Concentration levels, spatial variations and exchanges of polychlorinated biphenyls (PCBs) in ambient air, surface water and sediment in Bursa, Türkiye

In this study, ambient air, surface water and sediment samples were simultaneously collected and analyzed for PCBs to investigate their levels, spatial variations and exchanges between these three compartments at different sampling sites for 12 months in Bursa, Türkiye. During the sampling period, a total of 41 PCB concentrations were determined in the ambient air, surface water (dissolved and particle phase) and sediment. Thus, 945.9 ± 491.6 pg/m³ (average ± STD), 53.8 ± 54.7 ng/L, 92.8 ± 59.3 ng/L and 71.4 ± 38.7 ng/g, respectively. The highest concentrations of PCBs in the ambient air and in water particulate phase were measured at the industrial/agricultural sampling site (1308.6 ± 252.1 pg/m³ and 168.7 ± 21.2 ng/L, respectively), ∼ 4-10 times higher than background sites; while the highest concentrations in the sediment and dissolved phase were measured at the urban/agricultural sampling sites (163.8 ± 27.0 ng/L and 145.7 ± 15.3 ng/g, respectively), ∼ 5-20 times higher than background sites. PCB transitions between ambient air-surface water (f_A/f_W) and surface water-sediment (f_W/f_S) were investigated by fugacity ratio calculations. According to the fugacity ratios obtained, volatilization from the surface water to the ambient air was observed at all sampling sites (98.7 % of f_A/f_W ratios are <1.0). Additionally, it has been determined that there is a transport from the surface water to the sediment (100.0 % of f_W/f_S ratios are higher than 1.0). The flux values in ambient air-surface water and surface water-sediment environments ranged from -1.2 to 1770.6 pg/m²-day and from -225.9 to 0.001 pg/m²-day, respectively. The highest flux values were measured for PCBs with low chlorine content (Mono-, Di-Cl PCBs), while the lowest flux values were measured for the high chlorine content PCBs (Octa-, Nona- and Deca-Cl PCBs). As it was determined in this study that surface waters contaminated by PCBs have the potential to pollute both air and sediments, it will be important to take measures to protect surface waters.

Concentration levels and an assessment of human health risk of polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) in honey and pollen

Persistent organic pollutants (POPs) such as polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) accumulate in the food chain due to their physical and chemical properties and adversely affect human health. For this reason, this study aimed to determine the PAH and PCB concentration levels in pollen and honey samples in urban and semi-urban areas and to evaluate the risk of cancer that may occur by ingestion in Bursa, Turkey. The average total concentrations of 14 PAH (∑₁₄PAH) compounds in pollen and honey samples were found to be 304.3 ± 192.3 ng/g (average ± standard deviation) and 650.2 ± 118.1 ng/g for the urban area, and 329.6 ± 160.6 ng/g and 464.3 ± 66.4 ng/g for the semi-urban area, respectively. Similarly, ∑₁₄PCB concentrations in pollen and honey samples were found to be 8.7 ± 3.6 ng/g and 13.0 ± 4.8 ng/g for the urban area and 7.7 ± 2.2 ng/g and 17.4 ± 4.0 ng/g for the semi-urban area, respectively. It was determined that the pollen and honey samples in both sampling areas were affected by local PCB sources. The Pearson correlation coefficient (PCC) method determined the relationship between pollen and honey samples. According to the PCC values obtained, it was observed that pollen and honey in both sampling regions exhibited a significant relationship with each other. Finally, while there was no cancer risk for PCBs due to ingestion of honey and pollen in both sampling areas, acceptable cancer risk has been calculated for PAHs.

POS1216 POTENTIAL PREDICTORS OF OUTCOME FOR ANAKINRA TREATMENT IN COVID-19 PATIENTS WITH MACROPHAGE ACTIVATION SYNDROME

Background

A hyperinflammatory response compatible with features of macrophage activation syndrome (MAS) contributes to this worse outcome in patients with Coronavirus Disease 2019 (COVID-19). Glucocorticoids have become the standard of care for those requiring oxygen support or mechanical ventilation. More targeted anti-inflammatory treatments with tocilizumab and anakinra have also been shown to be effective.

Objectives

More studies are being awaited to clarify the features of patients who would benefit more, and we investigated the characteristics of the surviving and dead patients who received anakinra.

Methods

The records of hospitalized adult patients between March 2020 and May 2021 in a tertiary referral center were evaluated. Diagnosis of COVID-19-related MAS was based on the expert opinion and preliminary criteria developed by our group that patients with a score of ≥45 were accepted COVID-19-related MAS.1 Patients who received anakinra constituted the study group. Anakinra dose was determined according to the clinical and inflammatory parameters; and doses varied between daily 100-300 mg SC to 400-800 mg IV.

Laboratory data of surviving and died patients were comparatively analyzed by using the ANCOVA method on the relevant days (baseline, anakinra-onset day, first response to anakinra treatment, and discharge or death). The temporal variation (drug onset day-first response day, drug onset day-discharge, or death day) was evaluated using the ANOVA method. A 50% reduction of CRP compared to the anakinra start day was accepted as the first response to the treatment.

Results

Out of 1080 hospitalized patients, 218 (151 male, 67 female, mean age 60.0±14.1) who received anakinra were identified. Among them, 125 (57.3%) patients were followed in the ward, 21 (9.6%) did not need oxygen treatment during the hospitalization; 69 (31.6%) patients were followed at ICU, 40 of them were intubated, 30 (13.7%) died in ICU. Anakinra had been started in a mean of 4.8 days of hospitalization. Twenty had tocilizumab initially and then received anakinra because of ongoing inflammatory parameters. The majority (83.5%) received steroid treatment (79.5% methylprednisolone, 5% of dexamethasone), and 6 received one IV pulse 250 mg of methylprednisolone; 36 (16.5%) were followed before September 2020 and received anakinra without steroids because of the standard of care at that period. Only CRP was different between the alive and dead patients for the baseline parameters (p=0.05). On the first day of drug treatment, CRP and procalcitonin values were significantly higher in dead patients (Table 1). A 50% decrease in CRP level was achieved in 3.1 days in survivors and 4.7 days in dead patients. D-dimer (p=0.018), CRP (p=0.006), LDH (p=0.003), procalcitonin (p=0.005), creatinine kinase (p=0.001), and fibrinogen levels (p=0.05) were significantly different between the surviving and dead patients when the measurements between the first drug administration day and response day were compared. Neutrophil, lymphocyte count, ferritin, D-dimer, CRP, LDH, AST, procalcitonin, creatinine kinase, and fibrinogen levels were significantly different between the patients when the parameters between the first drug administration day and discharge/death day were compared. Dead patients had higher CRP values and they did not show a continuing CRP decrease with the steroids and anakinra (Figure 1).

Conclusion

Retrospective analysis of 218 patients suggests that starting anakinra earlier in hospitalized patients may provide better results, and a decrease in CRP, ferritin, D-dimer values, as well as an increase in lymphocyte count, are associated with favorable outcomes. Increasing values of D-dimer and troponin during treatment are associated with worse outcomes, possibly indicating cardiovascular and thrombotic pathologies not responding to anakinra. Changes in the CRP values are found to help monitor the response to anakinra. Other inflammatory pathways could be targeted in those who are not responding to appropriate doses of anakinra within 5 days.

Disclosure of Interests

None declared

Determining the effects of geomorphological factors on the distribution of land use and plant cover by different statistical methods

The aim of this study is to determine the role of geomorphological factors in land use and plant cover organization. For this purpose, the relationship between geomorphological factors such as geomorphological unit, elevation, slope, aspect, and curvature with land use and plant cover was analyzed using GIS (Geographical Information Systems) techniques and statistical methods (zonal analysis, correlation analysis, regression analysis). Using zonal analysis, the boundaries of both land use patterns and plant species are clearly drawn according to geomorphological factors. Using correlation analysis, the direction and intensity of the relationship between each geomorphological factor with land use patterns and plant species were determined. Finally, regression analysis method was used to determine the impact rate of geomorphological factors on land use patterns and plant cover. Thus, the effects of geomorphological factors on the distribution of both land use patterns and the each plant species were explained in detail. When the results of all three analyses are evaluated in general, the elevation is very strong, the slope strong, the aspect medium, the geomorphological unit weak, and the curvature has a very weak effect on the distribution of land use patterns and the plant species in the research area. The data obtained from the study will contribute to the planning and implementation of activities such as forest, agriculture, land use, water management to be carried out by local administrations and decision-makers. In addition, it will form a scientific basis for the sustainability of forest existence in harmony with the ecological conditions of Göksun Plain and its surroundings.

Atmospheric concentration, spatial variations, and source identification of persistent organic pollutants in urban and semi-urban areas using passive air samplers in Bursa, Turkey

In this study, the concentration of ambient persistent organic pollutants (POPs) such as polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), and organochlorine pesticides (OCPs) were measured for 12 months in urban and semi-urban areas using a passive air sampler. During the sampling period, a total of 14 PAH (∑₁₄PAH) concentrations measured in urban and semi-urban areas were found to be 54.4 ± 22.6 ng/m³ and 51.7 ± 34.3 ng/m³, respectively. Molecular diagnostic ratios (MDRs) were used to determine PAH sources. According to the MDR values, combustion sources were the most important PAH sources in both sampling areas. However, since the urban area is close to the industrial zone, the combustion sources occurred at high temperatures (> 800 °C), while the sources in the semi-urban area generally consisted of petrogenic fuel combustion. ∑₅₀PCB concentrations measured in the urban and semi-urban areas were found to be 522.5 ± 196.9 pg/m³ and 439.5 ± 166.6 pg/m³, respectively. Homologous group distributions were used to determine the source of PCBs. According to the homologous group distributions, tri-, tetra-, and penta-chlorinated PCBs were dominant in both sampling areas. ∑₁₀OCP concentrations measured in urban and semi-urban areas were found as 242.5 ± 104.6 pg/m³ and 275.9 ± 130.9 pg/m³, respectively. Also, α-HCH/γ-HCH and β-/(α + γ)-HCH ratios were used to determine the source of OCPs. Lindane was the predominant OCP in both sampling areas.

Existence of SARS-CoV-2 RNA on ambient particulate matter samples: A nationwide study in Turkey

Coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2 virus and has been affecting the world since the end of 2019. The disease led to significant mortality and morbidity in Turkey, since the first case was reported on March 11th, 2020. Studies suggest a positive association between air pollution and SARS-CoV-2 infection. The aim of the present study was to investigate the role of ambient particulate matters (PM), as potential carriers for SARS-CoV-2. Ambient PM samples in various size ranges were collected from 13 sites including urban and urban-background locations and hospital gardens in 10 cities across Turkey between 13th of May and 14th of June 2020 to investigate the possible presence of SARS-CoV-2 RNA on ambient PM. A total of 203 daily samples (TSP, n = 80; PM_2.5, n = 33; PM_2.5-10, n = 23; PM₁₀μm, n = 19; and 6 size segregated PM, n = 48) were collected using various samplers. The N1 gene and RdRP gene expressions were analyzed for the presence of SARS-CoV-2, as suggested by the Centers for Disease Control and Prevention (CDC). According to real time (RT)-PCR and three-dimensional (3D) digital (d) PCR analysis, dual RdRP and N1 gene positivity were detected in 20 (9.8%) samples. Ambient PM-bound SARS-CoV-2 was analyzed quantitatively and the air concentrations of the virus ranged from 0.1 copies/m³ to 23 copies/m³. The highest percentages of virus detection on PM samples were from hospital gardens in Tekirdağ, Zonguldak, and Istanbul, especially in PM_2.5 mode. Findings of this study have suggested that SARS-CoV-2 may be transported by ambient particles, especially at sites close to the infection hot-spots. However, whether this has an impact on the spread of the virus infection remains to be determined.

Organochlorine pesticides in honeybee, pollen and honey in Bursa, Turkey

g-In this study, the presence of OCP residues in the honeybee, pollen and honey samples in urban and semi-urban areas were investigated. A total of 10 OCP concentrations (∑₁₀OCP) in honeybee samples were 39.14 ± 11.06 ng g^-1 for the urban area and 39.93 ± 7.09 ng g^-1 for the semi-urban area, respectively. Similarly, ∑₁₀OCP concentrations in pollen and honey samples were estimated to be 21.72 ± 4.43 ng g^-1 and 41.83 ± 1.61 ng g^-1 for the urban area, 19.77 ± 2.86 ng g^-1 and 39.23 ± 3.90 ng g^-1 for the semi-urban area, respectively. Also, it was concluded that the existence of OCP residues in both sampling areas was due to the recent use of pesticides. Finally, the cancer risk caused by the consumption of pollen and honey samples was evaluated, and it was found that there was no cancer risk in both sampling areas.

OP0313 PRELIMINARY CRITERIA FOR MACROPHAGE ACTIVATION SYNDROME ASSOCIATED WITH CORONAVIRUS DISEASE-19

Background:

COVID-19 runs a severe disease associated with acute respiratory distress syndrome in a subset of patients, and a hyperinflammatory response developing in the second week contributes to the worse outcome. Inflammatory features are mostly compatible with macrophage activation syndrome (MAS) observed in other viral infections despite resulting in milder changes. Early detection and treatment of MAS may be associated with a better outcome. However, available criteria for MAS associated with other causes have not been helpful.

Objectives:

To identify distinct features of MAS associated with COVID-19 using a large database enabling to assess of dynamic changes.

Methods:

PCR-confirmed hospitalized COVID-19 patients followed between March and September 2020 constituted the discovery set. Patients considered to have findings of MAS by experienced physicians and given anakinra or tocilizumab were classified as the MAS group and the remaining patients as the non-MAS group. The MAS group was then re-grouped as the cases with exact-MAS and borderline-MAS cases by the study group. Clinical and laboratory data including the Ct values of the PCR test were obtained from the database, and dynamic changes were evaluated especially for the first 14 days of the hospitalization. The second set of 162 patients followed between September-December 2020 were used as the replication group to test the preliminary criteria. In the second set, hospitalization rules were changed, and all patients required oxygen support and received dexamethasone 6mg/day or equivalent glucocorticoids. Daily changes were calculated for the laboratory items in MAS, borderline, and non-MAS groups to see the days differentiating the groups, and ROC curves and lower and upper limits (10-90%) of the selected parameters were calculated to determine the cutoff values.

Results:

A total of 769 PCR-confirmed hospitalized patients were analysed, and 77 of them were classified as MAS and 83 as borderline MAS patients. There was no statistically significant difference in the baseline viral loads of MAS patients compared to the non-MAS group according to the Ct values. Daily dynamic changes in the MAS group differed from the non-MAS group especially around the 6th day of hospitalization, and more than a twofold increase in ferritin and a 1.5-fold increase in D-dimer levels compared to the baseline values help to define the MAS group. Twelve items selected for the criteria are given in Table 1 below. The total score of 45 provided 79.6% sensitivity for the MAS (including borderline cases) and 81.3% specificity around days 5 and 6 in the discovery set, and a score of 60 increased the specificity to 94.9% despite a decrease in sensitivity to 40.8%. The same set provided a similar sensitivity (80.3%) in the replication, but a lower specificity (47.4-66% on days 6 to 9) due to a group of control patients with findings of MAS possibly masked by glucocorticoids.

Table 1.

Preliminary Criteria for Macrophage Activation Syndrome Associated with Coronavirus Disease-19

1.Fever (>37.0 °C)2.Ferritin concentration > 550 ng/mL3.More than 2 times increase of ferritin concentration within 7 days of disease onset4.Neutrophil count > 6000 cell/mm35.Lymphopenia < 1000 cell/mm36.Neutrophil/lymphocyte ratio > 67.D-dimer concentration > 1000 ng/ml8.More than 50% increase of D-dimer concentration within 7 days of disease onset9.CRP concetration > 50 mg/L10.LDH concentration > 300 U/L11.ALT or AST concentration > 50 U/L12.Procalcitonin concentration < 1.2

1 point for each positive item assessed on Days 5-7

Score calculation: Total points / 12 x 100

Possible MAS ≥45 and Definite MAS ≥60

Conclusion:

This study defined a set of preliminary criteria using the most relevant items of MAS according to the dynamic changes in the parameters in a group of COVID-19 patients. A score of 45 would be helpful to define a possible MAS group with reasonable sensitivity and specificity to start necessary treatments as early as possible.

Disclosure of Interests:

None declared.

Characterization, source apportionment, air/plant partitioning and cancer risk assessment of atmospheric PAHs measured with tree components and passive air sampler

In this study, ambient air and olive tree components (leaf and branch) were simultaneously collected and analyzed for polycyclic aromatic hydrocarbons (PAHs) to investigate their levels and accumulations, temporal variations, possible sources, air-plant partitioning and cancer risks for 12 months. During the sampling period, total of 14 PAH (∑₁₄PAH) concentrations measured in the olive leaves (dissolved and particle phase) and braches (1- and 2-year-old) were 593 ± 472, 81 ± 67, 558 ± 273 and 316 ± 213 ng/g dry weight (DW), respectively. Similarly, the average ∑₁₄PAH concentrations measured in the ambient air was found to be 15 ± 16 ng/m³. Generally, 4-, 5- and 6- ring PAHs were the dominant groups for all tree components, while 2- and 3-ring PAHs were predominant in the air samples. Ring distributions and molecular diagnosis ratios were employed to determine PAH sources in the sampling site. Petroleum and combustion-related sources were found to be important. The Pearson correlation coefficient was allowed to figure out the affinity between PAH levels in the sampling materials and meteorological factors. Temperature and mixing layer height were found to be effective factors on the concentrations. Atmospheric PAH levels were also predicted to employ a bark-air exchange model for determining the PAH movement direction. The predicted/measured ratios were above 1.0. This was probably due to utilizing the branch values rather than bark values in the model. Finally, the risk of cancer has been evaluated. The calculated cancer risks via inhalation were at low levels for adults and children.

Atmospheric concentration, source identification, and health risk assessment of persistent organic pollutants (POPs) in two countries: Peru and Turkey

It is known that some persistent organic pollutants (POPs) are used worldwide, and these pollutants are dangerous for human health. However, there are still countries where measurements of these pollutants have not been adequately measured. Although many studies have been published for determining the concentrations of POPs in Turkey, there are limited studies in Latin American countries like Peru. For this reason, it is essential both to conduct a study in Peru and to compare the study with another country. This study is aimed at determining the atmospheric POPs such as polycyclic aromatic hydrocarbon (PAH), organochlorine pesticide (OCP), and polychlorinated biphenyl (PCB) concentrations using passive air samplers in Yurimaguas (Peru) and Bursa (Turkey). Molecular diagnosis ratios and ring distribution methods were used to determine the sources of PAHs. According to these methods, coal and biomass combustions were among the primary sources of PAHs in Peru, while petrogenic and petroleum were the primary sources of PAHs in Turkey. Then, α-HCH/γ-HCH and β-/(α+γ)-HCH ratios were used to determine the sources of OCPs. According to the α-HCH/γ-HCH ratios, the primary sources of OCPs in both countries were lindane. Similarly, according to β-/(α+γ)-HCH ratios, the HCHs have been historically used in Peru while they were recently utilized in Turkey. Finally, homologous group distributions were used to determine the sources of PCBs. Similar distributions of homologous groups were observed in the sampling sites in both countries. Also, the homologous group distributions obtained have been determined that industrial activities could be effective in the sampling areas in both countries. When the cancer risks that could occur via inhalation were evaluated, no significant cancer risk has been determined in both countries.

Biomonitoring and Source Identification of Polycyclic Aromatic Hydrocarbons (PAHs) Using Pine Tree Components from Three Different Sites in Bursa, Turkey

Pine trees are used as biomonitoring agents to evaluate atmospheric polycyclic aromatic hydrocarbons (PAHs). Due to industrialization, urban construction, and rapid population growth, the city of Bursa is experiencing air pollution. In this study, PAHs were measured in pine tree branches and needles at a wastewater treatment plant site, an industrial site, and semirural site in Bursa for 12 months. The concentrations fluctuated depending on the characteristics of the areas. The lowest concentration value was measured in the semirural site while the highest value was determined in the wastewater treatment plant site. The PAH concentrations in pine needles ranged from 24 to 2565 ng/g dry weight (DW) and in pine branches from 163 to 2871 ng/g DW for 16 PAHs. Naphthalene, phenanthrene, fluorene, and fluoranthene were determined as dominant species in both tree components. Diagnostic ratios, ring profile, principal component analysis, the coefficient of divergence, and the Pearson correlation coefficient methods were used in the definition of sources of PAHs in the sampling sites, although all source identification methods have advantages and disadvantages. According to the results, the PAHs mainly originated from biomass and coal burning, traffic, and mixed sources. It also was concluded that three sampling sites showed higher PAH concentrations during winter, and the main PAH sources were similar.

Atmospheric Polycyclic Aromatic Hydrocarbons (PAHs) at Two Sites, in Bursa, Turkey: Determination of Concentrations, Gas-Particle Partitioning, Sources, and Health Risk

This study investigated the concentration of polycyclic aromatic hydrocarbons (PAHs) using particle and gas-phase air samples collected in the Ovaakca and Cumalikizik region of Bursa, between May and September 2017. The concentration of Σ₁₆PAH measured in the gas phase, for Ovaakca and Cumalikizik, were 5.32 ± 1.98 and 4.91 ± 3.41 ng m^-3, respectively; and for the particle phase, 0.81 ± 0.56 and 1.84 ± 1.82 ng m^-3, respectively. The coefficient of gas-particle partitioning was related to the excessive cooled vapor pressure. The determined slope values were - 0.319 (Ovaakca) and - 0.505 (Cumalikizik), which showed the strong effect of organic carbon absorption and the distance to the equilibrium. These experimental values were compared with the results obtained using the octanol/air and Dual partition models, and Dual partition model showed more accurate values than the octanol/air model. The relations between temperature and concentration in the gas phase of PAHs were evaluated using the Clausius-Clapeyron equation. The results indicated the influence of long-range transport of the atmospheric concentrations of PAHs at the regions. Diagnostic ratio analysis showed that biomass burning, coal combustion, and vehicular emissions contributed greatly to the atmospheric PAHs in the regions. In principal component analysis analysis, wood-burning was found to be the predominant parameter in addition to PAH sources determined with diagnostic ratios. In this study, the lifetime risk of lung cancer was calculated according to the mean and max BaP-TEQ values. When calculated according to the average values, while both regions were acceptable risk levels (Ovaakca: 2.6 × 10^-6 and Cumalikizik: 8.6 × 10^-6), at low-risk level was determined according to max BaP-TEQ values only in the Cumalikizik region (1.93 × 10^-5).

Determination of polychlorinated biphenyls in honeybee, pollen, and honey samples from urban and semi-urban areas in Turkey

In recent years, honeybees and bee products such as pollen and honey have been used as bioindicators for monitoring environmental pollution. Unfortunately, there are few studies about polychlorinated biphenyl (PCB) concentrations in honeybees and bee products from Turkey. Honeybee and pollen samples were taken between May and September 2017, and honey samples were taken between July and September 2017 at urban and semi-urban areas in Bursa (Turkey). PCB concentrations measured by gas chromatography-microelectron capture detector (GC-μECD) were found to be 135.46 ± 6.53, 81.47 ± 23.52, and 106.35 ± 21.60 ng g^-1 dry weight (dw) for honeybee, pollen, and honey samples in the urban area, respectively; and 126.35 ± 26.54, 67.57 ± 27.34, and 118.88 ± 55.28 ng g^-1 dw for honeybee, pollen, and honey samples in the semi-urban area, respectively. Pearson correlation was made between meteorological parameters and pollutant concentrations. According to the correlation results, a significant relationship was found between the pollen and honey results and the total cloudiness and temperature in the semi-urban area. The coefficient of divergence (COD) and Pearson correlation coefficient (PCC) methods were applied to determine the similarities and differences between the pollutant concentrations and sources of the two areas and the temporal variation. According to these two methods, PCB concentrations and emission sources in honeybee and pollen samples in urban and semi-urban areas were generally different in May and June, and similar in August and September.

Assessments of seasonal trend, gas-particle partitioning and deposition flux of polycyclic aromatic hydrocarbons at a semi-rural site

Air samples were collected at a semi-rural area between February 2013 and February 2014 to determine the concentrations and gas/particle partitionings of polycyclic aromatic hydrocarbons (PAHs). The sampling was done with a high volume air sampler to cover four seasons and 40 samples were taken. Each sample period was about 24 h. The gas-particle partition coefficients (K_p) of PAHs were calculated and correlated with their subcooled liquid vapor pressures ( PL0 ). The determined slopes (m_L) varying from -0.59 to -0.28 were far from the theoretical value (-1) due to the absorption, the dominant mechanism. Experimentally determined K_p values were compared with the results obtained using the octanol-air and soot-octanol partitioning models. An octanol-based absorptive partitioning model resulted in a better prediction than the soot-octanol based partitioning model. The total (gas + particle) PAH concentrations changed between 6 and 798 ng m^-3 with an average of 205 ± 236 ng m^-3. According to Clausius-Clapeyron equation, the local PAH sources were effective. The diagnostic ratios indicated that coal and wood-burning, and traffic emissions were the dominant PAH sources. Dry deposition fluxes for gas and particle phase were also estimated using documented dry deposition velocities and mass transfer coefficients in the literature and concentrations measured in this study.

Corneal sensitivity and subjective complaints of ocular pain in patients with fibromyalgia

PurposeFibromyalgia (FM) is a chronic pain disorder associated with pain and hypersensitivity in various parts of the body. The aim of this study was to understand whether changes in corneal sensitivity were associated with the subjective complaints of these patients.Patients and methodsIn this study, we included 36 patients with FM (30 female, 6 male, mean age: 46.7±9.2 years) and 39 healthy control subjects (33 females, 6 males, mean age: 44.3±7.6 years). We performed a detailed ophthalmological examination, measured tear film breakup time (TBUT), and performed Schirmer I test without anesthetic (SIT). Only patients that did not have any eye disease were included in this study. Subjective complaints of the patients were evaluated with ocular surface disease index (OSDI) scores and the corneal sensation was evaluated with Cochet-Bonnet esthesiometer.ResultsThere was no significant difference between the groups for age, sex, and visual acuity. Both SIT (16.1 mm vs 15.3 mm, P=0.36) and TBUT results (17.8 s vs 18.8 s, P=0.40) were similar in FM group and the controls subjects. However, corneal sensations in central (60.0 mm vs 55.0 mm, P=0.03), superior (57.5 mm vs 50.0 mm, P=0.005), and inferior (53.89 mm vs 46.03 mm, P<0.001) regions were significantly increased in FM patients. There was a significant positive correlation between corneal sensation and OSDI scores.ConclusionIn this study, we have demonstrated that the patients with FM have increased corneal sensitivity and have related ocular surface complaints similar to dry eye disease in the absence of it.

Evaluation and application of a passive air sampler for polycylic aromatic hydrocarbons (PAHs)

Sampling of 15 PAHs by the use of both passive air sampler developed (D-PAS) in our research group and PAS (C-PAS) having widespread use in the literature was conducted to compare the performances of the samplers. Sampling was carried out for 1-year period (February 2013-February 2014), in different sampling periods by employing D-PAS and C-PAS. D-PAS and C-PAS were run in parallel for 10, 20, 30, 40 and 60 days. Sampling rates were calculated for both PASs by the use of concentration values obtained from a high-volume air sampler (HVAS). It was determined that calculated sampling values are different from each other by definition of design of C-PAS and D-PAS and difference in environment as velocity of wind and temperature are having different effects upon sampling rates. Collected σ₁₅PAHs amounts of 10-day periods in spring, summer, autumn and winter were obtained as 576 ± 333, 209 ± 29, 2402 ± 910 and 664 ± 246 ng for D-PAS and 1070 ± 522, 318 ± 292, 6062 ± 1501 and 6089 ± 4018 ng for C-PAS, respectively. In addition, according to seasons, when collected PAHs in two different samplers were considered, similar results were obtained for the summer time in which no combustion takes place with the aim of domestic heating, while there were differences determined for the seasons with combustion in need of domestic heating. Gas-phase σ₁₅PAHs' concentrations were reported depending on seasons in the spring, summer, autumn and winter sequences as 46 ± 32, 9 ± 3, 367 ± 207 and 127 ± 93 ng m^-3 for HVAS, respectively.

Effects of sampling interval on the passive air sampling of atmospheric PCBs levels

In this study, we collected Polychlorinated biphenyls (PCBs) using passive air samplers (PASs), between February 4, 2013 and February 2, 2014, with the sampling periods ranging from 10 to 60 days. The samples were collected with PASs that contained polyurethane foam (PUF). With these samples, 87 PCB congeners were analyzed. Sampling coefficient (R) values for the four seasons were calculated using both the high volume air sampler (HVAS) and PAS samples collected with the same time interval. The average of the annual concentrations of 87 PCB congeners, calculated using the R values specific to this study, was 234 ± 175 pg/m³. PCB congeners with 3- and 4- chlorines were dominant. The samples were collected at the same time interval but at different times to represent accumulation in the PASs. The linear regression coefficients (r) of the PCB mass accumulated in PASs against time ranged from 0.89 and 0.97 indicating that accumulation was linear. Moreover, the concentrations of the PCB congeners were statistically correlated with atmospheric conditions.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Monitoring of Long-Term Outdoor Concentrations of PAHs with Passive Air Samplers and Comparison with Meteorological Data

The passive air sampler (PAS) is a common and useful tool for the sampling of semivolatile organic compounds in the ambient air. In a study performed in a semirural area of Bursa, sampling of polycyclic aromatic hydrocarbons (PAHs), was completed between February 4, 2013, and February 3, 2014, during 10-, 20-, 30-, 40- and 60 day periods for 1 year. To determine polycyclic aromatic compounds (PAH) concentrations, 3 PASs and 1 high-volume air sampler were run simultaneously, and sampling rates (R [m(3)/d]) were calculated seasonally and according to the ring numbers of the PAHs. R values varied from 0.66 to 22.41 m(3)/d. The relationship of these values with meteorological conditions was examined statistically, and the regressions performed were found to be consistent. This study identified 15 PAH compounds [Formula: see text]. Concentration values of 10 day samples fluctuated from 6.4 to 1100 ng/m(3). Seasonal averages of the concentrations of ∑15PAHs were detected to be 141 ± 72.5 ng/m(3) for winter, 74 ± 59 ng/m(3) for spring, 7 ± 0.6 ng/m(3) for summer and 840 ± 170 ng/m(3) for autumn. In this study, the toxicity equivalents of seasonal PAH concentrations obtained were determined to be 0.5, 0.3, 0.1, and 1.8 ng/m(3) in winter, spring, summer and fall, respectively. The type posing a cancer risk has been identified as BaA.

No additive effects of inhaled iloprost and prone positioning on pulmonary hypertension and oxygenation in acute respiratory distress syndrome

BACKGROUND

In acute respiratory distress syndrome (ARDS), pulmonary hypertension is associated with a poor prognosis. Prone position is effective to improve oxygenation whereas inhaled iloprost can treat pulmonary hypertension. However, combination of these interventions has not been examined before. The hypothesis was that this combination had additive effects on oxygenation and pulmonary hemodynamics as compared with each intervention alone.

METHODS

In a prospective, randomized cross-over study, ten pigs were anesthetized, intubated and ventilated with volume controlled ventilation. Carotid, jugular venous and pulmonary artery catheters were inserted. ARDS was induced with oleic acid (0.20 mL/kg). Measurements were repeated in randomized different sequences of prone or supine positions with or without iloprost inhalation (220 ng/kg/min) (four combinations). Systemic and pulmonary arterial pressures; arterial and mixed venous blood gases; and Qs/Qt and the resistances were recorded.

RESULTS

Iloprost decreased pulmonary artery pressures (for MPAP: P=0.034) in both supine (37±10 vs. 31±8 mmHg; P<0.05) and prone positions (38±9 vs. 29±8 mmHg; P<0.05); but did not obtain a significant improvement in oxygenation in both positions. Prone position improved the oxygenation (p<0.0001) compared to supine position in both with (361±140 vs. 183±158 mmHg, P<0.05) or without iloprost application (331±112 vs. 167±117 mmHg, P<0.05); but did not achieve a significant decrease in MPAP.

CONCLUSION

Although iloprost reduced pulmonary arterial pressures, and prone positioning improved oxygenation; there are no additive effects of the combination of both interventions on both parameters. To treat both pulmonary hypertension and hypoxemia, application of iloprost in prone position is suggested.

EFFECT OF ELECTROMAGNETIC FIELDS EMITTED BY CELLULAR PHONES ON THE LATENCY OF EVOKED ELECTRODERMAL ACTIVITY

The widespread use of cellular phones raises the question of their possible adverse biological effects, especially on the central nervous system (CNS). Therefore, the authors examined the effect of electromagnetic fields emitted by cellular phones (CPEMFs) on the evoked neuronal activity of CNS relating to generation and representation of electrodermal activity (EDA), an index of sympathetic nervous system activity. EDA (skin resistance response; SRR) latency was lengthened approximately 200 ms with CPEMFs exposure irrespective of the head site next to mobile phone used. Hemispheric asymmetry of EDA-2 pathway, which is represented by shorter SRR latency in the right hand of the right hand responders, was also distorted with CPEMFs. Because the CNS regions including EDA-2 are also involved in tasks of motor timing and time estimation, delayed response in this neuronal network due to CPEMFs exposure may increase the response time of mobile phone users. Therefore, the findings point to the potential risks of mobile phones on the function of CNS and consequently, possible increase in the risk of phone-related driving hazards.

Measurement of atmospheric deposition of polychlorinated biphenyls and their dry deposition velocities in an urban/industrial site in Turkey

Dry deposition fluxes and total (gas+particle) concentrations of polychlorinated biphenyls (PCBs) were measured between August 2004 and May 2005. Samples were collected from an urban-industrial site of Bursa, Turkey. A stainless steel pot and a high volume air sampler (HVAS) were employed to collect deposition and ambient air samples, respectively. The dry deposition fluxes of PCBs ranged from 3,600 to 56,000 pg m(-2) d(-1) while the total PCB concentrations collected simultaneously were between 35 and 348 pg m(-3). The average dry deposition flux value was in line with the previously reported values. Possible variations in PCB fluxes were likely due to PCB and total suspended particle (TSP) concentrations, and meteorological conditions. No seasonal trends were observed for the bulk deposition samples. The 3- and 4- chlorobiphenyls (CBs) were abundant homolog groups in bulk and concentration samples with ratios of 67% and 90%, respectively. Apparent bulk deposition velocities were calculated by dividing the dry deposition flux value by particle phase air concentration values of PCBs measured with HVAS. The calculated apparent dry deposition velocities ranged from 0.23 cm s(-1) to 3.09 cm s(-1) (aver +/- SD, 0.74 +/- 0.23 cm s(-1)).

Mortality in Behçet's syndrome

Behçet's syndrome significantly increases mortality especially when seen in the young male, while it is less severe among females and the aged. In many patients, the condition abates with the passage of time. The main cause of mortality is large vessel disease, especially bleeding pulmonary artery aneurysms (PAA), almost exclusively seen among men. Central nervous system disease comes second. Interestingly, not much increased atherosclerosis is seen in Behçet's syndrome when compared to other inflammatory diseases. In controlled studies, there has been no increase in history of increased angina or myocardial infarction. Similarly, atherosclerotic plaque formation is not increased by ultrasound. On the other hand, intermittent claudication can be seen. However, this is not due to arterial involvement but due to venous disease of the lower extremities. Recently there has been a substantial decrease in mortality due to PAA thanks to prompt disease recognition and treatment.

Seasonal concentrations and partitioning of PAHs in a suburban site of Bursa, Turkey

Effects of space heating on atmospheric concentrations and gas-particle partitioning of PAHs were investigated in a suburban site of Bursa, Turkey. The average concentrations of summation operator(15)-PAHs in heating season samples were approximately 10 times higher than those of non-heating season samples. The plot of log K(p) versus log P(L)(0) for all the data set gave significantly different slopes. The slope for the heating season (-0.75) samples was steeper than the one for the non-heating season (-0.64) samples. It was also observed that partitioning of PAHs for the non-heating season samples showed different characteristics depending on air parcel trajectories. Generally steeper slopes were obtained for the air parcels traveled across the Black sea and arrived to the sampling site from northern sector. On the other hand, the variations in slopes according to air mass origin were insignificant for the heating season samples. Local contributions from space heating are the reason for this observation.

Deposition of polycyclic aromatic hydrocarbons (PAHs) and their mass transfer coefficients determined at a trafficked site

It is difficult to determine the deposition levels of gaseous polycyclic aromatic hydrocarbons (PAHs), as even atmospheric PAHs mainly exist in the gas phase. Gaseous PAH fluxes across the air-water interface were measured in Merinos, Bursa, Turkey. Direct gaseous fluxes of PAHs were measured intermittently for the period August 2004 through May 2005 when there was no precipitation. A modified water surface sampler (WSS), including a filter holder and an XAD-2 resin column, was employed to collect the flux samples. Average gaseous PAH flux into the WSS, determined by analyzing the XAD-2 resin column, was 31,068 +/- 16,035 ng m(-2) d(-1). This flux value was about 90% of the total (gaseous + particulate) PAH flux, which may indicate that gas exchange is a major removal mechanism for atmospheric PAHs in our sampling site. Variations in gas exchange fluxes likely resulted from changes in both meteorological conditions and concentrations whose level depends on many parameters including fuel characteristics and strength, combustion types, and their efficiencies. Vapor phase PAH fluxes were divided by ambient air concentrations measured with a high volume sampler to calculate overall gas phase PAH mass transfer coefficients (MTCs) (K(G)). The calculated average PAH MTC was 0.38 +/- 0.17 cm s(-1). The average MTC is comparable with ones calculated using a similar configuration of a WSS.

Bulk deposition of polycyclic aromatic hydrocarbons (PAHs) in an industrial site of Turkey

Ambient air and deposition samples were collected in the period of July 2004-May 2005 in an industrial district of Bursa, Turkey and analyzed for polycyclic aromatic hydrocarbon (PAH) compounds. The overall average of fourteen bulk deposition fluxes for PAHs was 3300+/-5100 ng m(-2) d(-1). PAH depositions showed a seasonal variation and they were higher in winter months. This was probably due to increases in residential heating activities and decreases in atmospheric mixing layer levels. Ambient air samples, measured with a high volume air sampler, were collected from the same site. The average total concentration including gas and particulate phase was about 300+/-420 ng m(-3) and it was in the range of previously reported values. Some of the ambient air and bulk deposition samples were collected simultaneously in dry periods. Both concurrently measured values were used to calculate the dry deposition velocities whose overall average value was 0.45+/-0.35 cm s(-1).

The Effects of Different Breeding Systems on Egg Productivity and Egg Quality Characteristics of Rock Partridges

This study was carried out to investigate the effects of different breeding systems (breeding on the ground and in the cage) on the egg production and egg characteristics of Rock Partridges. Egg production values of the ground and cage system groups were determined as 41.30 and 49.40%, respectively, and this difference was found to be significant (P < 0.05). The weight values of the eggs were 23.86 g in the ground system and 22.08 g in the cage system (P < 0.05). The difference between the shape index values, which were determined as 75.39 in the ground system and as 77.65 in the cage system, was statistically significant (P < 0.05). In addition, the values for yolk index (48.42 and 44.11), albumen index (1.45 and 1.66), Haugh unit (83.24 and 86.78), shell weight (2.39 and 2.86), yolk weight (8.55 and 7.89), and albumen weight (12.46 and 11.78) obtained in the ground and cage system, respectively, were obtained to be statistically different (P < 0.05). It was observed that the Rock Partridges could be bred in ground and cage systems during the egg production period, and although the investment cost and equipment expenditure increase in cage breeding, the egg quality, shape index, albumen index, and Haugh unit of Rock Partridges decrease dramatically in ground breeding.

The effects of breeding systems and stocking density on some blood parameters of rock partridges (Alectoris graeca)

In this study, the effects of breeding systems and stocking density on some blood parameters of rock partridges [total protein, total cholesterol, triglyceride, urea, glucose, calcium, phosphorus, alkaline phosphatase (ALP), sodium, chlorine, potassium, aspartate amino transferase (AST), and alanine amino transferase (ALT)] were investigated. For this purpose, blood samples of 18-wk-old male rock partridges, which were bred on the ground and in cages with 3 different stocking densities (group I: 15 partridges/m(2); group II: 20 partridges/m(2); and group III: 25 partridges/m(2)) were examined. Breeding method of rock partridges was found to have significant effects on blood total protein, (P < 0.05), total cholesterol (P < 0.05), triglyceride (P < 0.01), urea (P < 0.01), glucose (P < 0.05), calcium (P < 0.05), phosphorus (P < 0.01), ALP (P < 0.05), sodium (P < 0.01), chlorine (P < 0.05), and potassium (P < 0.01) levels, whereas it was found to have no significant effect on blood AST and ALT levels (P > 0.05). Stocking density of rock partridges was also found to affect significantly the levels of blood total protein, total cholesterol, triglyceride, urea, glucose, calcium, phosphorus, ALP, sodium, chlorine, and potassium (P < 0.05), whereas it did not have a significant effect on blood AST and ALT levels (P > 0.05). When the breeding method of the partridges was changed from the ground to the cages and the stocking density was increased, it was observed that the levels of blood total cholesterol, triglyceride, urea, glucose, sodium, and chlorine increased, whereas total protein, calcium, phosphorus, ALP, and potassium levels decreased. It was understood that the reactions of partridges toward breeding systems and stocking density were different and passing from ground system to cage system, and the increase in stocking density caused significant changes in blood parameters.

Exogenous zinc improves blood fluidity but has no effect on the mechanisms of vascular response to acetylcholine iontophoresis in humans

Recent findings in cellular signaling function of zinc through the mobilization intracellular calcium or by inducing ATP release suggest that extracellular zinc plays an important role in many physiological functions. However, such an extracellular signaling action of zinc for most cells is not known. Therefore, we investigated whether zinc plays any role in endothelium- dependent acetylcholine (ACh)-induced vasodilatation in microvascular beds. Transdermal iontophoresis was used to transport ACh through the forearm skin and cutaneous perfusion was measured using a laser Doppler flowmeter (LDF). Experiments were repeated using (1) zinc instead of ACh to test the effect of zinc ions alone and (2) concomitant iontophoresis of ACh and zinc to explore the effect of zinc on ACh-induced vasodilatation. Although zinc augments blood flow, curve-fitting to LDF signals indicate that zinc has no effect on the neural and endothelial component of ACh-induced vasodilatation. Additionally, no effect of Zn2+ on blood flow was found during its iontophoresis alone. Therefore, it is suggested from the Fourier analysis of LDF signals that the Zn+ might influence blood fluidity by its action on red blood cells deformability/ aggregability during a high-blood-flow condition, which might, in turn, decrease blood viscosity and improve blood flow in vivo.

Detrended fluctuation analysis of laser Doppler flowmetry time series: the effect of extrinsic and intrinsic factors on the fractal scaling of microvascular blood flow

The relative contribution of extrinsic (central) and intrinsic (local) oscillatory mechanisms to the fractal scaling of blood flow in forearm cutaneous microcirculation is unclear. The aim of this study was to investigate the contributions of these mechanisms to the fractal properties of the blood flow signal by using their frequency spectrum in the analyses. To evoke local oscillatory components, acetylcholine (ACh) was iontophoresed into the forearm and cutaneous perfusion was measured by a laser Doppler flowmeter (LDF) at rest. Depending on the involved factors in ACh-induced vasodilatation, central, cardiac and respiratory, signals have also increasingly appeared in LDF. The detrended fluctuation analysis (DFA) of filtered LDF time series demonstrated that the LDF was fractal with three distinct scaling regions. Furthermore, the findings of the present study indicated that these regions are related to the frequency bands of well-known control systems of blood flow and were called cardiac, cardio-respiratory and local regions. The mean scaling exponent increased with vasodilatation in the cardiac region but decreased and even changed its sign in the cardio-respiratory region. Inhibition of a local vasodilator mechanism not only decreased the scaling exponent of the local region but also eliminated the effect of respiratory coupling on fractal scaling. These findings suggest that the scaling exponents might have a diagnostic value for detecting pathological dynamics in vascular beds.

Monitoring of criteria air pollutants in Bursa, Turkey

The concentrations of criteria air pollutants such as CO, NOx (NO + NO2), SO2 and PM were measured in the period of May 2001 and April 2003 in the city of Bursa, Turkey. The average concentrations for this period were 1115 +/- 1600 microg/m3, 29 +/- 50 microg/m3, 51 +/- 24 microg/m3, 79 +/- 65 microg/m3, 40 +/- 35 microg/m3, 98 +/- 220 microg/m3, for CO, NO, NO2, NOx, SO2 and PM, respectively. Temporal changes in concentrations were analyzed using meteorological factors. Correlations among pollutant concentrations and meteorological parameters showed weak relations nearly in all data. Lower concentrations were observed in the summer months while higher concentrations were measured in the winter months. The increase in winter concentrations was probably due to residential heating. Pollutants were associated with each other in order to have information about their origin. NOx/SO2 ratio was also examined to bring out the source origin contributing on air pollution (i.e., traffic or stationary).

Reliability of procalcitonin as a severity marker in critically ill patients with inflammatory response

Procalcitonin (PCT) is increasingly recognised as an important diagnostic parameter in clinical evaluation of the critically ill. This prospective study was designed to investigate PCT as a diagnostic marker of infection in critically ill patients with sepsis. Eighty-five adult ICU patients were studied. Four groups were defined on the basis of clinical, laboratory and bacteriologic findings as systemic inflammatory response syndrome (SIRS) (n = 10), sepsis (n = 16), severe sepsis (n = 18) and septic shock (n = 41). Data were collected including C-reactive protein (CRP), PCT levels and Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores on each ICU day. PCT levels were significantly higher in patients with severe sepsis and septic shock (19.25 +/- 43.08 and 37.15 +/- 61.39 ng/ml) than patients with SIRS (0.73 +/- 1.37 ng/ml) (P < 0.05 for each comparison). As compared with SIRS patients, plasma PCT levels were significantly higher in infected patients (21.9 +/- 47.8 ng/ml), regardless of the degree of sepsis (P < 0.001). PCT showed a higher sensitivity (73% versus 35%) and specificity (83% versus 42%) compared to CRP in identifying infection as a cause of the inflammatory response. Best cut-off levels were 1.31 ng/ml for PCT and 13.9 mg/dl for CRP. We suggest that PCT is a more reliable marker than CRP in defining infection as a cause of systemic inflammatory response.

Hemispheric modulatory influences on skin resistance response latency: unilateral stimulation, bilateral recording

In order to evaluate the bilateral asymmetries in evoked electrodermal activity (EDA) and the use of EDA parameters as indices of relative hemispheric activation, skin resistance level (SRL), skin resistance response (SRR), and the SRR latency (L) were examined in 25 right-handed male subjects. We used bilateral recording with a unilateral stimulation (auditory click/patellar tendon tap) to assess the asymmetries of EDA variables related to the side of stimulation and to handedness. Although no significant asymmetry in C = SRRmax/SRL ratio was found, significant differences in latency were observed. Ipsilateral responses were 100 ms faster than contralateral responses for auditory stimulus, a result that can be explained in terms of contralateral delay of neuronal communication on EDA-l pathway. Response latency to reflex-motor activation was 60-100 ms shorter in the dominant hand, regardless of the stimulation site used. This result indicates that the reaction time of the EDA-2 pathway of the left hemisphere was shorter than the right for right-handed subjects. It is concluded that there is hemispheric asymmetry on EDA-2 pathway and that this asymmetry appears to be dependent on the preferred dexterity. These results have implications for the influence of both central and peripheral factors on EDA laterality and principally on laterality of response amplitude. Further, there is no single cortical mechanism modulating the asymmetries in the latency of this response.

Early first trimester ultrasound examination. Is it really efficient in the clinical management of the pregnancy?

OBJECTIVE

This is a retrospective study accomplished to determine the efficiency of the first trimester ultrasound examination especially when performed on elective conditions.

MATERIALS AND METHOD

The records of patients who had undergone early first trimester transvaginal ultrasound in Obstetrics and Gynecology Department of Cerrahpasa School of Medicine, Istanbul University between from January 1999 to December 2000 were reviewed. The records of 426 patients were eligible for the analysis. The age, parity, gestational week that the ultrasound performed, the complaint on appliance, the features visible on the ultrasound were noted. The patients were divided into two groups: patients without any complaint (Group 1) and patients applied with any complaint (Group 2). The prognosis of the pregnancy was determined through the follow-up. On the statistical analysis, chi-square test, student-t test, Pearson correlation analysis and multiple linear regression analysis were utilized.

RESULTS

In group 1, 79% of examinations were normal whereas the rate of normal ultrasound was 50% in group 2. The difference between the groups was statistically significant (p=0.000). On group 1, 7 subsequent abortions, 7 missed abortions and one case of mole hydatiform were identified (7.6%). When the patient applied with a complaint, ultrasound examination revealed abnormal findings that enabled to reach an accurate diagnosis in 29.9% of these patients. 50 abortions (inevitable or incomplete), 13 missed abortions, 3 ectopic pregnancies and 2 mole hydatiform were diagnosed. The difference between the two groups according to ability to reach a diagnosis on the initial ultrasound was statistically significant (p=0.000).

CONCLUSION

The value of ultrasound examination before the 10th weeks of pregnancy is not validated when the patient has no complaint even if it appears as the most powerful mean to assess the accurate gestational age and observing fetal cardiac activity is the best prognostic variable for the outcome of the fetus.

Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements

BACKGROUND

The present randomized, placebo-controlled, double-blind study was designed to assess the effect of peroperatively administered i.v. magnesium sulphate on anaesthetic and analgesic requirements during total i.v. anaesthesia.

METHODS

Eighty-one patients (36 women, 45 men) undergoing elective spinal surgery were included in one of two parallel groups. The magnesium group received magnesium sulphate 30 mg kg(-1) as a bolus before induction of anaesthesia and 10 mg kg(-1) h(-1) by continuous i.v. infusion during the operation period. The same volume of isotonic solution was administered to the control group. Anaesthesia was maintained with propofol (administered according to the bispectral index) and remifentanil (adjusted according to heart rate and arterial blood pressure) infusions.

RESULTS

A significant reduction in hourly propofol consumption was observed with magnesium administration. For example, the mean infusion rate of propofol in the second hour of the operation was 7.09 mg kg(-1) h(-1) in the control group vs 4.35 mg kg(-1) h(-1) in the magnesium group (P<0.001). The magnesium group required significantly less remifentanil (P<0.001) and vecuronium (P<0.001). No side-effects were observed with magnesium administration.

CONCLUSION

The administration of magnesium led to a significant reduction in the requirements for anaesthetic drugs during total i.v. anaesthesia with propofol, remifentanil and vecuronium.