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Background: Although chemotherapy-induced cardiotoxicity is an emerging problem, limited information is available on the effects of chemotherapy on left ventricular (LV) mechanical functions in patients with non-small cell lung cancer (NSCLC). Objective: We aimed to explore chemotherapy-induced alterations in cardiac mechanical functions in patients with NSCLC using speckle tracking echocardiography (STE). Methods: Seventy-one patients with NSCLC and 34 age and sex matched control subjects were consecutively included. Based on their good performance status (Eastern Cooperative Oncology Group performance status), 39 patients were treated with paclitaxel plus carboplatin (PC) regimen and 32 patients were treated with vinorelbine plus cisplatin (VC) regimen. All patients and controls underwent conventional two-dimensional echocardiography and STE at baseline to assess their LV functions. The echocardiographic examinations of NSCLC patients were repeated after the chemotherapy regimens. Results: None of the NSCLC patients developed any signs or symptoms of clinical heart failure during or after the chemotherapy. There were not any significant differences in LV ejection fraction between NSCLC patients and controls before and after chemotherapy. There were not any significant differences in baseline LV global longitudinal strain (GLS), radial strain (RS), and circumferential strain (CS) between NSCLC patients and controls. However, all LV GLS, RS and CS significantly decreased in patients treated with the PC regimen resulting in a significant difference compared to both VC group and controls while no significant decreases were observed in strain measures in VC group. Conclusion: Paclitaxel plus carboplatin, but not VC, may induce subclinical cardiotoxicity in patients with NSCLC, which may be detected by STE. Resumo: Introdução: Embora a cardiotoxicidade induzida pela quimioterapia seja um problema emergente, existe informação limitada sobre os efeitos da quimioterapia na função do ventrículo esquerdo (VE) em doentes com cancro do pulmão não de pequenas células (CPNPC). Objetivo: Avaliar alterações induzidas pela quimioterapia na função cardíaca em doentes com CPNPC utilizando a ecocardiografia de speckle tracking (EST). Métodos: Foram incluídos consecutivamente 71 doentes com CPNPC e 34 indivíduos caso controlo emparelhados por idade e género. Com base no seu desempenho (Eastern Cooperative Oncology Group performance status), 39 doentes foram tratados com regime de paclitaxel e carboplatina (PC) e 32 doentes foram tratados com regime de vinorelbina e cisplatina (VC). Todos os doentes e casos controlo foram submetidos a ecocardiografia bidimensional convencional (2DE) e a EST na fase basal para avaliar a função VE. As avaliações ecocardiográficas dos doentes com CPNPC foram repetidas após quimioterapia. Resultados: Nenhum dos doentes com CPNPC desenvolveu qualquer sinal ou sintoma clínico de insuficiência cardíaca durante ou após a quimioterapia. Não houve diferenças significativas na fração de ejeção do VE entre os doentes com CPNPC e os casos controlo antes e depois da quimioterapia. Não houve diferenças significativas nos valores basais da deformação longitudinal global do VE (GLS), deformação radial (RS) e deformação circunferencial (CS) do VE entre os doentes com CPNPC e os casos controlo. No entanto, todos os valores de deformação miocárdica VE diminuíram significativamente nos doentes tratados com o regime CP, resultando numa diferença significativa em comparação tanto com o grupo CV como com os casos controlo, embora não se tenham observado diminuições significativas nas medidas de strain no grupo VC. Conclusão: Apenas a PC, mas não a VC, pode induzir cardiotoxicidade subclínica em doentes com CPNPC, o que pode ser detetado por ecocardiografia de speckle tracking.

RESUMO Objetivo: Avaliar a incidência de fatores de risco para hipotensão pósintubação em pacientes críticos com COVID-19. Metódos: Foi realizado um estudo retrospectivo com 141 pacientes com COVID-19 que foram intubados na unidade de terapia intensiva. Hipotensão pós-intubação foi definida como a necessidade de qualquer dose de vasopressor a qualquer momento em até 60 minutos após a intubação. Pacientes com parada cardiorrespiratória relacionada à intubação e hipotensão antes da intubação foram excluídos do estudo. Resultados: Dos 141 pacientes incluídos, 53 pacientes (37,5%) e 43,6% dos pacientes (n = 17) eram do sexo feminino. A idade mediana do grupo com hipotensão pós-intubação foi de 75 anos (amplitude interquartil: 67,0 - 84,0). Na análise multivariada, índice de choque ≥ 0,90 (RC = 7,76; IC95% 3,14 - 19,21; p < 0,001), níveis de albumina < 2,92g/dL (RC = 3,65; IC95% 1,49 - 8,96; p = 0,005) e níveis de procalcitonina (RC = 1,07, IC95% 1,01 - 1,15; p = 0,045) foram fatores de risco independentes para hipotensão pós-intubação. A mortalidade hospitalar foi semelhante em pacientes com hipotensão pós-intubação e pacientes sem hipotensão pós-intubação (92,5% versus 85,2%; p = 0,29). Conclusão: A incidência de hipotensão pós-intubação foi de 37,5% em pacientes críticos com COVID-19. Um índice de choque ≥ 0,90 e níveis de albumina < 2,92g/ dL foram independentemente associados à hipotensão pós-intubação. Além disso, índice de choque ≥ 0,90 pode ser uma ferramenta do leito antes da intubação endotraqueal. Neste estudo, a hipotensão pós-intubação não esteve associada ao aumento da mortalidade hospitalar em pacientes com COVID-19.

Abstract Concerns about covid-19 become deeper globally. Due to these concerns, all countries, international health institutions, health authorities and health care professionals in the world take several measures through policies or practices to control and handle covid-19 pandemic. For example; different types of policies in the fight against covid-19 have been launched in Turkey. Therefore, in this study, we sought to determine how policies and practices against covid-19 were prioritized by health care professionals and other segments of society via AHP method. We observed that the order of importance of health care professionals and other segments of the society regarding the policies and practices used in combating the covid-19 outbreak was quite similar between the groups. The covid-19 test policy was revealed as the most important one of both groups. However, social welfare programs have more significance than economic measures for society, while health care professionals are more concerned with economic measures. With this study, we intend to provide evidence-based information to decision-makers in combating the pandemic.

BACKGROUND: wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. MATERIALS AND METHODS: the study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. RESULTS: the mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. CONCLUSION: among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war.

ABSTRACTBACKGROUND AND OBJECTIVES: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting.METHODS: 40 patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n = 20), patients did not receive sub-Tenon's anesthesia. In group 2 (n = 20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups.RESULTS: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p > 0.05). Pain scores 30 min post-surgery were significantly lower in group 2 than in group 1 (p < 0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p < 0.05).CONCLUSIONS: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.

Background and objectives:The induction and inhibition of cytochrome P450 isoenzymes by antiepileptic drugs lead to changes in the clearance of anesthetic drugs eliminated via hepatic metabolism. We investigated the duration of the sedation and additional anesthetic needs during magnetic resonance imaging in epileptic children receiving antiepileptic drugs that cause either enzyme induction or inhibition.Methods:In American Society of Anesthesiology I–II, 120 children aged 3–10 years were included. Group 1: children using antiepileptic drugs that cause cytochrome P450 enzyme induction; Group 2: those using antiepileptic drugs that cause inhibition; and Group 3: those that did not use antiepileptic drugs. Sedation was induced with the use of 0.05 mg kg−1 midazolam and 1 mg kg−1 propofol. An additional 0.05 mg kg−1 of midazolam and rescue propofol (0.5 mg kg−1) were administered and repeated to maintain sedation. The duration of sedation and the additional sedation needed were compared.Results:The duration of the initial dose was significantly shorter in Group I compared with groups II and III (p = 0.001, p = 0.003, respectively). It was significantly longer in Group II compared with groups I and III (p = 0.001, p = 0.029, respectively). The additional midazolam needed for adequate sedation was increased in Group I when compared with groups II and III (p = 0.010, p = 0.001, respectively). In addition, the rescue propofol dose was significantly higher only in Group I when compared with Group III (p = 0.002).Conclusion:In epileptic children, the response variability to the initial sedative agents during the magnetic resonance imaging procedure resulting from the inhibition or induction of the cytochrome P450 isoenzymes by the antiepileptic drugs mandated the titration of anesthetic agents.

Background and objectives: Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration. Case report: A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3 mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188 beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition. Conclusion: In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature.

OBJECTIVE: This study investigated interleukin-10 and nitric oxide plasma levels following surgery to determine whether there is a correlation between these two variables and if different desflurane anesthesia flow rates influence nitric oxide and interleukin-10 concentrations in circulation. MATERIALS AND METHODS: Forty patients between 18 and 70 years and ASA I-II physical status who were scheduled to undergo thyroidectomy were enrolled in the study. INTERVENTIONS: Patients were allocated into two groups to receive two different desflurane anesthesia flow rates: high flow (Group HF) and low flow (Group LF). MEASUREMENTS: Blood samples were drawn at the beginning (t 0) and end (t 1) of the operation and after 24 h (t 2). Plasma interleukin-10 and nitric oxide levels were measured using an enzyme-linked-immunosorbent assay and a Griess reagents kit, respectively. Hemodynamic and respiratory parameters were assessed. RESULTS: There was no statistically significant difference between the two groups with regard to interleukin-10 levels at the times of measurement. Interleukin-10 levels were increased equally in both groups at times t 1 and t 2 compared with preoperative concentrations. For both groups, nitric oxide circulating concentrations were significantly reduced at times t 1 and t 2 compared with preoperative concentrations. However, the nitric oxide value was lower for Group HF compared to Group LF at t 2. No correlation was found between the IL-10 and nitric oxide levels. CONCLUSION: Clinical usage of two different flow anesthesia forms with desflurane may increase interleukin-10 levels both in Group HF and Group LF; nitric oxide levels circulating concentrations were significantly reduced at times t 1 and t 2 compared with preoperative concentrations; however, at 24 h postoperatively they were higher in Group LF compared to Group HF. No correlation was detected between interleukin-10 and nitric oxide levels.

FUNDAMENTO: A obesidade é um fator de risco independente para as doenças cardiovasculares. Os efeitos da obesidade sobre a estrutura e função do ventriculo esquerdo têm sido relatados, mas, relativamente, pouco se sabe sobre o funcionamento do ventrículo direito (VD) na obesidade. OBJETIVOS: Avaliar as alterações subclínicas do VD em adultos jovens obesos, porém saudáveis, por ecocardiografia convencional e Doppler tecidual (TDI). MÉTODOS: Neste estudo, foram incluídos 35 indivíduos saudáveis de peso normal, com um índice de massa corporal (IMC) < 25 kg/m2 (grupo I), 27 indivíduos com um IMC de 30-34,99 kg/m2 (grupo II) e 42 indivíduos com um IMC > 35 kg/m2 (grupo III). Todos os indivíduos foram submetidos a ecocardiografia transtorácica. Além de medidas ecocardiográficas padrão, as velocidades sistólicas de pico do anel tricúspide (Sm), e as velocidado pico diastólico precoce (Em) e final (Am), tempo de contração isovolumétrica (TCIm), tempo de relaxamento isovolumétrico (TRIm), e o tempo de ejecção (TEm) foram obtidos por TDI e o índice de desempenho do miocárdico do VD (IDMm) foi calculado. RESULTADOS: No grupo II, a razão Em/Am do VD foi significativamente menor e o TRIm e o IDMm foram significativamente maiores em relação ao grupo I (p < 0,01). A Sm, Em, e a razão Em/Am do VD foram significativamente menores e TRIm e IDMm do VD foram significativamente maiores no grupo III em relação ao grupo II (p < 0,05 para Sm e TRIm do VD e p < 0,01 para os outros parâmetros). A Am do VD diferiu significativamente entre os grupos I e III (p < 0,05). O IMC teve uma correlação negativa significante com a Sm, Em, e a razão Em/Am do VD, mas uma correlação positiva com o IDM do VD (p < 0,01). CONCLUSÃO: Nosso estudo mostrou que a obesidade isolada em adultos jovens normotensos foi associada com disfunções subclínicas na estrutura e função do VD.

Mitotic metaphase chromosomes, karyotypic characters, monoploid karyograms and ideograms of Minuartia mesogitana subsp. mesogitana and Minuartia elmalia were investigated. Analysis of somatic metaphases showed that the chromosome numbers and the karyotype formula of these taxa were 2n = 2x = 24 = 8m + 8sm + 8st for Minuartia mesogitana subsp. mesogitana and 2n = 2x = 32 = 12m + 16sm + 4st for Minuartia elmalia. No satellites were observed in the karyotypes of the taxa. The intrachromosomal and interchromosomal karyotype asymmetries were estimated with Mean Centromeric Asymmetry (MCA) and Coefficient of Variation of Chromosome Length (CVCL).

Abstract Background: In recent studies, microRNAs (mi-RNAs) have been shown to play an important role in psoriasis pathogenesis. However, studies evaluating mi-RNAs in the blood of psoriasis patients including a large number of mi-RNA panels are scarce. Objective: The authors aimed to assess mi-RNA expressions in blood samples of psoriasis patients, as well as to evaluate the association between mi-RNA expression and psoriasis severity. Methods: This was a case-control study on 52 patients with psoriasis vulgaris and 54 controls. Patients' medical history, psoriasis area and severity index (PASI) scores, and dermatology life quality index (DLQI) scores were recorded. The 42 disease-related mi-RNA primers were assessed by real-time PCR. Results: In the patient group, 13.4% presented nail involvement and 8.2% had psoriatic arthritis. The mean PASI and DLQI scores were 7.90 ± 8.83 and 8.13 ± 5.50, respectively. Among 42 mi-RNA primers; hsa-miR-155-5p, hsa-miR-369-3p, hsa-miR-193b-3p, hsa-miR-498, hsa-miR-1266-5p, hsa-let-7d-5p, hsa-miR-205-5p, hsa-let-7c-5p, hsa-miR-30b-3p, and hsa-miR-515-3p expressions were significantly up-regulated, whereas hsa-miR-21-5p, hsa-miR-142-3p, hsa-miR-424-5p, hsa-miR-223-3p, hsa-miR-26a-5p, hsa-miR-106b-5p, hsa-miR-126-5p, hsa-miR-181a-5p, hsa-miR-222-3p, hsa-miR-22-3p, hsa-miR-24-3p, hsa-miR-17-3p, hsa-miR-30b-5p, hsa-miR-130a-3p, hsa-miR-30e-5p, and hsa-miR-16-5p were significantly down-regulated in psoriasis patients when compared with the control group (p < 0.05). Study limitations: As the study included patients with mild to moderate psoriasis who mostly only received topical treatments, changes in miRNA before and after systemic treatments were not assessed. Conclusion: The detection of 24 mi-RNA expressions up- or down-regulated in psoriasis patients, even in those with milder disease, further supports the role of mi-RNAs in the psoriasis pathogenesis. Future studies should clarify whether mi-RNAs can be used as a marker for psoriasis prognosis or as a therapeutic agent in the treatment of psoriasis.