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Resumo Justificativa e objetivos O bloqueio do plano transverso abdominal é um método de bloqueio periférico que tem sido usado com sucesso para alívio da dor após histerectomia abdominal total. No entanto, os efeitos da combinação do bloqueio do plano transverso abdominal e da anestesia geral sobre a necessidade de analgésico e anestésico ainda não estão claros. Este estudo randômico e controlado com placebo tem como objetivo avaliar os efeitos do bloqueio do plano transverso abdominal sobre o consumo de analgésico e anestésico durante histerectomia abdominal total sob anestesia geral. Métodos Foram randomizadas em dois grupos 66 mulheres submetidas à histerectomia abdominal total para receber apenas anestesia geral (grupo controle) ou associada a bloqueio do plano transverso abdominal com 20 mL de bupivacaína a 0,25% (grupo plano transverso abdominal). O consumo de remifentanil e sevoflurano no período intraoperatório foi registrado. Também avaliamos a dor pós‐cirurgia, náusea, qualidade dos escores de recuperação e necessidade de analgésico de resgate durante as 24 horas de pós‐operatório. Resultados O consumo total de remifentanil e sevoflurano foi significativamente menor no grupo plano transverso abdominal, respectivamente, média (DP): 0,130 (0,25) vs . 0,094 (0,02) mcg.kg −1 .min −1 ; p < 0,01 e 0,295 (0,05) vs . 0,243 (0,06) mL.min −1 ; p < 0,01. No pós‐operatório, os escores de dor foram significativamente reduzidos no grupo plano transverso abdominal logo após a cirurgia; mediana (intervalo): 6 (2‐10) vs . 3 (0‐5); p < 0,001, em 2 h (5 [3‐9] vs . 2,5 [0‐6]; p < 0,001), em 6 h (4 [2‐7] vs . 3 [0‐6], p < 0,001), em 12 h (3,5 [1‐6] vs . 2 [1‐5]; p = 0,003). As pacientes do grupo plano transverso abdominal apresentaram escores QoR‐40 significativamente maiores: 190,5 (175‐197) vs . 176,5 (141‐187); p < 0,001). Conclusão A combinação de bloqueio do plano transverso abdominal e anestesia geral pode proporcionar um consumo reduzido de opioides e anestésicos e melhorar a dor pós‐cirúrgica e a qualidade dos escores de recuperação em pacientes submetidas à histerectomia abdominal total. Background and objectives A transversus abdominis plane block is a peripheral block method that has been used successfully for pain relief after total abdominal hysterectomy. However, the effects of the combination of the transversus abdominis plane block and general anesthesia on analgesic and anesthetic requirements remain unclear. This randomized placebo‐controlled study is aimed to evaluate the effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy under general anesthesia. Methods Sixty‐six women undergoing total abdominal hysterectomy were randomized into two groups to receive general anesthesia alone (control group) or with transversus abdominis plane block using 20 mL of 0.25% bupivacaine (transversus abdominis plane group). Intraoperative remifentanil and sevoflurane consumption were recorded. We also evaluated the postoperative pain, nausea, quality of recovery scores and rescue analgesic requirement during postoperative 24 hours. Results The total remifentanil and sevoflurane consumption is significantly lower in transversus abdominis plane group; respectively mean (SD) 0.130 (0.25) vs. 0.094 (0.02) mcg.kg −1 .min −1 ; p < 0.01 and 0.295 (0.05) vs. 0.243 (0.06) mL.min −1 ; p < 0.01. In the postoperative period, pain scores were significantly reduced in transversus abdominis plane group soon after surgery; median (range) 6 (2–10) vs. 3 (0–5); p < 0.001, at 2 h (5 [3–9] vs. 2.5 [0–6]; p < 0.001), at 6 h (4 [2–7] vs. 3[0–6], p < 0.001), at 12 h (3.5 [1–6] vs. 2 [1–5]; p = 0.003). The patients in the transversus abdominis plane group had significantly higher QoR‐40 scores 190.5 (175–197) vs. 176.5 (141–187); p < 0.001). Conclusion Combining transversus abdominis plane block with general anesthesia can provide reduced opioid and anesthetic consumption and can improve postoperative pain and quality of recovery scores in patients undergoing total abdominal hysterectomy. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivos Esclarecer a importância do ano de residência e outros fatores que influenciam o sucesso do cateterismo epidural torácico (CET) em pacientes submetidos à toracotomia. Métodos Após a aprovação do Comitê de Ética, os dados foram retrospectivamente analisados a partir dos prontuários de 415 pacientes. Todos os pacientes assinaram os termos de consentimento informado. As tentativas de CET foram divididas em dois grupos: segundo‐terceiro ano (Grupo I ) e quarto ano (Grupo II ), de acordo com o ano de residência. Dados demográficos, características das tentativas de CET e todas as dificuldades e complicações durante o CET foram registrados retrospectivamente. Resultados A taxa de sucesso global de CET foi semelhante entre os grupos. Os níveis de colocação do cateter, o número e a duração das tentativas não foram diferentes entre os grupos ( p > 0,05). A alteração do nível de inserção da agulha foi estatisticamente maior no Grupo II ( p = 0,008), enquanto que a parestesia foi significativamente maior no Grupo I ( p = 0,007). As taxas de cefaleia durante e após punção dural foram maiores no Grupo I . Um índice de massa corporal (IMC) maior e o nível do local de inserção foram fatores significativos para o fracasso do CET e para as taxas de complicações no pós‐operatório, mas independentes da experiência dos residentes ( p < 0,001, 0,005). Conclusão O IMC e o nível do local de inserção foram significativos para o fracasso do CET e para as taxas de complicações no pós‐operatório. Pensamos que o ano de residência não é um fator significativo em termos de taxa de sucesso global para o CET, mas é importante para o resultado desses procedimentos. Background and objectives In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients. Methods After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second–third year (Group I ) and fourth year (Group II ) according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization. Results Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups ( p > 0.05). Change of needle insertion level was statistically higher in Group II ( p = 0.008), whereas paresthesia was significantly higher in Group I ( p = 0.007). Dural puncture and postdural puncture headache rates were higher in Group I . Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents’ experience ( p < 0.001, 0.005). Conclusion Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents’ grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivo Comparar os efeitos terapêuticos da cetamina isolada ou combinação de cetamina‐propofol em analgesia, sedação, tempo de recuperação e efeitos colaterais em crianças pré‐medicadas com midazolam‐cetamina‐atropina programadas para procedimentos de circuncisão. Métodos 60 crianças, estado físico ASA I ‐ II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), com idades entre três e nove anos, submetidas a procedimentos de circuncisão sob sedação, foram recrutadas de acordo com um protocolo de randomização duplo‐cego aprovado pelo Conselho de Revisão Institucional. Os pacientes foram randomizados e alocados em dois grupos com o uso do método de envelopes lacrados. Ambos os grupos receberam uma mistura de midazolam 0,05 mg kg −1 + cetamina 3 mg kg −1 + atropina 0,02 mg kg −1 por via intramuscular, na presença dos pais na área de intervenções pré‐operatórias. A indução foi realizada com propofol‐cetamina no Grupo I ou cetamina isolada no Grupo II . Resultados Nas comparações entre os grupos foram observadas a idade, o peso, a pressão arterial sistólica inicial e a diferença em relação à taxa de pulso inicial ( p > 0,050). A pressão arterial diastólica inicial e as mensurações seriadas subsequentes nos minutos 5, 10, 15 e 20 da pressão arterial sistólica, pressão arterial diastólica e taxa de pulso do grupo cetamina foram significativamente maiores ( p < 0,050). Conclusão Cetamina‐propofol (cetofol) proporcionou melhor qualidade de sedação e estabilidade hemodinâmica que cetamina isolada em cirurgias pediátricas de circuncisão. Não foram observadas complicações significativas durante a sedação nos dois grupos. Portanto, cetofol parece ser um método de sedação eficaz e seguro para procedimentos de circuncisão. Background and objective to compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam–ketamine–atropin who are prepared circumcision operation. Methods 60 American Society of Anaesthesiologists physical status I – II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double‐blind institutional review board‐approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre‐operative holding area. Patients were induced with propofol–ketamine in Group I or ketamine alone in Group II . Results in the between‐group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed ( p > 0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher ( p < 0.050). Conclusion propofol‐ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivos Tenoxicam é amplamente usado no tratamento da osteoartrite (OA) e o nosso objetivo foi comparar a eficácia de tenoxicam administrado por via oral (VO) e intra‐articular (IA) no tratamento da OA. Métodos Este estudo foi conduzido entre 2011 e 2012 por meio de análise retrospectiva e comparação dos resultados de 60 pacientes que foram clínica e radiologicamente diagnosticados com OA degenerativa de joelhos na Policlínica de Tratamento da Dor do Hospital Estadual de Bünyan. Os 60 pacientes incluídos no estudo foram alocados em dois grupos. O primeiro grupo (tenoxicam IA, n = 30) incluiu resultados de pacientes submetidos à injeção nos joelhos por via IA de 20 mg de tenoxicam uma vez por semana durante três semanas e o segundo grupo (tenoxicam VO, n = 30) incluiu pacientes que receberam 20 mg de tenoxicam por VO uma vez por dia durante três semanas. Todos os pacientes foram avaliados clinicamente na fase basal pré‐tratamento e em uma semana, um mês e três meses pós‐tratamento, de acordo com os critérios especificados. Resultados e conclusões Dos 60 pacientes, 22 eram do sexo masculino e 38 do sexo feminino. Em ambos os grupos, melhorias significativas foram detectadas em todos os parâmetros da escala visual analógica, do índice Western Ontario and MacMaster (Womac – dor, atividade física e rigidez dos joelhos) e do índice de Lequesne nas avaliações feitas em uma semana, um mês e três meses e comparadas aos valores basais. Além disso, uma melhor adesão ao tratamento e tolerabilidade ao sistema gastrointestinal no grupo tenoxicam IA também foram observadas. A administração de tenoxicam IA pode ser considerada como um método opcional de tratamento em pacientes com OA de joelhos que não podem usar tenoxicam por VO, especialmente por causa dos efeitos colaterais sobre o sistema gastrintestinal, e naqueles com dificuldades de adaptação ao tratamento. Background and objectives Tenoxicam is widely used in osteoarthritis treatment and we aimed to compare the effectivity of oral and intra‐articular administration of tenoxicam in osteoarthritis treatment. Methods This study was performed between 2011 and 2012 by retrospectively analyzing and comparing the findings of 60 patients who were clinically and radiologically diagnosed with knee degenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in the study were divided into two groups. The first group (tenoxicam IA, n = 30) included patient findings of those subjected to intra‐articular injection of 20 mg tenoxicam to the knee once a week for three weeks and the second group (oral tenoxicam, n = 30) included patients who were administered 20 mg oral tenoxicam once a day for three weeks. All patients were clinically evaluated pre‐treatment and in the 1 st week, 1 st month and 3 rd month post‐treatment according to specified criteria. Results and conclusions 22 of 60 patients included in the study were male and 38 were female. In both groups significant improvements were detected in all of the observed parameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physical activity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1 st week, 1 st month and 3 rd month with respect to pre‐treatment values. Besides, a better compliance to treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed. Intra‐articular tenoxicam administration could be thought as an alternative treatment method in patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemic gastrointestinal system side effects and those who have difficulties in adapting to treatment. [ABSTRACT FROM AUTHOR]

Resumo Justificativa As dificuldades no manejo das vias aéreas são a principal causa de morbidade e mortalidade relacionada à anestesia pediátrica. Objetivo Avaliar o valor do teste modificado de Mallampati, teste da mordida do lábio superior, distância tireomentoniana e relação altura‐distância tireomentoniana para prever intubação difícil em pacientes pediátricos. Projeto Análise prospectiva. Mensurações e resultados Dados coletados de 250 pacientes pediátricos, com idades entre 5 e 11 anos, submetidos à intubação traqueal. A classificação de Cormack e Lehane foi usada para avaliar laringoscopia difícil. Os valores de sensibilidade, especificidade, preditivo positivo e AUC para cada teste foram registrados. Resultados A sensibilidade e especificidade do teste modificado de Mallampati foram 76,92% e 95,54%, enquanto para o ULBT foram 69,23% e 97,32%. O ponto de corte ideal para a relação altura‐distância tireomentoniana e distância tireomentoniana para prever laringoscopia difícil foi 23,5 (sensibilidade, 57,69%; especificidade, 86,61%) e 5,5 cm (sensibilidade, 61,54%; especificidade, 99,11%). O teste de Mallampati modificado foi o mais sensível dos testes. A relação entre altura‐distância tireomentoniana foi o teste menos sensível. Conclusão Esses resultados sugerem que os testes de Mallampati modificado e da mordida do lábio superior podem ser úteis em pacientes pediátricos para a previsão de intubação difícil. Background The difficulties with airway management is the main reason for pediatric anesthesia‐related morbidity and mortality. Objective To assess the value of modified Mallampati test, Upper‐Lip‐Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. Design Prospective analysis. Measurements and results Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. Results The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61%) and 5.5 cm (sensitivity, 61.54%; specificity, 99.11%). The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. Conclusion These results suggested that the modified Mallampati and Upper‐Lip‐Bite tests may be useful in pediatric patients for predicting difficult intubation. [ABSTRACT FROM AUTHOR]

The hospital infections acquired during health careprovoke morbidity, mortality and high costs. The mainobjective of this article is to show the 'evaluation ofthe costs associated to hospital infections' in patientsof some internment specialities at the Centro HospitalarCova da Beira. To accomplish this objective, theempirical study was based on a Case-Control study. Itwas used the comparative method that involved theevaluation of costs associated to resources used by 77infected patients (Cases) and 77 non-infected patients(Controls). The results showed that: (1) infectedpatients had 2.4 plus time of hospital stay than noninfectedpatients, (2) the mean global costs of hospitalstay per service are two times higher in the infectedpatients, (3) in infected patients the costs withantibiotics were 2.5 times higher, (4) the costs withmicrobiologic cultures were 9 times higher, (5) the costswith clinic pathology exams were 2 times higher, (6)the costs with imagiologic exams were 2 times higherthan the costs for patients that did acquire infection.The conclusions of this study highlight the necessityof defining strategies of intervention for rationalisingthe use of antibiotics and engaging health careprofessionals for change of behaviour and adoption ofbest practices. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine menopausal age, related factors and climacteric complaints in Turkish women. Method: A population based, cross-sectional study was executed using questionnaire in their home. A convenience sample of 321 was chosen, according to stratified sampling method who live in Istanbul rural area and aged 45-64 years. Women who had surgical menopause were excluded. Main Outcome Measures: Natural menopause age, prevalence of climacteric complaints and attitudes toward menopause. Statistical analysis: Climacteric Complaint Tool (CCT) was developed by researcher and validity and reliability of CCT was tested. Factor analysis was used to test construct validity. Internal consistency of the CCT was tested by use of Cronbach's Alpha (Alpha= .86), Itemtotal item correlation ranged from .35 to .84 Results: The most prevalent climacteric complaints were aching muscle and joints (75.7%), irritability (74.5%), hot flushesflashes (72.9%), difficulty in sleeping (68.8%), feeling tired (53.6%), feeling depressed (49.8%) and loss of sexual desire (47.4%) and didn't found to be related with menopausal age and attitudes toward menopause. Conclusions: The median age of menopause in Turkish women is lower than Caucasian. Although Turkish women had many complaints, they didn't apply for a medical care to relief them. [ABSTRACT FROM AUTHOR]

Resumo Fundamento: A hipertensão pulmonar é uma condição que envolve a remodelação do ventrículo direito. A remodelação contínua também está associada ao prognóstico da doença. Durante o processo de reestruturação, alterações complexas como hipertrofia e dilatação também podem se refletir nos parâmetros eletrocardiográficos. Objetivos: Nosso estudo teve como objetivo investigar a relação entre prognóstico e parâmetros eletrocardiográficos em pacientes com hipertensão arterial pulmonar. Métodos: O estudo foi desenhado retrospectivamente e incluiu pacientes com diagnóstico de hipertensão arterial pulmonar entre 2010 e 2022. Os pacientes foram divididos em dois grupos com base no resultado de sobrevida. Vários parâmetros, incluindo parâmetros eletrocardiográficos, demográficos, ecocardiográficos, de cateter e sanguíneos, foram comparados entre os dois grupos. Um valor de p

Abstract Objective This study focused on pregnant and postpartum women during the COVID-19 pandemic, aiming to determine the attitudes and behaviors of vaccinated and unvaccinated groups, and the vaccination behaviors in the groups with and without the disease. The reasons for refusing the vaccine were also questioned. Methods This cross-sectional study was performed from September 2021 to October 2021. The study data were collected using a face-to-face questionnaire. The participants were pregnant women who applied to the hospital for routine antenatal care and were hospitalized, and women in the postpartum period. Additionally, pregnant and postpartum patients who were diagnosed with COVID-19 at the time of admission and were hospitalized and admitted to the intensive care unit due to this disease were also included in the study. Results A total of 1,146 pregnant and postpartum women who completed the questionnaire were included in our study. Only 43 (3.8%) of the participants were vaccinated; 154 (13.4%) of the participants had comorbidities. The number of COVID-19-positive patients was 153. The lack of sufficient information about the safety of the COVID-19 vaccine is the most common reason for the refusal. Conclusion Vaccine refusal can significantly delay or hinder herd immunity, resulting in higher morbidity and mortality. Considering the adverse effects of COVID-19 on pregnancy, it is essential to understand pregnant and postpartum women's perceptions toward vaccination to end the pandemic.

Resumo Fundamento: A triagem do câncer é absolutamente necessária em pacientes com derrame pericárdico, pois o câncer é uma das doenças mais graves em sua etiologia. Estudos anteriores indicaram que o índice de inflamação imunológica sistêmica (IIS), o índice prognóstico nutricional (PNI) e o escore de hemoglobina, albumina, linfócitos e plaquetas (HALP) podem ser escores relacionados ao câncer. Objetivos: Este estudo foi iniciado considerando que esses sistemas de pontuação poderiam prever o câncer na etiologia de pacientes com derrame pericárdico. Métodos: Os pacientes submetidos à pericardiocentese entre 2006 e 2022 foram analisados retrospectivamente. A pericardiocentese foi realizada em um total de 283 pacientes com derrame pericárdico ou tamponamento cardíaco de moderado a grande no período especificado. Os índices de HALP, PNI e IIS foram calculados do sangue venoso periférico retirado antes do procedimento de pericardiocentese. O nível de significância estatística foi aceito em p

ABSTRACT This paper investigates whether political pressure affects the conduct of monetary policy in Brazil. For the period between January 2010 and August 2020, we estimate a modified Taylor rule to empirically test whether the calls for lower interest rates by presidents induce Central Bank of Brazil (BCB) to lower the policy rate. We document that BCB is more likely to set the policy rate in line with the preferences of political leaders. We also show that the response of BCB to political pressure remained significant even though political pressure diminished in recent years.

ABSTRACT Objective: One of the common limitations after COVID-19 pneumonia is the decrease in exercise capacity. The identification of the factors affecting exercise capacity and the assessment of patients at risk are important for determining treatment strategy. This study was conducted to determine the predictors of decreased exercise capacity in long post-COVID-19 patients. Methods: We investigated the association of exercise capacity as measured by the incremental shuttle walk test (ISWT) with age, sex, spirometric variables, respiratory and peripheral muscle strength, quality of life, fatigue, hospital anxiety depression scale, chest X-ray involvement, and hospitalization. The patients were divided into three groups: outpatients, inpatients, and ICU patients. Regression analysis was used to determine which parameters were significant predictors of exercise capacity. Results: Of the 181 patients included in the study, 56 (31%) were female. The mean ISWT in percentage of predicted values (ISWT%pred) was 43.20% in the whole sample, whereas that was 52.89%, 43.71%, and 32.21% in the outpatient, inpatient, and ICU patient groups, respectively. Linear regression analysis showed that predictors of decreased ISWT%pred were sex (b = 8.089; p = 0.002), mMRC scale score (b = −7.004; p ≤ 0.001), FVC%pred (b = 0.151; p = 0.003), and handgrip strength (b = 0.261; p = 0.030). Conclusions: In long post-COVID-19 patients, sex, perception of dyspnea, restrictive pattern in respiratory function, and decrease in peripheral muscle strength are predictors of reduced exercise capacity that persists three months after COVID-19. In this context, we suggest that pulmonary rehabilitation might be an important therapy for patients after COVID-19.

Resumo Fundamento Foi demonstrado que as subunidades de interleucina-35 (IL-35) estão fortemente expressas nas placas ateroscleróticas em humanos. Assim, considera-se que elas têm um papel na aterosclerose. Objetivos Neste estudo, os níveis de IL-35 foram comparados com o grupo controle em pacientes com doença arterial coronariana (DAC) estável, e a associação entre os níveis de IL-35 e o tipo, gravidade e extensão da lesão foram investigadas com o escore Gensini (GS) e o escore Syntax (SS) no grupo de pacientes Métodos Sessenta pacientes (18 mulheres e 42 homens) com DAC, diagnosticados por meio da angiografia coronária, que apresentaram dor no peito típica e teste de esforço não invasivo positivo, e 46 pacientes (18 mulheres e 28 homens) com luminograma normal, foram incluídos no estudo. Tanto o GS quanto o SS foram calculados para o grupo de pacientes, e esses valores foram comparados com os níveis de IL-35. Variáveis com distribuição não normal foram avaliadas com o teste U de Mann-Whitney, enquanto os parâmetros com distribuição normal foram analisados com o teste t de Student. A diferença entre as variáveis categóricas foi avaliada pelo teste de qui-quadrado ou de Fisher. Os valores de p

Resumo Fundamento A patologia subjacente da ectasia da artéria coronária (EC) isolada não foi totalmente elucidada. Objetivo Nosso objetivo foi examinar a relação entre o índice de inflamação imune sistêmica (Sıı), que corresponde à multiplicação da razão neutrófilos-linfócitos (RNL) e as contagens de plaquetas, e EC isolada. Método A população do estudo retrospectivo incluiu 200 pacientes com EC isolada, 200 consecutivos com doença arterial coronariana obstrutiva e 200 consecutivos com angiografia coronária normal. Um valor de p bicaudal 517,35 tem 79% de sensibilidade, 76% de especificidade para a predição do EC [AUC: 0,832, (p

Resumo Fundamento Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular. Objetivos Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda. Métodos Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo. Resultados Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX. Conclusões Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

Abstract Bilateral tubal ectopic pregnancy is a very rare form of ectopic pregnancy. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. We report the case of bilateral tubal ectopic pregnancy. The patient was 30 years old and had a 3-year history of infertility; she was referred to the in-vitro fertilization (IVF) program because of tubal factor infertility. A pregnancy resulted from the transfer of two embryos during an artificial cycle. Despite the increase in β-hCG values during the follow-up, 22 days after the embryo transfer, the β-hCG levels were 2,408 U/L and the serum progesterone (P4) level was 10.53 ng/ml. After application with methotrexate, β-hCG levels did not decrease effectively. Moreover, the sonographic screening revealed a suspicious bilateral tubal focus for ectopic pregnancy. A mini-laparotomy was performed and a bilateral tubal pregnancy was found. In the case of unilateral tubal pregnancy after the transfer of two embryos, the situation of the other tube should be systematically checked and β-hCG levels should be monitored.

In this study, the situation of Mannheim offsets of ruled surfaces under the 1-parameter motions is investigated. Firstly, relationships between geodesic Frenet trihedrons of Mannheim offsets of ruled surfaces are obtained and the relationship between the curvatures of the surface pairs is examined. Also, change of integral invariants the surface pairs under the 1-parameter motions is studied. Finally, the relevant example is given for every Mannheim offsets of ruled surfaces.

The aim of this study is to evaluate the direct diagnostic costs for disease groups and other variables (such as gender, age, seasons) that are related to the direct diagnostic costs based on a 3-year data. The population of the study consisted of 31,401 patients who applied to family medicine outpatient clinic in Turkey between January 1st, 2016 and December 31st, 2018. With this study, we determined in which disease groups of the family medicine outpatient clinic were most frequently admitted. Then, total and average diagnostic costs for these disease groups were calculated. Three-year data gave us the opportunity to examine the trend in diagnostic costs. Based on this, we demonstrated which diseases' total and average diagnostic costs increased or decreased during 3 years. Moreover, we examined how diagnostic costs showed a trend in both Turkish liras and USA dollars’ rate for 3 years. Finally, we analysed whether the diagnostic costs differed according to variables such as age, gender and season. There has been relatively little analysis on the diagnostic costs in the previous literature. Therefore, we expect to contribute to both theorists and healthcare managers for diagnostic costs with this study.

Abstract Introduction: Bilateral superficial cervical plexus block (BSCPB) is a common method used for analgesia in thyroid surgery. We investigated the analgesic efficacy of bilateral superficial cervical plexus block in the intraoperative and postoperative periods. Materials and methods: Patients (n = 46) undergoing thyroidectomy were randomly separated into the following 2 groups: the general anesthesia group (GA; n = 23) and the general anesthesia plus BSCPB group (GS; n = 23). The intraoperative analgesic requirement (remifentanil) and visual analog scale (VAS) score at multiple time points during the postoperative period (after extubation, at 15 , 30 minutes and 1, 2, 6, 12, 24, and 48 hours post operation) were evaluated. Total tramadol and paracetamol consumption as well as the amount of ondansetron used was recorded. Results: The intraoperative remifentanil requirement was significantly lower in the GS Group than in the GA Group (p= 0.009). The postoperative pain scores were significantly lower in the GS Group than in the GA Group at 15 (p< 0.01), 30 (p< 0.01) minutes, and 1 (p< 0.01), 2 (p< 0.01), 6 (p< 0.01), 12 (p< 0.01) and 24 (p= 0.03) hours. The postoperative tramadol requirement was significantly lower in the GS Group than in the GA Group (p= 0.01). The number of patients that used ondansetron was significantly lower in the GS Group than in the GA Group (p= 0.004). Conclusion: We concluded that BSCPB with 0.25% bupivacaine reduces the postoperative pain intensity and opioid dependency in thyroid surgery patients.

ABSTRACT: Effects of dietary Agaricus bisporus mixture or stalk or cap on growth performance, carcass components and some meat quality parameters, mesophilic aerobic bacterial counts, and intestinal histomorphology in broiler chickens were investigated. Two hundred and forty one-day-old male Ross 308 broiler chickens were divided into 4 experimental groups with 4 replicates, each including 15 birds. Chickens were fed with basal diet (C), mushroom mixture (MM, 10 g stalk+10 g cap/kg diet), mushroom stalk (MS, 20 g/kg diet) and mushroom cap (MC, 20 g/kg diet). Feed conversion ratio (FCR) was improved (P < 0.01) by dietary MS while feed intake (FI) decreased (P < 0.01) in all treatment groups compared to control. However, body weight gain (BWG) was decreased (P < 0.01) by MC inclusion. Mushroom supplemented groups had higher (P < 0.05) mesophilic aerobic bacteria in the cecum. MS inclusion increased villus height to crypt depth ratio in the jejunum (P < 0.01) and villus height in the ileum (P < 0.01) and jejunum (P < 0.05). MC increased (P < 0.01) crypt depth in the jejunum. There were no statistical differences among groups for carcass components (P > 0.05). The L* values were decreased (P < 0.01) in thigh meat but increased (P < 0.01) in breast meat by mushroom inclusion. The a* values were decreased (P < 0.01) and b* values were increased (P < 0.05) in both thigh and breast meat with mushroom addition to diet. The obtained results indicated that A. bisporus stalk meal at an inclusion level of 20 g/kg of diet had favourable effects on growth performance with higher feed efficiency, improved intestinal morphology with higher villus height and increased meat quality of broiler chickens.

Introduction: Acute coronary syndromes (ACS) mostly occur in patients with traditional risk factors. Especially in young adults without major cardiovascular (CV) risk factors, one of the less common causes of ACS is myeloproliferative neoplasms (MPNs). Methods: We retrospectively collected data on 11 consecutive patients (nine men, two women, mean age 40.18±8.4 years) with a diagnosis of MPN who presented with ACS. The demographic characteristics of the study population, type of MPN, clinical manifestations, location of myocardial infarction (MI), coronary angiography findings, complete blood count and other related findings, and treatment strategy before and after diagnosis were analyzed. Results: Six patients were diagnosed with polycythemia vera, four with essential thrombocytosis and one with primary myelofibrosis. A JAK2 mutation was found in nine patients. Mean time to diagnosis of MPN was 2.81 years after presenting ACS and mean age at first MI was 32.9±6 years. Six patients had no major CV risk factors. Ten patients had anterior MI and one had inferior MI. After initiation of specific treatment for MPN, no recurrent thrombotic events were observed in a mean follow-up of 4±2.44 years. Conclusions: In young adults presenting with ACS, MPNs should be considered, especially in the absence of atherosclerotic coronary artery lesions. It is also important to pay attention to blood cell count abnormalities seen in intracoronary thrombotic events. Early diagnosis and treatment of MPNs is essential to prevent recurrence of thrombotic events and may reduce mortality and morbidity related to thrombotic complications. Resumo: Introdução: As síndromes coronárias agudas (SCA) ocorrem sobretudo em doentes com fatores de risco tradicionais. No caso particular dos adultos jovens sem fatores de risco cardiovasculares (CV) major, as neoplasias mieloproliferativas (NMP) são uma das causas raras de SCA. Métodos: Recolhemos dados retrospetivos de 11 doentes consecutivos com SCA (9 homens, 2 mulheres, de idade média de 40,18 ± 8,4) com o diagnóstico de NMP. Foram analisados os dados sobre as características demográficas da população do estudo, o tipo de NMP, as manifestações clínicas, a localização do enfarte do miocárdio (EM), os achados da angiografia coronária (AC), hemograma, outros achados relacionados, a estratégia de tratamento antes e após o diagnóstico. Resultados: Seis doentes foram diagnosticados com policitemia vera (PV), quatro doentes com trombocitemia essencial (TE) e um doente com mielofibrose primária (MFP). A mutação JAK-2 foi encontrada em nove doentes. Após apresentação da SCA, o tempo médio de diagnóstico da NMP foi de 2,81 anos. A idade média dos doentes foi de 32,9 ± 6 quando sofreram pela primeira vez um enfarte do miocárdio. Seis doentes não manifestaram fatores de risco CV major. Dez doentes tiveram EM anterior, um doente teve EM inferior. Após o início do tratamento específico da NMP, não foram observados eventos trombóticos recorrentes com um seguimento médio de 4 ± 2,44 anos. Conclusões: Nos adultos jovens com SCA, deve ser considerada a NMP, especialmente na ausência de lesões ateroscleróticas das artérias coronárias. É igualmente importante estar atento às anomalias no hemograma encontradas nos eventos trombóticos intracoronários. Um diagnóstico e um tratamento precoces da NMP são essenciais para prevenir a recidiva de eventos trombóticos e podem reduzir a mortalidade e a morbilidade relacionadas com complicações trombóticas. Keywords: Essential thrombocytosis, Acute coronary syndrome, Polycythemia vera, Young adults, Palavras-chave: Trombocitemia essencial, Síndrome coronária aguda, Policitemia vera, Adultos jovens

Abstract Background: Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. Objective: In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. Methods: Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. Results: Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. Conclusion: Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

BACKGROUND AND OBJECTIVES: In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients. METHODS: After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second-third year (Group I) and fourth year (Group II) according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization. RESULTS: Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p > 0.05). Change of needle insertion level was statistically higher in Group II (p = 0.008), whereas paresthesia was significantly higher in Group I (p = 0.007). Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents' experience (p < 0.001, 0.005). CONCLUSION: Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents' grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures.

ABSTRACT The objective of this study was to determine the effects of raw bee propolis and water or ethanol extract of propolis on growth performance, some blood parameters, and immunoglobulins in 15-20-week-old Ross-308 broiler breeders. The birds in the control were fed a diet without propolis, whereas the birds in the treatment groups were fed diets with raw propolis (RP), water (WEP), and ethanol (EEP) extract of propolis at the level of 1200, 400, and 400 ppm, respectively. Raw propolis and propolis extracts did not affect body weight gain, feed intake, feed conversion ratio, and some blood parameters, such as aspartate aminotransferase, alanine aminotransferase, total antioxidant status, triglyceride, and phosphorus. Birds fed EEP and those in control group had a lower IgA value compared with birds fed RP. Birds fed RP had higher IgM level than those of the other groups, and birds fed EEP had lower IgM level than those of control and RP-fed group. The IgY value of breeders fed EEP was higher than those of the other treatment birds, whereas that of WEP-fed birds was higher than those of control and RP treatment. The antibody levels of Anti-Newcastle disease virus and anti-infectious bursal disease virus were higher in EEP and RP-fed groups than those in the control and WEP-fed groups. The WEP decreased total oxidant status value compared with the control and RP treatments, whereas EEP and WEP increased plasma total protein and calcium contents compared with the control. The EEP increased plasma albumin content compared with RP. The addition of propolis extracts, especially WEP and EEP, to diet improves immunity and antioxidant activity, as well as enhances Ca absorption of broiler breeders.

ABSTRACTBACKGROUND AND OBJECTIVES:Tenoxicam is widely used in osteoarthritis treatment and we aimedto compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthri-tis treatment.METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing andcomparing the findings of 60 patients who were clinically and radiologically diagnosed with kneedegenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in thestudy were divided into two groups. The first group (tenoxicam IA, n = 30) included patientfindings of those subjected to intra-articular injection of 20 mg tenoxicam to the knee oncea week for three weeks and the second group (oral tenoxicam, n = 30) included patients whowere administered 20 mg oral tenoxicam once a day for three weeks. All patients were clini-cally evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatmentaccording to specified criteria.RESULTS AND CONCLUSIONS: Twenty two of 60 patients included in the study were male and 38were female. In both groups significant improvements were detected in all of the observedparameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physicalactivity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week,1st month and 3rd month with respect to pre-treatment values. Besides, a better complianceto treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed.Intra-articular tenoxicam administration could be thought as an alternative treatment methodin patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemicgastrointestinal system side effects and those who have difficulties in adapting to treatment.

ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050).CONCLUSION: Propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

Only a limited number of simple sequence repeat (SSR) markers is available for the genome of garlic (Allium sativum L.) despite the fact that SSR markers have become one of the most preferred DNA marker systems. To develop new SSR markers for the garlic genome, garlic expressed sequence tags (ESTs) at the publicly available GarlicEST database were screened for SSR motifs and a total of 132 SSR motifs were identified. Primer pairs were designed for 50 SSR motifs and 24 of these primer pairs were selected as SSR markers based on their consistent amplification patterns and polymorphisms. In addition, two SSR markers were developed from the sequences of garlic cDNA-AFLP fragments. The use of 26 EST-SSR markers for the assessment of genetic relationship was tested using 31 garlic genotypes. Twenty six EST-SSR markers amplified 130 polymorphic DNA fragments and the number of polymorphic alleles per SSR marker ranged from 2 to 13 with an average of 5 alleles. Observed heterozygosity and polymorphism information content (PIC) of the SSR markers were between 0.23 and 0.88, and 0.20 and 0.87, respectively. Twenty one out of the 31 garlic genotypes were analyzed in a previous study using AFLP markers and the garlic genotypes clustered together with AFLP markers were also grouped together with EST-SSR markers demonstrating high concordance between AFLP and EST-SSR marker systems and possible immediate application of EST-SSR markers for fingerprinting of garlic clones. EST-SSR markers could be used in genetic studies such as genetic mapping, association mapping, genetic diversity and comparison of the genomes of Allium species.

Background: The difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality. Objective: To assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. Design: Prospective analysis. Measurements and results: Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. Results: The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61%) and 5.5 cm (sensitivity, 61.54%; specificity, 99.11%). The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. Conclusion: These results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation.

JUSTIFICATIVA E OBJETIVOS: Neste estudo, objetivamos avaliar a memória implícita e explícita em pacientes submetidos à cirurgia abdominal sob anestesia venosa total (AVT) com propofol e remifentanil, na qual o nível de anestesia foi controlado pelo monitoramento do índice bispectral (BIS). MÉTODO: Anestesia venosa total foi administrada a 60 pacientes adultos para obter níveis de BIS de 40-60. Os pacientes foram randomicamente divididos em três grupos, de acordo com as gravações que ouviram. Os pacientes do grupo categoria (CT) ouviram uma fita gravada contendo cinco nomes de animais. Os pacientes do grupo recordar palavras (RP) ouviram uma fita gravada contendo cinco palavras de frequência média na língua turca, depois de adaptadas. Os pacientes do grupo controle (GC) ouviram os sons do mar até o fim da cirurgia. Duas horas após a cirurgia, os testes foram administrados a cada paciente na sala de recuperação para avaliar a memória. RESULTADOS: Houve uma diferença entre os escores dos grupos CT e GC no Miniexame do Estado Mental (MMSE); todos os escores foram > 20. Os resultados dos testes de categoria e recordar palavras, aplicados para avaliar a memória implícita, não foram estatisticamente diferentes entre os grupos. Não houve evidência de memória implícita em nenhum dos pacientes. Um paciente lembrou-se de ouvir "o som de água" como uma prova de memória explícita. Onze pacientes declararam não ter sonhado. CONCLUSÕES: Apesar de não termos encontrado nenhuma evidência de memória implícita sob anestesia adequada com AVT, um paciente apresentou memória explícita. Embora a profundidade adequada da anestesia fornecida pelo monitoramento do BIS corrobore nossos resultados para a memória implícita, ela não explica os resultados para a memória explícita.JUSTIFICATIVA Y OBJETIVOS: En este estudio evaluamos la memoria implícita y explícita en pacientes sometidos a la cirugía abdominal bajo anestesia venosa total (AVT), con propofol y remifentanilo, en la cual el nivel de anestesia fue controlado por el monitoreo del índice bispectral (BIS). MÉTODO: Anestesia venosa total que fue administrada a 60 pacientes adultos para obtener niveles de BIS de 40-60. Los pacientes fueron aleatoriamente divididos en tres grupos de acuerdo con las grabaciones que oyeron. Los pacientes del grupo categoría (CT) oyeron una cinta grabada que contenía cinco nombres de animales. Los pacientes del grupo recordar palabras (RP), escucharon una cinta grabada que contenía cinco palabras de frecuencia media en lengua turca, después de haber sido adaptadas. Los pacientes del grupo control (GC) oyeron los sonidos del mar hasta el final de la cirugía. Dos horas después de la cirugía, los test fueron administrados a cada paciente en la sala de recuperación para evaluar la memoria. RESULTADOS: Hubo una diferencia entre las puntuaciones de los grupos CT y GC en el Mini Examen del Estado Mental (MMSE) y todas las puntuaciones fueron > 20. Los resultados de los test de categoría y recordar palabras aplicados para evaluar la memoria implícita no fueron estadísticamente diferentes entre los grupos. No hubo evidencia de memoria implícita en ninguno de los pacientes. Un paciente recordó escuchar "el sonido del agua" como una prueba de memoria explícita. Once pacientes dijeron que no habían soñado. CONCLUSIONES: A pesar de no haber encontrado ninguna evidencia de memoria implícita bajo anestesia adecuada con AVT, un paciente tuvo memoria explícita. Aunque la profundidad adecuada de la anestesia suministrada por el monitoreo del BIS corrobore nuestros resultados para la memoria implícita, ella no explica los resultados para la memoria explícita.BACKGROUND AND OBJECTIVES: In this study, we aimed to assess implicit and explicit memory in patients who had abdominal surgery under total intravenous anesthesia (TIVA) with propofol and remifentanil, in which anesthesia level was controlled by bispectral index (BIS) monitoring. METHOD: Total intravenous anesthesia was administered to 60 adult patients, to obtain BIS levels of 40-60. Patients were randomly allocated to three groups according to tapes they listened to. Patients in the category group (CT) listened to a tape containing five animal names. Patients in the word recognition group (WM) listened to a tape containing five intermediate-frequency words, adapted into Turkish. Patients in the control group (CG) listened to sea sounds until the end of surgery. Two hours after surgery, tests were administered to each patient in the recovery room to assess memory. RESULTS: There was a difference between the CT and CG groups in their Mini-Mental State Examination scores, all values were > 20. The results of the category and word recognition tests that were applied to assess implicit memory were not statistically different among the groups. There was no evidence of implicit memory in any of the patients. One patient remembered hearing 'the sound of water' as a proof of explicit memory. Eleven patients said they had dreamt. CONCLUSIONS: Although no evidence of implicit memory under adequate anesthesia with TIVA was found, one patient showed explicit memory. Although adequate depth of anesthesia provided by BIS monitoring supports our implicit memory results, it does not explain the explicit memory results.

JUSTIFICATIVA E OBJETIVOS: Investigamos o efeito do óxido nitroso (N2O) em hipotensão controlada durante anestesia com baixo fluxo (isoflurano-dexmedetomidina) em termos de hemodinâmica, consumo de anestésico e custos. MÉTODOS: Quarenta pacientes foram randomicamente alocados em dois grupos. Infusão de dexmedetomidina (0,1 µg.kg-1.min-1) foi mantida por 10 minutos. Subsequentemente, essa infusão foi mantida até os últimos 30 minutos de operação a uma dose de 0,7 µg.kg-1.hora-1. Tiopental (4-6 mg.kg-1) e brometo de vecurônio (0,08 0,12 mg.kg-1) foram administrados na indução de ambos os grupos. Isoflurano (2%) foi administrado para manutenção da anestesia. O Grupo N recebeu uma mistura de 50% de O2-N2O e o Grupo A recebeu uma mistura de 50% de O2-ar como gás de transporte. Anestesia com baixo fluxo (1 L.min-1) foi iniciada após um período de 10 minutos de alto fluxo inicial (4,4 L.min-1). Os valores de pressão arterial, frequência cardíaca, saturação periférica de O2, isoflurano inspiratório e expiratório, O2 inspiratório e expiratório, N2O inspiratório e expiratório, CO2 inspiratório, concentração de CO2 após expiração e concentração alveolar mínima foram registrados. Além disso, as taxas de consumo total de fentanil, dexmedetomidina e isoflurano, bem como de hemorragia, foram determinadas. RESULTADOS: A frequência cardíaca diminuiu em ambos os grupos após a carga de dexmedetomidina. Após a intubação, os valores do Grupo A foram maiores nos minutos um, três, cinco, 10 e 15. Após a intubação, os valores de hipotensão desejados foram alcançados em 5 minutos no Grupo N e em 20 minutos no grupo A. Os valores da CAM foram mais altos no Grupo N nos minutos um, três, cinco, 10 e 15 (p < 0,05). Os valores da FiO2 foram mais altos entre 5 e 60 minutos no Grupo A, enquanto foram mais altos no Grupo N aos 90 minutos (p < 0,05). Os valores de Fi Iso (isoflurano inspiratório) foram menores no Grupo N nos minutos 15 e 30 (p < 0,05). CONCLUSÃO: O uso de dexmedetomidina em vez de óxido nitroso em anestesia com isoflurano pela técnica de baixo fluxo atingiu os níveis desejados de pressão arterial média (PAM), profundidade suficiente da anestesia, estabilidade hemodinâmica e parâmetros de inspiração seguros. A infusão de dexmedetomidina com oxigênio-ar medicinal como gás de transporte é uma técnica anestésica opcional.

JUSTIFICATIVA E OBJETIVOS: Avaliar a incidência de infecções nosocomiais associadas aos dispositivos invasivos permite comparar as infecções associadas aos cuidados em saúde (IACS) entre as unidades de terapia intensiva (UTI) de diferentes hospitais e unidades do mesmo hospital. MATERIAL E MÉTODOS: De janeiro de 2007 a dezembro de 2010, um estudo de vigilância retrospectivo foi realizado para identificar infecções nosocomiais, taxas de infecções relacionadas a dispositivos e agentes causadores na UTI de anestesiologia. As IACS foram definidas de acordo com os critérios do Centro de Controle e Prevenção de Doenças (CDC) e as infecções relacionadas aos dispositivos invasivos definidas de acordo com os critérios do Sistema Nacional de Vigilância de Infecções Nosocomiais (NNIS). RESULTADOS: Durante dois anos, 939 pacientes em um universo de 7.892 pacientes/dia foram avaliados. As taxas de IACS foram de 53% em 2007, 29,15% em 2008, 28,85% em 2009 e 16,62% em 2010. A IACS mais comum foi infecção da corrente sanguínea. A taxa de infecção de tecido mole e pele foi a segunda. Entre os pacientes com infecções nosocomiais, os agentes causadores mais comuns foram Gram (-) 56,68%, Gram (+) 31,02% e candidíase 12,3%. CONCLUSÕES: A incidência de IACS na UTI de nosso hospital foi alta, em comparação com as taxas turcas globais obtidas no Refik Saydam Center em 2007. Quando as taxas de infecções relacionadas aos dispositivos foram comparadas entre 2007 e 2008, foram maiores em 2007. A taxas de infecções relacionadas aos dispositivos em 2008 foram reduzidas abaixo da média nacional por causa das medidas de controle de infecção. Como a taxa de infecções relacionada ao cateter urinário ainda permanece alta, devemos exercer esforços contínuos para o controle das infecções.

A new solid phase extraction (SPE) method has been developed for the selective separation and preconcentration of Cu (II) ions in food and water samples prior to its flame atomic absorption spectrometry determination. The method is based on the adsorption of the Cu(II) - 2-{[4-Amino-3-(4-methylphenyl-5-oxo-4,5-dihydro-1H-1,2,4-triazol-1-yl]acetyl}-N-phenyl hydrazinecarbothioamide complex on Amberlite XAD-8 resin. The metal complex retained on the resin was eluted with 7.5 mL of 2.0 mol L-1 HCl in acetone. The optimum conditions for the SPE of Cu(II) ions were investigated, and the method was subsequently applied to sea water, stream water, rice, tea, and tobacco samples for the determination of Cu(II) levels.

FUNDAMENTO: A função endotelial braquial tem sido associada ao fluxo lento coronário (FLC). O aumento do fluxo sanguíneo para a artéria braquial faz com que o endotélio libere óxido nítrico (ON), com subsequente vasodilatação. Além de sua atividade com betabloqueador, o nebivolol provoca vasodilatação, aumentando a liberação endotelial de ON. OBJETIVO: Avaliar os efeitos do nebivolol na função endotelial vascular em pacientes com FLC. MÉTODOS: 46 pacientes com FLC e 23 indivíduos com artérias coronárias epicárdicas normais foram examinados com ecocardiografia transtorácica e ultrassonografia da artéria braquial. Os pacientes foram reavaliados dois meses após o tratamento com aspirina ou aspirina e nebivolol. RESULTADOS: Os pacientes com FLC apresentaram maior índice de massa corporal (26,5 ± 3,3 vs. 23,8 ± 2,8, p < 0,001), tempo de relaxamento isovolumétrico (TRIV) de influxo mitral (114,9 ± 18,0 vs. 95,0 ± 22,0 mseg, p < 0,001), menor fração de ejeção do ventrículo esquerdo (FEVE) (63,5 ± 3,1% vs. 65,4 ± 2,2, p = 0,009), colesterol HDL (39,4 ± 8,5 vs. 45,8 ± 7,7 mg/dL, p = 0,003) e dilatação fluxo-mediada da artéria braquial (DFM) (6,1 ± 3,9% vs. 17,6 ± 4,5%, p BACKGROUND: Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its β1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. OBJECTIVE: To assess the effects of nebivolol on vascular endothelial function in patients with CSF. METHODS: Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. RESULTS: Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1% vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9% vs. 17.6 ± 4.5%, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3% vs. 6.0 ± ,6%, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5% vs. 8.0 ± 2.9%, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 %, p = 0.030) whereas treatment with aspirin alone was not. CONCLUSION: Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF.