Comparison of Clinical and Hemodynamic Effects of Isoflurane and Sevoflurane Anesthesia in Calves

Background: Inhalation anesthesia is the preferred method for use on many animal species, including ruminants, due to its superiority over the injectable anesthetics. The most commonly used inhalation anesthetics are isoflurane and sevoflurane The aim of the study was to investigate the effects of isoflurane and sevoflurane anesthesia on the cardiovascular system of calves.Materials, Methods & Results: A total of 20 calves (11 male, 9 female) between 1 and 6 months in age and 50 to 85 kg in body weight were used. The calves were divided randomly into two groups of 10 each, with one group being administered isoflurane and the other sevoflurane. An intramuscular dosage of 0.1 mg/kg of xylazine was administered to the calves as premedication. Induction was performed 10 min after calves were given an intramuscular dosage of 4 mg/kg of ketamine. Inhalation anesthesia was maintained with isoflurane or sevoflurane in 100% oxygen saturation. Before anesthesia, after induction and at intervals of 5, 10, 15, 20, 25, 30, 45, and 60 min of anesthesia, the body temperature, heart rate, and respiratory rate of the calves were recorded. Additionally, before anesthesia, after induction and at intervals of 15, 30, 45, and 60 min of anesthesia, serum electrolyte (Na+, Ca++, K+, Mg++) and blood gases (pH, pCO2, pO2, HCO3-, TCO2, O2Sat, HCT) were evaluated from blood samples taken from both groups. The second derivation, durations and amplitudes of the P and T waves, the durations and amplitudes of the QRS complex, and the durations of PQ and QT intervals were evaluated on the ECGs recorded before anesthesia, after induction and during anesthesia. Following anesthesia termination, the extubation time and the time it took for straightening of the head and standing up were recorded. Decrease in heart rate and body temperature were found significant in two of the groups. Decrease in respiratory rate compared to initial values after premedication was statistically significant for both groups. However, during anesthesia, an increase occurred. This incresae in respiration rate was not statistically significant compared to initial values. The incease in the values of pCO2, pO2, HCO3 and the decrease in the values of pH and Hct comparing the initial values was found statistically significant in both groups.Discussion: In ruminants, isoflurane has an induction concentration of 3-5% and an anesthetic concentration of 1.5-3%, while sevoflurane has an induction concentration of 4-6% and an anesthetic concentration of 2.5-4%. In this study, the concentration of isoflurane was 2.3% (2-5) and the of sevoflurane was 4.07% (3-5) for surgery. In the isoflurane group, extubation, straightening of the head and standing up times were 12.40 ± 3.77 min, 20.4 ± 1.57 min, and 30.80 ± 1.89 min, respectively. In the sevoflurane group, extubation, straightening of the head and standing up times were 13.40 ± 4.99, 19.2 ± 1.49, and 28.0 ± 1.83 min, respectively. Although the calves in the isoflurane group were extubated earlier than those of the sevoflurane group, the time elapsed for straightening of the head and standing up were longer than that of the sevoflurane group. The anesthesia protocol provided a smooth anesthetic administration, general anesthesia and awakening. In conclusion, the effects of isoflurane and sevoflurane anesthesia on the cardiovascular and respiratory system were similar, and although the changes that emerged during anesthesia were statistically significant, it was nonetheless found that the changes were within the physiological limits

Quality of life among women with symptoms of gynecological morbidities: results of a cross‐sectional study in Karachi, Pakistan

AIMS: A population-based cross-sectional study design was used to study the effects of symptoms of various gynecological morbidities (GM) on health-related quality of life (HRQoL) of women, residents of squatter settlements of Karachi, Pakistan. MATERIAL AND METHODS: This cross-sectional study was conducted in squatter settlements of Karachi from September 2012 to August 2013, with 1002 married, non-pregnant women. After obtaining written informed consent from every participant, a structured questionnaire was used to collect information about symptoms of GM and their effect on four domains of HRQoL (physical, social, functional and financial domains). RESULTS: Of 1002 women who participated in the study, 578 reported suffering from one or more symptoms of GM. The most commonly reported symptoms were foul-smelling vaginal discharge, dysmenorrhea and uterovaginal prolapse while the least reported symptom was post-coital bleeding. Symptoms of GM were found to have a negative impact on HRQoL. Approximately one-third of women with the symptoms of GM reported having negative influences on the physical, financial and functional domains of HRQoL with social domain being comparatively less affected. Compared to other symptoms, dysmenorrhea and uterovaginal prolapse were reported to be mostly associated with poor HRQoL of women. CONCLUSION: The concept of HRQoL has been kept marginal and inconspicuous by clinicians. In order to achieve the psychosocial satisfaction of the patient, the focus needs to be diverted to all domains of HRQoL

Is BMI Sufficient to Evaluate the Association between Obesity and Ovarian Reserves?

Body fat content and distribution might have an effect on ovarian reserves. Here, we studied the effects of body fat distribution on the antral follicle count (AFC) of women who consulted for infertility. In this two-center study, the ovarian reserves of patients who came to the hospital for infertility treatment was evaluated based on their AFC and early follicular phase follicle-stimulating hormone (FSH) levels. In addition, adiposity was evaluated using their body mass index (BMI) and waist-to-hip ratios (WHRs), the subcutaneous tissue thickness of the bicipital and tricipital regions, and the body adiposity index (BAI). Body fat distribution was evaluated using bioelectrical impedance analysis (BIA). We evaluated 58 patients in this study. While we failed to show a relationship between BMI and WHR based on the AFC, there was a significant relationship between body fat percentage and the AFC. The AFC in patients with < 35% body fat and ≥ 35% body fat was 11.54 ± 4.27 and 9.00 ± 3.95, respectively (p = 0.029). There was no significant relationship between the AFC and the WHR, BAI, and bicipital and tricipital subcutaneous tissue thickness. BMI may not reflect the adiposity of every patient. When evaluating the ovarian reserves of patients, we must consider other measures of obesity that reflect body fatness. Further large studies must be conducted to investigate the relationship between body fat and infertility

Do Bmı or Waıst-to-Hıp Ratıo Interfere wıth The Number of Oocytes Retrıeved ın IVF Cycles?

The effect of obesity on ovarian response to ovulation induction and on in vitro fertilization (IVF) outcome is controversial. This controversy might stem from the fact that almost all studies on the subject use body mass index (BMI) for obesity measurement. We aimed to determine which obesity measure predicts the possible effect of obesity on ovarian response in IVF patients. In this retrospective study, patients who presented for IVF and underwent an antagonist protocol were included. Their histories and cycle properties were recorded, as well as their BMI and waist-to-hip (W/H) ratios. A total of 35 patients were included. While normal BMI significantly lowered the gonadotropin dose, normal W/H ratio increased the antral follicle count (AFC). Both BMI and W/H ratio did not significantly affect either the number of oocytes retrieved or the metaphase II oocytes. Ovulation induction during IVF cycles can overcome the adverse effects of obesity on ovarian reserve. Large-sample-sized, well-designed studies must be performed to clarify the best obesity measurement method for infertility treatment and to determine the real effect of obesity on IVF success

Clinical Study The Role of Serum Cytokines in the Pathogenesis of Hepatic Osteodystrophy in Male Cirrhotic Patients

Objective. In this study, we aimed to investigate the possible role of serum cytokines in the development of hepatic osteodystrophy. Matherial and Methods. 44 consecutive male cirrhotic patients (17 alcoholic, 20 hepatitis B, 7 hepatitis C), 15 age-and sex-matched chronic alcoholics without liver disease, and 17 age-and sex-matched healthy controls were included in the study during one year period. Bone mineral density was measured by dual X-ray absorptiometry in the lumbar vertebrate and femoral neck. Serum interleukin levels were measured by ELISA method. Results. Although osteopenia frequency between our cirrhotic patients was 20%, there was no difference in T-scores among the controls and other groups. Serum interleukin-1, interleukin-8, and tumor necrosis factor-alpha levels were not different between all groups. Serum interleukin-2 and interleukin-6 levels were higher in the cirrhotics than controls (P < 0.001). However, there were no significant difference between osteopenic and nonosteopenic cirrhotics. Conclusion. According to the results of the study in this small population of 44 male cirrhotic patients, frequency of hepatic osteopenia is small and serum interleukins 1, 2, 6, 8, and tumor necrosis factor-alpha may not play a role in the pathogenesis of hepatic osteodystrophy. Further studies in which large number of patients involved are necessary in this field

Comparison of the efficacy of once- and twice-daily colchicine dosage in pediatric patients with familial Mediterranean fever - a randomized controlled noninferiority trial

Background: In this study, we examined the efficacy and safety of a once-daily dosage schema of colchicine compared with a twice-daily dosage schema in pediatric patients with familial Mediterranean fever (FMF). Methods: In this 24-week, multicenter, randomized controlled noninferiority trial, pediatric patients newly diagnosed with FMF carrying a homozygous or compound heterozygous mutation and not receiving any treatment were included. Patients were randomly assigned using a block randomization method to receive treatment with a once- or twice-daily dosage. Clinical and laboratory characteristics and medication side effects were recorded and compared between groups. The study was carried out in compliance with Good Clinical Practice and the Consolidated Standards for Reporting of Trials (CONSORT) statement. Results: A total of 92 patients were selected, and 79 patients completed the study. There were 42 patients in the once-daily dosage group and 37 in the twice-daily dosage group. The results indicated that the once-daily dosage was not inferior to the twice-daily dosage regarding decrease in attack frequency and duration as well as improvement in clinical findings and Mor severity scores. Alterations in laboratory findings indicating inflammation, such as erythrocyte sedimentation rate, C-reactive protein, and serum amyloid A, were similar in both groups. The rates of drug side effects were similar between the once- and twice-daily dosage groups, implying comparable safety of colchicine, with the exception of diarrhea, which was slightly higher in the once-daily dosage group. Conclusions: Using colchicine with either a once- or twice-daily dosage provides similar clinical and laboratory improvements. Considering both efficacy and safety, colchicine can be prescribed with a once-daily dosage. Trial Registration ID: ClinicalTrials.gov identifier NCT02602028. Registered 5 November 2015

Cost-effectiveness Analysis of TPMT Genotype-guided Azathioprine Treatment Compared to Standard Treatment for Patients with Moderate/Severe Ulcerative Colitis

This study assessed cost-effectiveness of pharmacogenomics (PGx)-based azathioprine (AZA) compared to standard AZA therapy for ulcerative colitis (UC) patients in Canada. A patient-level Microsimulation model was developed to compare the lifetime costs and quality-adjusted life years (QALYs) gained by a hypothetical cohort of UC patients with age and sex characteristics. The parameters used in the model were derived from the published literature and costs from the Ontario Schedules of Payments and published sources. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard AZA, PGx-based AZA care was the dominant strategy with 0.17 incremental QALYs and cost savings of CAD$2,724. The probabilistic sensitivity analysis showed that PGx-based AZA had greater probability of being cost-effective compared to standard AZA at any willingness to pay (WTP) threshold. At a WTP threshold of$50,000/QALY, PGx-based AZA was the cost-effective treatment in 97% of the iterations, while standard AZA cost-effective strategy in 3% of the iterations. We found that PGx-based AZA care presents good value for money and has a higher probability of being cost-effective for UC patients in Canada at a WTP threshold of $50,000/QALY

Context-Dependent Construction Conflict Management Performance Analysis Based on Competency Theory

Construction project environments are shaped by uncertainty and complexity; therefore, conflict situations that lead to time and cost overruns are rather frequent. However, no empirical studies conducted so far have analyzed conflict management performances of individuals on a context-dependent basis. This paper proposes a performance assessment methodology for conflict management that integrates two different approaches from other disciplines: hypothetical situations and competency theory. The approach analyzes managers' performances in the exact same conflict cases through an after-scenario questionnaire based on their preferences toward candidate management scenarios, each of which reflects one of the required competencies for effective conflict management. Considering the context-dependent characteristics of the conflict phenomenon, the implementation of the methodology within this paper's context is confined to the construction industry. The methodology was implemented among 82 construction project managers through an after-scenario questionnaire, and three random participants' conflict management performances were analyzed. Based on a novel construction conflict management performance assessment methodology, this research can offer two contributions to the body of construction conflict management knowledge. First, it has revealed the lack of a generic hierarchy in terms of the competencies required. Second, the results confirmed that construction managers' conflict management performances may vary despite identical years of experience and managerial positions held