Changes in activated partial thromboplastin time and international normalised ratio after on-pump and off-pump surgical revascularization of the heart

Surgical revascularization of the heart (CABG - coronary artery bypass grafting) is one way of treating coronary heart disease. Bleeding is one of the serious and frequent complications of heart surgery and can result in increased mortality and morbidity. Hemostasis disorder may be secondary consequences of surgical bleeding, preoperative anticoagulant therapy, and the use of cardiopulmonary bypass. Tests used for routine evaluation of the coagulation system are activated partial thromboplastin time (APTT) and international normalized ratio (INR). The study encountered 60 patients who were hospitalized at the Clinic for Cardiovascular Diseases, University Clinical Center Tuzla. Patients underwent elective coronary artery bypass heart surgery either with cardiopulmonary bypass (on-pump CABG) or without it (off-pumpCABG). The aim of this study was to compare the changes in coagulation tests (APTT, INR) in patients who were operated on-pump and patients operated off-pump. Our study showed that the values of APTT and INR tend to increase immediately after surgery. Twenty-four hours after surgery these values are declining and they are approaching the preoperative values in all observed patients (p <0.05). Comparing APTT between the groups we found that postoperative APTT levels are significantly higher in the group of patients who underwent surgery with cardiopulmonary bypass (p <0.05). Changes in coagulation tests after surgical revascularization of the heart are more pronounced in patients who were operated with on-pump technique compared to patients operated off-pump technique

Post anesthesia recovery rate evaluated by using White fast tracking scoring system

Introduction: Postponed recuperation from anesthesia can lead to different complications such as apnoea, aspiration of gastric content whit consequent development of aspiration pneumonia, laryngospasm, bradycardia, and hypoxia. Aim of this research was to determine infl uence of propofol, sevoflurane and isoflurane anesthesia on post anesthesia recovery rate. Methods: This was a prospective study; it included 90 patients hospitalized in period form October 2011 to may 2012 year, all patients included in the study underwent lumbar microdiscectomy surgery. Patients were randomly allocated to one of three groups: group 1: propofol maintained anesthesia, group 2: sevoflurane and group 3: isofl urane maintained anesthesia. Assessments of recovery rate were done 1, 5 and 10 minutes post extubation using White fast tracking scoring system. Results: Significant difference was observed only 1 minute after extubation (p=0,025) finding recovery rate to be superior in propofol group. Propofol group compared to inhaled anesthesia with sevoflurane group, shows significantly faster recovery from anesthesia only one minute after extubation (p=0,046). In comparison of propofol group and isofl urane anesthesia group, statistical significance was noticed one minute following extubation (p=0,008). Comparison of propofol group and inhaled anesthesia groups recovery rates were not significantly different at all times measured. When we were comparing sevoflurane and isoflurane anesthesia, recovery rates shoved no signifi cant statistical difference. Conclusions: Recovery rate evaluated by using White fast tracking scoring system was superior and with fewer complications in propofol maintained in comparison to sevoflurane and isoflurane maintained anesthesia only one minute post extubation, while after fifth and tenth minute difference was lost

The concentration of homocysteine in patients after ischemic brain stroke and vascular dementia

Introduction: The aim of this study is to examine whether moderate hiperhomocysteinemia is an independent risk factor for cerebral infarction. Methods: We have measured homocysteine levels in 50 patients with ischemic stroke during acute phase and postacute phase, 50 patients diagnosed with vascular dementia and healthy group of 50 subjects. Homocysteine concentration in serum was measured, on the basis of fluorescent polarisation measuring. Results: The study demonstrated that homocysteine concentration was 16.93 µmol/L in the patient group with ischemic stroke, and in the group of patients with vascular dementia was 20.39 µmol/L. Homocysteine increases during the postacute phase of ischemic stroke after 7 days for 1.54 µmol/L and 14 days for 3.66 µmol/L compared to the concentration of homocysteine after the first hours of hospitalization. Using Wilcoxon signed ranks and Mann-Whitney (P < 0.05) tests we got significant difference between homocysteine concentration at acute phase and post-acute phase of ischemic stroke and it was significant difference between concentrations of homocysteine in the acute and post-acute phase of ischemic stroke and vascular dementia. The Spearman correlation test was found signifiant correlation between the number of strokes and the concentration of homocysteine in serum of patients with vascular dementia. Conclusions: The homocysteine concentration rises significantly during of acute phase of ischemic brain stroke, and it is significantly increased during post-acute phase, which is a predictor factor for further development of vascular dementia, or a new ischemic brain stroke

Increased expression and levels of human β defensins (hBD2 and hBD4) in adults with dental caries

Introduction: Defensins are small anti-microbial peptides produced by epithelial cells. These peptides have a broad range of actions against microorganisms, including Gram-positive and Gram-negative bacteria. Human defensins are classifi ed into two subfamilies, the α-, and β- defensins, which differ in their distribution of disulphide bonds between the six conserved cysteine residues. Defensins are found in saliva and others compartments of the body. Human β defensins 2 (hBD2), beta defensins 4 (hBD4) and alpha defensins 4 (hNP4) in saliva may contributes to vulnerability or resistance to caries. This study aimed to determine a possible correlation between caries and levels of defensins measuring the expression in gingival tissue and concentrations in saliva samples. Methods: Oral examinations were performed on 100 adults of both genders (18-30 years old), and unstimulated whole saliva was collected for immunoassays of the three peptides and for the salivary pH, buffer capacity, protein, and peroxidase activity. mRNA levels of defensins in gingival sample were assessed by semi-quantitative RT-PCR technique. Results: The median salivary levels of hBD2 and hBD4 were 1.88 μg/ml and 0.86 μg/ml respectively for the caries-free group (n=44) and 7.26 μ/ml (hBD2) and 4.25 μg/ml (hBD4) for all subjects with evidence of caries (n=56). There was no difference in the levels of hNP4, salivary pH, and proteins between groups, however the peroxidase activity and buffer capacity (interval 6.0-5.0) were reduced in caries group. Transcriptional levels of hBD2 and hBD4 did correlate with caries experience, the mRNA expression of hBD2 and hBD4 were signifi cantly higher in patients with caries than in patients with no-caries (p < 0.01). Conclusion: We conclude that high salivary levels and expression of beta defensins, low peroxidase activity and buffer capacity may represent a biological response of oral tissue to caries. Our observation could lead to new ways to prevent caries and a new tool for caries risk assessment