Effect of carvedilol on silent anthracycline-induced cardiotoxicity assessed by strain imaging: A prospective randomized controlled study with six-month follow-up

Background: The use of antracycline (ANT) in breast cancer has been associated with adverse cardiac events. Two-dimensional (2D) strain imaging (SI) can provide a more sensitive measure of altered left ventricular (LV) systolic function. We aimed to evaluate the preventive effect of carvedilol administration assessed by SI in a patient with breast cancer treated with ANT.Methods: Patients receiving ANT were randomly assigned to the carvedilol- or placebo-receiving group. Each received an echocardiographic examination with conventional 2D echocardiography, pulsed tissue Doppler, and 2D SI prior to and 6 months post ANT treatment.Results: During the 6-month follow-up period there were no patient deaths or interrupted chemotherapy treatments due to doxorubicin-induced cardiotoxicity. Both left ventricular ejection fraction (LVEF) and fractional shortening (FS) were within normal limits for all patients before and after ANT therapy. EF, FS and LV dimensions were measured using M-mode echocardiography and found to be similar in both groups before and after ANT therapy. The mean EF, FS, and LV echocardiograph baseline and control dimensions were similar in both groups after 6 months. Though baseline SI parameters were similar between the groups, there was a significant decrease in LV basal septal and basal lateral peak systolic strain in the control group compared to the carvedilol group.Conclusions: These results indicate that carvedilol has a protective effect against the cardiotoxicity induced by ANT.

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Renin-Angiotensin System Blockers May Prolong Survival of Metastatic Non-Small Cell Lung Cancer Patients Receiving Erlotinib

The aim of this study is to determine whether renin-angiotensin system blockers (RASBs), which include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-2 receptor 1 blockers (ARBs), improve the overall survival (OS) of patients with metastatic non-small cell lung cancer (NSCLC).The medical charts of 117 patients with metastatic NSCLC were retrospectively assessed. Thirty-seven patients (RASB group) using RASBs during systemic treatment were compared with 80 controls (control group) who did not use RASBs following the diagnosis of NSCLC. The histological tumor subtype, performance status, age, sex, smoking status, comorbidities, other medications, chemotherapeutics (CT), and erlotinib that were received in any line of treatment were recorded. We compared the OS of the patients in the RASB and control groups.The median (SD) age of the patients was 61 (+/- 1) years and all patients were administered systemic treatment (CT or erlotinib). The patients in RASB group were more likely to be smokers, have hypertension and ischemic heart disease, and use erlotinib, thiazides, beta-blockers, and calcium-channel blockers (P<0.05 for all) compared with the control group. The median follow-up time was 18.9 months (range 1-102 months) for the entire group. The median follow-up period was longer for RASB group than control group (17 vs 11 months, P=0.033). The most commonly prescribed RASB agent was valsartan (n=12/37). At the time of the analysis, 98 (83.7%) of all patients had died. In the univariate analysis, the median OS was longer in the RASB group compared with the control group (17 [+/- 4.1] vs 12 [+/- 1.4] months, P=0.016). Interestingly, further analyses revealed that RASBs significantly improved OS only if used with erlotinib concurrently (34 [+/- 13.8] vs 25 [+/- 5] months, P=0.002) and the OS benefit was more attributable to ARBs because only 4 patients received ACEI and erlotinib concurrently. However, the benefit of ARBs on OS disappeared in the multivariate analysis.The use of ARBs during erlotinib treatment may prolong OS of patients with metastatic NSCLC

OXA-type Carbapenemases and Susceptibility of Colistin and Tigecycline Among Carbapenem-Resistant Acinetobacter Baumannii Isolates from Patients with Bacteremia in Turkey

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as one of the most troublesome pathogens in healthcare settings worldwide. The present study was conducted to analyze the genes encoding resistance to carbapenems and to determine in vitro activity of colistin and tigecycline against CRAB isolates from blood culture of hospitalized patients at Istanbul University Cerrahpasa Medical School hospital

Is there any effect of insulin resistance on male reproductive system?

Objectives: To investigate the possible effect of insulin resistance (IR) on male reproductive system via evaluation of semen analysis, male sex hormones and serum lipid profiles, and testicular volumes. Methods: After the exclusions, a total of 80 male patients were enrolled in this prospective study. Body Mass Index (BMI), Testicular volume, semen samples, serum hormone/lipid profiles, high sensitive C-Reactive Protein (hsCRP) were obtained from all the subjects. Results: The patients were divided into two groups as study and control according to the presence of IR. There were no statistical differences in terms of age, marriage period, testicular volume, serum levels of hormone and lipid profiles and BMI between the groups. There were no relationship between homeostasis model assessment of insulin resistance (HOMA-IR) and semen volume (r = -0.10, p = 0.37), total sperm count (r = -0.09, p = 0.39), motility (r = -0.15, p = 0.16) and morphology (r = -0.14, p = 0.19). However, HOMA-IR was closely associated with hsCRP levels (r = 0.94, p &lt; 0.0001). Conclusions: Despite of the documented strong inverse relationships between Diabetes Mellitus (DM) and male/female fertility, and also between IR and female infertility via ovarian functions as in polycystic ovary syndrome, to our knowledge, there is no report about any influence of IR on male fertility. DM and metabolic syndrome (MetS) have negative influence on fertility. Thus, IR may be accused of causing detrimental effect on male infertility due to hyperinsulinemic state and being one of the components for MetS. Interestingly, due to our preliminary results, we do not found any inverse correlation between IR and male reproductive functions

Relative sustainability analysis of global-scale airports

The sustainability impact and reporting results of air transport have become important for societies. In this field, the Global Reporting Initiative presents the reports and databases of many sectors in chronological order. Nowadays, airports all over the world transparently present their sustainability results to the public with a sense of responsibility. In this respect measuring the sustainability performance of airports, determining the targets, and making the necessary improvements become more of an issue. In this study, the efficiency analysis of 30 international airports included in the comprehensive sustainability database of the Global Reporting Initiative was carried out using the Data Envelopment Analysis (DEA). In this context, common inputs and outputs affecting the sustainability of airports were determined and a sustainability performance measurement model was developed. The relative efficiency scores of the airports were found with the input-oriented CCR method by using the developed model. Thanks to the results, inefficient airports were identified, and necessary improvements were presented to improve sustainability levels

Myelin basic protein profile of central nervous system in experimentally induced demyelination and remyelination

Objective: The aim of the present study was to assess myelin basic protein (MBP) profiles of central nervous system in experimentally induced demyelination and remyelination