Histological changes following epidural injection of midazolam in the neonatal rabbit

Midazolam can produce antinociceptive effects when used via intrathecal or epidural routes. Neurotoxicity studies are scanty especially for neonates. The aim of this study was to carry out electron microscopic (EM) examinations in the neonatal rabbit to determine the histological effects of epidural midazolam on spinal cord. Twenty white New Zealand neonatal rabbits were randomly assigned to three groups receiving single dose of 0.9% saline (Group I; Control, n =4), 0.9% saline titrated to pH=3.9 by addition of hydrochloric acid (Group II; n =6), midazolam 250 μg·kg⁻¹ (Group III; n =12) epidurally. Half of each group were sacrificed on the second day and the remainder on the seventh day and spinal cord sections were evaluated by EM. Control group displayed normal histology on grids. Group II and II showed a variable degree of neurotoxic effects such as degeneration of vacuoles, cytoplasm and neurofilaments, disruption of myelin sheaths, lysis of cell membranes, perivascular oedema, pyknosis of nuclei. The toxic effects of acidic saline and midazolam are similar, in view of these results the epidural use of acidic midazolam (commercially available preparations) in neonates should be avoided.     

Proguanil metabolism in relation to S-mephenytoin oxidation in a Turkish population

The oxidation of proguanil was studied in 89 unrelated healthy Turkish volunteers after administration of proguanil (single dose, 200  mg, orally). Based on the distribution of the ratio of proguanil to cycloguanil excreted in urine, and using an antimode value of 15, the prevalence of poor metabolizers in a Turkish population was estimated to be 5.6% (95% confidence interval 2.0%–17.3%) which was similar to that in the other Caucasian populations. The relationship between the oxidative capacities of CYP2C19 for the two substrates, proguanil and mephenytoin, was studied in 39 subjects (two poor and 37 extensive metabolizers of proguanil). The two poor metabolizers of proguanil were also identified as poor metabolizers of S-mephenytoin and no misclassification by the two phenotyping methods was observed. The correlation between the metabolic ratio of proguanil to cycloguanil and the S/R-mephenytoin ratio as assessed by Spearman's rank test, was statistically significant ( r _s=0.50, P <0.001).     

Ambulatory oesophageal pressure,pH and ECG recording in patients with normal and pathological coronary angiography and intermittent chest pain

Abstract The present study was performed to compare pain-related oesophageal motility, gastro-oesophageal reflux and ST-segment deviations in patients with intermittent chest pain and normal or pathological coronary angiography. Thirty patients (11 males, 19 females; mean age 54.8 years) with normal and 15 patients (12 males, 3 females; mean age 66.7 years) with pathological coronary angiography were investigated by 24-h oesophageal pressure, pH and ECG recording. Chest pain correlated with motility abnormalities or gastro-oesophageal reflux occurred in 33% (10/30) of patients with normal coronary arteries and in 26% of patients with pathological coronary angiography. Symptomatic and asymptomatic ST-segment changes were less frequently observed in patients with normal angiography (4/30) than in patients with pathological coronary angiography (7/14; P = 0.02). Oesophageal dysfunction coincided with ST-segment deviation in 6.7% (2/30) of patients with normal and 40% (6/15) of patients with pathological coronary angiography (P = 0.02). The conclusions reached were: (1) pain-correlated abnormal motility or gastro-oesophageal reflux occurred in patients with normal and pathological coronary angiography at the same frequency; (2) ambulatory motility and pH recording alone does not appear to differentiate between cardiac and non-cardiac chest pain; (3) simultaneous ECG recording reveals a significant correlation of ST-segment deviation and gastro-oesophageal reflux or abnormal motility in patients with coronary artery stenosis.     

Correlation of serum and ascitic IL-12 levels with second-look laparotomy results and disease progression in advanced epithelial ovarian cancer patients

Forty-two consecutive patients with advanced epithelial ovarian cancer who underwent primary surgical treatment were evaluated. The control group comprised 21 patients who had undergone surgery associated with benign pathologies. Forty-one patients had stage III disease except one who had stage IV. Optimal debulking (<1 cm) was performed in all the patients who subsequently received chemotherapy. Based on the results of the second-look laparotomy and follow-up, the patients were divided into three groups: the first group had negative second-look laparotomy or no evidence of disease during follow-up (n= 21), the second group had positive second-look laparotomy or progressive disease (n= 21), and the third was the control group (n= 21). Interleukin-12 (IL-12) levels were measured in preoperative serum and intraoperative ascites samples for all the patients. The mean serum IL-12 levels (+/-SD) in serum (S) and ascites (A) were as follows: in the first group, S: 108.44 +/- 76.40 pg/mL and A: 330.93 +/- 125.25 pg/mL; in the second group, S: 51.80 +/- 40.95 pg/mL and A: 206.89 +/- 113.47 pg/mL; and in the control group, S: 36.55 +/- 33.16 pg/mL and A: 93.62 +/- 73.07 pg/mL (P= 0.01). In the patients with advanced ovarian cancer, IL-12 levels in serum and ascites were higher compared to the levels of the controls. Also, there was an inverse relationship between initial serum and ascitic IL-12 levels and disease progression.     

Stimulation of pancreatic secretion in man by a protease inhibitor (camostate)

Pancreatic secretion and plasma cholecystokinin (CCK) and secretin levels were measured in 10 healthy volunteers after application of a serine protease inhibitor (camostate) to study the mechanism of feedback regulation. Camostate produced a strong inhibition of trypsin and chymotrypsin activity in duodenal juice for 1 h. This was accompanied by an increase in duodenal aspirate volume and pancreatic enzyme secretion under both basal and secretin-stimulated conditions. Due to inhibition of tryptic activity, survival of lipase activity in duodenal juice was prolonged. In control experiments we ruled out that the volume and the pH of the solution were responsible for stimulation of pancreatic secretion. The protease inhibitor did not alter pancreatic secretion, which was stimulated by a test meal. Plasma levels of CCK and secretin were not changed after duodenal perfusion of camostate. These observations suggest that trypsin and chymotrypsin are involved in feedback regulation of pancreatic secretion in man which is, however, not mediated by CCK or secretin.     

Could serum albumin value and thrombocyte/lymphocyte ratio be an important prognostic factor in determining the severity of COVID 19?

Background and aimCreating potential clinical markers for risk assessment in patients with COVID-19 continues to be an area of interest. In this study, we aimed to evaluate whether serum albumin level and thrombocyte/lymphocyte ratio are related to the severity of the disease.Materials and methodsThe patients were divided into two groups according to the severity of disease. Demographic data, serum albumin value, lymphocyte count, TLO-1 values (thrombocyte/lymphocyte ratio-1), the highest thrombocyte count during hospitalization, TLO-2 (thrombocyte/lymphocyte ratio-2) values formed by the highest thrombocyte count, were recorded.ResultsThere was no statistically significant differences (P > 0.05) in terms of sex, thrombocyte count at the time of admission, and highest thrombocyte count during hospital follow-up. There were statistically significant differences in terms of age, comorbidity, lymphocyte value at the time of hospitalization, lymphocyte count during hospital follow-up, TLO 1, TLO 2, and serum albumin values between the groups. The ICU group were found to be older, had higher rates of comorbidity, lower lymphocyte values, higher TLO 1-2, and lower serum albumin levels (P < 0.05).ConclusionTLO-2 ratio above 260 and lymphocyte level below 1 103 cells/μL, would be a predictor of further intensive care unit need.