Sepsis is a life-threatening condition driven by a dysregulated host immune response to infection, with cytokine overproduction contributing to organ dysfunction and high mortality. Levosimendan, a calcium sensitizer used in acute heart failure, has been proposed to exert anti-inflammatory effects, but information on its immunomodulatory effects in early sepsis remains scarce. This study aimed to investigate the dose- and time-dependent effects of levosimendan on cytokine profiles in a rat model of lipopolysaccharide (LPS)-induced sepsis. Thirty-two male Wistar albino rats were randomly assigned to four groups: sham, sepsis control, low-dose levosimendan (1 mg/kg), and high-dose levosimendan (2 mg/kg). Cytokine levels (TNF-α, IL-1β, IL-6, IL-8, IL-17, MCP-1) were measured at 5 and 10 h post-LPS administration. High-dose levosimendan significantly reduced TNF-α, IL-1β, IL-6, and MCP-1 levels by the 10th hour, accompanied by improved Murine Sepsis Scores. IL-17 and IL-6 showed biphasic responses, increasing initially and decreasing significantly later, particularly with high-dose treatment. IL-8 reduction was observed only in the high-dose group. These findings support levosimendan’s dose and time-dependent anti-inflammatory effects and suggest it may modulate both early and late-phase cytokines in sepsis. Further studies are warranted to clarify its potential role in clinical sepsis management.

Botulinum neurotoxin A (BoNT) is being shown to have anticancer action as a potential adjuvant treatment. The transient receptor potential (TRP) melastatin 2 (TRPM2) stimulator action of BoNT was reported in glioblastoma cells, but not in colorectal cancer (HT29) cells. By activating TRPM2, we evaluated the impacts of BoNT and oxaliplatin (OXA) incubations on oxidant and apoptotic values within the HT29 cells. Control, BoNT (5 IU for 24 h), OXA (50 μM for 24 h) and their combinations were induced. We found that TRPM2 protein is upregulated and mediates enhanced BoNT and OXA-induced Ca2+ entry in cells as compared to control cells. The increase of free reactive oxygen species (ROS), but the decrease of glutathione is the main ROS responsible for TRPM2 activation on H29 exposure to oxidative stress. BoNT and OXA-mediated Ca2+ entry through TRPM2 stimulation in response to H2 O2 results in mitochondrial Ca2+ overload, followed by mitochondrial membrane depolarization, apoptosis and caspase-3/-8/-9, although they were diminished in the TRPM2 antagonist groups (N-(p-amylcinnamoyl)anthranilic acid and carvacrol). In conclusion, by increasing the susceptibility of HT29 tumour cells to oxidative stress and apoptosis, the combined administration of BoNT and OXA via the targeting of TRPM2 may offer a different approach to kill the tumour cells.

Objective: This study investigated the vasoactive responses of quiescent and pre-contracted isolated human umbilical veins and arteries to cumulative leptin. Materials and Methods: The vasoactive response of umbilical vessels pre-contracted with U46619 (10(-10)M) and angiotensin II (10(-6)M) to cumulative leptin (10(-11)-10(-7)M) were recorded in vitro. Results: Leptin did not affect the artery or vein basal tonus (p=1). The leptin-elicited relaxation in U46619-contracted vessels was greater in veins than in arteries (p<0.001). Incubation with N (omega)-nitro-L-arginine methyl ester (L-NAME) (10(-4)M) prevented the leptin-induced relaxation of the U46619 contraction response in the artery. The E-max and pD(2) values of the L-NAME-incubated veins were lower than those of the non-incubated veins (p<0.001 and p=0.001, respectively). The relaxation in angiotensin II-contracted veins was greater than that of the arteries (p<0.001). Incubation with L-NAME prevented leptin-induced relaxation in angiotensin II-contracted arteries. The E-max of leptin-induced relaxation of L-NAME-incubated veins was significantly lower than that of non-incubated veins (p=0.027); the pD(2) was similar. Conclusion: Leptin did not alter the resting tension of isolated umbilical vessels; however, the results indicated that leptin caused concentration-dependent relaxation in umbilical vessels pre-contracted with U46619 or angiotensin II. The maximum relaxation was greater in veins compared with arteries. Incubation with L-NAME completely inhibited leptin-induced relaxation in arteries and resulted in a significant inhibition in veins.

Background: Cystic fibrosis (CF) is a genetic disorder, in which defective clearance of airway secretions leads to progressive lung function loss. Inhaled mannitol is used to increase sputum and mucociliary clearance. There are little data from real-world studies on the effectiveness of mannitol in children. Our objective was to evaluate the spirometry and clinical results of mannitol in pediatric patients.Methods: We retrospectively reviewed the records of 30 children and adolescents with CF receiving inhaled mannitol who were already on recombinant human deoxyribonuclease (rhDNase) treatment. The change in forced expiratory volume in 1 second (FEV1) from baseline at 2-4 months was the primary outcome. Secondary measures were other spirometry results, body mass index (BMI), hospital admissions, sputum characteristics, and positive bacterial colonization.Results: Compared to baseline, we found significant improvement in percent predicted FEV1 at 2-4 months of treatment; 84.50 (58.00-99.00) vs. 96.00 (66.00-106.00) (P = 0.0007). The absolute change in FEV1 was +11.5% at 2-4 months, +6.5% at 5-7 months, and +4% at 8-12 months. Also, significant improvements in other spirometry results were observed. Adolescents had significantly lower FEV1 results, but the improvement in their lung function was sustained for a more extended period than children. Mannitol provided easier sputum removal, increased sputum volume, significant decline in hospitalizations, and significantly fewer patients with positive sputum cultures. A significant increase in BMI at 8-12 months was observed. Cough was the most frequent adverse effect.Conclusion: In a real-world setting, our results demonstrated that adding mannitol to rhDNase therapy is tolerable in pediatric patients with CF and may provide improved spirometry and clinical outcomes. In addition, our results showed that mannitol provided recovery in overall lung function at 2-4 months, which was sustained up to 12 months together with improved BMI, easier sputum removal, and a decline in bacterial colonization and hospital admissions. However, cough was the most frequent side effect.

Objective: To increase vaccine awareness, we aimed to determine individuals’ knowledge and behavioral approach to the COVID-19 vaccine. Methods: The data of this cross-sectional study were obtained online between June and July 31, 2021. One thousand one hundred seventy-six people over the age of 18 were included in the study. The researchers developed a data collection form consisting of 27 questions. Mean±standard deviation and median (1st quarter-3rd quarter) values, numbers, and percentages were used to summarize the data. Chi-square (χ2) test was used to show the relationship between categorical variables. Independent predictors of participants’ vaccine hesitancy/rejection were analyzed using logistic regression. Statistically, data with p<0.05 were considered significant. Results: A total of 1176 people, 55.7% of whom were women, with a mean age of 39.75±11.27 years, were included in the study. 71.6% of the participants were married, and 78.9% had a university/postgraduate degree. 9.7% of the participants stated that they were hesitant about the COVID-19 vaccine, and 7.1% refused the COVID-19 vaccine or would not be vaccinated when it was their turn. According to the logistic regression model established to examine the factors that may affect vaccine rejection; Age, the resources used to obtain information about the vaccine, the thought that it would not protect for two years, or the vaccine side effects were high, and the most effective way to get rid of the pandemic was not vaccination, were determined as the factors affecting vaccine rejection. Conclusion: As a result of the research, it was found that the participants had a positive attitude towards the COVID-19 vaccine. It was determined that 9.7% of the study group had vaccine hesitancy, and 7.1% had vaccine rejection. Keywords: Vaccine hesitancy, vaccine rejection, COVID-19 vaccines

Introduction: Influenza virus infections and pneumococcal pneumonia are associated with significant increases in hospitalization and mortality rates in patients with cardiovascular diseases (CVD). In Turkey, pneumococcal and flu vaccines are recommended for patients with chronic heart disease, adults aged 65 and older and adults who are at risk of pneumonia. Material and Method: This study was conducted between July 2019 and December 2019 among 240 CVD patients. The survey consisted of 29 questions aimed at evaluating the sociodemographic characteristics of the patients, the history of influenza and pneumococcal vaccines, and their knowledge and attitudes towards vaccines. Results: Vaccination rates were low in CVD patients. Last year, only 10% of the participants had been previously vaccinated with the pneumococcal vaccine and 27.75% with the influenza vaccine. While the percentage of vaccination influenza vaccine among university graduates was significantly higher than all other groups, this high was not detected for pneumococcal vaccine. Eighty percent of the participants visited their family physicians regularly in the previous year, while only 61.6% received information about the vaccination from the doctor or nurse. Influenza vaccine (39.2%) was recommended at a higher rate than pneumococcal pneumonia (12.1%) by the physicians or nurses of the participants during the visits. (p

OBJECTIVE:To determine the knowledge, opinions, experiences and trends regarding herbal treatment, traditional medicine and other complementary and alternative medicine. METHODS:Two cross-sectional studies were conducted at Meram Faculty of Medicine Hospital, Konya, Turkey, in 2012 and 2018, comprising subjects of either gender aged >18 years. Data was collected using a survey form prepared in the light of relevant literature. Data was summarised and compared between the two studies. RESULTS:Of the 810 subjects in the two studies, there were 405(50%) in 2012 with a mean age of 32.5±14.0 years, while the remaining 405(50%) were part of the 2018 study with a mean age of 34.4±13.8. There were significant differences between the two group of subjects about the use and indications of traditional and complementary medicine as those who believed traditional and complementary medicine was proper to use increased and those who believed it should not be used decreased significantly (p<0.001). There was a twofold increase in the use of social media as the source of relevant information (p<0.001). CONCLUSIONS:Significant changes in trends related to the use of traditional and complementary medicine between 2012 and 2018 were observed.

Objective Isoniazid for 6 to 9 months is the most widely used form of tuberculosis (TB) preventive treatment. We aimed to assess the adverse effects of isoniazid by using the serum levels of aspartate transaminase (AST), alanine transaminase (ALT), and uric acid (SUA) in children and adolescents receiving long-term isoniazid for latent TB infection. Methods The study included children <= 18 years of age who underwent TB preventive treatment with isoniazid (IPT) between 2015 and 2019 at a university hospital. Serum transaminase, SUA, urea, and creatinine levels of patients were measured before the initiation of IPT, 15th day, and once a month during treatment. Patients with ALT, AST, or SUA results above cut-off levels during treatment were evaluated. The final values in follow-up were included in the data analysis. Results A total of 141 children who underwent IPT were included. In total, 70 children had family members with confirmed TB disease, and 71 children had a positive tuberculin skin test. SUA increased above cut-off values in 16 children (11.3%), and half of them had uric acid levels over 7 mg/dL. The median duration of the development of hyperuricemia was 4.0 months. ALT or AST increased above cut-off values in 23 children (16.3%). ALT was above cut-off values in seven patients, AST was high in 20 patients. The median duration to the development of AST and/or ALT levels above cut-off was 4.0 months. Two patients had hepatotoxic transaminase levels. Three patients had both elevated transaminases and SUA levels. Conclusion Isoniazid may also cause hyperuricemia besides elevation in transaminases in children.

Amaç: Bu in vitro çalışma, EGb-761'in izole insan umbilikal arter üzerindeki vasküler etkilerini ve bu etkilerde nitrik oksit (NO) ve prostaglandinlerin rolünü değerlendirmeyi amaçlamaktadır. Gereçler ve Yöntem: Umbilikal arter şeritleri, Krebs-Henseleit solüsyonu içeren organ banyolarında asıldı. Uygulanan ajanların oluşturduğu izometrik vazoaktif değişiklikler kaydedildi. Farklı doku gruplarında (n=9) şu deneysel prosedürler yapıldı; 1) Kümülatif uygulanan EGb-761'in umbilikal arter şeritlerinin bazal tonusu üzerindeki etkisi. 2) Kümülatif EGb-761'in 10-6 M 5-HT ile arter şeritlerinde oluşturulan kasılma yanıtı üzerindeki gevşetici etkisi. 3) Kümülatif EGb-761'in L-NAME ile inkübasyon sonrası 5-HT ile arter şeritlerinde oluşturulan kasılma yanıtı üzerindeki gevşetici etkisi 4) Kümülatif EGb-761'in indometazin ile inkübasyon sonrası 5-HT ile arter şeritlerinde oluşturulan kasılma yanıtı üzerindeki gevşetici etkisi ve 5) Kümülatif EGb-761'in L-NAME ve indometazin ile inkübasyonu sonrası 5-HT ile arter şeritlerinde oluşturulan kasılma yanıtı üzerindeki gevşetici etkisi. Bulgular: Kümülatif EGb-761, 5-HT kaynaklı kasılma cevaplarında konsantrasyona bağlı gevşeme oluşturdu (p<0.05). L-NAME, EGb-761'in tüm konsantrasyonlarında 5-HT kasılmaları üzerinde oluşturduğu gevşeme yanıtlarını önemli ölçüde azalttı (p<0.05). L-NAME, EGb-761'in düşük konsantrasyonlarında oluşturduğu gevşeme yanıtlarını ise tamamen inhibe etti. İndometazin ise bu yanıtları daha yüksek EGb761 konsantrasyonlarında anlamlı şekilde inhibe etti (p<0.05). L-NAME + indometazin, tüm EGb-761 konsantrasyonlarının oluşturduğu yanıtları anlamlı şekilde inhibe etti (p<0.05). L-NAME ve indometazinin birlikte uygulanması, gevşeme yanıtlarında belirli EGb-761 konsantrasyonlarında tek başına L-NAME ve indometazinden daha güçlü bir inhibisyon ile sonuçlandı. Sonuç: EGb-761’in 5-HT ile önceden kasılma oluşturulan insan umbilikal arter şeritlerine kümülatif olarak uygulanması anlamlı şekilde konsantrasyona bağlı gevşeme yanıtı oluşturmaktadır. NO ve prostaglandinler, bu vazodilatasyon mekanizmasında EGb-761 konsantrasyonuna bağlı olarak değişen potansiyelde katkıda bulunmaktadır.

Introduction Autologous saphenous vein (SV) and internal mammary artery (IMA) are used as bypass conduits during coronary artery bypass graft surgery. Vasospasm of the arterial and venous grafts may constitute a significant clinical problem. Pretreatment with a vasodilator drug of the graft ex vivo or intraluminal injection before implantation may be used for spasm prophylaxis. This in vitro study was designed to assess the vasoactive effects and time-dependent changes of botulinum toxin A (BTX-A) and papaverine pretreatment on vasospasm of human SV and IMA grafts. Also, histomorphology of the vessels was assessed. Material and methods SV and IMA segments were suspended in organ baths, and isometric contraction responses to 2 different concentrations of 5-hydroxytryptamine (5-HT) and endothelin-1 (ET-1) were recorded after incubation with 2 different concentrations of BTX-A and papaverine at 2 time points (0 h and 2 h). Results The results revealed the following: 1) incubation with BTX-A and papaverine relaxes both SV and IMA rings contracted with 5-HT and ET-1; 2) the duration of the relaxant effect of BTX-A lasts longer than papaverine; and 3) no apparent histomorphological changes were observed in the grafts under light microscopy. Conclusions This study demonstrates that in human SV and IMA grafts, pretreatment with both BTX-A and papaverine are safe and have a potent inhibitory effect depending on the vessel and vasoconstrictor agent. The long-lasting vasodilatory effect of BTX-A on vascular smooth muscle may provide promising results in the prevention of venous and arterial graft spasm.

Background: Propolis is a product of honeybees that contains a variety of different compounds, including caffeic acid phenethyl ester (CAPE). Propolis and its bioactive compounds are widely used in folk medicine and as a dietary supplement. Previously it has been shown that CAPE has antioxidant, anti-inflammatory, antimicrobial, antiviral, immunomodulatory, and anticancer activity. Objective: This in vitro study was designed to investigate the vasoactive effects of CAPE on quiescent and precontracted human umbilical arteries. Methods: Umbilical artery strips were suspended in aerated organ baths containing a buffer solution. The strips were randomly allocated to study groups (n=8). Via a transducer and computer, changes in isometric tension were recorded. The effects of cumulative CAPE (10-8-10-4M) on basal tone of the artery, and in different groups of strips, the vasodilatory effect of cumulative CAPE on the constriction elicited by endothelin (ET-1), prostaglandin F2α (PGF2α) and U46619, and the effect of incubation with NO synthase inhibitor L-NAME, were recorded. Conclusion: CAPE elicits concentration-dependent relaxation on precontracted human umbilical artery strips depending on the constrictor agent. NO plays significant role in CAPE’s vasorelaxant effect.

AIM: To compare the effects of sevoflurane and propofol anesthesia on perioperative cerebral oxygenation in patients undergoing carotid endarterectomy (CEA) under general anesthesia by using near-infrared spectroscopy (NIRS) monitoring. MATERIAL and METHODS: Institutional approval was obtained, and the perioperative data of 33 patients undergoing CEA were retrospectively evaluated. The study groups were organized according to the anesthesia drugs used for maintenance: sevoflurane (n=17) and propofol (n=16). The regional cerebral oxygen saturation (rScO(2)) of the ipsilateral and contralateral hemispheres was monitored continuously using a NIRS instrument and analyzed at specific time points starting from induction to the 12th hour postoperation. The data were analyzed using the appropriate tests, and a p value of <0.05 was considered significant. RESULTS: Compared with those of groups with non-clamped hemispheres, the rScO(2) values of the sevoflurane and propofol groups decreased significantly during clamping (p<0.05) and increased to above-preoperative values after declamping (p<0.05). When the sevoflurane and propofol groups were compared, a significant decrease in rScO(2) was noted during extubation in the sevoflurane group (p<0.05). In the propofol group, female patients had significantly lower rScO(2) values compared with male patients during clamping of the carotid artery (p<0.05). None of the observed decreases was greater than 20%, which is considered an indication for shunting. CONCLUSION: Our NIRS monitoring results indicate that sevoflurane or propofol anesthesia does not generally cause significant differences in cerebral oxygenation during and after cross-clamping in patients undergoing CEA. The finding of sex-related differences in cerebral oxygenation in patients receiving propofol and decreased oxygenation during extubation in patients receiving sevoflurane warrants further studies.

Background: Deaths caused by recreational drug abuse have increased considerably in recent years. Therapeutic hypothermia offers the potential to improve neurological outcomes in post-resuscitation patients. Case Report: A 19-year-old man was brought to our emergency department after suffering out-of-hospital ventricular fibrillation (VF) cardiac arrest. He was resuscitated at our emergency department again due to VF. Urine analysis showed high levels of amphetamine and 3,4 methylenedioxymethamphetamine ( MDMA) (ecstasy). The patient was intubated, sedated, and ventilated. Within 1 h after the return of spontaneous circulation and hemodynamic stabilization, therapeutic hypothermia was initiated for neurologic protection. An external-cooling device was used for cooling. He was maintained at 33 degrees C for 72 h. The patient was weaned from the ventilator and extubated on day 5. He was discharged from the hospital on the day 10 with good cerebral performance. Why Should an Emergency Physician Be Aware of This?: Initiation of early therapeutic hypothermia within 1 h after return of spontaneous circulation might contribute to better neurologic outcome in patients who suffer VF cardiac arrest. We suggest that early therapeutic hypothermia may be considered in patients who suffer out-of-hospital cardiac arrest due to MDMA and amphetamine intoxications. (C) 2020 Elsevier Inc. All rights reserved.

Objective: Sepsis and septic shock are significant causes of mortality and morbidity. In septic shock, vasopressors and inotropic support are given for the treatment of hypotension. This study was designed to investigate the relationship between the vasoactive-inotropic score (VIS) and the results of sepsis patients in ICU. Methods: The data of 392 patients who were followed up with the diagnosis of septic shock in adult ICU were recorded retrospectively. Vasopressors and inotropic support of the patients during the first 48 hours after the diagnosis of septic shock were recorded. Mean and peak VIS values were calculated according to these values. The patients were divided into groups according to the mean VlS >= 10, peak VIS >= 10 and intensive care results and statistical analysis was performed. Results: The median ages of the patients were 68 (54.25-79) years and 239 (61%) were male. Dopamine 188 (47.9%), noradrenaline 365 (93.1%), adrenaline 53 (13.5%) and dobutamine 15 (3.8%) were used in the patients. The mean VIS was 9 (4-15), while the number of mean VIS >= 10 patients were 192 (49%). Peak VIS values were 11 (5-20), and the number of peak VIS >= 10 patients were 220 (56.1%). The mortality rate of the patients included in the study was 42.1%. The mean VIS score(13 vs 6, p=0.000), mean VIS >= 10 patient ratio (71.5% vs 32.6%, p=0.000), peak VIS score (16 vs 8, p=0.000), and peak VIS >= 10 patient ratio (73.3% vs 43.6%, p=0.000) were higher in non-survivors. The parameters such as mean VIS [OR 1.123, 95% CI 1.027-1.229, p=0.011], mean VIS >= 10 [OR 3.455, 95% CI 1.625-7.345, p=0.001] and peak VIS score [OR 0.917, 95% CI 0.851-0.989, p=0.024] were determined as independent risk factors for mortality. Conclusion: We conclude that vasoactive-inotropic score may be useful in predicting the outcome of septic shock patients in intensive care units.

Radial artery (RA) is widely used in coronary artery bypass (CABG) surgery and the prevention of spasm is crucial for graft patency. Botulinum toxin A (BTX-A) and B are commonly used for aesthetic reasons and neuromuscular disorders. They are proven to raise blood flow and increase survival of ischemic skin flaps. In this study we evaluated and compared the vasodilator effects of BTX-A and papaverine on human RA grafts. After resting 60 min in isolated organ baths, human RA grafts were examined. Contraction responses for different doses of serotonin (5-HT) and endothelin-1 (ET-1) were evaluated as a percent of maximum contraction response elicited by 80 mM potassium chloride (KCl). The inhibitory effects of BTX-A and papaverine on contraction responses taken at the 0th hour were compared with the 1st and 2nd hour responses. Inhibitory effects of BTX-A and papaverine against the contractile agent were evaluated by comparing the results of the first and last (0th and 2nd hour) application. In low concentrations, when we compared the effects of BTX-A (10− 8 M) and papaverine (10− 6 M) on 5-HT, papaverine was found to be more effective at both the 0th and 2nd hour (p < 0.05). Both BTX-A and papaverine inhibited the maximum contractile effect of ET-1 to the same extent at the 0th hour; but, the inhibitory effect of BTX-A was significantly stronger at the 2nd hour (p < 0.05). In high concentrations, when we compared the effects of BTX-A (10− 6 M) and papaverine (10− 4 M) on 5-HT, papaverine showed stronger inhibition (p < 0.05), whereas both agents had similar action of inhibition on ET-1 mediated maximum contraction responses. BTX-A inhibits both ET-1 and 5-HT induced contractions and its effectiveness does not decrease over time as observed with papaverine. This study is the first in the literature using human RA for prevention of vasospasm by BTX-A.

OBJECTIVE:The aim of this animal study was to investigate the short and long-term local histomorphologic effects and the utility of intra-articular application of ibuprofen. METHODS:Forty-six Wistar Albino rats were used in the study. The rats were randomized into 5 groups of 8 and a sham group of 6. The 40 rats in the study groups were anaesthetised with 60 mg/kg of ketamine, then 0.25 ml ibuprofen (25 mg) was injected to the right knee joint of each rat (ibuprofen group) and 0.25 ml 0.9% saline to the left knee joint as the control group. To the 6 rats in the sham group, only puncture was applied to both knee joints. The rats in each of the 5 study groups were sacrificed on days 1, 2, 7, 14 and 21 respectively. The histomorphologic changes were graded on a 6-point scale regarding inflammation of the synovia, cartilage tissue, and subchondral bone. Inflammation scores were compared using the Mann Whitney U-test and comparisons of the sacrifice day and drug used were evaluated with the Kruskal Wallis test. The p values below 0.05 were considered as significant. RESULTS:Statistically significant difference was found between the ibuprofen injected knees (10/40) and the saline injected (0/40) and sham knees (0/12) in respect of hematoma positivity (p = 0.002). Significantly higher inflammation scores were found in ibuprofen injected knees on the 1st, 2nd, 7th and 14th days compared to controls and sham (p < 0.05). Inflammation scores were similar in ibuprofen injected knees with and without hematoma (p > 0.05). Inflammation of the ibuprofen injected group was most severe on day one and the severity of inflammation reduced gradually throughout the 3 weeks. CONCLUSION:Our results show that intra-articular injection of ibuprofen can cause intra-articular hematoma. It also leads to transient inflammation of the synovia that is more severe in the early period, which gradually recovers.

AIM:To assess the feasibility of the vasoactive-inotropic score (VIS) in determining the amount of vasoactive support and its relationship with the mortality rate and characteristics of the patients with traumatic brain injury (TBI).MATERIAL AND METHODS:This study was conducted with a retrospective design involving the years 2013-2018 in a university hospital which provides tertiary intensive care service. A total of 102 patients who were admitted in the ICU with the diagnosis of severe TBI, and also were followed by neurosurgery service and who received vasoactive and inotropic support were analyzed concerning VIS value.RESULTS:The median age of the patients was 34 years, and 69.6% of the patients were male. Mortality rate was 43.1%. In the group with mean VIS≥10, the admission duration in the ICU and hospital were shorter (p < 0.0001) whereas mortality rates were higher (81.1% vs 21.5% and p < 0.0001). Besides, the number of patients with a VIS score of ≥10, ≥15 and ≥20 were higher in the group of patients who died (p < 0.0001). The results of the multivariate analysis such as VIS≥10 were significant.CONCLUSION:We can conclude that VIS, which is used to determine the amount of vasoactive and inotropic medicines during cardiac surgery and in sepsis patients, may be useful in predicting mortality in TBI patients.

Prolonged duration of action of rocuronium in an infant patient is rare. We report an unusual case of prolonged neuromuscular blockade with rocuronium in an infant undergoing cleft lip repair anesthetized with sevoflurane and management of the patient.