Attitude towards seeking psychological help regarding psychiatric symptoms and stigma in patients with fibromyalgia

OBJECTIVE

The current study aimed to examine the psychiatric symptoms that can be seen in fibromyalgia (FM) patients, their attitudes toward seeking psychological help, and their concerns about stigma. Besides, it was investigated whether the stigma concerns that they may experience about receiving psychiatric treatment constitute an obstacle for patients to receive psychiatric treatment.

SUBJECTS AND METHODS

This cross-sectional descriptive study was conducted between February and July 2020. Various seeking help were measured with Attitude Towards Seeking Psychological Help Scale-Short Form (ATSPPH-SF), Self-Stigma in the Process of Seeking Psychological Help Scale (SSPSPHS), Intention to Seek Psychological Help Inventory (ISPHI), and Social Stigma Due to Seeking Psychological Help Scale (SSDSPHS). FM symptoms of patients were measured with The Symptom Screening Questionnaire, Revised 90 Items (SCL-90-R). Quality-of-life parameters were measured with Fibromyalgia Impact Questionnaire (FIQ).

RESULTS

Fibromyalgia patients had higher somatization (p=0.001), psychotism (p=0.045) and phobic anxiety (p=0.015) scores than controls. The ATSPPH-SF (p=0.002) and SSPSPHS (p=0.043) scale scores of the FM patients were higher than the controls. There was a significant positive correlation between FIQ and SSPSPHS (r=0.288, p=0.043) and SCL-90 overall (r=0.602, p<0.001) and all subscales scores. Patients with high active psychotic symptom levels had higher FM exposure scale scores and SCL-90 overall scores than those with low active psychotic symptom levels (p<0.001).

CONCLUSIONS

The findings of this study showed that fibromyalgia patients have more somatization symptoms than healthy individuals, and as psychiatric symptoms increase in these individuals, their level of being affected by FM increases.

Brain abscess incidence and microbial etiology in Turkey: a nationwide cross-sectional study

OBJECTIVE

Brain abscess, a localized purulent central nervous system infection, arises from a variety of microorganisms. Expedited diagnosis and formulation of effective treatment strategies are crucial for mitigating mortality risks in patients with brain abscesses. A nuanced understanding of potential microbial agents is pivotal for the development of empirical antibiotic therapies. This study aimed to explore the incidence and microbial etiology of brain abscesses.

PATIENTS AND METHODS

This study is a nationwide cross-sectional analysis of patients diagnosed with brain abscesses in Turkey, employing the ICD 10 diagnosis code from January 1, 2015, to December 31, 2021. Data pertaining to age, sex, comorbidities, and microorganisms isolated from central nervous system samples were meticulously recorded and analyzed.

RESULTS

This study included 11,536 patients diagnosed with brain abscesses. The incidence fluctuated between 0.98 and 3.68 during the review decrease post-2017, with a notable increase in male patients during time. Diabetes constituted 56.5% of the patients. The predominant isolated pathogens were Staphylococcus (37.6%), Streptococci (13.3%), and Klebsiella spp. (7.8%), Escherichia coli (6.4%), and Candida species (6.1%).

CONCLUSIONS

The incidence of brain abscesses is decreasing in Turkey. Although staphylococci remain the most isolated agents, the frequent occurrence of Gram-negative bacteria and Candida species warrants consideration during empirical antibiotic selection.

Effect of the Presence of Silicone Oil in the Anterior Chamber After Complicated Retinal Detachment Surgery on Corneal Morphology by In Vivo Confocal Microscopy

PURPOSE

This study evaluated the corneal endothelium, stromal keratocytes, subbasal nerve number and density in patients with silicone oil transferred to the anterior camera after pseudophakic complicated retinal detachment surgery by in vivo laser scanning confocal microscopy (IVLSCM).

METHODS

Sequential measurements were made by IVLSCM between 3-6 months after surgery in two groups of patients: a) with silicon oil migration (Group 1) and without silicone oil migration (Group 2).

RESULTS

A total of 63 cases (Group 1: 32 and Group 2: 31) were examined. The mean ages of patients were 65 ± 12 and 61 ± 11 and M/F ratio was 18/14 and 17/14, respectively. Mean intraocular pressures were 16.60 ± 4.60 and 15.75 ± 5.70 mm Hg, respectively. Changes were detected by IVLSCM mostly on the superior part of the cornea. A significant decrease in endothelial cell density and the number was detected in group 1 (2072 ± 116.2 cells/mm2 vs 2752 ± 512.3 cells/mm2; p < 0.001). Significant increases in posterior keratocyte density and stromal hyperreflective deposits were observed in group 1 (887 ± 45.8 cells/mm2 vs 725 ± 65.8 cells/mm2; p < 0.001). A significant negative correlation was observed between the size of stromal deposits and endothelial cell density (r=-0.758; p < 0.001). The number and density of corneal subbasal nerves were significantly lower in group 1 (1.8 ± 0.8 and 4.8 ± 1.2 vs 420 ± 101 and 701 ± 112 µm/square; p < 0.001).

CONCLUSION

IVLSCM is a useful tool for the early detection of corneal abnormalities caused by silicone oil injection. This study verified silicone oil's detrimental effect on the corneal endothelium and revealed stromal changes in the anterior chamber, which we believe can be also been associated with the presence of silicone oil.

Using Alprazolam before phacoemulsification cataract surgery reduces complications and duration of the surgery

PURPOSE

To evaluate the effect of preoperative Alprazolam on complications of phacoemulsification cataract surgery, duration of surgery and early reoperation rate.

METHODS

Records of 1026 eyes of 1026 consecutive patients underwent phacoemulsification with topical and intracameral anesthesia between 2016 and 2020 years were retrospectively reviewed. Patients were divided into two groups, with or without using Alprazolam before surgery. Patients with planned first-time surgery for senile cataract and at least three months follow-up postoperatively were included. Those who had pseudoexfoliation, small pupil, zonular weakness, corneal and hearing problem as well as traumatic, brown, mature, hypermature, and posterior polar cataracts were excluded. Main outcome measures were duration of surgery, posterior capsule rupture, rapid posterior capsule opacification (PCO) formation requiring the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser and reoperation rate in early postoperative periods.

RESULTS

Alprazolam and control groups included 490 and 536 eyes, respectively. Mean surgical time was shorter in Alprazolam group (10.2 ± 3 versus 12.2 ± 4 min; < 0.001). Rate of posterior capsule rupture was higher in control group (4 versus 15 eyes; = 0.02). Four eyes (0.8%) in control group underwent unplanned secondary surgical procedures in early postoperative period (P = 0.126). Rate of rapid PCO formation was higher in control group (1 versus 9 eyes; = 0.027).

CONCLUSIONS

Using Alprazolam before phacoemulsification can lead to less posterior capsule rupture, short operation time and prevent repetitive surgery. It also reduces rapid PCO formation and, thus, early Nd:YAG laser intervention due to better cleaning the posterior capsule during surgery. We conclude that Alprazolam not only reduces intraoperative complications, but also facilitates their management.

The clinicopathological features and survival of Castleman disease: a multicenter Turkish study

OBJECTIVE

In this study, we aimed to investigate the clinicopathological features and survival of CD, which is quite rare and has many unknowns.

PATIENTS AND METHODS

This study was conducted by retrospectively evaluating patients diagnosed with CD in six different centers in Turkey.

RESULTS

The median age of 33 patients included in the study was 49 and 51.5% (n = 17) of these patients were women. 18 (54.5%) patients were in the hyaline vascular subtype and most of the patients were UCD (n = 20, 60.6%). The most common involvement region was head and neck (n = 19, 57.5%). The UCD group was younger than the MCD group (p=0.027). Visceral lymph node involvement was higher in MCD than in UCD (p=0.001). Similarly, it was observed that there was more hepatomegaly (p=0.035) and splenomegaly (p=0.013) in the MCD group. During the median 19.5 months follow-up period, there were no patients who died.

CONCLUSIONS

It was observed that UCD and MCD are different clinical entities. Promising survival times can be achieved with surgical and systemic treatments in both subtypes of this extremely rare disease. However, this result should be supported by well-designed prospective comprehensive studies.

Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients

BACKGROUND

Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce.

AIM

To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP.

METHODS

We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey.

RESULTS

In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001).

CONCLUSION

Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.

Evaluation of oxidative stress in patients with recalcitrant warts

BACKGROUND

Warts are benign conditions of the skin and mucosa caused by human papilloma viruses (HPV) that affect many people worldwide.

OBJECTIVE

The aim of this study was to evaluate OS by TOS/TAS, levels of 8-hydroxy-2-deoxyguanosine (8-OHdG) an indicator of DNA damage, and also protein oxidation levels by determining the dynamic serum thiol/disulphide homeostasis in patients with warts. We also aimed to investigate whether there is a relationship between thiol/disulphide homeostasis, recalcitrance of warts and DNA damage.

METHODS

Forty patients of age ≥18 years, having recalcitrant genital and/or non-genital warts that persisted for more than 2 years, 40 patients with warts that persisted for <2 years and 40 healthy controls were enrolled in the study. Blood TAS, TOS, OSI, 8-OHdG and dynamic thiol/disulphide homeostasis were evaluated.

RESULTS

Significant differences were detected between the groups in the levels of 8-OHdG, TOS, OSI, total thiol, native thiol, reduced thiol, as well as native thiol/total thiol ratio, disulphide/total thiol ratio and disulphide/native thiol ratio. Compared with the controls, patients with recalcitrant warts had significantly higher levels of 8-OHdG, TOS and OSI levels. Total thiol and native thiol levels were significantly lower in patients with recalcitrant warts compared with patients with warts that persisted for <2 years. Disulphide levels were significantly higher in the latter group of patients compared with patients with recalcitrant warts and controls. Native thiol/total thiol ratio was significantly higher in both patient groups compared with controls whereas disulphide/total thiol and disulphide/native thiol ratios were significantly lower in both patient groups than in controls.

CONCLUSION

Our findings suggest that impairment of thiol disulphide homeostasis in patients with recalcitrant warts may lead to increased OS and DNA damage. Thus, antioxidant administration with thiol containing proteins may help in the regression of warts and thereby prevent carcinogenesis.

A Novel Surgical Method to Treat Chronic Ocular Hypotony

BACKGROUND AND OBJECTIVES

To assess the effect of a novel surgical method for the treatment of chronic ocular hypotony (COH). The surgical method involves partially blocking the iridocorneal angle and decreasing aqueous humor outflow. A capsular tension ring (CTR) is placed in the iridocorneal angle.

PATIENTS AND METHODS

Thirteen eyes of 13 patients were included in this retrospective, interventional case series. All of the eyes had severe ocular hypotony with a diagnosis of hypotony after vitreoretinal surgery or glaucoma filtration surgery. A CTR was placed in the iridocorneal angle via a corneal incision. The follow-up period was at least 1 year. Main outcome measurement was intraocular pressure (IOP).

RESULTS

IOP increased in all of the eyes. The increase in IOP persisted during the follow-up period. Visual acuity increased or stabilized in all of the eyes. No ocular complications were noted due to the procedure.

CONCLUSIONS

The authors have described a novel and simple technique for the setting of IOP in COH. Mechanical obstruction of aqueous humor outflow with a CTR can increase IOP and stabilize or improve vision in eyes with COH for a follow-up time longer than 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e56-e60.].

Application of autologous serum eye drops after pterygium surgery: a prospective study

PURPOSE

The study aims to determine the effect of 50% autologous serum drops (ASD) on corneal healing and patient comfort following pterygium surgery.

METHODS

Fifty eyes of 50 patients who underwent pterygium excision combined with autologous conjunctival graft were included in this prospective randomized study: in 25 eyes, 50% ASD. In the remaining 25 eyes, conventional artificial tears (CAT) were applied postoperatively until corneal epithelium had completely epithelialized. Corneal epithelium healing speed, visual analog scale (VAS) for postoperative pain assessment, conjunctival inflammation, and recurrences were evaluated. Patients were followed up for 6 months.

RESULTS

Mean corneal epithelium closure time was 3.16 ± 0.37 days (range 3 and 4 days) in ASD group and 4.96 ± 0.84 days in CAT group (range 4 and 6 days), and the difference was statistically significant (p < 0.001). VAS scores were significantly lower in ASD group than CAT group in the first 5 days after surgery. In 9 of 50 eyes, moderate conjunctival inflammation continued 1 month: 4 (16%) in ASD group and 5 (20%) in CAT group (p = 0.713). In total, pterygium recurrence was seen in 5 (10%) eyes: 2 eyes (8%) in ASD group and 3 eyes (12%) in CAT group (p = 0.637).

CONCLUSION

ASD accelerated corneal epithelial healing following pterygium surgery. ASD group had lesser pain that was seem to be related with accelerated corneal epithelial healing.

Argon laser-assisted hypotony model in the rabbit

To investigate whether ocular hypotony formation with 360 degrees endocyclophotocoagulation is possible. Twelve male New Zealand White rabbits were used. Entire ciliary body epithelium was destructed with green laser photocoagulation after pars plana lensectomy and anterior vitrectomy in six rabbits. Endocyclophotocoagulation was not performed to the remaining six rabbits (control group). Intraocular pressure (IOP) was measured preoperatively and followed up everyday in the first week and weekly until the end of month one. All of the rabbits were sacrificed and ciliary bodies were left for gross and light microscopic examination. Mean baseline IOPs were similar in laser and non-laser group (14.8 ± 1.4 (range 12.2-17.3) vs 14.4 ± 1.4 (range 12.2-15.9), p = 0.650). Mean IOP was 6.6 ± 0.45 mmHg (range 5.9-7.1) in the laser group and 11.5 ± 1.2 mmHg (range 10.2-13.4) in the non-laser group in postoperative day 1. IOP was below 4 mmHg in all eyes on the second day and after in laser group. In the macroscopic evaluation, the entire ciliary body had a white (loss of pigmentation) and atrophic appearance in all of the eyes in the laser-treated group compared to non-laser group. In the laser group, light microscopic examination demonstrated a severe 360 degrees disruption of ciliary processes. Ciliary processes were covered with fibrin exudation consisting of fibroblasts. There was a mild inflammation with disruption or atrophy of ciliary body epithelium with cystic vacuolar degeneration. Three hundred sixty degrees endocyclophotocoagulation yielded severe ciliary epithelium damage. IOP reduction started very early and continued in hypotonic levels during follow up period.

Is Cytomegalovirus Surveillance Necessary for Patients With Low Reactivation Risk in an Autologous Hematopoietic Cell Transplantation Setting?

BACKGROUND

In an autologous hematopoietic cell transplantation (AHCT) setting, routine cytomegalovirus (CMV) surveillance is not indicated except in high-risk situations. On the other hand, some studies reported increased CMV reactivation in AHCT setting as a result of incorporation of novel agents into treatment algorithms, such as bortezomib and rituximab. We retrospectively analyzed CMV reactivation and infection rates in patients with no high-risk features, who were treated with AHCT.

METHODS

During January 2010 to November 2015, all consecutive, CMV-seropositive patients were included. The viral copy numbers were measured twice a week from the start of the conditioning regimen until engraftment, once a week for the remaining time period until day 30 after AHCT and once weekly only for patients who had been diagnosed with CMV reactivation before and who developed primary/secondary engraftment failure during 31 to 60 days after AHCT.

RESULTS

One hundred one (61.6%) men and 63 (38.4%) women were included in the study. The median age of study cohort was 51 years (range, 16-71 years). The indications for AHCT were Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma in 44 (26.8%), 41 (25%), and 79 (48.2%) patients, respectively. CMV reactivation occurred in 60 (37%) patients, and 13 patients (8%) received pre-emptive ganciclovir treatment.

CONCLUSIONS

On the basis of our results, it might be stated that CMV surveillance may be recommended during 40 days after AHCT in countries with a high CMV prevalence, even in patients without high-risk features regarding reactivation. Additionally, the risky conditions necessitating CMV screening after AHCT must be re-defined in the era of novel agents.

Protective effect of thymoquinone against cyclophosphamide-induced genotoxic damage in human lymphocytes

OBJECTIVE

Protective effect of thymoquinone (TQ) against the cytotoxic and genotoxic effects of cyclophosphamide (CP) was assessed in human peripheral blood lymphocyte culture.

METHODS

Mitotic indices were determined as endpoints of cytotoxicity, while sister chromatid exchanges (SCE) served as endpoints of genotoxicity. Firstly, the genotoxic effect of 0.16 µg/ml of CP was tested and CP was detected as genotoxic. In the second set, CP group was treated with 20 µM and 40 µM TQ.

RESULTS

TQ reduced the SCE frequencies, suggesting its protective action on human lymphocytes in vitro against the CP induced genotoxic damage.

CONCLUSIONS

Our results suggest that TQ produces a protective mechanism against CP-induced genetic damage, and suggest a role of DNA strand breaks in the genotoxicity (Tab. 1, Fig. 1, Ref. 19).

Subcutaneous Adipose Tissue Type II Deiodinase Gene Expression Reduced in Obese Individuals with Metabolic Syndrome

The present study aimed to evaluate the role of subcutaneous adipose tissue (SAT) type II deiodinase enzyme gene (DIO2) expression in developing metabolic syndrome (MetS). A total of 51 obese patients with MetS and without MetS and 13 healthy subjects enrolled in the study. Body mass index (BMI), waist circumference (WC), waist-to-hip circumference ratio (WHR), hip circumference, and systolic (SBP) and diastolic blood pressures (DBP) of all subjects were recorded. Fasting plasma glucose (FPG), fasting plasma insulin, high density lipoprotein- cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), total cholesterol (TC) and triglyceride (TG) of all subjects were analyzed. Expression of the DIO2 gene in adipose tissue was determined by reverse transcription polymerase chain reaction (qRT-PCR). BMI, WC and WHR were not significantly difference between obese with and without MetS. SBP, DBP, FPG and TG were significantly higher in obese with MetS group than obese without MetS group. While the free triiodothyronine (T3) level was in the normal range in all group, it was significantly lower in the obese with MetS than both obese without MetS and control group. DIO2 expression was significantly lower in the obese with MetS group compared to the control. In correlation analysis, DIO2 expression was negatively correlated with DBP, TG and homeostasis model assessment of insulin resistance (HOMA-IR) levels and positively correlated with free T3. In conclusion, the reduction of SAT DIO2 expression is negatively correlated with DBP and TG levels that are associated with the MetS. This might have an effect on developing MetS. We believe that DIO2 gene may be an important molecular target for future studies in developing targeted treatment options for obese people with MetS.

Pediatric open-globe injuries: clinical characteristics and factors associated with poor visual and anatomical success

PURPOSE

We determine the clinical characteristics, visual and anatomical outcomes, and factors associated with poor visual outcome and anatomical success in pediatric open-globe injuries (OGI).

METHODS

The records of patients aged 17 years and younger who had undergone surgical intervention after OGI between January 2000 and June 2010 were reviewed retrospectively.

RESULTS

In total, 182 patients were enrolled in the study (70.9 % males, 29.1 % females; mean age: 8.6 ± 4.5 years [range 1-17 years]). Injuries occurred mostly at home (45.1 %). Objects most often causing the ocular trauma were sharp objects (74.1 %). Over one-third of the eyes (39.7 %) had final visual acuities of 20/200 or better. Anatomical success was achieved in 76.9 % of eyes. Time between primary globe repair and secondary surgical intervention was 61.4 ± 144 days. Visual outcomes were poor in eyes with initial visual acuity less than for counting fingers, retinal detachment, proliferative vitreoretinopathy, and endophthalmitis. Anatomical success rates were low with retinal detachment.

CONCLUSION

Visual outcomes seem to be poor in more than half of the patients despite advanced microsurgical techniques.

Surgical Treatment of Dysthyroid Optic Neuropathy: Long-Term Visual Outcomes with Comparison of 2-Wall versus 3-Wall Orbital Decompression

PURPOSE

To compare the long-term visual outcomes after 2-wall (medial-lateral) versus 3-wall (medial-lateral-inferior) orbital decompression combined with fat removal in patients with dysthyroid optic neuropathy (DON).

METHODS

Records of 68 eyes of 42 patients were retrospectively reviewed. Two-and 3-wall decompression was performed in 41 and 27 eyes, respectively. Transcaruncular approach was used for medial wall decompression. Lateral canthotomy combined with upper eyelid crease incision was used for lateral wall removal, and combined with transconjunctival lower eyelid incision if floor decompression performed. Outcome measures were visual acuity (VA), color vision, Hertel measures, visual field mean deviation (MD) and pattern standard deviation (PSD) Result: The mean follow-up time was 39.3 months (range, 12-72 months). All indicators of visual function significantly improved after 2-and 3-wall decompression. The improvement in VA and color vision was similar between groups. (logMAR VA: 2-wall: 0.52 ± 0.68 versus 3-wall: 0.71 ± 0.86, p = 0.335); (color vision on Ishihara plates: 2-wall: 10.1 ± 8.1 versus 3-wall: 11.6 ± 7.8, p = 0.447). The improvement in MD and PSD were higher after 3-wall decompression (MD: 2-wall: 10.0 ± 5.5 versus 3-wall: 14.3 ± 7.5 dB, p = 0.020); (PSD: 2-wall: 3.5 ± 1.9 versus 3-wall: 4.8 ± 3.0 dB, p = 0.045). Proptosis reduction was higher after 3-wall decompression (2-wall: 5.1 ± 1.3 versus 3-wall: 7.2 ± 1.9 mm, p = 0.0001). New onset diplopia was seen 20% and 28.5% of cases in 2-and 3-wall decompression, respectively. No adnexal/orbital complications were seen in 2-wall group, however orbital hematoma (1 case) and persisting eyelid edema (1 case) were encountered in 3-wall group.

CONCLUSION

Both 2-and 3-wall orbital decompressions are safe and effective for management of visual dysfunction in DON. Although 3-wall decompression provide better improvement in the parameters of visual field analysis and Hertel measures, new onset diplopia, adnexal/orbital complications are more common with this technique.

Associations of serum Magnesium levels with diabetes mellitus and diabetic complications

BACKGROUND

Magnesium (Mg) deficiency is a common problem in diabetic patients. Deficiency of Mg may increase the incidence of diabetes mellitus (DM) and occurrence of diabetic complications. In this study, our aim was to evaluate an association between serum Mg level,  glycemic regulation, and diabetic complications.

MATERIAL-METHODS

In this retrospective study 673 diabetic patients were evaluated. According to Mg levels, the patients were divided into two groups; as normomagnesemic patients and hypomagnesemic patients.

RESULTS

Among the patients, 57.8% were men and 42.2% were women. Mean age was 55.6 years and the mean duration of diabetes was 81 ± 86.9 months. The mean glycosylated hemoglobin (HbA1c) was 9.0 ±2.4 % (4.5-18); mean magnesium level was 1.97 ± 0.25 (1.13 to 3.0) mg / dl.  There were 55 patients (8.2%) with diabetic retinopathy and 95 patients (14.1%) with diabetic neuropathy. Five hundred patients (74.3%)  had normoalbuminuria; 133 patients (19. 8%) had microalbuminuria (MA) and 40 patients (5.9%) had overt proteinuria. One hundred and seventy one patients (25.4%) had HbA1c levels equal or below 7%; and 502 patients (74.6%) had HbA1c levels above 7%. There was no statistical difference in age or duration of diabetes between the groups formed according to Mg levels. Although there were no differences between the groups for retinopathy and neuropathy, MA was more common in hypomagnesemic patients (p =0.004). HbA1c levels did not differ between the groups (p =0.243). However there was a weak negative correlation between serum Mg and HbA1c levels (r =-0.110, p =0.004) and also between serum Mg and urine protein level  (r =-0.127, p =0.018).

CONCLUSION

Mg depletion is a common problem in patients with DM. It affects both glycemic regulation and the occurence of complications. Also, poor glycemic regulation affects serum Mg levels. Hippokratia 2015; 19 (2):153-157.

Trabeculectomy with large area mitomycin-C application as a first-line treatment in advanced glaucoma: retrospective review

AIM

To evaluate the outcomes of trabeculectomy with large area mitomycin-C (MMC) application as a first line treatment in advanced glaucoma.

METHODS

The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy (initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy (primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure (IOP) values, visual acuities, mean deviations, morphology and function of the blebs, necessity for anti-glaucomatous medications and surgical complications were reported.

RESULTS

There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg (27-68mmHg) and 29.0±4.4mmHg (21-41mmHg), respectively (P=0.001). Average preoperative mean deviations (MD) in Groups 1 and 2 were 17.4±2.8dB (13.3-23dB) and 17.9±2.4 dB (13.7-23.2dB), respectively (P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2 (P=0.005). No cystic bleb formation was observed in Group 1, whereas 4 patients from Group 2 (10.8 %) developed cystic bleb (P=0.040). No visually devastating complication has occurred in both Groups.

CONCLUSION

Initial trabeculectomy with large area MMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.

Is there any association between mild hypertension and hot flash experience among women?

OBJECTIVE

To determine the association between ambulatory blood pressure (ABP), heart rate, and hot flash (HF) experience among women.

MATERIALS AND METHODS

The authors recruited 110 women aged 22 to 65 years with mild essential hypertension or normotension confirmed by 24-hour ABP monitoring. None of the women had organ damage, inflammatory diseases, on estrogen replacement therapy or any other risk factors. Participants wore an ABP monitor that both records heart rate during 24 hours and noted their awake and sleep times. HF were assessed using an everyday complaint questionnaire that included symptoms associated with menopause. Each participant was asked whether or not she had experienced each symptom during the two weeks before the interview.

RESULTS

Fifty-five of the participants (45%) reported having had HF during the two weeks before they completed the questionnaire. The results show that the prevalence of essential hypertension (EH) in the group of women who had HF was significantly higher than the group of women that did not have HF (p = 0.035). The authors also found that hypertensive women had HF more often than normotensive women (p = 0.035), but other parameters including mean awake and sleep systolic BP values, mean awake and sleep diastolic BP values, heart rates, and nocturnal dipping of BP did not differ statistically among the group of women who had HF and the group of women who did not have HF (p > 0.05).

CONCLUSIONS

These data suggest that the prevalence of EH in the group of women who have HF is significantly higher than the group of women that does not have HF.

The role of bilirubin and its protective function against coronary heart disease

BACKGROUND

Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality both in industrialized and developing countries. Atherosclerosis is a chronic inflammatory disease of the arterial wall, which also involves deposition and peroxidation of lipids. Bilirubin, an important endogenous antioxidant, may limit lipid peroxidation and retard the progression of atherosclerosis. Previous studies have reported an inverse relationship between serum bilirubin levels and the risk of coronary artery disease (CAD). Taking into account that atherosclerosis is a complex process that is initiated and accelerated by diverse risk factors, we aimed to test the antiatherosclerotic effects of bilirubin in a population with multiple risk factors for CAD.

METHODS

The study included 221 patients who underwent coronary angiography owing to symptoms suggestive of ischemia and/or positive noninvasive stress test results. Of the patients, 76 had normal coronary angiograms and served as the control group. The remaining 145 patients with documented CAD and two or more cardiovascular risk factors constituted the study group. The study group (n=145) was further classified according to the Gensini score as follows: group 1 if Gensini score was 1-19 (minimal CAD, n=82), and group 2 if Gensini score was 20 or higher (significant CAD, n=63). Biochemical assessments including total and direct serum bilirubin levels were carried out using standard methods in automated systems.

RESULTS

All of the cardiovascular risk factors were found significantly more frequently in the study group (groups 1 and 2) than in the control group. Total and direct serum bilirubin levels did not differ significantly between the control group, group 1, and group 2. There was a moderate and significant positive correlation between direct bilirubin levels and the Gensini score (r = 0.158, p = 0.019). There was no significant correlation between total bilirubin levels and the Gensini score.

CONCLUSION

In conclusion, our findings suggest that in the presence of multiple risk factors, similar concentrations of serum bilirubin may not confer the same level of protection against CAD as in an individual with a more favorable risk profile. The relationship between direct bilirubin levels and the Gensini score is unlikely to be causative, given the established antiatherosclerotic effects of bilirubin.

Addition of vardenafil into storage solution protects the endothelium in a hypoxia-reoxygenation model

OBJECTIVE

Based upon the well known protective effect of intracellular cyclic guanosine monophosphate (cGMP) accumulation, we tested the hypothesis that storage solution enriched with optimal concentration of the phosphodiestherase-5 inhibitor vardenafil could provide better protection of vascular grafts against reperfusion injury after long-term cold ischaemic storage.

METHODS

Isolated thoracic aorta obtained from rats underwent 24-h cold ischaemic preservation in physiological saline or vardenafil (10(-11) M)-supplemented saline solution. Reperfusion injury was simulated by hypochlorite (200 μM) exposure for 30 minutes. Endothelium-dependent vasorelaxation was assessed, and histopathological and molecular-biological examination of the aortic tissue were performed.

RESULTS

Compared with the control group, the saline group showed significantly attenuated endothelium-dependent maximal relaxation (Rmax) to acetylcholine after hypoxia-reoxygenation, which was significantly improved by vardenafil supplementation (Rmax control: 98 ± 1%; saline: 48 ± 6%; vardenafil: 75 ± 4%; p < .05). Vardenafil treatment significantly reduced DNA strand breaks (control: 10.6 ± 6.2%; saline: 72.5 ± 4.0%; vardenafil: 14.2 ± 5.2%; p < .05) and increased cGMP score in the aortic wall (control: 8.2 ± 0.6; saline: 4.5 ± 0.3; vardenafil: 6.7 ± 0.6; p < .05).

CONCLUSIONS

Our results support the view that impairment of intracellular cGMP signalling plays a role in the pathogenesis of the endothelial dysfunction induced by cold storage warm reperfusion, which can be effectively reversed by pharmacological phosphodiesterase-5 inhibition.