The effect of preemptive magnesium sulfate on postoperative pain in patients undergoing mastectomy: a clinical trial.

OBJECTIVE: The effects of preemptive magnesium sulfate (MgSO4) infusion on perioperative hemodynamics and postoperative analgesia in female patients who underwent mastectomy were evaluated. PATIENTS AND METHODS: American Society of Anesthesiologists (ASA) I-II female patients aged 18 years and over who underwent mastectomy were randomized into 2 groups, including 34 individuals each. The study group (Group I) was given 50 mg/kg MgSO4 in 250 ml isotonic 30 minutes before the induction, and the control group (Group II) was given 250 ml of normal isotonic solution. Standardized anesthesia was applied. Perioperative oxygen saturation, mean arterial pressure (MAP), pulse (HR), sedation scores (ss) in the recovery unit, Verbal Numeric Rating Scale (VNRS), need for rescuer fentanyl, and analgesic needs in the surgical period were evaluated. RESULTS: Demographic variables were similar. There was no statistical difference between the two groups in terms of the MAP, HR, and oxygen saturation values measured at entry, post-intubation, 15th, 30th, 45th, 60th minutes, and after extubation. There was a statistically significant difference between the two groups in terms of VNRS scores in the recovery unit and at the 2nd, 4th, 8th, and 12th hours during the postoperative surgical period (p=0.0001, 0.001, 0.001, 0.004, 0.021, respectively). The need for rescue analgesics in the first 2 hours of recovery was found to be lower in the study group (p=0.005). The need for postoperative analgesics in the surgical period was not statistically significant (p=0.1). CONCLUSIONS: Preemptive use of MgSO4 reduces postoperative VNRS scores without affecting hemodynamic parameters during induction and maintenance of general anesthesia.

Determination of Cystic Fibrosis Mutation Frequency in Preterm and Term Neonates with Respiratory Tract Problems.

Cystic fibrosis (CF) is an autosomal recessive disease. The genetic transition occurs with CF transmembrane conductance regulator (CFTR) gene mutation. We aimed to determine the frequency of CF mutations and also new mutations in the CFTR gene in neonates with respiratory distress. Newborn babies hospitalized due to respiratory distress were included in the patient group. The control group consisted of infants who had no respiratory distress. The CFTR genes of both groups were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. A total of 40 patients (20 in the patient group and 20 in the control group) were evaluated. The CFTR gene analysis was normal in 16 neonates in the patient group, whereas in others: A46D (c.137C>A) (n = 1), D1312G (c.3935A>G) (n = 1), R117H (c.350G>A) (n = 1), S1426P (c.4276T>C) (n = 1) heterozygotes were detected; CFTR gene analysis was normal at 14 neonates in the control group, whereas in others: E1228G (c.3683A>G) (n = 1), E217G (c.650A>G) (n = 1), E632TfsX9 (c1894_1895delAG) (n = 1), I807M (c.2421 A>G) (n = 2), S573F (c.1718C>T) (n = 1) heterozygotes were detected. There was no significant difference in the patient and control groups' CFTR gene analysis (p = 0.340). This study demonstrates the importance of CFTR gene analysis in asymptomatic newborn infants for follow-up and early diagnosis of CFTR-related disorders. In this study, a c.1894_1895delAG (E632TfsX9) heterozygous mutation detected in the CFTR gene in an asymptomatic newborn infant, was first encountered in the literature.

Improved neonatal prognosis following restriction in the number of transferred embryos in assisted reproduction - single center yearly comparison from Turkey.

PURPOSE: To evaluate the impact of new legislation for assisted reproductive technology (ART) restricting the number of transferred embryos on neonatal prognosis of infants born after infertility treatments. MATERIALS AND METHODS: Neonatal records of all live born infants in Ege University Maternity Ward were reviewed for 2006 and 2012. Neonatal outcome measures such as birth weight (BW), gestational age (GA), preterm birth (PTB), very low birth weight (VLBW), and neonatal intensive care unit (NICU) admission were evaluated. RESULTS: Compared to 2006 percentage of newborns conceived by medically assisted reproduction (MAR) decreased from 14.6% to 5% in all live births, from 23.8% to 8.2% in NICU patients in 2012. The number of fetuses in the last pregnancy, frequency of intrauterine reductions, spontaneous pregnancy losses, antenatal bleeding, and premature delivery decreased. Percentage of multiples among MAR newborns (31.7% vs. 55.7%), twins from 51.4% to 30.9%, triplets from 4.3% to 0.8% all decreased significantly. Mean BW and gestational age increased resulting in decreased frequency of PTB and VLBW. Consequently Level 3 NICU admission rate significantly decreased from 44.3% to 22%. CONCLUSION: The new ART legislation in Turkey resulted in decreased rate of multiple births, prematurity and related complications, and NICU admissions in MAR newborns. However the twin rates are still high. Since uncontrolled ovulation stimulation and intrauterine insemination techniques are also associated with multiple births and unfavorable neonatal outcomes, these procedures deserve close monitorization.

Preferential infection of dividing cells by Cryptosporidium parvum.

In spite of its limitations, the culture of Cryptosporidium parvum in monolayers of epithelial cells is a suitable model to study the interaction of this protozoan parasite with the host cell, to assay oocyst infectivity, and to screen drugs for anti-cryptosporidial activity. For unknown reasons, growth of Cryptosporidium in culture is limited in time and generally does not lead to the production of significant numbers of oocysts. In monolayers infected with high doses of oocysts, we observed that many cells remain uninfected, suggesting that some cells are less susceptible to the infection. Since C. parvum and the related species C. hominis lack many essential biosynthetic pathways, we tested whether the dependence of the parasite on host cell metabolites may favour the infection of cells in mitosis. The proportion of monolayer cells in stationary (G0/G1) phase and in mitosis (S/G2/M) was determined and the prevalence of infected cells in each subpopulation was quantified. Although C. parvum infects and develops in dividing and stationary cells, a significant preference for cells in S/G2/M phase was observed. Consistent with previous observations showing that C. parvum induces apoptosis in cell monolayers, infection was accompanied by a significant increase in the proportion of mitotic cells.

Anterior spinal artery syndrome after peripheral angiography of the lower limbs.

STUDY DESIGN: A case report of temporary anterior spinal artery syndrome secondary to peripheral angiography of the lower limbs. OBJECTIVES: To report a rare case of spinal cord ischemia following a straightforward peripheral angiography with femoral access. SETTING: Istanbul, Turkey. CASE REPORT: A 70-year-old patient with peripheral vascular disease developed temporary paraplegia after angiography caused by anterior spinal ischemia. His motor weakness improved gradually over a 2 month period. CONCLUSION: Spinal complications are extremely rare after peripheral angiography. The possible mechanisms of spinal cord damage are discussed, and the relevant data regarding the etiology are reviewed.

Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with idiopathic thrombocytopenic purpura.

Fifty-seven adult patients with idiopathic thrombocytopenic purpura (ITP) were treated with either conventional-dose prednisolone (CDP) (1 mg/kg/d, 36 patients) or high-dose methylprednisolone (HDP) (30 mg/kg/d, 21 patients), as first-line treatment. Patients in the HDP arm responded more rapidly (4.7 v 8.4 d), with a higher response rate (80% v 52.7%), and without severe side-effects. One quarter of the patients (3/12) who were non-responsive to CDP achieved complete remission when they were treated with HDP. The findings suggest that HDP may be a more effective first-line treatment than CDP for adult ITP, and it may also be preferred for life-threatening cases of ITP. However, these results must be confirmed by a randomized study prior to any change in the current practice of employing CDP as first-line treatment for adult ITP.