The effects of education on foot care behaviors and self-efficacy in type 2 diabetes patients

Background

Diabetic foot significantly affects the quality of life of patients with diabetes. It leads to loss of labor force, psychosocial trauma, and high treatment costs due to serious morbidity and mortality. Nurses have an important responsibility to improve the metabolic status of individuals with diabetes, to protect them from foot complications, and to teach patients foot care skills.

Aim

This study investigated the effects of education on type 2 diabetes patients regarding diabetic foot care and self-efficacy.

Materials and Methods

This quasi-experimental study was conducted from February to July 2016 in hospitals located in the city of Balıkesir in Turkey with type 2 diabetes patients who were admitted to the internal medicine clinic and monitored by the endocrinology and internal medicine outpatient clinics. G*power 3.1.9.2 software was used to calculate the sample size of 94 people with a 5% type 1 error, and 90% power. The study was carried out with stratified randomization, and a questionnaire was administered to the experimental and control groups. The experimental group received training, and both groups' scores on the Diabetic Foot Behavior Questionnaire [Appendix 1] and the Diabetic Foot Care Self-Efficacy Scale [Appendix 2] were compared after three months. The t-test, the paired t-test, and the Chi-square test were used.

Results

While the self-efficacy and the foot care behavior scores of the control group did not show any differences (P > 0.05), the experimental group's scores were significantly higher (P < 0.05). The control group's self-efficacy and foot care behavior scores on the pre-test and final test were similar, while the experimental group's scores increased (P < 0.05).

Conclusions

Starting from the diagnosis of diabetes, it is advisable to carry out foot assessments and to follow up with diabetics who received foot care education to increase their self-efficacy, to make foot care a habit, and to re-evaluate missing or incorrect practices during check-ups.

How to reduce pesticide exposure in farmers: An intervention study

BACKGROUND

Pesticide poisoning is a serious public health problem.

OBJECTIVE

The aim was to investigate the effect of safe pesticide application training given to farmers on their behaviors towards compliance with protective measures.

METHODS

In this interventional study, the target population was 9750 farmers living in Turkey. To achieve a study power of 95% , type I error and the effect size were assumed as 5% and 0.50 respectively. In the study, 61 farmers were selected using the systematic sampling method. Farmers were interviewed twice, before and after the training, and at each interview, they were asked questions about their pesticide use-related behaviors in the last four sprayings. In the analysis, the paired t test, repeated measures of ANOVA (post hoc: Bonferroni) were used.

RESULTS

The scores the participants obtained from the Pesticide Exposure Prevention Behavior Form which questions their compliance with protective measures taken during pesticide applications at the post-interview were significantly higher than were the scores they obtained at the pre-interview (P <  0.001). The analysis of the independent variables demonstrated that the scores obtained from the Pesticide Exposure Prevention Behavior Form at the post-interview were significantly different from those obtained at the pre-interview in almost all of the subgroups in terms of their sociodemographic characteristics.

CONCLUSION

It was observed that the training given to the farmers on the safe use of pesticides encouraged the farmers to develop positive behavioral changes. The study emphasizes the importance of implementing ongoing health education programs for farmers.

The Effect of Perceived Stress and Digital Literacy on Student Satisfaction with Distance Education

OBJECTIVE

To examine the relationship between perceived stress/digital literacy and student satisfaction in health science college students in the distance education process.

METHOD

The cross-sectional study was conducted by collecting data from 842 students. The dependent variable was student satisfaction in distance education. For the analyses, t-test, ANOVA (post hoc: Bonferroni), and linear regression methods were used.

RESULTS

Distance education student satisfaction was 178.21 ± 48.64. Student satisfaction was low among those who think that distance education is not more effective than face-to-face education, live in villages/towns, and have high perceived stress. Student satisfaction was high among those who do not have limited internet access, can access the internet via computer, follow the lessons regularly every week, think distance education is applicable in the health domain, can acquire instant feedback from the instructor, and have increased digital literacy.

CONCLUSION

Distance education student satisfaction was found to be moderate. Student satisfaction in distance education increases as perceived stress levels decrease and digital literacy levels increase.

Health literacy and quality of life among people in semi-urban and urban areas

OBJECTIVE

to investigate health literacy level, quality of life and related factors in semi-urban and urban areas.

METHOD

this cross-sectional study was carried out between December 2018 and February 2019 with 595 participants. The variables found significant in the bivariate regression analysis were included in the multivariate regression analysis.

RESULTS

according to the scores obtained from the Health Literacy Scale, participants' health literacy 76.5% levels were adequate. The factors affecting the Health Literacy Scale score in semi-urban areas were educational status, income status, presence of a chronic disease, perceived health, and understanding the health information provided. The factors affecting the Health Literacy Scale score in urban areas were age, marital status, reading habits, presence of a chronic disease, and understanding the health information provided (p < .05). There was a statistically significant difference between participants living in semi-urban and urban areas in terms of their health literacy and quality of life levels (p < .001).

CONCLUSION

the health literacy level was inadequate in three out of ten participants, and it was even lower in semi-urban areas.

The Predictive Strength of Students' Self-Efficacy, Problem Solving Skills to Perform Catheter Care

PURPOSE

The aim of this study was to determine the predictive strength of students' self-efficacy, problem-solving skills, and other characteristics in performing intravenous practices and monitor phlebitis and infiltration.

METHODS

This cross-sectional study was carried out with 736 third and fourth-year students studying at the Health Sciences Faculties of Balikesir and Sakarya universities. The data were collected using the Self-Efficacy Scale, Problem-Solving Inventory and Catheter Care and Infiltration Monitoring Questionnaire.

RESULTS

The participants' mean Catheter Care and Infiltration Monitoring Questionnaire score significantly and positively correlated with their mean Self-Efficacy Scale score on a moderate level (r=.25; p <.001) but significantly and negatively correlated with their mean Problem-Solving Inventory score on a moderate level (r=-.21; p <.001). In other words, because a low Problem-Solving Inventory score indicates that the person's problem-solving skill is high, the Care and Infiltration Monitoring Questionnaire score increased as the problem-solving skill increased. While the Self-Efficacy Scale predicted the year of study and catheter care and infiltration monitoring variables positively, the Problem-Solving Inventory predicted the satisfaction with the profession variable negatively.

CONCLUSION

Self-efficacy, problem-solving, liking the profession, and year of study predict success in catheter care and infiltration monitoring. For this reason, guidance may be provided in the development of a comprehensive education system toward increasing students' problem-solving skills, self-efficacy, and professional knowledge and skills.

Relationship between farmers' knowledge and attitudes towards pesticide use and their sociodemographic characteristics: a cross-sectional study from north-western Turkey

Background

The determination of farmers' knowledge and attitudes towards pesticide use is very important in terms of preventing pesticide use-related short- and long-term damages.

Objective

This study was aimed at investigating the relationship between the sociodemographic characteristics of farmers in Karacabey District of Bursa, a province in northwest Turkey, and their knowledge and attitudes towards pesticide use.

Material and methods

This cross-sectional study was conducted in Karacabey district between December 2018 and April 2019. The sample size was calculated as 1924 using the Epi info program by assuming the prevalence as 50%, type I error as 5%, standard deviation as 3% and design effect as 2. The dependent variable of the study was the farmers' knowledge of and attitudes towards pesticide use whereas the independent variables were their sociodemographic characteristics. The relationship between the dependent and independent variables was analyzed using the chi-square test and binary logistic regression model.

Results

The mean score the participants obtained from the Knowledge and Attitude Index was 12.8±2.8 and the median value was 13. While 49.5% of the participating farmers obtained a score lower than the median, 51.5% of them obtained a score equal to or above the median. While advanced age increased the possibility of getting a low score from the Knowledge and Attitude Index 2.7 times, not being married increased it 35.7 times, not getting formal education increased it 30.1 times, living in a non-crowded household increased it 2.1 times, and low income (2000 Turkish liras equal to ≤$310 according to April 2019 exchange rates) increased it 3.1 times.

Conclusion

The study indicated that the participating farmers' knowledge and attitudes towards the proper use of pesticides were inadequate, and that there was a strong relationship between their Knowledge and Attitude Index scores and their sociodemographic characteristics.

Occupational acute pesticide poisoning: a cross-sectional study of Turkish vegetable and fruit farmers based on self-reported symptoms and job characteristics

BACKGROUND

Occupational pesticide poisoning is an important public health concern worldwide, especially in developing countries.

OBJECTIVES

This study was aimed at determining the prevalence and risk factors of acute pesticide poisoning (APP) among the vegetable and fruit farmers in Karacabey District in northwest Turkey.

METHODS

The study group consisted of 565 farmers. The dependent variable of the study is APP defined according to the World Health Organization's APP case definition matrix. The study's independent variables are the farmers' sociodemographic characteristics and the preventive measures they use when they are applying pesticides. The chi-square and logistic regression analysis analyzed the relationship between the dependent and independent variables.

RESULTS

A total of 64 (11.3%) farmers reported APP and 75% of them presented to a health institution due to symptoms. The factors associated with increased risk of APP were: illiteracy (odds ratio (OR)=2.5), 14 years and less farming experience (OR=3.3), not reading the pesticide labels (OR=6.4), and contact with liquid pesticides (OR=2.3). -Conclusions: The study shows that approximately one out of ten farmers experience APP. Training programs should be planned and monitored to improve farmers' awareness of the dangers of pesticides, and they should be encouraged to adopt and implement protective measures.

Paraoxonase Activity and Phenotype Distribution in Patients with Chronic Obstructive Pulmonary Disease

OBJECTIVE

Paraoxonase 1 (PON1) and arylesterase (ARE) enzymes have an important role in the prevention of oxidative stress which is related to the pathogenesis of chronic obstructive pulmonary disease (COPD). PON1 levels vary widely among individuals and ethnic groups, which is in part associated with polymorphisms.

MATERIALS AND METHODS

We investigated PON1 and ARE activity and phenotype distribution in COPD patients and healthy individuals. Sixty six COPD patients and 59 control subjects were involved in the study. Serum PON1 and ARE activities were detected by spectrophotometric method. The ratio of salt-induced PON1 to ARE activity was used to determine phenotypes as QQ, QR, and RR.

RESULTS

COPD patients exhibited higher PON1 activity (199.1 vs 129.2, p=0.002) but lower ARE activity compared to control (21.3 vs 33.5, p=0.021). There was a significant difference between COPD and control group with respect to PON1 phenotype characteristics. RR phenotypic distribution was more common in the COPD group than in control (60.6% [95% CI: 48.8 - 72.3] versus 22.0 % [95% CI: 12.0 - 31.9], p=0.001). We also found that smoking (95.0% CI: 0.001-0.036, p<0.001) and RR phenotype (95.0% CI: 0.006 - 0.59, p=0.016) are independent determinants in COPD.

CONCLUSION

We found that RR phenotype was more common in COPD patients compared to control. Smoking and RR phenotype may be defined as independent factors associated with COPD.

Unmet needs for family planning among married women aged 15-49 years living in two settlements with different socioeconomic and cultural characteristics: a cross-sectional study from Karabuk Province in Turkey

AIM

The aim of the study was to investigate levels and related factors of the unmet needs for family planning among married women aged 15-49 years living in two settlements (rural and urban) having different economic, social and cultural structures in Karabuk, a province in north-western Turkey.

METHOD

This cross-sectional study was conducted in the rural Cumayani village and the urban Emek neighbourhood between October 2016 and June 2017. The sample size was determined to be 289 married women aged 15-49 years from each settlement according to the effect size of 0.3, alpha error probability of 0.05 and power of 0.95. In the study, 594 currently married women (298 from Cumayani and 296 from Emek) were contacted. The dependent variable was the level of unmet need for family planning. The independent variables included the sociodemographic and reproductive characteristics of the women. The data were collected through face-to-face interviews. The characteristics of the two settlements were compared using the χ2 test. Bivariate and multivariate logistic regression analyses were carried out to examine the factors associated with the dependent variable.

RESULTS

The comparison of the participants demonstrated that the education, employment and income levels of the rural women were lower than those of the urban women (p<0.001). The rural women had more pregnancies, miscarriages and stillbirths, and the mortality among their children was higher compared to the urban women (p<0.001). The level of unmet need for family planning in Cumayani village was about twice that of Emek neighbourhood (9.7% v 5.4%). The multivariate analysis was conducted separately for each settlement. Marrying by way of only a religious ceremony increased the level of unmet need for family planning by 4.61 times (95% confidence interval (CI) 1.3-16.1) (p=0.016) in Cumayani. The multivariate analysis of all the women participating in the study revealed that marriage by way of only a religious ceremony increased the level of unmet need by 4.96 times (95%CI 1.4-17.1) (p=0.011).

CONCLUSION

The study showed the effects of socioeconomic and cultural factors on women's fertility behaviours and unmet needs for family planning to favour urban women. Not being married by civil marriage was a significant predictor of unmet need. These findings highlight a need for intervention, particularly for the empowerment of rural women, in order to improve reproductive health outcomes.

Association between the ADAMTS proteinases and obstructive sleep apnea

BACKGROUND

A disintegrin and metalloproteinase with thrombospondin type-1 motifs (ADAMTS) proteinases have important roles in degradation/repairing of extracellular matrix (ECM). They are thought to play a key role in pathogenesis of many diseases. We aimed to investigate the association between ADAMTS 2, 3, and 14 (procollagen) and obstructive sleep apnea (OSA).

METHODS

Eighty-six individuals who were suspected of OSA were included. All cases underwent polysomnography. Participants were divided into 3 groups according to apnea-hypopnea index (AHI): control (n = 22), mild-to-moderate OSA (n = 36), and severe OSA (n = 28). ADAMTS proteinases 2, 3, and 14 were analyzed in serum samples.

RESULTS

When compared with other groups, patients with severe OSA showed significantly higher body mass index (BMI) (p = 0.001), whereas they showed significantly lower ADAMTS 3 levels (p = 0.016). No difference was found between groups with respect to the levels ADAMTS 2 and 14. There was a negative relation between the levels of ADAMTS 3 and the severity of OSA (Kendall's tau = - 0.19, p = 0.021). The levels of ADAMTS 3 were also found to be positively correlated with minimum SpO₂ (r = 0.31, p = 0.004) and negatively correlated with BMI, AHI, oxygen desaturation index (ODI), time duration with oxygen saturation < 90% (T90), and CRP (r = - 0.31 to - 0.49, p < 0.05). Multivariable regression analysis revealed that BMI (p = 0.013) and CRP levels (p = 0.005) were significantly associated with the levels of ADAMTS 3.

CONCLUSIONS

ADAMTS 3, one of the procollagen proteinases, was decreased in severe OSA. Lack of ADAMTS 3 proteinase may contribute to process of sleep apnea due to insufficient collagen syntheses.

The role of high sensitive C-reactive protein and histopathological evaluation in chronic gastritis patients with or without Helicobacter pylori infection

PURPOSE

To evaluate serum levels of high-sensitivity C-reactive protein (hs-CRP) in chronic gastritis patients to predict Helicobacter pylori (HP) infection, inflammatory activity, and precancerous lesions.

METHODS

A total of 811 patients with upper gastrointestinal symptoms and histopathological diagnosis of chronic gastritis were enrolled in the study. On endoscopy, five gastric biopsies were taken according to Modified Sydney protocol, which were stained with hematoxylin & eosin and Giemsa.

RESULTS

HP infection was found in 28.6% of patients, being significantly more common in specimens with acute and chronic inflammatory activity. Mucosal atrophy, intestinal metaplasia, and dysplasia were found in 20.2%, 18.8% and 2.7% of biopsy specimens. Mean hs-CRP was 1.9±1.6 mg/dl for males and 2.2±1.9 mg/dl for females. hs-CRP average were significantly higher in patients with severe acute inflammation (p:0.049), in patients with severe chronic inflammation (p:0.015) and in those with HP (p: 0.001) . The severity of HP infection increased significantly with the increased degree of acute inflammation, chronic inflammation and hs-CRP level (p=0.001 for both).

CONCLUSION

Serum hs-CRP level increases in patients with chronic gastritis, it could be an indicator of severity of acute or chronic mucosal inflammation, and presence of HP infection. Therefore, hs-CRP may aid the diagnosis of chronic gastritis, but it is not associated with pre-cancerous lesions.

The educational issues of male nursing workforce from the perspective of male nursing students: a qualitative study from Turkey

Background: The aim of the study was to determine the effects of gender on vocational training of male students who were enrolled in two university undergraduate nursing programs in Turkey.Methods: This qualitative study was carried out in 2014-2015. This qualitative study was carried out in University located in the northwest of Turkey and in University located in the west of Turkey in 2014-2015. The students were third and fourth year-students. In-depth interviews were conducted with students by using an interview guide composed of open-ended questions. The data were evaluated by using content analysis. The ethical approval was provided to conduct the study.Results: Five main themes raised from the in-depth interviews: 1) the reason for preferring nursing; 2) opinions about nursing; 3) educational environment and education content; 4) the issues in the clinical practise and 5) the working areas of the male nurses.Conclusions: The study pointed out the effect of the issues created by the gender discrimination on the education of the male nursing students along with the serious problems sprung from the insufficient infrastructure of the universities on nursing education.

Change from health center to family physician period in the Turkish health system: A qualitative study

INTRODUCTION

Health care reforms in Turkey have been implemented resolutely in the last 12 years. The shift from health center (HC) to a family physician (FP) approach is 1 of the basic interventions of these reforms. The goal of the current study is to evaluate opinions of patients, health care workers, and managers, using qualitative methods.

METHODS

In-depth interviews were conducted with patients who received health care services in both the FP and the HC periods, and with health care workers and managers in health care facilities that served in both periods. The interviews were recorded after obtaining permission, and then transcribed. Both health care staff that worked in the 2 periods and the patients that received health care services in the 2 periods reported that FP system was superior to HC system in attention showed by the family physicians, being followed by the same physician, and having confidence in physicians.

RESULTS

The current FP period is superior to HC in facilities such as patient records, computer, internet, and phone. The strengths of HC period include home visits, environmental health studies, and family planning services. According to health care workers who worked in the 2 periods, HC was superior to FP in team spirit, public service delivery, and surveillance of communicable diseases.

CONCLUSION

Public service delivery and environmental health studies and primary care practice in rural areas must be scrutinized in the context of the FP approach.

How primary care reforms influenced health indicators in Manisa district in Turkey: Lessons for general practitioners

Background: Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms.

Objectives: This study compares health status indicators during the HC period before reforms (2003–2007) and the FP period after reforms (2008–2012) in Turkey.

Methods: This study encompasses time series data consisting of the results of a 10-year assessment (2003–2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis.

Results: The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period.

Conclusion: Primary care services should be reorganized and integrated with public health services.

The endothelial nitric oxide synthase (eNOS) polymorphism in otitis media with effusion (OME)

OBJECTIVES

Otitis media with effusion (OME) is the most common disease after viral infections of upper respiratory tract (URTI) in children. Studies indicate the important role of nitric oxide (NO) in the etiology of hearing loss. However, there is no study that focuses on the role of nitric oxide synthase (eNOS) polymorphisms in the cases with OME. The aim of the present study is to evaluate the eNOS polymorphisms in the pediatric patients with OME.

MATERIALS AND METHODS

Eighty-nine patients who are diagnosed with otitis media with effusion and 85 healthy subjects who are compatible in terms of age and gender were included in the study. All patients in the study were subjected to complete ear, nose, throat (ENT) and audiological examinations. DNA analysis was performed with polymerase chain reaction (PCR) technique from the blood samples. The PCR product was cut by restriction fragment length polymorphism (RFLP) with BanII enzyme and checked by agarose gel electrophoresis.

RESULTS

As a result of genetic analysis, there is no significant difference between patients and the controls in terms of eNOS Glu298Asp polymorphism (G/G, G/T, T/T). When these groups were compared in terms of allele distributions, a significant relationship was found between the patients and the controls (P=0.037).

CONCLUSION

To the best of our knowledge, G allele was identified as predisposing to the development of OME and this is the first report indicates the correlation between the eNOS G894T polymorphism and OME in Turkey.

Electron microscopic examination of effects of bogma raki and walnut on cochlea: an experimental study

Illegal alcohol beverages known as bogma raki in our country are consumed widely in our region. The studies investigating the relationship between alcohol consumption and hearing ability report different results. In this study, we aimed to investigate the toxic effects of bogma raki that contains neurotoxic substances on cochlea by electron microscopy. To the best of our knowledge, this study is the first in the literature. A total of 48 Wistar male albino rats (aged 12-16 weeks and weighing 200-240 g) were used in the study. The rats were divided into 4 groups with 12 animals in each group. The groups include control, bogma raki, walnut, and walnut + bogma raki groups. Bogma raki (30% v/v, 9.2 ml kg(-1) day(-1)) is added to drinking water of rats in bogma raki group (n = 12) for 4 weeks. Walnut group rats (n = 12) are fed with standard rat food and walnut without limitation (10 g kg(-1) day(-1)). Bogma raki + walnut group rats (n = 12) are fed with standard rat food and walnut and bogma raki is added to drinking water. The cochleas were dissected and removed en bloc and examined by electron microscopy. Perineuronal oedema around neurons of spiral ganglion and hairy cells of organ of Corti were present in the bogma raki group, walnut group and bogma raki + walnut group under electron microscopic examination. Comparing these three groups, there were no differences in the ultrastructural pathological changes. In the ultrastructural examination of the myelinated axons forming cochlear nerve, no ultrastructural pathology was detected in all the groups.

Blood-pool SPECT in addition to bone SPECT in the viability assessment in mandibular reconstruction

INTRODUCTION

The assessment of the postoperative viability of vascularized and non-vascularized grafts used in the reconstruction of mandibular defects due to trauma and surgical reasons is a major problem in maxillofacial surgery.

AIM

In the present study, we evaluated the feasibility and image quality of blood-pool SPECT, which is used for the first time in the literature here in the assessment of mandibular reconstruction, in addition to non-invasive bone scintigraphy and bone SPECT. We also evaluated whether it would be useful in clinical prediction.

PATIENTS AND METHODS

Micro-vascularized and non-vascularized bone grafts were used in 12 Syrian men with maxillofacial trauma. Between days 5-7 after surgery, three-phase bone scintigraphy, blood-pool SPECT and delayed bone SPECT scans were performed. After month 6, the patients were assessed by control CT scans.

RESULTS

Of the non-vascularized grafts, one graft was reported as non-viable at week one. At month 6, graft resorption was demonstrated on the CT images. The remaining non-vascularized grafts and all of the micro-vascularized grafts were considered to be viable according to delayed bone SPECT and blood-pool SPECT images. However, only the anterior and posterior ends could be clearly assessed on delayed SPECT images, while blood-pool SPECT images allowed the clear assessment of the entire graft.

CONCLUSIONS

The combined use of blood-pool and delayed SPECT scans could allow for better assessment of graft viability in the early period, and can provide more detailed information to clinicians about prognosis in the follow-up of patients undergoing mandibular graft reconstruction.

Use and safety of conducted electronic devices: what is known?

Conductive electronic devices (CED), such as Taser and stun guns, are sold worldwide for use by security services, although they have also been used for self-defence and even for torture. CED are promoted as non-lethal weapons which can potentially save lives. However, there are multiple reports of deaths temporally associated with CED use. These weapons have definite physiological effects in normal volunteers, especially when accompanied by exertion. Medical examiners often report that deaths followed physical encounters which included the use of CED were due to natural causes, excited delirium and/or drug intoxication. These cases present complex situations in which multiple factors potentially contribute to the death, including electric shocks which cause neuromuscular incapacitation, severe pain and anxiety. Public health officials, physicians and hospital personnel need to be aware that individuals controlled with CED are at increased risk of death. We need better recording of incidents worldwide to understand the extent and outcomes of CED use.

The effects of propofol or halothane on free radical production after tourniquet induced ischaemia-reperfusion injury during knee arthroplasty

BACKGROUND

Ischaemia-reperfusion injury following tourniquet release is a good in vivo model for evaluating acute conditions. The aim of the study was to investigate the effects of propofol or halothane anaesthesia on oxidative stress by determining malondialdehyde (MDA) levels during knee arthroplasty.

METHODS

Thirty patients undergoing orthopaedic surgery were divided into two groups. Anaesthesia was induced with either fentanyl 100 microg and propofol 2 mg kg(-1) (Group 1) or fentanyl 100 microg and thiopentone 5 mg kg(-1) (Group 2) and maintained with infusion of propofol in Group 1 or inhalation of halothane in Group 2. ECG, SpO2, EtCO2, and mean arterial pressure (MAP) were monitored. Venous and arterial blood samples were obtained at different measurement times for MDA and blood gas analyses.

RESULTS

There was a significant decrease in MAP in the 1st and 5th minutes after tourniquet release (ATR) when compared with the 5th minute before tourniquet release (BTR) in both groups. Heart rate (HR) increased significantly in the 1st minute ATR in Group 1 only. EtCO2 increased significantly in the 1st and 5th minutes ATR, SpO2 decreased in the 1st minute ATR in both groups. There was a significant decrease in pH and increase in pCO2 at 1, 5 and 30 min ATR in both groups. pO2 values decreased in the 1st minute ATR in Group 1 only and returned to control values at 5 min ATR and decreased at 30 min ATR in the recovery room in both groups. The differences in SaO2 were similar to SpO2. MDA levels decreased before and after release of tourniquet when compared to baseline in both groups. However, there was a statistically significant decrease only in Group 1.

CONCLUSION

Propofol may be a good choice of anaesthetic when an ischaemia-reperfusion injury is anticipated as in orthopaedic surgery requiring a tourniquet, due to its antioxidant properties, but halothane needs further study.

The effect of EGb 761 on the doxorubicin cardiomyopathy

Doxorubicin (Dx) is used to treat a number of types of cancer. The drug produces many toxic reactions and cardiomyopathy. Many drugs have been used to prevent this myocardial damage caused by peroxidative alterations. EGb 761 is being used to prevent arrhythmias in ischemic myocardium. We decided to establish the tissue protective effect of EGb 761 against myocardial toxic effects of Dx in three groups of rats. Cardiotoxicity signs of Dx were found to be dose-related, beginning at 30 mg/kg dose and being apparent at 45 mg/kg dose. 48 hr after a single i.v. injection, myocardial tissues showed a marked edema, vacuolization and fragmentation. We compared the changes in heart tissue biochemically and histopathologically among the control, Dx treated and EGb 761 (100 mg/kg/d.x 4, i.p.) + Dx treated groups. Biochemical results of CK-MB and MDA values showed a significant decrease in Dx + EGb 761 group when compared with Dx treated group. Histopathologically, myocardial tissues of Dx + EGb 761 treated group were found to have diminished vacuolization and fragmentation. These results suggest that EGb 761 might have the same therapeutic potential in Dx related cardiomyopathy.

Hepatoprotective effects of Turkish folk remedies on experimental liver injury

Seven plants which are used in Turkish folk medicine were studied for possible hepatoprotective effects. These plants are Carduus acanthoides and C. nutans (Asteraceae), Cichorium intybus (Asteraceae), Fumaria asepalae and F. vailantii (Fumariaceae), Gentiana olivieri (Gentianaceae) and Plantago lanceolata (Plantaginaceae). Stems, bracts and receptaculum of Cynara scolymus were used as natural reference drugs. Effects of the ethanolic extracts were studied using the carbon tetrachloride-induced hepatotoxicity model in rats. The extracts of F. vailantii and G. olivieri significantly prevented the elevation of plasma and hepatic malondialdehyde formation (evidence of lipid peroxidation) as well as enzyme levels (AST and ALT) in acute liver injury, which might be ascribed to their potent hepatoprotective activity. Liver sections were also studied histopathologically to confirm the biochemical results.

Does remote organ ischaemia trigger cardiac preconditioning during coronary artery surgery?

The aim of this study is to provide biochemical evidence of the occurrence of cardiac preconditioning via remote organ ischaemia on the patients undergoing coronary artery surgery. Eight male patients were randomly allocated into two groups. Blood samples were collected via coronary perfusion catheter immediately before cardiopulmonary bypass (point 0), prior to declamping aorta (point 1) and 5 min after declamping the aorta (point 2) to determine creatinine phosphokinase (CPK), CPK-MB and lactate dehydrogenase (LDH) levels in the control group. A tourniquet wrapped around the right upper extremity of the patient was inflated and deflated twice to perform 3 min of ischaemia separated with 2 min of reperfusion in the preconditioning group. Blood samples were withdrawn as described for the control group. Only LDH levels at point 2 were found to be significantly higher than the control group's. These data implied that preconditioning appeared to protect myocardium by enhancing anaerobic glycolysis.

The beneficial effect of 2'-deoxycoformycin in renal ischemia-reperfusion is mediated both by preservation of tissue ATP and inhibition of lipid peroxidation

Renal ischemia injures the renal tubular cell by disrupting the vital cellular metabolic machinery. Further cell damage is caused when the blood flow is restored by oxygen free radicals that are generated from xanthine oxidase. Oxygen radicals cause lipid peroxidation of cell and organelle membranes, disrupting the structural integrity and capacity for cell transport and energy metabolism. In the present study, the possible therapeutic usefulness of the adenosine deaminase inhibitor, 2'-deoxycoformycin (DCF), during renal ischemia and reperfusion injury was investigated. The effects of DCF on renal malondialdehyde (MDA) and ATP levels were studied after 45 min ischemia and 15 min subsequent reperfusion in rat kidneys. MDA levels remained unchanged during ischemia, but increased after the subsequent reperfusion. DCF pretreatment (2.0 mg/kg i.m.) decreased MDA and increased ATP levels during the ischemia-reperfusion period. DCF exerts a dual protective action by facilitating purine salvage for ATP synthesis and inhibiting oxygen radical-induced lipid peroxidation. These results suggest that DCF therapy could be beneficial in the treatment of ischemia-reperfusion renal injuries.

The relation of optical density of seminal plasma with serum FSH and LH levels in azoospermic patients

The aim was to investigate the relation between optical density of seminal plasma, serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in azoospermic patients and to establish criteria depending on optical density measurements in order to estimate serum FSH and LH levels. Optical density of seminal plasma and serum FSH and LH levels were measured in 45 azoospermic patients. The semen samples with an optical density (OD) of more than 0.5 showed normal levels of FSH and LH, while those with less than 0.5 were observed to have high levels of FSH and LH. The optical density of seminal plasma can be used in the prediction of serum FSH and LH levels in azoospermic patients.

Serum fructosamine and fructosamine-albumin ratio as screening tests for gestational diabetes mellitus

To evaluate the role of fructosamine/albumin ratio as an alternative screening parameter for gestational diabetes mellitus (GDM), serum fructosamine, albumin, protein, fructosamine/albumin ratio, and oral glucose tolerance were measured in 56 non-pregnant control healthy subjects, and in 96 pregnant women who screened positive after a 50 g glucose challenge-test. Oral glucose tolerance test (OGTT) identified 12 of 96 pregnant women as having GDM. Fructosamine concentration of 1.98 +/- 0.32 mmol/L (mean +/- SD) and fructosamine/albumin ratio of 47 +/- 10 mumol/g (mean +/- SD) has been obtained in nonpregnant control subjects. During the second trimester a lower fructosamine level (1.84 +/- 0.29 mmol/L, p < 0.05) and a higher fructosamine/albumin ratio (62 +/- 15 mumol/g, p < 0.001) occurs in pregnant women, when compared to non-pregnant healthy control subjects, most likely due to the low serum albumin concentration (30 +/- 6 g/L). The serum fructosamine levels and fructosamine/albumin ratio were only slightly higher in the pregnant women with GDM than in normal pregnant women (2.05 +/- 0.47 mmol/L versus 1.84 +/- 0.29 mmol/L, 67 +/- 16 mumol/g versus 62 +/- 15 mumol/g, respectively) but the differences were not statistically significant. The fructosamine and fructosamine/albumin ratio values for normal and GDM groups overlapped considerably. Sensitivity, specificity, positive predictive and negative predictive values for fructosamine were 41.7%, 85.7%, 29.4% and 91%, and for fructosamine/albumin ratio 25%, 79.8%, 15% and 88% respectively. This suggests that both fructosamine and fructosamine/albumin ratio have low sensitivity as predictors of GDM and can therefore not be used as screening tests.

The effect of high-dose inhaled budesonide on lipid profile in asthmatic patients

1. We determined the effect of high doses of inhaled corticosteroid (budesonide, BUD, 1600 micrograms/day for 4 weeks) on fasting triglyceride, cholesterol and high-density lipoprotein (HDL)-cholesterol concentration in 11 asthmatic patients. 2. No significant change of serum fasting triglyceride concentrations was found before and after BUD therapy (p > 0.05). However, serum fasting cholesterol concentration decreased slightly (p = 0.03) and HDL-cholesterol concentrations increased after BUD therapy for four weeks (p = 0.01). 3. These results suggest that high-dose BUD therapy does have minor effects on lipid metabolism after long periods of use in asthmatic patients.

Findings of an external quality assessment scheme for determining aluminum in dialysis fluids and water

The analytical performance of laboratories participating in the dialysis fluids and water aluminum program of the Guildford External Quality Assessment Scheme over the period 1986-1993 has been reviewed. For aluminum concentrations > 3.33 mumol/L in dialysis fluids, the between-laboratory CV has fallen from approximately 36% to 23%, whereas for specimens of water the reduction was from 36% to approximately 18%. Improvements at lower concentrations were less impressive. Performance of individual participants varied; only a few consistently provided accurate results. Many of the participants are able to measure serum aluminum well, so lack of expertise is not responsible for poor results. We suggest that matrix effects associated with different specimen types have a significant influence on performance and that due account is not always taken of these factors. Resolution of these problems would be aided by appropriate reference materials.

Findings of an external quality assessment scheme for determining aluminum in dialysis fluids and water

The analytical performance of laboratories participating in the dialysis fluids and water aluminum program of the Guildford External Quality Assessment Scheme over the period 1986-1993 has been reviewed. For aluminum concentrations &gt; 3.33 mumol/L in dialysis fluids, the between-laboratory CV has fallen from approximately 36% to 23%, whereas for specimens of water the reduction was from 36% to approximately 18%. Improvements at lower concentrations were less impressive. Performance of individual participants varied; only a few consistently provided accurate results. Many of the participants are able to measure serum aluminum well, so lack of expertise is not responsible for poor results. We suggest that matrix effects associated with different specimen types have a significant influence on performance and that due account is not always taken of these factors. Resolution of these problems would be aided by appropriate reference materials.

The effect of deferoxamine on brain lipid peroxide levels and Na-K ATPase activity following experimental subarachnoid hemorrhage

1. In the present study we have studied the effects of deferoxamine treatment on lipid peroxidation and Na-K ATPase activity after experimental induction of subarachnoid haemorrhage (SAH) in guinea pigs. 2. We assessed the extent of lipid peroxidation by measuring the level of malondialdehyde and Na-K ATPase activity in 3 different groups (sham-operated, SAH, SAH + deferoxamine). 3. There was no significant difference in lipid peroxide content between sham-operated and haemorrhagic animals, but Na-K ATPase activity decreased after SAH. 4. Deferoxamine treatment reduced the malondialdehyde content and induced the recovery of Na-K ATPase activity, exerting a brain protective role against the detrimental effects of the haemorrhage.

The effect of short term lithium treatment on the leukocyte, liver and muscle carbohydrate metabolism of guinea-pigs

1. The effect of lithium treatment on the leukocyte, liver and muscle glycogen levels of guinea-pigs has been studied. 2. A 4-week treatment with lithium chloride (5 mmol/l i.p. in saline) increased leukocyte, liver and muscle glycogen and decreased blood glucose levels. 3. These results strongly suggest that a lithium-induced insulin-like effect may be related to the long term effect.