The usability of MCP-1, fetuin-A, TAS, and TOS levels in the diagnosis of acute myocardial infarction.

OBJECTIVE: Our aims were to determine whether the levels of plasma monocyte chemotactic protein-1 (MCP-1), fetuin-A, serum total antioxidant status (TAS), and serum total oxidant status (TOS) are cardiac biomarkers and to clarify their relationship with each other in acute myocardial infarction (AMI). PATIENTS AND METHODS: The study included 90 participants: 60 patients with AMI [30 with and 30 without ST-segment elevation myocardial infarction (STEMI)] and 30 cardiac patients without AMI. The diagnostic values of serum Hs-cTnT, MCP-1, fetuin-A, TAS, and TOS levels in predicting AMI were evaluated statistically. RESULTS: Median levels of MCP-1 [120.10 ng/L (interquartile range: 76.94-230.54 ng/L)] and TOS [2.89 U/MI (IQR: 2.31-3.94 U/Ml)] were statistically higher, and median levels of fetuin-A [433.52 mg/L (IQR: 387.89-584.49 mg/L)] and TAS (3.10 ± 0.86 U/mL) were lower in patients with AMI than in controls. The parameter with the area under the curve (0.815), sensitivity (73.3%), and specificity (66.7%) closest to those of Hs-cTnT was fetuin-A, followed by MCP-1, TOS, and TAS, respectively. A one-unit increase in MCP-1 levels increased the probability of AMI by 1.023 times (p = 0.002). A one-unit increase in fetuin-A levels decreased the probability of AMI by 0.995 times (p = 0.003). A one-unit increase in serum TOS levels was 1.29 times more characteristic of STEMI than of NSTEMI (p = 0.044). CONCLUSIONS: MCP-1, oxidative stress parameters, and fetuin-A might support Hs-cTnT levels in the early diagnosis of AMI. Fetuin-A and MCP-1 levels may be independent risk factors for AMI, whereas TOS could be used to distinguish STEMI from NSTEMI.

Clinical features and predisposing factors of delirium due to COVID-19 pneumonia in intensive care units.

OBJECTIVE: Delirium is an acute disorder in which attention, perception, memory, thought, mood, psychomotor activity and sleep-wake cycles change rapidly. Delirium is also a common clinical syndrome in patients hospitalized in intensive care units due to COVID-19 pneumonia. We reviewed clinical features and predisposing factors of delirium according to psychomotor subtype in patients hospitalized in the intensive care units due to COVID-19 pneumonia. PATIENTS AND METHODS: 64 patients who were hospitalized in the intensive care units due to COVID-19 pneumonia were included. Delirium status and psychomotor subtype were determined by applying the Confusion Assessment Method for the Intensive Care Unit scale to the patients daily. The gender, age, comorbidity, treatments, intubation, and mortality rates of the patients were recorded. Multivariate analyses were performed by examining predisposing factors, arterial blood gases, hemograms, biochemistry, and brain magnetic resonance imaging. RESULTS: There were 64 patients in delirium clinic, 65.6% (n=42) of them were male. Hypokinetic delirium was more common in 60.9% (n=39). 79.4% of the patients who received ventilator support were male (p=0.013).When mortality was analyzed in this group, hypoactive delirium was found to be significantly higher (p=0.035). In addition, leukocyte levels were higher in patients with hypokinetic delirium (p=0.029). Ferritin and fibrinogen levels were higher in patients with hyperkinetic delirium (p=0.039, p=0.008, respectively). CONCLUSIONS: The presence of additional diseases such as advanced age, male gender, hypertension, coronary artery disease, dementia, and hypoxia were factors that increased the frequency of delirium. In addition, the mortality rate was higher in patients with hypokinetic delirium.

Comparison of the therapeutic efficacy of topical tranexamic acid, epinephrine, and lidocaine in stopping bleeding in non-traumatic epistaxis: a prospective, randomized, double-blind study.

OBJECTIVE: Nasal packing is used to stop bleeding in cases of epistaxis. Different topical drugs are preferred to these packs in the emergency department. In this study, we aimed to compare the efficacy of lidocaine, epinephrine and tranexamic acid (TXA) in stopping bleeding in patients with epistaxis. PATIENTS AND METHODS: Patients with non-traumatic epistaxis were evaluated in three treatment groups as topical lidocaine, epinephrine, and TXA. These treatments were applied prospectively in a double-blind manner and randomized manner. The bleeding stop times of the patients were recorded with bleeding time parameters. RESULTS: A total of 108 patients were included in the study. The mean age of the patients was 55.7±17.7 years. When the bleeding stop times were compared between the groups, there was no statistically significant difference (lidocaine vs. epinephrine, p=0.870; lidocaine vs. TXA, p=0.502; and epinephrine vs. TXA, p=0.242). The systolic blood pressure value statistically significantly differed between the lidocaine and epinephrine groups (p=0.034) and between the epinephrine and TXA groups (p=0.003). There was also a statistically significant difference between the diastolic blood pressure values of the epinephrine and TXA groups (p=0.020). CONCLUSIONS: We found that nasal packing with lidocaine, epinephrine and TXA was not superior to each other in terms of stopping bleeding time.

Long-term treadmill exercise upregulated hippocampal learning-related genes without improving cognitive behaviour in socially isolated rats.

BACKGROUND: Some environment enrichments such as exercise has been reported to improve the diminished cognitive functions and related gene expression. Therefore, we aimed to investigate the effects of prolonged treadmill exercise on long-term learning and hippocampal gene expression, which involves learning and plasticity. MATERIALS AND METHODS: Male Wistar rats (n = 32) randomly assigned into four groups: control (C), social isolation (SI), exercised (E), social isolation + exercise (SE) during postnatal days (PNDs) 21-34. Social isolation protocol was applied during 14 days by placing the rat alone in a cage. Rats were exercised daily, 5 days per week, for overall 4 weeks. Finally, learning performance was evaluated by the novel object recognition test. At the end of learning test, the rats were decapitated to isolate hippocampus tissues for learning related gene expression such as N-methyl-d-aspartate receptor (NMDAR) subunit genes (Grin1, Grin2a, Grin2b) and cyclin dependent kinase 5 (Cdk5), Cdk5 regulatory subunit p35 (Cdk5r), activity-regulated, cytoskeletal-associated protein (Arc), the immediate early gene (c-Fos, a marker of neuronal activation), doublecortin (DCX), achaetescute homolog 1 (ASCL1), brain-derived neurotrophic factor (BDNF) by real-time polymerase chain reaction (RT-PCR). RESULTS: Grin1, NMDAR subunit gene expression was increased significantly in E group compared to other groups. Grin2b, NMDAR subunit gene expression was increased in E group compared to the SI group. Cdk5 level increased in E group compared to the SE group. The ASCL1 gene expression increased in E group compare to the SE group. The DCX gene expression increasing in C group compared to SI and SE groups. CONCLUSIONS: Taken together these findings may point out that long-term social isolation down-regulated learning-related genes. However, treadmill exercise together with social isolation did not restore this down-regulation although treadmill exercise increased learning-related genes without improving cognitive behaviour.

Comparing the interpretation of emergency department computed tomography between emergency physicians and attending radiologists: A multicenter study.

INTRODUCTION: Computed tomography (CT) interpretation in the emergency department is one of the vital issues that should be carried out rapidly and accurately. The objective of this study was to examine the interpretation accuracy of emergency physicians (EPs) regarding CT scans at the emergency department for traumatic and nontraumatic purposes. MATERIALS AND METHODS: The study that was carried out as a prospective, observational study was completed at four centers during 1 year. RESULTS: Accuracy ratios of CT interpretations of EP regarding cranial injuries, thoracic injuries and vertebral spine injuries are above 95% in addition to the fact that the concordance's with the final result are perfect, the concordance with the final results of the CT interpretations of EP for abdominal injuries was moderate (<0.75). Accuracy ratios of the CT interpretations of EP for nontrauma patients were above 90% for brain hemorrhage and chest injuries and that the concordance with the final results was perfect (≥0.75). The CT interpretation accuracy rates of EP for spontaneous pneumothorax and aortic aneurysm/aortic dissection cases were 100%. CT interpretation rate of EP for pulmonary embolism was 89.4%, whereas the level of concordance with the final results was moderate (<0.75). Whereas the CT interpretation accuracy rates of EP for nontraumatic abdominal injuries varied between 83.3% and 93.1%, their levels of concordance with the final results were moderate (<0.75). CONCLUSIONS: The CT interpretations for abdominal traumatic patients in addition to pulmonary embolism and acute nontraumatic abdominal injuries should be carried out more carefully.

Comparison of infracondylar versus subsartorial approach to saphenous nerve block: A randomized controlled study.

BACKGROUND AND OBJECTIVES: Only a few different approaches are currently utilized for saphenous nerve block. Our study aimed to compare two different ultrasound (US)-guided saphenous nerve blocks and designed this study to test the hypothesis that the medial infracondylar approach has more success rate than the subsartorial approach applied in saphenous nerve blockage. METHODS: The study included 76 patients (18-65 years old) with the American Society of Anesthesiologists physical status of I-III, who were scheduled for below-knee surgery by the orthopedics clinic. The patients who underwent US-guided saphenous nerve blockade were randomly divided into two groups: Group S (subsartorial approach) and Group M (medial infracondylar approach). For all patients who had a block procedure, the pinprick test was performed using a blunt needle on the saphenous nerve dermatome. Success rate, time of block performance (TBP), onset time of block (OTB), and duration of sensory blockade (DSB) were recorded using a patient follow-up form. RESULTS: The US-guided saphenous nerve block success rate was similar (88% vs. 91%) or both techniques. The DSB values were 415.2 ± 65.3 min (95% confidence interval [CI]: 286.3-539.8) for Group S and 369.7 ± 52.2 min (95% CI: 265.6-467.8) for Group M (P = 0.04), and no significant differences in the TBP and OTB were observed between the groups. CONCLUSION: Both of the different anatomical approaches have equally high success rates. Although the DSB was found to be significantly longer in the subsartorial approach, this is clinically unimportant, and the medial infracondylar approach is still a viable alternative technique during saphenous nerve blockage.

To compare aneuploidy rates between ICSI and IVF Cases.

INTRODUCTION: Intracytoplasmic sperm injection (ICSI) currently helps many couples with male infertility. However, ICSI procedure may cause asynchronous sperm decondensation. This could introduce a risk for aneuploidy. The ICSI technique also could cause damage to the second meiotic spindle during injection and cause significantly abnormal pairing of chromosomes when compared with In vitro fertilization (IVF). In this study, we have examined whether ICSI has a higher incidence of aneuploidy when compared with IVF. MATERIAL AND METHODS: A retrospective study was conducted on 36 individuals. Common numbers of chromosome abnormalities were detected using fluorescent in-situ hybridization (FISH). Seven probes were used to detect chromosome X, Y, 13, 16, 18, 21, and 22. Chi-square test was used for statistical analysis and presented as odd ratios with confidence intervals. RESULTS: The age range was 26 through 44 (mean age 35.5) for IVF and 25 through 46 (mean age 35.8) for ICSI. From the 36 egg retrievals, 57 embryos were obtained from nine individuals using IVF and 183 embryos were obtained from 27 individuals using ICSI. For the IVF group, 37 of the 57 examined embryos were abnormal (65%), whereas 128 of 183 examined embryos were abnormal for the ICSI group (69.9%). Among the 57 embryos from the IVF cases, the number of absolute abnormal chromosomes were as follows: X&Y chromosomes: 4 (12.9%), chromosome 13: 9 (29%), chromosome 16: 7 (22.5%), chromosome 18: 6 (19.3%), chromosome 21: 8 (25.8%), chromosome 22: 10 (32.2%). For the ICSI embryos: X and Y chromosomes: 18 (14%), chromosome 13: 34 (26.5%), chromosome 16: 23 (18%), chromosome 18: 23 (18%), chromosome 21: 26 (20.3%), chromosome 22: 31 (24.2%). The odds ratios for the difference between IVF and ICSI for each chromosome were as follows: X&Y chromosomes: 1.53 (0.598-3.916), chromosome 13: 0.969 (0.443-2.122), chromosome 16: 0.709 (0.307-1.639), chromosome 18: 1.650 (0.650-4.188), chromosome 21: 0.777 (0.350-1.724), chromosome 22: 0.647 (0.311-1.348). Overall no significant difference between two insemination procedures was seen 0.948 (0.678-1.324). CONCLUSIONS: As a result; ICSI does not create a significantly higher aneuploidy number when compared with IVF as examined by FISH analysis of seven chromosome pairs.

Evaluation of the Safety of Drugs and Biological Products Used During Lactation: Workshop Summary.

This report serves as a summary of a 2-day public workshop sponsored by the US Food and Drug Administration (FDA) to discuss the safety of drugs and biological products used during lactation. The aim of the workshop was to provide a forum to discuss the collection of data to inform the potential risks to breastfed infants with maternal use of medications during lactation. Discussions included the review of current approaches to collect data on medications used during lactation, and the considerations for future approaches to design and guide clinical lactation studies. This workshop is part of continuing efforts to raise the awareness of the public for women who choose to breastfeed their infants.

Maintenance of the parturient in the left lateral position after spinal anesthesia with plain levobupivacaine for cesarean section reduces hypotension: a randomized study.

PURPOSE OF INVESTIGATION: Hypotension during spinal anesthesia is a main concern in cesarean delivery. The authors hypothesized that keeping parturients in a prolonged left lateral position before turning them to a supine position with left lateral tilt would reduce the incidence of hypotension without jeopardizing the quality of anesthesia. MATERIALS AND METHODS: Randomized comparative unblinded prospective study. This randomized comparative prospective study was conducted at Gaziantep University Hospital between June and December 2011. Sixty parturients undergoing cesarean section were included. Patients were randomized to two groups: turning to the supine position with left lateral tilt immediately or 15 minutes after subarachnoid injection of 2.5 ml 0.5% plain levobupivacaine in the left lateral position. Loss of pinprick sensation to T6 was accepted as adequate for cesarean section, and surgery proceeded. Characteristics of anesthesia; incidences of hypotension, bradycardia, and other adverse events, and ephedrine use were assessed. RESULTS: Compared with the supine group, parturients kept in a lateral position for 15 minutes showed marked reductions in the incidence of hypotension (33.3% vs. 83.3%, p < 0.001) and adverse events related to hypotension, such as nausea and vomiting (16.7% vs. 57.3%, p <0.001). In addition, ephedrine consumption per hypotension case was significantly reduced in the lateral group (5.4 ± 4.7 vs. 8.9 ± 5.8 mg; p < 0.00 1). CONCLUSIONS: Keeping parturients in the lateral position for 15 minutes before turning them to the supine position for cesarean section can provide reliable spinal anesthesia with a lower incidence and severity of hypotension and nausea/vomiting.

Medication use in pregnancy and the pregnancy and lactation labeling rule.

On 30 June 2015, the US Food and Drug Administration Pregnancy and Lactation Labeling Rule (PLLR) took effect. This rule sets new and improved standards for the inclusion of information about the use of prescription drugs and biological products during pregnancy and lactation. The new labeling requirements have important implications for clinical pharmacology as there is a subheading that is dedicated to inclusion of clinical pharmacology information that inform dosing during pregnancy and the postpartum period, if available.

Nasolacrimal duct intubation in the treatment of congenital nasolacrimal duct obstruction in older children.

PurposeThe purpose of this study was to investigate the outcomes of nasolacrimal duct intubation in the primary treatment of congenital nasolacrimal duct obstruction (CNLDO) in children aged 7 years and older.MethodsThirty children aged ≥7 years who underwent primary unilateral nasolacrimal duct intubation because of CNLDO were enrolled in this study. CNLDO diagnosis was based on signs and symptoms including typical epiphora, increased tear meniscus, recurrent or persistent mucopurulent discharge, and an abnormal dye disappearance test (DDT). Surgical success was defined as complete resolution of previous signs and symptoms and DDT grade 0-1.ResultsThe mean age was 10.7±2.5 years (ranging from 7 to 15 years). Of the 30 patients, 18 were male and 12 were female. The mean follow-up period was 8.8±3.4 months (ranging from 6 to 16 months). The mean silicone tube removal time was 4.6±1.1 months (ranging from 3 to 6 months). The complete resolution of signs and symptoms with DDT grade 0-1 was observed in 22 of 30 cases (73.3%) during the follow-up period. The mean age of the patients with unsuccessful outcomes was 12.7±1.4 years, whereas that of the patients with successful outcomes was 10.0±2.4 years, and the difference was statistically significant (P=0.006). No serious intra- and/or post-operative complication was observed.ConclusionsThe current study demonstrates that nasolacrimal duct silicone intubation with intranasal endoscopic visualization has favorable outcomes as a primary treatment of persistent CNLDO in children aged 7 years and older. It can be used to reduce the need for dacryocystorhinostomy which is a more invasive procedure.

Migraine management in pregnancy.

In spite of the fact that migraines are one of the major problems seen by primary care providers, almost half of people with migraines do not obtain appropriate diagnosis or treatment. Migraine occurs in about 18% of women, and is often aggravated by hormonal shifts occurring around women's menses, during pregnancy, and during perimenopause. Quality of life with migraines is often greatly diminished, and many women miss work days with migraines. In women, the hormonal fluctuations seen during pregnancy and lactation can affect migraine frequency and magnitude. Understanding the evaluation of headache in pregnancy is important, especially given the increased risk of secondary headache conditions. Pregnancy and lactation can complicate treatment options for women with migraine because of the risk of certain medications to the fetus. This review includes details of the workup and then provides treatment options for migraine during pregnancy and lactation.

Troponin I and D-Dimer levels in preeclampsia and eclampsia: prospective study.

OBJECTIVE: The aim of this study was to evaluate serum cardiac troponin I and D-Dimer (D-Di) levels in preeclampsia (PE), eclampsia (E), and normotensive healthy pregnant women in third trimester in order to define their diagnostic value. MATERIALS AND METHODS: The study group consisted of 42 preeclamptic patients and 16 eclamptic patient; 108 healthy normotensive pregnant women in third trimester who were chosen from outpatients clinic and examined regularly used as a control group. Serum cardiac troponin I and D-Di levels were measured using an immunoassay. RESULTS: The average levels of troponin I were 0.0134 ± 0.0091, 0.017 ± 0.0085, 0.180 ± 0.136 in control group, preeclamptic, and eclamptic patients, respectively. The levels of troponin in eclamptic patients were statistically higher than the normotensive and preeclamptic group (p = 0.016, p = 0.014). There were no differences in terms of troponin I level between preeclamptic group and normotensive pregnant women in third trimester (p = 0.089). The average D-Di levels were 634 ± 228 ng/ml, 1426 ± 430 ng/ml, 2067 ± 580 ng/ml in control group, preeclamptic, and eclamptic patients, respectively. The levels of D-Di in preeclamptic and eclamptic patients were found significantly higher than the control groups (p = 0.034, p = 0.020). CONCLUSION: Serum troponin I levels increased in eclamptic patient because of myocardial damage. An increased level of troponin was not detected in preeclamptic patients. However; D-Di level increased in preeclamptic and eclamptic patients.

Rectus abdominal muscle endometriosis in a patient with cesarian scar: case report.

Endometriosis is the existence of endometrial tissue out of the intrauterine cavity. Abdominal wall endometrioma is a well-defined mass composed of endometrial glands and stroma that may develop after gynecologic and obstetrical surgeries. A cyclic painful mass at the site of a cesarean section scar is most likely due to an endometrioma, and wide local excision is the advisable treatment. The authors present a case of endometrioma in the abdominal wall, which was treated with local excision.

Comparison of propofol/ketamine versus propofol/alfentanil for dilatation and curettage.

BACKGROUND AND OBJECTIVES: The use of propofol with an analgesic agent is probably the principal technique for the induction of anesthesia for dilatation and curettage (D&C) at the present time. We designed a randomized, double-blind study to compare the clinical efficacy of ketamine and alfentanil when combined with propofol for short-lasting anesthesia during D&C. METHODS: The study included 60 patients scheduled for D&C. Either alfentanil 10 microg/kg(-1) IV (Group A) or ketamine 0.5 mg/kg(-1) IV (Group K) were given to each patient with propofol 0.7 mg/kg(-1) IV for anesthesia induction. Surgeon and patient satisfaction, Aldrete score, Verbal Pain Scale rating, total propofol dose, orientation time, and adverse events such as bradycardia, hypotension, nausea, and vomiting were evaluated. RESULTS: In Group A orientation time was significantly shorter and propofol consumption significantly lower than in Group K. CONCLUSIONS: Both alfentanil/propofol and ketamine/propofol combinations provide reliable and effective hypnosis and analgesia; however, the ketamine/propofol combination leads to higher consumption of propofol and results in a longer orientation time than the alfentanil/propofol combination.

Bone mineral density in patients with stroke.

OBJECTIVE: Stroke is an acute neurologic dysfunction of vascular origin, characterized by loss of voluntary movement, sensory disturbances, and neurologic findings in the contralateral half of the body. Acute and long-term complications because of immobilization are seen in all organ systems. The aim of this study was to determine any differences between the affected and unaffected sides' bone mineral densities of acute and chronic stroke patients. DESIGN: In this study, we determined the bone mineral densities (BMD) of 30 male patients with acute (0-20 days) and 30 male patients with chronic (6 months or longer) stroke and compared the densities with the normal side. Upper and lower limb BMDs were measured by dual-energy x-ray absorptiometry. Additionally, patients were evaluated for the degree of spasticity, the phases of motor improvement, and the activities of daily living. RESULTS: In acute-phase stroke patients, BMD of the affected side was not significantly different from BMD of the normal side. BMD of both upper limbs of acute stroke patients was not different from normal side upper limb BMD of chronic stroke patients. In both acute and chronic stroke patients, affected and unaffected side lower limb BMDs (femur total BMD scores) were not significantly different. However, in chronic stroke patients, affected side BMD of Ward's region was significantly higher compared with the normal side. There is no correlation between BMD and Brunnstrom phases, Ashworth scales, and the degree of activities of daily living. CONCLUSIONS: Higher BMD of the affected side Ward's region in chronic cerebrovascular accident patients may be related to spasticity and changes in walking pattern, which increase the mechanical stress loading of the Ward's region.