female offspring and led to alterations in hepatic gene expression patterns, reducing the detrimental effects of maternal cafeteria diet.

From a toxin to an obesogen: a review of potential obesogenic roles of acrylamide with a mechanistic approach.

Obesity and obesity-related disorders such as cancer, type 2 diabetes, and fatty liver have become a global health problem. It is well known that the primary cause of obesity is positive energy balance. In addition, obesity is the consequence of complex gene and environment interactions that result in excess calorie intake being stored as fat. However, it has been revealed that there are other factors contributing to the worsening of obesity. The presence of nontraditional risk factors, such as environmental endocrine-disrupting chemicals, has recently been associated with obesity and comorbidities caused by obesity. The aim of this review was to examine the evidence and potential mechanisms for acrylamide having endocrine-disrupting properties contributing to obesity and obesity-related comorbidities. Recent studies have suggested that exposure to environmental endocrine-disrupting obesogens may be a risk factor contributing to the current obesity epidemic, and that one of these obesogens is acrylamide, an environmental and industrial compound produced by food processing, particularly the processing of foods such as potato chips, and coffee. In addition to the known harmful effects of acrylamide in humans and experimental animals, such as neurotoxicity, genotoxicity, and carcinogenicity, acrylamide also has an obesogenic effect. It has been shown in the literature to a limited extent that acrylamide may disrupt energy metabolism, lipid metabolism, adipogenesis, adipocyte differentiation, and various signaling pathways, and may exacerbate the disturbances in metabolic and biochemical parameters observed as a result of obesity. Acrylamide exerts its main potential obesogenic effects through body weight increase, worsening of the levels of obesity-related blood biomarkers, and induction of adipocyte differentiation and adipogenesis. Additional mechanisms may be discovered. Further experimental studies and prospective cohorts are needed, both to supplement existing knowledge about acrylamide and its effects, and to clarify its established relationship with obesity and its comorbidities.

Can pseudocereals modulate microbiota by functioning as probiotics or prebiotics?

Amaranth, quinoa, and buckwheat, known as pseudocereals, have been consumed since ancient times and are considered sacred in most cultures. Their grains can be used as cereals for breakfast or mixed with other grains in meals and their health-enhancing effects have been investigated more in recent years. They have an antioxidant effect and their nutrient profiles are enriched with processing techniques such as sprouting and fermentation. Their suitability to different processing techniques and the rapid increase in microbiota researches highlighted the probiotic/prebiotic effects of pseudocereals. Using cultures or naturally fermented amaranth, quinoa and buckwheat exhibited good substrate properties for probiotic bacteria, especially for Lactobacillus strains. Studies have found that they reduce the number of pathogen microorganisms, increase the synthesis of short-chain fatty acids due to their prebiotic effects. Also the number of bacterial colonies do not change during the storage period and their organoleptic properties are revealed. It has been determined that pseudocereals decrease Ruminococcacea, Lachnospiraceae, Helicobacteracea, Clostridium, Escherichia and increase Peptoclostridium, Prevotellaceae, Lactobacillus, Bifidobacterium, Enterococcus, and Eubacteriaceae. Due to these effects, they are considered as good sources for synbiotic formulations to be developed for the treatment of dysbiosis, obesity, Celiac Disease, lactose intolerance, inflammatory bowel diseases and inflammation-mediated chronic disorders.

Effects of maternal taurine supplementation on maternal dietary intake, plasma metabolites and fetal growth and development in cafeteria diet fed rats.

BACKGROUND: Maternal obesity may disrupt the developmental process of the fetus during gestation in rats. Recent evidence suggests that taurine can exert protective role against detrimental influence of obesogenic diets. This study aimed to examine the effect of maternal cafeteria diet and/or taurine supplementation on maternal dietary intake, plasma metabolites, fetal growth and development. METHODS: Female Wistar rats were fed a control diet (CON), CON supplemented with 1.5% taurine in drinking water (CONT), cafeteria diet (CAF) or CAF supplemented with taurine (CAFT) from weaning. After 8 weeks all animals were mated and maintained on the same diets during pregnancy and lactation. RESULTS: Dietary intakes were significantly different between the groups. Both CAF and CAFT fed dams consumed less water in comparison to CON and CONT dams. Taurine supplementation only increased plasma taurine concentrations in CONT group. Maternal plasma adiponectin concentrations increased in CAF and CAFT fed dams compared to CON and CONT fed dams and there was no effect of taurine. Hyperleptinemia was observed in CAF fed dams but not in CAFT fed dams. Malondialdehyde was significantly increased only in CAF fed dams. Litter size, sex ratio and birth weight were similar between the groups. There was an increase in neonatal mortality in CONT group. DISCUSSION: This study showed that maternal taurine supplementation exerted modest protective effects on cafeteria diet induced maternal obesity. The increased neonatal mortality in CONT neonates indicates possible detrimental effects of taurine supplementation in the setting of normal pregnancy. Therefore, future studies should investigate the optimal dose of taurine supplementation and long term potential effects on the offspring.

Determination of aluminum concentrations of parenteral nutrition solutions by HPLC.

Aluminum (Al) contamination of parenteral nutrition (PN) solutions has been known for over 30 years. In particular, vascular intake of Al leads to its accumulation in tissues. In this study, 8 all-in-one PN solutions the aluminum concentration was analyzed by high-performance liquid chromatography. The mean Al concentration of the glucose solutions of the PN solutions combinations was 16.36 ± 8.31 µg/L, the mean Al concentration of the amino acid solutions was 4.96 ± 3.73 µg/L, and the mean Al concentration of the lipid solutions was 9.09 ± 11.23 µg/L. The Al concentration of the PN5 glucose and PN2 lipid solutions were above 25 µg/L, which is the limit set by the Food and Drug Administration (FDA). No studies in the literature have examined the Al concentrations of all-in-one PN solutions via HPLC. In two of the analyzed solutions, the Al concentration was found to be higher than the limit set by the FDA.

Cross-Sectional Evaluation of Food Items Preferred by Adolescents under the Influence of Television Advertisements.

BACKGROUND: Food and beverage advertisements on television play a significant role in food preferences, especially among children and adolescents. This study aimed to evaluate foods and beverages advertised on television and purchased by adolescents or their families using the World Health Organization (WHO) nutrient profiling model. STUDY DESIGN: A cross-sectional study. METHODS: This cross-sectional study was performed on 2,699 students (1380 males and 1319 females) aged 11-16 in Ankara, Turkey, in 2015. Socio-demographic characteristics, television-viewing habits, and the tendency to purchase foods and beverages under the influence of TV advertisements were recorded. The body weight and height were measured by the researchers. All reported food and beverage items (n  =  284) were evaluated and classified as permitted or not permitted to advertise, according to the WHO nutrient profile model (2015). RESULTS: The majority (69.8%) of students were underweight/normal weight, whereas 13.3% and 16.9% were classified as overweight and obese, respectively. A total of 69.6% of adolescents declared that they were influenced by food advertisements, and 66.4% bought those foods. The most purchased products included cakes and sweet biscuits (63.8%), chocolate and confectionery (44.9%), savory snacks (39.6%), and soft drinks (25.4%). Only 8.5% of all the advertised products (n  =  284) were permitted to be advertised, according to the WHO nutrient profile model (2015). Dairy products, meat products, grains, fruits and vegetables, soup, and some traditional Turkish foods (e.g., cig kofte and Turkish pizza) were permitted. The permitted products were preferred by only 13.6% of the adolescents. CONCLUSIONS: Unhealthy foods are advertised on television for adolescents, and food advertisement management may be an essential strategy to provide healthy food choices.

Is there a relationship between the dietary inflammatory index and metabolic syndrome among adolescents?

Background Dietary patterns have a crucial role in modulating chronic inflammation. This study aimed to determine the relationship between the Dietary Inflammatory Index (DII) and inflammation markers and metabolic syndrome components in adolescents (n = 343). Methods Fasting glucose, fasting insulin and lipid profile were analyzed and blood pressures were measured. Analysis of inflammation markers such as sedimentation, leukocyte, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) was also performed. The DII scores were calculated based on the adolescent's 3-day food consumption records. Results The dietary inflammatory score varied between 1.04 and 5.11 (3.6 ± 0.82). There was no significant difference in leukocyte and CRP levels between quartiles (p > 0.05). Those in the fourth quartile were observed to have higher levels of TNF-α and IL-6 compared to the others (p < 0.05). In the multiple regression analysis, a positive correlation existed only between IL-6 and DII, independent of other inflammatory markers (ß = 0.272; p < 0.05). The DII was associated with glucose intolerance (odds ratio [OR] for DII quartile 4 compared to 1 = 3.5, 95% confidence interval [CI] = 1.2-10.4) and dyslipidemia (OR for DII quartile 4 compared to 1 = 5.3, 95% CI = 1.7-16.8). Conclusions These data suggest that a higher DII score was significantly associated with an increased risk of metabolic syndrome and some metabolic syndrome components in adolescents. Hence, DII can be used to determine the inflammatory potential of a diet and a healthy diet with anti-inflammatory properties that may be conducive to the prevention of metabolic disorders.

Turkish version of the Yale Food Addiction Scale: preliminary results of factorial structure, reliability, and construct validity.

BACKGROUND: Yale Food Addiction Scale (YFAS) was established to identify individuals exhibiting signs of addiction towards certain types of food. This study aimed to develop a Turkish version of the Yale Food Addiction Scale and test its psychometric properties. METHODS: The backward translation techniques were used to develop Turkish versions of the YFAS, and its reproducibility was assessed. Turkish version of the YFAS was administered to a total of 1033 participants (439 men and 594 women), aged 19-65 years. Exploratory factor analysis and confirmatory factor analysis were used to examine the factorial structure of the tool. Construct validity was assessed by principal component factor analysis with varimax rotation. Reliabilities were estimated with Cronbach's alpha coefficient. The criterion-related validity was tested by the administration of Eating Attitude Test-26 (EAT-26) to all participants. RESULTS: The primary factor loadings for seven items were ranged between 0.45 and 0.79, and no items cross-loaded onto other factors. The fit indices showed that eight items of the YFAS were a good representation of the item responses and each item loaded significantly on the specified factor (p < 0.001 for each). YFAS subscales had a high internal consistency and test-retest reliability. The criterion-related validity of the tool showed a positive relationship with scales of the EAT-26. CONCLUSION: Current study suggested that the Turkish version of the YFAS is a reliable, valid, and useful tool for assessing the signs of food addiction in a non-clinical sample.

Cafeteria diet increased adiposity in comparison to high fat diet in young male rats.

BACKGROUND: Dietary intervention studies in animal models of obesity are crucial to elucidate the mechanistic effects of specific nutrients and diets. Although several models of diet induced obesity have been examined in rodents to assess obesity, there are few studies that have researched influence of different high fat and/or westernized diets. The aim of this study was to compare a high fat diet and a cafeteria diet on obesity related biochemical and physiological parameters in young male rats. METHODS: Five week old Wistar male rats were fed a control chow diet (C), butter-based high fat diet (HF) or cafeteria diet (CAF) for twelve weeks. In HF, 40% of energy came from fat and this ratio was 46% in CAF. CAF composed of highly energetic and palatable human foods along with chow diet. At the end of the feeding protocol all animals were culled using CO2 asphyxia and cervical dislocation after an overnight fasting. RESULTS: Total energy and fat intake of CAF was significantly higher than C and HF. CAF was more effective in inducing obesity, as demonstrated by increased weight gain, Lee index, fat depot weights and total body fat in comparison to C and HF. Despite increased adiposity in CAF, plasma glucose, insulin and HOMA-IR levels were similar between the groups. Plasma leptin and cholesterol levels were markedly higher in CAF than C and HF. DISCUSSION: We have demonstrated that there are differential effects of high fat diet and cafeteria diet upon obesity and obesity-related parameters, with CAF leading to a more pronounced adiposity in comparison to high fat diet in young male rats. Future studies should consider the varied outcomes of different diet induced obesity models and development of a standardized approach in similar research practices.

How does food addiction influence dietary intake profile?

This study aimed to investigate whether there was any difference in eating pattern, abnormal eating behaviour, obesity and the number of food addiction symptoms according to food addiction presence. A total sample of 851 healthy subjects living in Ankara (n = 360 male, n = 491 female) aged 19-65 years were included in this cross-sectional survey. Data on demographic information, 24-hour dietary recalls, Yale Food Addiction Scale (YFAS), Eating Attitudes Test-26 (EAT-26), and anthropometric measurements were collected through face-to-face interviews. Overall, 11.4% of participants were identified as "food addicted" (F: 13.0%; M: 9.2%). Subjects meeting criteria for 'food addiction' had higher body mass index (35.1% were obese and 3.1% were underweight), compared to subjects without food addiction (13.1% were obese and 10.2% were underweight) (p<0.05). Abnormal eating attitudes estimated with EAT-26 were determined as 45.5% in males, 37.5% in females and 40.2% in total, among subjects with food addiction. Daily energy, protein and fat intakes were significantly higher in food addicted females, compared to non-addicted females (p<0.05). Participants with food addiction reported significantly more problems with foods, which contain high amounts of fat and sugar, compared to the participants without food addiction. Food addiction behaviour should be considered as a part of efforts towards reducing food related problems involving obesity.

Impact of three different plate colours on short-term satiety and energy intake: a randomized controlled trial.

BACKGROUND: Plate colour was previously shown to alter the amount of food consumption due to its environmental effect on food intake. However, different studies have indicated that the effect of plate colour cannot be generalized. In light of this finding, the main objective of this study was to determine whether food consumption during an open buffet meal was different when using same-sized white, red or black plates. METHODS: This study was a crossover study conducted with 54 female participants aged 18-30 years with normal BMIs. On experimental days, participants ate a standard breakfast and were then randomly assigned to eat ad libitum lunch (pasta with tomato sauce and soft drinks) using white, red or black plates. Visual analogue scale (VAS) scores on satiety outcomes were measured for all meals. Energy and macronutrient intake during lunch was recorded. RESULTS: The results showed that plate colour exerted a significant effect on food intake during the test days (p = 0.021). The average total energy intake with red (1102.16 ± 47.12 kcal, p = 0.05) and black plates (1113.19 ± 47.12 kcal, p = 0.034) was significantly increased when compared to that with white plates (945.72 ± 47.12 kcal). There were no differences between red and black plates (p = 0.985). Overall, mean VAS scores did not indicate a significant difference between the groups. CONCLUSIONS: Plate colour may be a crucial determinant of energy intake.

Chia seed (Salvia Hispanica L.) added yogurt reduces short-term food intake and increases satiety: randomised controlled trial.

BACKGROUND/OBJECTIVES: Several studies have reported that consumption of Salvia Hispanica L.,commonly known as chia seed, may exert beneficial effects on health outcomes. The main purpose of this study was to examine the influence of chia seed consumption as a mid-morning snack on short-term satiety. SUBJECTS/METHODS: Subjects (n = 24) were tested using a randomized, cross-over design consisting of three mid-morning snacks. Yogurt with no chia seed, yogurt with 7 g chia seed, and yogurt with 14 g chia seed were given to subjects on different test days. After subjects were asked to report visual analog scale (VAS) scores on sensory outcomes, ad libitum lunch was served, and energy intake of individuals was measured. RESULTS: VAS scores indicated that participants reported significantly lower scores for hunger (P = 0.033), prospective food consumption (P = 0.031), amounts of food that could be consumed (P = 0.017), desire for sugary foods (P = 0.015), and higher scores for satiety (P = 0.031) on the test days with 7 g and 14 g chia seed. Energy intake of individuals during ad libitum lunch was significantly lower when they consumed yogurt with 7 g or 14 g chia seed (P = 0.037). CONCLUSIONS: The study demonstrated that chia seed consumption as a mid-morning snack may induce short-term satiety in healthy individuals.

Effect of plate size on meal energy intake in normal weight women.

BACKGROUND/OBJECTIVES: Use of smaller plates to control food intake is a commonly recommended strategy for restricting energy intake, despite conflicting results. Therefore, the aim of this study was to examine whether or not three different sizes of plates influence energy intake during a multi-itemed buffet meal in normal weight women. SUBJECTS/METHODS: This was a cross-over study conducted on 37 female participants aged 19-25 years with normal BMI levels. Participants were recruited from Hacettepe University and the surrounding community. On experimental days, participants ate a standard breakfast and were then randomly assigned to eat lunch using a small (19 cm), medium (23 cm), or large (28 cm) diameter plate. Visual analogue scale (VAS) scores on sensory and satiety outcomes were measured for all meals. Energy and macronutrient intakes during lunch were recorded. RESULTS: There was no evidence that use of a smaller plate size reduced energy or specific macronutrient intake during the free choice lunch meal. Multiple visits to the serving table were not associated with energy or macronutrient intake. Plate size did not affect VAS scores during the test days. CONCLUSIONS: Plate size did not influence energy intake, meal composition, or palatability in normal weight women during a multi-itemed open buffet lunch. Studies in natural settings at the population level are needed to clarify current outcomes.

A case of galactorrhea during paroxetine treatment.

Paroxetine is one of the selective serotonin reuptake inhibitor antidepressant drugs. Galactorrhea can be seen during antidepressant treatments. There are a few reports in literature on paroxetine use and related prolactin level changes. We present a case that was receiving paroxetine in whom despite low blood levels of the drug, hyperprolactinemia, and galactorrhea was found. We present a case that was receiving paroxetine despite low drug blood levels, hyperprolactinemia, and galactorrhea was found in this article.

Maternal Low Quality Protein Diet Alters Plasma Amino Acid Concentrations of Weaning Rats.

Several studies have indicated the influence of a maternal low protein diet on the fetus. However, the effect of a maternal low quality protein diet on fetal growth and development is largely unknown. Wistar rats (11 weeks old) were mated and maintained on either a chow diet with 20% casein (n = 6) as the control group (C), or a low quality protein diet with 20% wheat gluten (n = 7) as the experimental group (WG) through gestation and lactation. Maternal body weights were similar in both groups throughout the study. Birth weights were not influenced by maternal diet and offspring body weights during lactation were similar between the groups. Offspring's plasma amino acid profiles showed that plasma methionine, glutamine and lysine were significantly lower and aspartic acid, ornithine and glycine-proline were significantly higher in the WG. Plant based protein comprises an important part of protein intake in developing countries. It is well-known that these diets can be inadequate in terms of essential amino acids. The current study shows differential effects of a maternal low quality protein diet on the offspring's plasma amino acids. Future studies will examine further aspects of the influence of maternal low quality protein diets on fetal growth and development.

A case of sarcoidosis of the central nervous system and orbita.

Sarcoidosis is a multisystemic disease characterized by granulomatous inflammation. Lung or lymph node involvement is common. We present a rare case of sarcoidosis that began with orbital involvement, and a month later, due to insufficient treatment, it involved the central nervous system. A 49-year-old female patient began suffering from swelling in her right eye, redness, ptosis, and limited eye movements two months ago. Gadolinium-enhanced orbital magnetic resonance imaging showed thickening of the lacrimal gland and the right medial rectus muscle. After three weeks of local antibiotic and steroid treatments, her symptoms were resolved. One month ago, the patient reported sudden weakness in her right arm and leg. After laboratory tests and imaging studies, the patient was diagnosed with probable neurosarcoidosis using the Zajicek criteria and treated with prednisone (1 mg/kg/day). Although sarcoidosis frequently presents with lung and lymph node involvement, it is rarely accompanied by orbital involvement. Patients with orbital symptoms may receive a late diagnosis and insufficient central nervous system treatment. Involvement of the central nervous system in sarcoidosis leads to high morbidity and mortality rates. Therefore, early diagnosis and treatment are very important.

Improved oxidative status in major abdominal surgery patients after N-acetyl cystein supplementation.

BACKGROUND: Increased levels of reactive oxygen species during and after surgery may affect inflammatory response, post-operative adhesion molecule formation, and hemodynamic stability. The glutathione redox cycle is an important regulator in oxidative stress and its reduced forms scavenge free radicals. N-acetyl cysteine, a precursor of reduced glutathione, is considered as a potentially therapeutic wide spectrum agent in clinical practice. We therefore examined whether N-acetyl cysteine improves some biochemical parameters in cancer patients undergoing major abdominal surgery. METHODS: Thirty-three patients diagnosed with pancreas, stomach, rectum, colon malignancies, and undergoing major abdominal surgery at Ankara Numune Training and Research Hospital were randomly divided into two groups; control (CON) and N-acetyl cysteine (NAC). The NAC group had 1,200 mg N-acetyl cysteine starting two days before the operation day, in addition to isonitrogenous and isocaloric total parenteral nutrition of 1.2 g/kg protein, 25 kcal/kg, and 60:40 carbohydrate/fat ratio. Blood and urine samples were drawn two days before the operation, on operation day, and on the first, third, and fifth days post-operation. RESULTS: Plasma malondialdehyde was significantly lower in the NAC group (P < 0.001). N-acetyl cysteine treatment did not affect plasma levels of vitamin A, C or E. The NAC group exhibited a higher ratio of reduced glutathione to oxidised glutathione (P = 0.019). Urinary nitrate level was also significantly lower in the NAC group (P = 0.016). CONCLUSION: The study demonstrated the clinical importance of N-acetyl cysteine supplementation on antioxidant parameters in abdominal surgery patients. In these patients N-acetyl cysteine and vitamin administration can be considered as an effective method for improvement of oxidative status.

Chronic bilateral hearing loss in an immunocompetent patient. An atypical course of tuberculous meningitis.

Congenital, infectious, toxic, and demyelinating disorders are common etiological causes of deafness. Tuberculous meningitis, as one of the infectious causes, should be considered in the differential diagnosis since tuberculosis represents an endemic public health problem in developing countries. Multiple cranial nerve palsies can be expected due to basal meningitis; however, presentation with bilateral hearing loss is quite rare. Early diagnosis and treatment are crucial to prevent mortality and residual neurologic deficits. The focus of this discussion is a 42-year-old female presenting with bilateral hearing loss and nonspecific complaints who was finally diagnosed with chronic tuberculous meningitis. We also demonstrate the characteristic radiological and histopathological findings.