Sedoanalgesia for cardioversion: comparison of alfentanil, remifentanil and fentanyl combined with propofol and midazolam: a prospective, randomized, double-blind study.

OBJECTIVE: Electrical cardioversion (EC) is a short but painful procedure to restore sinus rhythm. The aim of this study is to compare the effect of fentanyl, remifentanil and alfentanil in association with propofol and midazolam for elective EC. PATIENTS AND METHODS: Ninety-nine patients older than 18-years, American Society of Anesthesiologists I/II/III grades undergoing elective EC were randomized into 3 groups. All patients received 2 mg midazolam and propofol (0.5 mg/kg). Group A received alfentanil (5 µg/kg i.v. bolus), Group F received fentanyl (0.5 µg/kg i.v. bolus) and Group R received remifentanil (0.25 µg/kg i.v. bolus). Hemodynamics and respiratory variables [Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), SpO2, respiratory rate (RR)], and Modified Aldrete recovery score (MARS) were assessed at six different time points (baseline, right after EC, and 3rd min, 5th min, 10th min, 30th min following EC). Also, induction times (time to reach RSS to 5) and recovery times (time to reach MARS to 8) were recorded. The incidence of respiratory depression, bradycardia, hypotension and adverse effects were also recorded. RESULTS: Hemodynamic variables were similar in all groups. SpO2 values in Group R were significantly lower at 3rd min (p = 0.005). Induction and recovery times were longest in Group F. There were significant differences at 3rd, 5th and 10th minute MARS values between groups. The incidence of hypotension and bradycardia were similar in all groups (p > 0.05) but respiratory depression was higher in Group R (p = 0.047). CONCLUSIONS: Propofol alfentanil combination has more beneficial advantages in their rapid onset, early recovery time and less respiratory depression than remifentanil and fentanyl.

Integrase Strand Transfer Inhibitors (INSTIs) Resistance Mutations in HIV-1 Infected Turkish Patients.

OBJECTIVES: Integrase strand transfer inhibitor (INSTI) is a new class of antiretroviral (ARV) drugs designed to block the action of the integrase viral enzyme, which is responsible for insertation of the HIV-1 genome into the host DNA. The aim of this study was to evaluate for the first time INSTI resistance mutations in Turkish patients. METHODS: This study was conducted in Turkey, between April 2013 and April 2015 using 169 HIV-1-infected patients (78 ARV naive patients and 91 ARV-experienced patients). Laboratory and clinical characteristics of ARV naive and ARV-experienced patients were as follows: gender (M/F): 71/7 and 80/11, median age: 38 and 38.4; median CD4(+) T-cell: 236 and 216 cells/mm(3), median HIV-1 RNA: 4.95+E5 and 1.08E+6 copies/ml. Population-based seqeunces of the reverse transcriptase, protease, and integrase domains of the HIV-1 pol gene were used to detect HIV-1 drug resistance mutations. RESULT: INSTI resistance mutations were not found in recently diagnosed HIV-1-infected patients. However, ARV-experienced patients had major resistance mutations associated with raltegravir and elvitegravir; the following results were generated:F121Y, Y143R, Q148R and E157Q (6/91 - 6.6%). CONCLUSIONS: The prevalence of INSTI resistant mutations in ART-experienced patients suggested that resistance testing must be incorporated as an integral part of HIV management with INSTI therapies.

Does the urea breath test predict eradication of Helicobacter pylori infection?

BACKGROUND AND AIM: Helicobacter pylori infection is common world-wide and has been linked to development of gastric and duodenal ulcers, gastric adenocarcinoma, and gastric lymphoma. However, antimicrobial resistance has decreased H. pylori eradication rates worldwide. This study aimed to evaluate the effect of -bacterial load on eradication rate. METHOD: This prospective study included 237 consecutive patients who presented to our institution with dyspeptic symptoms and underwent both upper endoscopy and urea breath tests (UBT). The patients were divided into three equal sized groups according to their UBT values. All subjects received a standard triple eradication regimen, followed by a bismuth- based quadruple eradication regimen if triple eradication was not successful. The three groups were compared with respect to age, endoscopic findings, sex, and eradication rates. RESULTS: Our results were consistent with those of previous studies : higher UBT values were associated with failure of standard 14-day triple treatment (p < 0.05). However, in patients who received a quadruple eradication regimen, differences between groups were not significant (p = 0.434). There was no relationship between UBT values and gastric pathologies (p = 0.751). Age and sex also did not differ significantly between groups (p = 0.061). CONCLUSIONS: Our study and others have found that high bacterial loads are negatively associated with achievement of eradication with triple treatment. However, differences between groups were not significant in patients who received a quadruple eradication regimen. Comparisons of treatment results according to bacterial density may be informative. The importance of H. pylori density should be further evaluated with new treatment protocols.

In vitro effect of sodium nitrite on platelet aggregation in human platelet rich plasma--preliminary report.

OBJECTIVE: The role of nitrates and nitric oxide on platelet functions has obtained an increasing attention with respect to their potential effects on cardiovascular disorders. In this study we aimed to analyze the effect of sodium nitrite on platelet functions in human platelets. PATIENTS AND METHODS: This in vitro study was designed to show the effect of sodium nitrite on platelet functions in seven healthy volunteers. Blood samples were centrifuged to prepare platelet rich plasma and platelet poor plasma. Platelet rich plasma was diluted with the platelet poor plasma to have a final count of 300,000 ± 25,000 platelets. Platelet rich plasma was incubated with six different increasing doses (from 10 µM to 5 mM) of sodium nitrite for 1 hour at 37°C. Then stimulating agents including collagen (3 µg ml-1), adenosine diphosphate (10 µM), and epinephrine (10 µM) were added to the cuvette. Changes in light transmission were observed for 10 minutes. In addition spontaneous aggregation were performed in control group with all aggregating agents separately. RESULTS: Effect of sodium nitrite on agonist-induced platelet aggregation depends on the concentration of sodium nitrite. Compared with control group, agonist-induced platelet aggregations were significantly suppressed by sodium nitrite at the concentration of 5, 1.0 and 0.5 mM. CONCLUSIONS: Our results suggested that sodium nitrite has inhibitory effects in vitro on platelet aggregation in a dose-dependent manner.

Serum YKL-40 levels as a novel marker of inflammation and endothelial dysfunction in patients with pseudoexfoliation syndrome.

PURPOSE: To evaluate serum levels of YKL-40 in patients with pseudoexfoliation syndrome (PEX) in comparison with those of age- and sex-matched healthy subjects. METHODS: Forty patients with PEX (PEX group) and 40 age- and sex-matched control subjects (control group) were enrolled in the study. An enzyme immunoassay method using the commercially available test MicroVue YKL-40 was used to measure serum YKL-40 concentration. Systolic and diastolic blood pressures, serum levels of high sensitivity C-reactive protein (hsCRP), total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglycerides were also examined. RESULTS: The mean age was 54.4±7.6 (ranging 41-65) years in each group. The mean serum YKL-40 level of the PEX group was significantly higher than that of the control group (P<0.001). In addition, the mean serum HsCRP, total cholesterol, LDL, and triglycerides levels were significantly higher, and mean serum HDL level was significantly lower in the PEX group than in the control group (all P<0.001, excluding both P=0.002 for triglycerides and HDL levels). Further, the mean systolic and diastolic blood pressures were significantly higher in the PEX group than in the control group (P1=0.001 and P2=0.01, respectively). CONCLUSION: We have shown a relationship between PEX and elevated serum levels of YKL-40. We imply that a better understanding of the role of YKL-40 in the pathogenesis of endothelial dysfunction and atherosclerosis is necessary to develop new therapies for preventing or treating PEX. Further studies are warranted to clarify the clinical relevance of these findings.

Patient expectation and satisfaction with nursing care in Turkey: a literature review.

BACKGROUND: Patient satisfaction is used as an important indicator of care quality and is frequently included in healthcare planning and evaluation. This study presents a review of research on patient expectation and satisfaction with nursing care in Turkey. AIM: To review the national literature on patient expectations and satisfaction with nursing care. METHODS: The researchers reviewed 3,089 articles of which 27 were discussed in detail. Of these 3,089 articles, 1,812 were from all issues of 14 Turkish nursing journals which have been published in the last 50 years, and 1,277 articles were from 24 nursing congress and symposium books. RESULTS: The results of this study are divided into two categories: expectations concerning 'nursing care', and 'satisfaction with nursing care'. The findings show that there exist conceptual and philosophic deficiencies in the approaches to patient satisfaction and that there is a need to use standardized instruments to study and assess patient satisfaction in the future. CONCLUSION: Over the last 20 years, studies of patient expectation and satisfaction with nursing care have been gaining high importance, but it is also noticed that in a national and philosophical approach the studies are not based on clearly defined concepts. Moreover, it has been concluded that there is a need for valid and reliable tools in the evaluation of satisfaction.

Endovascular treatment of massive retroperitoneal haemorrhage due to inferior adrenal artery injury. A case report.

Massive retroperitoneal haemorrhage because of adrenal bleeding following blunt trauma is a rare entity. We describe a 23-year-old woman with massive retroperitoneal haemorrhage as a result of inferior adrenal artery (IAA) disruption following a car accident. Superselective transcatheter embolization of the IAA using polyvinyl alcohol particles was performed successfully to control haemorrhage. To our knowledge, this is the second report of massive retroperitoneal haemorrhage caused by IAA disruption successfully treated by transcatheter embolization.

Subureteric polydimethylsiloxane injection in the treatment of vesico-ureteric reflux.

Endoscopic treatment of vesico-ureteric reflux is a viable alternative to open surgery. We evaluated the effectiveness of polydimethylsiloxane in the endoscopic treatment of vesico-ureteric reflux. In the period between September 1994 and March 1996, 30 ureteral units of 20 children with vesico-ureteric reflux were treated by means of subureteric polydimethylsiloxane injection. Median age was 8 years in the group including 8 female and 12 male patients. Of the 30 ureteral units, 26 had no reflux at the end of the first injection. Two of the remaining four units were not refluxing after the second injection procedure. Contralateral reflux was observed postoperatively in two of the eleven patients who were treated for unilateral disease. It seems that endoscopic polydimethylsiloxane injection is an effective procedure in the treatment of vesico-ureteric reflux.

Inhibition of penile erection in rats by a long-acting somatostatin analogue, octreotide (SMS 201-995).

OBJECTIVE: To assess the effect of a new somatostatin analogue (SMS 201-995, octreotide) on erectile function in rats. MATERIALS AND METHODS: Animals were fasted and anaesthetized intraperitoneally with pentobarbital. A cannula was placed in the trachea and the femoral vein cannulated for intravenous infusion. The hypogastric and pelvic nerve, major pelvic ganglion, and the nerve fibres to the lower genitourinary tract were identified. In 20 animals, these nerves were stimulated unilaterally using bipolar silver-wire electrodes; the stimulation was repeated every 15 min for 1 h. Twenty animals were divided into two equal groups; after measuring penile erection to obtain basal values, the animals received either saline or 50 micrograms SMS 201-995 over 1 h and 30 min later, the stimulation was repeated. RESULTS: After administering SMS 201-995 or saline, the levels of penile erection reduced linearly in both groups, but SMS 201-995 caused a greater decrease than in the control group (P < 0.05) and from baseline (P < 0.01) at all times. CONCLUSION: SMS 201-995 inhibits penile erection in rats and the systems may serve as an in vivo animal model for further investigation.

Endoscopic retrograde cholangiopancreatography in the diagnosis and management of choledochal cysts.

Choledochal cysts are an uncommon anomaly of the biliary system manifested by cystic dilatation of the extra or intrahepatic biliary tree or both. It is most frequently found in Orientals and in females. Endoscopic retrograde cholangiopancreatography is a valuable imaging technique in the diagnosis of choledochal cysts in adults. Additionally, in selected cases, a choledochocele may be effectively managed by endoscopic sphincterotomy. We present clinical and endoscopic findings of six adult patients with choledochal cysts. Clinical symptoms were characterized by abdominal pain, jaundice and cholangitis. Associated hepatobiliary pathologic findings included cholelithiasis, recurrent acute pancreatitis, gallbladder carcinoma, Cystolithiasis, choledocholithiasis, biliary stricture and hepatic abscess.

Value of preoperative spirometry to predict postoperative pulmonary complications.

In order to determine the incidence of postoperative pulmonary complications (POPC) and the value of preoperative spirometry to predict pulmonary complications after upper abdominal surgery, 24 women and 36 men (total 60 patients) were studied prospectively (mean age 48 center dot 3 years). On the day before the operation and for 15 days after the operation, each patient's respiratory status was assessed by clinical examination, chest radiography, spirometry and blood gas analysis, and patients were monitored for pulmonary complications by a chest physician and a surgeon independently. In this study, postoperative pulmonary complications developed in 21 (35%) patients (pneumonia in 10 patients, bronchitis in nine patients, atelectasis in one patient, pulmonary embolism in one patient). Of 31 patients with abnormal preoperative spirometry, 14 (45 center dot 2%) patients showed complications, whereas among 29 patients with normal preoperative spirometry, 7 (24 center dot 1%) patients showed complications (P <0 center dot 05). The incidence of POPC was higher in patients with advanced age, smoking, preoperative abnormal findings obtained from physical examination of the chest, higher ASA class and longer duration of operation. The sensitivity (0 center dot 76) and specificity (0 center dot 79) of abnormal preoperative findings obtained from physical examination to predict POPC were higher than abnormal preoperative spirometry (0 center dot 67 and 0 center dot 56 retrospectively). There was no significant difference between patients with and without pulmonary complications in regard to weight, serum albumin, type of incision, incidence of abnormal preoperative blood gases and duration of postoperative hospital stay. We conclude that POPC is still a serious cause of postoperative morbidity. Multiple risk factors include preoperative abnormal spirometry responsible for development of POPC. If used alone, spirometry has limited clinical value as a screening test to predict POPC after upper abdominal surgery.

Effect of essential amino acid supplementation in acute renal failure.

The effect of intravenous (i.v.) essential amino acids (EAA) in the treatment of acute renal failure was evaluated in 50 patients. Thirty patients (Group A) received daily 13.4 g of i.v. EAA solution [Nephramine (Don Baxter, McGraw) 250 ml/d]+dopamine i.v. 2 micrograms/kg/min + 20% hypertonic glucose solution 500 ml/d as compared with twenty patients (Group B) who received dopamine i.v. 2 micrograms/kg/min + 20% hypertonic glucose solution 500 ml/d. In Group A patients showed lower daily increase in blood urea nitrogen (BUN) (p < 0.05), higher serum total protein and albumin levels on the 15th day of the posttherapy period (p < 0.001), lower complication rate (p < 0.005), lower mortality rate (p < 0.005) and a reverse relation between serum total protein concentration, duration of oliguria and age (p < 0.01, r2 = 0.26; p < 0.001, r2 = 0.32). These data suggest that treatment of such patients with i.v. EAA solutions significantly improves survival.

The use of intraurethral prostatic spiral in high risk patients for surgery with benign prostatic hyperplasia.

Under local anaesthesia, 31 patients underwent insertion of an expandable stainless steel tubular spiral into the prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. Most of them had long-term indwelling urethral catheters (14 patients). The spiral allowed unobstructed voiding and is a good alternative to an indwelling urethral catheter. We recommend insertion of a spiral in patients with urinary obstruction if they are unfit for surgery.

[Effect of antisperm antibodies in male infertility]. / Antisperm antikorlarinin erkek infertilitesine etkisi.

Antisperm antibodies and their relationship with infertility has been investigated in semen and serum samples of 100 infertile and 25 fertile males. The investigation of antisperm antibodies has been done by latex agglutination test in semen samples and by ELISA procedure in serum samples. In addition, the semen samples have been investigation for several characteristics. Antisperm antibodies have been found 7% positive in blood and 30% positive in semen. In 28.5% of the patients with positive antisperm antibodies in blood, antisperm antibodies in semen have also been found to be positive. For cases with infertility of unknown cause the antisperm antibodies ratio has been found to be significantly high (p less than 0.002). These results have shown the importance of further investigation of antisperm antibodies in cases with infertility of unknown reasons.

Comparison of the effects of surgical and autologous fascial suture materials on testicular histology in rats subjected to orchiopexy.

In this study orchiopexy was performed in 30 Sprague-Dawley rats in order to compare traumatic effects of surgical and autologous fascial suture materials on testicular histology. Abscess formation was observed in 72.7% of the chromic, in 36.3% of the nylon, and in 18.1% of the vicryl fixed groups. There were no abscess formations in the dartos and autologous fascial fixed group. Examination of the testes revealed complete absence of spermatogenesis in the chromic fixed group. Spermatogenesis was normal, 72% in the vicryl, 18.1% in the nylon, 90.9% in the dartos and autologous fascial suture fixed groups. Antisperm antibody was not observed in any rat sera. We consider that it is preferred to use dartos pouch fixation. If necessary, it is advisable to use autologous fascial suture materials.

Effect of testicular torsion on the contralateral testis.

It has been previously shown that unilateral testicular torsion can cause disruptive anatomic changes in the contralateral testis in rats. In this experimental study plasma and urine prostaglandin E2 levels were studied correlatively with testicular histopathology in acute testicular torsion cases. As a result of this study, necrobiotic morphologic alterations causing testis necrosis and significant increase in plasma prostaglandin E2 levels were observed. Contralateral testicular histology was analyzed in all dogs. None of them showed abnormal tubular architecture.

Clinical, endocrinological and histopathological evaluation of male infertility.

In the years 1980-1988, 135 infertile males, 38 azoospermic and 98 oligozoospermic patients were studied. Physical findings, hormonal (FSH, LH, testosterone and prolactin) estimations were carried out. After doing testicular biopsies, all findings were evaluated.