Desenvolvimento de fibrilação ventricular por causa de etomidato para indução anestésica: um efeito colateral muito raro, relato de caso

ResumoJustificativa e objetivosA ocorrência de fibrilação ventricular em um paciente pode resultar em complicações inesperadas. Nosso objetivo é apresentar um caso de fibrilação ventricular que ocorreu após a indução anestésica com administração de etomidato.Relato de casoPaciente do sexo feminino, 56 anos, com pré‐diagnóstico de cálculos biliares, foi admitida na sala de cirurgia para colecistectomia laparoscópica. A anestesia foi induzida com a administração de etomidato com uma dose em bolus de 0,3mg/kg. A paciente apresentou uma grave e rápida adução dos braços logo após a indução. Taquicardia com QRS largo e frequência ventricular de 188bpm foram detectadas no monitor. O ritmo converteu‐se em fibrilação ventricular (FV) durante a preparação para a cardioversão. A paciente foi imediatamente submetida a desfibrilação. O ritmo sinusal foi obtido. Decidimos adiar a cirurgia por causa da condição de instabilidade da paciente.ConclusãoAlém dos efeitos secundários conhecidos de etomidato, taquicardia ventricular e fibrilação, embora muito raramente, também podem ser observadas. Até onde sabemos, esse é o primeiro caso na literatura de FV causado por etomidato.AbstractBackground and objectivesVentricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration.Case reportA fifty‐six‐year‐old female patient with a pre‐diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition.ConclusionIn addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature

Wave Energy Dissipation of Spilling and Plunging Breaking Waves in Spectral Models

On the basis of field experiments and modeling, the dependence of the dissipation of the energy of waves breaking by plunging and spilling on the frequency of wave spectra was investigated. It was shown that the modeling of wave breaking should take into account the compensation of the nonlinear growth of higher wave harmonics, which occurs in different ways for waves breaking with different types and for different methods of modeling a nonlinear source term. The study revealed that spilling breaking waves have a frequency selectivity of energy dissipation at frequencies of second and third harmonics for the Boussinesq and SWAN models for any method of modeling a nonlinear source term. Plunging breaking waves have a quadratic dependence of the dissipation coefficient on frequency in the Boussinesq model and SWAN model with the SPB approximation for a nonlinear source term. The SWAN model with default LTA approximation for plunging breaking waves also assumes frequency-selective energy dissipation. The discrepancy between the LTA default method and others can be explained by the overestimation of the contribution of the second nonlinear harmonic and by inaccurate approximation for the biphase. It is possible to improve the accuracy of LTA and SPB methods by tuning SWAN model coefficients

DC Electrowetting of Nonaqueous Liquid Revisited by XPS

Liquid poly­(ethylene glycol) (molecular weight, ∼600 Da) with a low vapor pressure is used as droplets in an ultrahigh-vacuum X-ray photoelectron spectrometer (XPS) chamber with traditional electrowetting on dielectric (EWOD) device geometry. We demonstrate that, using XPS data, independent of the sign of the applied voltage, the droplet expands on the substrate with the application of a nonzero voltage and contracts back when the voltage is brought back to zero. However, the main focus of the present investigation is about tracing the electrical potential developments on and around the droplet, using the shifts in the binding energy positions of the core levels representative of the liquid and/or the substrate in an noninvasive and chemically specific fashion, under imposed electrical fields, with an aim of shedding light on numerous models employed for simulating EWOD phenomenon, as well as on certain properties of liquid/solid interfaces. While the lateral resolution of XPS does not permit to interrogate the interface directly, we explicitly show that critical information can be extracted by probing both sides of the interface simultaneously under external bias in the form of potential steps or direct current. We find that, even though no potential drop is observed at the metal-wire electrode/liquid interface, the entire potential drop develops across the liquid/solid-substrate interface, which is faster than our probe time window (∼100 ms) and is promptly complying with the applied bias until breakdown. No indication of band bending nor additional broadening can be observed in the C 1s peak of the liquid, even under electrical field strengths exceeding 10⁷ V/m. Moreover and surprisingly, the liquid recovers within seconds after each catastrophic breakdown. All of these findings are new and expected to contribute significantly to a better understanding of certain physicochemical properties of liquid/solid interfaces

Sertraline-induced reproductive toxicity in male rats: evaluation of possible underlying mechanisms

This study was conducted to clarify the toxic effects of sertraline (SRT) on the reproductive system of male rats and to elucidate the underlying mechanisms. Rats were treated orally with SRT at doses of 5, 10, and 20 mg kg−1 for 28 consecutive days. At the end of the treatment period, sperm concentration, sperm motility, and sperm morphology were investigated by computer-assisted sperm analysis system whereas sperm DNA damage was detected by comet assay. The oxidative status of the testes was investigated, and a histopathological examination was conducted. Serum testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were measured to determine the effects of SRT on the spermatogenesis process. One-way ANOVA, post-hoc Dunnett′s T3 test for the sperm comet assay, and post-hoc Tukey′s test for the others were performed for statistical analysis. The results showed that SRT caused an increase in sperm DNA damage and induced histopathological lesions in all groups treated with SRT. There was abnormal sperm morphology and increased malondialdehyde (MDA) in the 10 mg kg−1 treatment group. More dramatic changes were observed in the 20 mg kg−1 treatment group. Decreased sperm count was accompanied by a significant increase in abnormal sperm morphology, DNA damage, and degeneration in cellular-tubular structures. Serum LH and testosterone levels were elevated in the 20 mg kg−1 treatment group. Decreased glutathione (GSH) and increased MDA were signs of enhanced oxidative stress (OS). In conclusion, SRT induced testicular toxicity in a dose-dependent manner and OS is suggested as a crucial mechanism

X-ray Photoelectron Spectroscopy with Electrical Modulation Can Be Used to Probe Electrical Properties of Liquids and Their Interfaces at Different Stages

Operando X-ray photoelectron spectroscopy (o-XPS) has been used to record the binding energy shifts in the C 1s peak of a pristine poly(ethylene glycol) (PEG) liquid drop in an electrowetting on dielectric (EWOD) geometry and after exposing it to several high-voltage breakdown processes. This was achieved by recording XPS data while the samples were subjected to 10 V dc and ac (square-wave modulation) actuations to extract electrical information related to the liquid and its interface with the dielectric. Through analysis of the XPS data under ac actuation, a critical frequency of 170 Hz is extracted for the pristine PEG, which is translated to a resistance value of 14 MΩ for the liquid and a capacitance value of 60 pF for the dielectric, by the help of simulations using an equivalent circuit model and also by XPS analyses of a mimicking device under similar conditions. The same measurements yield an increased value of 23 MΩ for the resistance of the liquid after the breakdown by assuming that the capacitance of the dielectric stays constant. In addition, an asymmetry in polarity dependence is observed with respect to both the onset of the breakdown voltage and also the leakage behavior of the deteriorated (PEG + dielectric) system such that deviations are more pronounced at positive voltages. Both dc and ac behaviors of the postbreakdown system can also be simulated, but only by introducing an additional element, a diode or a polarity- and magnitude-dependent voltage source (VCVS), which might be attributed to negative charge accumulation at the interface. Measurements for a liquid mixture of PEG with 8% ionic liquid yields an almost 2 orders of magnitude smaller resistance for the drop as a result of the enhanced conductivity by the ions. Coupled with modeling, XPS measurements under dc and ac modulations enable probing unique electrochemical properties of liquid/solid interfaces

The effects of endothelial lipase gene (LIPG) variants on inflammation marker levels and atherosclerosis development

Atherosclerosis is a major pathological process related with several important adverse vascular events including coronary artery disease, stroke, and peripheral arterial disease. Endothelial lipase is an enzyme the activity of which affects all of lipoproteins, whereas HDL is the main substrate. The purpose of our study was to investigate the effects of endothelial lipase gene polymorphism and inflammation markers (CRP, IL-1 beta, IL-6, IL-8 and TNF-alpha) in the atherosclerosis. 104 patients with atherosclerosis and 76 healthy individuals were included in the study. LIPG -584C/T polymorphism gene polymorphisms were assessed with PCR-RFLP method. The serum CRP levels were measured by turbidimetric method using a biochemistry autoanalyzer, whereas serum IL-1 beta, IL-6, IL-8, TNF-alpha levels were determined by enzyme-linked immunosorbent assay. In this study, we found that the frequencies of TC genotype are more prevalent in patients than controls. We found a statistically significant difference of IL-6 levels between patient and control group. Our findings suggest that T allele might play a potential role in the susceptibility to atherogenesis in the Turkish population

Responses of the stratified flows to their driving conditions-A field study

The Bosphorus is oceanographically very complicated two-layer stratified strait where denser water from the Marmara Sea flows towards North under the lighter water which is frequently flowing from the Black Sea towards South. The water level difference between both ends of the Bosphorus varies seasonally within the range of -0.2 and 0.6 m. The seasonal variability depends mainly on the water level changes in the adjacent basins related to the hydrological cycle, short-term changes in the atmospheric pressure and the wind characteristics. These variations together with the depth and alignment of the cross section along the strait dominate the spatial and temporal variations and sometimes sharp changes in the flow pattern in three dimensions. Although these hydrodynamic conditions are critical for all marine and hydraulic works along the Bosphorus, there was riot continuous long-term measurement for a sufficient time span in the strait for detailed evaluation of the current climate. An extensive site surveying work including current, wind, pressure and water level measurements was carried out between September 2004 and January 2006 in relation to the design and construction requirements of the Bosphorus Tube Crossing Project. In this study, the characteristics of stratified flow in the Bosphorus Strait and their relation to local and regional, short- and long-term changes in the meteorological parameters are studied by using the measurement data and the results are discussed comparatively

The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report

Background and objectives: Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration. Case report: A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3 mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188 beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition. Conclusion: In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature