Diagnostic yield of microarrays in individuals with non-syndromic developmental delay and intellectual disability

BACKGROUND

Intellectual disability (ID), or developmental delay (DD) when the individual is yet under 5 years of age, is evident before 18 years of age and is characterised by significant limitations in both intellectual functioning and adaptive behaviour. ID/DD may be clinically classified as syndromic or non-syndromic. Genomic copy number variations (CNVs) constitute a well-established aetiological subgroup of ID/DD. Overall diagnostic yield of microarrays is estimated at 10-25% for ID/DD, especially higher when particular clinical features that render the condition syndromic accompany.

METHODS

In this study, we aimed to investigate the diagnostic yield of microarrays in the subgroup of individuals with non-syndromic ID/DD (NSID/NSDD). A total of 302 NSID/NSDD individuals who have undergone microarray analysis between October 2013 and April 2020 were included. Accompanying clinical data, including head circumference, delayed developmental areas, seizures and behavioural problems were collected and analysed separately in NSID and NSDD subgroups.

RESULTS

The diagnostic yield of microarray analyses in NSID/NSDD was determined as 10.9% in NSID (10.7%) and in NSDD (11.1%). Presence of behavioural and epileptic problems did not contribute to the diagnostic yield. However, in the presence of macrocephaly, the contribution to diagnostic yield was statistically significant particularly in NSDD group. The most common pathogenic CNVs involved chromosomes 16, 15 and X. Lastly, we propose a Xq21.32q22.1 deletion as likely pathogenic in a child with isolated language delay and accompanying seizures.

CONCLUSIONS

Particularly in neurodevelopmental diseases, microarrays are useful for establishing the diagnosis and detecting novel susceptibility regions. Future studies would accurately classify the herein presented variants of uncertain significance CNVs as pathogenic or benign.

Relationship between First Values of Red Cell Distribution Width, Mean Platelet Volume, Platelet Distribution Width, and Hospital Mortality in Acute Deep Venous Thrombosis

OBJECTIVE

To determine the relationship between red cell distribution width (RDW), mean platelet volume (MPV), platelet distribution width (PDW) values and mortality in acute deep vein thrombosis (DVT).

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Canakkale Onsekiz Mart University Health Practice and Research Hospital, Turkey, from 2015 to 2020.

METHODOLOGY

Hospitalised cases of acute DVT were detected. Discharged patients (externe group -EG), mortal course (mortality group - MG) and control group ( healthy persons without thrombosis - CG) were formed. Statistical significance of the first values of RDW, MPV and PDW between groups was evaluated. In addition, the difference between the groups was evaluated according to the age, gender, platelet count, and level of the thrombosis (proximal, distal).

RESULTS

There was a significant increase in RDW values between CG and EG (13.63 ± 1.37 vs. 15.97 ± 3.20; p=0.012), CG and MG (13.63 ± 1.37 vs. 17.85 ± 3.73; p=0.003). There was a significant increase in PDW values between CG and MG (16.78 ± 0.41 vs. 18.05 ± 1.07; p<0.001) and between EG and MG (16.98 ± 0.51 vs. 18.05 ± 1.07; p<0.001). There was no significant difference in other variables.

CONCLUSION

The results show that increased RDW values may be associated with deep venous thrombosis; and increased PDW values may be associated with mortality. Following RDW and PDW values, which are fast, inexpensive and widely available, can be useful as an early predictor of thrombosis and poor prognosis. Key Words: Red cell distribution width, Mean platelet volume, Platelet distribution width, Deep venous thrombosis, Predictor, Mortality, Poor prognosis.

Efficiency of using a neurofeedback device in determining ischaemic early electroencephalography indicators in rabbits with acute brain ischaemia

OBJECTIVES

Continuous electroencephalography (EEG) monitoring is a useful method in surgical procedures in which brain circulation is at risk. Providing this function using neurofeedback devices reduced to small dimensions may provide ease of use in the early diagnosis of brain ischaemia. The goal of this study was to demonstrate the efficiency of using a neurofeedback device in determining the early EEG indicators of ischaemia in a rabbit model of acute brain ischaemia.

METHODS

Three randomized groups-carotid ischaemia (CI), global ischaemia (GI) and a sham group-each comprising 8 rabbits, were created. In the CI group, the bilateral main carotid artery was clamped; in the GI group, the bilateral subclavian and main carotid arteries were clamped and brain ischaemia was created for 15 min. Brain reperfusion was then achieved for 30 min. In the sham group, the same surgical preparation was performed but no ischaemia occurred. The brain EEG wave activities of all subjects were recorded during the experiment. At the end of the procedure, all brain tissue was removed and apoptotic indexes were determined by histopathological examination. The statistical significance of the histopathological results and the EEG wave activities among the groups was examined.

RESULTS

There was a significant difference between the sham, CI and GI average amplitude ratios, delta (1.02, 0.69, 0.16; P < 0.001) and total wave (0.99, 0.78, 0.49; P < 0.001), respectively. There was no significant difference between the sham and CI groups in delta (sham, CI, 1.01, 0.87; P = 0.1), total wave (sham, CI, 1.22, 0.98; P = 0.2) and amplitude standard deviation rates. However, there was a significant difference in the GI group (P < 0.001). There was a significant difference between all groups in apoptotic index (sham, 17.88; CI, 40.75; GI, 55.88; P < 0.001).

CONCLUSIONS

Significant EEG wave changes resulting from experimental brain ischaemia were analysed with the use of a neurofeedback device. The results indicated that the change in the delta and the total wave standard deviations may be an additional indicator in the formation of permanent brain damage.

Effectiveness of Brain Protection With Histidine-Tryptophan-Ketoglutarate Solutions

BACKGROUND

Tissue-protective solutions increase resistance of cells to ischemic conditions. Especially in carotid and aortic arch surgeries where the brain perfusion is at risk, these solutions may be beneficial to prevent ischemic brain damage. This study was designed to demonstrate the effectiveness of histidine-tryptophan-ketoglutarate (HTK) solution in increasing resistance of brain tissue to ischemic conditions.

METHODS

Three separate randomized groups were created, each consisting of eight rabbits. The groups were called the ischemia, HTK and sham groups, respectively. In the ischemia group, temporary brain ischemia was created for 15 minutes by placing clamps on the bilateral subclavian and common carotid arteries. Then the clamps were removed, and the brain was reperfused for 30 minutes. In the HTK group, HTK solution was sent to the brain through the internal carotid artery before the same ischemia-reperfusion protocol was applied. Histopathological analyses using a visual scoring system to assess the degree of ischemic changes and the apoptotic cell index by TUNEL test were performed in all brain tissue samples.

RESULTS

Apoptotic cell indices of the HTK (20.6%) and sham (17.8%) groups were lower than the ischemia group (56.8%) (P < .05). Statistically significant differences were detected between all groups in categorical scores (P < .05).

CONCLUSIONS

It was shown that less ischemic damage occurs in the brain tissue with the use of HTK solution, and it may be a candidate approach to prevent the brain from ischemic insults during cerebrovascular surgery. Further studies are required to demonstrate its exact effectiveness, in terms of dose, duration, and temperature.

Histopathological changes in myocardial tissue due to coronary venous hypertension

Introduction

In chronic venous insufficiency (CVI), an increase in venous pressure causes the passage of intravascular blood cells and molecules into the surrounding tissues and induces histopathological changes in the lower extremities, leading to increased pigmentation in the legs, ulceration, and tissue loss to various degrees. This study aimed to investigate whether an increase in venous pressure in the coronary veins can lead to the aforementioned histopathological changes.

Material and methods

Twenty-four New Zealand rabbits were divided into the following three groups: experimental model of coronary venous hypertension (CVH) (n = 8), sham group (n = 8), and control group (n = 8). After 21 days postoperatively, tissue samples from each group were compared for perivascular inflammation, erythrocyte extravasation, macrophage infiltration, and hemosiderin deposits by histopathological scoring under a light microscope. Matrix metalloproteinase-2 (MMP-2) activation was evaluated using immunohistochemical staining.

Results

In the CVH group, hemosiderin accumulation was significantly higher than in the sham and control groups (1.0 (1.0-3.0), 0.0 (0.0-1.0), 0.0 (0.0-0.0); p < 0.001). Immunohistochemically, in the CVH group, MMP-2 levels were significantly higher than in the sham and control groups (2.0 (1.0-3.0), 0.0 (0.0-1.0), 0.0 (0.0-0.0); p < 0.001).

Conclusions

This experimental study showed for the first time the histopathological and immunohistochemical changes in myocardial tissue, similar to those observed in CVI, as a result of increased coronary venous pressure due to coronary vein ligation. Further studies are needed to understand the clinical implications of these results.

Comparison between electronic method and conventional method recording and follow-up of general surgery ward-round notes taken

AIM

Patient anamneses and ward-rounds notes taken are two key elements which have been and will be used to ensure accurate and reliable sustainability at surgery services. In this study, we aimed to find a new method which is capable of better addressing the needs in this process, simplifying it and also saving time. We also targeted to compare this new method used by us with the method, also known as conventional method, having been used for years.

METHODS

Thirty patients were included in the study. The prehospitalization anamneses of the patients were taken using the two methods and the durations were recorded separately for the two methods. Thereafter, the patients were visited by two methods in the morning on each day of their stay. The durations were recorded daily and separately for the two methods. The durations were statistically evaluated separately for the anamneses and ward-round notes taken.

RESULTS

Evaluations showed that the method using hand terminal (1.2250 minutes) is more advantageous in terms of duration in recording ward-round scores than the conventional method (1.3853 minutes). It was founded that in regard to the duration, the average duration of manual anamnesis taking (16.3350 minutes) is higher than that of taking anamnesis by means of hand terminal (15.4733 minutes). Furthermore, it was also seen that the use of this new technique eliminated the problems previously experienced in data transfer, access to historical data etc.

CONCLUSION

In conclusion, this method that is tested by use of hand terminal is more advantageous than the conventional method in terms of time saving and accurate data transfer. It is our opinion that it will provide advantages in many more aspects if it is worked on.

Ventilator-associated pneumonia in patients using HME filters and heated humidifiers

BACKGROUND

Ventilator-associated pneumonia (VAP) is a clinical form of hospital-associated pneumonia, which may develop within 48 h in patients on mechanical ventilation who had no pre-existing pneumonia at the time of intubation.

OBJECTIVE

The objective of this study was to compare the incidence of VAP among patients who started receiving treatment with heat and moisture exchanger (HME) filters and heated humidifiers (HHs) for mechanical ventilation.

METHODS

Patients who were on the first day of intubation, did not have pre-intubation pneumonia, presented to the healthcare centre with no infections at the time of presentation, were not on antibiotic treatment for pulmonary infections and did not have evidence of infiltration with chest radiography were included in the study. Data were evaluated using Fischer's exact, Mann-Whitney's U and t tests.

RESULTS

The patients in the HME filter and HHs groups had a mean age of 47.9 ± 2.2 and 44.5 ± 2.1 years, respectively. Infiltration on chest radiography was identified on day 6.33 for the patients in the HME filter group and on day 5.8 in the HHs group. Patients using HME filters and HHs did not differ significantly with regard to the day of mechanical ventilation and number of days hospitalized (p > 0.5). Comparison of the two groups with regard to presence of fever during the first 24 h, however, demonstrated higher than expected values for the patients using HHs, with a significant difference (p = 0.001).

CONCLUSION

There were no significant differences between the groups on HME filters and heated humidifiers in terms of infection development; although pulmonary radiography showed delayed average days to infiltration development for subjects using HME filters.

A case of congenital warfarin syndrome due to maternal drug administration during the pregnancy

Warfarin, which is used for anticoagulant therapy, rarely produces congenital warfarin syndrome characterized with hypoplastic nose, stippled epiphyses, and skeletal abnormalities when ingested during pregnancy. Here, we present a male infant, whose mother was treated with warfarin because of a prosthetic heart valve replacement after rheumatic heart disease, with signs of warfarin embryopathy. The mother's first pregnancy at 12 weeks gestation resulted in abortus due to warfarin toxicity. Subsequently, she delivered two healthy girls after her treatment had changed to low molecular heparin during pregnancy periods. We want to emphasize that risk-benefit ratio should be well weighed by both obstetricians and cardiologists when considering warfarin therapy for a woman at childbearing age.

[Abdominal gunshot wounds: retrospective analysis of 164 patients]

The medical reports of 164 patients who were operated for abdominal gunshot wounds at Sirnak Military hospital were reviewed retrospectively. One hundred and twenty-nine patients had isolated abdominal injury whereas, 28 had associated thoracic injuries. Seven of these laparotomies revealed no intraperitoneal injury and were considered as non-therapeutic laparotomy. The time for transportation to the emergency department were less than 2 hours in 69% of the patients. The most commonly injured organs were the small bowel in 67, the colon in 63 and the liver in 49 patients. Postoperative complications occurred in 34 patients (20.7%) and mortality rate was 6% (10 patients). In spite of the developing technology and operative techniques, gunshot wounds are still very important with high morbidity and mortality rates.

[Injuries of the extremities caused by high energy gunshots and land-mines]

Hospital records of patients who had extremity injuries caused by high energy gunshots and and land-mines and treated in Sirnak Military Hospital between January 1997 and July 1999 were reviewed retrospectively. Among 236 cases 147 (62.3%) had lower extremity wounds and 89 (37.7%) had upper extremity wounds. The most frequently injured part was hands for the upper extremity and feet for the lower extremity. The most dramatic wounds were caused by stepping on anti personnel mines trapped with anti tank mines. The localization and the extension of the wounds varies with type and power of the gun, the position of the victim at the time of explosion and the distance between the victim and the gun.

Ultrasonographic appearance of non-Hodgkin's lymphoma in a pregnant woman

Non-Hodgkin's lymphoma during pregnancy is rare. We report a case of non-Hodgkin's lymphoma detected in a pregnant women. She was initially diagnosed as having an ovarian tumor by ultrasonography, but definitive diagnosis was made at the time of cesarean section. After delivery she took combined chemotherapy for 7 cycles and is in complete remission over 1 year.

Tubal histopathology in ectopic pregnancies

A histopathologic study in eighty six patients with ectopic pregnancy and in eighty six control patients was undertaken to evaluate the association between ectopic pregnancy and tubal pathology in our population. Fifty six (65%) and nine (10.4%) cases with chronic salpingitis (CS) were diagnosed in the study group and in the control group, respectively. This difference was statistically significant (p < 0.001). Twelve of 56 cases with chronic salpingitis were salpingitis isthmica nodosa (SIN) and no patient with SIN was observed in the control group. SIN was always concomittant with chronic salpingitis in our study. Based on these findings, we concluded that chronic salpingitis and SIN have an important role in the etiology of ectopic pregnancy in our population and SIN is significantly associated with chronic salpingitis.

The hormonal profile in ectopic pregnancies

The hormonal profile in a patient with an ectopic pregnancy (EP) differs in many respects from that of a patient with a normal intrauterine pregnancy (IUP). Although there are several reports using different hormones for early diagnosis of ectopic pregnancy most of the results are contradictory. In this study, therefore, we prospectively investigated the maternal serum level of beta-human chorionic gonadotropin (beta-hCG), progesterone (P), estradiol (E2), human placental lactogen (HPL), alfafetoprotein (AFP) and cancer antigen 125 (CA 125) during the first trimester of normal and abnormal pregnancies. Serum samples were obtained from 20 women with normal IUPs, 15 women whose pregnancies complicated with spontaneous abortion and 31 women with surgically and pathologically confirmed EPs. The mean serum levels of beta-hCG, E2 and p in patients with EPs (9490.55 +/- 3071.2 mlU/ml, 100.1 +/- 22.09 pg/ml, 4.18 +/- 1.19 ng/ml, respectively) were significantly lower than those measured in normal IUPs (73796.8 +/- 15554.7 mlU/ml, 500.15 +/- 98.84 pg/ml, 19.2 +/- 2.8 ng/ml, respectively p < 0.001) and significantly lower than in patients with spontaneous abortion (22524 +/- 6213 mlU/ml, p < 0.05, 339.8 +/- 112.16 pg/ml, p < 0.01, 10.59 +/- 3.03 ng/ml, p < 0.05 respectively). No significant difference was recorded with respect to serum levels of HPL, AFP and CA 125 among the groups. We also investigated the diagnostic value of simple E2 and P in patients with EPs. We could not identify a discriminatory cutoff value because there was a considerable overlap in serum P and E2 levels between the patients with IUPs and EPs.(ABSTRACT TRUNCATED AT 250 WORDS)