Production of Bovine Colostrum for Human Consumption to Improve Health

Colostrum contains all essential nutrients for the neonate during the first days of life, with impacts that continue far beyond these first days. Bovine colostrum has been used for human consumption due to the high concentrations of bioactive proteins, vitamins, minerals, growth factors, as well as free and conjugated oligosaccharides. Processes involved in the preparation of bovine colostrum for human consumption play a pivotal role in preserving and maintaining the activity of the bioactive molecules. As bovine colostrum is a multifunctional food that offers a myriad of benefits for human health, assessing the main processes used in preparing it with both advantages and disadvantages is a crucial point to discuss. We discuss major processes effects for colostrum production on the nutritional value, some advanced technologies to preserve processed bovine colostrum and the end-product forms consumed by humans whether as dairy products or dietary supplements.

Determining Total Protein and Bioactive Protein Concentrations in Bovine Colostrum

Colostrum is a complex biological fluid produced by mammals immediately after parturition. It meets all the nutritional requirements for neonates as a good source of macro- and micronutrients, bioactive peptides, and growth factors. Bovine colostrum is also a potential source of nutrition and bioactive because of its rich protein content that includes immunoglobulin G (IgG) and lactoferrin. However, the level of lactoferrin and IgG in bovine colostrum changes markedly during the lactation period. Therefore, monitoring the concentration of IgG and lactoferrin for the use of bovine colostrum as a protein source is an important question to study. Methods in this article describe how to determine protein content, as well as specific concentrations of lactoferrin and IgG. These methods include the following steps: Isolation of bovine colostrum proteins, Determination of protein concentration via Bicinchoninic acid assay (BCA), Visualization of proteins via SDS-PAGE, Determination of lactoferrin, and IgG concentration using an ELISA Assay.

Effects of clinical factors on quality of life following curative gastrectomy for gastric cancer

Aim

We aimed to assess the factors which may affect the quality of life (QoL) of the patients who underwent curative gastrectomy for gastric cancer.

Subjects and Methods

Patients with gastric cancer, who underwent gastrectomy with curative intent at Department of Gastrointestinal Surgery, Kartal Training and Research Hospital from January 2013 to December 2015, were retrospectively reviewed. Gastrointestinal Quality of Life Index was utilized for this research. The clinical factors that might affect QoL after gastrectomy were selected. They were demographic data (age and gender), the American Society of Anesthesiologists classification, body mass index (BMI), operative variables (level and type of resection, type of dissection [D1, D2], type of reconstruction, and additional organ resections), postoperative appetite level, type of oncological treatment, and pathological stages. One hundred and eighteen patients were included in this study.

Results

Eighty-seven (73.7%) of them were male and mean age was 59.4 ± 10.2 (36-74). Mean follow-up period was 25.7 ± 11.3 (6-42) months. According to multivariate analysis, advanced stage, neoadjuvant therapy, lower BMI, poor appetite, and shorter follow-up were independently associated with poorer cumulative scores.

Conclusions

Advanced stage, application of neoadjuvant therapy, low BMI level, and poor postoperative appetite may deteriorate the postoperative QoL of the patients with gastric cancer.

Effects of dexmedetomidine and thymoquinone on erythrocyte deformability in lower limb ischemia reperfusion injury in streptozotocin-induced diabetic rats

OBJECTIVE

In this study we aimed to evaluate the effect of dexmedetomidine and thymoquinone on erythrocyte deformability in lower limb ischaemia-reperfusion (IR) injury in streptozotocin-induced diabetic rats.

MATERIAL AND METHODS

Thirty Wistar albino rats were equally divided into 5 groups (n = 6); randomized control group (Group C), diabetes control group (Group DC), DIR group (Group DIR), DIR group with thymoquinone 25 mg.kg‒1 intraperitoneally (Group DIRT) and Group DIR with dexmedetomidine 100 µg.kg‒1 intraperitoneally (Group DIRD). Erythrocyte packs were prepared from heparinized blood samples and deformability measurements were performed.

RESULTS

IR significantly increased the relative resistance, a marker of erythrocyte deformability when compared to control group (p < 0.05). There were significant differences among the groups in comparisons with ANOVA test (p < 0.0001). Comparisons of the groups DIRD and DIRT revealed similar results (p = 0.824). The values of Group DIR were significantly higher than those of the control, DC, DIRD and DIRT groups (p < 0.0001, p = 0.001, p = 0.004, p = 0.002, respectively). The values of the DC, DIR, DIRD and DIRT groups were significantly higher than those of the control group (p < 0.0001, all).

CONCLUSION

Erythrocyte deformability may cause more problems in microcirculation. Dexmedetomidine and thymoquinone may be useful in reducing the adverse effects of this type of injury (Fig. 1, Ref. 41).

Effects of thoracic epidural or intravenous analgesia on the neutrophil-to-lymphocyte ratio in thoracotomy cases

Background and Purpose

Postoperative pain is a significant problem in thoracotomy patients. Our aim in this study was to investigate the relationship between postoperative pain and neutrophil-to-lymphocyte ratio (NLR) which is a marker of acute inflammatory response.

Materials and Methods

Thoracic epidural or intravenous analgesia was administered to thoracotomy patients who elected to undergo a planned surgery. Patients were divided into two groups according to the analgesia method applied postoperatively. Thoracic epidural analgesia was recorded as Group 1 and intravenous analgesia as Group 2. Whole blood counts were recorded from preoperative and postoperative 24^th- and 48^th-hour routine blood samples, and NLRs were recorded as retrospective file scanning. Postoperative 24^th- and 48^th-hour NLRs and preoperative NLR values were recorded.

Results

Demographic data of the patients included in the study were similar except for age. Preoperative NLR was significantly higher in Group 1 at 3.50 (P = 0.004) than in Group 2 at 2.51. Postoperative NLRs were similar among both groups. Postoperative NLR values at both the 24^th- and 48^th-hour increased by4.9 times in Group 1 and 9.23 times in Group 2 from the 24^th-hour preoperative period, when the preoperative NLRs were evaluated. The rate of increase in Group 1 was significantly lower than in Group 2 (P = 0.006).

Conclusion

Postoperative NLR alterations when compared with preoperative values were related to the analgesic regimen used.

Intrinsic charge-mobility in benzothieno[3,2-b][1]benzothiophene (BTBT) organic semiconductors is enhanced with long alkyl side-chains

Longer alkyl side-chains in BTBTs regulate structural order, cause balanced transport and lead to enhanced intrinsic charge-carrier mobility.

Effects of intravenous ibuprofen and lornoxicam on erythrocyte deformability in rats undergoing hind limb ischemia reperfusion injury

BACKGROUND AND AIM

Acute hind limb ischemia reperfusion (I/R) injury is a common consequence of abdominal aorta cross‑clamping during aortic surgery. Erythrocyte deformability is affected by I/R process and may lead to increased tissue and organ injury. Lornoxicam and intravenous ibuprofen are becoming commonly used as non-steroidal anti-inflammatory drugs (NSAID) for postoperative analgesia. In this study, we aimed to investigate the effects of lornoxicam (2 mg/kg iv) and intravenous ibuprofen (30 mg/kg iv) on erythrocyte deformability in I/R model in rats.

MATERIALS AND METHODS

Four study groups, each containing 6 Wistar rats were created. Laparotomy was performed in all groups under general anesthesia with ketamine and xylazine. In all groups except sham group, ischemia and reperfusion were achieved by clamping and declamping the infrarenal abdominal aorta for 120 minutes. Rats in Group IR+L received intravenous infusion of lornoxicam (2 mg/kg) while rats in Group IR+I received intravenous infusion of ibubrofen (30 mg/kg) following 2 hours of ischemic period. At the end of reperfusion period, erythrocyte packs were prepared from heparinized blood samples. Erythrocyte suspensions with hematocrit at a concentration of 5% in a phosphate‑buffered saline (PBS) were used in order to perform deformability measurements. The value of p<0.05 was considered statistically significant.

RESULTS

Relative resistance has increased in ischemia reperfusion group when compared to control group (p < 0.0001). Lornoxicam or ibuprofen intravenous treatments did not change the erythrocyte deformability during ischemia reperfusion period in rats (p=0.851, p=0.690).

CONCLUSION

Intravenous ibuprofen or lornoxicam administrations during ischemia reperfusion period in rats have no negative effect on erythrocyte deformability. The findings of the study should be supported with more detailed and extensive clinical/experimental studies in the future (Fig. 1, Ref. 18).

A retrospective analysis of blood gases with two different insulin infusion protocols in patients undergoing cardiovascular surgery

AIM

Intraoperative blood glucose concentration is known to be an independent risk factor for morbidity and mortality in patients undergoing cardiovascular surgery. Arterial blood gas analysis is an important investigation to monitor the acid-base balance and gas exchange in these patients. Hyperglycemia leads to a series of metabolic changes which affect acid-base balance and serum electrolytes. In this study, we aimed to look into the effect of glycemic control on arterial blood gas parameters, serum electrolytes, and hemoglobin (Hb).

MATERIALS AND METHODS

We collected data from diabetic patients who underwent cardiovascular surgery between 2010 and 2014. The patients were divided into two groups according to the insulin infusion protocols applied such as with conventional (180-250 mg/dl) (n = 17) (Group 1) and tighter glycemic targets (121-180 mg/dl) (n = 51) (Group 2). We retrospectively analyzed arterial blood gas results taken at different perioperative time points from these patients.

RESULTS

We found that pH HCO3and base excess, serum sodium, potassium, calcium, and Hb were similar in both groups.

CONCLUSION

Our study showed that a tighter intraoperative glycemic control does not affect arterial blood gas parameters, serum electrolytes, or Hb when compared to the conventional glycemic control.

The effects of low and high doses of sugammadex on kidney tissue in streptozotocin-induced diabetic rats

BACKGROUND

Sugammadex is primarily excreted via renal route. We investigated effects of low and high doses of sugammadex (16 mg/kg versus 96 mg/kg) on renal tissue samples of streptozotocin-induced diabetic rats.

MATERIAL AND METHODS

Twenty-four Wistar albino rats were divided into 4 groups. Group C (control - 0.9 % NaCl), Group DC (diabetes control; 55 mg/kg streptozotocin, IP, only), Group DR-16S (diabetes-rocuronium - 16 mg sugammadex, IV.) and Group DR-96S (diabetes- rocuronium - 96 mg sugammadex, IV). Renal tissue histopathological evaluation and antioxidant status (measurements of MDA levels and NO activities) were studied.

RESULTS

Significantly higher levels of all inflammation parameters (inflammation, degeneration/necrosis, tubular dilatation, tubular cell degeneration, dilatation in Bowman's space, tubular hyaline casts, and lymphocyte infiltration) were found in the 96 mg/kg sugammadex group. Higher MDA tissue levels and lower NO activity were found in the 96 mg/kg sugammadex group.

DISCUSSION

We can conclude that high-dose (96 mg/kg) sugammadex administration resulted in significant renal tissue damage in diabetic rats. As a consequence, low doses of sugammadex have to be preferred in diabetic patients (Tab. 2, Fig. 4, Ref. 26).

Effect of levosimendan on erythrocyte deformability during myocardial ischaemia-reperfusion injury

Diabetes mellitus (DM) is a chronic metabolic disorder accompanied by an increase in oxidative stress. Ischaemia-reperfusion (IR) injury is a cascade of events initiated by tissue ischaemia. The cellular damage produced by reperfusion leads to an active inflammatory response. Erythrocyte deformability and plasma viscosity are of crucial importance for the perfusion of tissues and organs. The aim of this study was to evaluate the effect of levosimendan on erythrocyte deformability during IR myocardial injury in diabetic rats.

METHODS

Twenty-four Wistar albino rats were included in the study after streptozocin (55 mg/kg) treatment for 4 weeks to observe the existence of diabetes. The animals were randomly assigned to one of four experimental groups. In Group C and DC (sham-control group), the coronary artery was not occluded or reperfused in the control rats. Myocardial IR was induced by ligation of the left anterior descending coronary artery for 30 min, followed by 2 h of reperfusion in the diabetes-IR (DIR) and diabetes-IR-levosimendan (DIRL) group. Deformability measurements were performed in erythrocyte suspensions containing Htc 5 % in a phosphate-buffered saline (PBS) buffer.

RESULTS

The deformability index was significantly increased in the diabetic rats. It was similar in Group DC and DIRL It was significantly increased in the DIR group compared to Group C, DIRL and DC. The relative resistance was increased in the IR models.

CONCLUSION

Erythrocyte deformability was decreased in rats with diabetes and IR injury. This injury might lead to further problems in microcirculation. Levosimendan may be useful in enhancing the adverse effects of this type of injury (Fig. 2, Ref. 41).

KEYWORDS

erythrocyte deformability, myocardial ischaemia reperfusion, experimental diabetes, levosimendan, rat.

Wound Infection After Simple Suture at the Emergency Ward

Of 386 consecutive patients whose wounds were sutured at the emergency ward of the Soroka Medical Center, 228 returned for a follow-up visit during which pus was observed in 40 sutured wounds. Most of the patients were males, 50% lived in the city, and 13% were Beduin. Fifty percent of the wounds were dressed prior to admission. All wounds were rinsed prior to suture, 78% in a cetrimide-chlorhexidine HC1 solution and in 71% an irrigation with a povidone-iodine solution was performed. The physicians who performed the procedure were graded by their medical experience; 43% of the sutures were performed by interns, 32% by junior residents, 19% by senior residents and 6% by a specialist. Silk thread was the most commonly used suture material (79%). Wounds were classified according to size, depth and state of the margins of the wound. It was noted whether an excision was performed and the type of treatment that was prescribed after the procedure. None of the above-mentioned criteria identified a group as high-risk. Experienced physicians sutured the more serious wounds, but their infection rate did not differ significantly from other physicians.

Effect of dexmedetomidine on erythrocyte deformability during ischaemia-reperfusion injury of heart in diabetic rats

The aim of this study is to evaluate the effect of dexmedetomidine on erythrocyte deformability during IR heart injury in diabetic rats.

METHODS

Eighteen Wistar Albino rats were included in the study after streptozocin (55 mg/kg) treatment for four weeks. In the Group C and DC (sham-control group), the coronary artery was not occluded or reperfused in the control rats. In the Group DIR, a branch of the left coronary artery was occluded for 30 minutes followed by two hours of reperfusion to produce IR. In the Group DIRD, a branch of the left coronary artery was occluded for 30 minutes followed by two hours of reperfusion to produce IR, and dexmedetomidine was administrated via 100 µg/kg IP route 30 minutes before ligating the left coronary artery. Deformability measurements were performed in erythrocyte suspensions containing Htc 5 % in a PBS buffer.

RESULTS

The deformability index was significantly increased in diabetic rats; however, it was similar in the Group DC and DIRD. It was significantly increased in the Group DIR when compared to the Group C, DIRD and DC. The relative resistance was increased in IR models.

CONCLUSION

Erythrocyte deformability was decreased in rats having diabetes and IR injury. This injury might lead to further problems in microcirculation. It was shown that dexmedetomidine might be useful in enhancing the adverse effects of this type of injury (Fig. 1, Ref. 39).

The effects of dexmedetomidine on pulmonary artery pressure in experiment

AIM

The primary purpose of this study is to assess the effects of dexmedetomidine (DEX) infusion on pulmonary artery pressures (PAP), heart rate (HR), and mean arterial pressure (MAP) in pigs. The secondary purpose is to evaluate whether DEX infusion via the pulmonary artery has any beneficial effect over the peripheral IV route.

MATERIALS AND METHODS

Sixteen healthy male pigs (25-35 kg) scheduled for laparoscopy training were used in this study. The animals were randomly allocated into two groups: Group I (n = 9): A loading dose of 1 μg/kg DEX was administered over 10 minutes followed by an infusion of 0.5 μg/kg/hr for one hour via the pulmonary artery catheter. Group II (n = 7): A loading dose of 1 μg/kg DEX was administered over 10 minutes followed by an infusion of 0.5 μg/kg/hr for one hour via the peripheral venous catheter. Mean PAP, HR, MAP, SpO2, and ETCO2 were recorded at 5, 10, 15, 30, 45, and 60 minutes after the initiation of the DEX infusion.

RESULTS

Heart rate and MAP were similar in both groups at all time points. Also, neither the HR nor the MAP deviated from the basal values in Groups I and II at any time point. The mean PAP values were similar in Groups I and II, and in Group I, the mean PAP values were similar to Group I's basal value at all time points. However, in Group II, the mean PAP values at 5, 45, and 60 minutes were significantly lower than Group II's basal value (p = 0.023, p = 0.041, p = 0.015, respectively).

CONCLUSION

DEX infusion did not elevate the mean PAP and the results from the administration of DEX through the peripheral vein and pulmonary artery were similar (Tab. 3, Ref. 13).

Investigation of the effects of propofol and vitamin C administration on erythrocyte deformability in rats with streptozotocin-induced diabetes mellitis

PURPOSE

In the current study we aim to investigate the effects of vitamin C and profol on red blood cell deformability in diabetic rats.

MATERIALS AND METHODS

Twenty- eight Wistar Albino rats were included in the study after streptozocin (60 mg/kg) treatment for 4 weeks of observation for diabetes presence. Twenty-eight rats were allocated to 4 groups. In group DP (n = 7) 150 mg.kg-1 of propofol was injected intraperitoneally. In group DP-vit C (n = 7) rats 100 mg/kg of vitamin C (Ascorbic acid, Redoxon® 1000 mg/5 mL - Roche) were applied one hour before administrating 150 mg.kg-1 of propofol, while rats in control group (n = 7), and diabetic control group (n = 7) received intraperitoneally physiological saline. Deformability measurements were achieved by using erythrocyte suspensions with hematocrit level of 5 % in PBS buffer.

RESULTS

Erythrocyte deformability was significantly higher in diabetic control group than in control and vitamin C plus propofol groups (p = 0.00, p = 0.025, respectively). Erythrocyte deformability indexes were found similar in control group and vitamin C plus propofol group (p = 0.949). Relative resistance was increased in diabetic rat model.

CONCLUSIONS

Erythrocyte deformability was damaged in rats with diabetes. This injury might lead to further problems in microcirculation. Application of propofol did not alter red cell deformability in diabetic rats. Vitamin C supplementation seems to reverse those negative effects and variations in erythrocyte deformability (Fig. 2, Ref. 57).

Postoperative analgesic effect of epidural neostigmine following caesarean section

AIM

The aim of this study was to evaluate the analgesic effects of postoperative epidural administration of neostigmine and morphine in patients scheduled for caesarean section under epidural anaesthesia.

MATERIAL AND METHODS

Sixty ASA I-II patients, scheduled for caesarean section under epidural anaesthesia, were randomly allocated into three groups. Neostigmine (10 μg/kg), morphine (3 mg), and saline (6 mL) were administered to the neostigmine, morphine, and control groups, respectively, 30 minutes after the surgery via the epidural catheter. Afterwards, postoperative pain treatment was administered to all patients with a patient-controlled epidural analgesia (PCEA) device, using 0.125% bupivacaine. The patients were followed up for 24 hours. The total volume of local anaesthetics used, the time to first analgesic requirement, analgesic requirements, VAS scores, analgesia quality, first passage of bowel gas, ambulation times, haemodynamic parameters and side effects were evaluated.

RESULTS

The time to first analgesic requirement was significantly longer in the morphine group than in the neostigmine and control groups (p<0.01), and in the neostigmine group compared to the control group (p<0.05). The total local anaesthetic consumption and the number of bolus injections were significantly higher in the control group than in the other groups (p<0.01). The first passage of bowel gas occurred significantly sooner in the neostigmine group than in the morphine (p<0.01) and the control (p<0.05) groups. Itching frequency was significantly higher in the morphine group than in the other two groups (p<0.05). VAS scores were similar in the morphine and neostigmine groups.

CONCLUSION

Postoperative single-dose epidural neostigmine reduced the 24-hour analgesic requirements but in the chosen doses presented an analgesic effect significantly lower than morphine. Hippokratia 2014; 18 (1): 44-48.

Effect of iloprost on erythrocyte deformability in rat's lower extremity undergoing an ischemia reperfusion injury

AIM

Ischemia reperfusion injury (I/R) in lower extremity is a frequent and important clinical phenomenon. The protective effect of iloprost on local and distant organ injury due to I/R has been well documented but its effect on erythrocyte deformability needs further investigation. Our aim was to investigate the effect of iloprost on erythrocyte deformability in the infrarenal aorta of rats undergoing I/R.

MATERIALS AND METHODS

Our study was conducted with 18 Wistar albino rats. Rats were divided into the 3 groups; the randomized control group (group C; n=6), I/R group without iloprost (group I/R; n=6) and I/R group with iloprost - 10 mcg.kg-1, 30 min infusion (group I/R-I; n=6). Packs of erythrocytes were prepared from heparinized blood samples and deformability measurements were done.

RESULTS

The comparisons of the control and I/R-I groups revealed similar results (p=0.951). The values of the IR group were significantly higher than those of the control and IR-I groups (p=0.006, p=0.011, respectively).

CONCLUSION

In our study, we detected the unfavourable effects of I/R on erythrocyte deformability, which may lead to disturbance in blood flow and hence tissue perfusion in the infrarenal rat aorta. We also found that Iloprost had beneficial effects by reversing the undesirable effects of I/R (Fig. 1, Ref. 15).

Activation of basophils by the double-stranded RNA poly(A:U) exacerbates allergic inflammation

BACKGROUND

It is commonly acknowledged that asthma is exacerbated by viral infections. On the other hand, basophil infiltration of lung tissues has been evidenced postmortem in cases of fatal disease, raising the question of a possible link between these two observations.

OBJECTIVES

Herein, we addressed the relationship between asthma exacerbation by viral infection and basophil activation and expansion by investigating how stimulation with the dsRNA polyadenylic/polyuridylic acid [poly(A:U)] affected basophil activities and recruitment in an allergic airway inflammation model.

METHODS

The effect of dsRNA on basophils was assessed by measuring the cytokine levels produced upon stimulation. We used an OVA-induced experimental model of allergic asthma. Airway hyperreactivity, recruitment of infiltrating cells, and cytokine production were determined in the lung of mice having received poly(A:U), as compared with untreated controls. The exacerbating effect of basophils was assessed both by adoptive transfer of poly(A:U)-treated basophils and by their in vivo depletion with Ba103 antibody.

RESULTS

We found that in vitro treatment with poly(A:U) increased basophil functions by inducing TH 2-type cytokine and histamine production, whereas in vivo treatment increased peripheral basophil recruitment. Furthermore, we provide the first demonstration for increased infiltration of basophils in the lung of mice suffering from airway inflammation. In this model, disease symptoms were clearly exacerbated upon adoptive transfer of basophils exposed to poly(A:U), relative to their unstimulated counterpart. Conversely, in vivo basophil depletion alleviated disease syndromes, thus validating the transfer data.

CONCLUSIONS

Our findings provide the first evidence for airway inflammation exacerbation by basophils following dsRNA stimulation.

Investigation of suitable digestion methods for the determination of total phosphorus in soils

Total phosphorus in five soils with different compositions which were obtained from different places were extracted by using Na(2)CO(3) fusion, HClO(4) digestion, HClO(4) + HNO(3) digestion, HF + HClO(4) digestion or NaOBr oxidation methods. In order to test the suitability of the HF + HClO(4) digestion the results obtained by this method were compared with the others above, especially the Na(2)CO(3) fusion which is accepted as a standard method. The phosphorus amount found with the HF + HClO(4) digestion method were almost the same as the phosphorus amount by the Na(2)CO(3) fusion method, while the superiority in extracting phosphorus when compared to other methods were obvious. The methods used in the study were evaluated according to the recovery of total phosphorus, ease of application and rapidity with which they were performed. Orthophosphate in the soil extracts was determined by the molybdenum blue colour method. The relationships between methods are examined statistically.

Does vitamin C prevent the effects of high dose dexmedetomidine on rat erythrocyte deformability?

PURPOSE

Dexmedetomidine is an anesthetic agent frequently used for sedation at the intensive care units and during general anesthesia. The purpose of our study was to investigate whether vitamin C prevents the effect of high dose dexmedetomidine on erythrocyte deformability in rats.

METHODS

The study was performed on 21 male rats, with 7 rats in each study groups and the control group. The rats in the study groups were treated with intraperitoneal dexmedetomidine (10 µg/kg) and intraperitoneal dexmedetomidine plus Vitamin C (ascorbic acid) (100 mg/kg ascorbic acid administered 1 hour before administration of 10 µg/kg dexmedetomidine), respectively. Intraperitoneal physiological saline was administered in the control group. Erythrocyte packs were prepared using heparinized total blood samples. Deformability measurements were done by erythrocyte suspensions in phosphate buffered saline (PBS) buffer. A constant flow filtrometer system was used to measure erythrocyte deformability and the relative resistance was calculated.

RESULTS

Erythrocyte deformability was significantly higher in dexmedetomidine group than in control and vitamin C plus dexmedetomidine groups (p=0.003, p=0.013, respectively). Erythrocyte deformability indexes were found similar in the control group and in the vitamin C plus dexmedetomidine group (p=0.383).

CONCLUSIONS

High dose dexmedetomidine may cause functional deterioration in blood flow and tissue perfusion with negative effects in erythrocyte deformability. Vitamin C supplementation seems to reverse those negative effects and variations in erythrocyte deformability. However, our preliminary results should be confirmed in wider serious of experimental and clinical trials (Fig. 1, Ref. 27).

Prevalence and risk factors for tinea pedis in Israeli soldiers

BACKGROUND

Tinea pedis is a common infection in soldiers. However, prevalence and risk factors for tinea pedis in soldiers were investigated in only a few studies.

OBJECTIVES

To investigate the prevalence and risk factors for tinea pedis in Israeli soldiers.

METHODS

A cross-sectional study including interviews, clinical skin examination and mycological tests was performed in Israeli soldiers. The presence of tinea pedis was assessed using the Athlete's Foot Severity Index (AFSI), a scoring system that was developed in order to evaluate the presence and severity of tinea pedis. In soldiers with clinical evidence of tinea pedis (AFSI > 1), scrapings were taken for direct microscopic examination (20% KOH preparation) and fungal culture. Statistical analyses were performed using chi-square or Fisher's exact test for dichotomous variables (as needed), or t-tests for continuous variables. Logistic regression was used for multivariate analyses of dichotomous variables.

RESULTS

Two hundred and twenty-three soldiers were included in the study: 205 men (91.9%) and 18 women (8.1%). Mean age was 19.6 years (SD 1.0 year). Clinical point prevalence was 60.1%. Mycological point prevalence was 27.3%. Further analyses were performed using the clinical point prevalence. Univariate analyses demonstrated that the prevalence of tinea pedis varied with the setting of military training (basic training: 70.3%, advanced infantry training: 81.5%, armor commander training: 56.4% and armor officer training: 34.8%) and was associated with male gender, frequency of sock changes and the length of military service. A multivariate analysis demonstrated that tinea pedis was associated with the setting of the military training (OR 1.6, 95% CI 1.2-2.1) and male gender (OR 4.3, 95% CI 1.4-13.8); however, there was no association with hygiene measures (e.g. frequency of changing socks or sleeping with socks) or the length of military service.

CONCLUSION

Tinea pedis is highly prevalent in Israeli soldiers. Association of tinea pedis with the setting of military training suggests that contagious spread may be an important risk factor. We suggest that environmental interventions should be planned to in order to decrease the morbidity of tinea pedis among soldiers.

Evidence for theory of mind deficits in euthymic patients with bipolar disorder

OBJECTIVE

i) To investigate the subtle ToM (theory of mind) deficits in euthymic patients with bipolar disorder. ii) To investigate the impact of non-ToM cognitive deficits on ToM abilities.

METHOD

Forty-three euthymic patients with bipolar disorder and 30 healthy control subjects were involved in this study. ToM was assessed by the Eyes test and the Hinting task. Both groups were also evaluated with a comprehensive neuropsychological battery including tasks for basic emotion and face recognition.

RESULTS

The patient group was impaired on both of the ToM tasks. The patient group also showed impairment in many cognitive tasks including tasks related to sustained attention.

CONCLUSION

Even euthymic patients with bipolar disorder may be impaired in advanced ToM tasks. Executive dysfunction and some other cognitives deficits such as basic emotion recognition may be at least partly responsible for this result.

Tracheoesophageal fistula due to disc-battery ingestion

Ingestion of a disc battery can lead to hazardous complications including tracheoesophageal fistula (TEF), especially when the battery is impacted in the esophagus. Urgent esophagoscopic removal of the battery is essential in all cases. Persisting respiratory symptoms and/or feeding difficulty after removal should alert the surgeon to evaluate for TEF. Esophagography and/or esophagoscopy should be performed. Once the TEF is identified, conservative management is the initial treatment of choice. Delayed primary repair can be tried if spontaneous closure does not occur. The authors present a case of TEF secondary to disc-battery ingestion with review of the current literature and discuss the management of this rare but potentially life-threatening complication.

Thymic teratoma or thymic remnant attached to mediastinal teratoma? The cellular origin of mediastinal teratomas revisited

Thymic tissue can be encountered in about 20 % of mediastinal teratomas. It is found located at the periphery of the teratoma mass. Although rare, mediastinal teratoma arising within the thymus can be seen. It has not been defined yet whether the thymus is an organ simply attached to the teratoma or whether the teratoma arises from the thymus. The authors present here two illustrative cases of mediastinal teratoma, one raised within the thymus and the other closely attached to the thymic remnant, to discuss the cellular origin of mediastinal teratomas.

Effects of X-ray radiation on lipid peroxidation and antioxidant systems in rabbits treated with antioxidant compounds

The aim of this study was to investigate the effects of supplemental antioxidant vitamins and minerals on lipid peroxidation and on the antioxidant systems in rabbits exposed to X-rays. The rabbits were divided into two experimental groups and one control group, each group containing seven rabbits. The first group (VG) received daily oral doses of vitamin E (460 mg/kg live weight) and vitamin C (100 mg/kg live weight). The second group (MG) was fed a mineral-enriched diet that contained 60 mg manganese chloride, 40 mg zinc sulfate, and 5 mg copper sulfate per kilogram of feed. The third group served as controls and received only a standard diet. Blood samples were obtained before and after the supplementation with vitamins or minerals, as well as before and after irradiation with a total dose of 550-rad X-rays. The blood samples were analyzed for their content of malondialdehyde (MDA), plasma vitamins C and E, retinol, reduced glutathione (GSH), and glutathione peroxidase activity (GPx). After irradiation, the control group showed increased levels of MDA and activity of GPx (p<0.05), whereas the levels of GSH, vitamin C, and vitamin E were decreased. In the VG, the concentration of MDA was lower (p<0.05), and the concentration of GSH and vitamins C and E were higher (p<0.05) when compared to controls. In the MG, the concentrations of MDA, GSH, vitamin C, and retinol were not affected by the mineral administration and radiation. The level of vitamin E in the MG increased with mineral administration (p<0.05), but decreased after irradiation (p<0.05). For the control group, the level of GSH was higher than in the two experimental groups. After irradiation, the VG animals had vitamin E and C levels that were higher than in MG and control groups (p<0.05). The activity of GPx was not affected by vitamin or mineral supplementation or by irradiation. We conclude that the supplementation with antioxidant vitamins and minerals may serve to reinforce the antioxidant systems, thus having a protective effect against cell damage by X-rays.

Nosocomial multi-drug resistant Acinetobacter baumannii bloodstream infection: risk factors and outcome with ampicillin-sulbactam treatment

The emergence of multidrug-resistant (MDR) Acinetobacter baumannii poses a therapeutic problem. The aim of this study was to assess the risk factors for nosocomial MDR-A. baumannii bloodstream infection (BSI) and the efficacy of ampicillin-sulbactam (A/S) in its treatment. Of 94 nosocomial A. baumannii BSI during the year 2000, 54% involved MDR strains, 81% of which were genetically related. Various risk factors for MDR-A. baumannii were found, of which intensive-care unit admission and prior aminoglycoside therapy were independently associated with MDR-A. baumannii acquisition on multivariate analysis. Of MDR-A. baumannii BSI cases, 65% received A/S and 35% inadequate antibiotic therapy, whereas of 43 non-MDR cases, 86% were treated according to susceptibility and 14% inappropriately with antibiotics to which these organisms were resistant. Crude mortality was comparable in the adequately treated groups. Respective mortalities among patients treated adequately and inadequately were 41.4 and 91.7% (p<0.001). Among severely ill patients, A/S therapy significantly decreased the risk of death (P=0.02 OR=7.64). MDR-A. baumannii has become highly endemic in our institution. A/S appears to be one of the last effective and safe empirical resorts for treatment of MDR A. baumannii BSI.

Studies on the effects of x-ray on erythrocyte zinc and copper concentrations in rabbits after treatment with antioxidants

The aim of this study was to investigate the effect of supplemental antioxidant vitamins and minerals on the erythrocyte concentrations of zinc and copper in rabbits after exposure to X-rays. The animals were divided into two experimental and one control group (CG). The first group (VG) was given daily oral doses of vitamins E and C; supplemental amounts of manganese, zinc, and copper were mixed with the feed and given to the second group of experimental animals (MG). Blood samples were taken from all groups before and after 4 wk of vitamin and mineral administration and after irradiation with a total dose of 550-rad X-rays. The administration of minerals caused the most significant increases of Zn and Cu. Even after irradiation, the zinc levels in the irradiated animals were higher than in the nonirradiated vitamin-supplemented animals (p<0.05). The results suggest that supplementation with antioxidant vitamins and minerals may have a protective effect against X-ray-induced damage.

Presumptive monosomy 21 with neuronal migration disorder re-diagnosed as de novo unbalanced translocation t(18p;21q) by fluorescence in situ hybridisation

We present clinical and cytogenetic data of a one year old boy with partial monosomy for both 21q and 18p, resulting from a de novo unbalanced translocation. The initial diagnosis of a seemingly full monosomy 21 was revised after fluorescence in situ hybridisation (FISH) with whole chromosome painting probes and a locus-specific chromosome 21 probe. The karyotype was reinterpreted as 45,XY,der(18)t(18;21)(p11.2;q22.1),-21. This karyotype, to our knowledge, has not been previously described. The boy presented with a spectrum of clinical features previously described for (partial) monosomy 18p only, for monosomy 21q only, or for both of these aneusomies. The radiological finding of a neuronal migration disorder with localised polymicrogyria (cortical dysplasia) has not been described for either monosomy before.

AFSS: athlete's foot severity score. A proposal and validation

We developed a simple scoring system to evaluate the severity of tinea pedis (Athlete's foot severity score, AFSS). The AFSS consists of a clinical evaluation, using a three-point scale, of erythema and scaling in the plantar and interdigital spaces of the feet, and counts of interdigital spaces involved. Each foot is evaluated separately. The validity of the AFSS was assessed in 224 soldiers of the Israel Defense Force using mycological cultures as the main outcome measure and subjective assessment of pruritus as the secondary outcome measure. Mycological examinations were performed in 106 patients who had clinical evidence of tinea pedis. AFSS was significantly associated with culture results (P<0.0001), as well as with the presence of pruritus (P=0.002), and pruritus scores (P=0.025). We conclude the AFSS is valid for the clinical evaluation of tinea pedis severity in military settings. The application of AFSS to civilian morbidity should be subjected to further evaluation. AFSS: Schweregrad-Beurteilung des Athletenfusses. Ein Vorschlag

[Overuse of antibiotics with upper respiratory tract infections in a primary care clinic]

In the majority of cases upper respiratory tract infections (URI's) are caused by viruses. Nonetheless, in many instances, patients with URI's are over-treated with antibiotics. In order to evaluate the use of antibiotic therapy in patients with URI's, we recorded medications prescribed for URI's in 394 young adults seeking care in a primary care clinic. The following parameters were assessed: rhinnorhea, cough, sore throat, dysphagia, tonsillar exudates, tonsillar enlargement and cervical lymphadenopathy. Throat cultures were taken from all the patients.

RESULTS

Antibiotic therapy was prescribed for 99 of the 370 patients (26.8%) with URI's and negative throat cultures. Among these patients, a high prevalence of the following findings was evident: tonsillar enlargement (66.7%), tonsillar exudates (48.5%), cervical lymphadenopathy (42.4%), lack of rhinorrhea (40.4%), lack of cough (32.0%) and fever (31.3%).

CONCLUSIONS

Excess antibiotic therapy was prescribed for patients with URI's. Possible explanations are: clinical findings that suggest a diagnosis of follicular tonsillitis, early antibiotic treatment that is not based on throat cultures or antigen detection tests, and multiple treating physicians.

RECOMMENDATIONS

We recommend that in cases of patients with URI's, antibiotics should not be prescribed unless diagnosis of a streptococcal infection is supported by results of throat cultures or antigen detection tests. Furthermore, in primary care clinics with a number of physicians, treatment should guarantee appropriate medical follow-up.

Impact of active monitoring of infection control practices on deep sternal infection after open-heart surgery

BACKGROUND

Deep-sternal infection is a devastating complication after open-heart surgery. However, the association between infection control practices and deep-sternal infection rates is unclear.

METHODS

To identify contributors to increased deep-sternal infection rates in our institution, consecutive open-heart surgery patients were prospectively studied during two periods (75 and 40 days), including 66 and 40 patients, respectively. Active monitoring including 149 infection control practices was performed in the operating room and intensive care unit. End-points were deep-sternal infection rates and their relation to infection control practices.

RESULTS

Mean age was 62+/-11 years and 68% were males. Coronary bypass was performed in 82%. Clinical and surgical features were comparable, except that patients in period 2 were more likely to have heart failure (15% vs 1.5%, p = 0.01) and had a longer mean duration of surgery (277 vs 217 minutes, p < 0.005). Only 57 practices (38%) were adequately performed. The main categories showing inadequate practices were disinfection, traffic, hand-washing, and surgical attire of nonscrubbed personnel, anesthesiologists, and pump technicians. Many categories showed a statistically significant improvement between periods. Deep-sternal infection rates in prestudy and poststudy periods were 10% and 2.8%, respectively (p = 0.007).

CONCLUSIONS

Active monitoring among personnel involved in open-heart surgery resulted in a significant and sustained decrease in deep-sternal infection rates, through modification of human behavior and improvement of performance standards, probably mediated by the Hawthorne effect. Periodic active monitoring may be a valuable tool to achieve and even sustain such a decrease with tremendous implications on morbidity, costs, and quality of care.

Epidural anaesthesia for Caesarean section in a patient with Devic's Syndrome

The anaesthetic management of a 29-year-old paraplegic woman suffering from Devic's Syndrome scheduled to undergo Caesarean section under epidural anaesthesia is presented. The case is discussed with particular reference to the risk of autonomic hyperreflexia.

A screening process predicts success rates in residency re-training among new immigrant physicians in Israel

OBJECTIVES

To evaluate predictors of success in training programs for Israeli international medical graduates (IMGs) from the former USSR.

SUBJECTS

IMGs up to the age of 45 who passed a national licensing examination and a Hebrew knowledge exam were eligible for participation.

INTERVENTION

Each IMG participated in one of three programs that offered similar academic activities. In two programs there was a preliminary selection process and one program had supplementary teaching hours.

MAIN OUTCOME MEASURES

Resident's self-evaluation of skills compared with evaluation by department heads. The evaluation included eight clinical skills, a general evaluation, and the passing rate for Phase I of the National Certification Exam.

FINDINGS

A total of 176 IMGs, all graduates from medical schools in USSR who immigrated to Israel from 1990 to 1996, and 20 heads of the participating departments completed the questionnaires. The response rate was 64% among the residents and 71% among the department heads. All residents had a similar level of self-esteem regarding clinical skills and considered themselves equal to or better than Israeli-trained residents. The department heads did not concur with this assessment, particularly for residents who participated in the program with no preliminary selection. Participants in the programs with preliminary selection received better evaluations from department heads than those in the program without and had significantly greater success in the written part of the board certification examination (p < 0.05).

DISCUSSION AND CONCLUSIONS

Re-training programs for IMGs should include a preliminary process for participant selection. The training program should be implemented in academic departments, in which case supplementary teaching hours are not required.

Determination of acidity constants of acid-base indicators by second-derivative spectrophotometry

A method for calculation of acid-base dissociation constants of monoprotic weak organic acids whose acid and base species have overlapping spectra from absorptiometric and pH measurements is described. It has been shown that the second-derivative spectrophotometry can effectively be used for determining the dissociation constants, when dissociation constants obtained for methyl orange and bromothymol blue were compared with the values given in the literature.

Incidence and clinical significance of bacteremia and sepsis among cardiac patients treated with intra-aortic balloon counterpulsation pump

In this prospective study, a significant incidence of fever (47%), true bacteremia (15%), and sepsis (12%), were found in 60 cardiac patients treated with an intra-aortic balloon counterpulsation pump. The benefit of antibiotic prophylaxis in this setting should therefore be evaluated.

Rett syndrome and genetic drift

An X chromosome gene is assumed to be responsible for the cause of Rett syndrome (RS). However, new genealogical observations suggest involvement of autosomal recessive gene(s) as well, at least in familial cases. To account for these and other recent observations, the theoretical model presented in 1990 by the authors of this paper is applied to the calculation of gene frequencies. Observed frequencies of sporadic and familial cases of RS are used, taking into account genetic drift in inbreeded areas. Moreover, an attempt is made to use the proportion of RS variants in familial and sporadic cases for the explanation of so called 'formes frustes', and as evidence for the existence of female as well as male carriers. The estimated frequency of the recessive autosome mutation, or possibly a frequent polymorphism, is 22.5%.

Massive pulmonary haemorrhage caused by leptospirosis successfully treated with nitric oxide inhalation and haemofiltration

A patient with leptospirosis who developed oliguric renal failure, massive pulmonary haemorrhage and respiratory failure is described. The patient's clinical condition and arterial oxygenation failed to improve despite vigorous supportive measures. Nitric oxide inhalation and haemofiltration resulted in a marked clinical improvement and subsequent full recovery. We suggest that the addition of haemofiltration and nitric oxide inhalation therapy should be considered in patients with pulmonary haemorrhage and renal failure caused by leptospirosis, in whom conventional therapy fails.