Kardiyak cerrahide miyokardiyal koruma açısından intermittant antegrad kardiyopleji ile antegrad/retrograd sürekli kardiyoplejinin karşılaştırılması

Amaç: Bu çalışmada kardiyak cerrahide miyokardiyal koruma açısından intermittant antegrad kardiyopleji ile antegrad/retrograd sürekli kardiyopleji karşılaştırıldı. Ça­lış­ma­pla­nı:­ Ekim 2010 - Ocak 2011 tarihleri arasında kliniğimizde kardiyak cerrahi ameliyatı uygulanan 106 hasta çalışmaya alındı. Hastalar, intermittant antegrad kardiyopleji uygulananlar (grup 1; 18 kadın, 14 erkek) ve antegrad/retrograd sürekli kardiyopleji uygulananlar (grup 2; 16 kadın, 58 erkek) olmak üzere iki gruba ayrıldı ve ameliyat sonrası elde edilen sonuçlar karşılaştırıldı. İşlem sürecinde troponin-I, kreatin kinaz-miyokard bandı (CK-MB) düzeyleri, kardiyopulmoner baypas (KPB) ve kros klemp süreleri, kardiyopleji toplam miktarları ve potasyum kullanımı değerlendirildi. Bul gu lar: Bulgularımıza göre, ortalama troponin-I ve CK-MB değerleri grup 1’de grup 2’den daha yüksekti. Ancak bu farklılık istatistiksel olarak anlamlı değildi. Grup 1’de troponin-I ve CK-MB değerleri kros-klemp ve KPB süresi ile korele iken, grup 2’de troponin-I ve CK-MB değerleri kros-klemp ve KPB süresi ile korele değildi. So­nuç:­ Troponin-I, CK-MB düzeyleri ile KPB ve kros-klemp zamanları arasında anterograd/retrograd sürekli kardiyopleji uygulanan grupta korelasyon bulunmadı. Buna göre, antegrad/ retrograd sürekli kardiyopleji ile efektif miyokardiyal koruma sağlandığında, troponin-I ve CK-MB değerleri etkilenmedi ve miyokardiyal koruma daha iyiydi. Anterograd/retrograd sürekli kardiyopleji daha iyi miyokardiyal koruma sağlasa da anterograd kardiyopleji sırasında aort basıncı istenen düzeylerde tutulabilmesi için monitörize edilmeli ve retrograd kardiyopleji sırasında da retrograd kanül doğru yerde tutulmalıdır. Anah­tar­söz­cük­ler: Kardiyopleji, koroner baypas cerrahi, miyokardiyal yaralanma, miyokardiyal koruma.Background:­ This study aims to compare intermittent antegrade cardioplegia and antegrade/retrograde continuous cardioplegia in terms of myocardial protection in cardiac surgery. Methods: Hundred six patients who underwent cardiac surgery in our clinic between October 2010 and January 2011 were included in the study. Patients were divided into two groups as patients who received intermittent antegrade cardioplegia (group 1; 18 females, 14 males) and who received antegrade/retrograde continuous cardioplegia (group 2; 16 females, 58 males), and postoperative results were compared. Troponin-I, creatine kinase-myocardial band (CK-MB) levels, durations of cardiopulmonary bypass (CPB) and cross-clamping, total amounts of cardioplegia, and potassium utilization during the process were evaluated. Results:­ According to our results, mean troponin-I and CK-MB levels were higher in group 1 than group 2. However, this difference was not statistically significant. While troponin-I and CK-MB values were correlated to durations of cross-clamping and CPB in group 1, troponin-I and CK-MB values were not correlated to durations of cross-clamping and CPB in group 2. Conclusion:­ No correlation was detected between troponin I, CK-MB levels, and durations of CPB and cross-clamping in the group which received anterograde/retrograde continuous cardioplegia. Therefore, troponin-I and CK-MB levels were not affected and myocardial protection was better once effective myocardial protection was obtained by antegrade/retrograde continuous cardioplegia. Although antegrade/retrograde continuous cardioplegia provides better myocardial protection, aortic pressure must be monitored to be kept between desired levels during antegrade cardioplegia, and the retrograde cannula must be kept in the appropriate place during retrograde cardioplegia

FACTORS ASSOCIATED WITH SUICIDE ATTEMPTS IN PATIENTS WITH BIPOLAR DISORDER TYPE I

Background: The aim of this study is to identify the risk factors that are associated with suicide attempts in patients with bipolar disorder type I. Subjects and methods: This cross-sectional study was conducted with inpatients and outpatients with BD type I. Patients who met the study inclusion criteria (n=91) were evaluated in terms of sociodemographic variables, history of childhood trauma, comorbidity of adult attention deficit hyperactivity disorder and posttraumatic stress disorder, and the course of the disease. The patients were divided into two groups: those with a history of suicide attempts and those without a history of suicide attempts. The parameters of the study groups were compared with t and chi-square tests as appropriate. Logistic regression was used to identify the predictors of suicide attempt. Results: Logistic regression analysis of the study parameters suggested that the number of major depressive episodes (odds ratio: 7.18; 95% confidence interval: 1.84-28) and history of emotional neglect (odds ratio: 1.83; 95% confidence interval: 1.15- 2.90) were significant predictors of suicide attempt in patients with BD. Conclusion: In BD type I patients with a history of suicide attempts, the number of depressive episodes and emotional neglect, a subtype of childhood traumas, were the most remarkable risk factors. Considering the frequency of depressive episodes during the course of the disease and assessing traumas including those in childhood may help predict future suicide attempts in patients with BD

Alteration of boza microbiota in the fermentation process

Boza is a fermented beverage containing beneficial microorganisms for human health. In our study, microbiota present in raw materials used boza production (corn flour, wheat flour, and mayşe), 1st day, 3rd day of boza fermentation and 4th day final product of boza, has been identified by Next Generation DNA Sequencing and metagenomic analysis. As a result of genus-level analysis directly from corn flour and wheat flour samples contained dominantly Streptophyta and Pleomorphobacterium, while in the 1st day, 3rd day, the final product of boza and boza ferment the dominant bacteria were Leuconostoc and Lactococcus at genus level. In the analysis of the pre-enriched samples, the dominant bacteria in corn flour were Enterococcus, Klebsiella, and Micromonospora and in wheat flour were Pantoea and Bacillus. Boza ferment, boza on the 1st day, boza on the 3rd day and the final product of boza dominantly contained Lactococcus. The bacterial diversity, similarity and differences among samples were analyzed by Principal Coordinate Analysis and dendrogram construction. The contribution of raw materials used in the production of boza change to the products at the fermentation stage and to the microbiota during the fermentation process and their contribution to the final product were determined by metagenomic analysis at DNA level.Boza, insan sağlığı için yararlı mikroorganizmaları içeren fermente bir içecektir. Çalışmamızda boza üretiminde ham madde olarak kullanılan (mısır unu, buğday unu, mayşe) ve boza fermantasyonunun 1. günü, 3. günü ve 4. gün son ürün boza’nın içerdiği mikrobiyota Yeni Nesil DNA Dizileme yöntemi ve metagenomik analiz ile ortaya çıkarılmıştır. Örneklerden doğrudan cins düzeyinde yapılan analiz sonucunda, mısır unu ve buğday ununda dominant olarak Streptophyta ve Pleomorphobacterium bulunurken; bozanın 1. gün, 3. gün ve son ürün ile boza mayasında dominant bakterilerin Leuconostoc ve Lactococcus cinsine ait olduğu tespit edilmiştir. Ön zenginleştirme yapılan örneklerin analizinde, mısır ununda dominant bakteriler Enterococcus, Klebsiella ve Micromonospora, buğday ununda ise Pantoea ve Bacillus olduğu, boza mayası, 1. gün boza, 3. gün boza ve satışa sunulan son üründe dominant bakteri Lactococcus olarak belirlenmiştir. Çalışmamızda örnekler arasındaki bakteriyel çeşitlilik, benzerlik ve farklılıklar Principal Coordinate Analiz ve dendrogram oluşturulması ile ortaya konmuştur. Boza üretiminde kullanılan ham maddelerin bozanın fermantasyon aşamalarındaki ürünler ile fermantasyon sürecinde mikrobiyotasına nasıl değiştiği ve son ürüne olan katkıları, DNA düzeyinde yapılan metagenomik analizler ile belirlenmiştir

Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

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

BIST30 Varantlarına Heston Stokastik Volatilite Modelinin Uygulanması

Heston modeli ilk ve en bilinen stokastik volatilite modellerinden biridir. Bu çalışmanın amacı Heston modelinin BIST30 üzerine yazılmış varantlar üzerindeki fiyat ve üretme (pricing and replication) performansını ve Heston modeli ile ilgili literatürde yapılmış gözlemlerin BIST30 verisiyle uyumunu incelemektir

Can mirabegron facilitate ureteral access sheath placement during flexible ureterorenoscopy?

Aim: In this study, we aimed to demonstrate the effect of mirabegron on ureteral access sheath (UAS) placement during flexible ureterorenoscopy (f-URS)