Geçici Hiperglisemi anında Sevofluran ve Desfluranın Eritrosit Deformabilitesi Üzerine Etkilerinin Araştırılması

Aim: Micro and macrovascular complications due to long-term hyperglycemia are associated with increased mortality and morbidity. Erythrocytes exposed to hyperglycemia for a long time may cause morphological changes in erythrocytes such as decreased deformability and development of aggregation. As a result, complications such as shortening life span of erythrocytes, impairment of oxygen carrying capacity, tissue hypoxia may occur. In our study, we would like to investigate the effects of Sevoflurane and Desflurane on erythrocyte deformability during transient hyperglycemia. Materials and Methods: In this study, 30 male Wistar albino rats were used. The animals were randomly divided into five groups, each contained 6 rats: Diabetic control (group DC), diabetic hyperglycemia group (group DH), diabetic hyperglycemia group with desflurane (group DH-D), and diabetic hyperglycemia group with sevoflurane (group DH-S) groups. Another 6 rats without diabetes were assigned as control group (group C). Streptozotocin- induced diabetic rats were kept 6 weeks, then transient hyperglycemia was created, and the administration of sevoflurane and desflurane were performed. After 24 hours blood samples were obtained and deformability measurements were performed in erythrocyte suspensions containing Htc 5% in a PBS buffer. Results: Diabetes mellitus was found to increase relative resistance in the control group (p <0.0001). Acute hyperglycemia increased relative resistance in diabetes control, relatively. Group DH, Group DH-D and Group DH-S deformability index were significantly different when compared to Group DC (p=0.007, p=0.025, p=0.016, respectively). It was found that administration of desflurane or sevoflurane did not alter erythrocyte deformability during acute hyperglycemia (p = 0.591, p = 0.739). Conclusion: As a consequence, we think that we can safely use inhalation anesthetics such as Desflurane and Sevoflurane during acute hyperglycemia attacks. But, it needs further investigation as both experimental and clinicalAmaç: Uzun süreli hipergliseminin oluşturduğu mikro ve makrovasküler komplikasyonlar mortalite ve morbidite artışı ile birliktedir. Eritrositlerin ise yaşam süreleri boyunca uzun süre hiperglisemiye maruz kalmaları morfolojik olarak eritrositlerde deformabilitede azalma ve agregasyon gelişmesi gibi bir takım değişikliklere neden olmaktadır. Bunun sonucunda eritrositlerin yaşam sürelerinde kısalma, oksijen taşıma kapasitesinde bozukluk, doku hipoksisi gibi komplikasyonlar meydana gelmektedir. Sevofluran ve desfluranın ise eritrosit deformabilitesi üzerine etkileri ile ilgili çeşitli çalışmalar mevcuttur. Biz de bu çalışmamızda geçici olarak oluşturulan hiperglisemi sırasında sevofluran ve desfluranın eritrosit deformabilitesi üzerine etkilerini araştırmayı amaçladık. Yöntem: Çalışma Gazi Üniversitesi Deneysel ve Klinik Araştırma Merkezi'nde Gazi Üniversitesi Deney Hayvanları Etik Kurulu onayı ile yapıldı. Çalışmaya 30 rat dahil edildi. Ratlar; kontrol grubu, diyabetik-kontrol, diyabetik hiperglisemi, diyabetik–hiperglisemi-sevofluran, diyabetik-hiperglisemi- desfluran olmak üzere 5 gruba ayrıldı. Streptozosin ile diyabet oluşturulan ratlar 6 hafta yaşatıldıktan sonra geçici hipergilisemi oluşturuldu ve sevofluran ve desfluran anestezisi uygulandı. 24 saat sonra kan örnekleri alındı ve santrifüj edildi. Eritrosit deformabilitesi sabit akım filtrometre sistemleri kullanılarak ölçüldü. Rölatif rezistansının artması eritrosit deformabilitesinin azalması olarak yorumlandı. Bulgular: Diyabet oluşturulmasının kontrol grubuna göre rölatif rezistansı arttırdığı bulundu (p<0.0001). Akut hiperglisemi, diyabet kontrol grubuna göre rölatif rezistansı arttırdı. Grup DH, Grup DH-D ve Grup DH-S deformabilite indeksi Grup DK ile karşılaştırıldığında anlamlı olarak farklı bulundu (p=0.007, p=0.025, p=0.016). Akut hiperglisemi sırasında Desfluran veya Sevofluran uygulanmasının ise eritrosit deformabilitesini değiştirmediği tespit edildi (p=0.591, p=0.739). Sonuç: Sevofluran ve Desfluran gibi inhalasyon ajanların akut hiperglisemi sırasında güvenle kullanılabileceğini düşünmekteyiz. Ancak bu bulguların daha detaylı ve geniş serilerde yapılacak klinik ve deneysel çalışmalarla desteklenmesi gerekmektedir

Prediction models for childhood asthma: a systematic review

Background The inability to objectively diagnose childhood asthma before age five often results in both under‐treatment and over‐treatment of asthma in preschool children. Prediction tools for estimating a child's risk of developing asthma by school‐age could assist physicians in early asthma care for preschool children. This review aimed to systematically identify and critically appraise studies which either developed novel or updated existing prediction models for predicting school‐age asthma. Methods Three databases (MEDLINE, Embase and Web of Science Core Collection) were searched up to July 2019 to identify studies utilizing information from children ≤5 years of age to predict asthma in school‐age children (6‐13 years). Validation studies were evaluated as a secondary objective. Results Twenty‐four studies describing the development of 26 predictive models published between 2000 and 2019 were identified. Models were either regression‐based (n = 21) or utilized machine learning approaches (n = 5). Nine studies conducted validations of six regression‐based models. Fifteen (out of 21) models required additional clinical tests. Overall model performance, assessed by area under the receiver operating curve (AUC), ranged between 0.66 and 0.87. Models demonstrated moderate ability to either rule in or rule out asthma development, but not both. Where external validation was performed, models demonstrated modest generalizability (AUC range: 0.62‐0.83). Conclusion Existing prediction models demonstrated moderate predictive performance, often with modest generalizability when independently validated. Limitations of traditional methods have shown to impair predictive accuracy and resolution. Exploration of novel methods such as machine learning approaches may address these limitations for future school‐age asthma predictio

Persistent ventilation inhomogeneity after an acute exacerbation in preschool children with recurrent wheezing

© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd. Background: Preschool children with recurrent wheezing suffer high morbidity. It is unclear whether objective measures of asthma control, such as pulmonary function tests (PFTs), provide additional information to the clinical assessment. Methods: We recruited children between 3 and 6years old, with a history of recurrent wheezing in the preceding year and treated for acute wheezing exacerbation in the emergency department (ED) into an observational cohort study. Children attended two outpatient visits: the first study visit within five days of discharge from the ED and the second study visit 12weeks after the ED visit. We performed standardized symptom score (test for respiratory and asthma control in kids (TRACK)), multiple breath washout (MBW), spirometry, and clinical assessment at both visits. Results: Seventy-four children, mean (standard deviation (SD)) age of 4.32years (0.84), attended both visits. Paired FEV0.75 and lung clearance index (LCI) measurements at both time points were obtained in 37 and 34 subjects, respectively. Feasibility for all tests improved at visit 2 and was not age-dependent. At the second study visit, a third had controlled asthma based on the TRACK score, and the mean lung clearance index (LCI) improved from 9.86 to 8.31 (P=.003); however, 46% had an LCI in the abnormal range. FEV0.75 z-score improved from −1.66 to −1.17 (P=.05) but remained in the abnormal range in 24%. LCI was abnormal in more than half of the children with “well-controlled” asthma based on the TRACK score. There was no correlation between PFT measures and TRACK scores at either visit. Conclusions: Lung clearance index demonstrates a persistent deficit post-exacerbation in a large proportion of preschoolers with recurrent wheezing, highlighting that symptom scores alone may not suffice for monitoring these children

Terrorism and international law

ÖZ Uluslar arası terörizm, 21. yüzyılda devletlerin karşı karşıya olduğu en ciddi tehdit algılamalarından biri haline geldi. Geride bıraktığımız yüzyılın son çeyreğinde yaşananlar ve özellikle 11 Eylül'le zirveye çıkan terör olayları, terörizmle bilhassa uluslar arası terörizmle mücadelede geleneksel yöntemlerin başarısızlığını bir kez daha ortaya koydu. Bu dönemde uluslar arası terör faaliyetleri hızla artmaya başlayınca, uluslararası toplumda daha etkin bir işbirliği talebi yüksek sesle dile getirilmeye başlandı. Buna ilişkin çalışmalar, başta bölgesel ve uluslararası anlaşmaların imzalanması suretiyle gerek BM ve gerekse bölgesel örgütler nezdinde hızla hayata geçirildi. Terörizm günümüzde yeni dünya düzenine, demokrasiye, evrensel insan haklarına ve ülkelerin ekonomik ve sosyal gelişmişliklerine karşı ciddi bir tehdit unsuru olarak önümüzde durmakta. Teröristlerin hareket kabiliyetini artıran yeni teknolojik gelişmeler, kitle iletişim araçlarının yaygınlaşması ve devletlerin bu soruna ilişkin uluslar arası ortak bir çözüm geliştirmedeki başarısızlığı gibi etmenler terörizmin önümüzdeki yüzyılda da etkisini hissettireceğini ve uluslar arası toplumun gündeminde önemli bir yer işgal edeceğini açık bir şekilde ortaya koymaktadır.ABSTRACTInternational terrorism has been one of the most serious threats to the states in the twenty first century. The events that took place in the last quarter of the twenteeth century especially the 9-11 terrorist activities have proved that the traditional suppression methods of terrorism are not successful enaugh to overcome the problem. In this process an effective coordination between national states was demanded more heavily in the international community because of the increased number of terrorist activities. By the way there have been made so many attempts against terrorism by either United Nations or international governmental organizations. Terrorism is a serious threat to the new world order to democrasy to universal human rights and to social and economical developments of states. New technological developments which improve the mobility of terrorists, the diffusion of communication possibilities between terrorist organizaations and the unachievment of a common international response to terrorism at international level prove that terrorism will increase its effect and is going to be on the agenda of the international community in the new century