Meperidine-induced reversible retrograde amnesia

Introduction: Meperidine is a synthetic opioid analog that is frequently prescribed for acute pain management. Normeperidine, the only active metabolite of meperidine, is neurotoxic and can cause significant central nervous system adverse events.Case summary: A 29-year-old woman (height, 170 cm; weight, 85 kg) presented to Marmara University Hospital Emergency Department, Istanbul, Turkey, complaining of low back pain she described as “stabbing.” Physical examination revealed impaired lower-extremity mobility and normal vital-sign findings. There was no evidence of foot drop, head or other trauma, and systemic physical examination was unremarkable. Other common causes (eg, pyelonephritis, nephrolithiasis, pancreatitis, trauma) of lower back pain were excluded. To achieve analgesia, meperidine 80 mg was administered intravenously in 100 mL of isotonic saline solution for 20 minutes. Within 20 minutes,analgesia was achieved,but the patient developed retrograde amnesia, becoming disoriented to time, location, and persons. Her speech slowed and perceptional changes developed. After the onset of amnesia, a complete physical examination was conducted.It failed to reveal focal neurologic deficit,and laboratory (sodium, potassium, magnesium, phosphorus, serum creatinine, blood urea nitrogen, albumin, bilirubin, hemoglobin,and platelet count) and subsequent vital-sign findings (blood pressure, 150/100 mm Hg; heart rate, 100 beats per minute; respiratory rate, 18 breaths per minute; body temperature, 37 ଌ and pulse oximetry,99%) were within the normal range. Noncontrast computed tomography did not reveal any abnormality. Initially, the patient''s condition was attributed to medication error due to incorrect dosage or infusion rate. Despite a review of medication logs, equipment, and the vital-sign record, the etiology for the phenomenon could not be identified. Meperidine was discontinued and oxygen and intravenous isotonic saline solution were initiated as supportive treatment. Three hours after meperidine administration was discontinued, the amnesia and disorientation spontaneously resolved.Conclusion: Meperidine was probably associated with reversible amnesia in this healthy patient after a single therapeutic dose.Key words: meperidine, amnesia, opioid analgesic, central nervous system toxicity     

Value of ischemia-modified albumin in the diagnosis of pulmonary embolism

Background

Pulmonary embolism (PE) is a common condition, but the diagnostic strategy for the evaluation of suspected PE is somewhat controversial. Despite the use of various biochemical markers (such as D-dimer and C-reactive protein) and various probability calculation algorithms based on clinical findings for that purpose, there is still a need for more specific and practical markers in PE diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of PE.

Methods

This case-control study was performed in the emergency department between March and September 2006. The serum IMA levels of a total of 60 individuals, consisting of 30 PE patients who had been definitively diagnosed via spiral computed tomographic angiography and 30 healthy volunteers, were examined.

Results

The measurement of IMA levels in patient plasma yielded mean values of 0.724 ± 0.122 absorbance unit (ABSU) in the PE group and 0.360 ± 0.090 ABSU in the control group. When plasma IMA levels in the PE group were compared with those in the control group, statistically significant increases in IMA were observed in the former (t = 13.19, df = 56, P < .0005). The value of 0.540 ABSU was calculated as the upper limit of reference interval. In the PE group, 97.7% (n = 29) had values exceeding 0.540 ABSU; none of the control subjects had values exceeding this cutoff value.

Conclusions

In conclusion, our data suggest that IMA levels may be useful as a discriminative marker to exclude pulmonary embolism.     

Localized delivery of methylprednisolone sodium succinate with polymeric nanoparticles in experimental injured spinal cord model

With important social and economic consequences, spinal cord injuries (SCIs) still exist among major health problems. Although many therapeutic agents and methods investigated for the treatment of acute SCI, only high dose methylprednisolone (MP) is being used currently in practice. Due to the serious side effects, high dose systemic MP administration after SCI is a critical issue that is mostly considered controversial. In our study, it is aimed to develop a nanoparticle-gel combined drug delivery system for localization of MP on trauma site and eliminating dose-dependent side effects by lowering the administered dose. For this purpose, methyl prednisolone sodium succinate (MPSS) loaded polycaprolactone based nanoparticles were developed and embedded in an implantable fibrin gel. The effects of MPSS delivery system are evaluated on an acute SCI rat model, by quantification the levels of three inflammatory cytokines (interleukin-1β, interleukin-6 and caspase-3) and assessment of the damage on ultrastructural level by transmission electron microscopy. Developed NP-gel system showed very similar results with systemic high dose of MPSS. It is believed that developed system may be used as a tool for the safe and effective localized delivery of several other therapeutic molecules on injured spinal cord cases.     

Sexual Myths Scale (SMS): Development,Validity and Reliability in Turkey

This study aims at developing a measurement tool that determines the sexual myths and testing its validity and reliability. The draft scale consisted of 74 items, and it was applied to 746 university students. Cronbach Alpha coefficient was found 0.91, and the test–retest reliability coefficient was 0.814. Eight factors consisting of 28 items, explaining 65 % of total variability were obtained in the factor analysis done with varimax rotation for the construction of validity. The factorial model of scale was found theoretically and statistically convenient after the confirmatory factor analysis. The results indicated that Sexual Myths Scale (SMS) is a valid and reliable instrument in Turkey.     

The effect of GM-CSF (granulocyte macrophage colony stimulating factor) on doxorubicin induced tissue necrosis and wound healing

PURPOSE: The effect of GM-CSF (granulocyte macrophage-colony stimulating factor) on tissue necrosis and ulceration induced with doxorubicin extravasation was studied. MATERIALS AND METHODS: Adult Wistar-Albino rats (n=36) were used in the study. Doxorubicin (0.4mg/300 g) was applied subcutaneously to abdominal wall. In group I (n=18), half hours after doxorubicin injection, GM-CSF 6 microg/300 mg was applied subcutaneously to the same localization. In group II (n = 18) same amount of physiologic saline (0.5 ml) were given subcutaneously to the injection site (as vehicle control groups). Group II and I were examined for induration or ulceration on 7th and 21st day. After evaluating the lesions, the injection sites were excised. Hydroxyproline (5-HP) values of dry tissue samples were calculated and histopathologic examination was done. RESULTS: At day seven there were four and eight ulceration in groups I and II, while there were four and 14 ulceration in the second evaluation at day 21st (p<0.05). 5-HP values of the groups were as follows. 97.43+/-20.39 in group land 91.34+/-22.26 in group II. Although there was an increase in epithelization, eosinophil and lymphocyte infiltration and mast cell number in group I in histopathologic examinations only the increase in angiogenesis in group I was found to be statistically significant (p<0.05). CONCLUSION: It can be concluded that GM-CSF may have beneficial effect in the treatment of doxorubicin induced tissue necrosis.