Determination of Bioactivity and Antimicrobial Activity of Bumblebee (Bombus terrestris L.) Nest Cover Wax Material

Bumblebee (Bombus terrestris L.) is a bee race that take part in pollination. It is though Bumblebee (Bombus terrestris L.) is only used in pollination. But, it is not only take part in pollination, it provide to produce different products. Nest cover wax material is a kind of bee product that produced by Bumblebee (Bombus terrestris L.). Although it is considered to be waste, nest cover wax material is an important hive product with its antioxidant and antimicrobial activities. In this study, Bumblebee nest cover wax material was produced under laboratory conditions in a controlled manner. Biochemical characterization of nest cover wax material obtained from five different colonies was performed and antimicrobial activities were determined. Accordingly, it was determined that the total phenolic content of the samples ranged between 3.778±0.165 and 9.504±0.353 mg GAE/g. In addition, it was observed that the samples were rich in p-coumaric acid, luteolin, quercetin, t-sinnamic acid, chrysin and pinocembrin components. It was determined that nest cover wax material, which also showed antimicrobial activity, had nearly equivalent activity to beehive products such as honey, pollen and bee bread. The data obtained show that nest cover wax material will be an alternative product for apitherapy applications.

Can serum basal cortisol values predict successful operations for bariatric surgery patients?

OBJECTIVE

Obesity is a chronic metabolic disease declared as the 21st century pandemic by the World Health Organization. Obesity has become an alarming situation for society, and it has to be treated. If the appropriate criteria are met by patients, bariatric surgery is an effective treatment method that provides weight loss in a short time. There are no definitive criteria regarding which groups of patients and characteristics may benefit most from bariatric surgery. In this study, we evaluate whether serum basal cortisol levels can predict successful outcomes of bariatric surgery and whether there is any difference in outcome between diabetic and non-diabetic patients.

PATIENTS AND METHODS

This observational study included 244 obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Preoperative and postoperative 6-month weight, body mass index (BMI), serum basal cortisol, fasting plasma glucose, 1-mg dexamethasone suppression test (DST) results, and Type 2 Diabetes Mellitus (T2D) history were recorded. We analyzed the patients first by dividing them into two groups as excessive weight loss (%EWL) ≥50% and %EWL< 50%, and then into two groups as diabetic and nondiabetic patients.

RESULTS

The mean age of patients with %EWL≥ 50% was found to be statistically significantly lower than that of patients with %EWL< 50% [39 (19-60) vs. 47 (36-61) years; p=0.046]. While there was no significant difference in basal cortisol values (p=0.513), DST results were statistically significantly lower in patients with %EWL≥ 50% than patients with %EWL< 50% [0.6 (0.1-2.1) vs. 0.8 (0.7-1.1); p=0.040].

CONCLUSIONS

In obese patients undergoing LSG, serum basal cortisol level may not predict the success of operation. However, the result of 1 mg DST may predict the operation success.

What is the effect of subepithelial lesions of the esophagus on esophageal motility?

OBJECTIVE

Esophageal motility is regulated both by coordinated stimulation and inhibition of the circular and longitudinal muscle layers of the esophagus. Although there are many diseases known to have an effect on esophageal motility, the effect of subepithelial lesions (SELs) of the esophagus on esophageal motility, which is often detected incidentally, remains still unclear. The aim of this study is to reveal the effect of SELs of the esophagus on esophageal motility evaluating it by high-resolution manometry (HRM).

PATIENTS AND METHODS

A total of 32 patients with SELs in the esophagus and 12 healthy individuals were included. All patients and controls included in the study underwent HRM using a Unisensor UniTip High Resolution catheter (Laborie, Amsterdam, Netherlands) and endosonographic examination.

RESULTS

The mean age was 52.60±15.56 years (range: 23-79) and the average body mass index (BMI) was 26.63±4.71 kg/m2. Gender, height, weight, and BMI measurements, smoking status, alcohol use, and DM status did not statistically differ significantly between the groups (p>0.05). Of 32 patients with SELs, 65.6% (n=21) had lesions originating in the muscularis propria, while 34.4% had lesions originating in the submucosa. The rate of abnormal motility both in the supine and in upright positions of patients with SELs was found to be significantly higher than in the control group (p=0.001, p<0.01, respectively). In patients with SELs, the incidence of infective motility was higher than the normal group (p=0.001, p<0.01, respectively). As the size of the lesion increases (>2 cm), the probability of abnormal HRM results increased.

CONCLUSIONS

SELs of the esophagus have pathological effects on esophageal motility, mainly ineffective esophageal motility disorder.

Are neutrophil-to-lymphocyte ratios and large unstained cells different in hospitalized COVID-19 PCR-positive patients with and without diabetes mellitus?

OBJECTIVE

SARS-CoV-2 might present with multisystem involvement due to its entry into many cells with ACE2 receptors on their surfaces, such as heart, endothelial, and lung alveoli cells. Studies have indicated that COVID-19 infection causes a severe clinical presentation in diabetic patients due to dysregulation of the metabolic and immune systems. The hematological effects of COVID-19 and the relationship of lymphopenia with the severity of the disease have been reported previously. The parameter of percentage of large unstained cells (LUCs) reflects active lymphocytes and peroxidase-negative cells. The neutrophil-to-lymphocyte ratio (NLR) is another reliable marker of inflammation in cases of cardiac diseases, solid tumors, and sepsis. The present study aimed to evaluate whether the parameters of LUCs and NLR differed between diabetic and nondiabetic individuals with COVID-19. Associations with disease severity were also sought.

MATERIALS AND METHODS

In our retrospective study, the data of 1,053 patients [230 diabetic patients (21.83%) and 823 nondiabetic patients (78.15%)] were reviewed. The white blood cell (WBC) count, neutrophil count, neutrophil%, lymphocyte count, lymphocyte%, LUC count, %LUCs, NLR, platelet count, hemoglobin level, HbA1c, history of diabetes, surveillance during hospitalization, and pulmonary infiltration status within the first 24 hours after admission to the hospital were analyzed from the records.

RESULTS

When diabetic patients were compared with nondiabetics, the age [65 (20-90) vs. 42 (18-94) years], WBC count [6.72 (2.6-24.04) vs.  5.91 (1.35-52.68)], neutrophil count [4.29 (1.28-65) vs. 3.68 (0.02-50.47)], neutrophil% [67.53±12.3 vs.  64.08±13.28], NLR [3.35 (0.83-38.11) vs. 2.48 (0.01-68.58)], and LUC count [0.11 (0.03-0.98) vs. 0.1 (0.02-3.06)] of the diabetic group were found to be higher and these differences were statistically significant (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.015, respectively).

CONCLUSIONS

We determined that LUC counts and NLR values in COVID-19-positive patients with diabetes were statistically significantly higher compared to nondiabetic patients.

P-655 Insulin like growth factor-1 levels in follicular fluids of patients with poor ovarian response undergoing in vitro fertilization

Study question

Does follicular fluid insulin like growth factor level (IGF-1) in poor responders (PR) differ from normoresponders? Is there a correlation between IGF-1 and IVF outcomes?

Summary answer

Follicular IGF-1 levels are decreased in poor-responders A positive correlation exists between IGF-1 and number of metaphase II (MII) oocytes, fertilized oocytes and transferred embryos

What is known already

IGFs are mainly synthesized in liver with growth hormone stimulation. IGF-1 component in follicular fluid has been reported to play a crucial role in follicular and embryonic development. In addition to previously reported positive correlation between follicular IGF-I levels and number of high quality embryos, a significant decrease in IGF-1 levels with PR and advanced maternal age has also been reported. GH supplementation in poor responders undergoing IVF has been suggested to improve IVF outcomes. A recent Cochrane analysis reported that GH slightly increases the number of oocytes retrieved and there is an uncertain effect on live birth rates (LBR).

Study design, size, duration

Study was designed prospectively. A power analysis, of 91% determined a need for 186 patients. Therefore 186 women undergoing IVF between October 2019 and December 2020 were included. 72 (%38,7) patients were assigned to PRs group according to Bologna criteria (BC) and 114 patients (%61.3) were recruited as controls. Antagonist protocol was used for controlled ovarian hyperstimulation. hCG was administered for ovulation trigger.

Participants/materials, setting, methods

Following the ovarian hyperstimulation follicular fluid samples were collected during oocyte retrieval. When the total desired number of patients was reached, frozen and preserved follicle fluids were thawed at room temperature. IGF-1 levels in samples were measured using hIGF-1 ELISA kit (BT®, China). Follicular IGF-1 levels in PRs were compared to normoresponders and correlation between IGF-1 levels and AMH levels, number of retrieved oocytes, MII and fertilized oocytes, transferred embriyos and LBR were evaluated.

Main results and the role of chance

Mean IGF-1 levels of normoresponders and Bologna subgroups (B1, B2, B3, B4) were 13.79±14.50 ng/ml vs 5.75±1.86, 5.47±2.83, 5.96±2.16 and 5.03±1.85 ng/ml respectively (p &lt; 0.001). There was no statistically significant difference in clinical pregnancy (CP) per transfer and LBR per transfer between normoresponders and PRs (CPR/ET: 55.1% vs 43.7%, p:0.375; 26.5% vs 12.5% , p: 0.257). In the ROC analysis for the prediction of collection of fewer than 4 oocytes at retrieval (according to BC definition of PR), statistically determined IGF-1 value was 7.02 with a sensitivity of 83% and a specificity of 38.6%. Patients with an IGF-1 value below 7.02 had a higher risk of having an oocyte number less than 4According to the results of Spearman's correlation analysis, IGF-1 levels were negatively correlated with age and number of previous failed cycles (r:-0.250, p:0,001; r:-0.153, p:0,039 respectively). IGF-1 levels were positively correlated with AMH levels, oocyte, MII oocyte, fertilized oocyte numbers and number of transferred embriyos (r: 0.221, p: 0.007; r: 0.283, p &lt; 0.001; r: 0.293, p &lt; 0.001; r: 0.282, p &lt; 0.001; r: 0.194, p: 0.008 respectively). There was a positive correlation between IGF-1 levels and cycle cancellation rates (r: 0.637, p &lt; 0,001). There was no correlation between IGF-1 levels and LBR (p:0.118).

Limitations, reasons for caution

Small number of patients was the main limitation of study.Results were not interpreted as LBR in all cases, as 21% (n:24) of the cases had still ongoing pregnancies

Wider implications of the findings

Detecting lower follicular levels of IGF-1 which plays a crucial role in GH activity may highligt the effect of GH supplementation in poor responders undergoing IVF in terms of improved outcomes. However, there is need for more solid data to employ GH in IVF treatment modalities of poor-responders.

Trial registration number

not applicable

A novel rapid and accurate method for detecting Helicobacter Pylori: the modified antigen test

OBJECTIVE

We aim to assess the diagnostic accuracy of the gastric biopsy Helicobacter pylori (H. pylori) antigen stool test as a novel method for detecting H. pylori, comparing this test with the histopathological evaluation of H. pylori and H. pylori antigen stool test as the reference standards.

PATIENTS AND METHODS

The study involves patients who are scheduled for an upper gastrointestinal endoscopy. Gastric biopsies were endoscopically obtained from all patients, and H. pylori antigen stool tests were performed for all patients. Results from the gastric biopsies that were studied using the H. pylori antigen stool test in terms of the novel method were obtained and recorded. The inter-rater agreement between the H. pylori tests in determining positive and negative results was investigated using Fleiss' and Cohen's kappa tests. The capacity of applied tests in predicting the presence of H. pylori was analyzed using a receiver operating characteristic (ROC) curve analysis.

RESULTS

A total of 55 patients were studied (32 females and 23 males). The strongest coherence was obtained between the gastric biopsy test and histopathological evaluation with a kappa value of 0.664 in Cohen's kappa analysis of overall coherence between tests. The most accurate sensitivity and specificity values were obtained for the gastric biopsy test and histopathological evaluation crosstabulation for both overall comparisons at 90.5% sensitivity and 79.4% specificity.

CONCLUSIONS

With this new, rapid, and easy-to-apply method, patients' endoscopies and gastric biopsies looking for the presence of H. pylori would be determined with more sensitive and more specific accuracy rates than current antigen stool tests, and H. pylori can be eradicated immediately without waiting for the histopathological evaluation period.

Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5-10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients.

Challenges of CYP21A2 genotyping in children with 21-hydroxylase deficiency: determination of genotype-phenotype correlation using next generation sequencing in Southeastern Anatolia

BACKGROUND/PURPOSE

Although it is known that there is generally a good correlation between genotypes and phenotypes, the number of studies reporting discrepancies has recently increased, exclusively between milder genotypes and their phenotypes due to the complex nature of the CYP21A2 gene and methodological pitfalls. This study aimed to assess CYP21A2 genotyping in children with 21-hydroxylase deficiency (21-OHD) and establish their predictive genotype-phenotype correlation features using a large cohort in Southeastern Anatolia's ethnically diverse population.

METHODS

The patients were classified into three groups: salt-wasting (SW), simple virilizing (SV) and non-classical (NC). The genotypes were categorized into six groups due to residual enzyme activity: null-A-B-C-D-E. CYP21A2 genotyping was performed by sequence-specific primer and sequenced with next generation sequencing (NGS), and the expected phenotypes were compared to the observed phenotypes.

RESULTS

A total of 118 unrelated children with 21-OHD were included in this study (61% SW, 24.5% SV and 14.5% NC). The pathogenic variants were found in 79.5% of 171 mutated alleles (60.2%, 22.2%, and 17.6% in SW, SV and NC, respectively). Patient distribution based on genotype groups was as follows: null-16.1%, A-41.4%, B-6.0%, C-14.4%, E-22%). In2G was the most common pathogenic variant (33.9% of all alleles) and the most common variant in the three phenotype groups (SW-38.8%, SV-22.2% and NC-23.3%). The total genotype-phenotype correlation was 81.5%. The correlations of the null and A groups were 100% and 76.1%, respectively, while it was lower in group B and poor in group C (71.4% and 23.5%, respectively).

CONCLUSION

This study revealed that the concordance rates of the severe genotypes with their phenotypes were good, while those of the milder genotypes were poor. The discrepancies could have resulted from the complex characteristics of 21-OHD genotyping and the limitations of using NGS alone without integrating with other comprehensive methods.

Pre-dilatation prior to carotid artery stenting in very severe carotid artery stenosis: beneficial or detrimental?

Background

There are many technical variations in carotid artery stenting and there is not a clear recommendation in pre-dilatation (Pre-D) prior to stenting. In this study we investigated the role of Pre-D before carotid artery stenting in patients with very severe carotid artery stenosis (≥90%).

Methods

A total of 298 patients with a carotid stenosis equal to or more than 90% were included to our study. Patients were divided into two groups as Pre-D and No-Pre-D. In-hospital and 3-year long-term clinical outcomes were compared between the groups.

Results

During the hospitalization, major stroke was more common in Pre-D group [n=6 (5.5%) vs. n=3 (1.5%), respectively], whereas overall ipsilateral stroke rates were similar between the groups. The rates of myocardial infarction were similar between the groups. In- hospital mortality was significantly higher in the Pre-D group than non-pre-D group [n=4 (3.6%) vs. n=0 (0%), respectively]. During the 3-year follow up period, the rates of ipsilateral stroke, major stroke, transient ischemic attack, myocardial infarction, and mortality were similar between the groups.

Conclusion

According to the literature, this is the first study evaluates the role of Pre-D in very severe (&gt;90%) carotid artery stenosis. The current study demonstrated that Pre-D might have a detrimental effect on in-hospital outcomes.

Funding Acknowledgement

Type of funding sources: None.

Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

Introduction

The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF).

Methods

A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis.

Results

A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97).

Conclusion

The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Comparison of D-dimer level measured on the third day of hospitalization with D-dimer level in predicting in-hospital mortality in COVID-19 patients

Objective

The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases.

Method

In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0–500 μg/mL. In the current research, the primary outcome was the in-hospital mortality.

Results

In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00–1.00, p&lt;0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836–0.968; p&lt;0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively).

Conclusion

The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1

Effect of the number of parity on right heart chamber quantification

Introduction

Pregnancy is a process that causes several physiological changes including all systems as well as cardiovascular system. Ventricular hypertrophy and dilation of cardiac chambers are seen as a result of these changes. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we have evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number.

Methods

This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups.

Results

In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the 4 independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10 – 1.20), body mass index (OR: 1.05, CI: 1.02 to 1.08), smoking (OR: 1.87, CI: 1.28 to 4.02), and giving a birth (OR: 3.94 CI: 1.82 – 8.81). There were also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders.

Conclusion

Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.

Funding Acknowledgement

Type of funding sources: None.

Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction

Background

Inflammatory markers are significantly associated with cardiovascular disease and many markers have been used as predictor in patients with STEMI. This study examines the predictive value of the novel systemic immune-inflammation index (SII) in patients with ST-segment elevation myocardial infarction (STEMI).

Method

A total of 1660 patients with STEMI who underwent primary percutaneous coronary intervention in a tertiary heart center were enrolled in the study. SII was calculated using the following formula: Platelet × Neutrophil/Lymphocyte ratio. The patients were stratified into four quartiles (Q) according to admission SII level. In-hospital and 3-year outcomes were compared between the four groups (Q1–4)

Results

In-hospital cardiogenic shock, acute respiratory failure, acute kidney injury, ventricular arrhythmia, stent thrombosis, recurrent myocardial infarction, major adverse cardiac events, and mortality were significantly higher in the high SII groups (Q3 and Q4). Logistic regression models demonstrated that Q3 and Q4 had independent risk of mortality and Q4 had an independent risk of cardiogenic shock compared to Q1. ROC analysis showed that the best cut-off value of the Systemic Immune-Inflammatory Index to predict the in-hospital mortality was 1781 with 66% sensitivity and 74% specificity (AUC: 0.75; 95% CI: 0.69–0.81; p&lt;0.001). Kaplan Meier overall survivals for Q1, Q2, Q3 and Q4 were 97.6%, 96.9%, 91.6% and 81.0% respectively. Cox proportional analysis for 3-year mortality demonstrated that Q3 and Q4 had independent risk of death compared to Q1.

Conclusion

SII, a novel inflammatory index, had a better prediction of in-hospital and long-term outcomes than traditional risk factors in patients with STEMI.

Funding Acknowledgement

Type of funding sources: None.

P–066 Does microfluidic sperm sorting (MSS) affect embryo euploidy rates in couples with high sperm DNA fragmentation (SDF)?

Study question

Does MSS (microfluid chip-sorted spermatozoa selection) provide improvement on embryo quality and euploidy rates in couples with high SDF (sperm DNA fragmentation) and previous failed in vitro fertilization/ intracystoplasmic sperm injection (IVF/ICSI) cycles?

Summary answer

Use of MSS technique provides higher number of top quality blastocysts compared to density gradient centrifugation (DGC), however euploidy and live birth rates weren’t improved.

What is known already

Previously it has been reported that sperm DNA damage leads to poor embryo development and there is a significant association between SDF and high embryo aneuploidy rates. Recently this fact raised attention to sperm selection techniques such as MSS to enhance embryo quality, miscarriage rates and embryonic euploidy rates.

Study design, size, duration

This was a retrospective electronic medical record (EMR) analysis of a tertiary assisted reproduction center between 2016 and 2020. All EMR were reviewed to select eligible cases as; couples undergoing a new IVF/ICSI cycle with PGT-A (preimplantation genetic testing for aneuploidies). In total, data from 243 patients were obtained for the analysis that accounts for 688 embryos.

Participants/materials, setting, methods

Patients had at least 2 previous failed IVF cycles and males had at least 20% SDF. In their new cycles, MSS was offered, preceding ICSI and PGT-A. Couples who accepted the technique were assigned to MSS group (92 cycles with 310 embryos) and the rest were managed with DGC and assigned as controls (151 cycles with 378 embryos). Azoospermia cases and women with age&gt;43, uterine abnormalities, trombophilia were excluded. Biopsies were performed at blastocyst stage.

Main results and the role of chance

Two groups were comparable in terms of demographic data including women and men age, SDF, sperm parameters and cycle characteristics. There was no difference between groups in terms of fertilization rates (MSS 85% vs DGC 79% p = 0.9), euploidy rates (MSS 53.2% vs DGC 50.7% p = 0.3), mean no of euploid embryo per patient (MSS 1.09 vs DGC 0.95 p = 0.3), positive pregnancy test (MSS 50% vs DGC 38.4% p = 0.06), clinical miscarriage (MSS 7.6% vs DGC 6.6% p = 0.7) and live birth rates (LBR)(MSS 42.4% vs DGC 31.7% p = 0.09). Total no of blastocysts and top quality blastocysts were significantly higher in MSS group than in DGC (3.9 vs 2.5 p &lt; 0.01 and 1.6 vs 0.8 p &lt; 0.001 respectively).

Limitations, reasons for caution

Retrospective design, small sample size, lack of proper randomization and power analysis are the main limitations.

Wider implications of the findings: Offering PGT-A to couples with unexplained repeated IVF failures and high SDF seems feasible. MSS for such cases improves embryonic division process as improved blastulation rates were documented. However, euploidy rates were not improved in MSS group revealing that other factors influence comprehensive chromosomal status of an embryo.

Trial registration number

Not applicable

Evaluation of retinal microvascular changes in patients with prediabetes

Aim

Diabetic retinopathy is a chronic progressive complication with neuronal cell and retinal microvascular involvement and is closely associated with blood sugar and blood pressure levels. Studies have shown that retinal neural dysfunction takes place before the microvascular changes in patients with Type 2 diabetes mellitus. The aim of this study is to compare the retinal microvascular changes of patients who are at the prediabetes stage and healthy volunteers.

Method

Our study included 41 patients with prediabetes who were referred to the internal medicine outpatient clinic and 47 healthy volunteers. All patients underwent ophthalmologic examinations, including best visual acuity, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination. Refractive error measurements were performed with the same automatic refractor-keratometer device. Typically, 3 × 3 mm macular images centered on foveola were obtained by using XR Avanti Optical Coherence Tomography Angiography with AngioVue (RTVue XR AVANTI, Optovue, Fremont, CA, USA) device. In the statistical analysis of the measurements, it was examined by Kolmogorov Smirnov test. Conditions expressed as IFG or IGT are considered as prediabetes; IFG is defined as fasting blood sugar to be between 100 and 125 mg/dL, while IGT is the condition in which the second hour value of the oral glucose tolerance test is 140-199 mg/dL.

Results

There was no statistically significant difference between the control and pre-DM groups in terms of mean age. The distribution of males and females between groups was statistically similar (P = 0.087). In the pre-DM group, 24 (58.6%) patients had IFG, 16 (39.0%) had IFG + IGT, and 1 (2.4%) had IGT. There were no statistically significant differences between the groups for the nonflow area (NFA) and the foveal avascular zone (FAZ) area (P > 0.05). The mean values of superficial and deep capillary plexus (DCP) density were not statistically significant differences between the groups. No statistically significant difference was found between the control group and pre-DM group in terms of the mean measurements of clinical ocular findings (P > 0.05). Retinal thicknesses were also not statistically significant differences between the groups (P > 0.05).

Conclusion

All of the retinal measurements of both patients with prediabetes and healthy volunteers are similar. We did not find any difference between prediabetes and control groups. The ophthalmologic examinations which contain best-visual acuity, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination are similar.

Is idiopathic mild hyperprolactinemia a cardiovascular risk factor?

Background

There is a strong relationship between arterial stiffness and endothelial dysfunction and hypertension. How arterial stiffness is affected in elevated PRL conditions is uncertain. Biological action of prolactin contributing to the atherosclerotic process is a new research area.

Aims

We aimed at investigating cardiovascular risk predictability by conducting arterial stiffness measurement in patients with idiopathic hyperprolactinemia.

Subjects and Methods

The biochemical parameters and arterial stiffness analyses of 54 patients with idiopathic hyperprolactinemia, who had applied to our polyclinic in 2017 and 2018, and 55 healthy volunteers having similar characteristics with regard to age, sex and body mass index.

Results

The median prolactin level of the idiopathic hyperprolactinemia patients with a median age of 31 was found to be 45 ng/mL. The peripheral and central blood pressures and pulse wave velocities (PWV) of both the patient group and the control group were found to be similar. Any relations between prolactin levels and blood pressure and arterial stiffness could not be found.

Discussion

Our study showed that arterial stiffness did not increase in young patients with idiopathic mild hyperprolactinemia. However, the long-term effects of mildly elevated prolactin levels are unknown. Prospective randomized studies are required, that could reveal more clearly the prolactin-cardiovascular risk relation, and the clinical effects of extra-pituitary hyperprolactinemia.

Comparison of Antibacterial and Antifungal Effects of Different Varieties of Honey and Propolis Samples

Honey is the most important bee product. There are many secondary metabolites, carbohydrates, enzymes, and vitamins in honey, thus, honey has antimicrobial activity. In this study, in vitro antimicrobial activity of forty-two honey and eight propolis ethanolic extracts (PEE) were investigated against 16 microorganisms. Total phenolic content ranged between 20.00–124.10 mg GAE/100 g and 103–232 mg GAE/g for honey and raw propolis samples, respectively. Pine and oak honeydew honeys had higher antimicrobial activity than four different grades of Manuka Honeys up to 18 mm minimum inhibition zone diameters. The ethanolic propolis extracts showed much higher antimicrobial activity than the honey samples. Fungi species were inhibited by the propolis samples. Helicobacter pylorii (H. pylorii) was the most sensitive, whereas Streptococcus agalactiae was the most resistant bacteria among the studied microorganisms. Brazilian and Zonguldak propolis had the closest antimicrobial activity to ampicillin, streptomycin, and fluconazole. It can be concluded that both honey and propolis could be used in preservative and complementary medicine.

Changes in thyroid volume and insulin-like growth factor 1 in pre- and post-pubertal obese children

Background

There is a mutual dynamic interaction between thyroid volume (TV), insulin-like growth factor-1 (IGF-1), and body mass index (BMI). These covariates undergo a change with the transition into puberty. The heterogeneity of the variates and study populations complicate the evaluation of the role of pure pubertal effect.

Objective

The purpose of this study was to investigate the effect of puberty on IGF-1 and TV in a predetermined homogenous population such as obese children.

Subjects and Methods

Three hundred and eighty children (202 girls and 178 boys) aged between 6 and 18 were enrolled in this prospective study. The children were assigned to two groups according to their pubertal status, i.e., prepubertal (n = 169) and postpubertal (n = 211). According to age and sex, the obese group (n = 222) was made up of children at and above the 95^th percentile, and the control group (n = 158) of children under the 85^th percentile. The following parameters were evaluated in all children: BMI, pubertal status, TV, and serum IGF-1, IGFBP-3, and IGF-1:IGFBP-3 molar ratio.

Results

In comparison to the prepubertal obese group, the obese group at Tanner stage 2 had a larger mean TV (P = 0.008) and higher IGF-1 level (P = 0.033). There was a positive correlation between IGF-1 and TV both in the prepubertal and pubertal group (r₁₆₉= 0.369, P = 0.001; r₂₁₁= 0.316, P = 0.004, respectively), whereas there was no correlation between IGF-1 and BMI (r₁₆₉= 0.99, P = 0.092; r₂₁₁= 0.094, P = 0.088, respectively).

Conclusion

This study showed that the TV and serum IGF-1 levels were increased in obese children in the early stage of puberty and that there was a positive correlation between these two variables in all children, which shows the specific effect of the early stage of puberty on the increase in TV and IGF-1 levels and suggests that increased TV is associated with the increase in IGF-1 levels in a homogenous group such as obese children.

Oral antibiotic prophylaxis in elective cesarean deliveries: pilot analysis in tertiary Care Hospital

INTRODUCTION

Puerperal infection remains a significant cause of maternal morbidity and mortality. Those infections occur more likely after cesarean delivery (CD). Prophylactic antibiotics are administered at the time of CD to prevent complications. In addition to intraoperative prophylaxis; prescription of antibiotics during hospital discharge to prevent surgical site infections (SSI) is quite common. Purpose of this study is to determine the utility of prophylactic oral antibiotic prescription in a cohort of low-risk women undergoing CD.

MATERIALS AND METHODS

A prospective observational study was conducted between 2014 and 2018 at Ufuk University School of Medicine, Department of Obstetrics and Gynaecology. Total of 389 low risk elective cesarean deliveries were selected. All cases received intraoperative prophylaxis. In group I (157 subjects), no further antibiotics were given and in group II (232 cases), oral cephuroxime 500 mg was given during hospital discharge. Primary outcome was SSI. Secondary outcomes were endometritis and other infectious conditions.

RESULTS

Overall SSI rate was 2.5%. Only 2 SSIs were noted in group 1 (1.2%) compared to eight in group II (3.4%). There was no statistical difference in SSI rate between two groups. Secondary outcomes were also comparable.

CONCLUSION

In this study, we failed to reveal any beneficial effect of oral antibiotic prescription during hospital discharge in low risk elective CDs. Therefore, use of oral antibiotics in addition to intraoperative prophylaxis should be questioned in terms of increased costs, emergence of bacterial resistance and long term effects on new born as a consequence of changes in gut microbiome.

The evaluation of preoperative and postoperative fetuin-A levels in patients with primary hyperparathyroidism

Objectives

Our objective was to evaluate preoperative and postoperative serum fetuin-A levels in female patients with primary hyperparathyroidism (PHPT) and search for the relationship with parathyroid hormone (PTH) and vitamin D (25OHD). Although a role for fetuin-A is suggested in regulating bone mineralization, its function has not been completely defined.

Materials and Methods

In this cross-sectional study, 43 female patients with PHPT and 30 healthy women were recruited as the control group. We evaluated 73 women because we had only women patients with PHPT. Of the 43 patients, 10 symptomatic and 23 asymptomatic patients were surgically treated, whereas 10 patients were not operated. In all 43 patients, 25OHD, PTH, fetuin-A levels, and bone mineral densitometry were evaluated. The biochemical parameters of 33 operated patients were reevaluated at the postoperative sixth week.

Results

Fetuin-A levels of the patients with PHPT were significantly higher than that in the controls (56.6 ± 13.8 vs. 42.6 ± 20.7 ng/mL; P = 0.010). Fetuin-A levels of the operated patients were higher than nonoperated group. Furthermore, serum fetuin-A levels of the nonoperated patients were not different from those of controls. After parathyroidectomy, fetuin-A (41.5 ± 25.2 vs. 56.4 ± 13.7 ng/mL; P = 0.003), PTH [80.0 (51.5-137.5) vs. 211.0 (151.5-278.5) pg/mL; P < 0.001], and calcium (9.2 ± 0.7 vs. 10.7 ± 0.8 mg/dL; P < 0.001) values were found to be decreased significantly.

Conclusion

In this study, fetuin-A levels of patients with PHPT were higher than those of the controls and significantly decreased after parathyroidectomy compared with the preoperative levels. Fetuin-A levels could be a beneficial marker to determine the changes in bone metabolism of the patients with PHPT and to detect the patients suitable for surgery.

Effect of alginate in patients with GERD hiatal hernia matters

Alginate-based formulations are frequently used as add-on proton pump inhibitor (PPI) therapy to help control of heartburn and regurgitation. There are limited data regarding the mechanisms and effects of alginate-based formulations. We aimed to evaluate the effects of the sodium alginate intake and its likely temporal relations on intraesophageal reflux events by MII-pH in patients with and without hiatal hernia (HH). Fifty GERD patients (18 with HH, 32 without HH) with heartburn or regurgitation once a week or more common were included. After combined multichannel intraluminal impedance and pH-metry (MII-pH) had been performed, all patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g regular yoghurt, and 200 mL water with total energy value of 744 kcal: 37.6% of carbohydrates, 21.2% of proteins, and 41.2% of lipids) during two consecutive days. On separate random two consecutive days, all patients took 10 mL of sodium alginate (GA; Gaviscon Advance; Reckitt Benckiser Healthcare, Hull, UK) or 10 mL of water, 30 minutes after the refluxogenic meal. After eating refluxogenic meal, patients were examined ½ hour for basal conditions, 1 hour in upright, and 1 hour in supine positions. Alginate significantly decreased acid reflux after intake at the first hour in comparison to water in patients with HH (6.1 vs. 13.7, P = 0.004) and without HH (3.5 vs. 5.5, P = 0.001). Weakly acid reflux were increased at the first hour in patients with HH (3.4 vs. 1.3, P = 0.019) and without HH (1.7 vs. 5, P = 0.02) compared to water. There was no distinctive effect of alginate on the height of proximal migration of reflux events in patients with HH and without HH. Alginate decreases acid reflux events within a limited time period, especially at the first hour both in patients with and without HH. Alginate has no effect on the height of reflux events along the esophagus both in patients with and without HH.

Serum nesfatin-1 levels are decreased in pregnant women newly diagnosed with gestational diabetes

OBJECTIVE

To investigate serum nesfatin-1 levels at 24-28 weeks of pregnancy in women newly diagnosed with gestational diabetes and determine the association of nesfatin-1 with several metabolic parameters.

SUBJECTS AND METHODS

Forty women newly diagnosed with gestational diabetes at 24-28 weeks of pregnancy and 30 healthy pregnant women matched in age and gestational week were included in this cross-sectional study. Serum nesfatin-1 levels were analyzed using ELISA, and the relationship between nesfatin-1 and several metabolic parameters were assessed.

RESULTS

Serum nesfatin-1 levels were found to be lower in women with gestational diabetes compared to the pregnant women in the control sample (p = 0.020). Multiple linear regression analysis revealed that nesfatin-1 was lower in participants with gestational diabetes independently from gestational age, BMI, HOMA-IR, fasting plasma glucose, and age. In correlation analysis, the only variable that was found to have a statistically significant correlation with nesfatin-1 was gestational age (p = 0.015, r = 0.30).

CONCLUSION

Lower nesfatin-1 levels in women with gestational diabetes compared to the control group at 24-28 weeks of gestation draws attention to nesfatin-1 levels in gestational diabetes and motivates further research in this area.

A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index

BACKGROUND AND AIM

The prognostic impact of poor nutritional status and cardiac cachexia in myocardial infarction is not clearly understood. Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in colorectal surgeries and postoperative septic complications. The present study aimed to evaluate the prognostic value of PNI in ST-segment elevation myocardial infarction (STEMI) patients.

METHODS AND RESULTS

We evaluated the in-hospital and long-term (3 years) prognostic impact of PNI on 1823 patients with STEMI undergoing primary percutaneous coronary intervention. Patients with lower PNI had significantly higher in-hospital and long-term mortality and major adverse cardiac events. After adjustment for all confounders, the in-hospital mortality rates were 7.9 times higher at the lower PNI level (95% CI: 5.0-15.8) than those at the higher PNI level. The long-term mortality rates were also 6.4 times higher at the lower PNI level (95% CI: 4.4-12.4) than those at the higher PNI level.

CONCLUSION

The present study demonstrated that the PNI, calculated based on the serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with STEMI.

Microvascular dysfunction affects the development and prognosis of sudden idiopathic hearing loss

OBJECTIVE

The aim of our study is to investigate whether systemic microvascular function affects the development and prognosis of sudden idiopathic hearing loss (SHL).

TYPE OF STUDY

A prospective case-control study.

MATERIALS AND METHODS

Fifty patients diagnosed with SHL at our hospital between September 2015 and May 2016 were included as the SHL group, and 50 healthy volunteers who came to the hospital for medical screening were included in the control group. Thirty-one patients from the SHL group who responded to treatment and 19 patients who did not respond to treatment were identified according to the Siegel criteria and were grouped. Patients with comorbid disorders were excluded from the study. To determine microvascular function, the videocapillaroscopic examination was conducted from the nailfold, measuring the capillary density (CD) and post-occlusive reactive hyperaemia (PORH) values and statistical analysis was performed between the groups.

RESULT

While CD was an average of 83.1 ± 6 in the SHL group, it was measured as 96.2 ± 10 in the control group. The CD value was significantly lower in the SHL group than the control group (P < 0.05). While the average PORH value in the SHL group was 80.5 ± 7.7, it was measured as 97.5 ± 10 in the control group. The PORH value was significantly lower in the SHL group than the control group (P < 0.05). The CD value did not differ significantly (P > 0.05) between the group that responded to treatment (83.4 ± 5.5) and the group that did not respond to treatment (82.7 ± 6.9). The PORH value was significantly lower (P < 0.05) in the group that did not respond to treatment (75.2 ± 7.9) than the group that did (83.8 ± 5.6).

CONCLUSION

To our best knowledge, our study is the first study in the literature. Although the role of specific mechanisms in SHL is not entirely understood, the capillaroscopic examination can show the importance of microvascular function in SHL. CD and PORH values were found to be low in SHL patients, and a low PORH value was found to be a factor of poor prognosis.

EVALUATION OF FIRST YEAR RESPONSE TO TREATMENT IN CASES WITH GROWTH HORMONE DEFICIENCY

Background/Aims

Growth hormone (GH) treatment has severe cost burden on patients, their families, and healthcare systems. Therefore, accuracy of diagnosis should be confirmed; factors affecting the response to treatment should be defined. The present study is performed to evaluate auxiliary diagnostic parameters and factors affecting treatment in growth hormone deficiency (GHD).

Methods

In this study, 142 patients under the age of 16, with at least one year of treatment, were included. Treatment dose of somatropin was 0.2 mg/kg/week in all cases. Response to treatment was evaluated by measuring annual height and height standard deviation score (SDS) gains every 3 months.

Results

Male to female ratio was 79 to 63, and follow-up duration before the treatment was 0.89±0.38 years. Annual growth rate before the treatment was 2.92±1.02 cm, and age at the treatment initiation was 9.97±3.22 years. Height gain SDS at the end of the first year was significantly higher in cases which were at the prepuberty, had severe short stature, low height SDS-mid parental height SDS (HSDS-MPHSDS), and initiated treatment at earlier ages. Correlations in height gain and height SDS gain at the end of the first year were significant between bone age at treatment baseline, delta SDS factors, L-dopa and clonidine stimulation results (both are p<0.01).

Conclusion

Height gain was positively related to body mass index, whereas negatively to bone age at treatment baseline, responses obtained from stimulation tests, and delta SDS values. In the treatment evaluation, the parameters which can affect according to model chosen by the investigator, may differ.

Incisional hernias after laparoscopic and robotic right colectomy

PURPOSE

Incisional hernia (IH) is a common complication after colectomy, with impacts on both health care utilization and quality of life. The true incidence of IH after minimally invasive colectomy is not well described. The purpose of this study was to examine IH incidence after minimally invasive right colectomies (RC) and to compare the IH rates after laparoscopic (L-RC) and robotic (R-RC) colectomies.

METHODS

This is a retrospective review of patients undergoing minimally invasive RC at a single institution from 2009 to 2014. Only patients undergoing RC for colonic neoplasia were included. Patients with previous colectomy or intraperitoneal chemotherapy were excluded. Three L-RC patients were included for each R-RC patient. The primary outcome was IH rate based on clinical examination or computed tomography (CT). Univariate and multivariate time-to-event analyses were used to assess predictors of IH.

RESULTS

276 patients where included, of which 69 had undergone R-RC and 207 L-RC. Patient and tumor characteristics were similar between the groups, except for higher tumor stage in L-RC patients. Both the median time to diagnosis (9.2 months) and the overall IH rate were similar between the groups (17.4 % for R-RC and 22.2 % for L-RC), as were all other postoperative complications. In multivariable analyses, the only significant predictor of IH was former or current tobacco use (hazard raio 3.0, p = 0.03).

CONCLUSIONS

This study suggests that the incidence of IH is high after minimally invasive colectomy and that this rate is equivalent after R-RC and L-RC. Reducing the IH rate represents an important opportunity for improving quality of life and reducing health care utilization after minimally invasive colectomy.

Combined progesterone (IM + V) versus vaginal progesterone for luteal support in cleavage-stage embryo transfer cycles of good prognosis patients

Many reports led to the consensus on the use of progesterone (P) for luteal-phase support. Vaginal P application is the method of choice due to its simplicity and high patient convenience but is hampered by application difficulties and personal or cultural aversions. Inappropriate vaginal P use may alter successful implantation, leading physicians to consider alternate P application routes. A worldwide survey revealed that intramuscular plus vaginal P (combined P) is the method used in nearly one-third of in vitro fertilization (IVF) cycles, particularly in Asia and North America; unfortunately, the outcomes of this approach have not been clearly elucidated. In the current analysis, we evaluated any additional benefit of short course parenteral P in addition to vaginal P capsules during a specific period in terms of implantation, pregnancy rates, miscarriages and ectopic pregnancies in cleavage stage embryo transfer (ET) cycles of good-prognosis patients. Despite significantly higher implantation rates in the combined arm, clinical and ongoing pregnancies were comparable in both groups, whereas a trend toward increased pregnancy rates was observed with combined support. The available data are too limited to draw conclusions.

Obstructive jaundice secondary to endoclip migration into common bile duct after laparoscopic cholecystectomy

Obstructive jaundice is a rare condition due to foreign body in common bile. In this article we report a 69 year-old man who was diagnosed obstructive jaundice secondary to the endoscopic clip migration. The patient had been performed laparoscopic cholecystectomy 5 years ago and had recovered without any complications. He presented with abdominal pain and jaundice. The magnetic resonance cholangiopancreatography (MRCP) revealed filling defect in choledoch consistent with a bile duct stone. The endoscopic retrograde cholangiopancreatography (ERCP) exhibited an endoclip migration into the common bile duct which caused bile duct stone. Endoclips can migrate into bile duct and cause obstructive jaundice. ERCP is the first option for its treatment.

How and how much do endoscopy professionals protect themselves against infection?

PURPOSE

It is aimed to identify, the educations given to professionals working in endoscopy units against infectious risks during the endoscopic procedures and awareness of professionals for protection from these infections.

MATERIAL AND METHOD

After obtaining the required ethic committee permissions, 50 physicians and 34 nurses, working in the endoscopy units of three university and one training and research hospital, were included in this study. A survey with 37 questions, prepared in accordance with the literature was applied to the participating endoscopist (E) and endoscopy nurses (EN). SPSS (Statistical Package for Social Sciences) for Windows 16.0 program was used for statistical evaluation of the obtained data.

FINDINGS

Forty-four (52%) of the subjects were female and 40 (48%) were male, and their average age was 39 (±6.82) years. When trainings on endoscopy of E and EN were evaluated, it was found that 44% (n = 37) of them precise an endoscopy course on endoscopy training, %56 (n = 47) received no training and they learned through master/apprentice system. Furthermore, it was found that 65% (n = 55) of the E and EN received no training on universal precautions procedures, infection and risks endoscopic procedures and only 35% (n = 29) received a specific course or on-the-job training. Nevertheless, rates of wearing protective gowns and gloves were high both for E and EN; but rate of other precautions such as wearing mask, using special gloves and face shields were found to be low. It was found that the rate of "receiving an education on endoscopy" for E was significantly higher than that of EN (p < 0001). The rate of reporting emergency situations such as contact with blood/body fluids or percutaneous injuries and the rate of taking universal precautions of EN who received an education, was statistically higher than that of EN who did not (p < 0.001 and p < 0008).

RESULTS

As a result of our investigation, it was determined that the endoscopists and endoscopy nurses did not effectively apply the universal precautions against infectious risks faced during endoscopic procedures and did not receive the basic trainings. The professionals who received training were more responsive for this issue. According to our results, organizing continuous training programs through endoscopy professionals is necessary to provide the universal precautions of avoiding exposure to blood and body fluids.

Relationship between exhaled leukotriene and 8-isoprostane levels and asthma severity, asthma control level, and asthma control test score

OBJECTIVE

Exhaled breath condensate (EBC) is a completely non-invasive method for the collection of airway secretions to measure intense inflammation in the airways of asthmatics. It has been shown that the childhood asthma control test (c-ACT) is a good tool for use in the evaluation of asthmatics. Whether the c-ACT score and asthma control level correlate with the airway inflammation is not well known. We aimed to evaluate the relationship between exhaled cysteinyl leukotrienes (Cys-LTs) and 8-isoprostane levels and asthma severity, asthma control level and c-ACT score in asthmatic children.

METHODS

Thirty asthmatic children were evaluated with c-ACT score and pulmonary function tests. Asthma severity and asthma control level were assessed according to GINA. EBC was collected and Cys-LTs and 8-isoprostane concentrations were determined using a specific immunoassay kit.

RESULTS

Exhaled 8-isoprostane level in patients with moderate persistent asthma [114 (55-146)pg/ml] was higher than in the mild persistent group [52 (21-91)pg/ml] (p=0.05, Mann-Whitney U [MWU]). EBC 8-isoprostane in children with 1-4 asthma exacerbations/year [52 (16-80)pg/ml] was significantly lower than in children with >4 asthma exacerbations/year [114 (57-129)pg/ml] (p<0.05, MWU). No significant relation was determined between exhaled 8-isoprostane and Cys-LTs levels and c-ACT score and asthma control level. Exhaled 8-isoprostane correlated negatively with bronchodilator response (p=0.015, r=-0.45).

CONCLUSIONS

Exhaled 8-isoprostane, as an oxidative stress specifier, was found to be increased in relation with asthma exacerbation frequency and oxidative stress increases with the severity of asthma. In contrast to asthma severity level, c-ACT score and asthma control level may not reflect airway inflammation.

(18)F-FDG PET/CT findings in a case with HIV (-) Kaposi sarcoma

Although mucocutaneous sites are the most frequently encountered sites of involvement, Kaposi Sarcoma (KS) may also occasionally involve the breast and the skeletal, endocrine, urinary and nervous systems.. Various imaging modalities may be used to delineate the extent of the disease by detecting unexpected sites of involvement. Herein, we report a case of classical type KS, in whom staging with (18)F-FDG PET/CT imaging disclosed widespread disease and unexpected findings of bone and salivary gland involvement.

Importance of serum VEGF and basic FGF levels in determining response to treatment and survival in patients with metastatic colorectal cancer

e21050

Background: Colorectal cancer has an important place in worldwide death from cancer causes. Angiogenesis, in which angiogenic factors such as VEGF and basic FGF have a key role, is an important factor in patient survival with respect to progression and metastatic spreading in colorectal cancer. In this study, we aimed to determine that whether serum VEGF and bFGF pre- and post-treatment serum levels are decisive in evaluating response to treatment and progression in metastatic colorectal cancer (mCRC) patients treated with FOLFIRI-bevacizumab. Methods: In 33 mCRC patients treated in our department serum VEGF and bFGF levels were monitored in the beginning of treatment and until progression during FOLFIRI-bevacizumab treatment before 4.-, 8.- and 12.-regimens. Serum levels of VEGF and bFGF were assssed using the quantitative sandwich enzyme immunoassay technique. Results: In our study serumVEGF and bFGF levels were significantly higher than the healthy controls (p<0.001). We found that the patients with pre-treatment high serum bFGF levels have significantly short PFS and with pre-treatment high serum LDH levels have significantly short overall survival (OS). In patients with pre-treatment low serum VEGF value (< 147.79 pg/ml) had significantly longer OS (27.93 vs 23.27 mounts, P:0.026) in metastatic rectum cancer. In multivariate analysis were found to be prognostic factors VEGF levels and side of tumor for PFS and VEGF levels and whether to be operated of tumor for OS. Conclusions: Serum VEGF level was detected to be one of the factors that determine PFS and OS in mCRC. Pretreatment serum bFGF levels were determined PFS and monitorization of serum bFGF during treatment was found to be releated to response to treatment. Pretreatment serum LDH level was detected to determine OS in metastatic CRC. Although there was no statistical significance, in mCRC patients, whose pretreatment serum VEGF were high, PSK was longer with bevacizumab treatment. The important of pretreatment high serum VEGF level to select for treatment of bevacizumab will be planed in metastatic CRC requires to be confirmed in comprehensive, prospective studies.