Transesophageal Echocardiography in Cardiac Surgical Emergencies

The value and utility of transesophageal echocardiography (TEE) in unstable cardiac surgical patients have been assessed; 119 TEE studies were performed and evaluated in the emergency setting. The studies were performed in the cardiac surgical intensive care unit (n = 62) and in the operating room (n = 57). There were 81 men and 38 women with a mean age of 58.2 years. The indications for TEE were as follows: hypotension refractory to conventional treatment (n = 83); prosthetic or native valve dysfunction (n = 25); and suspected aortic dissection (n = 10). TEE provided valuable diagnostic information in 107 patients and was completely normal in 12 patients. Based on these results 22 patients had urgent surgical intervention without further studies. The average time to diagnosis was 11.2 minutes. No significant complications were noted. Our results suggest that TEE is highly diagnostic for most of the abnormalities responsible for hemodynamic instability in the perioperative period and facilitates decision making in cardiac surgical emergencies.     

Reversibility of blood-brain barrier dysfunction in acute hypertension induced by angiotensin

The reversibility of blood-brain barrier (BBB) dysfunction was examined in rats after acute experimental hypertension. A short-lasting (≤4 min) acute hypertension was produced by intravenous injection of 20 μg/kg angiotensin. Evans blue, the barrier tracer, was administered intravenously either prior to or at intervals of 3, 10, 20, 30, and 60 min after the angiotensin injection. It was observed that the BBB dysfunction showed a peak 30 min after the angiotensin injection. Three of six animals that received Evans blue 60 min after angiotensin administration showed extravasation of the tracer on gross inspection. We concluded that BBB dysfunction may remain even 60 min after an acute hypertensive episode of short duration.     

Effect of alpha-lipoic acid on lipid peroxidation and anti-oxidant enzyme activities in diabetic rats

1. Oxidative damage has been suggested to be a contributory factor in the development and complications of diabetes. Recently, alpha-lipoic acid (ALA) has gained considerable interest as an anti-oxidant. Various studies have indicated the anti- oxidant effects of ALA and its reduced form dihydrolipoic acid. Therefore, it appears that these compounds have important therapeutic potential in conditions where oxidative stress is involved. The aim of the present study was to investigate the effect of ALA supplementation on lipid peroxidation and anti-oxidant enzyme activities in various tissues in diabetic rats. 2. Male Wistar rats were divided into three groups. Diabetes was induced by streptozotocin (STZ) injection in the two groups of rats to be supplemented and not to be supplemented with ALA. Another group of rats, which received saline injection, formed the control group. After 5 weeks of diabetes, rats were killed. In order to assess the redox status of various organs in the diabetic and control rats, thiobarbituric acid-reactive substances (TBARS) and glutathione (GSH) levels, as well as superoxide dismutase (SOD), glutathione peroxidase (G-Px) and glutathione reductase (G-Red) activities were determined in the liver, pancreas and kidney. 3. In both diabetic groups, TBARS levels and SOD activity were increased in the liver and pancreas, G-Px and G-Red activities were increased in the kidney and GSH levels were decreased in all organs compared with controls. In the ALA- supplemented group, TBARS levels were decreased, GSH levels were increased in the liver and pancreas, SOD activity was decreased in the liver, G-Px activity remained unchanged in all tissues and G-Red activity was increased in the pancreas compared with the diabetic group that did not receive ALA supplementation. 4. In conclusion, ALA supplementation has disparate effects on the redox status of different organs. These data are not sufficient for confirmation the beneficial effects of ALA supplementation on the redox status of various organs in diabetic rats.     

Assessment of the antibody response in 110 healthy individuals who have been subject to Vi capsular polysaccharide vaccine

Typhoid fever is a disease predominant in underdeveloped and developing countries. Typhoid fever is more prevalent, in fact endemic, in countries where fecal contamination of water and food sources are very common. The majority of the reported cases are in the adult age group. There are three different vaccines which can be used to prevent typhoid fever. In this study, we have used the parenteral Vi vaccine which was developed using the polysaccharide Vi antigen that covers the bacterial surface, thus, concealing the O antigen protecting the bacteria against Anti-O antibodies and regarded as virulence factor. A total of 110 individuals whose sera were negative for seroconversion prior to vaccination were included in this study in which we have assessed Anti-Vi antibodies by tube agglutination. Serum and stool samples of 110 individuals were assessed 1 month after the vaccination. A total of 105 (95.5%) of the vaccinated people were considered to have positive (1/40 and higher) response and this result was regarded as prophylactic seroconversion. None of the people in the study group had Salmonella typhi, S. paratyphi A,B,C isolated from their stool cultures.     

Medicolegal evaluation of cases with burn trauma: Accident or physical abuse

Introduction and objectiveBurns are thermal injuries that may have a wide variety of clinical consequences from simple injuries to mortality. There are many aspects that must be medicolegally addressed in both non-survivors and survivors from burn injuries. The objective of this study was to determine sociodemographic characteristics, injury patterns, treatment requirements and prognoses of patients with burn injuries to evaluate the findings of neglect-abuse and forensic reporting processes. This study also aimed to contribute to the medicolegal classification criteria in respect of the factors that have an effect on the prognosis in the analyses.Material and methodThe study was conducted by retrospective review of digital files and paper records of patients who received therapy in the Burns Unit of KTU Farabi Hospital between 1st January, 2013, and 31st December, 2017.ResultsEvaluation was made of a total of 1225 patients, comprising 769 (62.8%) males and 456 (37.2%) females, with a mean age of 21.8 ± 23.8 years (range, 1–89 years). The mean burnt body surface area was 14.29 ± 13.74. A trauma-related psychiatric disorder was diagnosed in 60 (4.9%) patients during treatment. When the medical history and physical examination findings were evaluated together, burn injuries suggested physical abuse in 54 patients (4.4%). The doctors who evaluated the patients with burn injuries in the emergency room and those who applied treatment in the Burns Unit made a forensic notification for 379 (30.9%) patients. The mean age of non-survivors was significantly higher than that of patients who survived to discharge (56.54 ± 28.60 years for non-survivors and 19.39 ± 23.12 years for survivors; p < 0.001).ConclusionBurn injuries are frequently encountered, and they require precautionary measures. Burn injuries due to abuse are more frequently observed in the elderly and especially in children. Thus, the findings must be correctly interpreted, and more effort should be made to improve the knowledge of healthcare professionals about forensic reporting. Moreover, regulations should be implemented in respect of the medicolegal classification of trauma.     

Alcoholism prevalence and some related factors in Edirne, Turkey

The aim of this research was to estimate the community prevalence of alcoholism and the potential risk factors that affect it in the Edirne provincial centre by using a scanning test. A cross-sectional study was carried out in the Edirne provincial centre. A sample population composed of 500 women and 200 men was selected randomly after the categorisation of the population according to ethnicity, age and sex. Through face-to-face interviews, data collection sheets, which were prepared to analyse potential factors affecting alcoholism frequency, were filled in by the sample population. The Michigan Alcoholism Scanning Test (MAST) was employed. According to MAST's normal grading, individuals with 5 or more points are evaluated as alcoholics. Accordingly, 8.2% of the sample population fit the definition of alcoholic. Alcoholism frequency was considerably higher in gypsies, the self-employed, smokers, and people with higher income. From logistic regression analysis alcoholism frequency was 12.4 times higher in men than in women, 3.2 times higher in gypsies than in others, 1.9 times higher in people who earned an income in the preceding week than in the unemployed, and 3.7 times higher in individuals who had smoked more than 100 cigarettes during their life or those who had smoked at least 1 cigarette for 3 months or for a longer period than in those who hadn't smoked any cigarettes. The prevalence of alcoholism in the Edirne provincial centre was similar to that in other countries in Europe. The most important finding was that alcohol consumption decreased in the unemployed, a finding that differs from that in other parts of the world. Gypsies, who differ in tradition, way of life, and job compared to the other strata of society, also suffered from higher alcohol consumption. This group usually consumed wine and generally did not eat while drinking.     

Hepatoprotective and neuroprotective effect of taxifolin on hepatic encephalopathy in rats

Metabolic Brain Disease - This study was planned to assess the potential protective effects of taxifolin against thioacetamide-induced hepatic encephalopathy and subsequently to portray its...     

Kikuchi Fujimoto disease as the presenting component of VEXAS syndrome: a case report of a probable association

Clinical Rheumatology -     

白内障手术技巧对术源性散光的影响

目的：评估行普通白内障超声乳化术,手术经验对术源性散光(SIA)的影响。

方法：选取患者50例53眼,平均年龄64.5±10.8a,随机分为两组,一组23眼,二组30眼。手术方式均采用透明角膜切口白内障超声乳化吸除联合人工晶状体植入术。第一组由白内障专家手术,第二组则由住院医师手术。术前所有患者均接受全面眼科检查,包括角膜曲率和自动屈光检测。SIA应用向量分析程序-Alpins法计算,于术后1d,1mo及2mo重复上述检查并记录结果变化。应用Shapiro Wilk和Mann-Whitney检验判断两组间SIA的统计学差异。

结果：两组患者人口资料差异无统计学意义。组间分析显示,一组术后1d,1mo及2mo的SIA分别为0.79±0.41 D,0.54±0.41 D及0.47±0.37 D; 二组分别为1.27±0.66 D, 0.98±0.56 D及0.94±0.54 D。 可见一组术后1d(P=0.002),1mo(P=0.004)及2mo(P=0.001)的SIA更小。

结论：手术经验是影响SIA的因素之一。住院医师应增加超声乳化术手术量以获取更多手术经验。     

The effect of different treatment strategies on left ventricular myocardial deformation parameters in patients with chronic renal failure

The aim of this study was to compare left ventricular (LV) functions by speckle tracking echocardiography (STE) in chronic kidney disease (CKD) patients in various stages and under different renal replacement treatments in order to evaluate possible differences between them. This prospective study included 150 patients with CKD. Renal transplantation patients with glomerular filtration rate greater than 60 ml/min/1.73 m², patients receiving hemodialysis three times a week, and patients in the predialysis stage with glomerular filtration rate less than 30 ml/dk/1.73 m² were assigned into Group 1 (n?=?50), Group 2 (n?=?50), and Group 3 (n?=?50), respectively. LV longitudinal, circumferential, and radial myocardial deformation parameters (strain, strain rate [SR], rotation, twist) were evaluated by STE. Peak systolic longitudinal strain was higher in the transplantation group than the hemodialysis group (??19.93?±?3.50 vs???17.47?±?3.28%, p?<?0.017). Peak systolic circumferential strain was lower in the hemodialysis group (??20.97?±?4.90%) than Groups 1 and 3 (??25.87?±?4.20 and ??24.74?±?4.55%, respectively, p?<?0.001). Peak systolic radial SR was higher in the transplantation group than the hemodialysis group (1.84?±?0.52 vs 1.55?±?0.52 s^?1, respectively, p?<?0.017). Other longitudinal and circumferential deformation parameters together with peak early diastolic radial SR and twist were also significantly different between the groups. Strain, SR, and twist values were mostly lower in the hemodialysis patients, but generally higher in the transplantation patients. LV functions evaluated by STE are better in the renal transplantation patients than the hemodialysis patients and than those in the predialysis stage. This may indicate beneficial effects of renal transplantation on cardiac functions.