Comparison of kinesiophobia in patients with rheumatoid arthritis and systemic lupus erythematosus

OBJECTIVE

Patients with rheumatic disease often experience arthritis and chronic joint pain, which can lead them to avoid movement, known as kinesiophobia. This may result in decreased mobility and endurance, as well as social isolation and depression. This study aimed to assess and compare the prevalence of kinesiophobia among patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and its association with disease activity, functional status, fear of falling, and fatigue.

PATIENTS AND METHODS

A cross-sectional study was conducted with 124 RA, 76 SLE patients, and 87 healthy controls. The tampa kinesiophobia scale (TKS) was used to assess kinesiophobia. The disease activity was assessed using Disease Activity Score 28 (DAS28) in RA, and systemic lupus erythematosus Disease Activity Index 2000 (SLEDAI-2K) in SLE patients. The Health Assessment Questionnaire (HAQ) was used to assess functional status, the Falls Efficacy Scale International (FES-I) was used to assess fear of falling, and the Fatigue Severity Scale (FSS) was used to assess fatigue levels.

RESULTS

Kinesiophobia was significantly more prevalent in RA patients compared to SLE patients [77.4% vs. 63.2%, odds ratio (OR): 2, 95% CI: 1.07-3.75; p<0.05]. The mean TKS score was 41.42±6.95 in RA patients, and 37.84±8.85 in SLE (p=0.005). TKS scores were positively correlated with DAS28 in RA patients; however, no correlation was found between SLEDAI-2K in SLE patients. A positive correlation was observed between TKS scores and the HAQ, FSS, and FES-I, both in RA and SLE patients.

CONCLUSIONS

RA patients exhibited significantly higher kinesiophobia scores compared to SLE patients. The higher rate of kinesiophobia levels in RA patients compared to SLE patients suggests an association between kinesiophobia and the more destructive course of RA, indicating that tight control of the disease is important. Kinesiophobia was associated with functional impairment, fear of falling, and fatigue. Timely identification and intervention for patients with kinesiophobia are essential to prevent progression, mitigate long-term consequences, and maintain functional capacity.

Awareness and Attitudes Toward Cornea Donation in a Turkish Population: A Web-Based Survey

OBJECTIVES

With low supply and high demand for donor corneas, we surveyed Turkish participants on level of knowledge, awareness, and willingness toward cornea donation.

MATERIALS AND METHODS

Our prepared internet-based questionnaire on awareness and attitudes toward cornea donation was structured into 6 parts (parts 1-2 examined socio-demographic data and existing chronic eye diseases, parts 3-4 evaluated level of knowledge on cornea donation and willingness to donate, parts 5-6 questioned whether level of cornea donation was sufficient within the country). For univariate analyses, the chi-square test (Fisher exact where appropriate) was used. We used stepwise logistic regression analyses to evaluate factors associated with willingness to donate (α = 0.05).

RESULTS

Of 2301 surveyed participants, 980 (42.6%) claimed to have knowledge on cornea donation/ - transplantation, with 1297 (56.4%) having willingness toward donation. Bachelor level or higher education (odds ratio = 1.33, 95% CI, 1.10-1.61; P = .004); being a health care professional (odds ratio = 1.55, 95% CI, 1.21-1.97; P = .001), university student (odds ratio = 1.53, 95% CI, 1.25-1.87; P < .001), or artist professional (odds ratio = 5.25, 95% CI, 1.12-24.6; P = .05); presence of chronic eye disease (odds ratio = 1.22, 95% CI, 1.03-1.45; P = .02); and self-reported awareness of donation/transplantation (odds ratio = 2.14, 95% CI, 1.78-2.58; P < .001) were independently associated with willingness to donate. The major disclosed reason for unwillingness was "lack of knowledge" (48.5%, n = 269); the 2 most common self-perceived reasons for negative public attitudes toward cornea donation were "lack of knowledge" (84.8%, n = 1948) and "religious and cultural reasons" (55.8%, n = 1283).

CONCLUSIONS

Associations between both higher education and self-reported knowledge and willingness to donate are testaments that community education can help alleviate unrealistic concerns and prejudices toward cornea donation and hence improve availability of donor corneas.

Efficacy and Safety of Trastuzumab Emtansine in Her2 Positive Metastatic Breast Cancer: Real-World Experience

AIM

The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment.

METHOD

Retrospective analysis of T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey.

FINDINGS

Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3-4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%).

DISCUSSION

The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC.

Relationship between mental health of nursing students and coping, self-esteem and social support

AIM

The aim of this study was to investigate the relationship between the mental health of Turkish nursing students and the stress experienced during their education, their ways of coping, self-esteem, social support and individual factors.

BACKGROUND

Studies on nursing students have shown that students who were not in possession of effective coping strategies were at risk of presenting psychiatric symptoms when under stressful conditions.

METHODS

This was a cross-sectional, case-control study. The sample consisted of 516 nursing students who were studying in an undergraduate program in Turkey. Participants provided data on sociodemographic characteristics by completing the Nursing Education Stress Scale, Coping Behavior Inventory for Nursing Students, Multidimensional Scale of Perceived Social Support, Rosenberg Self-Esteem Scale, and the General Health Questionnaire.

RESULTS

The main factors which were considered to affect the mental health of nursing students, including "total stress" and "self-esteem" scores, "general health" evaluation, "satisfaction with school life" and "presence of a negative event within the last year", were included in all models of the General Health Questionnaire analysis. Analysis of the data indicated that these factors had strong relationship with mental health of the nursing students.

DISCUSSION

It is recommended that the mental health of students be monitored throughout the nursing education period and that preventive practices should be established in order to forestall mental health problems amongst nursing students.

CONCLUSION

The stress levels of nursing students should be monitored in order to facilitate their ability to cope with stressful situations during their training, and components for coping with stress should be included in the curricula of nursing departments.

Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes

PURPOSE

In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients.

METHODS

This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers.

RESULTS

Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure.

CONCLUSIONS

Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.

Alexithymia and perception of illness in patients with cancer

This study aimed to determine how alexithymia affects the perception of illness in patients with cancer. This was a descriptive study conducted at the Atatürk University Health, Research and Practice Hospital and the Erzurum Regional Training and Research Hospital's Medical Oncology Clinic and Chemotherapy Unit. The study data were collected between July 2013 and January 2014. In total, data were collected from 283 patients with cancer. The data were collected using questionnaires enquiring about demographic and medical information: the IPQ and TAS-20. The study concluded that 50.5% of the participating patients had alexithymia. It was found that the alexithymic patients with cancer perceived the negative outcomes of their illness more strongly, and their negative feelings about the illness were more intense. This study suggests that further research should be carried out on alexithymia in patients with cancer and that their positive beliefs about the illness could be enhanced using psychosocial interventions.

Role of Diffusion and Perfusion-Weighted MR Imaging in Differentiating Meningioma from Solitary Dural Metastasis

In some instances conventional imaging techniques fail to differentiate meningiomas from isolated dural metastasis. This study aimed to evaluate the role of diffusion and perfusion-weighted MRI in differentiating meningiomas and dural metastasis. In this study, 14 metastasis and 26 meningiomas were involved. The imaging characteristics were analyzed using conventional MRI. Diffusion-weighted MRI was performed and ADC values were calculated from the solid components and the peritumoral edema. Perfusion-weighted MRI was performed and relative cerebral blood volume (rCBV) was calculated. Student's t test was used for the statistical analysis. Dural metastasis and meningiomas could not be differentiated by qualitative assessment of conventional and diffusion-weighted MRI. The mean intratumoral and peritumoral ADC values were not statistically significant (p > 0.05). The rCBV ratios for dural metastasis and meningiomas were 4.13 ± 2.32 and 7.32 ± 4.10 respectively and the difference between two was statistically significant (p = 0.003). Peritumoral rCBV ratios for dural metastasis and meningiomas were not statistically significant (p > 0.05). Conventional MRI findings of dural metastasis and meningiomas may overlap in some lesions. In differentiation of these lesions diffusion-weighted MRI yields no further information additional to conventional sequences. Perfusion-weighted MRI can be useful to distinguish these lesions by demonstrating high intratumoral rCBV ratios for meningiomas and low rCBV ratios for metastasis.

Efficiency of some soil bacteria for chemical oxygen demand reduction of synthetic chlorsulfuron solutions under agiated culture conditions

This study searches the efficiency of certain soil bacteria on chemical oxygen demand (COD) reduction of synthetic chlorsulfuron solutions under agitated culture conditions. It also aims to determine the turbidity of liquid culture medium with chlorsulfuron during bacterial incubation for 120 hours. As a result the highest and lowest COD removal efficiency of bacteria was determined for Bacillus simplex as 94% and for Micrococcus luteus as 70%, respectively at the end of the 96th hour. It was found that COD removal efficiency showed certain differences depend on the bacterial species. It was also observed that B. simplex had the highest COD removal efficiency and it was a suitable bacterium species for bioremediation of a chlorsulfuron contaminated soils.

Intraocular Pressure Changes During Oral Glucose Tolerance Tests in Diabetic and Non-diabetic Individuals

BACKGROUND

Hyperglycaemia in diabetic patients may lead to elevated intraocular pressure. Different reasons have been suggested in previous studies to explain the increase in intraocular pressure. The purpose of the present study was to investigate the change in intraocular pressure during oral glucose tolerance tests in diabetic and non-diabetic subjects.

PATIENTS AND METHODS

51 individuals who fulfilled the inclusion criteria of the study and were scheduled for oral glucose tolerances tests based on the recommendations of World Health Organization (WHO) underwent clinical examinations. Biochemical parameters associated with metabolic syndrome, insulin resistance (HOMA-IR) and systolic and diastolic blood pressure were also measured. A complete ophthalmologic examination was performed before the test. During the test, intraocular pressure was measured twice in the fasting state and at the first and second hours after oral glucose administration using rebound tonometry (ICARE).

RESULTS

The mean age of the 51 patients was 46.19±9.13 years. The participants were categorized as non-diabetic (n: 24) and diabetic (n: 27). The baseline glucose levels were higher in the diabetic patients (p<0.001). The first-hour intraocular pressures (IOP1-0) changes in the right eye were significant in the diabetic and non-diabetic participants, and the first-hour intraocular pressure changes in the left eye (IOP1-0l) in the diabetic group were significant (p=0.017, p=0.017, p<0.001, respectively).

CONCLUSION

The relation between diabetes mellitus and glaucoma has been addressed in many studies, but no clear underlying mechanisms have been identified. In our study of diabetic and non-diabetic individuals, hyperglycaemia during an oral glucose tolerance test was found to be positively related to intraocular pressure, which suggests that hyperglycaemia may represent a possible mechanism by which elevated IOP occurs.

Capacity of a newly isolated fungus Pleurotus eryngii from Tunceli, Ovacik for chemical oxygen demand reduction and biodecolorization of Azo-Dye Congo Red

Biodecolorization of Congo red dye in both agar&mdash;plate and agitated liquid culture mediums by newly isolated white rot fungus Pleurotus eryngii has been studied. This fungus isolated from Tunceli&mdash;Ovacik province of Turkey. We have also examined the chemical oxygen demand reduction after decolorization under agitated liquid culture medium. For agar plate screening the decolorization capacity of P. eryngii, growth and decolorization halos were determined on saboroud dextrose agar (SDA) plates containing 0.05, 0.1, 0.5, 1 and 2 g/l of Congo red. P. eryngii showed certain decolorization capacities and was able to decolorize all studied concentrations of Congo red, but not to the same extent. Our results indicated that the new isolate P. eryngii had maximum decolorization (87% at 100 mg/l initial dye concentration) and chemical oxygen demand reduction (82% at 25 mg/l initial dye concentration) activities after 7 days under agitated submerged culture conditions. This new isolate could be an effective bioremediation tool for treatment of Congo red containing textile wastewater.

Comparison of Goldmann applanation tonometry, rebound tonometry and dynamic contour tonometry in normal and glaucomatous eyes

AIM

To compare the intraocular pressure (IOP) measurements obtained with the rebound tonometry (RT), dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in normal and glaucomatous eyes and investigate the effects of central corneal thickness (CCT) and corneal curvature (CC) on IOP measurements.

METHODS

One hundred and twenty-four eyes of 124 subjects were enrolled in this cross-sectional study. Fifty-six of participants were healthy individuals and 68 of them were glaucomatous patients. IOP was measured on each subject always in the same order, ICare RT-Pascal DCT-GAT, after a minimum interval of 10min between measurements. CCT and CC were measured using a rotating Scheimpflug camera before the IOP measurements in all subjects. One way repeated measures ANOVA, Pearson correlation coefficient and regression analysis, and Bland-Altman analysis was used for the statistical assessment.

RESULTS

Mean IOP for all enrolled eyes was 16.00±3.80 mm Hg for GAT, 16.99±4.91 mm Hg for RT, and 20.40±4.44 mm Hg for DCT. Mean differences between GAT and RT was -1.75±3.41 mm Hg in normal (P<0.001) and -0.37±3.00 mm Hg in glaucomatous eyes (P=0.563). Mean differences between GAT and DCT was -4.06±3.42 mm Hg in normal (P<0.001) and -4.67±3.12 mm Hg in glaucomatous eyes (P<0.001). GAT and RT were significantly positive correlated with CCT in normal (r=0.317, P=0.017 and r=0.576, P<0.001, respectively) and glaucomatous eyes (r=0.290, P=0.016 and r=0.351, P=0.003, respectively). DCT was also significantly positive correlated with CCT in normal eyes (r=0.424, P=0.001) but not in glaucomatous eyes (r=0.170, P=0.165). All tonometers were unaffected by CC.

CONCLUSION

IOP measurements by RT and DCT were significantly higher than GAT. DCT has highest IOP measurements among these tonometers. RT was most influenced tonometer from CCT although all tonometers were significantly positive correlated with CCT except DCT in glaucomatous eyes. CC did not influence IOP measurements.

Essential oil composition, antioxidant and antifungal activities of Salvia sclarea L. from Munzur Valley in Tunceli, Turkey

The essential oil composition and in vitro antioxidant and antifungal activity of the Salvia sclarea L. from Munzur Valley in Tunceli, Turkey were evaluated in this research. The in vitro antifungal activity of ethanol, hexane and aqueous extracts of S. sclarea against pathogen fungi Epicoccum nigrum and Colletotrichum coccodes were investigated. The essential oil of aerial parts of S. sclarea was obtained by hydrodistillation and was analysed by GC and GC—MS. Total antioxidant status was determined by using Rel assay diagnostics TAS assay kit (Lot.RL024) by Multiscan FC (Thermo). 33 compounds were identified representing the 85.0% of the total oil. The most abundant components (>5%) of the S. sclarea essential oils were caryophyllene oxide (24.1%), sclareol (11.5%), spathulenol (11.4%), 1H-naphtho (2,1,6) pyran (8.6%) and b—caryophyllene (5.1%). The best antifungal and antioxidant effect was seen in ethanolic S. sclarea extract. It can be said that Salvia sclerae could be used as natural antioxidant.

Good Tolerance of Weekly Irinotecan in a Patient with Metastatic Colorectal Cancer on Chronic Hemodialysis

Pharmacokinetic properties of many antineoplastic agents or their metabolites change with organ dysfunction. Unfortunately, chemotherapy doses determined in phase I and II studies in patients with normal hepatic and renal reserves are not usually applicable to those with hepatic and/or renal dysfunction. Considering the high incidence of colorectal adenocarcinoma, it is not unusual for a colorectal cancer patient to be on chronic hemodialysis. We report a patient with metastatic colorectal cancer on chronic hemodialysis who tolerated weekly irinotecan at 50 mg/m2 well without significant toxicity. We briefly discuss therapeutic dose modification in such patients.

Assessment of left ventricular systolic and diastolic dyssynchrony with tissue Doppler echocardiography in patients with heart failure and narrow QRS complex

AIM

Cardiac dyssynchrony is a well known entity in patients with wide QRS complex (>120 ms). Dyssynchrony may also cause ventricular dysfunction in heart failure patients with narrow QRS complexes. In the study, the presence and extent of cardiac dyssynchrony were investigated in patients with heart failure both with narrow and wide QRS complexes using tissue Doppler echocardiography (TDE).

METHODS

Forty-nine patients with heart failure, were included to the study. The first group of 30 patients with a QRS duration of <120 ms (23M; mean age, 64±10.1 years) and the second group consisted of 19 patients with a QRS duration of >120 ms (12M; mean age, 65±11.6 years). In order to examine cardiac synchronization, TDE was performed. Systolic and diastolic intraventricular dyssynchrony and interventricular dyssynchrony were calculated. In order to define systolic and diastolic dyssynchrony, intraventricular delay was accepted as >60 ms, and interventricular delay was accepted as >40 ms.

RESULTS

Left ventricular systolic dyssynchrony was detected in 18 patients (60%) within the narrow QRS group and in 18 patients (94%) within the wide QRS group. Interventricular dyssynchrony was detected in 17 patients (56%) within the narrow QRS group and in 18 patients (94%) within the wide QRS group. For systolic dyssynchrony, correlations existed between intraventricular delay and QRS duration (r=0.48), left ventricular end diastolic diameter (r=0.62), left ventricular end systolic diameter (r=0.61), and EF (r=-0.63). Similarly, correlations existed between interventricular delay and QRS duration (r=0.58), left ventricular end diastolic diameter (r=0.65), left ventricle end systolic diameter (r=0.64), and EF (r=-0.64).

CONCLUSION

The present study suggested that systolic or diastolic dyssynchrony exists despite normal levels of QRS duration.

Single high dose atorvastatin does not ameliorate endothelial function and large arterial stiffness in dyslipidemic patients without atherosclerosis

BACKGROUND

Many studies show that statins have beneficial effects on atherosclerotic risk factors and markers such as flow mediated dilatation (FMD). However, studies on early effects of statins on endothelial function of non atherosclerotic humans are limited.

AIM

The purpose of this study was to determine whether a single high dose of atorvastatin could improve endothelial function and large arterial stiffness in statin naive dyslipidemic non-atherosclerotic patients.

MATERIALS AND METHODS

Thirty statin naïve dyslipidemic non-atherosclerotic patients from Cardiology Outpatient Clinic were enrolled. Arterial stiffness and endothelial function of patients were evaluated by assessing the finger photoplethysmography and the flow-mediated dilatation (FMD) of the brachial artery before and 24 hour after oral administration of 80 mg atorvastatin.

RESULTS

Stiffness indices and FMD 24 hours after administration of 80mg atorvastatin did not differ from baseline measurements (6.89 +/- 1.90 vs. 7.06 +/- 2.37 p : NS and 9.13 +/- 6.07 vs. 9.80 +/- 6.34 p : NS).

CONCLUSIONS

Although it is widely accepted that statins improve endothelial function, evidences of early effect might largely be associated with endothelial injury. Our study suggests that beneficial early effects of statins might not be applicable to patients without atherosclerosis.

Genetic and biochemical differentiation in Vitis vinifera (Kabarcik) populations grown at different altitudes in Coruh Valley

We examined genetic differences of four Vitis vinifera populations (A, B, C, D) including local Kabarcik cultivar grown along an altitude gradient of 800, 900, 1000, and 1150 m above sea level in the Coruh Valley (800 m: A population; 900 m: B population; 1000 m: C population; 1150 m: D population). Leaf samples were used for both RAPD and fatty acid analysis. A total of 60 individuals with 15 individuals per population were included in this study. RAPD analyses showed various band sizes, which ranged from 250 to 3000 bp. Mean polymorphic locus ratios were determined as 96.29% considering four populations. The highest percentage of polymorphic loci (97.8%) was produced by the highest altitude. Thirty-two different fatty acids were found; linoleic acid was the most common in all four populations. According to the dendograms obtained from statistical analyses of RAPD and fatty acid profiles the populations that were close to each other in terms of geographical distance also were similar genetically.

Genetic diversity in wild sweet cherries (Prunus avium) in Turkey revealed by SSR markers

Wild sweet cherry (Prunus avium) trees are abundant in the northern part of Turkey, including the Coruh Valley. We analyzed 18 wild sweet cherry genotypes collected from diverse environments in the upper Coruh Valley in Turkey to determine genetic variation, using 10 SSR primers. These SSR primers generated 46 alleles; the number of alleles per primer ranged from 3 to 7, with a mean of 4.6. The primer PS12A02 gave the highest number of polymorphic bands (N = 7), while CPSCT010, UDAp-401 and UDAp-404 gave the lowest number (N = 3). Seven groups were separated in the dendrogram, although most of the genotypes did not cluster according to phenological and morphological traits. This level of genetic diversity in these wild sweet cherry genotypes is very high and therefore these trees would be useful as breeders for crosses between cultivated sweet cherry and wild genotypes.

Genetic relationships among wild pomegranate (Punica granatum) genotypes from Coruh Valley in Turkey

The pomegranate has been used traditionally in Coruh Valley in Turkey for a long time; fruits are harvested from wild, semi-domesticated and cultivated trees. In the valley, it occurs in general along with olive trees. We sampled 23 wild-grown pomegranate genotypes sampled from different parts of Coruh Valley and compared them using RAPD primers to determine genetic variability. Eighty-six RAPD primers were used for molecular characterizations, among which 12 gave reliable polymorphic patterns. These primers generated 145 RAPD bands of which 91% were polymorphic. The highest polymorphism ratio was observed with primers OPY06, OPY13, OPBA03, OPBB03, OPBB07, and OPBB09 (100%), while the lowest was with OPBB09 and OPBB10 (75%). The band size was between 250 and 2400 bp. There were five main clusters in the dendrogram; the highest genetic similarity was 0.24 and the lowest was 0.08.

Genetic relationships among turnip (Brassica rapa var. rapa) genotypes

Turnip (Brassica rapa var. rapa) is one of the main vegetables consumed by people living in Eastern Anatolia in Turkey. In this region, farmers obtain their own seeds for production, which results in considerable morphological variability. We examined the genetic variation and relationships among 11 turnip genotypes sampled from diverse environments of the Erzurum region located in Eastern Anatolia in Turkey. Thirty-two Operon RAPD primers were screened; among them, 20 gave reproducible and clear DNA fragments after amplification. The average polymorphism ratio was 90.4%. The genetic distance between turnip genotypes were found to range from 0.302 to 0.733, indicating high genetic variability. Eleven genotypes were divided into three main clusters in a dendrogram; ETS2 and ETS8 genotypes were the most distant. We conclude that RAPD analysis would be useful for genotyping turnip genotypes.

Genetic variation among date plum (Diospyros lotus) genotypes in Turkey

Turkey is one of the most important genetic resources of the date plum, Diospyros lotus, especially in the northeastern part of the country. Authenticating the identity of germplasm resources of D. lotus would be of great value for breeding. We examined the genetic variability of 11 D. lotus genotypes sampled from Coruh Valley in Turkey. One hundred and twenty-eight DNA markers were generated by 12 random primers. The highest polymorphism ratio was observed with the primer OPA-01 (71%) while the lowest was with OPY-01 (36%). The band size was between 350 and 2500 bp for these primers. The percentage of polymorphic bands was 58%, which demonstrated the efficiency of these primers. The similarity between genotypes ranged from 0.48 to 0.76. The RAPD markers permitted us to distinguish all the genotypes.

An Evaluation of P Wave Dispersion, QT, Corrected QT and Corrected QT Dispersion Intervals on the Electrocardiograms of Malnourished Adults

The aim of our study was to investigate P wave dispersion (Pwd), QT, corrected QT (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) intervals in subjects with malnutrition diagnosed in the pre-anaesthetic assessment, compared to those without malnutrition.

A total of 76 adult patients were included. Main diagnoses, anthropometric measurement, body mass index, electrocardiogram and serum sodium, potassium, chloride, magnesium and calcium levels were recorded for all patients. Pwd, QT and QTd intervals were measured on all electrocardiogram records and QTc and QTcd intervals determined with the Bazett formula. Protein-energy malnutrition was diagnosed with the nutritional risk index.

No statistically significant difference was found between the age, gender and malignant cancer diagnosis rates between patients with malnutrition (group M) and those not suffering from malnutrition (group N) (P >0.05). Serum albumin, total protein, potassium, calcium, magnesium and chloride values of group M were found to be significantly lower than group N (P <0.05). In group M, Pwd, QT, QTc, QTd and QTcd intervals were significantly longer than in group N (P <0.001).

Patients diagnosed with malnutrition during pre-anaesthetic assessment had significantly longer Pwd, QTc and QTcd interval durations than the control group. We attribute such extended Pwd, QTc and QTcd durations in these patients to malnutrition and malnutrition-related electrolyte imbalance.

Serum vitamin D status and bone mineral density in fibromyalgia

OBJECTIVES

To compare serum vitamin D levels and bone mineral density (BMD) values in patients with fibromyalgia and healthy controls.

BACKGROUND

The so far available reports of low levels of vitamin D and low BMD values in patients with fibromyalgia are inconsistent.

METHODS

Serum 25-hydroxyvitamin D (25-OHD) levels and BMD values were measured in thirty women with fibromyalgia and compared with thirty age-matched healthy women. Serum calcium, phosphorus, alkaline phosphatase and parathyroid hormone (PTH) levels were also measured. All participants completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Score (HADS). Pain severity was assessed with visual analog scale (VAS).

RESULTS

Mean serum 25-OHD levels did not differ between the groups (fibromyalgia 10.57 +/- 10.46, controls 10.87 +/- 5.52 ng/l; p=0.89); nor did the frequency of vitamin D deficiency (25-OHD < or = 20 ng/l) in each group (fibromyalgia 86.7%, controls 96.7%; p=0.353). Although, mean serum PTH level was found significantly higher in fibromyalgic patients than in controls (p=0.014), only one patient and two of controls had barely elevated PTH levels. There was no relationship between vitamin D level and FIQ score (p=0.707) or HADS (p=0.824) or pain VAS (p=0.414). BMD values in the patients with fibromyalgia were comparable to those in controls at both, the lumbar spine (p=0.866) and femur neck (p=0.61).

CONCLUSION

Neither vitamin D levels nor BMD values are different between women with and without fibromyalgia. In this cross-sectional study, mean serum PTH level was found higher in the fibromyalgic patients than in controls. Nevertheless, in order to confirm the findings of this preliminary study it is still necessary to perform a controlled longitudinal study (Tab. 2, Fig. 2, Ref. 35). Full Text in free PDF www.bmj.sk.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Perforating corneal injury with a fish hook

A 10-year-old boy presented with a corneal perforation of the right eye caused by a fish hook injury while watching a friend fish. Surgical removal of the fish hook was performed. Under general anesthesia, the shank of the fish hook was cut and the hook was advanced and released. The observation of fly fishing is accompanied by risk similar to participation. Management is guided by the peculiarities of the injury.

Adenoid hypertrophy in adults: clinical and morphological characteristics

This study compared the aetiology and pathological characteristics of adult and childhood adenoid hypertrophy (AH). Clinical and morphological features and accompanying otolaryngological pathologies were recorded in 40 adults and 23 children undergoing adenoidectomy for obstructive AH. Both AH forms were similar in terms of symptomatology and associated inflammations. There were, however, significant differences in otitis media rate, with effusion and dullness, and retraction in the eardrum both more prevalent in childhood AH. Adult AH was associated with nasal septum deviation in 25.0% of patients. Histopathological features of adenoidal lymphoid tissue were dissimilar in the two groups: numerous lymph follicles with prominent germinal centres was the chief finding in childhood adenoids, whereas adult adenoids showed chronic inflammatory cell infiltration and secondary changes (e.g. squamous metaplasia). These results underline the importance of considering AH as a cause or contributing factor in nasal obstruction and related pathologies in adults and supports the theory that it represents a long-standing inflammatory process rather than being a novel clinical entity.

Delayed surgical treatment of traumatic hearing loss due to ossicular disruption

OBJECTIVE

Surgical treatment of dislocation and fracture of the middle ear ossicles is recommended to be carried out within months of the initial injury. Here we present 6 patients with traumatic ossicular injury whose surgery was delayed over 1 year. We evaluated the clinical and pathological changes that occurred over time and assessed the surgical outcomes in delayed cases.

METHODOLOGY

Histories of the causative traumas, computerized tomography (CT) and tympanometry findings, pre- and postoperative hearing thresholds, and ossicular damages assessed at the tympanotomies were evaluated.

RESULTS

The time lapse between the trauma and the surgery varied from 1 to 6 years. The resultant hearing losses were moderate or moderately severe, conductive, mixed or sensorineural type. Tympanometry and CT revealed ossicular discontinuity in only two cases. In operations, various types of ossicular abnormalities in the form of absence, displacement, fracture and/or fixation were identified. Continuity and mobility of the ossicular chains were restored with various techniques. Air-bone conduction gap was brought to within 20 dBHL in all cases, and within 10 dB in 3 (50%) of the cases. Gains in the bone conduction were also notable.

CONCLUSION

Trauma to the middle ear may result in an elevation in the air and/or bone conduction thresholds due to ossicular disruption and fixation. Our findings confirmed that tympanotomy is superior to methods such as CT and tympanometry in delineating the type and extent of the traumatic ossicular damage, and usually gives favorable results even in delayed cases.

Intracranial myeloid sarcoma: conventional and advanced MRI findings

Chloroma (myeloid or granulocytic sarcoma) is a rare type of tumour comprising immature granulocytic cells. It generally accompanies acute myeloid leukaemia and, rarely, other myeloproliferative disorders. When presenting as dural-based mass lesions, radiological differential diagnosis includes meningioma, metastasis and lymphoma. There is a limited number of descriptions of chloromas mimicking dural-based masses in the literature. We present preliminary diffusion-weighted MR, perfusion-weighted MR and MR spectroscopy findings of an intracranial myeloid sarcoma.

Functional MRI in Patients with Intracranial Lesions near Language Areas

We aimed to depict Broca's area and Wernicke's area by word generation and sentence formation paradigms in patients with various intracranial lesions adjacent to language areas using functional MRI technique and to evaluate the ability of functional MRI to lateralize the hemispheric dominance for language. Twenty-three right-handed patients were included in this study. Lesions were classified as low-grade glioma (n=8), high-grade glioma (n=9), metastasis (n=1), meningioma (n=1), arteriovenous malformation (n=2) and mesial temporal sclerosis (n=2). We performed blood-oxygenated-level-dependant functional MRI using a 1.5-T unit. Word generation and sentence formation tasks were used to activate language areas. Language areas were defined as Brodmann 44, 45 (Broca's area) and Brodmann 22 area (Wernicke's area). Laterality index was used to show the dominant hemisphere. Two poorly cooperative patients showed no activation and were excluded from the study. Broca's area was localized in 21 patients (100 %). Wernicke's area, on the other hand, could only be localized in eight of the 21 patients (38 %).The left hemisphere was dominant in 86% of patients while atypical language lateralization (right or bilateral) was demonstrated in 14% of the patients. Bilateral activation areas were shown in 10% of those patients while right cerebral hemisphere was dominant in 4% of the patients. Word generation and sentence formation tasks are especially helpful in localizing Broca's area. Wernicke's area could also be demonstrated in some of the cases. Functional MRI can be used as an important and useful means of demonstrating language areas in patients with lesions adjacent to those areas and depicting the hemispheric dominance.

Morphologic and volumetric analysis of amygdala, hippocampus, fornix and mamillary body with MRI in patients with temporal lobe epilepsy

Our aim was to demonstrate lateralization morphometrically and volumetrically measuring the main limbic structures like hippocampus, amygdala, fornix and mamillary bodies in patients with temporal lobe epilepsy (TLE) and to establish the contribution of each anatomical structure to lateralizing the pathological site. Forty-two patients with complex partial seizures originating from the temporal lobe and 42 control healthy volunteers were included in the study. T2-weighted FSE sequences in axial and oblique coronal planes and T1-weighted SE sequences in the sagittal plane were used. A high-resolution IR sequence was used for the volumetric analysis of amygdala and hippocampus and for the measurement of fornix and mamillary body thickness. Intensity changes and atrophy of limbic structures were observed qualitatively and measurement of these structures was performed quantitatively. Student's t test and Mann-Whitney U-test were used for the statistical analysis. The p values <0.05 was taken as statistically significant. Ten out of 42 patients had intracranial masses and were excluded from the study. Qualitative analysis revealed atrophy in 84% and intensity increase in 60% of cases. Quantitative measurement demonstrated that control cases had a larger hippocampus than the patients ( p<0.001). There was unilateral hippocampal volume loss in 88% and bilateral volume loss in 13% of patients. There was no difference in the volume of amygdala between the groups ( p>0.05). According to the difference in the volumes of the right and left sides, there was unilateral atrophy in 34% of patients. Bilateral atrophy was not observed. There was a significant difference in fornix and mamillary bodies of the patients and control subjects ( p<0.005). In 62.5% of cases, there were abnormalities in the fornix with bilateral involvement in 13% of cases. Mamillary bodies were abnormal in 37% of patients with bilateral involvement in 15%. Lateralization was accomplished in 65% of the patients according to the percentage difference ratios of fornix and in 38% of the patients according to the mamillary bodies. It is important to demonstrate hippocampus atrophy in patients with TLE. In the decision of lateralization of the epileptic side, evaluation of the fornix could be a good and practical solution. However, hippocampal volumetry is an indispensable criterion in demonstrating hippocampal atrophy more accurately. Atrophy of the amygdala and thickness of mamillary bodies have the least importance for lateralization.

Glioblastoma multiforme with atypical diffusion-weighted MR findings

The aim of this study is to review the diffusion-weighted MRI findings of glioblastomas, to investigate those with atypical characteristics and to emphasise the reasons responsible for the atypical features on diffusion-weighted MR images. 48 cases of histologically proven glioblastomas were included in this study. In addition to conventional sequences of routine tumour protocol, diffusion-weighted MRI with spin-echo echo-planar sequence was performed. The cystic-necrotic components of the lesions, according to the conventional sequences, were determined on the diffusion-weighted MR images and were classified as typical or atypical. The presence of high signal intensity was accepted as an atypical feature while low signal intensity was accepted as typical. The apparent diffusion coefficient (ADC) values of the cystic components were calculated. The statistical significance of the typical and atypical glioblastomas was evaluated with the students t-test. In six of the cases apparent high signal intensity in diffusion weighted MR images was interpreted. In three cases the high signal intensity occupied all of the cystic component and in the other three most of the cystic component. The ADC values of the lesions varied between 0.86 x 10(-3) mm(2) s(-1) and 1.39 x 10(-3) mm(2) s(-1) (mean value 1.06+/-0.17 x 10(-3) mm(2) s(-1)). In 42 of the lesions the cystic-necrotic component demonstrated low signal intensity and the ADC values varied between 1.56 x 10(-3) mm(2) s(-1) and 3.32 x 10(-3) mm(2) s(-1) (mean value 2.36+/-0.46 x 10(-3) mm(2) s(-1)). The difference between ADC values of atypical and typical lesions was statistically significant (p<0.001). The vast majority of glioblastomas do not exhibit restricted diffusion in diffusion-weighted MRI, but some of them display homogeneous or heterogeneous high signal intensity and decrease of ADC values. Diffusion-weighted MRI alone is not helpful in the differentiation of malignant tumours from abscesses with low ADC values and similar conventional MRI findings.

Transient splenial lesion of corpus callosum associated with antiepileptic drug: conventional and diffusion-weighted magnetic resonance images

Transient focal lesions of splenium of corpus callosum can be seen as a component of many central nervous system diseases, including antiepileptic drug toxicity. The conventional magnetic resonance (MR) findings of the disease are characteristic and include ovoid lesions with high signal intensity at T2-weighted MRI. Limited information exists about the diffusion-weighted MRI characteristics of these lesions vanishing completely after a period of time. We examined the conventional, FLAIR, and diffusion-weighted MR images of a patient complaining of depressive mood and anxiety disorder after 1 year receiving antiepileptic medication.

Triterpenes from Campanula lactiflora

One new triterpene compound, 3beta-acetoxylup-20(30)-en-29-al and two known 3-acetylptiloepoxide and 3beta-acetoxylup-20(29)-ene were isolated for the first time from the leaves of Campanula lactiflora and their structures were deduced by high field 1D and 2D 400 MHz NMR, EI-MS and (+) LC-MS/MS spectra.

Duplex sonography of retro-orbital and carotid arteries in patients with normal-tension glaucoma

PURPOSE

To evaluate retrobulbar and carotid arterial hemodynamics in patients with normal-tension glaucoma using Doppler sonography.

MATERIALS AND METHODS

Duplex sonography was performed in 41 patients with normal-tension glaucoma and 30 control subjects to evaluate resistance indices (RIs) in retro-orbital and carotid arteries. Mean values were compared using the independent t-test. The ratios of the RI in retro-orbital to RIs in the carotid arteries (CCA and ICA) and interocular and intercarotid differences in RI (DeltaRI) were also calculated.

RESULTS

Is in the central retinal (CRA) and temporal and nasal posterior ciliary arteries (TPCA and NPCA) were statistically significantly greater in glaucomatous eyes (p < 0.001). Plaque formation in carotid arteries without significant stenosis was noted in 12% of patients and 10% of control subjects. Ratios of RI of CRA or TPCA or NPCA to that of CCA and the ratios of RI of CRA or NPCA to that of ophthalmic arteries (OA) were significantly greater in glaucomatous eyes. We also found that ratios of the RI of CRA or TPCA or NPCA to that of ICA and the ratio of the RI of OA to CCA were nearly equal to 1 in both patients and control subjects. We found no significant difference between interocular and intercarotid DeltaRIs in patients and control subjects.

CONCLUSIONS

In patients with symmetric normal-tension glaucoma, duplex sonography showed an elevated RI in CRA and PCA. The Doppler evaluation of carotid arteries was useful.

Iron, nitric oxide, and myeloperoxidase in asthmatic patients

Plasma nitric oxide (NO), myeloperoxidase (MPO), and iron (Fe) levels were determined in bronchial asthma. The relations among these parameters in different stages of asthma were interpreted. Their association with airway inflammation observed in patients with bronchial asthma as well as the roles and the contributions to the pathological processes were evaluated. A total of 62 individuals, 32 asthmatics and 30 controls, were included into the scope of this study. Plasma nitric oxide metabolites (NOx) and MPO and Fe levels were determined by the Griess reaction, ELISA, and the automated TPTZ (2,4,6-tri[2-pyridyl]-5-triazine) method, respectively. In the asthmatic individuals, plasma NOx, MPO, and Fe concentrations were 133 +/- 13 microM, 95 +/- 20 ng/ml, and 159 +/- 20 microg/dl, respectively; in the control group these values were 82 +/- 11 microM, 62 +/- 11 ng/ml, and 96 +/- 9 microg/dl. Increased values were detected for plasma MPO (p > 0.05), NOx (p < 0.01), and Fe (p < 0.01) concentrations in asthmatic individuals. Considering the facts that NO modulates the catalytic activity of MPO and induces the expression of heme oxygenase as important contributors to the mechanisms causing free Fe release, it is concluded that elevated NOx, MPO, and Fe levels observed in the asthmatic group act in a concerted manner and appear to be involved in the pathogenesis of asthma.

An overwhelming pulmonary fungus ball in a systemic lupus erythematosus patient

Impaired host immunity has been regarded as a predisposing factor in post-primary tuberculosis in adults. Patients with systemic lupus erythematosus (SLE) are usually exposed to high doses of corticosteroids and eventually develop defective cellular immunity that increases the risk for active tuberculosis. SLE-associated pulmonary tuberculosis tends to have a higher incidence of miliary, far-advanced pulmonary disease and therefore establishing the diagnosis can easily be delayed due to generalized, non-specific clinical symptoms such as fever, malaise and weight loss which are also commonly observed in lupus patients. However, cavitary tuberculosis is very rare in patients with SLE. To the best of our knowledge, fungus ball formation in the tuberculosis cavity in a patient with SLE, has not been previously reported. Thus, we present a case of SLE who was found to have a fungus ball within a preexisting tuberculosis cavity. The diagnosis was resolved by computerized tomography of the chest and was confirmed with histopathological examination.

Treatment of intracameral fibrinous membranes with tissue plasminogen activator

BACKGROUND AND OBJECTIVE

To evaluate the efficacy of intracameral tissue plasminogen activator (tPA) in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment.

PATIENTS AND METHODS

In this technique, 0.1 mL of aqueous was aspirated, followed by injection of 0.1 mL (25 microg) of tPA into the anterior chamber in 15 patients with severe fibrinous membranes that developed after pars plana vitrectomy (n = 6), cataract extraction (n = 4), combined cataract and glaucoma surgery (n = 2), trabeculectomy (n = 1), and endophthalmitis (n = 2). The clearance of fibrinous membranes and changes in visual acuity and in intraocular pressure were observed.

RESULTS

Patients were treated 2 to 10 days postoperatively (mean, 5.6 +/- 0.57 days). Complete fibrinolysis was observed in all cases. The mean time for clearance of fibrin was 7.73 +/- 2.73 hours. A temporary increase in intraocular pressure was noted in two cases.

CONCLUSION

In this technique, intracameral injection of 25 microg of tPA is both effective and safe in the treatment of severe fibrinous membranes that do not respond to anti-inflammatory treatment.