The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study

The aim of the present prospective, randomized study was to investigate and compare the safety and efficacy of dexmedetomidine versus midazolam in providing sedation for gastroscopy. A total of 50 adult patients (25 patients receiving dexmedetomidine and 25 patients receiving midazolam), 18 to 60 years of age, and rated I and II on the American Society of Anesthesiologists physical status classification system were included. A brief questionnaire was used to collect demographic data; patients were asked to rate anxiety, satisfaction with care to date and expected discomfort on a visual analogue scale. The following parameters were measured continuously and recorded every minute: heart rate, mean arterial pressure, hemoglobin oxygen saturation and respiratory rate. The two groups were similar with regard to age, body mass index, sex, education, duration of endoscopy, and ethanol or tobacco use. After the procedure, full recovery time, mean arterial pressure, heart rate, respiratory rate and hemoglobin oxygen saturation levels were similiar in both groups. Both groups also had low levels of perceived procedural gagging, discomfort and anxiety scores (P>0.05), and high satisfaction levels (90.1±3.0 for dexmedetomidine versus 84.9±4.5 for midazolam; P>0.05). Retching and endoscopist satisfaction were significantly different in patients receiving dexmedetomidine versus those receiving midazolam (88.8±6.5 versus 73.5±16.4, P<0.05; and 20.6±4.4 versus 45.2±6.0; P<0.001). In the midazolam group, the number of patients who had adverse effects was higher than the dexmedetomidine group (P<0.05). As a result, dexmedetomidine performed as effectively and safely as midazolam when used as a sedative in upper gastroscopy; it was superior to midazolam with regard to retching, rate of side effects and endoscopist satisfaction. It was concluded that dexmedetomidine may be a good alternative to midazolam to sedate patients for upper endoscopy

Endothelial Progenitor Cell Levels and Extent of Post-prandial Lipemic Response

BACKGROUND AND OBJECTIVE: Due to the frequency of meal ingestion, individuals spend the majority of the day, ~18 h, in a status of post-prandial (PP) stress. Remnant-like lipoprotein particles (RLPs) are predominant in PP phase playing an important role in the development of atherosclerosis. Endothelial progenitor cells (EPCs) have been suggested to play a role in vessel wall homeostasis and in reducing atherosclerosis. However, there is no information about peripheral blood EPCs number following PP stress. We investigated the association between circulating EPCs levels and extent of PP lipemia in healthy subjects following a high-fat meal. MATERIALS AND METHODS: A total of 84 healthy subjects (42 men, 42 women) aged 17–55 years were included in the study. PP lipemic response of subjects was determined by Oral Fat-Loading Test (OFLT). All the subjects were classified on the basis of their plasma TG levels after PP lipemic stressors in categories 1 (low), 2 (moderate), and 3 (high). Circulating EPCs numbers were measured by the flow cytometry method. RESULTS: There was a significant difference in terms of lipid parameters between men and women: high-density lipoprotein cholesterol (HDL-C) was significantly lower in men than in women (p < 0.001). Total cholesterol (TC) (p = 0.004), low-density lipoprotein cholesterol (LDL-C) (p < 0.001), triglyceride (TG) (p < 0.001), and TG-AUC (p < 0.001) were significantly higher in men than in women. There was no significant difference between the genders in terms of CD34(+)KDR(+) and CD34(+)KDR(+)CD133(+)cell number and MMP-9 levels. Vascular endothelial growth factor (VEGF) levels were significantly higher in men than women (p = 0.004). TC, LDL-C, and TG were significantly higher in the 3rd category than 1st and 2nd categories (p < 0.001) in women. Age, body mass index (BMI), fat rate, TG, TC, and LDL-C were significantly higher in the 3rd category than 1st category (p < 0.001, p = 0.002, p = 0.002, p = 0.01, p = 0.007, p = 0.004; respectively), in men. Circulating numbers of EPCs in men were significantly higher in the PP hyperlipidemia group than in the low TG levels category, independently from age (p < 0.05). Circulating EPC levels showed a positive correlation with OFLT response in men (r = 0.414, p < 0.05). Also, OFLT response showed a strong positive correlation with fasting TG levels (r = 0.930, p < 0.001). EPC levels in categories of women were not different. CONCLUSION: Increased EPCs levels in subjects with different PP hyperlipidemia may be associated with a response to endothelial injury, related to increased atherogenic remnant particles at the PP phase

The diagnostic value of protein carbonyl levels in acute carbon monoxide intoxication

Tatli, Ozgur/0000-0003-0263-7630WOS: 000419631500004Objective: Carbon monoxide (CO) is the main cause of intoxication-related mortality and morbidity in developed countries. It is responsible for more than half of fatal intoxications in many countries. The purpose of this study was to determine the diagnostic value of protein carbonyl (PC), a good marker of oxidative stress, in association with oxidative stress resulting from hypoxia emerging in patients with acute CO intoxication. Methods: Thirty-four patients diagnosed with acute CO intoxication at the Emergency Department and 38 healthy volunteers were included in the study. Patients' PC levels at time of admission and after treatment were compared with those of a control group. Results: No statistically significant difference was observed among PC levels at time of admission in the patient and control groups (p = 0.305, patient group 0.025 +/- 0.01, control group 0.026 +/- 0.01). A significant decrease was determined in post-treatment PC levels in the patient group compared to those at time of admission (p = 0.006, admission 0.025 +/- 0.01, post-treatment 0.017 +/- 0.008). No significant correlation was determined between patients' carboxyhemoglobin (CO-Hb) levels and PC levels at time of admission (Correlation coefficient = -0.006, p= 0.971). Conclusions: We think that PC is not suitable for use as a biomarker in the acute period in patients with CO intoxication

The diagnostic value of protein carbonyl levels inAcute carbon monoxide intoxication

Amaç: Karbonmonoksit (CO) gelişmiş ülkelerde zehirlenme ile ilişkili mortalite ve morbiditenin ana nedenidir ve birçok ülkede ölümcül zehirlenmelerin yarısından fazlasından sorumlu tutulmaktadır. Bu çalışmada akut CO zehirlenmeli hastalarda meydana gelen hipoksi nedeniyle ortaya çıkan oksidatif strese bağlı olarak, iyi bir oksidatif stres markerı olan protein karbonilin (PC) tanısal değerini belirlemek amaçlanmıştır. Gereç ve Yöntem: Acil serviste CO zehirlenmesi tanısı alan 34 hasta ve sağlıklı 38 gönüllü çalışmaya alınmıştır. Hastaların başvuru anı ve tedavi sonrası PC seviyeleri, kontrol grubu ile karşılaştırılmıştır. Bulgular: Başvuru anında ortalama PC seviyeleri arasında hasta grubu ve kontrol grubu arasında istatistiksel olarak anlamlı fark tespit edilmemiştir, p 0.305 (hasta grubu 0.025 0.01, kontrol grup 0.026 0.01). Hasta grubunda tedavi sonrası PC seviyelerinde başvuru anına göre anlamlı bir düşüş tespit edilmiştir, p 0.006 (başvuru 0.025 0.01, tedavi sonrası 0.017 0.008). Hastalarda başvuru anında CO-Hb seviyeleri ile PC seviyeleri arasında istatistiksel olarak anlamlı bir korelasyon tespit edilmemiştir (Corelation coefficient -0.006, p 0.971). Sonuç: PC'nin CO zehirlenmeli hastalarda akut dönemde bir biyobelirteç olarak kullanılmasının uygun olmadığını düşünmekteyiz.Objective: Carbon monoxide (CO) is the main cause of intoxication-related mortality and morbidity in developed countries. It is responsible for more than half of fatal intoxications in many countries. The purpose of this study was to determine the diagnostic value of protein carbonyl (PC), a good marker of oxidative stress, in association with oxidative stress resulting from hypoxia emerging in patients with acute CO intoxication. Methods: Thirty-four patients diagnosed with acute CO intoxication at the Emergency Department and 38 healthy volunteers were included in the study. Patients' PC levels at time of admission and after treatment were compared with those of a control group. Results: No statistically significant difference was observed among PC levels at time of admission in the patient and control groups (p 0.305, patient group 0.025 ± 0.01, control group 0.026 ± 0.01). A significant decrease was determined in post-treatment PC levels in the patient group compared to those at time of admission (p 0.006, admission 0.025 ± 0.01, post-treatment 0.017 ± 0.008). No significant correlation was determined between patients' carboxyhemoglobin (CO-Hb) levels and PC levels at time of admission (Correlation coefficient -0.006, p 0.971). Conclusions: We think that PC is not suitable for use as a biomarker in the acute period in patients with CO intoxication

Cholesterol Forms and Traditional Lipid Profile for Projection of Atherogenic Dyslipidemia: Lipoprotein Subfractions and Erythrocyte Membrane Cholesterol

yilmaz, adnan/0000-0003-4842-1173WOS: 000330341200002PubMed: 24240543Atherogenic dyslipidemia characterized by abnormal changes in plasma lipid profile such as low high-density lipoprotein (HDL) and increased triglyceride (TG) levels is strongly associated with atherosclerotic diseases. We aimed to evaluate the levels of pro- and antiatherogenic lipids and erythrocyte membrane cholesterol (EMC) content in normo- and dyslipidemic subjects to investigate whether EMC content could be a useful marker for clinical presentation of atherogenic dyslipidemia. Low-density lipoprotein (LDL), HDL and their subfraction levels and erythrocyte lipid content were determined in 64 normolipidemic (NLs), 42 hypercholesterolemic (HCs) and 42 mixed-type dyslipidemic subjects (MTDs). Plasma atherogenic lipid indices [small-dense LDL (sdLDL)/less-dense HDL (LHDL), TC/HDL-C, TG/HDL-C and Apo B/AI] were higher in MTDs compared to NLs (p < 0.001). the highest sdLDL level was observed in HCs (p < 0.01). Despite a slight increase in EMC level in dyslipidemic subgroups, the difference was not statistically significant. A significant negative correlation, however, was observed between EMC and sdLDL/LHDL in HCs (p < 0.035, r = -0.386). Receiver operating characteristic curves to predict sdLDL level showed that TG and EMC levels had higher area under curve values compared to other parameters in HCs. We showed that diameters of larger LDL and HDL particles tend to shift toward smaller values in MTDs. Our results suggest that EMC content and TG levels may be a useful predictor for sdLDL level in hypercholesterolemic patients.TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [2008.102.02.2]Supported in part by TUBITAK (Grant No. 2008.102.02.2)

Cholesterol forms and traditional lipid profile for projection of atherogenic dyslipidemia: lipoprotein subfractions and erythrocyte membrane cholesterol

yilmaz, adnan/0000-0003-4842-1173WOS: 000330341200002PubMed: 24240543Atherogenic dyslipidemia characterized by abnormal changes in plasma lipid profile such as low high-density lipoprotein (HDL) and increased triglyceride (TG) levels is strongly associated with atherosclerotic diseases. We aimed to evaluate the levels of pro- and antiatherogenic lipids and erythrocyte membrane cholesterol (EMC) content in normo- and dyslipidemic subjects to investigate whether EMC content could be a useful marker for clinical presentation of atherogenic dyslipidemia. Low-density lipoprotein (LDL), HDL and their subfraction levels and erythrocyte lipid content were determined in 64 normolipidemic (NLs), 42 hypercholesterolemic (HCs) and 42 mixed-type dyslipidemic subjects (MTDs). Plasma atherogenic lipid indices [small-dense LDL (sdLDL)/less-dense HDL (LHDL), TC/HDL-C, TG/HDL-C and Apo B/AI] were higher in MTDs compared to NLs (p < 0.001). the highest sdLDL level was observed in HCs (p < 0.01). Despite a slight increase in EMC level in dyslipidemic subgroups, the difference was not statistically significant. A significant negative correlation, however, was observed between EMC and sdLDL/LHDL in HCs (p < 0.035, r = -0.386). Receiver operating characteristic curves to predict sdLDL level showed that TG and EMC levels had higher area under curve values compared to other parameters in HCs. We showed that diameters of larger LDL and HDL particles tend to shift toward smaller values in MTDs. Our results suggest that EMC content and TG levels may be a useful predictor for sdLDL level in hypercholesterolemic patients.TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [2008.102.02.2]Supported in part by TUBITAK (Grant No. 2008.102.02.2)

An observational, prospective, multicenter study on rescue high-frequency oscillatory ventilation in neonates failing with conventional ventilation

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