The Effect of One-Lung Ventilation on Cognitive Functions: Cross-Sectional Research

Amaç: Postoperatif kognitif disfonksiyon (POKD), majör cerrahi sonrası özellikle ileri yaş olmak üzere tüm yaş grubu hastalarda sıkça görülür ve aylarca sebat edebilir. Etiyolojisi multifaktöriyel olmakla birlikte, serebral oksijen sunum ve tüketim dengesini etkileyen faktörler suçlanmaktadır. Bu nedenle hipoksi gibi ciddi komplikasyonlarla seyredebilen tek akciğer ventilasyonu (TAV) uygulanan torasik cerrahi hastalarında POKD'yi mini-mental durum testi ile değerlendirerek hastalarda POKD'nin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu çalışmaya 20 yaş ve 72 yaş arası, torasik cerrahide TAV adayı hastalar dâhil edildi. Anestezi protokolü tüm hastalarda aynı şekilde uygulandı. Kognitif değerlendirme operasyondan 1 gün önce, operasyondan 1 ve 3 gün sonra yapıldı. Bu amaçla MiniMental Durum Değerlendirme Testi kullanıldı. Bulgular: Çalışmaya 30 hasta dâhil edildi. TAV uygulanan hastaların %26,6'sında POKD tespit edildi. Hastaların yapılan mini-mental durum değerlendirme testi, ameliyat öncesi ile ameliyat sonrası 1. gün ile 3. gün arasında kognitif disfonksiyon açısından fark tespit edildi. Ameliyat sonrası 1. gün ile ameliyat sonrası 3. gün arasında fark tespit edilmemiştir. Sonuç: Toraks cerrahisinde TAV uygulanan hastalarda erken dönem kognitif disfonksiyon görülmektedir. Bunda cerrahi süre, anestetik ilaçlar, hastayla ilgili parametreler etkili olmakta olup, hastalar intaroperatif yakın takip edilmeli ve ameliyat sonrasında da hastalar kognitif fonksiyonları açısından yakından izlenmelidir.Objective: Postoperative cognitive dysfunction (POCD) is frequently seen in patients of all age groups, especially advanced age, after major surgery and may persist for months. Although its etiology is multifactorial, factors affecting the balance of cerebral oxygen delivery and consumption are blamed. For this reason, it was aimed to evaluate whether patients developed POCD by evaluating POCD with mini-mental state test in thoracic surgery patients who underwent one lung ventilation (OLV), which can progress with serious complications such as hypoxia. Material and Methods: Patients between 20 years and 72 years of age candidates for OLV in thoracic surgery were included in the study. The anesthesia protocol was applied the same way in all patients. Cognitive assessment was conducted 1 day before the operation, 1 day after the operation and 3 days after. For this purpose, Mini-Mental Status Examination test was used. Results: Thirty patients were included in the study. POCD was detected in 26% of patients who underwent OLV. The mini-mental state test of the patients showed a difference in terms of cognitive dysfunction between preoperative and postoperative day 1 and day 3. However, no difference was detected between day 1 and day 3 after surgery. Conclusion: Early cognitive dysfunction is observed in patients undergoing OLV in thoracic surgery. Surgical time, anesthetic drugs, and patient-related parameters are effective, and patients should be closely monitored in terms of cognitive functions of the patients, in close follow-up and after surgery

The effect of body mass index and anxiety status on blood pressure in patients admitted to family medicine outpatient clinic

Introduction: Hypertension is a global public health problem that is the leading cause of preventable death in the world and a disease which can cause many morbidities and mortality if not controlled or treated effectively. In many studies, it has been determined that anxiety and body mass index(BMI) are among the factors affecting hypertension. However, different results have been obtained in many studies in terms of the relationship between anxiety and hypertension. This study was carried out with the aim to evaluate the effect of body mass index and anxiety on blood pressure and the factors affecting blood pressure in patients who applied to outpatient clinic of family medicine at Dicle University Faculty of Medicine.Methods: 403 patients aged between 18- 65 years, who applied to outpatient clinic of family medicine at Dicle University Faculty of Medicine between 01.04.2018 and 01.07.2018, were included in this cross-sectional study. The population of the study was the province where the study was carried out, and the sample size was calculated with a power of 80%. The patients' body mass index and anxiety scores from Beck anxiety scale were calculated and measurements of arterial blood pressure were performed. The relationship between BMI, Beck anxiety scores and blood pressure of patients were investigated.Results: Of the participants, 50.1% were male, 49.9% were female and the average age was 34.11 in years. Of the patients, the mean BMI as 25.52 kg/m², the mean anxiety score as 7.40 and the arterial blood pressures as 117.80/75.54 mmHg were measured. It was found that arterial blood pressure raised significantly as the BMI group increased. While the relationship between the severity of anxiety and systolic blood pressure was significant, its relationship with diastolic blood pressure was not significant. There was a positive correlation between BMI, anxiety score and systolic and diastolic blood pressure.Conclusions: According to the results of this study, it was found that the increase in BMI and Beck anxiety scores may be related with increase in arterial blood pressure. This result showed that common health problems in primary care such as anxiety, obesity and hypertension may be associated with each other, and it can be effectively fought against hypertension and its complications with the perspective of family medicine and biopsychosocial approach.Keywords: Anxiety, Hypertension, Blood Pressure, Obesity, Body Mass Inde

In vitro investigation of the antibacterial activity of levobupivacaine on pseudomonas aeruginosa

Lokal anesteziklerin antibakteriyel etkisi epidural katetere bağlı enfeksiyon oluşumunun önlenmesinde önemli bariyerlerden biridir. Bu çalışmada; levobupivakainin hastanemizde postoperatif ağrı tedavisi (% 0.125) ve ağrısız doğumda kullandığımız (% 0.0625) konsantrasyonlarının Hasta Kontrollü Epidural Analjezi modelinde Pseudomonas Aeruginosa üzerine antibakteriyel etkinliğinin deneysel olarak araştırılması amaçlandı. Çalışma solüsyonları 100 ml olacak şekilde hazırlandı. Grup 1 (n=10) : % 0,125 levobupivakain + 4 ml fentanil (200 μg), Grup 2 (n=10): % 0,0625 levobupivakain + 4 ml fentanil (200 μg), Grup 3 (n=10): 4 ml fentanil (200 μg), Grup 4 (n =10) : 99 ml serum fizyolojik içerecek şekilde hazırlanarak tüm gruplara 1 ml Pseudomonas Aeruginosa 0.5 McF (3x106 cfu/ml) eklendi. Tüm gruplardaki örnekler EGEMEN marka bakteri filtresinden (n=40) Hasta Kontrollü Analjezi cihazı ile 5 ml/sa infüzyon hızında geçirilerek steril şişelerde toplandı. Şişelerden (n=40), filtre giriş (n=40) ve çıkışlarından (n=40) alınan örnekler Kanlı Agar'a ekilerek bakteri koloni sayımları yapıldı. Sonuçlar SPSS 15.0 programı kullanılarak gruplar arasındaki farkı anlamak için Kruskal-Wallis, iki grup arasındaki farkı anlamak için Mann- Whitney-U testi ile istatistiksel olarak karşılaştırıldı ve p < 0.05 istatistiksel olarak anlamlı kabul edildi. Çalışmamızın sonuçlarına göre tüm grupların verilen Pseudomonas Aeruginosa koloni sayılarını anlamlı olarak azalttığı tespit edildi (p<0.05). Levobupivakain konsantrasyonu arttıkça koloni sayısının azaldığı fakat bu azalmanın istatistiksel olarak anlamsız olduğu görüldü (p>0.05). Bakteri filtresinin Pseudomonas Aeruginosa'yı tutma kapasitesinin %100 olduğu saptandı. Bu sonuçlar doğrultusunda, Hasta Kontrollü Epidural Analjezide kullanılan levobupivakainin Pseudomonas Aeruginosa bakterisine antibakteriyel etkisinin olduğu; fentanilin de antibakteriyel etkisinin olduğu, levobupivakain ile kullanıldığında bu etkiyi artırdığı ve enfeksiyon riskini azaltan ek bir bariyer olarak düşünülebileceği kanaatine varıldı. The antibacterial activity of local anesthetics is one of the major barriers to prevent occurrence of epidural catheter-related infections. In this study, it was aimed to investigate the antibacterial activity of levobupivacaine on Pseudomonas Aeruginosa experimentally through the Patient Controlled Epidural Analgesia Model, at two concentrations chosen for postoperative pain treatment (0.125%) and painless childbirth procedures (0.0625%) in our hospital. Working solutions were prepared as 100 ml. Contents of the solutions were as follows: Group 1 (n = 10): 0.125% levobupivacaine + 4 ml of fentanyl (200 μg), Group 2 (n = 10): 0.0625% levobupivacaine + 4 ml of fentanyl (200 μg), Group 3 (n = 10): 4 ml of fentanyl (200 μg), Group 4 (n = 10): 99 ml of normal saline. 1 ml of Pseudomonas Aeruginosa 0.5 McF (3x106 cfu/ml) was added to all groups. Samples of the groups (n = 40) were filtered through EGEMEN brand bacteria filter, infused with the Patient Controlled Analgesia device at a rate of 5 ml / h, and collected at sterile bottles. Samples taken from the bottles (n = 40), filter inputs (n = 40) and filter outlets (n = 40) were cultured on Blood Agar, and bacterial colony count were determined for each sample. Results were analysed with the SPSS 15.0 program. In statistical analysis, Kruskal-Wallis test was used to determine differences between the goups, and Mann- Whitney-U test was used to compare two groups. p <0.05 was considered statistically significant. Our findings showed that all of the solutions significantly decreased the number of colonies of Pseudomonas Aeruginosa (p <0.05). The number of colonies decreased as the concentration of levobupivacaine increased, but this correlation was not found statistically significant (p> 0.05). Our data revealed that holding capacity of the bacteria filter wass? 100% for Pseudomonas Aeruginosa. Based on these results, we concluded that levobupivacaine, which is widely used in patient controlled epidural analgesia, showed antibacterial activity against Pseudomonas aeruginosa, fentanyl was also effective against Pseudomonas aeruginosa, and when used concomitantly with levobupivacaine, it increased overall antibacterial activity, and could be considered as an additional barrier reducing the risk of infection

A Rare Complication after Caudal Epidural Steroid Injection: Persistent Hiccup

Lumbar caudal epidural steroid injection (LKES ) is one of the non-surgical treatment of back pain. In this case re­port; we presented persistent hiccup after lomber caudal epidural steroid injection for chronic low back pain and treatment of this case

Dexmedetomidine and Magnesium Sulfate: A Good Combination Treatment for Acute Lung Injury?

Objectives: In this study, we aimed to investigate the therapeutic effects of magnesium sulfate (MgSO4) and dexmedetomidine (dex) in a model of acute lung injury (ALI). We determined whether concomitant administration decreased the inflammatory effects of hydrochloric acid (HCl)-induced ALI in a synergistic manner. Materials and Methods: In this study, 42 Sprague–Dawley rats were randomized into six groups: Group S (saline), Group SV (saline + mechanical ventilation), Group HCl (HCl), Group Dex (Dex), Group Mag (MgSO4), and Group DM (Dex + MgSO4). All groups except Group S were mechanically ventilated prior to HCl-induced ALI. Saline or HCl was administered via tracheostomy. Prior to treatment, HCl was administered to Group HCl, Group Dex, Group Mag, and Group DM to induce ALI. Dex and MgSO4 were administered intraperitoneally. The rats were monitored for 4 h after treatment to measure oxidative stress parameters in blood, and prolidase enzyme activity. Lung tissue damage were determined via histopathology. Results: A significant increase in heart rate and rapid desaturation was observed in HCl-administered groups. Treatment administration decreased the pulse values. Increased saturation values and decreased oxidative stress indices were observed in groups that were subsequently administered​ Dex and MgSO4. Serum prolidase activity increased significantly in Group HCl. Severe pathological findings were detected following HCl-induced ALI. Group Mag showed greater improvement in the pathology of HCl-induced ALI than did Group Dex. Administration of both Dex and MgSO4 did not improve the pathological scores. Conclusions: The antioxidant and anti-inflammatory effects of Dex and MgSO4 ameliorated the detrimental effects of HCI-induced ALI. However, adverse effects on hemodynamics and lung damage were observed when the two drugs were administered together

Socio-demographic and clinical factors related to mortality among the geriatric suicide attempters admitted to the emergency department

Objective: The ratio of elderly people in Turkey is rapidly growing. Accordingly, psychiatric problems and suicidality among elderly people are growing concerns. In this study, we aimed to investigate the socio-demographic characteristics of older people who attempted suicide by drug and to identify risk factors affecting mortality. Methods: Patients who were over 65 years old and admitted to the emergency department of a university hospital due to drug-related suicide attempt between January 1, 2004 and December 30, 2014, were included into this retrospective cross-sectional study. Relationship between suicide attempt and mortality was investigated in regard to socio-demographic and clinical factors. Patients were divided into two groups according to whether they survived or died. Results: Of the 107 patients included in the study, 68.2% were female and 31.8% were male; 34.6% were married. Common reasons for suicide attempt were depression (34.6%) and domestic violence (30.8%). Analgesics (33.6%) were the most common drugs used in suicide attempts. The analysis of the factors related to suicide attempt and mortality revealed that significant factors were loneliness, being widowed, being retired, having adjustment disorder and anxiety disorder. Conclusion: Loneliness, being widowed, being retired, adjustment disorder, and anxiety disorder were found as the risk factors affecting mortality in geriatric suicide attempts

A Miracle That Accelerates Operating Room Functionality: Sugammadex

Background. Sugammadex offers a good alternative to the conventional decurarisation process currently performed with cholinesterase inhibitors. Sugammadex, which was developed specifically for the aminosteroid-structured rocuronium and vecuronium neuromuscular blockers, is a modified cyclodextrin made up of 8 glucose monomers arranged in a cylindrical shape. Methods. In this study, the goal was to investigate the efficacy of sugammadex. Sugammadex was used when there was insufficient decurarisation following neostigmine. This study was performed on 14 patients who experienced insufficient decurarisation (TOF <0.9) with neostigmine after general anaesthesia in the operating rooms of a university and a state hospital between June, 2012, and January, 2014. A dose of 2 mg/kg of sugammadex was administered. Results. Time elapsed until sugammadex administration following neostigmine 37 ± 6 min, following sugammadex it took 2.1 ± 0.9 min to reach TOF ≥ 0.9, and the extubation time was 3.2 ± 1.4 min. No statistically significant differences were detected in the hemodynamic parameters before and after sugammadex application. From the time of administration of sugammadex to the second postoperative hour, no side effects or complications occurred. None of the patients experienced acute respiratory failure or residual block during this time period. Conclusion. Sugammadex was successfully used to reverse rocuronium-induced neuromuscular block in patients where neostigmine was insufficient

Carvacrol prevents methotrexate-induced renal oxidative injury and renal damage in rats

Purpose: The purpose of this study was to investigate the effect of carvacrol (CAR) on methotrexate (MTX)-induced renal damage in rats. Methods: Twenty-four male rats were equally divided into three groups: group I, control treatment; group II, MTX-treated; and group III, MTX+CAR-treated. A single dose of CAR (73 mg/kg) was administered intraperitoneally to group III on the first day of the experiment and a single dose of MTX (20 mg/kg) was administered intraperitoneally to groups II and III on the second day of the experiment. Blood samples and kidney tissue were obtained from each animal on day 8 for the measurement of malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). Light microscopy was used for histopathological examination of kidney specimens. Results: MDA, TOS and OSI levels were significantly greater in the group receiving MTX alone relative to the control animals, while the TAS level was significantly reduced in the MTX group compared with the control group. The administration of CAR was associated with significantly decreased MDA, TOS, and OSI levels and increased TAS levels relative to the rats treated with MTX alone. Animals treated with CAR exhibited decreased tubular degeneration and architectural impairment relative to animals treated with MTX alone; however, the difference in histological scores did not meet the threshold of statistical significance. Conclusions: MTX treatment results in oxidative damage to the rat kidney; damage which is partially abrogated by the administration of CAR

Improved Oxidative Status In Major Abdominal Surgery Patients After N-Acetyl Cystein Supplementation

PubMedWoSScopu