[Show abstract][Hide abstract] ABSTRACT: Background: This study aims to investigate whether serum interleukin (IL)-18 is an early biomarker of acute kidney injury (AKI). Methods: Thirty consecutive patients (22 males, 8 females; mean age 62.4 +/- 9.0 years; range 49 to 78 years) who underwent open-heart surgery were enrolled in this prospective study. Serum IL-18 concentrations were analyzed prior to induction of anesthesia, at weaning from cardiopulmonary bypass (CPB) and two hours after weaning from CPB. Serum creatinine levels were analyzed in the postoperative first, second, and third days. Acute kidney injury was defined as creatinine levels exceeding 50% of the basal value or exceeding the basal value by 0.3 mg/dl at 48 hours postoperatively. The patients were classified into two groups including AKI (n=12) and non-AKI (n=18). Serum IL-18 levels were compared between the groups. Results: Twelve patients (40%) developed AKI. The diagnosis was able to be made using the serum creatinine levels at 24 to 48 hours postoperatively. Although IL-18 concentrations at weaning from CPB decreased slightly in the AKI group, the decrease in the non-AKI presenting group was higher. Using univariate analyses, IL-18 concentrations at two hours after weaning from CPB were found to be related to AKI (p=0.031). The difference in serum IL-18 concentrations between the preoperative period and two hours after weaning from CPB were found to be statistically significant (p=0.017). According to the Receiver operating characteristic curve analysis, the threshold value for AKI prediction of serum IL-18 concentrations at two hours after weaning from CPB was 353.7 pg/ml with a sensitivity of 58.3% and a specificity of 83.3% (AUC=0.736). Conclusion: Serum IL-18 concentration may be used as a biochemical indicator for early detection of acute kidney injury following open heart surgery.
[Show abstract][Hide abstract] ABSTRACT: Urinary tract infections (UTIs) are important causes of morbidity and mortality in patients with spinal cord injury and 22% of patients with acute spinal cord injury develop UTI during the first 50 days.
[Show abstract][Hide abstract] ABSTRACT: Aim: Atrial fibrillation is the most common arrhythmia and complication following coronary bypass surgery. Besides well-known risk factors, inflammatory parameters have gained popularity assessing the risk of postoperative atrial fibrillation. In this study, we aimed to document the relation between neutrophil/lymphocyte ratio and postoperative atrial fibrillation. Methods: Between January 2011 and June 2012, 523 patients on normal sinus rhythm, undergoing elective on-pump coronary bypass operations were prospectively followed up for occurrence of postoperative atrial fibrillation. Total and differential white blood cell counts were made immediately before the operation and on postoperative day 2. Neutrophil/lymphocyte ratio was calculated from these measured values. Results: Ninety-one (17.4%) patients developed postoperative atrial fibrillation The mean age of the patients maintaining normal sinus rhythm was lower compared to ones with atrial fibrillation (60.76±9.59 vs. 65.44±8.63, P<0.001). Preoperative and postoperative total and differential white blood cell counts did not have any effect on occurrence of atrial fibrillation. There were not statistically significant differences between normal sinus rhythm and atrial fibrillation groups when preoperative and postoperative neutrophil/lymphocyte ratios were considered (2.90±2.11 vs. 3.02±2.30, P=0.619; 10.07±21.97 vs. 9.34±6.73, P=0.752, respectively). Conclusion: Neutrophil/lymphocyte ratio was not found to be a predictor for new onset atrial fibrillation following coronary bypass surgery.
The Journal of cardiovascular surgery 10/2013; · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The relation between coronary artery disease (CAD) and the levels of serum androgen has been revealed in various population studies. The Gensini coronary scoring system is used to evaluate the degree of coronary stenosis, taking into account its location and producing a numerical score. The aim of the study was to explore the association between serum testosterone levels and both the presence and severity of coronary artery disease indicated by the Gensini score in middle-aged men. Material and methods: Between October 2011 and April 2012, 124 middle-aged (40-59) male patients with known or suspected coronary artery disease were included in the study. Coronary angiography was performed in all patients, and their Gensini scores were calculated. Total serum testosterone levels were also measured. Results: The mean Gensini score of the patients was 44.11 +/- 39.08. The mean plasma testosterone level was 3.51 +/- 1.39 ng/ml. There was no correlation between the severity of coronary artery disease and the serum testosterone levels (r = -0.161, p > 0.05). When the patients with coronary artery disease (Gensini score >= 1) were compared with the patients without it (n = 29, Gensini score: 0), their mean serum testosterone levels were revealed to be lower (p = 0.043). There was no correlation between the testosterone levels and the high-density lipoprotein cholesterol and triglyceride levels. There was a correlation between the serum testosterone levels and total cholesterol levels (p = 0.008), low-density lipoprotein cholesterol levels (p = 0.019), and body mass index (p = 0.001). Conclusions: The mean serum testosterone levels were lower in the CAD group. We did not manage to document their relation with disease severity by means of the Gensini score.
Polish journal of cardio-thoracic surgery 09/2013; 3(3):211-215. DOI:10.5114/kitp.2013.38094 · 0.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: In this study, we aimed to investigate the newly introduced inflammatory biomarker, neutrophil/lymphocyte ratio, as a mortality predictor following coronary artery bypass graft (CABG) surgery. Methods: Between December 2011 and April 2012, 210 consecutive patients who underwent isolated CABG surgery in our clinic were prospectively analyzed. The baseline characteristics of the patients and preoperative neutrophil/lymphocyte ratio were determined. The postoperative follow-up was 86.1 +/- 38.9 days. The primary endpoint was all-cause mortality. Results: Eight patients (3.8%) died of whom four deaths occurred during the first 30 days of follow-up. Univariate analyses revealed a significant difference in the preoperative neutrophil/lymphocyte ratio between the groups in which mortality was seen and the group in which no mortality was observed (p=0.037). The Receiver operating characteristic (ROC) curve showed a threshold value of 2.81 for neutrophil/lymphocyte ratio (AUC=0.72, sensitivity: 75%, specificity: 67%). Logistic regression analysis of the variables with significant differences between two groups revealed that the neutrophil/lymphocyte ratio over its threshold value was an independent predictor for mortality (OR 6.47, 95% CI 1.18-35.38, p=0.031). Conclusion: Neutrophil/lymphocyte ratio, which can be easily calculated, can be used as an independent factor in predicting early mortality following CABG surgery.
Turkish Journal of Thoracic and Cardiovascular Surgery 08/2013; 21(3-3):588-593. DOI:10.5606/tgkdc.dergisi.2013.8210 · 0.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Since the advent of cardiopulmonary bypass, many efforts have been made to avoid the complications related with it. Any component of the pump participates in occurrence of these adverse events, one of which is the type of prime solution. In this study, we aimed to compare the effects of 6% hydroxyethyl starch 130/0.4 with a commonly used balanced electrolyte solution on postoperative outcomes following coronary bypass surgery.
Two hundred patients undergoing elective coronary bypass surgery were prospectively studied. The patients were randomized in to two groups. First group received a balanced electrolyte solution and the second group received 6% hydoxyethyl starch 130/0.4 as prime solution. The postoperative outcomes of the patients were studied.
The mean age of the patients was 61.81 ± 10.12 in the crystalloid group whereas 61.52 ± 9.29 in the HES group. There were 77 male patients in crystalloid group and 74 in HES group. 6% hydroxyethyl starch 130/0.4 did not have any detrimental effects on renal and pulmonary functions. The intensive care unit stay and postoperative hospital length of stay were shorter in hydroxyethyl starch group (p < 0.05 for each). Hydroxyethyl starch did not increase postoperative blood loss, amount of blood and fresh frozen plasma used, but it decreased platelet concentrate requirement. It did not have any effect on occurrence of post-coronary bypass atrial fibrillation (p > 0.05).
6% hydroxyethyl starch 130/0.4 when used as a prime solution did not adversely affect postoperative outcomes including renal functions and postoperative blood transfusion following coronary bypass surgery.
Journal of Cardiothoracic Surgery 04/2013; 8(1):71. DOI:10.1186/1749-8090-8-71 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: Postoperative atrial fibrillation is the most common arrhythmia following bypass
surgery with significant morbidity, mortality and increased healthcare costs. The aim of this study
is to determine the incidence and timing of atrial fibrillation, identify the risk factors covering
preoperative and intraoperative periods, evaluate rate of return to sinus rhythm by disharge, and
explore the impact on postoperative outcomes in a large group of patients operated in a single
center by a single surgeon.
Patients and Methods: Between January 2011 and January 2012, 418 patients on preoperative
sinus rhythm were operated for ischemic heart disease and associated complications (left ventricle
aneurysm repair and ischemic mitral insufficiency) in a single center, by a single surgeon.
The preoperative, intraoperative and postoperative variables were studied.
Results: The mean age of the patients were 61.92 ± 10.05, and 77.5% were male. Atrial fibrillation
developed in 68 (16.3%) patients. The incidence peaked at second day. Patients with atrial
fibrillation were older (p< 0.001). Gender, preoperative comorbidities, ejection fraction, left atrial
diameter, preoperative beta-blocker use, leukocyte count, type of operation and intraoperative
variables did not affect its occurence. Intensive care unit and hospital length of stay were longer
(p< 0.05). 95.5% (n= 65) of patients were in normal sinus rhythm at discharge.
Conclusion: Postoperative atrial fibrillation is a popular subject with unknowns and controversial
results which may lead to wrong interpretations. We believe that every center has its own risk factors related with the population of that region. Discussion will last, but simple precautions and close monitoring will help to minimize
[Show abstract][Hide abstract] ABSTRACT: Atrial Fibrillation is the most common arrhythmia encountered following cardiac surgery. The most commonly administered drug used in treatment and prophylaxis is amiodarone which has several toxic effects on major organ functions. There are few clinical data concerning prevention of toxic effects and there is no routinely suggested agent. The aim of this study is to document the cytotoxic effects of amiodarone on cell culture media and compare the cytoprotective effects of commonly used antioxidant agents.
L929 mouse fibroblast cell line was cultured and 100,000 cells/well-plate were obtained. First group of cells were treated with increasing concentrations of amiodarone (20 to 180 μM) alone. Second and third group of cells were incubated with one-fold equimolar dose of vitamin C and N-acetyl cysteine prior to amiodarone exposure. The viability of cells were measured by MTT assay and the cytoprotective effect of each agent was compared.
The cytotoxicity of amiodarone was significant with concentrations of 100 μM and more. The viabilities of both vitamin C and N-acetyl cysteine treated cells were higher compared to untreated cells.
Vitamin C and N-acetyl cysteine are commonly used in the clinical setting for different purposes in context of their known antioxidant actions. Their role in prevention of amiodarone induced cytotoxicity is not fully documented. The study fully demonstrates the cytoprotective role of both agents in amiodarone induced cytotoxicity on cell culture media; more pronounced with vitamin C in some concentrations. The findings may be projectile for further clinical studies.
Journal of Cardiothoracic Surgery 06/2012; 7:61. DOI:10.1186/1749-8090-7-61 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Özet Amaç: Atriyal fibrilasyon kalp cerrahisi sonrası en sık görülen ritim bozuklu-ğudur. Perioperatif seyri olumsuz etkilemekte, morbidite ve mortalitede be-lirgin artışa neden olmaktadır. Kanıtlanmış risk faktörleri yanında, yeni ta-nımlanmakta olan bir çok risk faktörü de mevcuttur. Hemoglobin A1c diyabe-tik hastalarda glisemik kontrolün takibinde kullanılan bir belirteçtir. Son yıl-larda atriyal fibrilasyon ile ilişkisi olduğu gösterilmiştir. Biz bu çalışmada, tek merkezde, diyabetik hastalarda preoperatif bakılan hemoglobin A1c seviyele-ri ve postoperatif atriyal fibrilasyon arası ilişkiyi göstermeyi amaçladık. Ge-reç ve Yöntem: Mayıs 2011-Aralık 2011 arası iskemik kalp hastalığının teda-visi amaçlı opere edilen toplam 261 hastanın 109'u diyabetikti (%41.76). Ça-lışmaya dahil edilen bu hastalardan preoperatif hemoglobin A1c seviyeleri bakıldı ve postoperatif dönemde atriyal fibrilasyon gelişimi arasındaki ilişki değerlendirildi. Bulgular: Çalışmaya dahil edilen 109 hastanın yaş ortalama-sı 62.05 ± 7.85 idi ve hastaların %81.6'sı erkek idi. Postoperatif atriyal fibri-lasyon insidansı %19.3 idi. Atrial fibrilasyon gelişen grupta hemoglobin A1c değerleri %8.52 ± 1.96 iken; AF gelişmeyen grupta %8.23 ± 1.52 idi (p>0.05). Hastaların preoperatif demografik özellikleri ve intraoperatif değişkenleri in-celendiğinde atriyal fibrilasyon ile anlamlı ilişki saptanmadı. Postoperatif dönemde atriyal fibrilasyon gelişen grupta hastane yatış süresi anlamlı ola-rak fazla idi (p<0.05). Sonuç: Hemoglobin A1c değerleri ve postoperatif atri-yal fibrilasyon arası ilişki nispeten yeni tartışılan bir konu olup, literatürde çe-lişkili sonuçlar mevcuttur. Bizim çalışmamızda hemoglobin A1c değerleri ve postoperatif atriyal fibrilasyon arası anlamlı bir ilişki saptanmadı. Bu konuy-la ilgili daha geniş çalışmalara ihtiyaç duyulmaktadır.
[Show abstract][Hide abstract] ABSTRACT: Coronary artery bypass grafting in patients with low ejection fraction is still a challenge despite the developments in technical and surgical fields. These patients have higher mortality and morbidity rates. In this study, we report the clinical outcomes of the patients with low ejection fraction who underwent coronary artery bypass grafting surgery (on-pump or off-pump) with or without concomitant procedures. We analyzed 61 patients with ejection fraction below 35% operated between January 2011 and May 2012 retrospectively. The mean age of the patients was 62.80±10.77 years and there were 9 female patients (14.8%). The mean ejection fraction was 31.85±3.98%. There was no mortality reported during the study period. The most important feature in perioperative management of low ejection fraction patients is careful patient selection, which depends on good assessment of left ventricular functions. We believe that in carefully selected patients with low ejection fraction, with good perioperative management, coronary artery bypass surgery can be safely performed. (Anatol J Clin Investig 2012;6(3):169-173). Özet Günümüz kalp cerrahisinde, teknik ve cerrahi alandaki gelişmelere rağmen düşük ejeksiyon fraksiyonlu hastalarda koroner arter baypas cerrahisi halen oldukça sorunludur. Bu hastaların morbidite ve mortalite oranları yüksektir. Bu çalışmada biz, düşük ejeksiyon fraksiyonlu hastalarda, izole ya da eşlik eden prosedürlerle beraber uygulanmış koroner arter baypas cerrahisi sonuçlarımızı bildiriyoruz. Ocak 2011 ve Mayıs 2012 tarihleri arasında opere edilen ejeksiyon fraksiyonu %35'in altında olan 61 hastayı retrospektif olarak inceledik. Hastaların ortalama yaşı 6,80±10,77 idi ve hastaların 9'u (%14,8) kadın idi. Ortalama ejeksiyon fraksiyonu %31,85±3,98 idi. Çalışma boyunca mortalite görülmedi. Düşük ejeksiyon fraksiyonlu hastalarda, perioperatif yönetimde en önemli nokta sol ventrikül fonksiyon değerlendirmesine dayanan iyi hasta seçimidir. Biz, dikkatli seçilmiş düşük ejeksiyon fraksiyonlu hastalarda, iyi perioperatif yönetimle, koroner baypas cerrahisinin güvenle yapılabileceğini düşünüyoruz. (Anatol J Clin Investig 2012;6(3):169-173). Anahtar sözcükler: Koroner arter baypas; ventrikül fonksiyonu, sol; sonuç değerlendirmesi. Introduction Coronary artery bypass grafting (CABG) in patients with low ejection fraction (EF) is superior to medical therapy in terms of survival and quality of life, but these patients carry a higher risk of death when compared to patients with higher EF (>40%). The hospital mortality is reported to be 5-15% in different studies [1-5]. Five-year mortality can be as high as 25% . With the improvements in surgical techniques, myocardial management, extracorporeal perfusion strategies, cardiac anesthesia, perioperative and postoperative care, the mortality rates have decreased significantly, but CABG in low EF patients is still a challenging subject.
Anatolian Journal of Clinical Investigation 01/2012; 6(3):169-173.
[Show abstract][Hide abstract] ABSTRACT: Bu çalışmada bir büyük şehirde çalışan temizlik işçilerinin sosyodemografik özellikleri ve çalışma koşulları ile iş kazaları ve meslek hastalıkları sıklığının belirlenmesi amaçlanmıştır. Mayıs-Haziran 2005 tarihinde yapılan araştırmanın evreni Ankara'da üç merkez ilçede çalışan (Çankaya, Mamak, Yenimahalle) tüm temizlik işçileridir. Bu ilçelerde araştırma sırasında toplam 820 işçi çalışmakta olup, %95 güvenilirlik ve %5 sapma ile araştırma örneklemine 262 kişinin alınması planlanmış, daha sonra basit rasgele örnekleme yöntemi ile rasgele sayılar tablosu kullanılarak katılımcılar belirlenmiştir. Temizlik işçilerinin %52.8'i çalıştığı yerde işyeri sağlık birimi, %50.7'si işyeri hekimi, %57.9'u işyeri hemşiresi/sağlık memuru olmadığını belirtmiştir. %83.0'ü işe giriş muayenesi olmuş, %47.4'ü aralıklı kontrol muayenesi olmaktadır. %85.2'si işiyle ilgili mesleki eğitim, %87.4'ü işiyle ilgili sağlık ve güvenlik eğitimi almamıştır. %80.1'i işini yaparken kişisel koruyucu kullanmamaktadır. İşçilerinin %26.0'sı iş kazası geçirmiştir. %5.3'ünde iş kazasına bağlı kalıcı sakatlık meydana gelmiştir. %9.6'sı meslek hastalığı tanısı almış, %4.8'inde meslek hastalığına bağlı kalıcı sakatlık meydana gelmiştir. Sonuçlar temizlik işçilerinin iş sağlığı hizmetlerinden yeterince yararlanmadığını göstermektedir. İşçilerin yaklaşık üçte birinin de iş kazası veya meslek hastalığı geçirmesinin bu durumun bir sonucu olduğu düşünülmektedir.