[Tenolysis of extensor and flexor tendons of the hand]

BACKGROUND

Unrestricted gliding of extensor and flexor tendons is essential for normal functioning of the hand. If tendon gliding is impaired, a restricted range of motion of finger joints and, finally, joint stiffness result.

OBJECTIVES

To answer the questions about the causes of tenodesis in the hand, which examinations are most informative, how tenolysis is technically performed, and what results can be expected.

METHODS

The reasons, examinations, surgical technique, and results of extensor and flexor tendon tenolysis are presented.

RESULTS

Based on the data in the literature tenolysis of flexor tendons leads to range of motion that is only 50-60% of the preoperative range of motion. In about 20% of patients, deterioration as serious as secondary tendon rupture is observed. Meaningful results of extensor tendon tenolysis have not yet been published.

CONCLUSIONS

Tenolysis of extensor and flexor tendons in the hand is a demanding surgical procedure, and in addition to detailed knowledge of anatomy and biomechanics, it requires sufficient experience-especially following the primary repair of tendon injuries. The earliest indication for tenolysis can occur at about 3 months, usually after 6 months, if continuous intensive hand therapy and splinting have not been successful. General and individual benefits and risks must be carefully weighed. The key to successful tenolysis is the patient's access to and unrestricted participation in competent postoperative treatment, ideally performed by a specialist in hand therapy, which may last for weeks or months.

Multiple antipsychotics use in patients with schizophrenia: Why do we use it, what are the results from patient follow-ups?

In this study, the rates of antipsychotic polypharmacy, factors affecting combined drug use, the relationship between antipsychotic polypharmacy as it relates to duration of hospitalization and re-hospitalization, and treatment compliance were evaluated in schizophrenia patients. The study data was obtained between January 1, 2017 and December 31, 2017 by examining the files of all patients who were hospitalized in Ondokuz Mayıs University Faculty of Medicine Hospital, Ankara Numune Training and Research Hospital, Ankara Gulhane Training and Research Hospital psychiatric services. The inpatients' drug prescriptions at discharge and after one-year outpatient follow-up, as well as treatment compliance and re-hospitalization, were examined. The mean duration of illness was 109.3 ± 109.7 months, and the mean duration of hospitalization was 24.6 ± 19.1 days. For a total of 599 patients, multiple antipsychotic medication was used in 21.2% of hospitalizations. 11.2% of patients using single antipsychotic and 14.2% of patients using multiple antipsychotics were re-hospitalized within one year (X ² :0.830, p:0.362). Disease duration (Z:-3.654, p < 0.001) and duration of hospitalization (Z:-3.333, p < 0.001) were found to be longer in multiple antipsychotic users. 37.8% of the patients used a depot antipsychotic. There was no significant difference between depot antipsychotic use and oral antipsychotic use as it related re-hospitalization rates. As a conclusion, multiple antipsychotic use has reduced in Turkey. Contrary to popular belief, the use of multiple antipsychotics does not shorten, but rather may prolongs hospitalization, and it has no effect in reducing re-hospitalization. Drug combinations are generally used together with a depot treatment, clozapine treatment is preferred less frequently in combinations, clinicians have proven effectiveness of the drug combination they prefer, and they should give priority to the treatments recommended in treatment guidelines.

Prognostic Significance of Serum Albumin in Patients With Acute Coronary Syndrome

In patients with unstable angina pectoris (UAP) or non-ST elevation myocardial infarction (NSTEMI), long-term mortality remains high despite improvements in the diagnosis and treatment. In this study, we investigated whether serum albumin level is a useful predictor of long-term mortality in patients with UAP/NSTEMI. Consecutive patients (n = 403) who were hospitalized with a diagnosis of UAP/NSTEMI were included in the study. Patients were divided into 2 groups based on the presence of hypoalbuminemia and the relationship between hypoalbuminemia and mortality was analyzed. Hypoalbuminemia was detected in 34% of the patients. The median follow-up period was 35 months (up to 45 months). Long-term mortality rate was 32% in the hypoalbuminemia group and 8.6% in the group with normal serum albumin levels ( P < .001). On multivariate analysis, hypoalbuminemia, decreased left ventricular ejection fraction, and increased age were found to be independent predictors of mortality ( P < .05). The cutoff value of 3.10 g/dL for serum albumin predicted mortality with a sensitivity of 74% and specificity of 67% (receiver-operating characteristic area under curve: 0.753, 95% CI: 0.685-0.822). All-cause long-term mortality rates were significantly increased in patients with hypoalbuminemia. On-admission albumin level was an independent predictor of mortality in patients with UAP/NSTEMI.

How Do Childhood and Parental Anxiety Features Affect the Consequences of Child Sexual Abuse?

The purpose of the study was to investigate the anxiety features of children who experience child sexual abuse (CSA) and their parents, along with the features and consequences of sexual abuse in the environment of Child Advocacy Centers (CAC). The sample of this study comprised 150 children affected by CSA and one of their parents who were admitted to İzmir CAC between June 2016 and November 2016.The children-age range 9 to 13 years-and one of their parents were asked to complete the State-Trait Anxiety Inventory separately. The children also completed the Childhood Anxiety Sensitivity Index (CASI). During psychiatric evaluations of the children, sociodemographic characteristics and features of sexual abuse were noted and all psychiatric conditions were examined. The statistical analyses yielded significant correlations between the STAI scores of the parents and STAI-C and CASI scores of the children. There were statistically significant differences between the CASI scores, STAI-C subscale scores, and STAI subscale scores according to some variables of CSA along with their psychiatric diagnosis. Our findings showed that having higher anxiety sensitivity and trait anxiety levels and having parents with higher trait anxiety might be considered as risk factors for being diagnosed as having a psychiatric disorder due to CSA.

Publication Rate of Abstracts Presented at the Psychiatry National Congresses Held by the Psychiatric Association of Turkey

OBJECTIVE

In this study we aimed to investigate the frequency and the factors determining the conversion rate of the oral and poster presentations into articles. Five consecutive national psychiatry congresses held by the Psychiatric Association of Turkey (PAT) between 2012 and 2016 were evaluated.

METHOD

The manuscripts published in peer-reviewed journals were identified using the Web of Knowledge, PubMed and Google Scholar databases. The identified manuscripts were classified according to the type of the publication, the duration until publication, the impact factor and the index of the journal.

RESULTS

Out of the total 1372 reports presented at the five consecutive National Congress of Psychiatry events, a total of 297 abstracts (21.6%), comprising 201 of the 1104 posters and 96 of the 268 oral presentations, were converted in to publications. A significantly higher percentage of the oral presentations (p<0.001) compared to the poster presentations were converted into publications; and more of the publications consisted of research reports as compared to case reports. The mean time taken from presentation at the congress to publication was 19.04 (±12.47) months. The mean impact factor of the journals at the time of publication was 1.45 (±1.49).

CONCLUSION

Although the publication percentage of the presentations made in National Congress of Psychiatry events held by the PAT is similar to that of other studies conducted in Turkey, they are below the percentage reported by similar research in the international literature. There is a need in the mental healthcare institutions of Turkey for time allocation to make research and for creating units that can support researchers in the difficult process of publishing research results. Also, a more selective approach should be adopted when evaluating the congress presentations, and research that is considered to be of high academic value should be encouraged for submission as oral presentations.

Effects of trimetazidine on nerve regeneration in a rat sciatic nerve injury model

AIM

The aim of this study was to evaluate the efficacy of trimetazidine(TMZ) after end-to-end repair in a peripheral nerve injury model.

METHOD

We performed end-to-end primary repair of sciatic nerves in rats and showed TMZ's regenerative effect. For this objective 30 male Sprague Dawley albino rats were used. Surgery+water group, rats were assigned to a placebo group and were given water by oral gavage. Surgery+TMZ group, rats were given trimetazidine by oral gavage. All medications were given for 12 weeks. Motor function test was performed. Afterwards, electromyography (EMG) recording was done. Finally, blood samples were taken, the animals were euthanized andsciatic nerve was removed.

RESULTS

The amplitudes of compound muscle action potential (CMAP) increased significantly in the Surgery+TMZ group when compared with the group that have been given Surgery+Water. Nerve growth factor (NGF) immunoexpression in the Schwann cell was significantly increased in the Surgery+TMZ group compared with the Surgery+Water group. Moreover, fibrosis score was reduced in the Surgery+TMZ group compared to the Surgery+Water group.CONCLUSİONS: In conclusion, we demonstrated the superiority of TMZ on nerve healing in our experimental study which was evaluated with comparative groups (Tab. 3, Fig. 2, Ref. 31).

Deletion of TLS polymerases promotes homologous recombination in Arabidopsis

Unrepaired DNA damage hinders the maintenance of genome integrity because it blocks the catalytic activity of replicase. The stalled replication fork can be processed through either translesion synthesis (TLS) with specific polymerases, or replication using the undamaged template. To investigate how TLS activities are regulated and how the stalled replication fork is processed in plants, reversion frequencies and homologous recombination (HR) frequencies were analyzed using GUS-based substrates. The HR frequencies in plants deficient in DNA polymerase ζ (Pol ζ) or Rev1 were higher than that in wildtype plants under normal conditions, and were significantly increased by ultraviolet light irradiation. Heat shock protein (HSP) 90 is known to be involved in various stress responses. To examine the role of HSP90 in the regulation of damage tolerance, we analyzed reversion frequencies and HR frequencies in plants grown in the presence of a HSP inhibitor, geldanamycin (GDA). Reversion frequency was lower in GDA-treated plants than in mock-treated plants. Though the HR frequency was higher in GDA-treated wildtype plants than in mock-treated plants, no significant difference was detected in Rev1-deficient plants. In yeast, TLS polymerases interacted with each other or with a replication clump component, proliferating cell nuclear antigen (PCNA). HSP90 interacted with REV1 or REV7 in Nicotiana benthamiana cells. These results suggest that HSP90 interacts with TLS polymerase(s), which promotes error-prone TLS in plants.

A Rare Case of Fahr'S Disease Presenting as Epileptic Seizure in the Emergency Department

Fahr's disease (striato-pallido-dentate calcifications) is a rare neurodegenerative disorder characterised by bihemispherical and symmetrical calcium deposits in certain areas of the brain, particularly in the basal ganglia. We report an unusual case of Fahr's disease in a 36-year-old man who presented with generalised seizure in our emergency department. Basing on clinical, radiological, and endocrinological aspects, the patient was diagnosed as Fahr's disease associated with hypoparathyroidism. Administration of parenteral calcium and calcitriol supplementation were started in the emergency department. The clinical outcome was favourable after the treatment. The case illustrates that Fahr's disease, though rarely seen, has to be considered in a patient with convulsive state associated with calcifications of the basal ganglia. Systematically searching for dysparathyroidism in such patients is extremely important.

Opipramol Overdose Presented with Wide-Complex Tachycardia to the Emergency Department

Opipramol is an antidepressant and anxiolytic drug similar in structure to tricyclic antidepressants (TCAs) but it is primarily used for the treatment of generalized anxiety disorders. Unlike many TCAs, opipramol has no reuptake-inhibiting properties. Opipramol acts as a high affinity sigma receptor agonist. Opipramol acts as a low to moderate affinity antagonist for the dopamine-2 (D2), 5-hydroxtryptamine (5-HT2), histamine 1 (H1), histamine 2 (H2), and muscarinic acetylcholine receptors accounting for its antihistamine effects, and muscarinic anticholinergic properties. Here, we report a rare case of opipramol overdose case involving a 18-year-old woman, presenting to our emergency department (ED) with loss of consciousness and wide-complex tachycardia. A firm diagnosis of opipramol overdose was made on the basis of clinical, laboratory and electrocardiogram findings.

The Role of Oxidative Status in Initial Evaluation of Paediatric Patients with Graded Traumatic Brain Injury

Introduction

The purposes of this study were (a) to investigate the oxidative and antioxidative status in paediatric patients with varying severity of traumatic brain injury (TBI) during the early post-traumatic period; (b) to correlate injury severity with the oxidative and antioxidative status of patients; and (c) to identify early predictors of outcome in patients with TBI.

Methods

Fifty-two consecutive paediatric patients with isolated TBI and 31 age- and sex-matched healthy controls were enrolled. Patients were divided into two groups based on their Glasgow Coma Scale (GCS) scores recorded upon admission to the emergency department within the first 24 hours after injury. Twenty-three patients with moderate to severe TBI and 29 patients with mild TBI (GCS scores of >13) were included. The primary outcome variable was hospital mortality. Plasma total oxidant status (TOS), total antioxidant status (TAS), and the oxidative stress index (OSI) were assessed as predictors of early oxidative changes in serum using a novel automated measurement method.

Results

Compared to patients with mild TBI, TOS and OSI values were markedly elevated in patients with moderate to severe TBI. However, TAS levels did not show significant changes in either group of patients. Both GCS scores and Revised Trauma Scores were negatively correlated with the TOS and OSI, but neither was significantly correlated with the TAS. The TOS and OSI were significantly higher in non-survivors than in survivors. However, there was no significant difference in TAS levels between survivors and non-survivors.

Conclusion

Paediatric patients with isolated TBI are exposed to extensive oxidative stress, which varies with injury severity.

Critical Thinking Dispositions of Emergency Nurses in Turkey: A Cross-Sectional Study

Introduction

This cross-sectional descriptive study was conducted to determine the critical thinking dispositions of emergency nurses and any influencing factors related to critical thinking. The study is considered to respond to this need and contribute to the relevant literature.

Method

The study was conducted with the participation of 248 emergency nurses. The study data were collected using an information form covering characteristics of the nurses and the California Critical Thinking Disposition Inventory. The data were analyzed using independent-samples t test, independent-samples one-way variance analysis (F-test), and Pearson correlation test.

Results

The critical thinking dispositions of the emergency nurses in the study group were found to be at medium level (246.76±23.24). It was found that the female emergency nurses had higher levels of critical thinking dispositions than that of male nurses. The emergency nurses with graduate degrees had higher levels of critical thinking dispositions than that of the nurses with other educational levels. It was demonstrated that age, marital status, experience, or participation in in-service emergency training and certificate program did not affect the critical thinking dispositions of the nurses.

Conclusion

The results of the study reveal that the emergency nurses who are required to make quick and correct decisions. They need to develop their critical thinking skills and further studies should be conducted with more representative sample group.

Effects of subchronic exposure to zinc nanoparticles on tissue accumulation, serum biochemistry, and histopathological changes in tilapia (Oreochromis niloticus)

Zinc nanoparticles (ZnNPs) are among the least investigated NPs and thus their toxicological effects are not known. In this study, tilapia (Oreochromis niloticus) were exposed to 1 and 10 mg/L suspensions of small size (SS, 40-60 nm) and large size (LS, 80-100 nm) ZnNPs for 14 days under semi-static conditions. Total Zn levels in the intestine, liver, kidney, gill, muscle tissue, and brain were measured. Blood serum glucose (GLU), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and lactate dehydrogenase (LDH) were examined to elucidate the physiological disturbances induced by ZnNPs. Organ pathologies were examined for the gills, liver, and kidney to identify injuries associated with exposure. Significant accumulation was observed in the order of intestine, liver, kidney, and gills. Zn levels exhibited time- and concentration-dependent increase in the organs. Accumulation in kidney was also dependent on particle size; NPs SS-ZnNPs were trapped more effectively than LS-ZnNPs. No significant accumulation occurred in the brain (p > 0.05) while Zn levels in muscle tissue increased only marginally (p ≥ 0.05). Significant disturbances were noted in serum GOT and LDH (p < 0.05). The GPT levels fluctuated and were not statistically different from those of controls (p > 0.05). Histopathological tubular deformations and mononuclear cell infiltrations were observed in kidney sections. In addition, an increase in melano-macrophage aggregation intensity was identified on the 7th day in treatments exposed to LS-ZnNPs. Mononuclear cell infiltrations were identified in liver sections for all treatments. Both ZnNPs caused basal hyperplasia in gill sections. Fusions appeared in the gills after the 7th day in fish treated with 10 mg/L suspensions of SS-ZnNPs. In addition, separations in the secondary lamella epithelia were observed. The results indicated that exposure to ZnNPs could lead to disturbances in blood biochemistry and cause histopathological injuries in the tissues of O. niloticus. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1213-1225, 2017.

Association between attitudes towards Internet usage and health practices in high-school students in 2 schools in Turkey: a cross-sectional study

Excessive usage of the Internet can negatively affect health and health practices especially among youth. To examine the issue among Turkish students, this study determined the association between high-school students' attitudes towards Internet usage and their health behaviour. The sample (n = 2043) was randomly drawn from all students at two high schools in Turkey: one in Anatolia and one (a vocational school) in Istanbul. Data were collected using the Structured Questionnaire, Attitude Scale towards Internet Usage (ASTIU) and Adolescent Lifestyle Profile (ALP). The mean age of the students was 16.3 years, 77.7% were male and 96.9% used the Internet; mean duration of Internet use was 18.8 h/week. Female students had more positive attitudes towards Internet usage. Mean scores for ASTIU and ALP were 72.58 (SD 17.64) and 111.34 (SD 16.61) respectively, which were average levels. There was a statistically significant but weak overall negative correlation between adolescents' attitudes towards Internet usage and their health behaviour. Our results concur with studies in different cultures which suggest some negative effects, of heavy Internet use.

Report of mecC-carrying MRSA in domestic swine

Objectives

We unexpectedly identified MRSA isolates carrying mecC (mecC-MRSA) from a Danish swine farm located in eastern Zealand. The objective of the present study was to investigate the origin of these isolates and their genetic relatedness to other mecC-MRSA isolates from Zealand.

Methods

WGS was used to infer the phylogenetic relationship between 19 identified mecC-MRSA isolates from the swine farm and 34 additional epidemiologically unrelated human isolates from the same geographical region of Denmark. Variations in the accessory genome were investigated by bioinformatics tools, and antibiotic susceptibility profiles were assessed by MIC determination.

Results

mecC-MRSA was isolated from a domestic swine farm, but not from cattle reared at the same farm. Phylogenetic analysis revealed that all mecC-MRSA isolates from both farm animals and workers formed a separate cluster, whereas human isolates from the same municipality belonged to a closely related cluster. Analysis of the accessory genome supported this relationship.

Conclusions

To the best of our knowledge, this is the first report of mecC-MRSA isolated from domestic swine. The investigation strongly indicates that transmission of mecC-MRSA has taken place on the swine farm between the farmers and swine. The close clustering of farm isolates and isolates from the same municipality suggests a local transmission of mecC-MRSA.

Effects of long-term exposure to 900 megahertz electromagnetic field on heart morphology and biochemistry of male adolescent rats

The pathological effects of exposure to an electromagnetic field (EMF) during adolescence may be greater than those in adulthood. We investigated the effects of exposure to 900 MHz EMF during adolescence on male adult rats. Twenty-four 21-day-old male rats were divided into three equal groups: control (Cont-Gr), sham (Shm-Gr) and EMF-exposed (EMF-Gr). EMF-Gr rats were placed in an EMF exposure cage (Plexiglas cage) for 1 h/day between postnatal days 21 and 59 and exposed to 900 MHz EMF. Shm-Gr rats were placed inside the Plexiglas cage under the same conditions and for the same duration, but were not exposed to EMF. All animals were sacrificed on postnatal day 60 and the hearts were extracted for microscopic and biochemical analyses. Biochemical analysis showed increased levels of malondialdehyde and superoxide dismutase, and reduced glutathione and catalase levels in EMF-Gr compared to Cont-Gr animals. Hematoxylin and eosin stained sections from EMF-Gr animals exhibited structural changes and capillary congestion in the myocardium. The percentage of apoptotic myocardial cells in EMF-Gr was higher than in either Shm-Gr or Cont-Gr animals. Transmission electron microscopy of myocardial cells of EMF-Gr animals showed altered structure of Z bands, decreased myofilaments and pronounced vacuolization. We found that exposure of male rats to 900 MHz EMF for 1 h/day during adolescence caused oxidative stress, which caused structural alteration of male adolescent rat heart tissue.

Chronic exposure of tilapia (Oreochromis niloticus) to iron oxide nanoparticles: Effects of particle morphology on accumulation, elimination, hematology and immune responses

Effects of chronic exposure to alpha and gamma iron oxide nanoparticles (α-Fe2O3 and γ-Fe2O3 NPs) were investigated through exposure of tilapia (Oreochromis niloticus) to 0.1, 0.5 and 1.0mg/L (9.2×10(-4), 4.6×10(-3) and 9.2×10(-3)mM) aqueous suspensions for 60days. Fish were then transferred to NP-free freshwater and allowed to eliminate ingested NPs for 30days. The organs, including gills, liver, kidney, intestine, brain, spleen, and muscle tissue of the fish were analyzed to determine the accumulation, physiological distribution and elimination of the Fe2O3 NPs. Largest accumulation occurred in spleen followed by intestine, kidney, liver, gills, brain and muscle tissue. Fish exposed to γ-Fe2O3 NPs possessed significantly higher Fe in all organs. Accumulation in spleen was fast and independent of NP concentration reaching to maximum levels by the end of the first sampling period (30th day). Dissolved Fe levels in water were very negligible ranging at 4-6μg/L for α-Fe2O3 and 17-21μg/L for γ-Fe2O3 NPs (for 1mg/L suspensions). Despite that, Fe levels in gills and brain reflect more dissolved Fe accumulation from metastable γ-Fe2O3 polymorph. Ingested NPs cleared from the organs completely within 30-day elimination period, except the liver and spleen. Liver contained about 31% of α- and 46% of γ-Fe2O3, while spleen retained about 62% of α- and 35% of the γ-polymorph. No significant disturbances were observed in hematological parameters, including hemoglobin, hematocrit, red blood cell and white blood cell counts (p>0.05). Serum glucose (GLU) levels decreased in treatments exposed to 1.0mg/L of γ-Fe2O3 NPs at day 30 (p<0.05). In contrast, GLU levels increased during the elimination period for 1.0mg/L α-Fe2O3 NPs treatments (p<0.05). Transient increases occurred in glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and lactate dehydrogenase (LDH). Serum Fe levels did not change during exposure (p>0.05), but increased significantly within elimination period due to mobilization of ingested NPs from liver and spleen to blood. Though respiratory burst activity was not affected (p>0.05), lysozyme activity (LA) was suppressed suggesting an immunosuppressive effects from both Fe2O3 NPs (p<0.05). In contrast, myeloperoxidase (MPO) levels increased significantly in treatments exposed to α-Fe2O3 NPs (p<0.05), and the effect from γ-polymorph was marginal (p≥0.05). The results indicate that morphological differences of Fe2O3 NPs could induce differential uptake, assimilation and immunotoxic effects on O. niloticus under chronic exposure.