Effects of topical mometasone furoate therapy on local and systemic macrophage migration inhibitory factor levels in allergic rhinitis patients

Amaç: Bu çalışmada mometazon furoat nazal sprey (MFNS) ile tedavi ettiğimiz alerjik rinitli hastalarda tedavi öncesi (TÖ) / tedavi sonrası (TS) serumda ve nazal lavaj sıvılarında makrofaj migrasyon inhibitör faktör (MİF) düzeylerini araştırdık. Ayrıca, tedavinin naza lmukozadaki eozinofil düzeyine etkilerini irdeledik. Gereç ve Yöntem: İlk muayene sırasında alerjik rinit yakınmalarının en az ikisine sahip olan 22 hastanın semptomları skorlandı, muayene bulguları kaydedildi; serumda ve nazal lavaj sıvısında MİF değerleri saptandı. Hastalara günde bir kez 100 g MFNS (Nasonex®) başlandı. TS dördüncü haftada semptomlar ve muayene bulguları yeniden değerlendirildi, nazal lavaj/serum MİF değerleri ELISA metodu ile ölçüldü. Nazal mukoza impresyonsitolojisimateryallerinde eozinofillerin diğer hücrelere göre oranları hesaplandı. Bulgular: TÖ/TS nazal lavaj MİF ortalaması (sırasıyla 503,53 294,50 pg/ml ve 1422.35 1097,98 pg/ml, P0.05) bulundu. Nazal mukozanın impresyon sitolojisinde eozinofil yüzdesi TÖve TS, sırasıyla 51.86 28,94 ve 25.64 23,60 idi. Eozinofil yüzdeleri arasındaki fark istatistiksel olarak anlamlıydı (p<0.001). Semptomskorları ortalaması TÖve TS sırasıyla 16,95 4,27 ve 9,24 3,38 idi. Skor ortalamalarındaki fark istatistiksel olarak anlamlıydı (P<0.001). Sonuç: HastalarımızdaTSda anlamlı klinik bir düzelme görüldü.TS semptomskorları ve nazalmukoza eozinofil yüzdeleri belirgin şekilde azaldı. TSda lokal MİF düzeylerinde ise artış izlendi. MFNS tedavisini takiben MİF değerlerinde izlenen anlamlı değişikliğin klinik düzelmeyle ilişkisinin daha ayrıntılı incelenmesi gerekmektedir.Background: In this study we aimed to investigate the systemic and local levels of macrophagemigration inhibitory factor (MIF) before and after topically applied mometasone furoate therapy in patients with allergic rhinitis. We also investigated the effects of therapy on local eosinophil accumulation. Material and Methods: Twenty-two patients (8 males and 14 females; median of 46 years ranging, from 17 to 68 years) with AR were subjects of this study. Percentages of eosinophils in nasal smears were calculated. MIF levels in serum and nasal lavage were measured by an enzyme-linked immunosorbent assay. Results: Topical glucocorticoid treatment significantly inhibited total symptom score (TSS) (16,95 4,27 and 9,24 3,38, respectively, p<0.001). After therapy, mean percentages of eosinophils decreased significantly (51.86 28,94 and 25.64 23,60 respectively, p<0.001) by impression cytology. MIF levels both in serum (782,55 759,43pg/ml and 917.10 1080,37 pg/ml, respectively) and nasal lavage (503,53 294,50 pg/ml and 1422.35 1097,98 pg/ml, respectively) increased after mometasone therapy. However, only the change in nasal lavage samples was statistically significant (p<0.001). Conclusions: TSS and nasal eosionophil numbers in nasal mucosa decreased following therapy. Further investigations are needed to evaluate the relations between clinical improvement and the significant changes in MIF levels following MFNS treatment

Nöropatik agri tedavisinde non-opioid ve opioid ajan kullanimi

PubMed ID: 19117151Treatment of neuropathic pain is difficult despite new treatments and there is no single treatment that Works for all conditions and their underlying mechanisms. Given the increasing evidence for effective treatments of neuropathic pain, it is important for the clinician to know which drugs are most effective neuropathic pain relieving pain and associated with the fewest adverse effects and there is a need for an evidence-based algorithm to treat neuropathic pain conditions. Ideally, the evidence for the non-opioids and opioids choices in such an algorithm would be based on direct comparisons of one drug with another, for both efficacy and side effects. There are very few such direct comparisons available

Anesthesia management of bilateral lung transplantation: Case report [Bilateral akciger transplantasyonunda anestezi yönetimi]

In recent years, lung transplantation (LT) has been considered to be the most effective treatment method for increasing the quality of life and survival rates in patients with end-stage pulmonary disease. Anesthesiologists can encounter some difficulties in patients undergoing LT. It has been established that induction of anesthesia, positive pressure ventilation, achievement and maintenance of one lung ventilation, clamping and declamping of the pulmonary artery and reperfusion of the transplanted lung were the critical stages when problems tended to occur. Therefore, thorough knowledge of the pathologic physiology of the end-stage pulmonary disease as well as full understanding and adequate management of the specific stages of surgery are essential for anesthesia during bilateral LT. In this case report, we aimed to present the anesthetic management of a 15 year-old male patient with end-stage respiratory failure who underwent the very first bilateral LT in our country and the difficulties faced by the anesthesia team during the operation

Spinal tüberkülozda (Pott Hastalığı) multimodal analjezi

Spinal tuberculosis (Pott‘s disease) is one of the causes for the low back pain that is rare but has high morbidity rate. Patients may have both somatic and neuropathic severe pain. A female patient aged 70-year who had been diagnosed and operated with Pott‘s disease 4 years ago presented to our outpatient clinic with a compliant of severe pain (VAS=10/10). A MRI scan revealed a severe destruction at the level of T7-T8 spines with neural compression and collapse. the patient had undergone surgery twice for the same reason. Because of gr TTS fentanyl, tramadole 400minadequate pain control despite the use of 100 mg/day and paracetamol 4 g/day, she was started pregabalin twice daily, and thereafter the dose was up-titrated to 150 mg twice daily, the effective dose. in the month 18 followup visit, she had mild pain (VAS: 2/10), could walk with the aid of a walker and perform her daily activities partially with pregabalin g, tramadole 200 mg/day, paracetamol 2 g daily. Ourm300 mg/day, fentanyl TTS 25 case is the first one for treatment whom pregabalin was used as part of a multimodal analgesia in the treatment of Pott‘s disease.Spinal tüberküloz (Pott Hastalığı) bel ağrısının nadir fakat morbidite oranı yüksek nedenlerinden biridir. Hastalarda hem somatik hem de nöropatik nitelikte siddetli ağrı olusabilir. 70 yasında, kadın hasta, 4 yıl önce Pott Hastalığı tanısı konulmus ve opere edilmis, siddetli ağrı sikayeti (VAS=10/10) ile kliniğimize basvurdu. MRG’de T7-T8 omurlarında siddetli yıkım, çökme ve sinir basısı mevcuttu. Hasta aynı nedenle 2 kez opere edilmisti. 100 mgr TTS fentanil, 400 mg/gün tramadol ve 4 gr/gün parasetamol kullanımına rağmen yeterli ağrı kontrolü sağlanamayan hastaya, 2x75 mg/gün pregabalin baslandı ve etkin doz olan 2x150 mg/gün’e çıkıldı. Hastanın 18. ay kontrolünde, 300 mg/gün pregabalin, 25 mgr fentanil TTS, 200 mg/gün tramadol, 2 gr parasetamol tedavisiyle hafif ağrısının (VAS: 2/10) olduğu, yürüteç yardımıyla yürüyebildiği ve günlük islerini kısmen yapabildiği saptandı. Olgumuz, Pott Hastalığı’nda multimodal analjezide pregabalinin kullanıldığı ilk olgu özelliğindedir

Preemptive analgesic efficacy of dexketoprofen trometamol on impacted third molar surgery

PubMed ID: 24481581Summary Objectives: The aim of this study was to compare the pre-emptive analgesic efficacy of intravenous (IV) dexketoprofen trometamol (DT) and placebo, following impacted mandibular third molar surgery. Methods: Twenty patients over 18 year old who needed bilateral lower third molar extractions were included in this prospective, randomized and placebo-controlled clinical trial. Patients whom had taken DT 50 mg of before their one extraction, took placebo before their other extraction which had been performed on the opposite side. A total of 40 observations were made. Pain scores were evaluated with a Verbal Rating Scale (VRS) after surgery. Moreover; the time to first analgesic requirement use, additional analgesic need of patients, patient and doctor satisfaction, side effects were also determined. Results: During the first 12 hours, the VRS values in DT group were significantly lower than those of placebo group patients (p<0.05). In placebo group, the time to first analgesic requirement use was significantly earlier than that of patients in DT group (p<0.05). Additional analgesic need of placebo group were significantly greater, when compared with the analgesic need of DT group patients (p<0.05). Among the DT group patients, patient and physician satisfaction was greater, which was statistically significant (p<0.05). Conclusion: Preemptive use of IV DT is more effective than placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent removal of an impacted mandibular third molar surgery