Gamma Knife radiosurgery for the treatment of trigeminal neuralgia: A single center-experience

INTRODUCTION AND OBJECTIVES

We aimed to assess the outcomes of patients with trigeminal neuralgia (TGN) who underwent Gamma Knife radiosurgery (GKRS).

MATERIALS AND METHODS

Fifty-three patients with typical TGN underwent GKRS from May 2012 until December 2022. Among these patients, 45 patients who were follow-up for at least 12 months were included in the study. A mean dose of 87.5 Gy (range, 80-90) was administered to the trigeminal nerve. Postoperatively, outcome was considered excellent if the patient was pain- and medication-free.

RESULTS

The mean symtpom duration was 9.53 years, and the mean patient age was 59.8 years (range, 34-85). The mean follow-up period was 46.8 months (range, 12-127 months). 46.7% of patients had a history of previous surgical interventions. A single nerve division was affected in 14 patients (31.1%), and multiple divisions were affected in 31 patients (68.9%). The rate of initial pain relief was 80%. Hypoesthesia in the area of trigeminal nerve developed in 30 (66.7%). Twenty patients (44.4%) exhibited excellent results within 72.4 months. Recurrence occurred in 11 patients (24.4%) with 27.6 months.

CONCLUSIONS

Our results suggest that GKRS is a safe and effective procedure. Thus, it is an attractive first- and second-line treatment choice for TGN.

Combined thalamic and pallidal deep brain stimulation in diabetic hemiballism/hemichorea

Hemiballism/Hemichorea (HH) is a hyperkinetic movement disorder observed mostly after cerebrovascular diseases in elderly patients. Even though the improvement in symptoms would be maintained without treatment, in rare cases, lesioning or DBS (deep brain stimulation) surgery provide a chance on relieving the severe involuntary movements. HH is a more rarely reported entity as a diabetic complication and we encountered very few cases treated with surgical intervention for diabetic HH. A 75-year-old female patient with type-II diabetes mellitus was admitted for left-sided disabling involuntary movement despite being medically treated for six months. A GPi (globus pallidus internus) and thalamic Vim (ventral intermediate) nucleus targeted DBS surgery was performed. Complete resolution was achieved with combined stimulation at 1.7 mA of thalamic Vim nucleus and 2.4 mA of GPi. Combined stimulation of thalamic Vim nucleus and GPi resulted in an effective treatment method for HH secondary to diabetes in our case. Even if the rarity of the cases treated surgically withholds us to come to a certain conclusion, it provides a new option to treat HH to our experience.

Knowledge and Attitude of Healthcare Professionals Towards Ozone Therapy

In medicine, ozone therapy is used in many instances. This study aims to understand the knowledge and attitudes of healthcare professionals towards ozone therapy. We conducted a cross-sectional survey in a comprehensive hospital between November 2020 and January 2021. In addition to evaluating the sociodemographic characteristics of the healthcare professionals, we performed evaluations through a data collection form that we prepared based on the literature. A total of 544 people were included in the study. We found ozone therapy to be the fifth-most frequently heard (72.2%) and experienced (2%) application among traditional and complementary medical applications. Of the participants, 20.8% (n = 113) correctly answered the questions regarding the methods of application of ozone therapy. We found that the most common route of administration was intravenous administration, with a rate of 56.5% (n = 307). The number of correct answers received for the questions regarding ozone therapy was related to professional experience, sex, and occupation (P = .035, P < .001, and P < .001, respectively). We determined that the knowledge and attitudes of healthcare professionals towards ozone therapy are not satisfactory.

Endovascular treatment of posterior circulation aneurysms: Results from a single-team experience of 81 cases including 13 flow diversion treatment

INTRODUCTION

Relatively constant surgical risks and rapid advances in endovascular treatment have caused a major shift toward endovascular management of posterior circulation aneurysms. This paper presents the results of a series of endovascularly treated posterior circulation aneurysms.

METHODS

A total of 81 patients who underwent endovascular treatment of posterior circulation aneurysms performed by a single team between 2009 and 2019 were included. Demographic, clinical, radiologic, and management details were retrospectively obtained from hospital records.

RESULTS

Among the included patients, 50 (61.7%) and 31 (38.3%) were female and male, respectively. Subarachnoid hemorrhage was observed in 30 patients (37%). Moreover, 40 (49.3%) aneurysms were treated with stent-assisted coiling, 1 (1.2%) aneurysm was treated with parent artery occlusion, 2 (2.4%) aneurysms were coiled using balloon assistance, 24 (29.6%) aneurysms were coiled primarily, 1 (1.2%) patient had an unsuccessful treatment attempt, and 13 (16.0%) aneurysms were treated with flow-diverter stents or stent monotherapy. During the last follow-up, 57 (83.8%) aneurysms were completely occluded, whereas 6 (8.8%) and 2 (2.9%) aneurysms did and did not have a residual neck, respectively. Flow diversion was used to treat 13 patients, among whom 8 had total occlusion or stable residue. A total of 7 deaths (8.6%) were encountered in this series.

CONCLUSION

Endovascular treatment should be considered as the primary treatment modality for posterior circulation aneurysms. Despite the high morbidity and mortality rates, promising results can be achieved with correct patient selection. Flow diversion can be a feasible alternative for complex aneurysms that are difficult to treat.

The impact of the COVID-19 pandemic on the orthopaedics outpatient clinic

OBJECTIVE

The COVID-19 pandemic has significantly impacted orthopaedic practice since it started. In our study, we aimed to examine these effects on outpatient services.

PATIENTS AND METHODS

The patients who applied to the orthopedic outpatient clinic (n=1,518) in six months period under the effect of the COVID-19 pandemic (September 2020-March 2021) and patients (n=1,207) who applied during the same period before the pandemic (September 2019-March 2020) were analyzed according to the demographic characteristics (age, gender), reasons for admission, duration of complaints, treatments applied, surgical acceptance rate, and compliance with treatment.

RESULTS

The mean age in the pre-pandemic outpatient clinic admissions was 39.1 years (1-91 years), the gender ratio was 635/572 (Female/Male), the mean age of the patients was 38.1 years (1-95), and the sex ratio was 793/725 (F/M) during the pandemic. Admissions of patients with acute complaints decreased after the pandemic, and applications for subacute or chronic complaints increased. Applications for sports medicine, pediatrics, and hand surgery increased, applications for trauma, foot and ankle surgery decreased, and applications for oncology and spine did not change. Conservative treatment recommendations decreased, the surgical treatment recommendation did not change, and the rate of patients who were given only follow-up decisions increased. There was no significant difference in the treatment rejection and surgical acceptance rate.

CONCLUSIONS

We observed that the number of traumas decreased, and the hospital admission duration extended. The increase in the consultation rate and follow-up preference indicates that the treatment is more conservative in this period. In this process, patients should be adequately informed about the precautions taken, and their treatment should not be interrupted.

Evaluation of organ weights and ventricular thicknesses in electrocution related deaths based on autopsy reports: A biophysical approach

OBJECTIVE

To evaluate autopsy reports of the deaths due to electrocution in terms of body mass index, body surface area, and organ weights with a biophysical perspective.

METHODS

The retrospective study was conducted in Malatya, Turkiye, and comprised autopsy reports of electrocution cases that were obtained from the local branch of the Council of Forensic Medicine related to the period from 2012 to 2019. Organ weights and ventricular thicknesses were compared in terms of body mass index and body surface area. Electrical marks were also evaluated in detail. Data was analysed using SPSS 18.

RESULTS

Of the 45 cases, 36(%) were male and 9(%) were female. The overall mean age was 39±13 years (range: 20-71 years). There were no significant differences in organ weights and ventricular thicknesses in different body mass index groups (p>0.05). The weights of head and heart were significantly different in relation to body surface area (p<0.05), but no significant difference were found for other organs and ventricular thickness (p>0.05).

CONCLUSIONS

Comparing the organ weights in electrocution autopsies to normal organ weights may help decide the cause of death. During autopsy, electrical marks should be evaluated by considering the characteristics of the electrical current.

Staff scheduling for residential care under pandemic conditions: The case of COVID-19

The COVID-19 pandemic severely impacted residential care delivery all around the world. This study investigates the current scheduling methods in residential care facilities in order to enhance them for pandemic conditions. We first define the basic problem that addresses decisions associated with the assignment and scheduling of staff members, who perform a set of tasks required by residents during a planning horizon. This problem includes the minimization of costs associated with the salary of part-time staff members, total overtime, and violations of service time windows. Subsequently, we adapt the basic problem to pandemic conditions by considering the impacts of communal spaces (e.g., shared rooms) and a cohorting policy (classification of residents based on their risk of infection) on the spread of infectious diseases. We introduce a new objective function that minimizes the number of distinct staff members serving each room of residents. Likewise, we propose a new objective function for the cohorting policy that aims to minimize the number of distinct cohorts served by each staff member. A new constraint is incorporated that forces staff members to serve only one cohort within a shift. We present a population-based heuristic algorithm to solve this problem. Through a comparison with two benchmark solution approaches (a mathematical programme and a non-dominated archiving ant colony optimization algorithm), the superiority of the heuristic algorithm is shown regarding solution quality and CPU time. Finally, we conduct numerical analyses to present managerial implications.

P-472 Extended oocyte cryostorage period is not associated with decreased post-warm survival rate: a retrospective study of 5208 vitrified/warmed oocytes at a single centre

Study question

Is extended oocyte cryostorage period associated with decreased post-warm survival rate?

Summary answer

There is a weak inverse correlation between oocyte cryostorage duration and post-warm survival (r = 0.09, p = 0.01). This equates clinically to a reduction of 0.0003% survival/day.

What is known already

It is widely reported that extended embryo storage is not associated with reduced post-warm survival rates, however there are no such studies in the literature relating to the effect of extended cryostorage duration on oocytes.

Successful outcomes from oocyte vitrification are related to reduced patient age however UK government regulations only permit those with a medical indication to store and use their gametes over 10 years.

With the intended extension of this 10-year limit, it is therefore fair for clinics to expect an increasing population of younger patients choosing to store their oocytes for longer periods.

Study design, size, duration

A retrospective audit of all vitrified/warmed oocyte cycles at a single centre from 2014-2021. A total of 5208 oocytes were included in the study, from 602 treatment cycles.

Participants/materials, setting, methods

Patients of all ages were included in the study. Data was obtained retrospectively from IDEAS V6.0 at CRGH, UK. All oocytes were vitrified/warmed according to the Irvine Scientific/Kitazato media protocols, with all other protocols excluded. Data was analysed using IBM® SPSS® Statistics V24. Kendall’s tau-b and Spearman’s Rho correlation coefficients measured the strength and direction of association between variables. A linear regression model was used to establish the effect of duration on survival per day.

Main results and the role of chance

The median age at oocyte vitrification was 31 years (range 18-45 years, LQR=25 years, UQR=37 years). There was a median of 8 oocytes thawed per case (LQR=6, UQR 11 oocytes) with a median of 6 oocytes surviving (LQR=3, UQR=9 oocytes). The median survival rate across all ages was 81% (LQR=58%, UQR=100%). There was no significant difference in oocyte survival rate between age categories (&lt;35 years vs &gt; 35 years; p = 0.137, n = 414 & 188 respectively). Increasing age was however, significantly correlated with fewer oocytes vitrified (r = 0.283, p = 0.001).

There is a weak inverse correlation between oocyte cryostorage duration and post-warm survival (r = 0.09). This correlation reaches statistical significance (p = 0.01), however this equates clinically to a reduction of 0.0003% survival rate per day.

No significant difference was observed in post-warm oocyte survival rate across duration of vitrification categories (≤3 years vs 4-5 years vs &gt; 5 years; p = 0.154, n = 416, 141 & 45 cases respectively).

The median duration for which oocytes remained in cryostorage was 565 days (1.6 years) (LQR & UQR=233 days (0.64 years) and 1390 days (3.8 years) respectively).

Limitations, reasons for caution

Although retrospective, the study benefits from many cycles, all of which were carried out at the same unit, using the same vitrification/warming media protocol. Limitations of this study include a relatively short median cryostorage duration time which could be masking the true effect of duration on post-warm oocyte survival.

Wider implications of the findings

Following a public consultation in 2020 regarding the 10-year storage limit for gametes and embryos, the UK Government proposed changes the current legislation which will allow patients to extend cryostorage beyond 10 years without a medical indication. To our knowledge, this is the first study to lend support this movement.

Trial registration number

IRB-001C03-01-22

P-357 Predicting live birth following single euploid frozen blastocyst transfer - does the journey matter?

Study question

Does the number of available euploid embryos affect the success rate of the first single euploid frozen thawed embryo transfer (FTET)?

Summary answer

The live birth rate (LBR) following the first single euploid FTET is independent of the number of available euploid embryos.

What is known already

Preimplantation testing for aneuploidy (PGT-A) is a controversial laboratory technique as an embryo selection tool to increase LBR per transfer and reduce time to pregnancy. There have been many efforts to identify factors predictive of LBR following a euploid embryo transfer. The number of euploid embryos available is known to increase the expected cumulative LBR. However, there is lack of evidence whether the number of available euploid embryos is also significantly associated with chances of live birth for the first euploid FTET cycle. This is important for individualized patient counselling.

Study design, size, duration

A retrospective analysis of the first, single, euploid FTET of 506 women, between January 2015 to March 2020 following PGT-A was carried out. The indication for PGT-A was advanced maternal age, recurrent miscarriage or implantation failure. Embryos were biopsied on day 5 or 6 and tested with array comparative genetic hybridization or next generation sequencing. The FTET outcomes were compared based on the number of euploid embryos available.

Participants/materials, setting, methods

198 women had one euploid embryo available (group 1), 120 women had two (group 2) and 188 women had three or more (group 3). Baseline characteristics were analysed for all participants to adjust for confounders. Reproductive outcomes such as pregnancy rate (PR), clinical miscarriage rate and LBR were compared between the 3 groups for the first euploid FTET. Univariate analysis with Kruskal-Wallis H, chi-square and multivariate logistic regression was performed with SPSS.

Main results and the role of chance

Baseline characteristics were similar between the groups including age at egg collection (EC), body mass index, use of partner or donor sperm, method of insemination, number of ECs, endometrial preparation protocol and endometrial thickness prior to transfer. Women with three or more euploid embryos were younger at the time of EC compared to groups 1 and 2 (mean age 37 vs 39 and 38). The number of oocytes per EC (15 vs 11 and 11, p &lt; 0.001), the total number of oocytes following batching cycles (20 vs 15 and 16, p &lt; 0.001) and the number of blastocysts biopsied (8 vs 4 and 5, p &lt; 0.001) were significantly higher for Group 3 vs Group 1 and Group 2, respectively. Group 1 embryos were less frequently of excellent and very good morphology and less frequently biopsied on day 5 vs 6.

Univariate analysis suggests Group 3 had statistically higher PR and LBR compared to Group 1, but similar miscarriage rate. However, when applying a multivariate logistic regression model, the LBR after first euploid FTET was independent of the number of euploid embryos available but was influenced by age at EC (p = 0.006) and biopsy day (Day 6 vs day 5, OR 0.53, 95% CI 0.33-0.85, p = 0.008).

Limitations, reasons for caution

The main limitation of this study is its retrospective nature performed in a single centre, and therefore vulnerable to bias and confounding factors that may have not been accounted for.

Wider implications of the findings

Our findings suggest that the success rate of the first euploid FTET does not depend on the number of euploid embryos but is influenced by the age at EC and the embryo stage at biopsy. This could be useful when counselling women with a low number of euploid embryos available.

Trial registration number

Not Applicable

Attitudes and Behaviors Regarding Smoking in Friends and Relatives of Patients in Emergency Room: A New Frontier in the Fight against Tobacco

BACKGROUND

Emergency rooms (ERs) are usually crowded with friends and relatives (F&Rs) of the patients. This experience may result in changes in smoking behaviors and create opportunities for smoking cessation interventions. The study aims to investigate these changes and offers a new frontier in the fight against smoking.

METHODS

This cross-sectional study was conducted in the ERs of two universities in different cities. A questionnaire consisting of 18 questions was applied to F&Rs of the emergency patients. Statistical analysis was performed using Jamovi program.

FINDINGS

A total of 603 respondents were included in the study. Of them, 71.3% were first-degree relatives, 51.7% waited 5 or more times in ER before, and 68.6% spent 0-2 hours in a day around the ER. Upon witnessing patients in the ERs, 53.4% of the F&Rs had the idea of quitting smoking and 42.9% wanted to have smoking cessation therapy during their wait in the hospital. While 76.1% of the participants were not using different brands of cigarettes when offered in normal life, this rate was lower around the ERs (64.6%) (P < 0.001). Participants smoked 0.82 ± 0.34 cigarette per hour in normal life excluding sleeping time; this number raised almost 6 folds during the wait (4.85 ± 2.11) (P < 0.001).

CONCLUSION

F&Rs smoked more during waiting around ERs. However, they also expressed desire to quit smoking and receive smoking cessation intervention during the wait. Providing smoking cessation counseling to F&Rs in the ER may be a valuable intervention.

Effect of Intraoperative Computed Tomography on Ventriculoperitoneal Shunt Survival

BACKGROUND

In patients with hydrocephalus who undergo ventriculoperitoneal shunt placement, the ventricular catheter tip position is one of the most important prognostic factors influencing shunt survival. The aim of this study was to present our findings of ventriculoperitoneal shunt placement performed with intraoperative computed tomography (CT) and to evaluate the effect of intraoperative CT-based image guidance on optimal catheter positioning and overall shunt survival.

METHODS

Of the study enrolled 345 patients with hydrocephalus who underwent ventriculoperitoneal shunt placement for the first time between 2008 and 2018. Ventricular catheters were inserted freehand via the Kocher point into the lateral ventricle in all patients. In 163 patients, intraoperative CT was performed to confirm the tip position. In this group of patients, if the tip position was nonoptimal, the catheter was ejected and reinserted during the surgery. In the remaining 182 patients, the tip position was assessed with routine postoperative CT. The effect of performing intraoperative CT on catheter tip positioning and shunt failure was investigated.

RESULTS

Nonoptimal tip position was significantly correlated with shunt dysfunction even when excluding nonobstructive causes (P < 0.001). In the intraoperative CT group, 11 ventricular catheters (6.7%) were intraoperatively repositioned. The repositioning significantly improved the optimal tip position rate from 54% to 58.3% (P = 0.007). Intraoperative CT usage also showed direct correlation with shunt survival (P = 0.006).

CONCLUSIONS

Intraoperative CT is an effective tool for increasing the rate of optimal tip positioning and thereby overall shunt survival.

Evaluation of painkillers according to the principles of rational drug use in patients registered to a family medicine unit

AIMS

We aimed to evaluate knowledge, attitudes and usage of the painkillers within the framework of rational drug use.

METHODS

This study was conducted in a family medicine unit with a questionnaire consists of 27 questions.

RESULTS

Total of 506 patients participated in the study. The number of people who used pain medication every day was 29 (5.7%) and paracetamol was the most common analgesic (51.1%). The use of painkillers was more common in women and amongst the patients over 65 years of age. The rate of those who preferred painkillers in the form of pills was higher in married patients and the singles preferred injectables (P = .004). Inappropriate use of painkillers was much more prominent in nonsteroidal antiinflammatory drug users (P < .05).

CONCLUSION

Demographic features and disease characteristics were the notable factors that affected painkillers selection and the level of knowledge about them.

Relation between index of cardioelectrophysiological balance and stroke severity in patients with acute ischemic stroke

Background

The index of cardioelectrophysiological balance (iCEB), measured as QT interval divided by QRS duration, has recently been defined as a new risk marker for arrhythmias. Increased or decreased iCEB is associated with malignant ventricular arrhythmias.

Aim

In this study, we aimed to investigate the relationship between iCEB and stroke severity in patients with acute ischemic stroke.

Methods

The study comprised 105 adult patients (males, 58; females, 47; 69 ± 15 years) with acute ischemic stroke. Nine patients were excluded. Patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale (NIHSS) score (Group 1, NIHSS score <16; Group 2, NIHSS score ≥16). Demographic, clinical, and laboratory data for all patients were collected. Electrocardiography (ECG) was recorded from all patients on admission to the neurology care unit. iCEB (QT/QRS) was calculated from the 12-lead electrocardiogram.

Results

There were no significant differences among the demographic parameters of patients. iCEB score was significantly higher in Group 2 patients than Group 1 patients (3.97 ± 0.61 vs 3.43 ± 0.57, P = 0.0024).

Conclusion

Our results suggested that iCEB is associated with stroke severity on admission in patients with acute ischemic stroke. It is known that high iCEB is associated with torsade de pointes (TdP), ventricular tachycardia.

Protective effects of caffeic acid phenethyl ester and thymoquinone on toluene induced liver toxicity

Toluene is an organic solvent that is toxic to humans. Caffeic acid phenethyl ester (CAPE) and thymoquinone (TQ) exhibit antioxidant and antitoxic effects. We investigated the protective effects of CAPE and TQ on toluene induced hepatotoxicity. Wistar albino rats were divided into seven groups of eight. The animals were injected intraperitoneally (i.p.) with 0.1 ml/10 g/day corn oil (control I), 0.1 ml/10 g/day corn oil + 2 ml/kg/day 10% ethanol (control II), 20 mg/kg/day TQ dissolved in 0.1 ml/10 g corn oil (TQ), 10 µmol/kg/day CAPE dissolved in 10% ethanol (CAPE), 500 mg/kg/day toluene (T), toluene and TQ together (T + TQ), or toluene and CAPE together (T + CAPE). All rats were sacrificed on day 15. Liver samples were obtained for histological analysis. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured to evaluate liver function. Liver sections from the control I and TQ groups exhibited normal histology. Sections from the T group exhibited sinusoid dilation, hemorrhage, vacuolization and necrosis. TQ and CAPE protected against toluene induced histopathological changes. AST and ALT levels were increased significantly in T group compared to both control groups. CAPE decreased significantly the toluene induced increase in AST and ALT levels, while TQ did not. CAPE and TQ exhibited some antitoxic and hepato-protective effects on toluene induced liver damage.

Time estimations by network of beta globin gene cluster haplotypes linked with Hb D-Los Angeles [β121 (GH4) Glu → Gln GAA → CAA] mutation in the world populations

Background

β‐Globin gene cluster haplotypes associated with the Hb D‐Los Angeles mutation have been reported in many different locations in different populations including Italy, Iran, Thailand, Belgium, Mexico, Holland, and Turkey. In this study, we have identified genetic relationships and formation periods between the haplotypes reported in the world regarding the Hb D‐Los Angeles.

Methods

We comparatively analyzed the RFLP (restriction fragment length polymorphism) data in Denizli region and world populations using Arlequin 3.5 statistical software program. The data obtained from the Arlequin software were then entered into the Phylogenetic Network software to calculate the age estimates and to discover possible links between the haplotypes.

Results

We observed the frequencies of the β‐globin gene haplotypes for the seven polymorphic restriction sites around the world and calculated the estimated time of haplotypes using Network software on the basis of ancestral haplotypes. We performed the phylogenetic network analysis of the haplotypes linked with Hb D‐Los Angeles mutation by processing the data of frequency and age estimations with Network software.

Conclusion

Our period of time results suggests that HAP1 was formed before modern human migration to Asia and/or independent origin of the Hb D‐Los Angeles mutation from other populations. Considering that the population in Denizli region started the Hb D‐Los Angeles mutation past about 40,000 years ago, it can be said that HAP1, HAP15, and HAP21 belong to the gene pool with an external effect. Our period of time results of HAP6 is compatible with published dating results.

Palivizumab prophylaxis, respiratory syncytial virus and subsequent development of asthma

BACKGROUND

Respiratory syncytial virus (RSV) infection is a disease commonly encountered during childhood and it may relapse. An experience in the early childhood would induce asthma development in the future. Palivizumab has a proven efficacy for the RSV prophylaxis so it may prevent asthma. Our aim was to evaluate the possible protective effect of palivizumab on the development of asthma by using the modified Asthma Predictive Index (mAPI).

METHODS

This study's data consist of 339 children between 2 to 5 years of age followed up in healthy children unit from 2008 to 2011. Cases were evaluated in terms of wheezing frequency and characteristic features. Evaluations were performed among three groups; palivizumab-treated children born preterm (group 1), palivizumab-untreated children born preterm (group 2) and term newborn children (group 3) with equal number of patients in each group (N.=113).

RESULTS

Frequency of the answers about children's experienced wheezing times was significant between groups (P=0.003). A significant difference was found between the groups in terms of the clinician who diagnosed asthma (P=0.045). The groups were compared in terms of the mAPI positivity and a significant difference was found among the groups (P=0.001). Group 1 had lowest and group 3 had highest positivity. Group 1 and group 3 were different (P=0.000), group 2 was found higher than group 1, but was similar to group 3 (P=0.628).

CONCLUSIONS

This study supports the benefit of administration of palivizumab to premature children to reduce the risk of asthma development.

Diverticular disease and posture during defecation : a prospective comparative study

BACKGROUND AND STUDY AIMS

Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation.

PATIENTS AND METHODS

This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662).

RESULTS

The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis.

CONCLUSION

Sitting during defecation seems to increase the risk of CD.

The effects of chronic smoking on lung tissue and the role of alpha lipoic acid

We investigated the effects of alpha lipoic acid (ALA) on blood and lung tissue exposed chronically to cigarette smoke (CS). Female Sprague-Dawley rats were divided into three groups. Group 1 was the control group (CON): fresh air was supplied twice daily and 0.1 ml physiological saline was given orally for 8 weeks. Group 2 was exposed to CS: 12 cigarettes were smoked daily at two sessions for 1 h and 0.1 ml saline was given orally for 8 weeks. Group 3 (CS + ALA) was exposed to 12 cigarettes daily in two sessions for 1 h and 100 mg/kg/day ALA was given orally for 8 weeks. DNA damage was assessed using comet analysis; oxidative damage was assessed using ischemia-modified albumin (IMA) from blood; and total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were measured in blood and lung tissue. Histopathological and immunohistochemical evaluation of hypoxia-inducible factor (HIF)-1α, and -2α, caspase-3, vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF₂) were conducted using lung tissue. The oxidative markers, TOS, OSI and IMA, and the comet analysis score were increased and the TAS level was decreased in the blood of the CS group compared to the CON group. IMA levels in blood, and TOS and OSI levels in the lung were decreased significantly in the CS + ALA group compared to the CS group. We observed increased septal wall thickness, marked and diffuse inflammatory reaction, emphysema, and necrotic cell debris in bronchial and bronchiolar lumens in the CS group. HIF-1α, HIF-2α, caspase-3 and FGF₂ expressions were increased, while VEGF expression decreased in the lung tissues of the CS group compared to the CON group. ALA slightly ameliorated the damage caused by chronic exposure to CS in the lungs, but further investigation is needed to determine its possible protective effects at different dosages.

Estimating the age of Hb G-Coushatta [β22(B4)Glu→Ala] mutation by haplotypes of β-globin gene cluster in Denizli, Turkey

BACKGROUND

Hb G-Coushatta variant was reported from various populations' parts of the world such as Thai, Korea, Algeria, Thailand, China, Japan and Turkey. In our study, we aimed to discuss the possible historical relationships of the Hb G-Coushatta mutation with the possible migration routes of the world. For this purpose, associated haplotypes were determined using polymorphic loci in the beta globin gene cluster of hemoglobin G-Coushatta and normal populations in Denizli, Turkey.

METHODS

We performed statistical analysis such as haplotype analysis, Hardy-Weinberg equilibrium, measurement of genetic diversity and population differentiation parameters, analysis of molecular variance using F-statistics, historical-demographic analyses, mismatch distribution analysis of both populations and applied the test statistics in Arlequin ver. 3.5 software program.

RESULTS

The diversity of haplotypes has been shown to indicate different genetic origins for two populations. However, AMOVA results, molecular diversity parameters and population demographic expansion times showed that the Hb G-Coushatta mutation develops on the normal population gene pool. Our estimated τ values showed the average time since the demographic expansion for normal and Hb G-Coushatta populations ranged from approximately 42,000 to 38,000 ybp, respectively.

CONCLUSION

Our data suggest that Hb G-Coushatta population originate in normal population in Denizli, Turkey. These results support the hypothesis that the multiple origin of Hb G-Coushatta and indicate that mutation may have been triggered the formation of new variants on beta globin haplotypes.

Author-based journal selection system that helps authors save time in article submission

Submission to journals takes a lot of time and format related submission requirements vary greatly from one journal to another. Lack of time and motivation in academia reduces scientific outputs and demotivates researchers. Author-based journal selection system (ABJSS) is a platform for pooling manuscripts conceived to minimize the time spent for manuscript submission and to increase scientific output. The system will provide two types of account: “Author” and “Journal Administrator”. Each account type will have its own abilities and permissions.

The ABJJS system is an ongoing project that will be designed in cooperation with IT experts and academicians and it will be presented to the scientific world as soon as it secures sufficient support.

Treatment of resistant idiopathic hiccups with pulse radio frequency on phrenic nerve and gabapentin: A case report

Hiccups affect life quality, career and family life when they become persistent. We present here a 54-year-old man who worked as a mason and a blacksmith with hiccups complaint for nearly one and a half years. In this period, he was admitted to emergency service ten times with fainting or almost fainting, cold sweating and hand stretching complaints. The patient expressed that he frequently threw up when he had hiccups and his social life was negatively affected. He reported that he was treated with baclofen, esomeprazole and hyoscine-n-butyl bromur without relief. He used escitalopram and chlorpromazine for a short time and quit because they negatively affected his sleeping. As he did not have any relief from medications, he refused any oral medical therapy including gabapentin and started to seek remedy from paramedical treatments resulted with no benefit. The patient was referred to algology department and an intervention on phrenic nerve with pulse radio frequency (8 minutes, 45 Volts, 20 milliseconds wavelength) was performed. Symptoms stopped immediately after the procedure but one week later, although the patient reported a significant decline in symptoms he still had hiccups. The patient was offered oral medical therapy again. With considerable relief from symptoms, the patient accepted oral therapy this time. Gabapentin 300 mg bid was prescribed. The symptoms were completely recovered and the patient reported no hiccups after 30 days of Gabapentin administration. Our case suggests that administration of gabapentin after pulsed radiofrequency might be effective for the treatment of persistent hiccups.

Carpal Tunnel Syndrome Surgery Anti-Adhesion Gel Is Effective?

PURPOSE OF THE STUDY The purpose of the current study is to assess the efficacy of anti-adhesion gel on the symptom severity and functional outcomes after mini incision open surgery for carpal tunnel syndrom (CTS). MATERIAL AND METHODS A total of 200 CTS patients (154 women, 46 men) were included in this study. Group I (n = 100; 78 women, 22 men) did not receive local administration of anti-adhesion gel, while anti-adhesion gel consisting of hyaluronic acid-carboxymethylcellulose (Seprafilm®, SanofiBiosurgery, Bridgewater, NJ, USA) was locally applied to patients in Group II (n = 100; 76 women, 24 men). All patients recruited in this study had received conservative treatment comprised of non-steroidal antiinflammatory drugs, steroid injection, replacement of vitamin B and stabilization with splints. Cases that did not benefit from these therapeutic options during one year were assigned as candidates for surgical treatment. RESULTS There was no significant difference between two groups in terms of mean age, gender distribution, preoperative and postoperative Boston questionnaire (BQ) scores, difference of BQ scores after the operation, and the presence of the disease on the left or right side. According to postoperative 1. Year results, there was no significant difference between two groups. CONCLUSIONS Results of the current study demonstrated that use of anti-adhesion gel during mini incision open surgery for CTS did not bring about significant advantages in terms of functional or symptomatic outcomes. Further, controlled trials on larger series are warranted to understand the beneficial effects of anti-adhesive materials during the surgical treatment of CTS. Key words: anti-adhesion gel, Boston questionnaire, carpal tunnel syndrome.

The Relation of Religious Attitudes and Behaviours with Depression in Boarding Quran Course Students

BACKGROUND

Boarding Quran courses are religious institutions where course attendees spend large part of the year. Depression is an ever-increasing health problem. So, it is worth to study on the effects of religion concept and religious belief and behaviours' that religion concept brings, on depression. The main purpose of this study, is to analyse the effect of religious attitudes and behaviours on depression in Quran course / hafiz students.

SUBJECTS AND METHODS

The study is a cross sectional, case-control survey research. Boarding Quran courses and high schools were visited in Samsun city. A total of 956 participants enrolled between June 2015 and December 2015 were included into study from Samsun city of Turkey. Volunteers, 13 years and over ones without any psychiatric disorders were included in the study. Religious attitude-behaviour inventory and Beck's depression inventory were used in the study.

RESULTS

Median point of case group attitude scale was 49, control group's was 57 and difference among both has a statistical meaning (p<0.001). Beck's depression score average of case group is 12.93±9.33, its control group's average is 13.74±11.14 and difference between them is not important. Median score of both groups are 11. When scores of attitude and depression scales compared with each other in terms of demographic parameters, there is a difference among group, gender, age and education parameters (p<0.001).

CONCLUSIONS

It was seen that religious attitudes and behaviours can be protective for boarding Quran course students but it cannot be enough by itself.

The IL-8 Gene Polymorphisms in Behçet's Disease Observed in Denizli Province of Turkey

Behçet's disease is a multisystemic inflammatory disorder as a triad of symptoms including recurrent oral and genital aphthous ulceration and uveitis with unknown pathogenesis. IL-8, a proinflammatory cytokine, has been found increased in the active stage of BD. DNA samples were obtained from 88 patients with BD and 112 healthy control subjects in Denizli province of Turkey. All genotyping experiments of SNPs in IL-8 gene were performed using polymerase chain reaction-restriction fragment polymorphism. We found that IL-8 -845 T > C and -738 T > A sites are non-polymorphic. There were no differences in the polymorphisms of IL-8 +396 G/T, +781 C/T, and +1633 C/T sites except IL-8 -251 T > A in between patients and healthy controls. Analysis of IL-8 polymorphisms indicates that the distribution of frequencies seems to be associated with -251 T > A and gender, -251 T > A and erythema nodosum, -251 T > A and ocular involvement, +781 C > T and erythema nodosum, +396 G > T and pathergy positivity, and +1633 C > T and papulopustular lesion. We demonstrated that the frequencies of IL-8 haplotypes were significantly different with BD patients than control group. We found that the distribution of IL-8 haplotypes was significantly different with genital ulcers, ocular involvement, positive pathergy test, erythema nodosum, papulopustular lesions, and arthritis with BD patients than healthy control individuals. Our study suggests that IL-8 gene polymorphisms may affect susceptibility to BD and increase the risk of developing disease. In order to confirm and assess the association of IL-8 and other cytokine gene polymorphisms in the pathophysiology of BD, large cohort studies are needed.

The Effect of the iNOS Inhibitor S-Methylisothiourea and Hyperbaric Oxygen Treatment on Radiation Colitis in Rats

INTRODUCTION

External radiotherapy is one of the main treatment modalities for a variety of malignancies. However, the lower gastrointestinal tract is sensitive to the ionizing radiation. Hyperbaric oxygen treatment (HOT) has been suggested as a viable treatment for refractory radiation colitis, but the effect of S-Methylisothiourea (SMT) in the radiation colitis have not reported. To investigate the effect of SMT, HOT and the combination of both in an acute radiation-induced enterocolitis model.

METHODS

Sixty Sprague-Dawley rats were divided randomly into five equal groups. A single dose of gamma irradiation (25 Gy) was administered through the colorectal region to anesthetized rats. In the control group, we applied 2 ml of saline solution intraperitoneally for five days. In the HOT group, 100-per-cent oxygen at 2.5 atm pressure was applied for five days. In the SMT group, 10 mg/kg/day of SMT was applied intraperitoneally for five days. In the HOT+SMT group, HOT and SMT were both applied in the same dosages as in the preceding two groups. At the end of five days, the rats were sacrificed and colon samples were collected for histological grading. Blood samples were collected to test for : tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), IL-1β, transforming growth factor-β (TGF-β) and intercellular adhesion molecule-1 (ICAM-1) mRNA.

RESULTS

The TNF-α, IL-1β, IL-10 and TGF-β levels were reduced by SMT, HOT and HOT+SMT applications (p < 0.05). However ICAM-1 mRNA levels were not significantly lower (p:0.19). The microscopic scores differed significantly between the SMT, HOT and HOT+SMT groups and the control group. There was significant improvement histologically, especially in the HOT+SMT group. When we compared the weight of the rats before and after the study, weight loss was significantly lower in the SMT, HOT and HOT+SMT groups compared with the control group (p < 0.05).

CONCLUSION

HOT and SMT together were significantly more effective in preventing weight loss and in reducing inflammation and the severity of colitis histology when compared with HOT and SMT separately.

Surgery for Pyogenic Brain Abscess over 30 Years: Evaluation of the Roles of Aspiration and Craniotomy

AIM

To evaluate the roles of craniotomy and aspiration in the treatment of pyogenic brain abscess throughout 30 years of computerized tomography.

MATERIAL AND METHODS

A retrospective study of 224 patients who were surgically treated at Istanbul Medical Faculty, Department of Neurosurgery between 1982 and 2012 was undertaken. The records were analyzed for demographic, clinical and radiological findings, surgical interventions (resection, free-hand aspiration and image-guided aspiration), data regarding abscesses (etiological factors, site, size, number, localization and identified microorganism), corticosteroid and antibiotic usage and complications, and the outcomes were reviewed.

RESULTS

The male-to-female ratio was 2.2, and the mean age was 26.2±1.25 years. The most common presenting symptom was headache (56.7%), followed by nausea and vomiting (28.5%). Otitis media and mastoiditis were the most common causes of abscess (41.9%), and 44 patients had multiple abscesses. Aerobic gram-positive microorganisms were the most frequently isolated pathogens in culture (51.5%). Primary surgical interventions were as follows: craniotomy and resection (38.8%), free-hand aspiration (49.1%) and image-guided aspiration (12.1%). The aspiration-to-resection ratio was 1.36 (64/47) in the first decade, 2.94 (50/17) in the second decade and 1 (23/23) in the last decade. Age, level of consciousness at the time of admission and potent corticosteroid usage were found to be significantly associated with mortality (p=0.001, p≤0.001 and p=0,038, respectively). The total morbidity and mortality ratios were 4.9% and 9.8%, respectively. Seizures were more common in patients of craniotomy group (p=0.023).

CONCLUSION

Treatment of pyogenic brain abscess remains challenging, despite advances in surgical and imaging technology, and craniotomy retains a significant role in surgical treatment.

The evaluation of Nesfatin-1 levels in patients with OSAS associated with metabolic syndrome

PURPOSE

The association of obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS) has been demonstrated in studies and in recent years; the effect of OSAS on insulin resistance independent of the level of obesity is being investigated. Nesfatin-1 is a newly defined 82 amino acid protein with a precursor molecule of NUCB2 (nucleobindin 2). Nesfatin-1 is not only essential in regulation of food ingestion but also important in regulation of some brain functions, autonomic regulation, stress, mental state, and paradoxical sleep. We aimed to evaluate the relationship between OSAS and MS and the MS dependent or independent effect of Nesfatin-1 on this relationship.

METHODS

Patients admitted with clinical signs of OSAS are included. Patients are divided into three groups based on Apnea-Hypopnea Index (AHI) on Polysomnography (PSG) as mild, moderate, and severe OSAS. A total of 59 patients were included the control patients. Several OSAS parameters and laboratory findings which are and are not MS dependent are compared. Nesfatin-1 levels are evaluated in all OSAS patients with and without MS.

RESULTS

There were significantly more males in all groups (p = 0.007). There was no significant difference between groups in terms of Nesfatin-1 levels. Nesfatin-1 levels were significantly lower in MS group compared to non-MS group (p = 0.021).

CONCLUSION

Nesfatin-1 which is known to play a role in the pathophysiology of insulin resistance can be a beneficial target in developing new therapeutic targets for treatment of patients with obesity without any toxic effects in the future.

Evaluation of inhibitory effects of benzothiazole and 3-amino-benzothiazolium derivatives on DNA topoisomerase II by molecular modeling studies

There has been considerable interest in DNA topoisomerases over the last decade, as they have been shown to be one of the major cellular targets in anticancer drug development. Previously we synthesized some benzothiazole derivatives and corresponding benzothiazolium forms, and tested their DNA inhibitory activity to develop novel antitumor agents. Among the 12 prepared compounds, compound BM3 (3-aminobenzothiazole-3-ium 4-methylbenzene sulfonate) exhibited extreme topoisomerase II inhibitory activity compared with the reference drug etoposide. We also tried to determine the DNA and enzyme binding abilities of BM3 and found that BM3 acted on topoisomerase II first at low doses, while it had also showed DNA minor groove binding properties at higher doses. In this study the interactions between DNA topoisomerase II and the compounds were examined in detail by molecular modelling studies such as molecular docking and pharmacophore analysis performed using Discovery Studio 3.5. As a result, it was found that benzothiazolium compounds exhibited a totally different mechanism than benzothiazoles by binding to the different amino acids at the active site of the protein molecule. 3-Aminobenzothiazoliums are worthy of carrying onto anticancer studies; BM3 especially would be a good anticancer candidate for preclinical studies.