The frequency of change in five-point scale score with a Bayesian penalised likelihood PET reconstruction algorithm on interim FDG PET-CT and its potential implications for therapy decisions in Hodgkin's lymphoma

AIM

To assess the effect of a Bayesian penalised likelihood (BPL) reconstruction algorithm on the five-point scale (5-PS) score, response categorisation, and potential implications for therapy decisions after interim 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)-computed tomography (CT) (iPET-CT) to guide treatment in classical Hodgkin's lymphoma (HL).

MATERIALS AND METHODS

The present study included new patients with HL undergoing iPET-CT from 2014-2019 after two cycles of doxorubicin (Adriamycin), bleomycin, vincristine, and dacarbazine (ABVD). Two reporters categorised response using the 5-PS and measured maximum standardised uptake values (SUV_max) of the most avid tumour residuum, mediastinal blood pool, and normal liver with ordered subset expected maximisation (OSEM) and BPL reconstructions.

RESULTS

Eighty-one iPET-CT examinations were reviewed. Compared with OSEM, BPL increased the 5-PS score by a single score in 18/81 (22.2%) patients. The frequency of potential treatment intensification by changing a score of 3-4 was 13.6% (11/81) and represented 25% (11/44) of patients with a score of 3 on OSEM. All 11 patients remained in remission without a change in therapy (mean 63 months) except one who required second-line treatment for refractory disease. Median SUV_max of tumour residuum was significantly higher with BPL compared with OSEM (2.7 versus 2.4, p<<0.0001), whilst liver SUV_max was significantly lower for both reporters (up to 6.6%, p<0.0001).

CONCLUSION

BPL PET reconstruction increased the 5-PS score on iPET-CT in 22% of HL patients and can potentially result in unnecessary treatment escalation in over half of these patients.

Randomized Study to Evaluate the Impact of Telemedicine Care in Patients With Type 1 Diabetes With Multiple Doses of Insulin and Suboptimal HbA1c in Andalusia (Spain): PLATEDIAN Study

OBJECTIVE

To assess the impact of a telemedicine visit using the platform Diabetic compared with a face-to-face visit on clinical outcomes, patients' health-related quality of life (HRQoL), and physicians' satisfaction in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

PLATEDIAN (Telemedicine on Metabolic Control in Type 1 Diabetes Mellitus Andalusian Patients) (NCT03332472) was a multicenter, randomized, 6-month follow-up, open-label, parallel-group controlled study performed in patients with type 1 diabetes with suboptimal metabolic control (HbA_1c <8% [<64 mmol/mol]), treated with multiple daily injections. A total of 388 patients were assessed for eligibility; 379 of them were randomized 1:1 to three face-to-face visits (control cohort [CC]) (n = 167) or the replacement of an intermediate face-to-face visit by a telemedicine visit using Diabetic (intervention cohort [IC]) (n = 163). The primary efficacy end point was the mean change of HbA_1c levels from baseline to month 6. Other efficacy and safety end points were mean blood glucose, glucose variability, episodes of hypoglycemia and hyperglycemia, patient-reported outcomes, and physicians' satisfaction.

RESULTS

At month 6, the mean change in HbA_1c levels was -0.04 ± 0.5% (-0.5 ± 5.8 mmol/mol) in the CC and 0.01 ± 0.6% (0.1 ± 6.0 mmol/mol) in the IC (P = 0.4941). The number of patients who achieved HbA_1c <7% (<53 mmol/mol) was 73 and 78 in the CC and IC, respectively. Significant differences were not found regarding safety end points at 6 months. Changes in HRQoL between the first visit and final visit did not differ between cohorts, and, regarding fear of hypoglycemia (FH-15 score ≥28), statistically significant differences observed at baseline remained unchanged at 6 months (P < 0.05).

CONCLUSIONS

The use of telemedicine in patients with type 1 diabetes with HbA_1c <8% (<64 mmol/mol) provides similar efficacy and safety outcomes as face-to-face visits.

Mad Honey Poisoning Presenting with Ventricular Tachycardia and Acute Myocardial Infarction: A Case Report

Apart from its role as an important nutrient, honey is used for alternative medicinal purposes. Cases presenting with severe hypotension, bradycardia, atrioventricular block and asystole have been reported following ingestion of honey in northern parts of Turkey, and certain parts of Japan, Brazil and Nepal. Herein, we report a case presenting with ventricular tachycardia and acute inferoposterolateral myocardial infarction after ingestion of mad honey (grayanotoxin). According to our knowledge, such case is being reported for the first time in the literature.

Increased Systemic Cytokine/Chemokine Expression in Asthmatic and Non-asthmatic Patients with Bacterial, Viral or Mixed Lung Infection

This study was aimed to determine the profiles of serum cytokines (IL-1β, TNF-α, IL-4, IL-5) and chemokines (MCP-1: monocyte chemoattract protein-1 and RANTES: regulated on activation normal T cell expressed and secreted) in individuals with an asthmatic versus a non-asthmatic background with bacterial, viral or mixed acute respiratory infection. Asthmatic (n = 14) and non-asthmatic (n = 29) patients with acute viral, bacterial or mixed (bacterial and viruses) respiratory infection were studied. Patients were also analysed as individuals with pneumonia or bronchitis. Healthy individuals with similar age and sex (n = 10) were used as controls. Cytokine/chemokine content in serum was determined by ELISA. Increased cytokine/chemokine concentration in asthmatic and non-asthmatic patients was observed. However, higher concentrations of chemokines (MCP-1 and RANTES) in asthmatic patients infected by viruses, bacteria or bacteria and viruses (mixed) than in non-asthmatic patients were observed. In general, viral and mixed infections were better cytokine/chemokine inducers than bacterial infection. Cytokine/chemokine expression was similarly increased in both asthmatic and non-asthmatic patients with pneumonia or bronchitis, except that RANTES remained at normal levels in bronchitis. Circulating cytokine profiles induced by acute viral, bacterial or mixed lung infection were not related to asthmatic background, except for chemokines that were increased in asthmatic status.

A safer disposal of hazardous phosphate coating sludge by formation of an amorphous calcium phosphate matrix

Phosphate coating hazardous wastes originated from the automotive industry were efficiently encapsulated by an acid-base reaction between phosphates present in the sludge and calcium aluminate cement, yielding very inert and stable monolithic blocks of amorphous calcium phosphate (ACP). Two different compositions of industrial sludge were characterized and loaded in ratios ranging from 10 to 50 wt.%. Setting times and compressive strengths were recorded to establish the feasibility of this method to achieve a good handling and a safe landfilling of these samples. Short solidification periods were found and leaching tests showed an excellent retention for toxic metals (Zn, Ni, Cu, Cr and Mn) and for organic matter. Retentions over 99.9% for Zn and Mn were observed even for loadings as high as 50 wt.% of the wastes. The formation of ACP phase of low porosity and high stability accounted for the effective immobilization of the hazardous components of the wastes.

Cutaneous Richter syndrome: a better place to transform?

The development of high-grade lymphoma in patients with chronic lymphocytic leukaemia is known as Richter syndrome (RS) and is associated with a grave prognosis, with a mean survival of 8 months despite treatment. Cutaneous RS has been described in a handful of cases and may be associated with a better outcome than the more common extracutaneous variants. We review the literature with particular emphasis on pathogenesis, treatment and survival of RS. We postulate that the absence of B symptoms and a normal lactate dehydrogenase level, presumably reflecting localized or limited disease, and a lower tumour burden, may explain the apparently better survival in some patients with cutaneous RS than with extracutaneous variants.

Anti-cyclic citrullinated peptide antibodies in patients with sarcoidosis

INTRODUCTION

Anti-cyclic citrullinated peptide (anti-CCP) antibodies have a high predictive value in rheumatoid arthritis (RA) patients and are associated with disease severity. Sarcoidosis is a chronic inflammatory disease characterized by non-calcified granuloma formations.

AIM

To determining the prevalence of anti-CCP antibodies in patients with sarcoidosis, and identifying a possible correlation with clinical and laboratory findings.

MATERIALS AND METHODS

Forty-two patients presenting to the rheumatology polyclinic and diagnosed with sarcoidosis as a result of the examinations made, 45 RA patients and 45 healthy subjects were included in the study. Demographic, clinical, serological and radiological data of all patients were recorded. Anti-CCP antibodies were evaluated by using a second-generation ELISA method. Rheumatoid factor (RF) IgM was determined with the nephelometry method.

RESULTS

Forty-two patients (10 males) were included in the study. Mean patient age was 45.2 years (20-70 years) and mean duration of disease was 3.5 years. Two sarcoidosis patients (4.7%) and 38(84.4%) RA patients were found to be positive for anti-CCP antibodies while the antibody wasn't detected in any healthy subject. The two sarcoidosis patients found positive for anti-CCP were also diagnosed with rheumatoid arthritis. RF positivity was detected in 7 sarcoidosis patients (16.6%) and in only one subject in the control group.

CONCLUSION

The prevalence of anti-CCP antibodies in patients with sarcoidosis was found to be significantly lower than RA patients and similar with the healthy control group. This result shows that anti-CCP antibodies don't have an important role in the pathogenesis of sarcoidosis, but could be important in revealing the overlap syndromes of sarcoidosis-RA.

A new cytotype of the African pygmy mouse Mus minutoides in Eastern Africa. Implications for the evolution of sex-autosome translocations

The African pygmy mice (genus Mus, subgenus Nannomys) are recognized for their highly conserved morphology but extensive chromosomal diversity, particularly involving sex-autosome translocations, one of the rarest chromosomal rearrangements among mammals. It has been shown that in the absence of unambiguous diagnostic morphological traits, sex-autosome translocations offer accurate taxonomic markers. For example, in Mus minutoides, irrespective of the diploid number (which ranges from 2n = 18 to 34), all specimens possess the sex-autosome translocations (X.1) and (Y.1) that are unique to this species. In this study, we describe a new cytotype that challenges this view. Males are characterized by the translocation (Y.1) only, while females carry no sex-autosome translocation, the X chromosome being acrocentric. Hence, although sex-autosome translocations (X.1) and (Y.1) are still diagnostic when one or both are present, their absence does not rule out M. minutoides. This cytotype has a large distribution, with specimens found in Tanzania and in the eastern part of South Africa. The nonpervasive distribution of Rb(X.1) provides an opportunity to investigate different evolutionary scenarios of sex-autosome translocations using a phylogenetic framework and the distribution of telomeric repeats. The results tend to support a scenario involving a reversal event, i.e., fusion then fission of Rb(X.1), and highlighted the existence of a new X1X1X2X2/X1X2Y sex chromosome system, confirming the remarkable diversity of neo-sex chromosomes and sex determination systems in the African pygmy mice.

Treatment of toxic metal aqueous solutions: encapsulation in a phosphate-calcium aluminate matrix

Polyphosphate-modified calcium aluminate cement matrices were prepared by using aqueous solutions polluted with toxic metals as mixing water to obtain waste-containing solid blocks with improved management and disposal. Synthetically contaminated waters containing either Pb or Cu or Zn were incorporated into phosphoaluminate cement mortars and the effects of the metal's presence on setting time and mechanical performance were assessed. Sorption and leaching tests were also executed and both retention and release patterns were investigated. For all three metals, high uptake capacities as well as percentages of retention larger than 99.9% were measured. Both Pb and Cu were seen to be largely compatible with this cementitious matrix, rendering the obtained blocks suitable for landfilling or for building purposes. However, Zn spoilt the compressive strength values because of its reaction with hydrogen phosphate anions, hindering the development of the binding matrix.

The impact of the duration of admission to the emergency room on the mortality of intensive care patients

OBJECTIVE

There are many factors affecting the mortality of patients admitted to the intensive care unit (ICU). Among these are the patients' age, diagnosis, and concomitant pathology. The aim of this retrospective study was to investigate whether there is an adverse effect of the time between admission to the Emergency Room (ER) and admission to the ICU on the mortality of these patients.

MATERIALS AND METHODS

The medical records of the patients who were admitted to the Emergency Department (ED) of the Bolu Izzet Baysal State Hospital and subsequently were admitted to the ICU between December 2009 and August 2011 were analyzed in terms of the time of admission, the season of admission, and the waiting and the stand-by times in the ER.

RESULTS

A total of 2380 patients, who were admitted to the ED of the Bolu Izzet Baysal State Hospital and subsequently to the ICU, were included in the study. The median waiting time in the ER was 1.23 h (10 min to 10.02 h). After completion of the admission procedures, the median hospitalization time in the ER was 0.16 h (3 min to 2.58 h). There was no statistically significant difference between the patients who died after admission to the ICU and the ones who survived, in terms of the waiting and the stand-by times in the ER ( P > 0.05).

CONCLUSION

The waiting times at the ED did not affect the mortality of the ICU patients.

Simultaneous quantitative determinations of fluticasone propionate and salmeterol xinafote in diskus inhalers

In the present study, two new methods were developed for the quantitative determination of active components of Seretide(®), commercially available pharmaceutical preparation in the diskus form. One of these methods was based on derivative spectrophotometry and used a zero-crossing technique. The determinations of fluticasone propionate and salmeterol xinafoate were performed by first order derivatisation at 216.5 nm and second order derivatisation at 250 nm, respectively. The concentration ranges were 5.0-32.5 μg/mL for fluticasone propionate and 2-12 μg/mL for salmeterol xinafoate. The second method developed also included high performance liquid chromatography. In this method, a methanol-water mobile phase mixture (95:5, v/v) and a C18 chromasil column as a stationary phase were used. The wavelength of the diode array UV detector was 260 nm; the flow rate was 1 mL/min. The concentration ranges were 2-16 μg/mL for fluticasone propionate and 1-8 μg/mL for salmeterol xinafoate. The results for both methods from diskus are in the pharmacopea limits. For the statistical determination of these results, these two methods were compared with t-test for the means and with F-test for the standard deviations.

The Obstetrics Gynecology and Children's Hospital Emergency Room waiting time before hospitalization

BACKGROUND

One of the most substantial factors affecting patient satisfaction in the Obstetrics-Gynecology and Children's Hospital is the wait time in the emergency room.

OBJECTIVE

We retrospectively studied the waiting periods of patients visiting the emergency room patients in Bolu Izzet Baysal Obstetrics-Gynecology and Children's hospital.

METHOD

Using an automated documentation system for each patient that recorded the season in which the patients consulted the emergency room, the month, day, time, examination time, hospitalization decision time, the hospitalization clinic following the decision to hospitalize, and the time to hospitalization, we retrospectively studied the waiting periods of emergency room patients in Bolu Ýzzet Baysal Obstetrics-Gynecology and Children's Hospital.

RESULTS

A total of 15,004 patients who consulted the hospital emergency room between November 24, 2009, and August 25, 2011, and who were hospitalized in a clinic were included in this study. The highest frequency of emergency room patient visits occurred during the summer season (28.1%), in the month of July (10.2%), on Mondays (16.1%), and between 8 and 11 AM (22.1%; p < 0.05). The emergency room wait time of patients consulting the pediatric clinic was (55 ± 67 min), which was significantly shorter than the wait time of patients consulting other clinics (p < 0.05).

CONCLUSION

The majority of patients who were hospitalized in any clinic through the emergency room consulted the hospital during the daytime hours. The time to hospitalization for the admitted patients was within an acceptable time frame. We believe that conducting comprehensive research to determine whether it is possible to reduce wait times even further to increase patient satisfaction will be instructive.

Protective effect of montelukast, a cysteinyl leukotriene receptor-1 antagonist, against intestinal ischemia-reperfusion injury in the rat

OBJECTIVE

Ischemia-reperfusion (I-R) injury of the intestine is a significant problem because the initial damage caused by ischemia is exacerbated by reperfusion. In this study, we examined the protective effect of montelukast against I-R-induced intestinal tissue damage.

MATERIALS AND METHODS

Eight-week-old male Sprague-Dawley rats were randomly divided into three treatment groups : a sham-operated group, a group receiving I-R, and a group receiving I-R plus montelukast (I-R/M). Tissue samples were evaluated and scored histologically. The blood levels of malondialdehyde (MDA), myeloperoxidase (MPO), glutathione (GSH), and cardiotrophin-1 (CT-1) were measured.

RESULTS

In the I-R group, the histological score and the levels of serum MDA and MPO were increased compared with those in the control group. In the I-R/M group, the histological score and serum MDA and MPO levels were significantly decreased compared with those in the I-R group. Additionally, compared with the IR group, the I-R/M group had increased serum GSH and CT-1 levels and a decreased intestinal injury score. Ileal sections from the I-R/M group showed minimal alterations, characterized by moderate lifting of the epithelial layer from the lamina propria, and few apoptotic enterocytes were observed compare with the number in the I-R group.

CONCLUSION

The findings of the present study demonstrated that montelukast can protect I-R-induced intestinal damage in rats.

Solidification/stabilization of toxic metals in calcium aluminate cement matrices

The ability of calcium aluminate cement (CAC) to encapsulate toxic metals (Pb, Zn and Cu) was assessed under two curing conditions. Changes in the consistency and in the setting time were found upon the addition of the nitrates of the target metals. Both Pb and Cu caused a delay in CAC hydration, while Zn accelerated the stiffening of the mortar. Compressive strengths of the metal-doped mortars, when initially cured at 60 °C/100% RH, were comparable with that of the free-metal mortar. Three different pore size distribution patterns were identified and related to the compounds identified by XRD and SEM. Sorbent capacities of CAC for the toxic metals were excellent: a total uptake was achieved for up to 3 wt.% loading of the three metals. In this way, CAC mortars were perfectly able to encapsulate the toxic metals, allowing the use of CAC for waste management as proved by the leaching tests.

The importance of the mean platelet volume in the diagnosis of supraventricular tachycardia

BACKGROUND

This retrospective study aimed to investigate the diagnostic relation between the mean platelet volume (MPV) and supraventricular tachyarrhythmia (SVT) in patient with documented atrial tachyarrhythmia in the emergency department (ED).

METHODS

Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period.

RESULTS

In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was significantly higher than in the control group (9.12 ± 1.22 flvs 8.64 ± 0.89 fl, p<0.001). Multivariate logistic regression analysis showed that just MPV was independent predictor of SVT in patients with palpitation in ED (odds ratio [OR] 8.497, 95% confidence interval (6.181 to 12.325), p=0.012).

CONCLUSION

The present study described that MPV is helpful parameter for the diagnosis of SVT in emergency department, for the first time in the literature.

Evaluation of patients with Crimean-Congo hemorrhagic fever in Bolu, Turkey

BACKGROUND

Crimean-Congo hemorrhagic fever (CCHF), which is associated with a high mortality rate in the Black Sea region of Turkey, has received increasing attention.

OBJECTIVE

In this study, the epidemiological features, clinical and laboratory findings, treatments, and outcomes of patients diagnosed with CCHF between 2006 and 2012 based on data obtained from the Bolu Provincial Directorate of Health (BPDH) were evaluated.

METHODS

BPDH data were reviewed for the period between 1 January 2006 and 31 July 2012. The locations where the tick had attached to the patient, the site of the tick bite on the patient's body, the dates of tick bite and removal, and the demographic characteristics of each patient were recorded. BPDH data on the total number of tick bites, patients with confirmed CCHF, and deaths due to CCHF in Bolu Province during the study period were also evaluated.

RESULTS

A total of 46 patients with CCHF and 38 patients without CCHF but who had been bitten by ticks were admitted to the BPDH. Of the patients with CCHF, 54.3% were female. The mean age of the patients was 46.88 ± 2.05 years (range, 1-79 years). The mortality rate was 8.82%. Patients were predominantly observed in June and July. When the patients were distributed according to their occupations, the majority was houswife (48.6%), followed by animal husbandry worker (27.0%), farmer (10.8%), health worker (5.4%), and other (8.1%). The symptoms of the patients with CCHF included fatigue (60.9%), fever (60.9%), and myalgia (60.9%). Of those patients with CCHF, 41.3% were determined to have a high fever.

CONCLUSIONS

The probability of developing CCHF decreased as the duration of tick attachment increased. Moreover, although the clinical presentation is important, it is not diagnostic. Physical examination and laboratory findings become more specific in later stages.

International project on individual monitoring and radiation exposure levels in interventional cardiology

Within the Information System on Occupational Exposure in Medicine, Industry and Research (ISEMIR), a new International Atomic Energy Agency initiative, a Working Group on interventional cardiology, aims to assess staff radiation protection (RP) levels and to propose an international database of occupational exposures. A survey of regulatory bodies (RBs) has provided information at the country level on RP practice in interventional cardiology (IC). Concerning requirements for wearing personal dosemeters, only 57 % of the RB specifies the number and position of dosemeters for staff monitoring. Less than 40 % of the RBs could provide occupational doses. Reported annual median effective dose values (often <0.5 mSv) were lower than expected considering validated data from facility-specific studies, indicating that compliance with continuous individual monitoring is often not achieved in IC. A true assessment of annual personnel doses in IC will never be realised unless a knowledge of monitoring compliance is incorporated into the analysis.