Management of ischaemic stroke survivors in primary care setting: the road to holistic care

The management of ischaemic stroke survivors is multidisciplinary, necessitating the collaboration of numerous medical professionals and rehabilitation specialists. However, due to the lack of comprehensive and holistic follow-up, their post-discharge management may be suboptimal. Achieving this holistic, patient-centred follow-up requires coordination and interaction of subspecialties, which general practitioners can provide as the first point of contact in healthcare systems. This approach can improve the management of stroke survivors by preventing recurrent stroke through an integrated post-stroke care, including appropriate Antithrombotic therapy, assisting them to have a Better functional and physiological status, early recognition and intervention of Comorbidities, and lifestyles. For such work to succeed, close interdisciplinary collaboration between primary care physicians and other medical specialists is required in a holistic or integrated way.

Evaluation of T-cell subsets in pregnant women infected with SARS-CoV-2

OBJECTIVE

Immune responses to SARS-CoV-2 are the main cause of tissue damage in coronavirus disease 2019. However, the pathophysiological mechanism of the disease has not been fully elucidated. The aim of this study was to examine T cell subsets of pregnant women infected with SARS-CoV-2 and evaluate the relationship between the possible differences in trimesters and clinical findings of the disease.

MATERIALS AND METHODS

Fifty-six pregnant patients with SARS-CoV-2 and 61 healthy pregnant controls were included in the study. T cell subsets were analyzed by flow cytometry.

RESULTS

The CD3+ total T cell (p = 0.006 and p = 0.027) of pregnant patients infected with SARS-CoV-2 in second and third trimesters was found to be lower than in the control group. CD3+CD4+ helper T cell (p = 0.035), Treg (p = 0.001), and Treg/Th17 ratio (p = 0.001) were found to be lower in the third trimester patients infected with SARS-CoV-2 than in the controls. Significant decreases were observed only in the Treg (p = 0.001) and Treg/Th17 ratio (p = 0.001) in the first trimester patients infected with SARS-CoV-2 compared to the controls. When trimesters were compared in terms of T subsets, no difference was found (p > 0.05).

CONCLUSION

The CD3+ total T cell (p = 0.001), CD3+CD4+ helper T cell (p = 0.011), Treg (p = 0.001), and Treg/Th17 ratio (p = 0.001) were found to be lower in pregnant women infected with SARS-CoV-2. This difference was associated with the development of pneumonia but not with adverse pregnancy outcomes.

Far-infrared treatment of experimental sinusitis in rabbits: a pilot study

OBJECTIVE

Thermal therapy has existed for thousands of years and dates back to ancient civilizations such as the Finns, Romans, ancient Chinese, American Indians, and Egyptians. Sun therapy is a form of natural Far Infrared Rays (FIR) thermal therapy. Far infrared rays are invisible rays with the longest wavelength of natural sunlight. However, sunbathing should only be done in moderation, as sunlight contains ultraviolet rays that can burn and damage the skin. More than 30 million people in Asia, Europe, and Australia receive Far Infrared Therapy with FIR lamps. They emit 2-25-micron wavebands. We aimed to investigate whether FIR therapy that uses a similar waveband improves sinusitis symptoms.

MATERIALS AND METHODS

This study was conducted on 10 New Zealand rabbits of both sexes, 7-8 months old, with an average weight of 1.8-2.4 kg. They were divided into four study groups. Sinusitis was induced in rabbits by blocking the sinus ostium, whereas some were left as control. Far infrared treatment with an infra-sin device was given with or without antibiotics. Mucosal samples were evaluated microscopically regarding epithelial eruption, epithelial vacuolization, interstitial edema, vascular congestion, leukocyte infiltration, and mucosal thickening.

RESULTS

We found clinical and histopathological improvements in rabbits with sinusitis on the right side of the nose, to which we applied FIR treatment with the device Infra-Sin.

CONCLUSIONS

Our findings in this animal study led us to conclude that it would be beneficial to study the effects of FIR treatment on people with allergic rhinitis and sinusitis and to identify the optimal dosing, treatment duration, and intensity. To add to our findings, looking into whether FIR therapy can be used as an alternative to antibiotic treatment for human sinusitis is essential.

At the heart of the matter: how mental stress and negative emotions affect atrial fibrillation

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, affecting 2%-3% of the world's population. Mental and emotional stress, as well as some mental health conditions (e.g., depression) have been shown to significantly impact the heart and have been suggested to act both as independent risk factors and triggers in the onset of AF. In this paper, we review the current literature to examine the role that mental and emotional stress have in the onset of AF and summarise the current knowledge on the interaction between the brain and heart, and the cortical and subcortical pathways involved in the response to stress. Review of the evidence suggests that mental and emotional stress negatively affect the cardiac system, potentially increasing the risk for developing and/or triggering AF. Further studies are required to further understand the cortical and sub-cortical structures involved in the mental stress response and how these interact with the cardiac system, which may help in defining new strategies and interventions to prevent the development of, and improve the management of AF.

Stroke in Atrial Fibrillation and Other Atrial Dysrhythmias

PURPOSE OF REVIEW

Atrial fibrillation (AF) is a major risk factor for systemic embolism and ischaemic stroke. Furthermore, AF-related strokes are associated with higher mortality, greater disability, longer hospital stays and lower rates of hospital discharge than strokes caused by other reasons. The aim of this review to summarise the existing evidence on the association of AF with ischemic stroke and provide insights on the pathophysiological mechanisms and the clinical management of patients with AF in order to reduce the burden of ischemic stroke.

RECENT FINDINGS

Beyond Virchow's triad, several pathophysiological mechanisms associated with structural changes in the left atrium, which may precede the identification of AF, may contribute to the increased risk of arterial embolism in AF patients. Individualised thromboembolic risk stratification based on CHA₂DS₂-VASc score and clinically relevant biomarkers provides essential tool towards a personalised holistic approach in thromboembolism prevention. Anticoagulation remains the cornerstone of stroke prevention moving from vitamin K antagonists (VKA) to safer non-vitamin K direct oral anticoagulants in the majority of AF patients. Despite the efficacy and safety of oral anticoagulation, still the equilibrium between thrombosis and haemostasis in AF patients remains suboptimal and future directions in anticoagulation and cardiac intervention may provide novel treatment options in stroke prevention. This review summarises the pathophysiologic mechanisms of thromboembolism, aiming the current and potential future perspectives in stroke prevention in AF patients.

Right ventricular adaptation and subclinical damage by echocardiography in heart transplantation recipients: insights from myocardial work index

Aim

Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx) and a challenge for echocardiographic evaluation. We sought to evaluate the accuracy of the most novel echocardiographic tools for the assessment of RV remodelling and function in asymptomatic HTx recipients with and without rejection.

Methods

All patients underwent right heart catheterization with biopsy, cardiac magnetic resonance (CMR) and echocardiography in a row within the same day while fasting, irrespective of symptoms, as part of institutional follow up protocol dedicated to HTx recipients. Invasively measured systolic pulmonary artery pressure was used to calculate RV myocardial work index (MWI) from strain-pressure loops by using the custom software (EchoPAC BT204, Horten, Norway). Event timings were determined from pulmonic and tricuspid valve opening and closures. With the aim to generate full bull's eye map by automated function imaging, we computed RV LS data from the apical 4-chamber view 3 times, from 3 consecutive cycles substituting apical LV views. Other indices of RV function were measured according to the EACVI 2015 recommendations for chamber quantification. RV volumes and ejection fraction (EF) were quantified by CMR. Echocardiographic measurements were compared with CMR derived RV EF and biopsy findings as the reference for microstructural changes. We also evaluated by echocardiography organ donors as healthy controls.

Results

Sixty-one fully matching studies (echo, CMR, catheter, biopsy) were analyzed. Tricuspid systolic annular velocity (S'), peak systolic excursion (TAPSE) and longitudinal strain (LS) were significantly lower in healthy HTx recipients as compared to controls (p<0.001 for all). Whereas, RV volumes, EF and fractional area change (FAC) were not different between HTx recipients and healthy controls (Figure 1, EDV:end-diastolic volume). In the overall HTx recipients, only FAC (r=0.51, p<0.001) but not S', TAPSE, LS or MWI correlated with CMR derived EF. Biopsy defined subclinical rejections however were nicely mirrored by LS, and MWI (Figure 2), whereas other indices failed to reflect microstructural changes. In addition, MWI had higher accuracy than LS to discriminate biopsy findings. RV volumes, EF, FAC as well as TAPSE, S' were insensitive to subclinical myocardial damage.

Conclusion

RV adaptation in healthy HTx recipients is characterized by decreased longitudinal function but preserved overall RVFAC, EF, and volumes. MWI seems to be more reliable than other echocardiographic parameters to track subclinical RV myocardial damage due to rejection, while the RV EF remains preserved.

Funding Acknowledgement

Type of funding sources: None.

T1 mapping of the right ventricle in heart transplant recipients: how does it correlate with endomyocardial biopsy findings?

Aim

Noninvasive detection of cardiac allograft rejection is highly desirable. We sought to assess how right ventricular (RV) T1 mapping correlates with endomyocardial biopsy findings.

Methods

All patients underwent right heart catheterization with biopsy and cardiac magnetic resonance (CMR) irrespective of symptoms, as part of the institutional registry protocol dedicated to heart transplant (HTx) recipients. CMR studies were performed using a 1.5 T scanner and analyses by using a commercially available software (CMR42, Circle CVI, Calgary, Canada). Endocardial and epicardial borders were drawn on end-systolic and end-diastolic phases for ventricular function analysis. For T1 measurements, region of interests located at the RV free-wall were drawn manually on midventricular short-axis slices avoiding blood pool and epicardial fat. Extracellular volume (ECV) was calculated as ECV = (1 − hematocrit) × (ΔR1 myocardium/ΔR blood), where R1 = 1/T1. Late gadolinium enhancement (LGE) images were also obtained using a phase-sensitive inversion recovery segmented gradient echo sequence. Hyperenhancement was assessed semi-quantitatively as segmental (2–3 cm) or diffuse (>3 cm). Allograft rejection was determined based on the severity of inflammatory infiltrates and myocyte damage on pathological specimens according to the standardized International Society for Heart and Lung Transplantation (ISHLT) nomenclature.

Results

In all, 61 paired studies were evaluated. None of the patients had heart failure symptoms. We defined 3 subgroups: Group I; never rejected (n=23), group II; biopsy remarkable for rejection (n=19) and group III; history of past rejection(s) (n=19). RV volumes and ejection fraction (EF) did not differ between the groups. However, rejections were nicely mirrored by T1 time and particularly by ECV. Of note, T1 time and ECV improved but not completely normalized after resolution of rejection. Overall, T1 time (cut off 1060ms) and ECV (cut off 35%) were sensitive (84%, both) and had high negative predictive values (88% and 87%, respectively) but not specific (43% and 52% respectively) for discriminating rejection related subclinical RV damage. Their specificity slightly improved to 52 and 61% respectively, if patients with previous rejection were excluded (Figure 1). LGE did not discriminate rejection.

Conclusion

RV volumes and EF are insensitive to detect allograft rejection. Native T1 time and ECV of the RV, as a means of extracellular expansion, likely reflect interstitial fibrosis, oedema, and inflammation that are typical for, but not limited to allograft rejection. Hence, these parameters can help to exclude rejection but have limited standalone value for making the nonivasive diagnosis due to their low specificity. These results cannot be extrapolated to the left ventricle.

Funding Acknowledgement

Type of funding sources: Private hospital(s). Main funding source(s): University of Baskent

The effect of surgical margin on cancer-specific survival in patients treated with nephron-sparing surgery

Background

Nephron-sparing surgery (NSS) is currently the recommended treatment modality for selected renal tumors. The prognostic significance of positive surgical margin (PSM) and surgical margin width (SMW) after NSS is controversial.

Aim

To evaluate the effect of PSM and SMW on cancer-specific survival (CSS) in patients who underwent NSS.

Materials and Methods

The pathological samples of 142 patients who underwent NSS were reviewed. Patients were divided into two groups with PSM and negative surgical margin (NSM), and after that those with PSM were divided into two groups according to SMW as those with 0.1-2 mm and those >2 mm. CSS was calculated using Kaplan-Meier method. Cox regression analysis was used to adjust the clinicopathologic variables. A P value < 0.05 was considered statistically significant.

Results

Local recurrence rate and distant metastasis rate were higher in patients with PSMs than those with NSMs (P = 0.018 and P = 0.039, respectively). However, there was no significant difference between the two groups in terms of CSS. In the group with SMW 0.1-2 mm, the tumor diameter was longer (P = 0.018), enucleation number was higher (P = 0.026), and local recurrence was higher (P = 0.034) than the group with SMW > 2 mm. There was no significant difference between the two groups in terms of CSS.

Conclusion

In patients who underwent NSS, PSMs and SMWs have a negative effect on local recurrence but have no significant effect on CSS.

Color Doppler Imaging in Uveitis

PURPOSE

To evaluate the vascular hemodynamic changes that can be detected with color Doppler imaging (CDI) in diagnosis, differential diagnosis and prognosis of uveitis with different etiologies including Behçet's disease.

METHODS

Four groups consisting of healthy volunteers, uveitis patients with different etiologies and Behçet's disease patients with and without ocular involvement were examined by CDI. Central retinal artery (CRA), posterior ciliary artery (PCA), ophthalmic artery (OA) and central retinal vein (CRV) flow velocities and vascular resistances were measured prospectively by a radiologist blinded to the presence and etiology of uveitis.

RESULTS

The peak systolic and end-diastolic velocities in CRA and PCA in Behçet's disease with ocular involvement were significantly lower than all other groups (p < 0.001). Peak systolic and end-diastolic velocities in CRA were lower than the control group in Behçet's disease patients without ocular involvement (p < 0.001) but there were no differences in PCA and OA flow velocity (p > 0.05). In the uveitis group, CRA and CRV flow velocities were significantly lower than in the control group (p < 0.001).

CONCLUSIONS

According to our results, uveitis in Behçet's disease is associated with significant reductions of CRA and PCA flow velocities when compared with other types of uveitis and healthy subjects. In cases without ocular involvement, CRA flow velocities were lower than the control group, but there were no real differences in the PCA and OA values. This suggests that vasculitic involvement of PCA is more specific to Behçet's disease and occurs later in the course of the disease. The results also suggest that it may be possible to detect and follow hemodynamic changes in Behçet's disease with CDI before clinical findings of ocular involvement become evident.

Optical Coherence Tomography Findings in Branch Retinal Artery Occlusion

PURPOSE

To report the optical coherence tomography (OCT) findings in a 35-year-old man with acute inferior branch retinal artery occlusion.

METHODS

OCT findings in acute branch retinal artery occlusion were evaluated.

RESULTS

OCT disclosed diffuse thickening of the neurosensory retina in the inferior perifoveolar area. Increased reflectivity was noted in the inner retinal layers rom the surface of the retina to the photoreceptor layers. Decreased reflectivity was observed from the photoreceptor layers and the retinal pigment epithelium secondary to the shadowing effect. Foveolar depression, photoreceptor layer in the fovae, and retinal pigment epithelium underneath the fovea were normal. OCT findings in the superior perifoveolar area were also normal.

CONCLUSIONS

In the retinal artery occlusion, denaturation and breakdown of the normally transparent intracellular protein and an increase in the intracellular fluid cause ischemic whitening of the retina. Otherwise there is no retinal thickening secondary to the accumulation of serous fluid escaping from retinal capillaries into the extracellular space. The OCT findings support these descriptions.

Intravitreal Triamcinolone Acetonide in Vogt-Koyanagi-Harada Syndrome

PURPOSE

To report the results of intravitreal triamcinolone acetonide in two eyes of a patient with Vogt-Koyanagi-Harada syndrome.

METHODS

A 24-year-old woman with Vogt-Koyanagi-Harada syndrome was treated with a single 4-mg dose of intravitreal injection of triamcinolone acetonide in both eyes.

RESULTS

On the seventh day after injection, visual acuity improved from 20/50 to 20/20 in the right eye and from 20/100 to 20/32 in the left. One month after injection, visual acuity was 20/20 in the right eye and 20/32 in the left, and fluorescein angiography showed that serous detachment had almost completely resorbed. The ocular examination remained stable during the 8-month follow-up period.

CONCLUSIONS

In this study, a prompt improvement in the clinical picture of a patient with Vogt-Koyanagi-Harada syndrome after intravitreal triamcinolone acetonide injection was described. The results suggest that intravitreal triamcinolone acetonide injection may be an additional tool in the treatment of Vogt-Koyanagi-Harada syndrome.

Macular Sensitivity in Eyes with Central Serous Chorioretinopathy

Purpose

To determine macular sensitivity and fixation characteristics in eyes with central serous chorioretinopathy (CSC) using fundus-related microperimetry.

Methods

The authors reviewed 19 eyes with serous elevation within the central 10° due to CSC and 15 normal healthy eyes that had undergone fundus-related microperimetry. The macular sensitivity was measured using the fundus-related microperimeter, MP-1. The best-corrected visual acuity (BCVA), mean retinal sensitivity in the central 10° (central microperimetry, cMP-1) and in the paracentral 10° to 20° (paracentral microperimetry, pMP-1), and fixation stability and location were determined and compared with that of control eyes.

Results

Eyes with CSC showed significantly lower logMAR BCVA (p<0.001), cMP-1, and pMP-1 sensitivity than control eyes (p<0.001, p<0.01, respectively). Eyes with CSC were not significantly different in fixation location (p=1.00) or fixation stability than control eyes (p=0.45). Fixation location was predominantly central in all eyes with CSC; fixation was stable in 17 (89%) and relatively unstable in 2 (11%).

Conclusions

Eyes with CSC showed significantly lower retinal sensitivity not only at the central but also in the paracentral area. Even with decreased BCVA and retinal sensitivity, our patients showed central and stable fixation in their affected eyes.

Comparative heel stick study showed that newborn infants who had undergone repeated painful procedures showed increased short-term pain responses

AIM

We evaluated the short-term effect of repeated pain exposure on the pain responses of newborn infants using different pain assessment methods, as this area had been under-researched.

METHODS

We compared 20 term, large for gestational age infants and 40 term, appropriate for gestational age controls. All had undergone a heel stick for a newborn screening test just before discharge, but the larger babies had also undergone at least other five painful stimuli prior to that. A pulse oximeter and a skin conductance algesimeter (SCA) were connected to the babies during the heel prick, and video recordings were made. Crying time, the Neonatal Infant Pain Scale (NIPS), heart rate, peripheral oxygen saturation (SpO₂ ) and SCA measurements were compared within and between the groups.

RESULTS

After the heel prick, the crying time (p = 0.021) and NIPS (p = 0.013) scores were significantly higher in the study group and the SpO₂ levels were significantly lower (p = 0.009), but the heart rate (p = 0.981) was not significantly different between the groups. SCA measurements did not differ significantly between the groups.

CONCLUSION

Babies who received more painful stimuli during the first few days of life showed greater pain responses during a subsequent heel prick.

The impact of CYP2C19 polymorphisms on citalopram metabolism in patients with major depressive disorder

WHAT IS KNOWN AND OBJECTIVE

Genetic variations in drug-metabolizing enzyme genes change drug pharmacokinetics and response. CYP2C19 is a clinically important enzyme that metabolizes citalopram (CIT). The objective of this study was to determine CYP2C19 genetic polymorphisms and to evaluate the impact of these polymorphisms on the metabolism of citalopram in a sample of the Turkish population. We also assessed *17 polymorphism in healthy subjects in this population.

METHODS

The CYP2C19 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism method (209 healthy individuals and 50 patients for CIT metabolism), and the plasma concentrations of CIT and demethylcitalopram (DCIT) were quantified by high-performance liquid chromatography.

RESULTS AND DISCUSSION

The CYP2C19*1 and *17 allele frequencies for the patient group and the healthy group were 71·0%, 18·0% and 81·1%, 18·9%, respectively. There was no significant difference between the two groups (P > 0·05). The mean plasma concentrations and the mean dose-corrected (C/D) plasma levels of DCIT were significantly higher in patients with the CYP2C19*1/*1 genotype compared to patients with CYP2C19*1/*2 and CYP2C19*2/*2 genotypes (P < 0·05). Furthermore, the mean metabolic ratio (MR, CIT/DCIT) was also significantly higher in the CYP2C19*1/*2 + CYP2C19*2/*2 genotypes (P < 0·05). On the other hand, plasma CIT, DCIT concentrations and M/R value in the CYP2C19*1/*1 genotypes were no different to those of the CYP2C19*1/*17 genotypes (P > 0·05).

WHAT IS NEW AND CONCLUSION

Our data suggest that CYP2C19*17 polymorphism does not have a significant effect on CIT metabolism. In contrast CYP2C19*2 polymorphism has a prominent role and is likely to contribute to interindividual variability in CIT metabolism in vivo at therapeutic doses.

A different technique for the closure of trocar sites

This study aims to present a different technique for the closure of trocar sites in laparoscopic surgeries.

MATERIALS AND METHODS

Retrospective records of cases who received the new closure technique were collected. Multifilament synthetic absorbable suture was used in this technique, with no additional tools.

RESULTS

This technique was applied in a total of ten cases, which included myomectomy, hysterectomy, sacrocolpopexy, and ectopic pregnancy. No intraoperative and postoperative complications were seen in any of the cases.

CONCLUSION

This new and relatively easy-to-use technique can be used as an alternative technique for the closure of trocar sites in laparoscopy.

Airway changes in pregnant women before and after delivery

AIM

High incidence of difficult or failed intubation in obstetric patients is still a major problem to challenge anaesthesiologists. Although the probability of difficult intubation is impossible to predict preoperatively, some simple, practical bedside tests may help. This study used five simple tests in an attempt to better evaluate airway changes in pregnant women before and after delivery.

MATERIALS AND METHODS

Pregnant women from the ASA I-II group who were planning to undergo a normal vaginal delivery were evaluated as to the possibility of experiencing difficult intubation. Mallampati scores, thyromental distance, sternomental distance, mouth opening, and the degree of neck extension were recorded just before delivery and 24 h after delivery.

RESULTS

Significant differences were seen in the pre- and post-delivery measurements (p < 0.05). Before delivery, Mallampati scores I, II, III, IV were 35, 24, 2, 0, respectively, and 24 h after delivery became 46, 15, 0, 0, respectively.

CONCLUSIONS

Within 24 h after delivery, Mallampati scores changed in one-third (n 21, 36.6%) of the patients. Significant differences between the two measurements of thyromental and sternomental distances, mouth opening, and the degree of neck extension confirm difficult airway management in pregnant women.

The effects of hydrogen sulphide on alveolar bone loss in periodontitis

AIM

Hydrogen sulphide (H2S), recently considered the third endogenous gaseous transmitter capable of modulating many physiological processes. The purpose of this study was to analyze the morphometric and histopathological changes associated with experimental periodontitis in rats in response to systemic administration of H2S METHODS: Forty-eight Wistar rats were divided into six experimental groups: non-ligated (NL) group; ligature only (LO) group; systemic administration of NaHS (H2S donor drug) alone (NaHS) group (14 µmol/kg body weight per day); and ligature placed and systemic administration of three different doses of NaHS groups (14, 28 and 70 µmol/kg/day) (L-NaHS-14, L-NaHS-28 and L-NaHS-70, respectively). Silk ligatures were placed at the gingival margin of lower first molars. Changes in alveolar bone levels were clinically measured and tissues were histopathologically examined.

RESULTS

At the end of 15 days alveolar bone loss significantly higher in the entire ligature (LO and L-NaHS-14, -28 and -70) groups compared to the unligated groups (P<0.05) but there were no statistically significant differences in alveolar bone loss between LO and L-NaHS groups. Osteoclast number was significantly lower in L-NaHS-70 group than those of L-NaHS-14 and L-NaHS-28 groups (P<0.05). The osteoblastic activity of the L-NaHS-14 and -70 groups were significantly higher than those of the other groups (P<0.05).

CONCLUSION

The findings of this study suggested that NaHS, when administered systemically with three different doses, did not prevent or increase alveolar bone loss in the rat model.

Effect of ozone therapy on autogenous bone graft healing in calvarial defects: a histologic and histometric study in rats

AIM

The purpose of this study was to analyze histologically the effect of ozone therapy in combination with autogenous bone graft on bone healing in rat calvaria.

METHODS

Critical size defects were created in calvaria of 27 male Wistar rats. The animals were divided into three groups of nine animals each: autogenous bone graft group (n = 9); autogenous bone graft with ozone therapy group (80%, 30 s 3 d for 2 wk, n = 9); non-treatment (control) group (n = 9). Animals were killed after 8 wk. Histomorphometric assessments, using image analysis software, and histological analyses were performed. Primary outcome was total bone area. Secondary outcomes (osteoblast number, new bone formation) were also measured.

RESULTS

Histomorphometrically, the total bone area in the autogenous bone graft with ozone therapy group (9.3 ± 2.2) were significantly higher than that of the autogenous bone graft group (5.1 ± 1.8) (p < 0.05). Also, the ozone therapy group significantly increased the percentage of total bone area compared to the autogenous bone graft group (p < 0.05). The osteoblast number significantly increased in the autogenous bone graft with the ozone therapy group (58 ± 12.3) compared to the autogenous bone graft group (9.3 ± 3.5) (p < 0.05). Also, it was observed that autogenous bone graft with ozone therapy group showed significant new bone formation when compared to the autogenous bone graft group (p < 0.05).

CONCLUSION

Ozone therapy enhances new bone formation by autogenous bone graft in the rat calvarial defect model.

N-acetylcysteine decreases alveolar bone loss on experimental periodontitis in streptozotocin-induced diabetic rats

BACKGROUND AND OBJECTIVE

The purpose of this study was to evaluate the morphometric and histopathological changes associated with experimental periodontitis in diabetic rats in response to systemic administration of N-acetylcysteine (NAC), a sulfhydryl-containing thiol antioxidant.

MATERIAL AND METHODS

 Sixty Wistar rats were divided into six experimental groups: nonligated (NL) group; ligature-only (L) group; streptozotocin-only (STZ) group; STZ and ligature (STZ + L) group; and systemic administration of NAC and ligature (70 and 100 mg/kg body weight per day, respectively) (NAC70 and NAC100 groups). Diabetes mellitus was induced by 60 mg/kg of streptozotocin. Silk ligatures were placed at the gingival margin of the lower first molars of the mandibular quadrant. The study duration was 30 d and the animals were killed at the end of this period. Changes in alveolar bone levels were clinically measured and tissues were histopathologically examined to assess the differences among the study groups.

RESULTS

At the end of the 30-d study period, alveolar bone loss was significantly higher in the STZ + L group compared with the other groups (p < 0.05). Also, alveolar bone loss in all the NAC groups was significantly lower than in the STZ + L and L groups (p < 0.05). The osteoblastic activity in the NAC100 group was significantly higher than in the other groups (p < 0.05).

CONCLUSION

Within the limits of this study, it can be suggested that NAC, when administered systemically, prevents alveolar bone loss in the diabetic rat model.

Periodontal health knowledge and smoking are associated with periodontal treatment need according to tooth brushing levels

OBJECTIVE

The aim of this study is to determine whether periodontal health knowledge is associated with frequency of tooth brushing and periodontal treatment need.

METHODS

Four hundred and two subjects participated in the study. Data on sociodemographic variables (age, gender, marital status, income, and education), general health, smoking behaviour tooth cleaning habits and knowledge on periodontal health/disease were collected with a questionnaire. Periodontal treatment need was examined using the Community Periodontal Index of Treatment Needs (CPITN). According to the CPITN scores, the treatment needs were grouped as minimum (CPITN = 0), low-level (CPITN = 1-2), or high-level (CPITN = 3-4).

RESULTS

Statistical differences were found between the frequency of tooth brushing and smoking status, marital status, periodontal health knowledge and periodontal treatment needs. Gender (females), place of residence (urban areas), education and periodontal health knowledge had positive relationship with tooth brushing frequency, while smoking and periodontal treatment need had negative relationship. When multivariate logistic regression analysis was applied, age, marriage and poor periodontal knowledge were associated with increased low-level periodontal treatment needs, and age, marriage and smoking were associated with increased high-level periodontal treatment need.

CONCLUSION

In the limits of this study, we suggest that gender, smoking habits, marital status, place of residence, education and periodontal health knowledge are determining factors related to tooth brushing frequency. Periodontal knowledge and smoking are associated with periodontal treatment needs.

Preventive effects of thymoquinone in a rat periodontitis model: a morphometric and histopathological study

BACKGROUND AND OBJECTIVE

Thymoquinone has a variety of pharmacologic properties, including antihistaminic, antibacterial, antihypertensive, hypoglycemic, anti-inflammatory and anti-oxidative activities. Through its anti-inflammatory and antioxidant properties, thymoquinone may play an important role in preventing periodontal diseases. The aim of this study was to evaluate the effectiveness of thymoquinone in preventing the initiation and progression of periodontitis in a rat periodontitis model.

MATERIAL AND METHODS

Twenty-four rats were randomly divided into three experimental groups: a nonligated (NL) treatment group (n = 8), a ligature-only (LO) treatment group (n = 8) and a ligature plus thymoquinone (10 mg/kg, daily for 11 d) (TQ) treatment group. In order to induce experimental periodontitis, a 4/0 silk suture was placed at the gingival margin of the right-mandibular first molars of the rats. Thymoquinone was administered by gastric feeding until the animals were killed on day 11. Changes in the alveolar bone levels of rats in each group were measured clinically, and tissues of rats in each group were examined histopathologically to determine inflammatory cell infiltration (ICI), osteoblast and osteoclast activities, and osteoclast morphology.

RESULTS

Alveolar bone loss around the mandibular molar tooth was significantly higher in the LO group compared with NL and TQ groups (p < 0.05). The ratio of the presence of ICI and osteoclast numbers was significantly higher in the LO group than in the NL and TQ groups (p < 0.05). Osteoblastic activity was significantly lower in the LO group than in the NL and TQ groups (p < 0.05).

CONCLUSION

The present study showed that the oral administration of thymoquinone diminishes alveolar bone resorption in a rat periodontitis model.

Bilateral extra-adrenal perirenal myelolipomas: CT features

Myelolipomas are rare benign tumours composed of adipose tissue and haematopoietic cells that are typically found in adrenal glands but have also appeared in extra-adrenal sites. Distinguishing between extra-adrenal myelolipomas and malignant tumours, such as liposarcomas, is crucial to avoid an invasive procedure. To this end, we present a comprehensive report of the CT imaging characteristics of a pathologically proven bilateral extra-adrenal perirenal myelolipoma.

Hemobilia and occult cystic artery stump bleeding after a laparoscopic cholecystectomy: endovascular treatment with N-butyl cyanoacrylate

Hemobilia is a rare phenomenon. In this case report we present an emergent transcatheter glue embolization (in which N-butyl cyanoacrylate is used as an embolizing agent) due to arteriobilary fistula occurred following the laparoscopic cholecystectomy in a 41-year-old woman.

Health literacy among adults: a study from Turkey

Patients' health literacy is increasingly recognized as a critical factor affecting health communication and outcomes. We performed this study to assess the levels of health literacy by using Rapid Estimate of Adult Literacy in Medicine (REALM) and Newest Vital Sign (NVS) instruments. Patients (n = 456) at a family medicine clinic completed in-person interviews, REALM and NVS tests which were translated into the Turkish language by translation-back translation process. Additional questions regarding demographic characteristics were also collected. The mean scores (mean + or - standard error) for REALM and NVS were 60.29 + or - 0.32 and 2.60 + or - 0.08, respectively. The REALM test scores showed that 2.7% had inadequate (less than or equal to 6th grade), 38.6% marginal (7th to 8th grade) and 58.7% (greater than or equal to 9th grade) adequate health literacy. The NVS test score revealed a proportion of 28.1% had adequate health literacy. Educational attainment was the most important demographic characteristic found to be related to the health literacy. Reading and vocabulary skills were better than numerical capabilities. Female, primary school educated and poor economic condition participants and those who were older had the lowest scores in both the tests.

Effects of bovine milk lactoperoxidase system on some bacteria

Bovine lactoperoxidase (LPO) was purified from skimmed milk using amberlite CG-50-H+ resin, CM sephadex C-50 ion-exchange chromatography, and sephadex G-100 gel filtration chromatography. Lactoperoxidase was purified 20.45-fold with a yield of 28.8%. Purity of enzyme checked by sodium dodecyl sulphate-polyacrylamide gel electrophoresis method and a single band was observed. Km was 0.25 mM at 20 degrees C, Vmax value was 7.95 micromol/ml min at 20 degrees C (pH 6.0). Antibacterial study was done by disk diffusion method of Kir-by-Bauer using Mueller-Hinton agar medium with slight modification. Bovine LPO showed high antibacterial activity in 100 mM thiocyanate-100 mM H2O2 medium for some bacteria (Brevibacillus centrosaurus, B. choshinensis, B. lyticum, Cedecea davisae, Chryseobacterium indoltheticum, Clavibacter michiganense pv. insidiosum, Kocuria erythromyxa, K. kristinae, K. rosea, K. varians, Paenibacillus validus, Pseudomonas syringae pv. populans, Ralstonia pickettii, Rhodococcus wratislaviensis, Serratia fonticola, Streptomyces violaceusniger, Vibrio cholerae-nonO1) respectively, and compared with well known antibacterial substances (levofloxacin, netilmicin). LPO system has inhibition effects on all type bacteria and concentration is really important such as LPO-100 mM thiocyanate-100 mM H2O2 system was proposed as an effective agent against many factors causing several diseases.

The perception of menopause and hormone therapy among women in Turkey

OBJECTIVES

To investigate the influence of sociodemographic characteristics and menopause perception on self-reported menopause-related symptoms among Turkish women and analyze their knowledge and attitudes towards menopause and hormone therapy.

METHODS

This was a population-based, cross-sectional, descriptive study. A total of 1007 women were recruited while attending primary-care health clinics. Women who agreed to participate in the study gave written informed consent. Each woman completed a questionnaire and had an interview to investigate her current health problems.

RESULTS

Various different problems were reported by 86% of the women, mainly hot flushes. The women who perceived menopause as a pathological period had more complaints. The level of education influenced a more positive perception of the menopause. Only 12% of women were taking a hormonal treatment.

CONCLUSION

Different perceptions of menopause among Turkish women are influenced by many factors, including cultural differences, level of education, regular exercise, social factors, and impact of the media. These need to be considered when studying the frequency and characteristics of menopausal problems.

Serous detachment of macula in cystoid macular edema associated with latanoprost

PURPOSE

To report serous macular detachment in two patients with cystoid macular edema (CME) associated with latanoprost.

METHODS

Two eyes of two patients with CME associated with latanoprost underwent an ophthalmoscopic examination, fluorescein angiography, and optical coherence tomography (OCT).

RESULTS

In both patients, besides CME, OCT showed serous macular detachment composed of retinal elevation over a nonreflective cavity with minimal shadowing of the underlying tissues.

CONCLUSIONS

This is the first case report that shows an association between serous macular detachment and CME associated with latanoprost.

Macular function by multifocal electroretinogram in diabetic macular edema after intravitreal triamcinolone acetonide injection

PURPOSE

The purpose of this study was to assess macular function by multifocal electroretinography (mfERG) in eyes with diabetic macular edema (DME) after intravitreal triamcinolone acetonide (IVTA) injection.

METHODS

Fifteen eyes of 15 patients with DME scheduled for 4 mg IVTA injection were prospectively recruited. The response to treatment was monitored functionally by visual acuity (VA) measurement and mfERG and anatomically by foveal thickness measured by optical coherence tomography (OCT). The first-order kernel P1 mfERG responses from 0 to 7 degrees (central) and 7 to 25 degrees (peripheral) were grouped and analyzed. Changes in functional parameters (VAs and the P1 mfERG response amplitudes and peak latencies) and morphometric parameters (OCT foveal thickness) in eyes with DME 1 and 3 months after IVTA injection were compared with baseline values by Student t test.

RESULTS

The mean baseline logMAR value for VAs of the patients before treatment was 0.49+/-0.26. After treatment, it was 0.27+/-0.23 at 1 month and 0.26+/-0.18 at 3 months, and differences from pretreatment values were significant (for each, p<0.001). There were statistically significant decreases in the mean foveal thickness at 1 and 3 months after treatment compared with pretreatment values (for each, p<0.001). There were also statistically significant increases in the mean P1 response amplitude for both central and peripheral groups at all examinations compared with pretreatment (for each, p<0.001). The mean P1 peak latencies for both the central and peripheral groups were shortened, but not significantly.

CONCLUSIONS

As well as the reduction in DME and improvement in VA, IVTA injection improves macular function as assessed by mfERG in diabetic patients.

Hamartoma of the breast

Breast hamartoma is a rare benign tumour that leads to unilateral breast enlargement without a palpable localized mass lesion. Histologically, a hamartoma consists of varying amounts of adipose, gland, fibre and smooth muscle tissue. The characteristic mammographic appearance of hamartoma of breast has distinct mammographic features with circumscription and fat and soft-tissue density surrounded by a thin radiopaque capsule or pseudocapsule. Ultrasonographic findings include a well-defined mass lesion consisting of echogenic and sonolucent areas. We present histopathological and radiological findings of a 42-year-old female patient with breast hamartoma who has no complaint.

Primary serous papillary carcinoma of the retroperitoneum: magnetic resonance imaging findings with pathologic correlation

The incidence of a primary serous papillary carcinoma of the retroperitoneum is extremely rare. We present a case of the tumour in an adult simulating an adrenal mass with MRI findings and histopathological correlation.