Propofol-ketamine combination: a choice with less complications and better hemodynamic stability compared to propofol? On a prospective study in a group of colonoscopy patients.

BACKGROUND AND AIMS: In this study, we compared duration for reaching desired Ramsay Sedation Score (RSS) and postoperative recovery according to Modified Aldrete Score (MAS) of propofol and propofol-ketamine combination in a group of colonoscopy patients. Rates of cardiovascular, respiratory, laryngospasm, visual and nausea/vomiting complications were also compared as secondary outcomes. METHODS: This is a double-blinded prospective randomized controlled trial. 95 patients were included and blocked randomized to either propofol (GroupP, n: 47) or propofol-ketamine (GroupPK, n: 48). GroupP patients received 0.5 mg/kg propofol and GroupPK received 0.5 mg/kg ketamine-propofol. Subjects were monitorized noninvasively preoperatively and every 5 min during procedure. RSS was recorded for every minute before starting procedure and for every 5 min during procedure. Recovery after colonoscopy was evaluated according to MAS. Same observer checked for MAS just after procedure in postoperative 1 min and for every 3 min during follow-up. Postoperative respiratory depression was defined as rate <10/min, hypercapnia/hypercarbia-arterial CO2 tension >50 mmHg or SO2 <90 while hypotension was defined as a decrease of 20 % in mean blood pressure compared to initial values. RESULTS: GroupPK patients needed shorter duration for achieving RSS ≥ 4 (p: 0.038) but longer duration for achieving MAS ≥ 9 (p: 0.005). GroupP's intraoperative blood pressures and heart rates were significantly lower compared to initial values. We observed that respiratory depression (19.1 vs 0 %, p: 0.001), hypotension (29.8 vs 10.4 %, p: 0.018), and nausea/vomiting (17 vs 4.2 %, p: 0.041) were significantly more common in GroupP. CONCLUSION: Propofol-ketamine combination is an advantageous choice in means of achieving sedation in a shorter period of time, a better hemodynamic stability, less nausea and vomiting and respiratory complication rates. Yet it seems that this choice might be related with longer recovery duration.

The association of neutrophil to lymphocyte ratio with presence and severity of obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is characterized by reductions in breathing amplitude during sleep caused by an obstructed or collapsed upper airway. The neutrophil to lymphocyte ratio (NLR) has been proposed as a novel biomarker for systemic inflammatory response. The aim of the present study was to evaluate the relationship between NLR and OSA. METHODS: The study population consisted of 195 consecutive patients with clinical suspicion of OSA. Full night polysomnography was performed for all patients. Patients with an apnea hypopnea index (AHI) ≥ 5 were considered to have OSA. NLR was calculated as the ratio of neutrophil count to lymphocyte count. RESULTS: While 130 patients (91 male, mean age: 49.9±9.8 years) had OSA, 65 patients (42 male, mean age: 48.7 ± 10.2 years) had normal findings according to AHI scores. Cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking were more common in patients with OSA. Patients with OSA had significantly higher NLR than controls (1.87±0.80 vs 1.49±0.48, p=0.005). AHI score was significantly correlated with NLR (r=0.228, p=0.001). NLR and presence of hyperlipidemia were independent predictors of OSA (OR: 2.451, 2.850, p=0.001, 0.004, respectively). NLR of 1.62 or higher predicted OSA with a sensitivity of 56.2 % and specificity of 63.1 %. CONCLUSIONS: NLR was higher and also correlated with AHI score in patients with OSA which has not been reported previously. NLR more than 1.62 was an independent predictor of OSA. A simple, cheap white blood cell count may also give an idea about the presence and severity of OSA (Tab. 3, Fig. 3, Ref. 30).

Plasma oxytocin levels are reduced in Slovak autistic boys.

BACKGROUND: Obstructive sleep apnea (OSA) is characterized by reductions in breathing amplitude during sleep caused by an obstructed or collapsed upper airway. The neutrophil to lymphocyte ratio (NLR) has been proposed as a novel biomarker for systemic inflammatory response. The aim of the present study was to evaluate the relationship between NLR and OSA. METHODS: The study population consisted of 195 consecutive patients with clinical suspicion of OSA. Full night polysomnography was performed for all patients. Patients with an apnea hypopnea index (AHI) ≥ 5 were considered to have OSA. NLR was calculated as the ratio of neutrophil count to lymphocyte count. RESULTS: While 130 patients (91 male, mean age: 49.9 ± 9.8 years) had OSA, 65 patients (42 male, mean age: 48.7 ± 10.2 years) had normal findings according to AHI scores. Cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking were more common in patients with OSA. Patients with OSA had significantly higher NLR than controls (1.87 ± 0.80 vs 1.49 ± 0.48, p=0.005). AHI score was significantly correlated with NLR (r=0.228, p=0.001). NLR and presence of hyperlipidemia were independent predictors of OSA (OR: 2.451, 2.850, p=0.001, 0.004, respectively). NLR of 1.62 or higher predicted OSA with a sensitivity of 56.2 % and specificity of 63.1 %. CONCLUSIONS: NLR was higher and also correlated with AHI score in patients with OSA which has not been reported previously. NLR more than 1.62 was an independent predictor of OSA. A simple, cheap white blood cell count may also give an idea about the presence and severity of OSA (Tab. 3, Fig. 3, Ref. 30).

The use of low dose plain solutions of local anaesthetic agents for spinal anaesthesia in the prone position: bupivacaine compared with levobupivacaine.

In this study, we aimed to test the hypothesis that 1-ml plain solution of 0.5% bupivacaine or 0.5% levopubivacaine administered in a subarachnoid block can provide adequate anaesthesia and operating conditions for pilonidal cyst/sinus operations performed in the prone position. There were no significant differences between the two groups in terms of patient demographic data, duration of operation, patient-surgeon satisfaction, haemodynamic changes and side effects. There were no significant differences found in the onset time, highest block level achieved, two segment regression, time to S(2) regression of sensory block and the number of anaesthetised dermatomes, between the two groups (p = 0.077, 0.057, 0.091, 0.084 and 0.057 respectively). The incidence of complete motor blockade was 16% and 8% in Group B at the start and at the end of the operation. There was no complete motor blockade in Group L (p = 0.110 and 0.490 respectively). We conclude that both regimens are effective and safe for use in subarachnoid anaesthesia for pilonidal cyst/sinus operations performed in the prone position.

Temperament and character profile of patients with psoriasis.

BACKGROUND: Psychosocial factors have been implicated as being important in the onset and/or exacerbation of psoriasis.(1) The aim of this study is to examine both the personality factors of patients with psoriasis and the correlations between temperament and character dimensions. MATERIAL AND METHODS: A total number of 105 psoriasis patients and 109 healthy individuals were enrolled in the study. Questionnaires including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Temperament and Character Inventory (TCI) were administered individually. Both groups were evaluated in terms of depression, anxiety and characteristic features by using these psychological tests and compared statistically. The relationship between psoriasis area and severity index (PASI) score and the BDI, BAI and TCI scales were also evaluated. RESULTS: The mean BDI score of the psoriasis group were significantly higher than the control group. The psoriasis group had significantly higher scores of harm avoidance and lower scores of being self-directedness than the control group. The duration of psoriasis and the PASI scores were not correlated with BDI and BAI scores. CONCLUSION: The current study shows that psoriasis patients have distinctive temperament and character dimensions when compared with the control group. We suggest that evaluation and treatment of psoriasis should also include psychosomatic approaches in clinical practice.

The prevalence of fibromyalgia in women aged 20-64 in Turkey.

OBJECTIVE: The objectives of this study were to determine the prevalence of fibromyalgia syndrome (FMS) in women aged 20-64 in the city of Trabzon, Turkey, and to evaluate associated demographic variables. METHODS: A minimum of 1825 subjects eligible for the study was calculated, and 2000 subjects were eventually planned for inclusion. Of these, 1930 subjects participated in the screening phase (a participation rate of 96.5%). The screening protocol included several interview items that have been defined as components of FMS. Subjects were also asked questions concerning demographics. Individuals with positive screening results were invited to be examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS using the 1990 American College of Rheumatology (ACR) classification criteria. RESULTS: Seventy of the 1930 women were diagnosed with FMS. The prevalence of fibromyalgia was 3.6% (95% CI 2.8-4.4). The prevalence was highest in the 50-59 age group (10.1%, 95% CI 8.8-11.4), in the uneducated (10.7%, 95% CI 9.3-12.1), in the widowed (8.8%, 95% CI 7.5-10.1), and in subjects with an annual household income of < USD 2000 (7.3%, 95% CI 6.1-8.5). CONCLUSION: This cross-sectional study is the first report of the prevalence of FMS in Turkey. These data will assist decision-making in the health system.