Evaluation of interferon gamma release assay to measure t-cell response in COVID-19 patients from intensive care units and inpatient departments.

BACKGROUND: Interferon gamma release assay (IGRA) is an in vitro blood test to measure interferon gamma (IFN-γ) released from antigen-specific T cells after stimulation with pathogen-specific peptides. In this study, it was aimed to investigate the T-cell response using IGRA and to compare various laboratory values in Coronavirus Disease (COVID-19) patients hospitalized either in hospital inpatient departments or in intensive care units. METHODS: A total of 100 patients (50+50) who were identified as positive for COVID-19 through the molecular method in Selcuk University Faculty of Medicine Infectious Diseases Service and Reanimation Intensive Care Unit were included in the study. IFN-γ levels in blood samples collected from patients were determined using the QuantiFERON Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) (QIAGEN, Germany) kit. The patients' gender, age, c-reactive protein (CRP), aspartate aminotransferase (AST), alanine transaminase (ALT), interleukin (IL)-6, lymphocyte count, procalcitonin, and D-dimer results were obtained from the hospital automation system. RESULTS: Thirty-eight of the IGRA test results were negative, 44 were positive and 18 were inconclusive. The age of patients with negative IGRA test results was significantly higher (p<0.001) compared to patients with positive results. There were no significant differences between patients' IGRA test results and gender, prognosis, IL-6, lymphocyte counts, CRP, AST, and ALT values.Age, death rates, D-dimer, CRP, procalcitonin, AST and ALT values of patients hospitalized in the intensive care unit were significantly higher (p<0.001) compared to the those hospitalized in the inpatient department, while conversely, the lymphocyte values were lower (p<0.001). CONCLUSION: The relatively higher IGRA negative results in the elderly, negative and intermediate results in intensive-care patients, and low lymphocyte levels in intensive-care patients indicate that the cellular immune response is diminished and/or absent. The death rates, D-dimer, CRP, procalcitonin, AST and ALT values of the patients hospitalized in the intensive care unit were higher compared to those from the in-patient department, indicating the severity of inflammation and signaling the development of organ failure. In the light of these findings, we suggest that IGRA tests may serve as a guide in immunomodulatory therapy (Tab. 2, Fig. 2, Ref. 27). Text in PDF www.elis.sk Keywords: COVID-19, interferon gamma release assay test, T cell response.

The use of granisetron on bupivacaine induced sciatic nerve block in rats.

PURPOSE: The effects of the 5-hydroxytryptamine (5-HT3) receptor antagonists on regional anaesthesia are complex and unclear. The present study was designed to test the hypothesis that granisetron, a selective 5-HT3 receptor antagonist, would decrease the duration of motor block, sensory block, and proprioception in a dose-dependent fashion in a rat model of bupivacaine-induced sciatic nerve blockade. MATERIALS AND METHODS: Thirty-eight male Wistar Albino rats that received unilateral sciatic nerve blocks were randomly divided into five experimental groups. Group B received a perineural of 0.3 ml of bupivacaine alone; Group BG800 received perineural 0.3 ml of bupivacaine and 800 µg of granisetron 10 min later; Group BG1200 received perineural 0.3 ml of bupivacaine and 1200 µg of granisetron 10 min later; Group BG1200IP received a perineural 0.3 ml of bupivacaine and an intraperitoneal injection of 1200 µg of granisetron 10 min later; and Group S was sham operated. A blinded investigator assessed motor, sensory and proprioception function every 10 min until the return of normal function. RESULTS: The medians for recovery times in Group B, Group BG800, Group BG1200, and Group BG1200IP were 105, 64, 85, and 120 min for motor function, respectively; 80, 64, 84, and 104 min for sensory function; 80, 63, 85, and 108 min were calculated for the proprioception function. The time to the return of normal motor, sensory, and proprioception function was not statistically significantly different between the groups (p > 0.05). Motor block did not develop in any of the rats in Group S. CONCLUSIONS: Local and systemic application of granisetron was not significantly decrease the duration of bupivacaine induced motor, sensory, and proprioception block of sciatic nerve in rat.

Autoantibodies against type I IFNs in humans with alternative NF-κB pathway deficiency.

Patients with autoimmune polyendocrinopathy syndrome type 1 (APS-1) caused by autosomal recessive AIRE deficiency produce autoantibodies that neutralize type I interferons (IFNs)1,2, conferring a predisposition to life-threatening COVID-19 pneumonia3. Here we report that patients with autosomal recessive NIK or RELB deficiency, or a specific type of autosomal-dominant NF-κB2 deficiency, also have neutralizing autoantibodies against type I IFNs and are at higher risk of getting life-threatening COVID-19 pneumonia. In patients with autosomal-dominant NF-κB2 deficiency, these autoantibodies are found only in individuals who are heterozygous for variants associated with both transcription (p52 activity) loss of function (LOF) due to impaired p100 processing to generate p52, and regulatory (IκBδ activity) gain of function (GOF) due to the accumulation of unprocessed p100, therefore increasing the inhibitory activity of IκBδ (hereafter, p52LOF/IκBδGOF). By contrast, neutralizing autoantibodies against type I IFNs are not found in individuals who are heterozygous for NFKB2 variants causing haploinsufficiency of p100 and p52 (hereafter, p52LOF/IκBδLOF) or gain-of-function of p52 (hereafter, p52GOF/IκBδLOF). In contrast to patients with APS-1, patients with disorders of NIK, RELB or NF-κB2 have very few tissue-specific autoantibodies. However, their thymuses have an abnormal structure, with few AIRE-expressing medullary thymic epithelial cells. Human inborn errors of the alternative NF-κB pathway impair the development of AIRE-expressing medullary thymic epithelial cells, thereby underlying the production of autoantibodies against type I IFNs and predisposition to viral diseases.

The comparison of ultrasound-guided ilioinguinal/iliohypogastric nerve block and pre-incision wound infiltration for pediatric inguinal hernia repair: A prospective randomized clinical study.

OBJECTIVES: Inguinal hernia repair is one of the most common daily surgeries performed in pediatrics. This prospective randomized clinical trial aims to compare ultrasound (USG)-guided ilioinguinal/iliohypogastric (IL/IH) nerve block and pre-incisional wound infiltration (PWI) in terms of post-operative analgesia on pediatric unilateral inguinal hernia repair. METHODS: After receiving ethics committee approval, 65 children aged 1-6 years who had unilateral inguinal hernia repair were allocated to USG-guided IL/IH nerve block (group IL/IH, n=32) and (group PWI, n=33). In both groups, 0.5 mg/kg 0.25% bupivacaine+2% prilocaine mixture was used by calculating the volume as 0.5 mL/kg for the block and infiltration. The primary outcome was to compare both groups' post-operative Face, Legs, Activity, Cry and Consolability (FLACC) scores. The secondary outcomes included the time to first analgesic request and the total acetaminophen consumption. RESULTS: The FLACC pain scores at the 1st, 3rd, 6th, and 12th h were statistically significantly lower in group IL/IH than in group PWI (p=0.013, p<0.001, p<0.001, and p=0.037, respectively) (p<0.001). There was no difference between the groups at the 10th and 30th min and at 24 h (p=0.472, p=0.586, and p=0.419, respectively) (p>0.05). CONCLUSION: USG-guided IL/IH nerve block in pediatric patients with inguinal hernia repair was found to be superior to PWI in terms of lower pain scores, less additional analgesia requirement, and longer first analgesia requirement.

Effect of Obesity on the Recovery Profile After General Anesthesia in Children: A Prospective Cohort Study.

BACKGROUND: Obesity has become a serious problem not only in adult patients but also in pediatric patients. AIM: To evaluate whether obesity affects the recovery profile after general anesthesia in children. PARTICIPANTS: 40 children (aged 2-12 years) who underwent surgery under general anesthesia and had an American Society of Anesthesiologists (ASA) physical I and II. METHODS: This prospective cohort study was conducted over a period of 3 months (January- April, 2021). The patients were divided into two groups according to body mass index (BMI): Group I comprised obese children (BMI ≥95th for age percentile) (n=20) and Group II comprised children with a normal BMI (25-75th for-age percentile) (n=20). Anesthesia induction and maintenance were performed as per standard guidelines in both the groups. OUTCOME: The recovery profile was evaluated with the following parameters: time to spontaneous ventilation, laryngeal mask airway removal time, time to open eyes, and post-anesthesia care unit discharge time. RESULTS: When the recovery profiles were compared, no significant differences were found between the groups. Time to spontaneous ventilation [mean difference (95% CI); 0.66 (0.09-1.42); P=0.085], laryngeal mask airway removal time [MD (95% CI); 1.12 (0.06-2.22); P=0.057), time to open eyes [MD (95% CI) 0.66 (0.40-1.74); P=0.217], and post-anesthesia care unit dis-charge time [MD (95% CI) 3.60 (0.59-7.25); P=0.054] were higher in Group II; however, these differences lacked both statistical and clinical significance. CONCLUSION: The results suggest that obesity has no effect on the recovery profile after general anesthesia in children in our setting.

Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units.

BACKGROUND: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. AIMS: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. STUDY DESIGN: Retrospective, observational cohort. METHODS: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. RESULTS: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). CONCLUSION: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

Estimating the Lumbar Puncture Needle Depth in Children.

Background: Lumbar puncture's (LP) success is dependent on the skill of the physician, anatomy, size, and posture of the patient. Aims: The purpose of this study was to describe a method that could be used to help estimate the correct depth of needle (Y) insertion in children based on age, weight (W), and height (H). Methods: The study consisted of 200 children American Society of Anesthesiologist class I-II aged 0-12 years who underwent spinal block for orthopedic, pediatric, and genitourinary surgery. The distance from the skin entry point to the tip of the spinal needle was measured after the LP was performed. The relationship between the Y and W, H and body mass index (BMI) was calculated. Predictive statistical models were used to determine the LP needle depth. A paired sample t-test was conducted to compare the findings of the developed model with those of earlier models. Results: The patients were aged 2-144 months, with H and W of 43-154 cm and 2.5-48 kg, respectively. The BMI was 10.75-37.72 kg/m2. Before the Y was estimated, the relationship between the independent variables and the depth variable, which was the dependent variable, was examined. According to the obtained results, the model consists of strong relationships with H, W, and H + W. The formula for predicting Y based on W plus H was as follows: for all patients: Y (cm) = 0.861 + 0.012 × H (cm) + 0.035 × W (kg). Based on H, the formula for predicting the required Y was as follows: For all patients: Y (cm) = 0.393 + 0.023 × H (cm). Based on W, the formula for predicting the required Y was as follows: For all patients: Y (cm) = 1.460 + [0.067 × W (kg)]. Conclusion: The formula may provide a more reliable estimate of the required LP depth in children than that obtained using current models. However, larger studies are needed to standardize the formula.

Postconditioning Ozone Alleviates Ischemia-Reperfusion Injury and Enhances Flap Endurance in Rats.

Introduction: Muscle-flap transferring is a routine approach utilized in reconstructive operations; however, flap morbidity is often a source of post-operative difficulty. Ischemia-Reperfusion Injury (IRI) is an important contributor to the viability of flaps after transferring. The goal of this research was for assess the probable useful impacts of ozone on flap survival in a rat muscle-flap design. Materials and Methods: We examined the effects of postconditioning ozone administration on viability of pedicled composite flaps. Twenty-eight Wistar rats were randomized into four groups: sham-operated (S), ischemia-reperfusion (IR), sham-operated + ozone (O), IR + ozone (IR + O), respectively. The animals were sacrificed on the eighth day. In a general histological evaluation, flap tissues were examined with a light microscope, and apoptotic cells were counted. The Apoptotic Index (AI) was then calculated. Flap-tissue samples were sent for analyses of malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and protein carbonyl (PCO), and blood samples were sent for analyses of Total Oxidant Score (TOS), and Total Antioxidant Capacity (TAC). Data were evaluated statistically using the Kruskal-Wallis test. Results: The histomorphometric score was remarkably greater in O (p = .002). The AI was greater in IR (p = .002). The antioxidant parameters values as regards SOD, GSH-Px, CAT, and TAC were found to be greater in O (p < .005). The oxidant parameters values as regards MDA, PCO, TOS were found to be greater in IR (p < .005). Discussion: The current research indicates that ozone application can attenuate the muscle-flap injury brought about by IR through triggering the increase of the antioxidant capacity.

Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after totalknee arthroplasty: a randomized clinical trial.

BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated withperiarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability. CLINICAL TRIAL REGISTRY: ACTRN-12618000438257.

Ultrasound-guided adductor canal block using levobupivacaine versus periarticular levobupivacaine infiltration after totalknee arthroplasty: a randomized clinical trial

ABSTRACT BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated withperiarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability. CLINICAL TRIAL REGISTRY: ACTRN-12618000438257.

Comparison of Glasgow Coma Scale and Full Outline of Unresponsiveness (Four) Score: A Prospective Study.

AIM: To assess reliability by comparing the Full Outline of Unresponsiveness (FOUR) scores and Glasgow Coma Scale (GCS) values assigned by specialists from two different fields to patients in the Anesthesiology and Reanimation and Neurosurgery intensive care units. MATERIAL AND METHODS: This study was conducted between March 2017 and June 2017 at Selcuk University Faculty of Medicine, Departments of Anesthesiology and Reanimation and Neurosurgery. Seventy-nine patients aged 18-65 years who were treated for at least 24 hours in the intensive care unit were independently assessed by two raters, an anesthesiologist and a neurosurgeon,using FOUR and GCS. The Kolmogorov-Smirnov normality test was applied for continuous variables, and SPSS 20.0 version software was used for data analyses. RESULTS: There were no significant differences between FOUR scores and GCS values given by the two raters. The mortality rate among patients with low scores on both FOUR and GCS was higher than the hospital mortality rate. CONCLUSION: Considering that FOUR score allows a more detailed neurological evaluation than GCS, and our findings suggest that FOUR score is more useful for patients who are unconscious or dependent on mechanical ventilation.

The Relationship Between Vasoactive-Inotropic Score and Mortality in Adult Patients with Traumatic Brain Injury.

AIM: To assess the feasibility of the vasoactive-inotropic score (VIS) in determining the amount of vasoactive support and its relationship with the mortality rate and characteristics of the patients with traumatic brain injury (TBI). MATERIAL AND METHODS: This study was conducted with a retrospective design involving the years 2013-2018 in a university hospital which provides tertiary intensive care service. A total of 102 patients who were admitted in the ICU with the diagnosis of severe TBI, and also were followed by neurosurgery service and who received vasoactive and inotropic support were analyzed concerning VIS value. RESULTS: The median age of the patients was 34 years, and 69.6% of the patients were male. Mortality rate was 43.1%. In the group with mean VISâ‰A10, the admission duration in the ICU and hospital were shorter (p < 0.0001) whereas mortality rates were higher (81.1% vs 21.5% and p < 0.0001). Besides, the number of patients with a VIS score of â‰A10, â‰A15 and â‰A20 were higher in the group of patients who died (p < 0.0001). The results of the multivariate analysis such as VISâ‰A10 were significant. CONCLUSION: We can conclude that VIS, which is used to determine the amount of vasoactive and inotropic medicines during cardiac surgery and in sepsis patients, may be useful in predicting mortality in TBI patients.

A comparative randomized trial of intubation success in difficult intubation cases: the use of a Frova intubation catheter versus a Bonfils intubation fiberoscope.

INTRODUCTION: A difficult airway is one of the main causes of morbidity and mortality in patients who undergo surgical interventions. Therefore, many devices and algorithms have been developed for the management of a difficult airway. However no study has been conducted comparing Frova catheter (FC) and a Bonfils fiberoscope (BF) to date. AIM: To compare the effectiveness and success of two devices, a FC and BF, in difficult intubation cases. MATERIAL AND METHODS: Design: Single-centre randomized controlled trial in patients with difficult airways. The assignment order was created by unplanned number charts, and the assignment was hidden in closed covers, which were not unlocked until case permission had been provided. Setting: The trial was undertaken in a university hospital in Turkey. The primary analysis was based on 60 participants (n = 30, n = 30) with difficult intubation. The main outcomes were the success rates of placement of the tracheal tube in the trachea and the duration of the tracheal intubation process. RESULTS: In the BF group, successful intubation was carried out in 25 of the 30 (83.3%) patients, whereas intubation was successful in 28 of the 30 patients (93.3%) in the FC group. Patients who could not be intubated with the first device were intubated with the other device. The mean duration of intubation was 109 (85-140) s in the BF group, whereas it was 38.8 (26-60) s in the FC group. CONCLUSIONS: Both devices were successful in difficult intubation cases. However, given the shorter duration of intubation using the FC and its lower cost as compared with that of the BF, the FC can be considered superior to the BF in difficult intubation cases.

Neostigmine treatment protocols applied in acute colonic pseudo-obstruction disease: A retrospective comparative study.

BACKGROUND/AIMS: When conservative methods fail, neostigmine is recommended in the pharmacological treatment of acute colonic pseudo-obstruction (ACPO). The objective of this study was to analyze the response of patients to different neostigmine protocols. MATERIALS AND METHODS: Patients diagnosed with ACPO in the intensive care unit between January 2015 and September 2017 were retrospectively studied. Either of the two neostigmine protocols, the bolus dose (BD) or continuous infusion (CI), was applied to the ACPO patients who were unresponsive to conservative treatments, and the results were analyzed. RESULTS: In 79 of 122 (64%) patients, the resolution of symptoms was observed with conservative treatments. Of 43 patients who did not respond to conservative treatments, 20 were applied neostigmine as BD, and 23 were applied by CI. A total of 55% of patients in the BD group and 60.9% patients in the CI group responded to neostigmine therapy after the first dose. The group-specific protocols were reapplied in patients unresponsive to the first dose. A total of 25% in the BD group and 8.7% in the CI group responded to the second dose treatment. As a result, 80% of patients from the BD group and 69.6% from the CI group responded to neostigmine therapy. Although an overall response rate was higher in the BD group, there was no significant difference between groups (P=0.322). Colonic complications were observed in 2 patients, 1 from each group. There were no major side effects requiring treatment cessation. CONCLUSION: The safety and effectiveness of both neostigmine protocols applied to ACPO patients were similar. Clinical and radiological responses were obtained without serious side effects with CI.

Ozone Prevents Cochlear Damage From Ischemia-Reperfusion Injury in Guinea Pigs.

The cochlea is an end organ, which is metabolically dependent on a nutrient and oxygen supply to maintain its normal physiological function. Cochlear ischemia and reperfusion (IR) injury is considered one of the most important causes of human idiopathic sudden sensorineural hearing loss. The aim of the present study was to study the efficacy of ozone therapy against cochlear damage caused by IR injury and to investigate the potential clinical use of this treatment for sudden deafness. Twenty-eight guinea pigs were randomized into four groups. The sham group (S) (n = 7) was administered physiological saline intraperitoneally (i.p.) for 7 days. The ozone group (O) (n = 7) was administered 1 mg/kg of ozone i.p. for 7 days. In the IR + O group (n = 7), 1 mg/kg of ozone was administered i.p. for 7 days before IR injury. On the eighth day, the IR + O group was subjected to cochlear ischemia for 15 min by occluding the bilateral vertebral artery and vein with a nontraumatic clamp and then reperfusion for 2 h. The IR group was subjected to cochlear IR injury. After the IR procedure, the guinea pigs were sacrificed on the same day. In a general histological evaluation, cochlear and spiral ganglionic tissues were examined with a light microscope, and apoptotic cells were counted by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. The apoptotic index (AI) was then calculated. Blood samples were sent for analyses of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase, malondialdehyde (MDA), the total oxidant score (TOS), and total antioxidant capacity (TAC). Data were evaluated statistically using the Kruskal-Wallis test. The AI was highest in the IR group. The AI of the IR + O group was lower than that of the IR group. The biochemical antioxidant parameters SOD and GSH-Px and the TAC values were highest in the O group and lowest in the IR group. The MDA level and TOS were highest in the IR group and lowest in the O group. Controlled ozone administration stimulated endogenous antioxidant defense systems, thereby helping the body to combat IR injury. Although this study revealed a statistically significant decrease in cochlear IR damage following ozone therapy, further studies will be necessary to explain the protective mechanisms of ozone therapy in cochlear IR injury.

A Novel and Modified Technique in the Prone Position for Radiotherapy Processes in Children.

The i-gel has a thick airway tube and occasionally, achieving the airway can be difficult because of obstruction in the prone position. The authors aimed at solving this problem and used a modified i-gel airway in the prone position for radiotherapy processes in children.