Real-World Evidence of Antipsychotic Monotherapy Versus Polypharmacy in the Treatment of Schizophrenia Spectrum Disorders

PURPOSE/BACKGROUND

It is still not well known whether antipsychotic monotherapy versus polypharmacy differs in terms of efficacy in the emergency department (ED) utilization, presentation with agitation/aggression, and rehospitalization in schizophrenia spectrum disorders (SSD) patients. This study aimed to determine the effectiveness of antipsychotic monotherapy and polypharmacy for these outcomes in the real world.

METHODS/PROCEDURES

The study was conducted with electronic health records of 669 SSD patients admitted to the ED. Patients were evaluated in 4 groups according to antipsychotic use at the first admission to ED: antipsychotic noncompliance for more than 90 days, antipsychotic noncompliance for 15 to 90 days, antipsychotic monotherapy, and polypharmacy. All patients followed up for at least 1 year after index admission. The primary outcomes determined an association between antipsychotic monotherapy versus polypharmacy and all-cause psychiatric hospitalization between the groups after index admission in the SSD.

FINDINGS/RESULTS

The groups, including patients with antipsychotic noncompliance, had higher ED visits, more hospitalizations, and more admissions with agitation/aggression compared with antipsychotic monotherapy or polypharmacy. However, no differences were found between monotherapy and polypharmacy groups regarding these outcomes. In addition, there was no difference in the risk of hospitalization in monotherapy antipsychotic users compared with polypharmacy users. Patients discharged with monotherapy or polypharmacy also had similar rehospitalization rates at follow-up.

IMPLICATIONS/CONCLUSIONS

There is no positive evidence that recommending polypharmacy over antipsychotic monotherapy is superior with regard to the resulting frequency of ED visits, ED admissions with agitation/aggression, hospitalization, and rehospitalization. In this context, antipsychotic monotherapy may be preferred over polypharmacy in patients who are not resistant to treatment.

Tuning the structure and physiochemical properties of sodium alginate and chitosan composite films through sodium tripolyphosphate (STPP) crosslinking

Sodium tripolyphosphate (STPP), an inorganic and non-toxic polyphosphate, has potential applications as a crosslinking agent in the fabrication of edible films. This study utilized STPP in the development of sodium alginate-chitosan composite films, with a focus on their suitability for food packaging applications. The results indicate that the incorporation of STPP led to an increase in film thickness (from 0.048 ± 0.004 to 0.078 ± 0.008 mm), elongation at break (from 11.50 ± 1.49 % to 15.88 ± 2.14 %), water permeation (from 0.364 ± 0.010 to 0.521 ± 0.021 gmm/(m2h*kPa)), and moisture content (from 25.98 ± 0.20 % to 28.12 ± 0.17 %). In contrast, there was a decrease in tensile strength (from 30.23 ± 2.08 to 25.60 ± 1.22 MPa) and swelling index (from 752.9 ± 17.1 to 533.5 ± 8.9 %). Scanning electron microscopy (SEM) analysis revealed the formation of distinctive needle-like microcrystals with the incorporation of STPP. Fourier-transform infrared spectroscopy (FTIR) analysis indicated intermolecular interactions between STPP and the film-forming biopolymers. The data obtained from Thermogravimetric analysis (TGA) and Differential Scanning Calorimetry (DSC) demonstrated enhanced thermal stability of STPP-loaded films at elevated temperatures. Furthermore, the films exhibited increased DPPH scavenging activity with the addition of STPP. This study underscores the potential of STPP as a crosslinking agent for the development of composite edible films, suggesting applications in the field of food packaging.

Pectin/sodium alginate films tailored with Acetyl-11-keto-beta-boswellic acid for active packaging

The present study aimed to develop food packaging films by using a combination of pectin (PE) and sodium alginate (SA) enriched with Acetyl-11-keto-beta-boswellic acid (AKBA) as a functional or active ingredient. The fabricated films underwent comprehensive evaluation of their morphological, chemical, mechanical, barrier, optical, thermal, antioxidant, and antimicrobial properties. SEM and FTIR analysis showed that AKBA had good compatibility with film-forming components. The AKBA-loaded film samples exhibited a decrease in their barrier properties and tensile strength, but enhancements in both elongation at break and thickness values was observed. With the addition of AKBA, a significant increase (p < 0.05) in the ultraviolet barrier properties of the films and total colour variation (ΔE) was observed. TGA analysis of the films unveiled an improvement in thermal resistance with the incorporation of AKBA. Moreover, the films loaded with AKBA exhibited potent antioxidant activity in the ABTS and DPPH assay methods. Disk diffusion analysis showed the antimicrobial activity of AKBA-loaded films against P. aeruginosa, highlighting the potential of AKBA as a natural antimicrobial agent for the safety of food products. The results demonstrate the practical application of PE and SA active films loaded with AKBA, particularly within the food packaging industry.

Enhancing Tensile Strength, Thermal Stability, and Antioxidant Characteristics of Transparent Kappa Carrageenan Films Using Grapefruit Essential Oil for Food Packaging Applications

The trends in food packaging technologies are shifting toward utilizing natural and environmentally friendly materials prepared from biopolymers such as kappa carrageenan to replace synthetic polymers. In the current study, varying amounts (0.1, 0.2, and 0.3%) of grapefruit essential oil (GFO) were incorporated in kappa carrageenan-based edible films to improve their physicochemical properties. The developed film samples were characterized for their barrier, mechanical, morphological, optical, thermal, antioxidant, and biodegradable properties. The results obtained showed that the tensile strength of the carrageenan films enhanced significantly from 65.20 ± 4.71 to 98.21 ± 6.35 MPa with the incorporation of GFO in a concentration-dependent manner. FTIR and SEM analysis confirmed the intermolecular bonding between carrageenan and GFO, resulting in the formation of compact films. Incorporating GFO significantly enhanced the thermal resistance of oil-loaded films, as confirmed by TGA, DSC, and DTG analysis. The addition of GFO led to a substantial increase in the radical scavenging activity of the films, as evidenced by the DPPH and ABTS assays. Furthermore, the developed films were biodegradable in soil and seawater environments, indicating their potential as a sustainable alternative to traditional plastics. Findings demonstrated that GFO can be used as a natural antioxidant agent in kappa carrageenan-based films for potential applications in food packaging.

Structural, mechanical, barrier and antioxidant properties of pectin and xanthan gum edible films loaded with grapefruit essential oil

This research focused on the development of films based on pectin and xanthan gum composite loaded with different concentrations of grapefruit essential oil (GFO). The fabricated films were characterized to assess the effect of GFO on the structural, mechanical, barrier, chemical, and antioxidant properties. The addition of GFO enhanced the functional properties of the films, as confirmed by FTIR analysis showing molecular interactions within the film matrix. SEM observations revealed that films with higher GFO content had a smoother, more compact structure with uniform oil distribution. Films loaded with oil demonstrated enhanced water resistance, as their decreased permeability ranged from 0.733 ± 0.009 to 0.561 ± 0.020 (g mm)/(m2.h.kPa). Additionally, these films showed a notable increase in tensile strength, ranging from 2.91 ± 0.19 to 8.55 ± 0.62 MPa. However, the addition of oil led to a reduction in the elongation at break of the films, which decreased from 52.84 ± 3.41 % to 12.68 ± 1.52 %, and a decline in transparency from 87.57 ± 0.65 % to 76.18 ± 1.12 %. Fabricated films exhibited enhanced antioxidant properties, as evidenced by increased DPPH• and ABTS•+ radical scavenging activities with the addition of GFO. The findings of the current study suggest that GFO is an effective natural additive for enhancing the physiochemical properties of pectin and xanthan gum-based films, making them more suitable for food packaging applications.

A novel film based on a cellulose/sodium alginate/gelatin composite activated with an ethanolic fraction of Boswellia sacra oleo gum resin

Boswellia sacra and its derivatives exhibit notable bioactive properties, which have been the subject of extensive scientific research; however, their potential applications in food packaging remain largely untapped. In the current study, cellulose, sodium alginate, and gelatin composite edible films were fabricated with the addition of different concentrations (0.2% and 0.3%) of the ethanolic fraction of Boswellia sacra oleo gum resin (BSOR). The resultant films were examined for their physical, chemical, mechanical, barrier, optical, and antioxidant properties. Moreover, the films were characterized using Scanning Electron Microscopy (SEM), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR) to study the impact of incorporating BSOR on the morphological, crystalline, and chemical properties of the films. The addition of BSOR increased the film thickness (0.026-0.08 mm), water vapor permeability (0.210-0.619 (g.mm)/(m2.h.kPa), and the intensity of the yellow color (3.01-7.20) while reducing the values of both tensile strength (6.67-1.03 MPa) and elongation at break (83.50%-48.81%). SEM and FTIR analysis confirmed the interaction between the BSOR and film-forming components. The antioxidant properties of the edible films were significantly increased with the addition of BSOR. The comprehensive findings of the study demonstrated that BSOR possesses the potential to serve as an efficient natural antioxidant agent in the fabrication of edible films.

The physicochemical properties and molecular docking study of plasticized amphotericin B loaded sodium alginate, carboxymethyl cellulose, and gelatin-based films

Plasticizers are employed to stabilize films by safeguarding their physical stability and avoiding the degradation of the loaded therapeutic drug during processing and storage. In the present study, the plasticizer effect (glycerol) was studied on bioadhesive films based on sodium alginate (SA), carboxymethyl cellulose (CMC) and gelatin (GE) polymers loaded with amphotericin B (AmB). The main objective of the current study was to assess the morphological, mechanical, thermal, optical, and barrier properties of the films as a function of glycerol (Gly) concentration (0.5-1.5 %) using different techniques such as Scanning Electron Microscope (SEM), Texture analyzer (TA), Differential Scanning Calorimeter (DSC), X-Ray Diffraction (XRD), and Fourier Transforms Infrared Spectroscopy (FTIR). The concentration increase of glycerol resulted in an increase in Water Vapor Permeability (WVP) (0.187-0.334), elongation at break (EAB) (0.88-35.48 %), thickness (0.032-0.065 mm) and moisture level (17.5-41.76 %) whereas opacity, tensile strength (TS) (16.81-0.86 MPa), and young's modulus (YM) (0.194-0.002 MPa) values decreased. Glycerol incorporation in the film-Forming solution decreased the brittleness and fragility of the films. Fourier Transform Infrared (FTIR) spectra showed that intermolecular hydrogen bonding occurred between glycerol and polymers in plasticized films compared to control films. Furthermore, molecular docking was applied to predict the binding interactions betweem AmB, CMC, gelatin, SA and glycerol, which further endorsed the stabilizing effects of glycerol in the complex formation between AmB, CMC, SA, and gelatin. The Findings of the current study demonstrated that this polymeric blend could be used to successfully prepare bioadhesive films with glycerol as a plasticizer.

Novel applications of black pepper essential oil as an antioxidant agent in sodium caseinate and chitosan based active edible films

In the current study, sodium caseinate and chitosan-based composite edible films were developed with the incorporation of black pepper (Piper nigrum) essential oil (BPO) in various concentrations (0.05, 0.1 and 0.15 %) for potential food packaging applications. The chemical composition of BPO was determined using GCMS and the major compound detected were β-caryophyllene, limonene, β-phellandren, pinene, copaene and α-humulene. The addition of BPO resulted in an increase in the thickness, EAB, WVP, moisture content and swelling index values of the films; however, the TS and water solubility decreased. The inclusion of BPO led to a substantial enhancement in the DPPH and ABTS radical scavenging capabilities of the edible films. SEM micrographs demonstrated intermolecular interaction between BPO, sodium caseinate, and chitosan. FTIR spectra confirmed the interaction of the functional groups of the polymers and BPO. The incorporation of the BPO increased the crystallinity of the films. Moreover, the thermal analysis including TGA, DSC and DTG demonstrated an increase in the thermal stability of the edible films with the addition of the BPO. These findings demonstrated that sodium caseinate and chitosan composite based edible films loaded with BPO can be used as sustainable active food packaging material.

Psychological state and predictors of psychiatric morbidity in COVID-19 patients six weeks after discharge

To be able to detect possible psychological distress and long-term deterioration caused by COVID-19, following the patient, who has recovered, is crucial. Therefore, this study (i); aims to examine the ongoing fear-loss of control, the rate of anxiety, depression, and post-traumatic stress disorder levels following the 6th week after discharge; (ii) to examine the effect of post-traumatic stress disorder on anxiety, and depression and (iii) within the same context to reveal the developmental markers of psychiatric morbidity and the risk group. The study includes 180 patients who were hospitalized with COVID-19 diagnosis. Sociodemographic Data Form, the Hospital Anxiety Depression Scale and the Impact of Event Scale-Revised were used in the current study. High rates of symptoms of anxiety, depression, and PTSD were reported by the inpatients, as more than one-third scored above the anxiety and depression cut-off scores of borderline abnormal and abnormal. Also, 37.22 % of the participants reported the likely presence of PTSD symptoms. Anxiety and depression were significantly positively related to the symptoms of PTSD. The results suggest that there is psychiatric morbidity in anxiety, depression, and post-traumatic stress disorder and that especially posttraumatic stress poses a risk for other psychopathologies.

Application of plant-based proteins for fortification of oat yogurt storage stability and bioactivity

The purpose of this study was to evaluate the addition of plant-based peanut protein isolate (PNP) and commercial pea protein (CPP) on the quality of oat yogurt (OY). PNP and CPP were partially characterized for techno-functional properties. PNP had higher solubility (acidic and basic regions) and emulsifying activity than CPP. The water absorption capacity of CPP is significantly (p < 0.05) higher than PNP. Amino acid profiles of PNP and CPP were promising for the nutritional enhancement of OYs. OYs with PNP or CPP (0.5, 1, 2% w/v) were stored for 21 days and compared to the control group with no protein. On the 21st day of storage, (i) PNP- or CPP-added OYs were found to be comparable to the control with respect to post-acidification and viscosity, (ii) syneresis was more evident in PNP-added OYs than in CPP-added ones, (iii) total color change of 1% CPP-added OY was equal to the control, and (iv) hardnesses of control, 2% PNP, and 2% CPP-added OYs were 0.29 ± 0.00, 0.39 ± 0.01, and 0.45 ± 0.00 N, respectively. No adverse sensory effects were detected for CPP or PNP addition. Both proteins increased the total phenolic, soluble protein, antioxidant, antihypertensive, and α-glucosidase inhibition activity of oat milk and OYs, with PNP superior to CPP overall. Compared to oat milk, the fermentation process increased ACE inhibition activity in in vitro digested samples, whereas it reduced digested yogurts' antioxidant activity. Utilization of PNP in OY can solve the waste problem of peanut producers and the texture problem of the OY producers while formulating a functional product. PRACTICAL APPLICATION: Plant-based (PB) yogurts have a growing consumer demand. The low-protein content of PB yogurts results in low acceptance with respect to their undesirable textural and sensorial attributes. This study provided a technical basis for the PB yogurt manufacturers focusing on the addition of commercial pea protein and isolated peanut protein into oat yogurt formulation without any thickeners or flavors. In vitro digestion of protein-added oat milk and oat yogurts showed the benefits of fermentation on bioactivity to the consumers.

Physical, Chemical, Barrier, and Antioxidant Properties of Pectin/Collagen Hydrogel-Based Films Enriched with Melissa officinalis

The essential oil extracted from Melissa officinalis (MOEO) exhibits a wide range of therapeutic properties, including antioxidant, antibacterial, and antifungal activities. The current research aimed to analyze the mechanical, barrier, chemical, and antioxidant properties of pectin and collagen-based films. Hydrogel-based films loaded with varying concentrations of MOEO (0.1%, 0.15%, and 0.2%) were prepared by solvent-casting method, and their physicochemical as well as antioxidant properties were examined. GC-MS analysis revealed the presence of major components in MOEO such as 2,6-octadienal, 3,7-dimethyl, citral, caryophyllene, geranyl acetate, caryophyllene oxide, citronellal, and linalool. Fourier transform infrared (FTIR) results revealed the interaction between components of the essential oil and polymer matrix. Scanning electron microscopy (SEM) revealed that films loaded with the highest concentration (0.2%) of MOEO showed more homogeneous structure with fewer particles, cracks, and pores as compared to control film sample. MOEO-incorporated films exhibited higher elongation at break (EAB) (30.24-36.29%) and thickness (0.068-0.073 mm); however, they displayed lower tensile strength (TS) (3.48-1.25 MPa) and transparency (87.30-82.80%). MOEO-loaded films demonstrated superior barrier properties against water vapors. According to the results, the incorporation of MOEO into pectin-collagen composite hydrogel-based films resulted in higher antioxidant properties, indicating that MOEO has the potential to be used in active food packaging material for potential applications.

Routine laboratory parameters in estimating mortality and morbidity in COVID-19 diagnosed cases followed in the intensive care unit

OBJECTIVE

In this study, our goal was to assess the neutrophil/lymphocyte, platelet/lymphocyte ratios, urea/albumin, lactate, C-reactive protein/albumin procalcitonin/albumin, dehydrogenase/albumin, and protein/albumin rates in 368 critical COVID-19 cases following the entrance to the intensive care unit (ICU) to investigate the effects of biomarkers on prognosis and mortality.

PATIENTS AND METHODS

The Ethics Committee approved this study carried out in our hospital's intensive care units between March 2020 and April 2022. 368 patients, 220 (59.8%) male, and 148 (40.2%) female, diagnosed with COVID-19 and aged between 18 and 99 years were included in this research.

RESULTS

The average age of non-survivors was statistically considerably higher than survivors (p<0.05). There was no numerical significance in terms of gender concerning mortality (p>0.05). The duration of ICU stay was statistically considerably prolonged in survivors than in those who did not survive (p<0.05). The leukocytes, neutrophils, urea, creatinine, ferritin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatine kinase (CK), C-reactive protein (CRP), procalcitonin (PCT), and pro-brain natriuretic peptide (pro-BNP) levels were numerically considerably higher in the non-survivors (p<0.05). The platelet, lymphocyte, protein, and albumin levels statistically considerably declined in non-survivors in comparison with survivors (p<0.05).

CONCLUSIONS

Acute renal failure (ARF) increased mortality by 31.815-fold, ferritin by 0.998-fold, pro-BNP by 1-fold, procalcitonin by 574.353-fold, neutrophil/lymphocyte by 1.119-fold, CRP/albumin by 2.141-fold, and protein/albumin by 0.003-fold. It was found that the number of days in the ICU increased mortality by 1.098-fold, creatinine by 0.325-fold, CK by 1.007-fold, urea/albumin by 1.079-fold, and LDH/albumin by 1.008-fold.

A Comparative Study of the Properties of Gelatin (Porcine and Bovine)-Based Edible Films Loaded with Spearmint Essential Oil

Gelatin (bovine/porcine)-based edible films are considered as an excellent carrier for essential oils (EOs) to preserve food quality and extend their shelf life. Spearmint essential oil (SEO) is known for its potential antioxidant and antimicrobial effects; nevertheless, its food applications are limited due to the volatile nature of its active components. Thus, edible films loaded with essential oil can be an alternative to synthetic preservatives to improve their food applications. In the present study, the effect of SEO addition was investigated on the physicochemical properties of bovine and porcine gelatin films, and antioxidant activity was assessed. GCMS (Gas chromatography mass spectrometry) analysis revealed the presence of carvone (55%) and limonene (25.3%) as major components. The incorporation of SEO into the films decreased the opacity, moisture content, water solubility, and elongation at break of bovine and porcine gelatin films. However, with the addition of EO, the thickness and water vapor permeability of bovine and porcine-based gelatin films increased. Moreover, the addition of SEO increased the tensile strength (TS) of the porcine-based film, whereas bovine samples demonstrated a decrease in tensile strength. XRD (X-ray diffraction) findings revealed a decrease in the percentage crystallinity of both types of gelatin films. SEM (scanning electron microscope) results showed the changes in the morphology of films after the addition of SEO. Antioxidant properties significantly increased with the incorporation of EO (p < 0.05) when compared with control films. Therefore, the addition of SEO to gelatin-based edible films could be an effective approach to prepare an active food packaging material to prevent food oxidation.

Fabrication, Characterization, and Antioxidant Potential of Sodium Alginate/Acacia Gum Hydrogel-Based Films Loaded with Cinnamon Essential Oil

Several studies have reported the advantages of incorporating essential oils in hydrogel-based films for improving their physiochemical and antioxidant attributes. Cinnamon essential oil (CEO) has great potential in industrial and medicinal applications as an antimicrobial and antioxidant agent. The present study aimed to develop sodium alginate (SA) and acacia gum (AG) hydrogel-based films loaded with CEO. Scanning Electron Microscopy (SEM), X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC), and texture analysis (TA) were performed to analyze the structural, crystalline, chemical, thermal, and mechanical behaviour of the edible films that were loaded with CEO. Moreover, the transparency, thickness, barrier, thermal, and color parameters of the prepared hydrogel-based films loaded with CEO were also assessed. The study revealed that as the concentration of oil in the films was raised, the thickness and elongation at break (EAB) increased, while transparency, tensile strength (TS), water vapor permeability (WVP), and moisture content (MC) decreased. As the concentration of CEO increased, the hydrogel-based films demonstrated a significant improvement in their antioxidant properties. Incorporating CEO into the SA-AG composite edible films presents a promising strategy for producing hydrogel-based films with the potential to serve as food packaging materials.

The Effect of Sage (Salvia sclarea) Essential Oil on the Physiochemical and Antioxidant Properties of Sodium Alginate and Casein-Based Composite Edible Films

The aim of this study was to examine the effect of Sage (Salvia sclarea) essential oil (SEO) on the physiochemical and antioxidant properties of sodium alginate (SA) and casein (CA) based films. Thermal, mechanical, optical, structural, chemical, crystalline, and barrier properties were examined using TGA, texture analyzer, colorimeter, SEM, FTIR, and XRD. Chemical compounds of the SEO were identified via GC–MS, the most important of which were linalyl acetate (43.32%) and linalool (28.51%). The results showed that incorporating SEO caused a significant decrease in tensile strength (1.022–0.140 Mpa), elongation at break (28.2–14.6%), moisture content (25.04–14.7%) and transparency (86.1–56.2%); however, WVP (0.427–0.667 × 10−12 g·cm/cm2·s·Pa) increased. SEM analysis showed that the incorporation of SEO increased the homogeneousness of films. TGA analysis showed that SEO-loaded films showed better thermal stability than others. FTIR analysis revealed the compatibility between the components of the films. Furthermore, increasing the concentration of SEO increased the antioxidant activity of the films. Thus, the present film shows a potential application in the food packaging industry.

Physicochemical Characterization and Antioxidant Properties of Chitosan and Sodium Alginate Based Films Incorporated with Ficus Extract

Aqueous extract of fruit obtained from Ficus racemosa enriched with phenolic components was used for the first time to fabricate chitosan (CS) and sodium alginate (SA)-based edible films. The edible films supplemented with Ficus fruit aqueous extract (FFE) were characterized physiochemically (using Fourier transform infrared spectroscopy (FT-IR), Texture analyser (TA), Thermogravimetric analysis (TGA), scanning electron microscopy (SEM), X-ray diffraction (XRD), and colourimeter) and biologically (using antioxidant assays). CS-SA-FFA films showed high thermal stability and high antioxidant properties. The addition of FFA into CS-SA film decreased transparency, crystallinity, tensile strength (TS), and water vapour permeability (WVP) but ameliorate moisture content (MC), elongation at break (EAB) and film thickness. The overall increase in thermal stability and antioxidant property of CS-SA-FFA films demonstrated that FFA could be alternatively used as a potent natural plant-based extract for the development of food packaging material with improved physicochemical and antioxidant properties.

Are the perfusion İndex and pleth variability index title an early İndicator of brachial plexus block?

BACKGROUND

Studies on the evaluation of the Perfusion Index (PI) and the Pleth Variability Index (PVI) and the success of PI and PVI block in patients undergoing brachial plexus are limited and quite inadequate.

AIM

In our study, we aimed to compare PI and PVI between the interscalen block and infraclavicular block and evaluate its use as an early marker in block success.

PATIENTS AND METHODS

Single-center prospective randomized controlled trials. Preoperative unit, operating room. Patients over 18 years of age who have had upper extremity surgery. Brachial plexus block (interscalene, infraclavicular). Demographic data, Hemodynamic parameters, Perfusion index and Pleth Variability Index. 40 patients, including ASA1-2, 20 patients over the age of 18, who were planned for upper extremity surgery, in the interscalen group, and 20 in the supraclavicular group, were included in the study. Demographic data of the patients were recorded by measuring PI and PVI values at baseline before the block and at the 1^st, 5^th, 10^th, 15^th, and 20^th minutes after the block, both simultaneously.

RESULTS

62.5% (n = 25) of the patients included in the study were female. The mean age of the patients was detected as 52.63 ± 16.472, the mean BMI as 26.57 ± 4.423, and the mean entry hemoglobin level as 13.71 ± 1.87 g/dL. The hemodynamic data of the groups were similar across the time periods. The increase in PI increased significantly after 1 minute in both groups. The PVI was similar between the groups at all measurement times.

CONCLUSION

In our study, we observed an increase in PI from the 1^st minute compared to the non-blocked arm in successful block applications. We consider the early indicator of PI in the evaluation of block success. In our study, we did not observe a significant change in the arm that was blocked and the arm that was not treated with PVI.

Psychological impacts of COVID-19 pandemic in cancer patients on active treatment

Introduction

Although cancer patients have a high risk of exposing COVID-19 and developing severe complications, they have to receive active treatment. We aimed to determine the psychological conditions of cancer patients and shed light on the establishment of early psychological intervention and intervention policies by making specific recommendations.

Method

We consecutively evaluated 385 cancer patients under treatment. Post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, stress, and associated sociodemographic/clinical characteristics were investigated. In addition, we applied depression-anxiety-stress-scale-21 (DASS-21) for the mental states of patients and Impact of Event-Scale-Revised (IES-R) for the psychological effects of Covid-19.

Results

The mean age was 58 (18-88). 47.2% were psychologically distressful per DASS-21, and 39.3% were traumatic per IES-R scores. 71.9% stated the risk of getting COVID-19 was high since they had cancer, and 82% stated serious complications would develop if they had COVID-19 infection. Patients diagnosed for more than one year were more stressed, anxious, and depressive (p-value = 0.001,0.003,0.049, respectively). Singles were more stressed, depressed, and traumatized than couples (p-value = 0.001, 0.011, 0.001). In multivariate analysis, a significant correlation with being under psychiatric treatment before the pandemic was found for depression (OR: 3.743, 95 %CI: 1.790-7.827) anxiety (OR: 3.776-95 %CI: 1.945-7.332) and stress levels (OR: 4.129, 95 %CI: 1.728-9.866). Having relatives who died or received treatment for COVID-19(OR: 0.515,0.296-0.895) and being unmarried (OR: 2.445-95% CI: 1.260-4.747) predicts PTSD development.

Conclusions

When the psychological effects of the COVID-19 pandemic are manifesting strongly, cancer patients' anxiety and exposure levels are high. It is of great importance that clinicians understand needs, recognize psychological distress, and direct them to relevant departments for supportive care.

Evaluation of plethysmographic variability index and hemoglobin monitoring in patients who underwent laparoscopic cholecystectomy

OBJECTIVE

The aim of the study was to determine the interaction of Pleth Variability Index, Perfusion Index (PI) and Peripheral Blood Hemoglobin (SpHb) values during the surgical phases of laparoscopic cholecystectomy.

PATIENTS AND METHODS

After the approval of the Ethics Committee, the patients who experienced laparoscopic cholecystectomy between October 2020 and January 2021 in our hospital were included in the study. We analyzed peripheral blood hemoglobin, pleth variability index, and the perfusion index values of 87 patients who underwent cholecystectomy. We performed the study with Masimo Radical 7 pulse oximeter probe (Masimo Radical 7; Masimo Corp., Irvine, CA, USA) in this present study.

RESULTS

According to the analysis of our results it has been found that hemoglobin, T5, T6, T7 values were found to be significantly higher than T3, T4, T8 values (p<0.05). The PVI T4 value was the highest within the periods, and it was found to be statistically significantly higher between T5, T6, and T7 values (p<0.05). Close values were detected in PI, T1 and T8 periods. T2 value measured during the period of mechanical ventilator was found to be significantly higher than the in T1, T3, T6 values (p<0.05).

CONCLUSIONS

In this study, we followed the SpHb, SPOC, and ORI values in these steps (T1-T8) and investigated the interaction between them. Knowing the response of monitoring to these conditions is important for the treatments to be performed.

Time from first tumor manifestation to diagnosis in patients with GEP-NET: Results from a large German tertiary referral center

Patients with neuroendocrine tumors (NET) often go through a long phase between onset of symptoms and initial diagnosis.Assessment of time to diagnosis and pre-clinical pathway in patients with gastroenteropancreatic NET (GEP-NET) with regard to metastases and symptoms.Retrospective analysis of patients with GEP-NET at a tertiary referral center from 1984 to 2019; inclusion criteria: Patients ≥18 years, diagnosis of GEP-NET; statistical analysis using non-parametrical methods.Four hundred eighty-six patients with 488 tumors were identified; median age at first diagnosis (478/486, 8 unknown) was 59 years; 52.9% male patients. Pancreatic NET: 143/488 tumors; 29.3%; small intestinal NET: 145/488 tumors, 29.7%. 128/303 patients (42.2%) showed NET specific and 122/486 (25%) patients other tumor-specific symptoms. 222/279 patients had distant metastases at initial diagnosis (187/222 liver metastases). 154/488 (31.6%) of GEP-NET were incidental findings. Median time from tumor manifestation (e.g., symptoms related to NET) to initial diagnosis across all entities was 19.5 (95% CI: 12-28) days. No significant difference in patients with or without distant metastases (median 73 vs 105 days, P = .42).A large proportion of GEP-NET are incidental findings and only about half of all patients are symptomatic at the time of diagnosis. We did not find a significant influence of the presence of metastases on time to diagnosis, which shows a large variability with a median of <30 days.

Time from first symptoms to diagnosis in GEP-NET patients: Results from a large German tertiary referral center

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Background: Patients with neuroendocrine tumors (NET) often go through a long phase between onset of symptoms and initial diagnosis. Methods: Retrospective analysis of 486 patients with GEP-NET (488 tumors) at tertiary referral center from 1984-2019; inclusion criteria: Patients > 18 years, diagnosis of GEP-NET; descriptive analysis using SPSS; Cox regression, Log rank test. Results: Demographics: Male 54% / 52.9% (all/GEP-NET), median age at first diagnosis 63y/58y (all /GEP-NET). Localizations: small intestine 145/488 (29.7%), pancreas 143/488 (29.3%), CUP 53/488 (10.9%), colon 49/488 (10%), stomach 45/488 (9.2%), rectum 27/488 (5.5%), other digestive organs 11/488 (2.3%), esophagus 5/488 (1%), other 10/488 (2%). Ki67 in 330/488 (67.6%) evaluable patients: < 3%: 155/330; 46.9%; ≥ 3%: 111/330; 33.6%; > 20%: 64/330;19.3%. 128/488 (26.2%) of patients had NET specific symptoms (abdominal pain 77/128; 60.2%, diarrhea 51/128; 39.8%, flush 19/128; 14.8%, carcinoid syndrome 8/128; 6.3% tachycardia 6/128; 4.7%). 122/488 (25%) patients showed other tumor-specific symptoms (weight loss 48/122; 39.3%, stool irregularity 21/122; 17.2%, hypoglycemia 10/122; 8.2%, painless jaundice 8/122; 6.6%). 154/ 488 (32%) of NET were incidental findings (imaging 39.6%, endoscopy 23.4%, surgery for other causes 18.8%, appendectomy 15.6%). 221/279 (initial diagnosis/any time; 79.2%) patients had distant metastases at initial diagnosis (187/221 liver metastases). Time from tumor manifestation to initial diagnosis: pNET 360 ± 116 days, siNET 309 ± 87 days, gastric NET 66 ± 47 days, colonic NET 98 ± 67 days. Time from onset of symptoms to diagnosis in symptomatic patients was significantly longer than in asymptomatic patients (388 ± 86 days vs. 174 ± 58 days, p = 0.001). No significant difference in patients with or without distant metastases (223 ± 78 days vs. 259 ± 57 days, p = 0.355). Conclusions: A large proportion of NET are incidental findings and only about half of all patients are symptomatic at the time of diagnosis. Diagnosis for symptomatic patients takes significantly longer than for asymptomatic, which might be due to mainly unspecific symptoms. Presence of metastases has no influence on time to diagnosis.

Predicting Chronic Leukaemias from Assessment of Complete Peripheral Blood Counts

The chronic leukaemias include two distinct chronic neoplastic disease states, namely chronic myelogenous leukaemia (CML) and chronic lymphocytic leukaemia (CLL). The aim of this study was to assess the utility of leucocyte count, neutrophil percentage and absolute lymphocyte count from differential complete blood count analyses as indicators of the possible presence of CML and CLL. Blood counts from 102 patients with histopathologically confirmed CML and CLL were compared with counts for 858 cancer-free control subjects. Optimal cut-off values were identified by selecting values with the highest sensitivity–specificity combination for each blood count parameter for the two diseases. The results indicated that any individual with mature-appearing lymphocytes at a level > 6.65 × 109/l in the peripheral blood should be examined further for CLL, and that any individual with a leucocyte count > 18.0 × 109/l or a neutrophil proportion > 72.6% should be investigated for CML.

The Effect of Synthetic Cannabinoids on P-Wave Dispersion: An Observational Study

OBJECTIVE

The aim of this study was to investigate the effect of synthetic cannabinoids (SC) on P-wave dispersion (PD) in patients who consume SC.

MATERIALS AND METHODS

The study population included 72 patients who consumed SC and 36 age- and sex-matched healthy controls. The severity of addiction was detected using the addiction profile index (BAPI). The PD was measured by 12-lead ECG obtained upon admission to hospital. Statistical analyses were performed using the SPSS v20.0 statistical software package.

RESULTS

The mean age of the patients and controls was 26.9 ± 7.0 and 26.3 ± 6.5 years, respectively. Mean duration of SC consumption was 1.7 ± 0.7 years. Mean BAPI score of patients who consumed SC was 12.8 ± 3.4. Patients who consumed SC had a significantly higher PD value than controls (37.7 ± 11.5 vs. 30.6 ± 6.4 ms, p < 0.001). The BAPI score was significantly correlated with PD value (r = 0.675, p < 0.001). In the linear regression model that included PD value, age and heart rate, PD value was significantly and independently correlated with BAPI score (r2 of the model = 0.339; p < 0.001).

CONCLUSIONS

In this study, patients who consumed SC had significantly higher PD values than controls, and the BAPI score correlated with the PD value. Hence SC consumption could lead to an increased risk of cardiovascular disease through prolonged PD. We recommend the use of the simple and inexpensive ECG to assess cardiovascular risk in patients who consume SC.

Breast cancer in octogenarian women: clinical characteristics and outcome

PURPOSE

Breast cancer incidence increases in the elderly but data on treatment and outcomes of elderly patients is limited. We assessed the clinicopathological features and outcomes of our patients with breast cancer aged ≥80 years in comparison with their younger postmenopausal counterparts.

METHODS

The records of 83 patients diagnosed with breast cancer after the age of 80 (group 1) between 2003 and 2011 in 4 different centers were retrospectively evaluated and the clinicopathological features and outcomes were assessed in comparison with a control group (group 2) of 249 patients aged between 60-70 years.

RESULTS

Median ages at diagnosis were 82 years (range 80-95) and 64 years (range 60-70) for group 1 and group 2, respectively. The incidence of invasive cancers other than ductal or lobular type was higher in group 1 than in group 2 (20 vs 8%; p=0.0177rpar;. More patients in group 1 had Charlson Comorbidty scores ≥1 than those in group 2 (49 vs 36%; p=0.011). Patients in group 1 had more conservative operations and less axillary node dissections (ALND) and they received chemotherapy, trastuzumab or radiotherapy less frequently compared to their younger counterparts in group 2. Median follow up period was 36 months (range 1-178) in group 1 and 24 months (range 12-217) in group 2. Five-year disease free survival (DFS) was 53.7 and 75.9) (p=0.005), 5-year overall survival (OS) was 61.9% and 80.47percnt; in group 1 and group 2 (p=0.001), respectively. Advanced stage (stage IV vs stage I, II, III, p=0.051) and cerbB2 positivity (p<0.001) were found to be associated with shorter DFS in patients ≥80 years of age.

CONCLUSION

Although the majority of patients were undertreated in our study according to the current guidelines, mortality rates were quite low. Different biology of the disease in the elderly might explain this difference.

Effects of Imatinib Mesylate on Renin–Angiotensin System (RAS) Activity during the Clinical Course of Chronic Myeloid Leukaemia

The renin–angiotensin system (RAS) is involved in cell growth, proliferation and differentiation in bone marrow in an autocrine–paracrine manner, and it modulates normal and neoplastic haematopoietic cell proliferation. This study aimed to assess expressions of the RAS components, renin, angiotensinogen and angiotensin-converting enzyme (ACE), during imatinib mesylate treatment of patients with chronic myeloid leukaemia (CML). Expressions of RAS components were studied in patients with CML at the time of diagnosis ( n = 83) and at 3, 6 and 12 months after diagnosis ( n = 35) by quantitative real-time polymerase chain reaction. De novo CML patients had increased ACE, angiotensinogen and renin mRNA levels and these expression levels decreased following administration of imatinib. The RAS activities were significantly different among Sokal risk groups of CML, highlighting the altered biological activity of RAS in neoplastic disorders. The results of this study confirm that haematopoietic RAS affects neoplastic cell production, which may be altered via administration of tyrosine kinase inhibitors such as imatinib mesylate.

Successful treatment of myelodysplastic syndrome-induced pyoderma gangrenosum

We report successful treatment of a refractory myelodysplastic syndrome-associated pyoderma gangrenosum with the combination of thalidomide and interferon-alpha2a in a single patient. A non-healing wound developed on a 40-year-old woman's left thumb after minor trauma. Massive ulcerovegetative lesions developed after reconstruction surgery. Histopathological examination of the bone marrow and cytogenetic studies revealed an atypical myeloproliferative/myelodysplastic syndrome. The skin lesions resolved dramatically after two months of thalidomide and interferon-alpha2a combination therapy and the haematological status improved.

Overt gastrointestinal bleeding in haematologic neoplasms

BACKGROUND AND AIM

Patients with acute leukaemia suffer from various haemorrhages, most frequently due to thrombocytopenia. We could not reach any information regarding the frequency of gastrointestinal bleeding in acute leukaemia and decided to search this complication in patients with acute and chronic leukaemias and myeloproliferative disorders, retrospectively.

PATIENTS AND METHODS

During a 6-year period, 291 patients with acute leukaemia, 52 patients with chronic leukaemia and 108 patients with myeloproliferative disorders had been followed. Thirty-two cases of overt gastrointestinal haemorrhage episodes (25 upper, 7 lower) were observed during the mentioned period.

RESULTS

The frequency of bleeding episodes was 7.1% (32/451) in haematologic malignancies as a whole, 5.8% (17/291) for acute leukaemia, 1.9% (1/52) for chronic leukaemia and 13% (14/108) for myeloproliferative disorders. If the patients with myeloproliferative disorders in blastic phase were analysed separately, the ratio was 30% (6/20). Oesophagogastroduodenoscopy, which could be performed in 8 of 25 upper gastrointestinal haemorrhage episodes, revealed erosive gastritis in five patients and duodenal ulcers in three patients. Neutropenic enterocolitis was the underlying cause in all of the seven patients with lower gastrointestinal haemorhage. Five out of the seven patients had acute leukaemia. In 7 bleeding attacks, out of 32, the ultimate result was death. Generally, the haemorrhage was only a contributing cause of mortality. All of the mortality cases were patients with acute leukaemia.

CONCLUSION

Especially, the patients with myeloproliferative disorders are prone to develop gastrointestinal haemorrhage. The manifestation is generally as upper gastrointestinal bleeding due to gastric erosions and duodenal ulcers. Lower gastrointestinal bleeding is frequently a problem of the patients with acute leukaemia. It is commonly a sign of neutropenic enterocolitis.

A patient presenting with spinal cord compression who had two distinct follicular cell type thyroid carcinomas

A 61-yr-old woman presented with complaints of weakness and pain in her legs. A magnetic resonance imaging showed a 3 x 5.6 x 7.8 cm mass lesion destructing the T1 and T2 vertebral bodies and compressing the spinal cord. The mass was excised surgically. It was follicular carcinoma metastasis of the cervicodorsal region. Then, she underwent a total thyroidectomy. Pathological examination showed two different types of carcinomas in two different focuses; follicular carcinoma in the left lobe and follicular variant papillary carcinoma in the isthmic lobe. After the operation she was given 100 mCi 131I. This is the first report of a patient who had both metastatic follicular carcinoma and follicular variant papillary carcinoma together.

Plasma leptin levels of large for gestational age and small for gestational age infants

The hormone leptin produced in the adipose tissue is involved in the regulation of body weight. This study investigates whether plasma leptin levels are related to an infant's birthweight, and whether the levels change with feeding. We measured plasma leptin levels from infants who were large for gestational age (n = 21), small for gestational age (n = 21), and appropriate for gestational age (n = 20). Two blood samples were collected before and after breastfeeding from each infant and plasma leptin concentrations were determined by radioimmunoassay. Leptin concentration was found to be increased in large for gestational age infants and to be decreased in small for gestational age infants compared with the level in appropriate for gestational age infants. There was a positive correlation between plasma leptin levels and both the infants' birthweights and the body mass indexes. Plasma leptin concentrations were found to be decreased during fasting and to be increased after feeding (p < 0.01). It is concluded that the plasma leptin levels correlate with the size of adipose tissue mass and are related to the nutritional status.

[Test of electrical stimulation of the round window. Diagnostic and prognostic value of the rehabilitation of total deafness by cochlear implant]

The round window electrical stimulation (RWES) test has been performed in 708 cases of total deafness. Among them 244 have successfully benefited with a cochlear implant. Electrical Brain Stem Evoked (EBSE) potential elicited by this stimulation have been registrated in 283 cases, 113 of them during general anesthesia necessary in children. This test supplies the patient with a subjective sound sensation and/or EBSE in 93% of cases. The correlation between electrical data of this RWES test and clinical results of the cochlear implant is described. This test is discussed regarding the simple transtympanique promonotory stimulation test.