A new COVID-19 prediction scoring model for in-hospital mortality: experiences from Turkey, single center retrospective cohort analysis

OBJECTIVE

Although many studies reported prognostic factors proceeding to severity of COVID-19 patients, in none of the article a prediction scoring model has been proposed. In this article a new prediction tool is presented in combination of Turkish experience during pandemic.

MATERIALS AND METHODS

Laboratory and clinical data of 397 over 798 confirmed COVID-19 patients from Gülhane Training and Research Hospital electronic medical record system were included into this retrospective cohort study between the dates of 23 March to 18 May 2020. Patient demographics, peripheral venous blood parameters, symptoms at admission, in hospital mortality data were collected. Non-survivor and survivor patients were compared to find out a prediction scoring model for mortality.

RESULTS

There was 34 [8.56% (95% CI:0.06-0.11)] mortality during study period. Mean age of patients was 57.1±16.7 years. Older age, comorbid diseases, symptoms, such as fever, dyspnea, fatigue and gastrointestinal and WBC, neutrophil, lymphocyte count, C-reactive protein, neutrophil-to-lymphocyte ratio of patients in non-survivors were significantly higher. Univariate analysis demonstrated that OR for prognostic nutritional index (PNI) tertile 1 was 18.57 (95% CI: 4.39-78.65, p<0.05) compared to tertile 2. Performance statistics of prediction scoring method showed 98% positive predictive value for criteria 1.

CONCLUSIONS

It is crucial to constitute prognostic clinical and laboratory parameters for faster delineation of patients who are prone to worse prognosis. Suggested prediction scoring method may guide healthcare professional to discriminate severe COVID-19 patients and provide prompt intensive therapies which is highly important due to rapid progression leading to mortality.

An expandable approach for design and personalization of digital, just-in-time adaptive interventions

Objective

We aim to deliver a framework with 2 main objectives: 1) facilitating the design of theory-driven, adaptive, digital interventions addressing chronic illnesses or health problems and 2) producing personalized intervention delivery strategies to support self-management by optimizing various intervention components tailored to people's individual needs, momentary contexts, and psychosocial variables.

Materials and Methods

We propose a template-based digital intervention design mechanism enabling the configuration of evidence-based, just-in-time, adaptive intervention components. The design mechanism incorporates a rule definition language enabling experts to specify triggering conditions for interventions based on momentary and historical contextual/personal data. The framework continuously monitors and processes personal data space and evaluates intervention-triggering conditions. We benefit from reinforcement learning methods to develop personalized intervention delivery strategies with respect to timing, frequency, and type (content) of interventions. To validate the personalization algorithm, we lay out a simulation testbed with 2 personas, differing in their various simulated real-life conditions.

Results

We evaluate the design mechanism by presenting example intervention definitions based on behavior change taxonomies and clinical guidelines. Furthermore, we provide intervention definitions for a real-world care program targeting diabetes patients. Finally, we validate the personalized delivery mechanism through a set of hypotheses, asserting certain ways of adaptation in the delivery strategy, according to the differences in simulation related to personal preferences, traits, and lifestyle patterns.

Conclusion

While the design mechanism is sufficiently expandable to meet the theoretical and clinical intervention design requirements, the personalization algorithm is capable of adapting intervention delivery strategies for simulated real-life conditions.

A new treatment modality for unilateral athelectasis: Recruitment maneuver with endobronchial blocker

Atelectasis is a commonly seen complication during the post-operative period in intensive care units. The treatment of atelectasis depends on the underlying cause. We aimed to share our experience on the treatment of right total atelectasis in our intensive care unit applied with the help of the endobronchial blocker.

Comparison of alfentanil and remifentanil infusions in combination with propofol for the outpatient extra-corporeal shock wave lithotripsy

PURPOSE

The aim of this study is to compare the efficiency of propofol+remifentanil to propofol+alfentanil in reducing pain in patients with urinary system stones undergoing outpatient Extracorporeal Shock Wave Lithotripsy (ESWL).

METHODS

In this prospective study, 30 patients, ASA (American Society of Anesthesiologist) I-II, who are 18-60 years old and undergoing Extracorporeal Shock Wave Lithotripsy for urinary system stones were included. Patients were randomly selected for either propofol+remifentanil (Group PR) or propofol+alfentanil treatment (Group PA). Propofol was given at a dose 1 mg/kg, and then 5mg doses were given to maintain a BIS (Bispectral Index) level 60-70. Remifentanil (0.2 microg/kg (-1) bolus dose and later 0.02 microgkg(-1) min(-1) infusions) was given to the group PR and alfentanil (bolus dose 7 microgkg(-1) and later with 0.7 microgkg(-1) min(-1) infusions) was given to the group PA. If needed, the patients might use 10 ig remifentanil and 50 ig alfentanil bolus doses in group PR and PA using patient controlled analgesia (PCA) device. ECG, SpO2, BIS levels and arterial blood pressures were monitored and recorded. Patients were evaluated with Ramsay Sedation Level Evaluation Scale and with Modified Aldrete Scoring System during and after the procedure. VAS was given to patients to mark their pain level on this scale at the end of the procedure.

RESULTS

The values at pre-induction and post- induction in each group were statistically different but difference did not exist between the PR and PA groups.

CONCLUSION

We concluded that both methods may be successfully used for patients undergoing ESWL (Tab. 6, Rief. 29).

Pain relief during dressing changes of major adult burns: ideal analgesic combination with ketamine

Pain management during burn dressing changes is a critical part of treatment in acute burn injuries. Although several treatment options have been suggested, it is still a challenge in a clinical setting. This study is aimed at finding out an ideal analgesic, sedative and/or anxiolytic combination that would minimise the unwanted effects of ketamine. A total of 24 patients, with burns up to 20-50% of total body surface area (TBSA), were included in the study and randomly divided into three groups. In group I, 2 mg kg(-1) ketamine was administered. In group II, 1 mg kg(-1) tramadol was administered and 30 min later, 1 microg kg(-1) dexmedetomidine and 2 mg kg(-1) ketamine was administered. In group III, 1 mg kg(-1) tramadol was applied and 30 min later, 0.05 mg kg(-1) midazolam and 2 mg kg(-1) ketamine was administered. The evaluation was performed with cardiopulmonary monitoring, sedation and visual analogue pain scores and overall patient satisfaction. Any adverse effects of ketamine were recorded. The results showed that group II had better outcomes with respect to pain management during dressing changes. As a conclusion, the use of the combination of ketamine, tramadol and dexmedetomidine was found to be a good treatment option for the prevention of the procedural pain suffered by adult patients during dressing changes.

Proanthocyanidin protects intestine and remote organs against mesenteric ischemia/reperfusion injury

BACKGROUND

Intestinal ischemia/reperfusion (IR) induces a systemic inflammatory response and releases harmful substances that may affect the function and integrity of distant organs such as lung, liver, and kidney. We conducted this study to find out if proanthocyanidins (PA) has protective effects against mesenteric IR injury and mesenteric IR-induced intestinal and distant organ injury.

MATERIALS AND METHODS

Thirty-two Sprague-Dawley rats were divided into four groups: control, control + PA, IR, IR + PA. The IR and IR + PA groups were subjected to mesenteric arterial ischemia for 60 min and reperfusion for 6 h. The Control + PA and IR + PA groups were administered PA (100 mg/kg/day via oral gavage) for 7 days prior to injury insult. We collected ileal and distant organ tissues, such as pulmonary, hepatic, and kidney specimens to measure tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and nitrite plus nitrate (NO(x)), and we then evaluated histological changes.

RESULTS

In the IR group, significant increases in MDA and NO(x) levels and significant increases in SOD and GPx activities of intestine, liver, kidney, and lung were observed. The MDA and NO(x) levels were significantly lower, as were the SOD and GPx activities in the IR + PA group than that in the IR group. Although the intestine and distant organs damage scores were significantly higher in the IR group, these injuries were prevented by PA in the IR + PA group.

CONCLUSIONS

This study demonstrates that PA has a significant effect in the protection of the intestine and the remote organs against mesenteric IR injury.

Does preemptive stellate ganglion blockage increase the patency of radiocephalic arteriovenous fistula?

OBJECTIVE

Radio-cephalic arteriovenous fistulas (AVFs) have high early failure ratio. Increased sympathetic activity and spasm of radial artery during the surgery may responsible for early occlusion rate.

DESIGN

Fifty patients were randomized to two groups (each containing 25 patients). Stellate Ganglion Blockade (SGB) was performed in Group 1. Another group was considered as control group (Group 2) to make statistical comparisons. All AVFs were performed under local anesthesia in both groups.

RESULTS

Average fistula flow was 201.4+/-40.4 ml/min in Group 1 and 155.6+/-27.4 ml/min in Group 2 (p < 0.001). While average peak velocity of radial artery was 167.1+/-31.3 cm/sec in Group 1, it was 107.8+/-15.8 cm/sec in Group 2 (p < 0.001). Thrill was found in all Group 1 patients, but there was thrill only 13 of the Group 2 patients (p < 0.001). Mean maturation time was 41.4+/-6.8 days after surgery in Group 1 and 77.1+/-10.5 days in Group 2 (p < 0.001). Adequate vascular access was obtained 19 patients in Group 1 and 12 patients in Group 2 (p = 0.041).

CONCLUSION

AVF occlusion rate is much more common in early postoperative period. Diminished sympathetic tonus by preemptive SGB not only increases early patency rate but also increases fistula maturation rate.

Cardioprotective effects of sevoflurane, isoflurane, and propofol in coronary surgery patients: a randomized controlled study

BACKGROUND

This study was undertaken to compare the in vivo effects of isoflurane, sevoflurane, and propofol anesthesia on ischemia- and reperfusion-mediated free-radical injury and oxidative stress during coronary artery bypass graft surgery. We also compared the effects of these anesthetic agents on levels of end products of lipid peroxidation and nitric oxide (NO) in human right atrial tissue and blood.

METHODS

Sixty patients scheduled to undergo elective coronary surgery with cardiopulmonary bypass (CPB) were enrolled. Patients were randomly allocated to receive 1 of 3 different anesthetic protocols: propofol (group A), isoflurane (group B), or sevoflurane (group C). We recorded global hemodynamic data (mean arterial pressure, mean pulmonary artery pressure, central venous pressure, pulmonary capillary wedge pressure, cardiac output, cardiac index, and systemic vascular resistance index) just before the start of surgery, before the start of CPB, 15 minutes after the end of CPB, at the end of the operation, 6 hours after installation in the intensive care unit, and 12 and 24 hours later. Samples of the right atrial appendage were harvested before and after exposure of the heart to blood cardioplegia and short-term reperfusion under conditions of CPB. Biochemical and oxidative stress parameters were analyzed in both blood and tissue.

RESULTS

Hemodynamic parameters were kept stable throughout in all groups. Troponin I increased transiently with all used anesthetic regimens, but this increase was significantly lower in groups B and C. After clamp removal, lipid peroxidation in patients who received propofol (group A) was less than in patients who received isoflurane (group B) or sevoflurane (group C) (P= .001, P= .005, respectively). Although the 3 groups showed no statistically significant differences in tissue levels of thiobarbituric acid-reactive substances and superoxide dismutase, propofol significantly lowered NO production in atrial tissue after clamp removal and induced less NO production than sevoflurane (P< .05).

CONCLUSION

Inhalation anesthetics such as isoflurane and sevoflurane preserved cardiac function in coronary surgery patients after CPB with less evidence for myocardial damage than propofol. Furthermore, propofol induced lower blood levels of lipid peroxidation than isoflurane and sevoflurane. Propofol also increased glutathione peroxidase activity but induced less NO production compared to sevoflurane. These findings also support the cardioprotective properties that are demonstrated by hemodynamic parameters.

Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy

INTRODUCTION

The aim of the study is to evaluate the analgesic efficiency of perioperative magnesium sulphate infusion in patients undergoing laparoscopic cholecystectomy (LC).

METHODS

In a randomized, double-blind trial study, 83 patients were divided into two groups. Group MT received 50 mg/kg i.v. magnesium sulphate in 100 ml of 0.9% normal saline and Group T received the same volume of isotonic saline during the intraoperative period. The cumulative post-operative tramadol consumption was measured to assess the analgesic effect using a patient-controlled analgesia device. Pain intensities at rest and while coughing were evaluated at 0, 2, 4, 8, 12, and 24 h post-operatively.

RESULTS

The pain scores in Group MT were significantly lower than Group T at 0, 4, and 12 h post-operatively. The average of visual analogue scale at rest and during cough during 24 h post-operatively was found to be statistically significant between groups. The total dose of tramadol the 24-h period in Group MT and Group T was found to be 281.34 +/- 90.82 and 317.46 +/- 129.59, respectively.

CONCLUSION

Per-operative 50 mg/kg magnesium sulphate infusion is effective in reducing post-operative pain in patients undergoing LC.

A comparison of different hemorrhoidectomy procedures

OBJECTIVE

To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel (HS) and classical methods.

METHODS

Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS (n=22), closed HS (n=22), Miligan Morgan (n=22), and Ferguson (n=21) hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time.

RESULTS

Bleeding volume was significantly lower in Groups I-II (p<0.001). Operation time was significantly shorter in Group I (p<0.001). Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III (p<0.001) compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III (p<0.004). Visual Analogue Scale results were similar in Groups II and IV. Analgesic consumption in Groups I-III was significantly lower than Groups II-IV (p<0.001). Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III (p<0.007) and similar in closed hemorrhoidectomy group.

CONCLUSION

The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain.

Combination sedoanalgesia with remifentanil and propofol versus remifentanil and midazolam for elective cardioversion after coronary artery bypass grafting

Postoperative atrial fibrillation (AF) occurs in up to 50% of cardiac surgery patients and represents the most common postoperative arrhythmic complication. Elective cardioversion, a short but painful procedure, remains an option for patients who do not convert to sinus rhythm with medical therapy. Combinations of remifentanil (a potent analgesic with a short elimination time) with propofol (a hypnotic agent) or midazolam (a sedative agent) produce a synergistic interaction. This study was undertaken to compare these combinations in terms of effectiveness and pain relief when given as sedoanalgesia for elective cardioversion. In this prospective, randomized trial, 60 adult patients with postoperative AF after coronary artery bypass grafting were given a single dose of propofol 1 mg/kg combined with remifentanil 0.1 microg/kg (group 1), or midazolam 0.05 mg/kg combined with remifentanil 0.1 microg/kg (group 2). Cardiorespiratory parameters were monitored and recorded. Demographic data were similar (P>.05) and sufficient sedoanalgesia and successful cardioversion were achieved in both groups. Hemodynamic parameters revealed no significant differences between groups (P>.05); however, induction time, time to eye opening, recuperation time, and time to full recovery of psychomotor function were faster in group 1 than in group 2 (P<.05). The remifentanil/propofol combination provided sufficient analgesia, satisfactory hemodynamic stability, and mild respiratory depression, along with faster recovery and discharge times from the intensive care unit.

Fournier's gangrene: report of thirty-three cases and a review of the literature

BACKGROUND

Fournier's gangrene (FG) is an extensive fulminant infection of the genitals, perineum or the abdominal wall. The aim of this study is to share our experience with the management of this difficult infectious disease.

METHODS

Thirty-three male patients were admitted to our clinic with the diagnosis of FG between February 1988 and December 2003. The patient's age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment, and outcome were analyzed. The patients were divided into two groups. The first 21 patients (Group I) were treated with broad-spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and then they underwent split-thickness skin grafts or delayed closure as needed. The other 12 patients (Group II) were treated with unprocessed honey (20-50 mL daily) and broad-spectrum triple antimicrobial therapy without debridement. Their wounds were cleaned with saline and then dressed with topical unprocessed honey. The wounds were inspected daily and the honey was reapplied after cleaning with normal saline. Then, the patients' scrotum and penis were covered with their own new scrotal skin. The mean age of the patients was 53.9 +/- 9.56 years (range = 23-71).

RESULTS

The source of the gangrene was urinary in 23 patients, cutaneous in seven patients, and perirectal in three patients. The predisposing factors included diabetes mellitus for 11 patients, alcoholism for 10 patients, malnutrition for nine patients, and medical immunosuppression (chemotherapy, steroids, malignancy) for three patients. The mean duration of hospital stay was 41 +/- 10.459 (range = 14-54) days. Two patients in Group I died from severe sepsis. The clinical and cosmetic results were better in Group II than Group I.

CONCLUSION

Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Traditionally, good management is based on aggressive debridement, broad-spectrum antibiotics, and intensive supportive care but unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality.

An anesthesiological approach to nerve agent victims

The potential use of weapons of mass destruction has recently become a real threat even in the areas of ongoing armed conflicts. Mass casualty victims can suffer from psychological and physical trauma. The exposure of physically injured patients to a toxic substance, in a scenario of mass injury, has recently gained major attention among planners of future protocols for emergency medical services. Because rapid deterioration and multiorgan involvement are to be expected after physical injuries, proper organization and complex but efficient acute medical care systems must be organized and deployed to ensure a maximal number of saved lives. These victims will inevitably require urgent surgical intervention and prolonged perioperative care. Understanding the interdependence between the toxic and traumatic occurrences and the drugs used to prevent or treat nerve agent intoxication (pyridostigmine bromide, a reversible inhibitor of acetylcholinesterase; atropine, a muscarinic receptor antagonist that is one of the on-site, first aid, pharmacological resuscitation drugs; and oxime-like pralidoxime chloride or obidoxime chloride, acetylcholinesterase reactivators) is vital. In addition, the administration of anesthesia and emergency surgery pose further unpredictable threats to the central nervous system, the cardiovascular system, and respiratory function, all of which may be compromised after chemical intoxication and physical trauma. It is noteworthy that information concerning the effects of nerve agent intoxication among human subjects is derived largely from reports of incidents of intentional terrorist attacks or of accidental exposure to organophosphate pesticides, compounds that are chemically related to nerve agents.

Direct Versus Guidewire-Assisted Pediatric Radial Artery Cannulation Technique

OBJECTIVE

Radial artery cannulation is a more difficult procedure in pediatric patients. Direct technique commonly fails in these patients, and several techniques have been developed for successful arterial cannulation. The purpose of this study was to compare direct radial artery cannulation with guidewire-assisted cannulation in children undergoing cardiac or aortic surgery. The hypothesis was that the guidewire-assisted technique would lead to fewer attempts and provide better long-term blood pressure monitoring and blood sampling.

MATERIALS AND METHODS

One hundred pediatric patients with congenital heart defects undergoing major cardiovascular surgery, who required a radial artery catheter, were included in the study. Patients were divided into 2 groups: group 1 included 50 patients who had radial artery cannulation with the direct technique, and group 2 included 50 patients who had a guidewire-assisted radial artery cannulation.

RESULTS

A radial artery was successfully cannulated in 48 patients in group 2 but only 38 patients in group 1. Mean elapsed time for radial artery cannulation was 22 +/- 4.6 minutes in group 1 and 7 +/- 4.2 minutes in group 2 (p = 0.001). The average number of attempts for cannulation was 4.5 in group 1 and 2.1 in group 2 (p = 0.022). The opposite radial or an alternative artery was used more commonly in the direct technique group. Satisfactory blood pressure monitoring and sampling of blood were obtained in 28 patients in group 1 and 46 patients in group 2 (p < 0.001).

CONCLUSION

The authors recommend the use of a guidewire-assisted radial artery cannulation technique rather than a direct technique. The guidewire-assisted technique provided easy, safe, and quick cannulation and allowed for long-term satisfactory blood pressure monitoring and blood sampling because of the longer length of the Teflon catheter advanced into the artery over the guidewire, and a low rate of dissection of the radial artery.

Successful ABO-incompatible liver transplantation with pre- and postoperative plasmapheresis, triple immunosuppression, and splenectomy for fulminant hepatic failure

Fulminant hepatic failure continues to be a challenge to hepatologists and surgeons. Because of the rapid deterioration in the clinical condition of patients with fulminant hepatic failure and the scarcity of available grafts, an ABO-incompatible liver donor may be the only choice for a patient with life-threatening hepatic insufficiency. Here, we report a patient with fulminant hepatic failure who received an ABO-incompatible liver transplantation who was treated with pre- and posttransplantation double-volume total plasma exchange, splenectomy, and triple immunosuppression (tacrolimus, mycophenolate mofetil, and prednisone) in July 2003. At 26 months' follow-up, the patient's postoperative course has been uneventful. Using protocols aimed at removing existing isohemagglutinins and reducing further antibody production, ABO-incompatible liver transplantation may be performed as a life-saving procedure in patients with fulminant hepatic failure.

Hearing impairment associated with spinal anesthesia

OBJECTIVES

Hearing loss after spinal anesthesia has been reported to be related to the transmission of a reduced subarachnoid pressure to the inner ear via the cochlear aqueduct due to loss of spinal fluid. However, there are also some controversies related to this phenomenon, which require systematic investigation.

MATERIAL AND METHODS

The effect of spinal needle diameter on hearing loss was investigated using audiometric tests in a prospective comparative study of 30 patients who were scheduled for surgery with spinal anesthesia. The bony structure of the cochlear and vestibular aqueducts was determined from temporal bone CT scans.

RESULTS

Four out of 15 patients (26.67%) treated with a 22 G spinal needle demonstrated hearing loss the day after surgery, which recovered within 2-5 weeks. However, none of the patients treated with a 27 G spinal needle had statistically significant hearing loss in either ear at any frequency. Three out of four patients with hearing loss had an acute-onset balance problem. There was no difference between the two groups in terms of the widths of the vestibular and cochlear aqueducts.

CONCLUSIONS

It has been shown audiometrically that the diameter of the spinal needle used to induce spinal anesthesia seems to have an effect on subsequent hearing loss. The patency of the bony canal determines the transmission of pressure changes to the inner ear. However, the individual risk of this complication is not predictable as there is no radiological abnormality of the canal.

Dynamic modification of XML documents

In this paper we describe a mechanism for invoking external applications from XML documents and returning the results back into the documents such that it becomes possible to create dynamic XML documents with content fetched from external resources such as remote databases or legacy applications. One possible application is to support dynamic electronic catalogs in XML where the catalog content is automatically and dynamically updated to contain the most recent data external to the document by accessing resources like legacy applications or databases each time it is parsed.The mechanism introduced involves a way of specifying applications to be invoked from an XML document through a new processing instruction, called EXECUTE. The proposed approach necessitates a "variable" mechanism to be able to pass input parameters to the invoked applications and to use the returned results. A variable mechanism is not readily available in XML therefore we have modified the code of an XML parser such that it became possible to redefine the values of XML entities and thus to use them as variables. XML-RPC from UserLand is used for remote method invocation.When it comes to integrating the returned results into the original document, as long as a single value is returned, it can be readily inserted into an XML document. However a piece of XML document may also be the result of the external application. In this case if a validating parser is being used, as in our case, then the DTD specified should be that of the final document.The paper concludes by discussing the future work.

Methylprednisolone and vitamin E therapy in perinatal hypoxic-ischemic brain damage in rats

To study the efficacy of methylprednisolone/vitamin E in reducing cerebral edema and improving the ultimate neuropathological outcome in perinatal cerebral hypoxia-ischemia, 40 seven-day postnatal rats were subjected to right common carotid artery ligation followed by exposure to 8% oxygen at 37 degrees C for 3 h. The animals were divided into groups. Twenty rat pups received an intraperitoneal injection of 30 mg/kg body weight methylprednisolone and vitamin E (100 U/kg) immediately following cerebral hypoxia-ischemia. Control animals received either no therapy (n = 10) or an equivalent volume of normal saline (n = 10). After 72 h of recovery from hypoxia-ischemia, the animals were killed and their brains were examined to measure the water contents in the right and left hemispheres (29 rat pups), whereas the others were killed at 21 days for neuropathological examination. Methylprednisolone/vitamin E-treated rats had significantly less water content in the right hemisphere (87.08 +/- 0.28%, mean +/- S.E.M.) than saline-treated animals (89.07 +/- 0.37%, mean +/- S.E.M., P < 0.0001). Methylprednisolone/vitamin E significantly reduced water content in the right hemisphere of the brain. Neuropathological study was performed on nine rat pups. The brains of four methylprednisolone/vitamin E- and five saline-treated pups were examined at the end of the 21-day recovery period. Two groups of the right cerebral cortex included thinning of the cortex. Significantly less damage was seen in the methylprednisolone/vitamin E-treated pups. Our study suggests that trials of methylprednisolone/vitamin E might be effective if they are given to the mother at risk of fetal hypoxia during labor or to the hypoxic infant right after delivery in preventing hypoxic brain damage.