ABSTRACT The Pan American Health Organization’s Revolving Fund for Access to Vaccines (the Revolving Fund) is a shared pool of funds for the procurement of vaccines, syringes, and cold-chain equipment for the Member States of the Organization. With a view to evaluating the results obtained during the Revolving Fund’s operation and analyzing its contributions to achievements in immunization, a review was conducted of historical documents and grey literature related to the Fund’s history and current processes, as well as data from platforms fed by countries’ annual reports, with reference to growth indicators, burden of vaccine-preventable diseases, introduction of new vaccines in the Region of the Americas, and lessons learned. In its 43 years of operation, the Revolving Fund has grown and contributed to the introduction of new vaccines, and the Region has made rapid progress in the field of immunization. However, several countries and territories in the Region have not yet introduced certain vaccines due to their high cost and the economic impact of sustainably administering them. The requirement to obtain the lowest possible price and to set a uniform price for all participating Member States has been instrumental in the Revolving Fund’s contribution to the vaccination goals of national immunization programs, and for timely planning of demand, accompanied by technical advice. An interprogrammatic approach and the planning of auxiliary inputs are key to the success of the programs. Pandemic preparedness, regional vaccine production, and the protection of national budgets for sustainable procurement of high-cost vaccines are current and future challenges.

RESUMO O Fundo Rotativo para Acesso a Vacinas (FR) da Organização Pan-Americana de Saúde é um fundo comum de capital e compra conjunta de vacinas, seringas e equipamento da cadeia de frio para os Estados Membros da Organização. Com o objetivo de avaliar os resultados obtidos durante sua operação e analisar sua contribuição para os êxitos da imunização, procedeu-se a uma revisão de documentos históricos e da literatura cinzenta relacionados à história do FR e revisaram-se os processos atuais, os dados de plataformas alimentadas pelos relatórios anuais dos países, os indicadores de crescimento, a carga de doenças imunopreveníveis, a introdução de novas vacinas na Região das Américas e as lições aprendidas. Constatou-se que, em seus 43 anos de operação, o FR cresceu e contribuiu para a introdução de novas vacinas e a região avançou com rapidez no campo da imunização. Entretanto, vários países e territórios da região ainda não introduziram determinadas vacinas em razão dos altos preços e do impacto econômico de manter sua administração. A cláusula do menor preço disponível e do preço uniforme para todos os Estados Membros participantes foi fundamental para a contribuição do FR para as metas de vacinação dos programas nacionais de imunização, bem como para o planejamento oportuno da demanda acompanhado pela assessoria técnica. A abordagem interprogramática e o planejamento de insumos auxiliares são necessários para o êxito dos programas. A preparação para pandemias, a produção regional de vacinas e a proteção dos orçamentos nacionais para a compra de vacinas de alto custo e sua sustentabilidade ainda constituem desafios atuais e futuros.

RESUMEN El Fondo Rotatorio para el acceso a las vacunas (FR) de la Organización Panamericana de la Salud es un fondo común de capital y compra mancomunada de vacunas, jeringas y equipo de cadena de frío para los Estados Miembros de la Organización. Con el objetivo de evaluar los resultados obtenidos durante su funcionamiento y analizar su contribución a los logros de inmunización, se llevó a cabo una revisión de documentos históricos y literatura gris relacionados con la historia del FR, y se revisaron los procesos actuales, los datos de plataformas alimentadas por los informes anuales de los países, los indicadores de crecimiento, la carga de enfermedades prevenibles por vacunación, la introducción de nuevas vacunas en la Región de las Américas, y lecciones aprendidas. Se encontró que, en sus 43 años de funcionamiento, el FR ha crecido y ha contribuido a la introducción de nuevas vacunas, y que la Región ha avanzado de manera acelerada en el ámbito de las inmunizaciones. Sin embargo, varios países y territorios de la Región todavía no han introducido ciertas vacunas debido a sus altos precios y al impacto económico del mantenimiento de su administración. La cláusula del precio más bajo posible y del precio uniforme para todos los Estados Miembros participantes ha sido fundamental para la contribución del FR a las metas de vacunación de los programas nacionales de inmunización, así como para la planeación oportuna de la demanda acompañada por la asesoría técnica. El abordaje interprogramático y la planeación de insumos auxiliares son necesarios para el éxito de los programas. La preparación ante pandemias, la producción regional de vacunas y la protección de presupuestos nacionales para la compra de vacunas de alto costo y su sostenibilidad constituyen aún retos en el presente y el futuro.

Resumo Fundamento Pacientes pré-diabéticos têm um risco aumentado de doença cardiovascular aterosclerótica, e, portanto, a detecção precoce é importante. Objetivo Nosso estudo teve o objetivo de revelar a usabilidade dos níveis de endocan sérico como biomarcador no diagnóstico de aterosclerose subclínica em pacientes pré-diabéticos, com base em medições de EIMC. Métodos Os participantes foram classificados de acordo com a presença (n=42) ou ausência (n=42) de pré-diabetes. Os valores de endocan sérico, glicemia em jejum, insulina em jejum e hemoglobina glicada (HbA1c) dos pacientes foram examinados e a EIMC foi medida. O nível de significância para a análise estatística foi 0,05. Resultados Apesar de se ter determinado que os níveis de endocan sérico são mais baixos em pacientes pré-diabéticos em comparação com o grupo de controle (p=0,042), determinou-se que os valores de EIMC são mais altos (p=0,046). A avaliação do endocan sérico por análise regressiva multivariada detectou que seu nível estava associado à EIMC, independentemente de outros parâmetros (p=0,007). Encontramos uma correlação negativa entre insulina plasmática em jejum e níveis de endocan (r=-0,320, p=0,001). Conclusões Este estudo demonstrou que a espessura íntima-média de carótida é mais alta e o nível de endocan sérico é mais baixo em pacientes pré-diabéticos. Os níveis de endocan sérico diminuídos em pacientes pré-diabéticos podem ser um fator que contribui para os mecanismos de formação de aterosclerose.

Abstract Background Patients with prediabetes have an increased risk of atherosclerotic cardiovascular disease; therefore, early detection is important. Objective The present study aimed to reveal the usability of serum endocan levels as a biomarker in the diagnosis of subclinical atherosclerosis in patients with prediabetes, based on CIMT measurements. Methods Participants were classified according to the presence (n=42) or absence (n=42) of prediabetes. Serum endocan, fasting blood sugar, fasting insulin, and glycated hemoglobin (HbA1c) values of patients were examined, and CIMT was measured. The level of significance for statistical analysis was 0.05. Results While serum endocan levels were found to be lower in patients with prediabetes, when compared to the control group (p=0.042), CIMT values were found to be higher (p=0.046). When evaluated by multivariate regression analysis, the serum endocan level was found to be associated with CIMT, regardless of other parameters (p=0.007). A negative correlation was found between plasma fasting insulin and endocan levels (r=-0.320, p=0.001). Conclusions Carotid intima media thickness was found to be high and the serum endocan level was low in patients with prediabetes. Decreased serum endocan levels in patients with prediabetes may be a contributing factor to atherosclerosis formation mechanisms.

ABSTRACT BACKGROUND: Favipiravir is generally used in treating coronavirus disease 2019 (COVID-19) pneumonia in Turkey. OBJECTIVE: To determine the side effects of favipiravir and whether it is a good treatment option. DESIGN AND SETTING: Retrospective study conducted in Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey. METHODS: 357 patients who completed favipiravir treatment at the recommended dose were included. 37 patients with drug side effects and 320 patients without drug side effects were examined in two groups. RESULTS: Side effects were observed in 37 (10.36%) out of 357 patients using favipiravir. The most common side effect was liver dysfunction, in 26 (7.28%) of the patients. The following other side effects were also observed: diarrhea (1.4%), nausea (0.84%), abdominal pain (0.28%) and thrombocytopenia (0.28%). One patient (0.28%) presented both increased transaminases and nausea. CONCLUSION: In this study, it was determined that favipiravir may constitute an alternative for treating COVID-19 pneumonia given that its side effects are generally well tolerated and not serious.

RESUMO Objetivo Este estudo teve como objetivo determinar o consumo alimentar tradicional e local, bem como a adesão à dieta mediterrânea no Chipre. Também teve como objetivo melhorar a adesão à dieta mediterrânea e ao consumo de alimentos tradicionais e locais. A partir desse ponto, este trabalho atual teve como objetivo revisar a Pirâmide da Dieta Mediterrânea do Chipre, que é baseada na Pirâmide da Dieta Mediterrânea Atual. Métodos O tamanho da amostra foi calculado com um mínimo de 386 de acordo com intervalo de confiança de 95,0% e erro de 5,0%. Este estudo foi realizado online entre novembro de 2020 e abril de 2021 em Chipre. Todos os voluntários foram convidados para esta análise nas plataformas públicas nacionais de internet. A adesão dos participantes à dieta mediterrânea foi avaliada pelo Medidor de Adesão à Dieta Mediterrânea. As frequências de consumo alimentar tradicional e local foram determinadas pelo Questionário de Frequência Alimentar. Foi desenvolvida uma nova Pirâmide da Dieta Mediterrânica de e para o Chipre, com alimentos tradicionais e locais. A modificação teve também como objetivo salvaguardar a saúde do planeta, aumentar o consumo de alimentos tradicionais e a adesão à dieta mediterrânea. Resultados No total de 1.007 adultos (78,0% naturais da ilha/cipriotas) participaram voluntariamente no estudo. A pontuação média obtida no Medidor de Adesão à Dieta Mediterrânea foi de 7,55±2,30 pontos, com apenas 34,4% aderindo fortemente à dieta mediterrânea. De acordo com as suas respostas, houve necessidade de aumentar a utilização de azeite, vegetais, frutas, peixe e vinho tinto, bem como de diminuir o consumo de carnes vermelhas e sobremesas. Com base nas suas respostas ao Medidor de Adesão à Dieta Mediterrânea e as suas frequências de consumo alimentar tradicional/local, foi feita uma pirâmide da Dieta Mediterrânea do Chipre atualizada, ou seja, uma pirâmide alimentar nacional para o Chipre. Alimentos locais e regionais comumente consumidos foram adicionados à pirâmide para aumentar a adesão à dieta mediterrânea. Alimentos consumidos de acordo com as recomendações foram adicionados para torná-los específico da região, e alimentos pouco consumidos foram adicionados para ajudar a aumentar o consumo. Conclusão Acredita-se que esta modificação seja determinante para aumentar a adaptação da dieta mediterrânea e o consumo de alimentos tradicionais e locais, além de diminuir o impacto da nutrição na saúde do planeta. Ainda, essa modificação pode lançar luz sobre o desenvolvimento das outras pirâmides alimentares tradicionais.

ABSTRACT Objective The present study aimed to determine traditional and local food consumption and adherence to the Mediterranean diet in Cyprus. And also, aimed to improve their adherence to the Mediterranean diet and traditional and local food consumption. From this point, this current study aimed to revise the Cyprus Mediterranean Diet Pyramid, based on the Current Mediterranean Diet Pyramid. Methods The sample size was calculated as a minimum of 386 according to a 95.0% confidence interval, and a 5.0% error. This study was conducted online between November 2020-April 2021 in Cyprus. All volunteers were invited to this study on the national public internet platforms. Participant´s adherence to the Mediterranean diet was determined by the Mediterranean Diet Adherence Screener. Traditional and local food consumption frequencies were determined by a Food Frequency Questionnaire. A novel Cyprus Mediterranean Diet Pyramid was developed with traditional and local food items for Cyprus. The modification was also aimed to safeguard planet health, to increase traditional food consumption and adherence to the Mediterranean diet. Results 1,007 adults (78.0% native islanders/Cypriots) participated voluntarily in the current study. The mean Mediterranean Diet Adherence Screener score was 7.55±2.30 points and only 34.4% had high adherence to the Mediterranean diet. According to their responses, there was a need to increase use of olive oil, vegetables, fruits, fish, and red wine consumption and to decrease red meat and dessert consumption. According to responses to the Mediterranean Diet Adherence Screener and their traditional/local food consumption frequencies an up-to-date Cyprus Mediterranean Diet Pyramid was done hence a national food pyramid for Cyprus. Commonly consumed traditional and local foods were added to the pyramid to facilitate increased adaptation of the Mediterranean diet in the general population. Adequately consumed foods were added to make it more region-specific and rarely consumed foods were added to help to increase consumption. Conclusion This modification is believed to be instrumental to increase Mediterranean diet adaptation, traditional/local food consumption and decrease the impact of nutrition on the planet´s health. And also, this modification can shed light on the development of the other traditional food pyramids.

Abstract: Knowing the effects of natural aging on wood properties is important both for the conservation of historical wooden material and for reuse of aged wood. The aim of this study was to investigate the wood properties of old wooden elements not impregnated with any protective chemicals and taken from different parts of Zeytinlik houses in Giresun, Turkey. Test samples were prepared from old wooden elements and freshly cut chestnut timber. The anatomical, chemical, physical and mechanical properties were determined according to standard procedure, and the results were compared with those of recent wood specimen. As a result of the anatomical identification, it was determined that the wooden elements used in traditional Zeytinlik houses belong to species of Anatolian chestnut (Castanea sativa), and after an average service life of 88, 113 and 120 years, there was no change in the anatomical structure of the old wooden elements. Fourier transform infrared band characterization of old wood specimens revealed that hemicelluloses degraded and lignin structure changed on the surface of almost all specimens. Especially, the wood density values of the facade elements were smaller than that of recent wood specimen. Except for the modulus of rupture of window sill and rafter, all mechanical properties were significantly greater compared with those of recent wood specimen. The results of this research showed that old wood not damaged by fungi and insects could be evaluated for reuse.

Resumo Introdução: O presente estudo investigou a associação entre Disfunção Cognitiva Pós-Operatória (DCPO) e aumento do nível sérico de S100B após Prostatectomia Radical Laparoscópica Assistida por Robô (PRLAR). Métodos: O estudo incluiu 82 pacientes consecutivos submetidos à PRLAR. Os níveis séricos de S100B foram determinados: no pré-operatório, após indução anestésica, e aos 30 minutos e 24 horas do pós-operatório. A função cognitiva foi avaliada com testes neuropsicológicos no pré-operatório, no 7° dia pós-operatório (7 DPO) e aos 3 meses após a cirurgia (3 MPO). Resultados: Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) após 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os níveis séricos de S100B estavam significantemente aumentados aos 30 minutos e às 24 horas do pós-operatório nos pacientes que apresentaram DCPO no 7 DPO (p= 0,0001 para os dois momentos) e 3 meses após a cirurgia (p= 0,001 para os dois momentos) A duração anestésica também foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparação com pacientes sem DCPO (p= 0,012, p= 0,001, respectivamente), assim como a duração da posição de Trendelenburg (p= 0,025, p= 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duração da posição de Trendelenburg e a duração da anestesia (p= 0,0001 para ambos). Conclusão: S100B aumenta após PRLAR e o aumento está associado ao desenvolvimento de DCPO. A duração anestésica e o tempo decorrido em posição de Trendelenburg contribuem para o desenvolvimento de DCPO. Número de registro do estudo: Clinicaltrials.gov (n° NCT03018522)

Abstract Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively. Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. Trial Registry Number: Clinicaltrials.gov (N° NCT03018522).

Abstract The standard treatment of transposition of the great arteries is the arterial switch operation (ASO). Despite successful surgical correction, patients cannot tolerate extubation after the operation. Major aortopulmonary collaterals (MAPCAs) are one of the rare causes of prolonged mechanical ventilation due to significant hemodynamic effects. We report a 28-day-old newborn with transposition of the great arteries and a ventricular septal defect (VSD) who underwent ASO and VSD closure. After postoperative extubation failed twice, four large MAPCAs were revealed during heart catheterization. After transcatheter closure of these four MAPCAs, the patient was extubated and discharged 27 days after the procedure.

ABSTRACT Objective Ultrasound assessment plays an important role in the diagnosis, and monitoring of subacute thyroiditis (SAT). However, the relationship between ultrasonographic findings and severity or prognosis of the disease is not known. The aim of the present study was to evaluate the relationship between bilateral and unilateral disease involvement and severity and prognosis of the disease. Subjects and methods The initial laboratory values, ultrasonographic findings and long-term outcomes of 247 SAT patients were evaluated retrospectively. Results In the ultrasonographic evaluation, bilateral involvement was detected in 154 patients, and unilateral involvement in 93 patients at the time of diagnosis. No significant difference was found between patients with bilateral or unilateral disease at the time of diagnosis in respect of the initial acute phase reactants. FT4 was significantly higher and TSH was significantly lower in the group with bilateral disease. Bilobar or unilobar disease on ultrasound at the time of diagnosis was not found to be a risk factor for permanent hypothyroidism or recurrence. The mean thyroid volume was determined to be 22.5 ± 10 cm3 at the beginning of treatment, and 11.2 ± 8 cm3 at the end of treatment. The initial thyroid volume and the thyroid volume at the end of treatment were significantly lower in patients who developed hypothyroidism. Conclusion There was no relationship between initial acute phase reactants and bilateral or unilateral involvement of the disease. FT4 levels were found to be associated with the extension of the disease. The risk of recurrence and permanent hypothyroidism are not associated with the initial ultrasonographic aspect. Arch Endocrinol Metab. 2020;64(3):306-11

Resumo Introdução: A cirurgia de quadril é uma cirurgia de grande porte que causa dor intensa no pós-operatório. Embora a dor durante o repouso seja consideravelmente reduzida, a mobilização é importante em termos de complicações tromboembólicas. O bloqueio doquadrado lombar é uma técnica analgésica regional que bloqueia os ramos nervosos de T6-L3. Esse bloqueio pode fornecer analgesia adequada e reduzir o consumo de opioides após cirurgiasde quadril. Relato de caso: Realizamos o bloqueio contínuo do quadrado lombar tipo 3 em dois pacientes submetidos à artroplastia de quadril. Durante as 24 hs de pós-operatório foram registrados os escores de dor, o consumo de anestésicos locais em analgesia controlada pelo paciente e a necessidade de analgésicos adicionais. Em dois pacientes, os escores de dor pós-operatória foram < 6 durante o repouso e fisioterapia. O paciente foi mobilizado no período pós-operatório imediato, sem precisar de analgésico opioide adicional e sem fraqueza muscular. Discussão: O bloqueio contínuo do quadrado lombar pode ser usado para aliviar a dor aguda no pós-operatório de cirurgia de quadril porque fornece anestesia unilateral sem fraqueza muscular.

Abstract Introduction: Hip surgery is a major surgery that causes severe postoperative pain. Although pain during rest is usually considerably reduced mobilization is important in terms of thromboembolic complications. The quadratus lumborum block is a regional analgesic technique that blocks T6-L3 nerve branches. This block may provide adequate analgesia and reduce opioid consumption after hip surgery. Case report: We performed continuous quadratus lumborum type 3 block in two patients who underwent hip arthroplasty. Postoperative 24-h pain scores, local anesthetic consumptions on patient-controlled analgesia and additional analgesic requirement were recorded. In two patients, postoperative pain scores were less than 6 during rest and physiotherapy. Patient was mobilized in the early postoperative period without additional opioid analgesic requirement and without muscle weakness. Discussion: Continuous quadratus lumborum block may be used to relieve postoperative acute pain in hip surgery because it provides one-sided anesthesia without muscle weakness.

Resumo Fundamento: Embora a disfunção do ventrículo direito (VD) nas doenças pulmonares tenha sido associada ao aumento da morbidade, as ferramentas para a identificação da disfunção do VD não estão bem definidas. Objetivo: O objetivo deste estudo foi avaliar a disfunção do VD por ecocardiografia speckle tracking (STE) em pacientes com doença pulmonar obstrutiva crônica (DPOC), e se a STE pode ser usada como indicador de melhora da função ventricular direita após um programa de reabilitação pulmonar (RP). Métodos: Quarenta e seis pacientes com DPOC submetidos ao programa de RP e 32 controles sadios pareados por sexo e idade foram incluídos no estudo. A função do VD foi avaliada na admissão e após o programa de RP por ecocardiografia bidimensional convencional e por STE. Além disso, a tolerância ao exercício foi avaliada pelo teste de caminhada de seis minutos (TC6M). Resultados: Pacientes com DPOC apresentaram pior função do VD segundo STE e ecocardiografia bidimensional convencional. Em comparação ao método convencional, a STE mostrou maior sensibilidade em determinar melhora da função ventricular direita após o programa de RP - strain longitudinal (SL) global do VD: 20,4 ± 2,4% vs. 21,9 ± 2,9% p < 0,001; SL da parede livre do VD: 18,1 ± 3,4% vs. 22,9 ± 3,7%, p < 0,001. O SL da parede livre do VD relacionou-se diretamente com a distância percorrida no TC6M basal (r = 0,58, p < 0,001) e com a variação no TC6M ∆ (TC6M) (r = 0,41, p = 0,04). Conclusões: Concluímos que a STE pode ser tão eficaz como a ecocardiografia bidimensional convencional na avaliação das funções globais e regionais do VD. Ainda, a STE pode se tornar uma importante ferramenta de avaliação e acompanhamento de pacientes com DPOC submetidos à RP para determinar a relação entre função ventricular direita e tolerância ao exercício.

Abstract Background: Although right ventricular (RV) dysfunction in pulmonary diseases has been associated with increased morbidity, tools for RV dysfunction identification are not well defined. Objective: The aim of this study was to evaluate the magnitude of RV dysfunction by means of speckle tracking echocardiography (STE) in patients with chronic obstructive pulmonary disease (COPD) and to investigate whether STE could be used as an index of RV improvement after a pulmonary rehabilitation (PR) program. Methods: Forty-six patients with COPD undergoing PR program and 32 age-sex matched healthy subjects were enrolled. RV function was evaluated at admission and after PR program by conventional two-dimensional echocardiography (2DE) and STE. In addition, exercise tolerance of subjects was evaluated using the six-minute walk test (6MWT). Results: COPD patients had worse RV function according to STE and 2DE as well. STE was more sensitive than conventional 2DE in determining RV improvement after PR program - RV global longitudinal strain (LS): 20.4 ± 2.4% vs. 21.9 ± 2.9% p < 0.001 and RV free wall LS: 18.1 ± 3.4% vs. 22.9 ± 3.7%, p < 0.001). RV free wall LS was directly related to distance walked at baseline 6MWT (r = 0.58, p < 0.001) and to the change in the 6MWT distance (6MWTD ∆) (r = 0.41, p = 0.04). Conclusions: We conclude that STE might be as effective as 2DE for evaluation of global and regional RV functions. STE may become an important tool for assessment and follow-up of COPD patients undergoing PR program to determine the relationship between RV function and exercise tolerance.

Abstract Purpose: To evaluate the preventive effect of ascorbic acid on sevoflurane-induced acute renal failure in an experimental rat model. Methods: Twenty-four adult male Wistar rats were randomly distributed into three groups. Subjects were allocated into 3 groups: Group I received sevoflurane only, whereas Groups II and III had moderate (150 mg/kg) and high (300 mg/kg) doses of AA in addition to sevoflurane, respectively. Rhabdomyolysis and myohemoglobinuric ARF was formed by intramuscular administration of glycerol on the upper hind limb on the 15th minute of inhalation anesthesia. Biochemical parameters consisted of serum levels of blood urea nitrogen, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), total antioxidant capacity (TAC), and protein carbonyl content. Histopathological variables were tubular necrosis, fibrin, and cast formation. Results: NGAL levels were significantly lower in Group III than Group II and Group I. On the other hand, TAC, PCO, urea and creatinine levels were notably higher in Group I compared with Groups II and III. There was a significant difference between 3 groups on frequencies of acute tubular necrosis (p=0.003), fibrin (p<0.001) and cast (p<0.001). Acute tubular necrosis and fibrin formation were more prominent in Group I. Casts were more common in Groups II and III. Conclusions: The ascorbic acid serve as a prophylactic agent against renal damage in patients receiving sevoflurane anesthesia and higher doses were associated with more apparent protective effects.

PurposeTo compare totally tubeless and standard percutaneous nephrolitotomy procedures on many parameters.Materials and MethodsPercutaneous nephrolitotomy was performed on 195 patients between June 2009 and May 2012. The data of those patients were evaluated retrospectively. Totally tubeless cases were enrolled to Group 1, and Group 2 consisted of non-tubeless cases (re-entry or Foley catheter).ResultsGroup 1 included 85 cases and group 2 a total of 110 patients. Paper tracing values for the kidney stones were 321.25 ± 102.4 mm2 and 324.10 ± 169.5 mm2 respectively. Mean fluoroscopy time was 4.9 ± 1.9 min and 5.08 ± 2.7 min, mean operation time was 78.8 ± 27.9 min and 81.9 ± 28.77 min and mean decrease in hematocrit was 2.6 ± 1.6 and 3.74 ± 1.9 respectively. All these comparisons were statistically significant. Length of hospitalization was 1.6 ± 1.1 and 3.5 ± 1.5 days for Groups 1 and 2 respectively. Mean superficial pain score was 5.8 ± 1.6 and 6.7 ± 1.2 respectively for both groups after 1 hour. At 6 hours, the scores changed to 3.87 ± 1.22 and 4.84 ± 1.3 respectively. The analgesic dose was 1.00 ± 0.7 and 1.53 ± 0.6 for the groups respectively at 6 hours. All the statistical differences were significant for these three parameters.ConclusionsWe believe that, because of their post operative patient comfort and decreased length of hospital stay, totally tubeless procedures should be considered as an alternative to standard percutaneous nephrolitotomy.

Método espectrofluorometrico rápido e sensível é descrito para a determinação de anlodipina (AD), um bloqueador de canais de cálcio, em amostras de plasma. O tipo de solvente, a faixa de comprimento de onda e a faixa de concentração foram escolhidas a fim de otimizar as condições experimentais. As curvas de calibração foram lineares (r > 0,997) na faixa de concentração de 0,1-12,5 ppm de AD. Os valores LoQ e LoD do método para amostras de plasma foram 0,1 ppm e 0,07 ppm, respectivamente. A precisão calculada como desvio padrão relativo (RSD) foi menor do que 3,5% e a precisão (erro relativo) foi melhor do que 5,5% (n=6). O método desenvolvido neste estudo pode ser fácil e diretamente aplicado para a determinação de AD sem derivatização no plasma.

A rapid and sensitive spectrofluorimetric method was developed for the determination of amlodipine (AD), a calcium channel blocker, in the plasma. The type of solvent, the wavelength range, and the range of AD concentration were selected to optimize the experimental conditions. The calibration curves were linear (r² >0.997) in the concentration range of 0.1-12.5 ppm of AD. The limit of quantitation and limit of detection values for the method for plasma samples were 0.1 ppm and 0.07 ppm, respectively. The precision calculated as the relative standard deviation was less than 3.5%, and the accuracy (relative error) was better than 5.5% (n=6). The method developed in this study can be directly and easily applied for the determination of AD in the plasma without derivatization in plasma.

OBJETIVO: Avaliar a eficácia do tratamento da fratura em martelo, pelo método de Ishiguro de bloqueio de extensão com fio de Kirschner. MÉTODOS: Trinta e oito pacientes foram tratados prospectivamente. O acompanhamento médio foi 18 meses e todos os pacientes foram avaliados radiológica e clinicamente, de acordo com os critérios de Crawford. RESULTADOS: A união da fratura foi obtida em todos os pacientes. Os resultados alcançados foram satisfatórios em 34 casos e não satisfatórios em quatro casos. CONCLUSÃO: Consideramos que a técnica de bloqueio de extensão é segura e eficaz e pode ser usada em todas as fraturas em martelo. Nível de Evidência IV, Série de Casos

OBJECTIVE: To evaluate the effectiveness of treating the mallet fracture with the Ishiguro extension block Kirschner wire method. METHODS: Thirty-eight patients were treated prospectively. The mean follow-up was 18 months and all patients were evaluated radiologically and clinically according to Crawford’s criteria. RESULTS: Union was obtained in all patients. The results obtained were satisfactory in 34 cases and unsatisfactory in four cases. CONCLUSION: We consider the extension block technique a safe and effective method that can be used in all mallet fractures. Level of Evidence IV, Case Series.

Methanolic extracts of eight Salvia species, namely S. aethiopis, S. candidissima, S. limbata, S. microstegia, S. nemorosa, S. pachystachys, S. verticillata, and S. virgata, sampled from Eastern Anatolia in Turkey, were screened for their possible antioxidant activities by two complementary test systems, namely DPPH free radical scavenging and b-carotene/linoleic acid. Total phenolic content of the extracts of Salvia species were performed Folin-Ciocalteu reagent and gallic acid used as standard. A wide variation has been observed among species in terms of antioxidant activity and total phenolic content. In both DPPH and b-carotene system, the most active plant was Salvia verticillata with a value of IC50=18.3 μg/ml and 75.8%, respectively. This specie also has the highest total phenolic content (167.1 mgGAE/g DW). The total amount of phenolics was between 50.3 to 167.1 mg GAE/g DW among species. A positive linear correlation was observed between total phenolic content and antioxidant activity of the extracts. The results suggest that the extract of Salvia species, notably Salvia verticillata with the highest antioxidant activity, can be used as natural antioxidants in the food industry.