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Dostbil A, Ince I, Altinpulluk EY, Perez MF, Peksoz U, Cimilli G, Kasali K, Atalay C, Ozmen O, Sahin T, Yilmaz EP. Analgesic effect of erector spinae plane block after cesarean section: A randomized controlled trial. Niger J Clin Pract 2023; 26:153-161. [PMID: 36876603 DOI: 10.4103/njcp.njcp_1636_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background Ultrasound-guided bilateral erector spinae plane block is also a technique for providing analgesia after a cesarean section. Aim We hypothesized that bilateral erector spinae plane block applied from the transverse process of T9 who underwent elective cesarean section could provide effective postoperative analgesia. Patients and Methods Fifty parturients who were scheduled to undergo elective cesarean section under spinal anesthesia were included in the study. Group SA (n = 25) was categorized as the group in which spinal anesthesia alone (SA) was performed, and Group SA+ESP (n = 25) was categorized as the group in which SA + ESP block was performed. All patients were given a solution containing 7 mg isobaric bupivacaine + 15 μg fentanyl intrathecally through spinal anesthesia. In the SA + ESP group, the bilateral ESPB was performed at level T9 with 20 ml 0.25% bupivacaine + 2 mg dexamethasone immediately after the operation. Total fentanyl consumption in 24 h, the visual analogue scale for pain, and time to the first analgesic request were evaluated postoperatively. Results The total fentanyl consumption in 24 h was statistically significantly lower in the SA + ESP group than the SA group (279 ± 242.99 μg vs. 423.08 ± 212.55 μg, respectively, P = 0.003). The first analgesic requirement time was statistically significantly shorter in the SA group than the SA + ESP group (150.20 ± 51.83 min vs. 197.60 ± 84.49 min, respectively, P = 0.022). Postoperative VAS scores at 4th, 8th, and 12th h at rest were statistically significantly lower in group SA + ESP than in group SA (P = 0.004, P = 0.046, P = 0.044, respectively). VAS scores during the postoperative 4th, 8th, and 12th h cough were statistically significantly lower in group SA + ESP than in group SA (P = 0.002, P = 0.008, P = 0.028, respectively). Conclusion Ultrasound-guided bilateral ESP provided adequate postoperative analgesia and significantly decreased postoperative fentanyl consumption in patients having cesarean section. Also, it has a longer analgesia time than the control group, and it has been shown to delay the first analgesic requirement.
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Affiliation(s)
- A Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - I Ince
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey; Outcomes Research Consortium, Cleveland, Ohio, USA, Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School, Madrid, Spain
| | - E Y Altinpulluk
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey; Outcomes Research Consortium, Cleveland, Ohio, USA; Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School, Madrid, Spain; Department of Anaesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - M F Perez
- Morphological Madrid Research Center (MoMaRC), Ultra Dissection Spain EchoTraining School; Department of Anesthesia, Hospital Universitario de Móstoles, Madrid, Spain
| | - U Peksoz
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - G Cimilli
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
| | - K Kasali
- Anesthesiology Clinical Research Office, Ataturk University; Department of Biostatistics, Ataturk University School of Medicine, Erzurum, Turkey
| | - C Atalay
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - O Ozmen
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - T Sahin
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
| | - E P Yilmaz
- Department of Obstetrics and Gynecology, Ataturk University School of Medicine, Erzurum, Turkey
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Gunes AK, Serin I, Demir I, Sarifakiogullari S, Durusoy SS, Akkurt DM, Ince I, Ozkan G, Cinli TA, Pehlivan M. Comparison of Mitoxantrone-Melphalan and BEAM Conditioning Regimens in Patients with Lymphoma. Hematol Oncol Stem Cell Ther 2022; 15:201-207. [PMID: 33933474 DOI: 10.1016/j.hemonc.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/20/2021] [Accepted: 03/27/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE/BACKGROUND Lymphoma is seen as a highly treatable and curable malignancy with aggressive treatment methods. Efficacy is often limited by toxicity and many patients need alternative treatment strategies as they cannot tolerate existing high cytotoxic approaches. Our aim is to compare BEAM [carmustine (BCNU), etoposide, cytarabine (ARA-C, cytosine arabinoside), and melphalan] and mitoxantrone-melphalan (Mx-Mel) regimens utilized in our patients with a diagnosis of lymphoma who underwent autologous stem cell transplantation (ASCT), and to demonstrate that the Mx-Mel regimen has similar but less toxic results than the BEAM regimen we have been using frequently as standard conditioning regimen. METHODS A total of 101 patients with lymphoma who underwent ASCT were included in our study. The BEAM regimen included BCNU, etoposide, ARA-C, and melphalan. The Mx-Mel regimen included mitoxantrone and melphalan. RESULTS Of 101 patients included in the study, 60 (59.4%) received BEAM and 41 (40.6%) received Mx-Mel (40.6%) conditioning regimen. The median time to neutrophil engraftment was 10 (range: 9-20) days and 12 (range: 9-12) days in the BEAM and Mx-Mel arms, respectively; it was statistically significantly shorter in the BEAM arm (p = .001). CONCLUSION This study demonstrates that the Mx-Mel regimen has similar efficacy and toxicity compared with the BEAM regimen. Although time to neutrophil engraftment was shorter in the BEAM arm, it did not result as significant transplant-related complications between the two regimens. The Mx-Mel regimen is seen as a good alternative with low toxicity and high efficacy.
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Affiliation(s)
| | - Istemi Serin
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Ilknur Demir
- Gaziantep Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | | | | | - Dervis Murad Akkurt
- Gaziantep University, Faculty of Medicine, Department of Hematology, Gaziantep, Turkey
| | - Idris Ince
- Dr. Ersin Aslan Training and Research Hospital, Department of Hematology, Gaziantep, Turkey
| | - Gulkan Ozkan
- Istanbul Hamidiye Sisli Etfal Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Tahir Alper Cinli
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, Istanbul, Turkey
| | - Mustafa Pehlivan
- Gaziantep University, Faculty of Medicine, Department of Hematology, Gaziantep, Turkey
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Kar M, Ince I, Yildirim C, Burukoğlu Dönmez D, Karasulu Y, Cingi C. Development of an intranasal formulation containing indomethacin and xylometazoline for rhinosinusitis treatment. Eur Rev Med Pharmacol Sci 2022; 26:65-71. [PMID: 36524913 DOI: 10.26355/eurrev_202212_30486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Use of the nasal route of drug administration dates back many years and is used both to achieve topical treatments and to allow systemic absorption. The objective was to develop a formulation with novel features which enhance prolonged contact with the nasal and sinusal lining, since this should increase any therapeutic benefit. The anti-inflammatory drug selected was indomethacin, which was combined with xylometazoline, an effective nasal decongestant agent. MATERIALS AND METHODS 28 Sprague-Dawley rats were used. They were then allocated at random to one of the four groups of equal size. All rats received a nasal application of 50mL of the platelet-activating factor solution at a concentration of 16 µg/mL and had induced rhinosinusitis. Indomethacin or xylometazoline HCl or both were dissolved in the oily phase of the solution and then a magnetic stirrer was used to homogenize the solution for 60 min at room temperature. All the O/W solutions exhibited stability and remained at neutral pH for the entire duration of the experiment. The only intervention was application of inactive 0.9% saline in group 1. The intervention was nasal application of xylometazoline and indomethacin in the combined formulation in group. The intervention was nasal application of xylometazoline only in group 3. The intervention was nasal application of indomethacin only in group 4. RESULTS For the animals in group 1 (the controls), the mucosa had sustained a significant level of damage and the vessels were highly congested. Inflammatory cells were extensively infiltrating the mucosa. (Figure 1 - A1, 2, 3). In group 2, by contrast, the vessels were hardly congested and there were very few infiltrates. The epithelium appeared completely intact (Figure 1 - B1, 2, 3). Furthermore, when groups 1 and 2 were compared in terms of congested vessels, inflammatory cellular infiltrates and injury to the epithelium, the differences reached statistical significance, with p-values of <0.01, >0.001 and <0.001, respectively. Comparison of groups 2 and 4 with the control group also revealed statistically significant differences in terms of cellular infiltrates (p<0.001) and damage to the epithelium (p<0.001). For the degree of congestion of the vessels, however, the difference between groups was not at the level of statistical significance (p<0.071). Groups 3 and 4 differed at a statistically significant level in terms of degree of congested vessels, cellular infiltrates, and damage to the epithelium (p<0.025 and p<0.001). The sections from rats in groups 2 and 3 had a lower degree of congested vessels, which may be due to the actions of xylometazoline. CONCLUSIONS In the future, topically applied intranasal NSAIDs will be valuable formulations. Innovative types of formulation, such as those demonstrating thixotropic behavior, permit the agent to remain in prolonged contact with the nasal and sinusal lining. Alongside increased efficacy, these preparations will also improve the side effect profile of NSAIDs, largely eliminating systemic effects.
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Affiliation(s)
- M Kar
- Department of Otorhinolaryngology, Alaaddin Keykubat University, Alanya Training and Research Hospital, Alanya, Turkey.
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Gemici A, Ozkalemkas F, Dogu MH, Tekinalp A, Alacacioglu I, Guney T, Ince I, Geduk A, Cagliyan GA, Maral S, Serin I, Gunduz E, Karakus V, Bekoz HS, Eren R, Pinar IE, Gunes AK, Sargın FD, Sevindik OG. A Real-life Turkish Experience of Venetoclax Treatment in High-risk Myelodysplastic Syndrome and Acute Myeloid Leukemia. Clin Lymphoma Myeloma Leuk 2021; 21:e686-e692. [PMID: 34059487 DOI: 10.1016/j.clml.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Venetoclax is a selective B-cell lymphoma 2 (BCL2) inhibitor, which is approved to treat elderly patients with newly diagnosed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) in combination with either low-dose cytarabine (ARA-C) or hypomethylating agents. We aimed to collect and share data among the efficacy and safety of venetoclax both as a monotherapy or in combination with other drugs used to treat high-risk MDS or AML. MATERIALS AND METHODS A total of 60 patients with a median age of 67 (30-83) years from 14 different centers were included in the final analysis. Thirty (50%) of the patients were women; 6 (10%) of the 60 patients were diagnosed with high-risk MDS and the remaining were diagnosed with AML. RESULTS The best objective response rate (complete remission [CR], complete remission with incomplete hematological recovery (CRi), morphological leukemia-free state [MLFS], partial response [PR]) was 35% in the entire cohort. Best responses achieved during venetoclax per patient number were as follows: 7 CR, 1 CRi, 8 MLFS, 5 PR, and stable disease. Median overall survival achieved with venetoclax was 5 months in patients who relapsed and not achieved in patients who were initially treated with venetoclax. Nearly all patients (86.7%) had experienced a grade 2 or more hematologic toxicity. Some 36.7% of these patients had received granulocyte colony stimulating factor (GCSF) support. Infection, mainly pneumonia (26.7%), was the leading nonhematologic toxicity, and fatigue, diarrhea, and skin reactions were the others reported. CONCLUSION Our real-life data support the use of venetoclax in patients with both newly diagnosed and relapsed high-risk MDS and AML.
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Affiliation(s)
- Aliihsan Gemici
- Department of Hematology, Medipol University, Istanbul, Turkey.
| | | | | | - Atakan Tekinalp
- Department of Hematology, Necmettin Erbakan University, Konya, Turkey
| | | | - Tekin Guney
- Department of Hematology, University of Medical Sciences, Ankara City Hospital, Ankara, Turkey
| | - Idris Ince
- Division of Hematology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Ayfer Geduk
- Department of Hematology, Kocaeli University, Kocaeli, Turkey
| | | | - Senem Maral
- Division of Hematology, Diskapi Training and Research Hospital, Ankara, Turkey
| | - Istemi Serin
- Division of Hematology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Eren Gunduz
- Department of Hematology, Osman Gazi University, Eskisehir, Turkey
| | - Volkan Karakus
- Department of Hematology, Alaaddin Keykubat University, Alanya, Turkey
| | | | - Rafet Eren
- Division of Hematology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Ahmet Kursad Gunes
- Department of Hematology, University of Medical Sciences, Ankara City Hospital, Ankara, Turkey
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Frechen S, Ince I, Dallmann A, Gerisch M, Jungmann N, Becker C, Lobmeyer M, Trujillo M, Xu S, Burghaus R, Meyer M. Physiologically-based pharmacokinetic (PBPK) exploration of extrinsic factors influencing vericiguat pharmacokinetics. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Vericiguat is a once daily, novel oral stimulator of soluble guanylate cyclase (sGC) that showed clinical benefit in the Phase III VICTORIA study in heart failure patients with reduced ejection fraction (HFrEF, NCT02861534). Nonclinical and clinical studies demonstrated that the primary route of elimination of vericiguat was glucuronidation to an inactive metabolite M-1 (N-glucuronide). This glucuronidation was catalyzed by uridine 5'-diphospho-glucuronosyltransferases (UGT)1A9 as well as UGT1A1, thus vericiguat may have a potential for victim drug-drug interaction (DDI) when co-administered with potent UGT inhibitors.
Purpose
In a clinical DDI study with mefenamic acid as an UGT1A9 inhibitor no clinically relevant increase in vericiguat exposure in healthy subjects was observed (EudraCT 2014–000764–17). This analysis aims to prospectively investigate as extrinsic factors the DDI potential with atazanavir as a selective UGT1A1 inhibitor via full dynamic physiologically-based pharmacokinetic (PBPK) modelling.
Methods
A PBPK model for vericiguat and M-1 in healthy adults was built with PK-Sim (PBPK platform as part of the Open Systems Pharmacology Suite) by integrating physicochemical, in vitro metabolism and transporter data as well as PK data from clinical pharmacology studies in order to assess the victim DDI potential of vericiguat when co-administered with UGT inhibitors. First, PBPK models for mefenamic acid and atazanavir were separately developed and verified using published literature data. The PBPK model for vericiguat was then verified with regard to its fraction of metabolism by UGTs by comparing simulated and observed data of the clinical mefenamic acid DDI study. Finally, the UGT1A1 DDI potential of vericiguat was prospectively predicted by simulating an in silico study between the UGT1A1 inhibitor atazanavir and vericiguat.
Results
In line with the results of the clinical DDI study with mefenamic acid, an increase in total vericiguat exposure by 14% (area under the concentration time curve ratio (AUCR) of 1.14 (geoCV 5.3%; 90% population interval: 1.06 to 1.25) and peak exposure increase by 6% (CmaxR of 1.06; geoCV 5.9%; 90% population interval: 1.01 to 1.20) was simulated using the PBPK model. A prospective prediction of a virtual DDI trial between the UGT1A1 inhibitor atazanavir yielded an AUCR of 1.12 (geoCV 2.9%; 90% population interval: 1.07 to 1.17) and a CmaxR of 1.04 (geoCV 1.1%; 90% population interval: 1.03 to 1.06). The proposed population intervals for AUCR and CmaxR for both DDI studies lie within the default no-effect boundary of 0.80 to 1.25 according to the to January 2020 FDA DDI guideline.
Conclusion(s)
Results of UGT1A9-DDI simulations were consistent with those of the clinical study-The prospective UGT1A1-DDI simulation results suggest a low potential for vericiguat to be subject to DDI when co-administered with UGT1A1 inhibitors.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Funding for this research was provided by Bayer and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
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Affiliation(s)
- S Frechen
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | - I Ince
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | - A Dallmann
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | | | | | - C Becker
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Lobmeyer
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Trujillo
- Merck Sharp & Dohme Corp., Inc., Kenilworth, United States of America
| | - S Xu
- Merck Sharp & Dohme Corp., Inc., Kenilworth, United States of America
| | - R Burghaus
- Bayer AG, Clinical Pharmacometrics, Wuppertal, Germany
| | - M Meyer
- Bayer AG, Clinical Pharmacometrics, Wuppertal, Germany
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Duncan AE, Jia Y, Soltesz E, Leung S, Yilmaz H, Mao G, Timur AA, Kottke‐Marchant K, Rogers HJ, Ma C, Ince I, Karimi N, Yagar S, Trombetta C, Sessler DI. Effect of 6% hydroxyethyl starch 130/0.4 on kidney and haemostatic function in cardiac surgical patients: a randomised controlled trial. Anaesthesia 2020; 75:1180-1190. [PMID: 32072617 PMCID: PMC9291605 DOI: 10.1111/anae.14994] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 01/27/2023]
Abstract
Whether third‐generation hydroxyethyl starch solutions provoke kidney injury or haemostatic abnormalities in patients having cardiac surgery remains unclear. We tested the hypotheses that intra‐operative administration of a third‐generation starch does not worsen postoperative kidney function or haemostasis in cardiac surgical patients compared with human albumin 5%. This triple‐blind, non‐inferiority, clinical trial randomly allocated patients aged 40–85 who underwent elective aortic valve replacement, with or without coronary artery bypass grafting, to plasma volume replacement with 6% starch 130/0.4 vs. 5% human albumin. Our primary outcome was postoperative urinary neutrophil gelatinase‐associated lipocalin concentrations, a sensitive and early marker of postoperative kidney injury. Secondarily, we evaluated urinary interleukin‐18; acute kidney injury using creatinine RIFLE criteria, coagulation measures, platelet count and function. Non‐inferiority (delta 15%) was assessed with correction for multiple comparisons. We enrolled 141 patients (69 starch, 72 albumin) as planned. Results of the primary analysis demonstrated that postoperative urine neutrophil gelatinase‐associated lipocalin (median (IQR [range])) was slightly lower with hydroxyethyl starch (5 (1–68 [0–996]) ng.ml−1) vs. albumin (5 (2–74 [0–1604]) ng.ml−1), although not non‐inferior [ratio of geometric means (95%CI) 0.91 (0.57, 1.44); p = 0.15] due to higher than expected variability. Urine interleukin‐18 concentrations were reduced, but interleukin‐18 and kidney injury were again not non‐inferior. Of 11 individual coagulation measures, platelet count and function, nine were non‐inferior to albumin. Two remaining measures, thromboelastographic R value and arachidonic acid‐induced platelet aggregation, were clinically similar but with wide confidence intervals. Starch administration during cardiac surgery produced similar observed effects on postoperative kidney function, coagulation, platelet count and platelet function compared with albumin, though greater than expected variability and wide confidence intervals precluded the conclusion of non‐inferiority. Long‐term mortality and kidney function appeared similar between starch and albumin.
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Affiliation(s)
- A. E. Duncan
- Departments of Cardiothoracic Anesthesiology and Outcomes Research Cleveland Clinic Cleveland OH USA
| | - Y. Jia
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - E. Soltesz
- Department of Thoracic and Cardiovascular Surgery Cleveland Clinic Cleveland OH USA
| | - S. Leung
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - H.O. Yilmaz
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - G. Mao
- Departments of Quantitative Health Sciences and Outcomes Research Cleveland Clinic Cleveland OH USA
| | - A. A. Timur
- Department of Laboratory Medicine Cleveland Clinic Cleveland OH USA
| | - K. Kottke‐Marchant
- Department of Pathology and Laboratory Administration Cleveland Clinic Cleveland OH USA
| | - H. J. Rogers
- Department of Laboratory Medicine Cleveland Clinic Cleveland OH USA
| | - C. Ma
- Departments of Quantitative Health Sciences and Outcomes Research Cleveland Clinic Cleveland OH USA
| | - I. Ince
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - N. Karimi
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - S. Yagar
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
| | - C. Trombetta
- Department of Cardiothoracic Anesthesiology Cleveland Clinic Cleveland OH USA
| | - D. I. Sessler
- Department of Outcomes Research Cleveland Clinic Cleveland OH USA
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Demir U, Ince I, Aksoy M, Dostbil A, Arı MA, Sulak MM, Kose M, Tanios M, Ozmen O. The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery. J INVEST SURG 2019; 34:82-88. [PMID: 30966835 DOI: 10.1080/08941939.2019.1576809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Postoperative pain is an important problem for patients undergoing shoulder surgery. Our study investigated analgesic efficacy, duration of analgesia, postoperative analgesic use and patient satisfaction with the use of preemptive intravenous dexketoprofen for interscalene block in addition to general anesthesia in arthroscopic shoulder surgery. Methods: 60 patients, scheduled for arthroscopic shoulder surgery were randomized (30 patients each) into either: - control group (Group1) or dexketoprofen group (Group 2). Patients were followed for 48 hours to compare both groups for; post-operative pain scores, effectiveness of postoperative analgesia, duration of analgesia, and analgesia consumption. Duration of postoperative sensory block of the shoulder joint was defined as time to onset of pain at the incision site. Duration of postoperative motor block of the shoulder joint was defined as time to onset of first shoulder movement. Results: While no significant difference was determined for motor block time, sensory block time was significantly longer in the dexketoprofen group (p < 0.05).VAS scores were significantly lower at all times in the dexketoprofen group (p < 0.05).Total PCA fentanyl consumption was 274.16 ± 314.89 (μg) in the dexketoprofen group, and 490.00 ± 408.98 (μg) in the control group, the difference was statistically significant (p < 0.05). No significant difference was observed between the groups' demographic and hemodynamic data. Conclusion: Pre-emptive IV dexketoprofen may be a good option for arthroscopic shoulder surgery and provides effective analgesia.
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Affiliation(s)
- U Demir
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - I Ince
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - M Aksoy
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - A Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - M A Arı
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - M M Sulak
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - M Kose
- Department of Orthopaedic Surgery, Ataturk University School of Medicine, Erzurum, Turkey
| | - M Tanios
- Anesthesiology Institute Outcomes Research Department, Cleveland Clinic, Cleveland, Ohio, USA
| | - O Ozmen
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
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Aksoy AN, Tör IH, Aksoy M, Ahıskalıoglu A, Ince I, Kürsad H. The effect of colloid preload versus prophylactic ephedrine administration on QTc intervals during cesarean delivery: A randomized controlled study. Niger J Clin Pract 2016; 19:115-20. [DOI: 10.4103/1119-3077.173710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Celik M, Dostbil A, Aksoy M, Alici H, Dogan N, Ince I, Aydin Y, Ahiskalioglu A. Anesthetic Management in Children with Congenital Lobar Emphysema. Acta Chir Belg 2015; 115:279-83. [PMID: 26324029 DOI: 10.1080/00015458.2015.11681112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The cause of congenital lobar emphysema (CLE) is unknown and characterized by hyperinflation of one or more lobes of the lung. The purpose of this retrospective study was to present the anesthetic management of children with congenital lobar emphysema (CLE) receiving treatment in our center. METHODS Ten children underwent CLE-related surgical treatment in our center between March 1995 and August 2014. All cases were diagnosed on the basis of postero-anterior chest radiography and computerized tomography. Age, sex, preoperative clinical findings, location of lesions, surgical and anesthetic procedures, results of anesthesia and duration of hospitalization were evaluated. RESULTS Six patients were male (60%) and four female (40%). Their ages ranged from 40 days to 6 years. Dyspnea was present in all cases and severe in four of them. Four patients had emphysema in the left upper lobe, three in the right middle lobe, one in the right upper lobe and one in the left lower lobe. All patients were extubated in the operating room and none experienced post-operative respiratory distress. Post-operative analgesia was provided via the previously placed intrapleural catheter. All the patients were extubated in the operation room. There was no post-operative mortality or morbidity. CONCLUSIONS Anesthetic management of patients with CLE is challenging. In these patients the surgical team and -anesthetists should collaborate closely and the time between anesthesia induction and thoracotomy should be as short as possible.
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Abstract
OBJECTIVES Primary aneurysms of superficial venous system are rare and frequently misdiagnosed as varicose veins. Clinical presentation is variable depending on the presence of compression to surrounding structures. We report a rare case of primary cephalic vein aneurysm presented with wrist pain due to radial nerve compression. METHOD/CASE A 61-year-old woman was admitted with right wrist pain and localized mass. Physical and imaging examinations showed a localized cephalic vein aneurysm compressing radial nerve. Simple excision was performed successfully. RESULTS Cosmetic and clinical results at the first month follow-up were successful. DISCUSSION Although primary superficial venous aneurysms of upper extremities are very rare, the treatment of choice is most commonly same as the ones in lower limbs. Simple excision is the best approach in the most of the cases, while sclerotherapy could be preferred in order to obtain better cosmesis or to avoid injuries to surrounding structures.
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Affiliation(s)
- M Cakıcı
- Department of Cardiovascular Surgery, Diskapi Yildirim Beyazit E.A. Hospital, Ankara, Turkey
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Mora B, Ince I, Birkenberg B, Skhirtladze K, Pernicka E, Ankersmit HJ, Dworschak M. Validation of cardiac output measurement with the LiDCOTM pulse contour system in patients with impaired left ventricular function after cardiac surgery*. Anaesthesia 2011; 66:675-81. [DOI: 10.1111/j.1365-2044.2011.06754.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Ince I, Yesil-Celiktas O, Karabay-Yavasoglu NU, Elgin G. Effects of Pinus brutia bark extract and Pycnogenol in a rat model of carrageenan induced inflammation. Phytomedicine 2009; 16:1101-1104. [PMID: 19577447 DOI: 10.1016/j.phymed.2009.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 04/08/2009] [Accepted: 05/14/2009] [Indexed: 05/28/2023]
Abstract
The present study was conducted to explore the anti-inflammatory activities of Pinus brutia bark extract and Pycnogenol in a rat model of carrageenan-induced inflammation. Firstly, the compositions of both samples were determined using HPLC. Then, carrageenan-induced paw edema was used to assess anti-inflammatory activity in mice. Paw volume was measured before and 1, 2, 3, 4, 5 and 6h after the injection of carrageenan. Intraperitoneal administration of both the extract and Pycnogenol inhibited paw swelling dose-dependently at 2, 3, 4, 5 and 6h after carrageenan injection. Both samples exhibited significant anti-inflammatory activities at doses of 75 and 100 mg/kg body wt. between 2 and 4 hours after administration (p<0.05), respectively. Additionally, P. brutia bark extract showed significantly better activity at doses of 75 and 100mg/kg body wt. than indomethacine at the dose of 10mg/kg body wt. (p<0.05). No acute toxicity was identified in intraplantar injection of the extract at a dose of 2000 mg/kg body wt.. Therefore, P. brutia bark extract possessing 3.3-fold more total catechins and 9.8-fold more taxifolin than Pycnogenol can be utilized as an anti-inflammatory agent.
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Affiliation(s)
- I Ince
- Center for Drug R&D and Pharmacokinetic Applications, Ege University, 35100 Bornova-Izmir, Turkey
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13
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Karasulu E, Apaydin S, Ince I, Tuglular I. Theophylline granule formulation prepared by the wet granulation method: comparison of in vitro dissolution profiles and estimation of in vivo plasma concentrations. Eur J Drug Metab Pharmacokinet 2007; 31:291-8. [PMID: 17315541 DOI: 10.1007/bf03190470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The primary and secondary objectives of this study were to develop and evaluate the predictability of in vitro-in vivo correlation models for theophylline sustained release (SR) granules. Theophylline SR granules meeting the USP Drug Release Test criteria were prepared using ethyl cellulose (EC) and/or stearyl alcohol (SA) and the wet granulation method. In vitro dissolution studies of granule formulation were performed, and a commercial dosage form was prepared using USP XXIII apparatus II at pH 4.5. Differences and similarities between in vitro dissolution curves were compared using both model-dependent (t-test) and -independent (f1, f2 test) statistical techniques, and it was shown that the three dissolution profiles i.e model-dependent, model-independent, and methods based on ANOVA were very similar. The in vivo performance of the commercial dosage form was tested by oral route using male rabbits and in vitro-in vivo correlations were established. This study indicates that the dosage forms with similar in vitro dissolution profiles may have a similar in vivo performance, and that this performance could be estimated using appropriate correlation equations.
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Affiliation(s)
- E Karasulu
- Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ege, Bornova, Izmir, Turkey.
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Apaydin S, Zeybek U, Ince I, Elgin G, Karamenderes C, Ozturk B, Tuglular I. Hypericum triquetrifolium Turra. extract exhibits antinociceptive activity in the mouse. J Ethnopharmacol 1999; 67:307-312. [PMID: 10617065 DOI: 10.1016/s0378-8741(99)00071-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of the present study was to investigate the antinociceptive activity of Hypericum triquetrifolium Turra. extract. The lyophilized extract was administered to male Swiss mice. Formalin paw test and tail flick tests were used for the evaluation of the antinociceptive activity. Plant extract (10, 25, 50 and 60 mg kg(-1), i.p.) (n = 16-24 for each group) or vehicle (n = 27) was administered 30 min before the subplantar formalin injection. In the tail flick test, mice were examined for latency to withdraw their tails from a noxious thermal stimulus using a tail flick meter (n = 8 for each group). The effects of the extract on sensorimotor performance was also assessed (n = 16-24 for each group). The extract caused a significant dose-related inhibition of the first phase (50, 60 mg kg(-1), i.p.) and second phase (10, 25, 50 and 60 mg kg(-1), i.p.) of formalin induced hindpaw licking. Additionally, the extract administration (50, 60 mg kg(-1), i.p.) increased the tail flick latencies. No significant change was observed in any of the treatment groups in the sensorimotor performance test. The observed antinociceptive activity of the extract may be due to its noradrenaline and serotonin reuptake blocking activity. Moreover, the probable antiinflammatory activity of the extract may play a role in the dose-related inhibition of the second phase of formalin paw test.
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Affiliation(s)
- S Apaydin
- Ege University, Center for Drug R&D and Pharmacokinetic [E1]Applications, Izmir, Turkey.
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