Severe skin and soft tissue infection in cohort patients admitted in a teaching hospital in Belgium: identification of risk factors for surgery

BACKGROUND

Necrotizing soft tissue infections (NSTIs) are associated with significant mortality if not promptly diagnosed and surgically treated.

AIM

This study aims to compare patients with severe skin and soft tissue infection treated with or without a surgical intervention and to identify risk factors that can predict the need for early surgery.

METHODS

Demographics, clinical, laboratory, Risk Indicator for Necrotizing Fasciitis (LRINEC) and imaging results were retrospectively collected.

RESULTS

There were 91 non-NSTI (group 1), 26 NSTI who were operated (group 2) and eight suspected NSTI who were not operated (group 3). In the multivariate analysis, skin necrosis, tachycardia, CRP value and hyperglycemia were predictive for surgery. A performance analysis revealed AUC of 0.65 (95%CI: 0.52-0.78) as to the LRINEC score for the use of surgery. The AUC for a predictive model associating four variables (heart rate, skin necrosis, CRP and glycemia at admission) was 0.71 (95%CI: 0.59-0.84). In terms of outcome, the median length of stay (LOS) was statistically higher in group 2 vs. group 1 (seven days (5-15) vs. 34 days (20-42), p < .001) and in group 2 vs. group 3 (34 days (20-42) vs. 14 days (11-19), p = .005). The overall in-hospital mortality at 30 days was 3.2% and did not statistically differ between the three groups.

CONCLUSIONS

Although the LRINEC score performed well in predicting surgery, the AUC of a model combining four predictive variables (glycemia, skin necrosis, CRP and heart rate) was superior. Further research is needed to validate this model.

Pulmonary Physician Consultancy in Emergency Services in Turkiye (PuPCEST) - a cross-sectional multicenter study

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.

Implications of obstructive sleep apnea on reproductive health: a study on anti-Mullerian hormone levels

PURPOSE

This study aimed to explore the association between anti-mullerian hormone (AMH) levels and obstructive sleep apnea (OSA) severity.

METHODS

A cross-sectional design was employed to evaluate AMH levels in 68 premenopausal women diagnosed with OSA at Van Yüzüncü Yıl University Faculty of Medicine. OSA severity was scored according to the 2018 AASM guidelines using a 16-channel Embla device. AMH levels were measured from blood samples using a commercially available kit.

RESULTS

The study found that AMH levels in OSA patients were significantly lower than those in the healthy control group. A statistically significant negative correlation between AMH and AHI levels was observed. When stratified by OSA severity, the lowest AMH levels were found in the severe OSA group.

CONCLUSION

OSA may have potential endocrine implications, especially concerning reproductive health. Decreased AMH levels in OSA patients could indicate future risks of infertility or early menopause.

Trap-integrated fluorescence detection with silicon photomultipliers for sympathetic laser cooling in a cryogenic Penning trap

We present a fluorescence-detection system for laser-cooled 9Be+ ions based on silicon photomultipliers (SiPMs) operated at 4 K and integrated into our cryogenic 1.9 T multi-Penning-trap system. Our approach enables fluorescence detection in a hermetically sealed cryogenic Penning-trap chamber with limited optical access, where state-of-the-art detection using a telescope and photomultipliers at room temperature would be extremely difficult. We characterize the properties of the SiPM in a cryocooler at 4 K, where we measure a dark count rate below 1 s-1 and a detection efficiency of 2.5(3)%. We further discuss the design of our cryogenic fluorescence-detection trap and analyze the performance of our detection system by fluorescence spectroscopy of 9Be+ ion clouds during several runs of our sympathetic laser-cooling experiment.

The role of irisin in predicting obstructive sleep apnea severity among obese individuals: a comparative analysis

PURPOSE

This study aimed to investigate the predictive value of circulating irisin levels in discriminating the presence and severity of obstructive sleep apnea (OSA) in obese individuals.

METHODS

This study was conducted on obese volunteers with and without OSA. All volunteers underwent polysomnography. Blood samples were taken on the day of the test. In addition to routine biochemistry studies, irisin levels were determined by enzyme-linked immunosorbent measurement. ROC analysis was performed to determine the predictive value of irisin.

RESULTS

Of 100 volunteers, 75 had OSA and 25 did not. Irisin levels were significantly lower in the group with OSA than in the non-OSA group. The lowest irisin levels were determined in the group with severe OSA. Irisin levels showed high sensitivity and specificity in distinguishing between OSA and non-OSA groups. It had high sensitivity and specificity in differentiating severe OSA from other groups in subgroups, while it had low sensitivity and specificity in differentiating patients with mild and moderate OSA. In logistic regression analysis, a low irisin level was determined to be a risk factor for OSA independent of BMI.

CONCLUSION

This study indicated that irisin levels decrease in obese individuals with OSA, correlating with the severity of the condition. Additionally, irisin levels may act as an independent predictor for OSA. The predictive value of irisin in identifying severe OSA among obese patients suggests its potential as a promising biomarker.

BASE-STEP: A transportable antiproton reservoir for fundamental interaction studies

Currently, the world's only source of low-energy antiprotons is the AD/ELENA facility located at CERN. To date, all precision measurements on single antiprotons have been conducted at this facility and provide stringent tests of fundamental interactions and their symmetries. However, magnetic field fluctuations from the facility operation limit the precision of upcoming measurements. To overcome this limitation, we have designed the transportable antiproton trap system BASE-STEP to relocate antiprotons to laboratories with a calm magnetic environment. We anticipate that the transportable antiproton trap will facilitate enhanced tests of charge, parity, and time-reversal invariance with antiprotons and provide new experimental possibilities of using transported antiprotons and other accelerator-produced exotic ions. We present here the technical design of the transportable trap system. This includes the transportable superconducting magnet, the cryogenic inlay consisting of the trap stack and detection systems, and the differential pumping section to suppress the residual gas flow into the cryogenic trap chamber.

Ultra-thin polymer foil cryogenic window for antiproton deceleration and storage

We present the design and characterization of a cryogenic window based on an ultra-thin aluminized biaxially oriented polyethylene terephthalate foil at T < 10 K, which can withstand a pressure difference larger than 1 bar at a leak rate <1×10-9 mbar l/s. Its thickness of ∼1.7 μm makes it transparent to various types of particles over a broad energy range. To optimize the transfer of 100 keV antiprotons through the window, we tested the degrading properties of different aluminum coated polymer foils of thicknesses between 900 and 2160 nm, concluding that 1760 nm foil decelerates antiprotons to an average energy of 5 keV. We have also explicitly studied the permeation as a function of coating thickness and temperature and have performed extensive thermal and mechanical endurance and stress tests. Our final design integrated into the experiment has an effective open surface consisting of seven holes with a diameter of 1 mm and will transmit up to 2.5% of the injected 100 keV antiproton beam delivered by the Antiproton Decelerator and Extra Low ENergy Antiproton ring facility of CERN.

BASE-high-precision comparisons of the fundamental properties of protons and antiprotons

Abstract

The BASE collaboration at the antiproton decelerator/ELENA facility of CERN compares the fundamental properties of protons and antiprotons with ultra-high precision. Using advanced Penning trap systems, we have measured the proton and antiproton magnetic moments with fractional uncertainties of 300 parts in a trillion (p.p.t.) and 1.5 parts in a billion (p.p.b.), respectively. The combined measurements improve the resolution of the previous best test in that sector by more than a factor of 3000. Very recently, we have compared the antiproton/proton charge-to-mass ratios with a fractional precision of 16 p.p.t., which improved the previous best measurement by a factor of 4.3. These results allowed us also to perform a differential matter/antimatter clock comparison test to limits better than 3 %. Our measurements enable us to set limits on 22 coefficients of CPT- and Lorentz-violating standard model extensions (SME) and to search for potentially asymmetric interactions between antimatter and dark matter. In this article, we review some of the recent achievements and outline recent progress towards a planned improved measurement of the antiproton magnetic moment with an at least tenfold improved fractional accuracy.

Graphic Abstract

The Efficiency of Diffusion-weighted Magnetic Resonance Imaging in the Differentiation of Malign and Benign Cavitary Lung Lesions

PURPOSE

The present study investigates the diagnostic efficiency of apparent diffusion coefficient (ADC) values in differentiating between malignant and benign cavitary lesions on diffusion-weighted magnetic resonance imaging (DWI).

MATERIALS AND METHODS

This prospective study included 45 consecutive patients identified with a cavitary lung lesion with a wall thickness of ≥5 mm on thoracic computed tomography in our clinic between 2020 and 2022, and who underwent thoracic DWI within 1 week of their original computed tomography. ADC measurements were made on DWI by drawing a region of interest manually from the cavity wall, away from the lung parenchyma in the axial section where the lesion was best demonstrated. The patients were then classified into benign and malignant groups based on the pathology or clinico-radiologic follow-up.

RESULTS

The sample included 29 (64.4%) male and 16 (35.6%) female patients, with a mean age of 59.06±17.3 years. Included in the study were 1 patient with 3 and 3 patients with 2 cavitary lesions each, with a total for the sample of 50 cavitary lesions. There were 23 (46%) malignant and 27 (54%) benign cavitary lung lesions. The mean ADC value (×10 -3  mm 2 /s) of the malignant and benign cavitary lesions was 0.977±0.522 (0.511 to 2.872) and 1.383±0.370 (0.930 to 2.213), respectively. The findings were statistically significant using an independent samples t test ( P =0.002). The mean wall thickness of the malignant and benign lesions was 12.47±5.51 mm (5 to 25 mm) and 10.11±4.65 mm (5 to 22 mm), respectively. Although malignant cavities had a higher mean wall thickness than benign cavities, the difference was statistically insignificant ( P =0.104).

CONCLUSION

A significant difference was identified between the ADC values measured in DWI of the malignant and benign cavitary lung lesions. DWI, a noninvasive and rapid imaging method, can provide useful information for the differential diagnosis of cavitary lesions and can minimize unnecessary biopsies.

Blood Prestin Levels in COVID-19 Patients

BACKGROUND

Many studies have found that viral infections affect different tissues, including the inner ear. COVID-19, a viral infection, is a significant health problem worldwide. Prestin is a motor protein with important functions both in the outer hair cells of the inner ear and in cardiac tissue. In addition, prestin is promising as an early biomarker in the detection of ototoxicity. To determine the severity of infection in COVID-19 patients and to determine whether other tissues are affected by the infection, lactate dehydrogenase (LDH), C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase MB (CK-MB), Biochemical markers such as ferritin and D-dimer are used. This study aimed to compare prestin levels in patients with COVID-19 and healthy volunteers.

METHODS

In blood samples taken from 45 patients diagnosed with COVID-19 and 40 healthy volunteers, prestin levels were determined with the kit that used an enzyme-linked immunosorbent assay method and was commercially available. At the same time, LDH, CRP, ALT, AST, CK-MB, ferritin and D-dimer levels were also detected in both patients and healthy control groups and correlations with prestin levels were examined.

RESULTS

The main result of our study is that serum prestin levels in COVID-19 patients are significantly higher than in healthy controls (p<0.001). In addition, a statistically significant strong positive correlation was found between prestin-LDL (r=0.537, p=0.001), prestin-CRP (p=0.654, p=0.001) and prestin-D-dimer (r=0.659, p=0.001).

CONCLUSION

The levels of prestin, a motor protein in inner ear outer hair cells and cardiac myocytes, were found to be higher in COVID-19 patients than in healthy volunteers. It also showed a positive correlation with CRP and D-dimer. This may be associated with systemic dysfunction.

Examining dietary acid load in individuals with type 2 diabetes: a case-control study

OBJECTIVE

Diabetes is a chronic disease that can cause various complications and has a high prevalence. Evidence increasingly shows that acid-base homeostasis is critical to maintaining normal metabolic function. This case-control study aims to evaluate the relationship between dietary acid load and the risk of type 2 diabetes.

PATIENTS AND METHODS

This study recruited 204 participants, 92 of whom had just been diagnosed with type 2 diabetes, and 102 healthy controls who were matched in age and gender as controls. Twenty-four dietary recall was used for dietary intake assessments. Dietary acid load was approximated using two different methods: potential renal acid load (PRAL) and net endogenous acid production (NEAP), both calculated from dietary recalls.

RESULTS

In the case and control groups, the dietary acid load mean scores were 4.18±26.8, 20.84±29.54 mEq/day for PRAL, and 55.11±29.23, 68.43±32.23 mEq/day for NEAP, respectively. When it came to the multiple possible confounders, the participants in the highest tertile of PRAL (OR 4.43, 95% CI: 1.38-23.81, ptrend<0.001) and NEAP (OR: 3.15, 95% CI: 1.53-9.59, ptrend<0.001) had a significantly higher risk of developing type 2 diabetes compared to those in the lowest tertile.

CONCLUSIONS

The findings of the present study suggest that a high acid load in the diet may increase the risk of type 2 diabetes. Therefore, it is possible that limiting dietary acid load could lower type 2 diabetes risk in vulnerable individuals.

Evaluation of different anthropometric indices for predicting metabolic syndrome

OBJECTIVE

Metabolic syndrome is a condition characterized by metabolic abnormalities. Its overall prevalence increases with age, in turn resulting in a substantial burden of disease all around the world. The aim of this study is to evaluate the efficacy of several anthropometric indices for predicting metabolic syndrome among the elderly people.

SUBJECTS AND METHODS

This study was conducted on 348 elderly people aged 65 and over, including those who were diagnosed with metabolic syndrome based on the National Cholesterol Education Program's Adult Treatment Panel III criteria and those who did not suffer from metabolic syndrome. A trained dietitian performed body weight, height, waist circumference, and hip circumference measurements. Furthermore, body mass index, waist-hip ratio, waist-height ratio, conicity index, abdominal volume index, body shape index, and body roundness index values were measured. The receiver operating characteristic (ROC) curve was applied to assess the capability of these indices to predict metabolic syndrome.  RESULTS: Of the 348 subjects recruited, 56.0% had metabolic syndrome. Body Roundness Index had the largest area under the curve for predicting metabolic syndrome in both males and females (0.678 and 0.645, respectively), followed by abdominal volume index (0.673 and 0.626, respectively) and waist circumference (0.672 and 0.626, respectively).

CONCLUSIONS

Body roundness index was more effective compared to the other seven indices for predicting metabolic syndrome in the elderly population in Turkey.

Evaluation of cell morphology and adhesion capacity of human gingival fibroblasts on titanium discs with different roughened surfaces: an in vitro scanning electron microscope analysis and cell culture study

BACKGROUND

Implantoplasty is an option in peri-implantitis treatment. What is known about the effects of implantoplasty on peri-implant soft tissue adhesion and cell behaviours is limited. This study aimed to evaluate the morphological features and adhesion capacity of human gingival fibroblast (HGF) cells onto sand-blasted, large-grit, acid-etched (SLA®) titanium (Ti) discs surfaces roughened with different implantoplasty protocols.

MATERIALS AND METHODS

The study included a total of 48 Ti discs divided into four groups (n = 12 per group): Group I: machined, smooth surface discs; Group II: SLA® surface discs; Group III: SLA® surface discs roughened with diamond bur sequence (40 and 15-μm grit); Group IV: SLA® surface discs roughened with diamond bur sequence (125 and 40-μm grit). Following polishing procedure, the surface roughness value of discs was assessed by a profilometer and scanning electron microscope. HGFs were cultured on Ti discs and cell adhesion was examined after the 24th, 48th, and 72nd hours. Statistical significance was set at the p ≤ 0.05 level.

RESULTS

Scanning electron microscope analyses of the discs revealed that fibroblasts exhibited well-dispersion and a firm attachment in all groups. The cells in group I and II had thin and long radial extensions from the areas where the nucleus was located to the periphery; however, attached cells in group III and IV showed more spindle-shaped morphology. The surface roughness parameters of the test groups were lower than those of the SLA®. The SLA® group showed the highest HGF adhesion (group II) (p ≤ 0.05). HGF adhesion in group IV was greater compared to group III, but less than group I.

CONCLUSIONS

This study showed that the characteristics of the burs applied in the implantoplasty protocol are determinant for the surface roughness and fibroblast adhesion occurs on surfaces with decreased roughness following implantoplasty. Consequently, it should be kept in mind that the surface properties of the implant may affect the adherent cell morphology and adhesion.

Analysis of endogenous oxidative damage markers and association with pulmonary involvement severity in patients with SARS-CoV-2 pneumonia

Introduction

The SARS-CoV-2 virus affects many organs, especially the lungs, with widespread inflammation. We aimed to compare the endogenous oxidative damage markers of coenzyme Q10, nicotinamide dinucleotide oxidase 4, malondialdehyde, and ischemia-modified albumin levels in patients with pneumonia caused by SARS-CoV-2 and in an healthy control group. We also aimed to compare these parameters between patients with severe and non-severe pulmonary involvement.

Methods

The study included 58 adult patients with SARS-CoV-2 pneumonia and 30 healthy volunteers. CoQ10 and MDA levels were determined by high-pressure liquid chromatography. NOX4 and IMA levels were determined by ELISA assay and colorimetric method.

Results

Higher levels of CoQ10, MDA, NOX4, and IMA and lower levels of COQ10H were observed in patients with SARS-CoV-2 pneumonia than in the control group. MDA, IMA, NOX4, and CoQ10 levels were significantly higher in patients with severe pulmonary involvement than in patients with non-severe pulmonary involvement, but no significant difference was observed in CoQ10H levels. CoQ10 levels were significantly and positively correlated with both ferritin and CRP levels.

Conclusion

SARS-CoV-2 pneumonia is significantly associated with increased endogenous oxidative damage. Oxidative damage seems to be associated with pulmonary involvement severity.

NOX4, MDA, IMA and oxidative DNA damage: can these parameters be used to estimate the presence and severity of OSA?

PURPOSE

Obstructive sleep apnoea (OSA) involves recurrent obstructive apnoeas and hypopnoeas which cause cyclic hypoxia, reoxygenation and formation of reactive oxygen species (ROS). We aimed to investigate a member of the nicotinamide adenine dinucleotide phosphate oxidase (NOX) family of enzymes, specifically (NOX4), not previously studied in humans, as well as 8-OHdG/106dG, MDA and IMA, which are known to be associated with oxidative stress. We also evaluated these parameters in predicting the presence and severity of OSA.

METHODS

All 120 subjects (90 with OSA, 30 healthy controls) underwent polysomnography and had blood serum samples taken at the same time of day. Subjects were grouped by presence and severity of OSA, and serum markers were compared among groups.

RESULTS

Age and body mass index were not significantly different among groups. In the OSA group, the levels of NOX4, IMA, MDA and 8-OHdG/106dG were significantly higher than in the healthy control group. NOX4 and other parameters were positively correlated with the severity of OSA. For all parameters, the highest levels were detected in patients with severe OSA.

CONCLUSIONS

The repeated hypoxia of OSA is associated with increases in the serum levels of inflammatory mediators such as MDA, IMA and 8-OHdG/106dG and the ROS NOX4. In this study, NOX4 and other markers were associated with the presence and severity of OSA.

Delftia acidovorans pneumonia with lung cavities formation

Case Description

A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years.

Clinical Finding

Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm³ and Platelet counts were 29,000 mm³. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system.

Treatment and outcomes

The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up.

Clinical Relevance

This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.

Decline in Instrumental Activities of Daily Living over 4-Year: The Association with Hearing, Visual and Dual Sensory Impairments among Non-Institutionalized Women

OBJECTIVE

Most older adults express the wish to live at home as long as possible, thus autonomy promoting measures are essential. Hearing and visual impairments are common among older people, and they have been consistently associated with functional disability. However, longitudinal data are scarce, notably regarding dual sensory impairments (both in hearing and vision). We aimed at assessing the relationship between hearing, visual, and dual sensory impairments, and subsequent decline in instrumental activities of daily living (IADL).

DESIGN

Longitudinal.

SETTING

the French E3N-elderly sub-cohort.

PARTICIPANTS

4,010 community-dwelling older women born between 1925 and 1930, and free of IADL limitations in 2006.

MEASUREMENTS

Hearing and visual impairments were self-reported in 2006. IADLs were evaluated in 2006 and 2010.

RESULTS

After 4 years of follow-up, 588 women became limited in their IADLs. In logistic regression models adjusted for potential confounders, odds ratios [95% confidence interval] for developing IADL limitations were 1.18 [0.98; 1.41], 1.98 [1.26; 3.11], and 2.61 [1.50; 4.54] for hearing, visual, or both sensory impairments respectively, compared with no sensory impairment at baseline.

CONCLUSION

Results suggest that among autonomous older women, visual, and to a lesser extent, hearing impairment, have a short-term negative impact on their ability to perform daily activities, with some evidence of a multiplicative effect between sensory impairments. Appropriate evaluation and management of sensory impaired elderly, and more particularly those with dual impairments, may contribute to prevent disability in aging.

Systemic vasculitis in a patient with rhupus syndrome

Rhupus is a rare syndrome characterized by overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Previous reports mentioned that rhupus patients have prominent RA associated clinical manifestations and only mild organic damage related to SLE. Progressive or life-threatening manifestations are rare in rhupus patients. Our patient diagnosed as rhupus was a young women, presented with multi-organ involvement of systemic vasculitis. Rheumatologists should be aware of possibility that rhupus may be accompanied by progressive or life-threatening conditions such as vasculitis.

Two-year survival of severe chronic obstructive pulmonary disease subjects requiring invasive mechanical ventilation and the factors affecting survival

OBJECTIVE

To investigate two-year survival rates and the factors affecting survival in patients of severe chronic obstructive pulmonary disease requiring invasive mechanical ventilation.

METHODS

The retrospective study was conducted at Yuzuncuy?l University, Van, Turkey, and comprised record of in-patients with moderate to severe chronic obstructive pulmonary disease who required invasive mechanical ventilation in the intensive care unit of the Pulmonary Diseases Department between January 2007 and December 2010. Correlation between survival and parameters such as age, gender, duration of illness, history of smoking, arterial blood gas values, pulmonary artery pressure, left ventricular ejection fraction, body mass index and laboratory findings were investigated. SPSS 19 was used for statistical analysis.

RESULTS

Of the 69 severe COPD subjects available, 20 (29%) were excluded as they did not meet the inclusion criteria. Overall in-hospital mortality rate was 42% (n:29). Of the remaining 20 (29%) who comprised the study group, 14(70%) were men and 6(30%) were women. The mortality rates at the end of 3rd, 6th, 12th and 24th months were 61%, 76%, 84% and 85.5% respectively. There was no correlation between gender and survival in time point (p>0.05). The only factor that affected the rate of mortality at the end of the 3rd month was age (p<0.05). Mortality was high in subjects with advanced ages (p<0.05). Duration of illness affected the survival at the end of the six month (p<0.05). Survival rates were high in subjects with longer illness durations (p<0.05). Haematocrit level was the only factor that affected mortality rates at the end of 12th and 24th months (p<0.05). Subjects with higher haematocrit levels had higher survival rates (p<0.05).

CONCLUSIONS

Age, duration of illness and haematocrit levels were the most important factors that affected survival in chronic obstructive pulmonary disease patients requiring mechanical ventilation.

Liver granulomatosis: a case of Chlamydophila pneumoniae infection

An 18-year-old man was referred to the Internal Medicine ward because of a 2-week history of intermittent high fever, weight loss and cough. Clinical examination revealed hepato-splenomegaly and multiple lymph nodes swelling while laboratory tests showed elevated C-reactive protein, gamma glutamyl transferase and lactate dehydrogenase. All serologic testes for auto-immune antibodies, viruses and bacteria were negative except for Chlamydophila pneumoniae. An 18-FDG PET computed tomography scanner showed hypermetabolism in the liver, spleen and lymph nodes. We therefore conducted a liver biopsy that demonstrated non-necrotizing granulomas. We conclude to a C. pneumoniae infection associated with a granulomatous hepatitis. After treatment with Doxyciclin the patient had no more fever, hepatosplenomegaly resolved and blood testes normalized. This case report is to our knowledge the first report of a granulomatous hepatitis associated with C. pneumoniae respiratory infection.

Loeffler's syndrome: an interesting case report

Loeffler's syndrome is an acute pneumonia with an unclear cause. One fourth of Loeffler's syndrome patients are idiopathic, although the most common etiologic causes include parasites. Asymptomatic form is usually a reversible, self-limited disease, which does not require a specific treatment regimen. We presented a 17-year-old young man with diagnosis of Loeffler syndrome.

Left ventricular strain and strain rate by two-dimensional speckle tracking echocardiography in patients with subclinical hypothyroidism

AIM

Subclinical hypothyroidism (SH) is an asymptomatic condition defined by increased serum thyroid-stimulating hormone (TSH) with normal free thyroid hormone levels. Heart is a major target organ for thyroid hormone action. The aim of this study was to evaluate cardiac functions in patients with SH by speckle tracking imaging.

PATIENTS AND METHODS

We included 23 consecutive patients with untreated SH (Group A; 7 male, mean age: 40.9±1.6 years) and 21 patients with treated SH (Group B; 6 male, mean age: 40.2±2.1 years). The control group included 25 healthy volunteers (8 male, mean age: 39.9±2.8 years). Left ventricular (LV) functions were assessed with speckle tracking imaging.

RESULTS

Age and sex distributions were similar among the groups. Mean serum TSH and free T4 levels were 11.7±2.9 µIU/mL, 1.16±0.06 ng/dL for group A; 2.6±0.3 µIU/mL, 1.35±0.09 ng/dL for group B; 1.4±0.3 µIU/mL, 1.31±0.09 ng/dL for controls, respectively (p = 0.001, p = 0.122). The untreated SH patients had significantly lower LV strain and strain rate values compared to controls. The treated SH patients had higher LV strain and strain rate values compared to untreated SH patients although the difference was not statistically significant. The treated SH patients had lower LV strain and strain rate values compared to controls but the difference was not statistically significant.

CONCLUSIONS

Untreated SH is associated with impairment in LV longitudinal myocardial function. Speckle tracking echocardiography appears to be useful both for early detection of LV impairment in patients with SH and documentation of improvement in myocardial deformation parameters with treatment.

Could conscious sedation with midazolam for dental procedures be an alternative to general anesthesia?

AIM

The aim of our study was to evaluate the likelihood that conscious sedation (CS) with intravenous midazolam could become an alternative modality to general anesthesia (GA) for dental procedures.

MATERIALS AND METHODS

In our study, 58 and 47 American Society of Anesthesiologists (ASA)-1 pediatric patients, aged 2-12 (mean 6) years, underwent dental procedures and minor oral surgical procedures under GA and CS with intravenous midazolam, respectively. The two groups were evaluated in terms of vital signs, duration of the treatment procedure, patient behavior, and the treatment comfort experienced by the physicians.

RESULTS

The oxygen saturation level was significantly lower (GA: 99.0 ± 0.30, CS: 98.4 ± 1.02; P < 0.001) and the duration of the treatment procedure was significantly shorter (P < 0.001) in the sedation group compared with the GA group. The physicians encountered various difficulties during implementation of the treatment strategy in cases where they used CS. Minor oral surgical procedures and tooth extraction processes requiring no saline irrigation, however, could be performed successfully under CS.

CONCLUSIONS

In cases requiring multiple dental management issues, the sedation method was not found to be a useful alternative to GA.

The effect of heat on the mechanical properties of glass ionomer cements

AIM

The objective of this study was to assess the effect of heat application on the mechanical properties of glass ionomer cements.

STUDY DESIGN

experimental design. The effect of heat on glass ionomer cements during their setting was evaluated by measuring compressive strength, flexural strength and microhardness. Moroever, temperature changes from one surface of the glass ionomer cement specimens 2, 4, and 6 mm thick to the other surface were measured. A condensable glass ionomer cement (Fuji IX) and a ceramic-reinforced glass ionomer cement (Amalgomer CR) were used as test materials. Heat was applied with soldering iron for 2 minutes at 80±2oC. All mechanical tests were carried out 24 hours after the setting of glass ionomer cements.

RESULTS

No significant differences in compressive strength were found between the control groups and the heated groups. There were no statistically significant differences in the flexural strength value for both groups of Fuji IX. On the contrary, when heat was applied to Amalgomer, its mean flexural strength reached a value that was higher than that of Amalgomer control. Significant differences in microhardness were found between the control groups and the heated groups and between Fuji IX and Amalgomer CR. Temperature rising in both glass ionomer cements was also noted.

STATISTICS

two-way ANOVA was used where appropriate and independent samples t-test was used in case of interaction.

CONCLUSION

It is established that heat application improved the surface mechanical properties of conventional glass ionomer cements.

Possible neoplastic effects of acrylamide on rat exocrine pancreas

We investigated whether the acrylamide formed during cooking carbohydrate-rich foods at high temperatures causes neoplastic changes in rat pancreas. Azaserine, which is an amino acid derivative that has the ability to initiate neoplastic changes in rat pancreas, was injected into 14-day-old male rats once a week for three weeks. Acrylamide was given to both azaserine-injected and non-injected rats at doses of 5 and 10 mg/kg/day in drinking water for 16 weeks after which tissue slides were prepared from the pancreata. Pancreas weights and body weights of rats treated with azaserine and acrylamide together increased significantly compared to the other groups. Moreover, the size, average diameter and volume of atypical acinar cell foci that developed in the pancreata of rats treated with azaserine and acrylamide together increased significantly compared to rats treated with either azaserine or acrylamide alone and control groups. Atypical acinar cell adenoma or adenocarcinoma was not observed in the pancreata of rats in any group.

The protective effects of ketamine and propofol in obstructive jaundice: an experimental study

OBJECTIVE

In this study, we investigated the protective effects of frequently used intravenous anesthetics (ketamine, propofol, thiopental, and fentanyl) in oxidative stress in a rat liver model of obstructive jaundice.

MATERIALS AND METHODS

Thirty-two Wistar albino rats were divided into four groups in a randomized fashion. All rats were subjected to laparotomy, common bile duct ligation and severance on day 0. Following 7 days, laparotomy was again performed using ketamine, propofol, pentobarbital, or fentanyl anesthesia. After 2 hours, the animals were sacrificed and tissue specimens were acquired for histopathological scoring and determination of malondialdehyde (MDA), superoxide dismutase (SOD) and catalase (CAT) activities.

RESULTS

All rats demonstrated enlargement in the bile duct, obstructive jaundice, and histopathologic ductal proliferation. MDA and SOD levels were significantly lower in the ketamine group compared with the thiopental and fentanyl groups. CAT was significantly increased in the ketamine group compared with the other groups. The best portal polymorphonuclear leukocyte and necrosis scores were in the ketamine group, but this difference was not statistically significant ( p=0.07).

CONCLUSION

Ketamine and propofol were observed to cause the least amount of oxidative stress in this rat model of induced oxidative stress generated by ligation of the common bile duct. This experiment is the first study on this subject in the literature (Tab. 3, Ref. 65).

The comparison of the effects of hepatic regeneration after partial hepatectomy, silybum marinaum, propofol, N-acetylcysteine and vitamin E on liver

AIM

We investigated the comparison of the effects of N-acetylcysteine, silybum marinaum, propofol, and vitamin E on liver hepatic regeneration after partial hepatectomy.

METHOD

Forty-eight rats were randomized into 6 different groups of the same age and weight. After partial hepatectomy, all animals were resuscitated with 5 ml of isotonic sodium chloride solution administered subcutaneously while group 1 (sham) did not receive any injection, group 2 (control) received serum physiologic intraperitoneally, group 3 received 25 mg /kg of propofol intraperitoneally, group 4 received 20 mg/kg of N-acetylcysteine intraperitoneally, group 5 received 400 mg/kg of vitamin E intraperitoneally, and group 6 received 10 mg/kg of silybum intraperitoneally. None of these groups were given antibitotics. On the third day, a half of the rats, and on the seventh day, the other half of rats were reoperated and sacrificed.

RESULTS

Blood samples were used for biochemical parameters (AST, ALT). Ki-67 proliferation index was used for histopathologic parameters. A statistically meaningful difference was detected in silybum, vitamin E, N-acetylcysteine, and propofol groups for AST, ALT levels when compared to control and sham groups (p<0.05). Ki-67 regeneration proliferation index of all groups, which were given agents on the third and seventh days were statistically higher than the control and sham groups (p<0.05). During the evaluation, AST, ALT, Ki-67, Ro (regeneration value) levels of silybum group displayed a statistically significant difference according to other groups (p<0.05).

CONCLUSION

Our experimental study indicates that hepatic regeneration after partial hepatectomy was meaningful and significant in groups with intraperitoneal administration of silybum marinaum,vitamin E, N-acetylcysteine and propofol. Hepatic regeneration rate was particularly higher in silybum group compared to other groups (Fig. 16, Ref. 26).

Clinical and prognostic features of patients with pandemic 2009 influenza A (H1N1) virus in the intensive care unit

OBJECTIVE

To investigate the clinical and prognostic features of patients admitted to intensive care unit (ICU) with pandemic 2009 influenza A (H1N1) virus.

METHODS

Patients admitted to the intensive care unit for severe pneumonia associated with pandemic 2009 influenza A (H1N1) virus were evaluated.

RESULTS

The study included 20 patients with the mean age of 36±13. Of the 20 subjects, 17 (85%) had underlying conditions. Of the 20 patients, 11(55%) were discharged and 9 (45%) died. Cardinal symptoms were fever, myalgia, and hemoptysis with the rates of 85 %, 75 % and 45 %, respectively. All patients had pneumonic infiltrations in their chest roentgenograms. Main laboratory findings were lymphopenia, high creatin phosphokinase (CPK) and Lactate dehydrogenase (LDH) levels. All patients had positivity on real time reverse transcription-polymerase chain reaction (RT-PCR). None of the patients had pandemic 2009 influenza A (H1N1) virus vaccination. None of them had taken oseltamivir within 48 hours. Main reasons for mortality were cardiovascular complications and ventilatory associated pneumonia due to Acynetobacter baumannii.

CONCLUSION

Early diagnosis and antiviral treatment in these cases seem to be the best approach to avoid serious illness. Special attention should be given to patients having underlying conditions such as cardiovascular and pulmonary diseases and pregnancy.

Determination of bone density distribution in proximal femur by using the 3D orthotropic bone adaptation model

Most of the models developed and presented in the literature about bone remodelling assume bone as isotropic material. During this study, a structural model which has orthotropic bone properties is developed to simulate bone behaviour under mechanical loads. For a three-dimensional finite element modelling of proximal femoral bone, a computer code was written to investigate bone property changes owing to mechanical loads. The bone density distribution was determined after stress analysis was carried out in an iterative method. At every time step the bone properties were calculated depending on density change. Additionally, the effects of the bone remodelling parameters and sensors on numerical results were investigated. The most realistic bone density distribution in the proximal femur is obtained with strain energy density sensor. Generally initial bone density values do not have any effect on density distribution but at the low iteration numbers they may have some effects. Lastly, the density distribution of proximal femoral bone is more realistic for the dead zone size less than 0.35 and the stimulus value less than 2500.

Effects of different management factors on broiler performance and incidence of tibial dyschondroplasia

(1) This study was to determine the effects of two lighting programmes (continuous--24L:0D or intermittent--12L:3(1L:3D)), two feeding programmes (continuous--ad libitum or meal Jeeding--3 h feed:3 h deprivation x 4 times per d) and two ascorbic acid (AA) supplementations (0 or 150 mg/l in water) on broiler performance and incidence of tibial dyschondroplasia (TD). (2) One-day-old male commercial (Ross PM3) broiler chicks (1600) were used. The chicks were randomly divided into 8 treatment groups (2 x 2 x 2) and their replicates (2) replicates per treatment). (3) Intermittent lighting increased body weight and improved feed conversion. Body weight of broilers was decreased by meal feeding. AA supplementation had no significant effect on the body weight and feed conversion ratio. There was no lighting x feeding x supplemental AA interaction for body weight, feed conversion ratio, mortality rate and carcase weight. (4) Supplemental AA improved the cortical thickness of tibiotarsus and decreased the incidence of TD. (5) It was concluded that the application of intermittent lighting in combination with supplementation of 150 mg/l AA is a useful method to reduce TD in broilers without loss of performance.

Ohmic and Conventional Heating of Pomegranate Juice: Effects on Rheology, Color, and Total Phenolics

Ohmic heating is an alternative fast-heating method especially for liquid foods. In this study, pomegranate juice samples, prepared by two different extraction methods, were heated ohmically by matching the same thermal history, with that of the conventional method. The ohmic heating application was conducted by changing the voltage gradient (10—40 V/cm) at 50 Hz. The samples were heated from 20 ° C to 90°C and held at 90 °C for different treatment times (0, 3, 6, 9 or 12 min). Although rheological properties, color, and total phenolic content (TPC) values changed at the initial heating up period, there were no significant changes during holding period (p < 0.05). Non-Newtonian (power law) rheology model had higher regression coefficient than Newtonian model, and the extraction method affected the consistency of pomegranate juice samples (p < 0.05). Color values of juice extracted from arils (APJ) was better than that of juice extracted from whole fruits (PPJ), as PPJ contained higher amount of TPC (p < 0.05). Since the heating method did not affect the rheological properties, color, and TPC values, it could be said that there was no electrical effect rather than thermal effects during ohmic heating of pomegranate juice. Ohmic heating could be recommended as an alternative fast-heating method for fruit juices.

Effects of ascorbic acid and lighting schedule on tibiotarsus strength and bone characteristics in broilers

Abstract. This study was conducted to determine the effects of two lighting programs (continuous program; 24 h lighting or intermittent; 12 h daylight followed by three cycles of 1 h lighting and 3 h dark program during the night period) and three different ascorbic acid (AA) supplementations (0, 200 and 400 mg/l, added to water) on some serum parameters, ash content and mechanical properties of tibiotarsus. For this purpose one-day-old male commercial (Ross PM3) broiler chicks (n=600) were divided into 6 treatment groups (2×3) with random replicates (4 replicates per treatment). At the end of 6 weeks, intermittent lighting program negatively influenced serum alkaline phosphatase (ALP) and calcium (Ca) levels (P<0.001) while continuous lighting program had positive influence on bone ash, Ca and phosphorus (P) content (P<0.001). The AA addition decreased serum inorganic phosphorus (Pi) level and positively affected bone chemical characteristics (P<0.001). On the mid-section of the bone, although intermittent lighting had positive effect on bone mechanical parameters (P<0.001), no remarkable effect was observed by AA supplementation. The results of the present study suggest that interaction of intermittent lighting and AA supplementation (200 mg/ l) may have positive effect on chemical composition and mechanical characteristics of bone in broilers.

Effects of amylin on bone development and egg production in hens

Amylin is a member of the calcitonin family of hormones cosecreted with insulin from the pancreatic beta-cells that can act as an osteoblast mitogen and as an inhibitor of bone resorption in mice and humans. The aim of this study was to investigate the role of amylin on bone formation and some egg parameters in hens. The study was performed in 60 hens aged 10 wk. Thirty hens constituting the treatment group were s.c. injected with amylin at a 75 microg/kg dose every other day. The remaining hens were used as the control group. Five birds from the treatment and control groups were slaughtered at 14, 16, 18, and 20 wk of age and serum and bone parameters were compared between the treatment and control groups. The remaining 20 hens were fed without any amylin injection until 35 wk. All hens at the end of the 35th week were slaughtered and then serum, bone, and egg parameters were assessed. In the treatment group, bone calcium levels increased, whereas serum calcium levels decreased. This dose of amylin also increased the cortical width of tibiotarsuses in hens. Eggshell thickness was found thicker in the treatment group than in the control group. Overall, the results of this study suggest that amylin may stimulate the bone and eggshell quality by increasing calcium uptake from the bloodstream and may influence the sustainability of yield in hens.

Ghrelin and orotic acid increased in subclinical mastitis

Hormone ghrelin and orotic acid accelerate wound healing as well as controlling inflammation and immunity. We have, therefore, investigated the serum and milk levels of ghrelin and orotic acid in dairy cows with (n = 21) or without (n = 21) subclinical mastitis. Acylated and des-acylated ghrelin as well as orotic acid concentration were detected by using high performance liquid chromatography (HPLC). The results revealed that ghrelin level in milk and serum was significantly higher in dairy cows with subclinical mastitis than that of dairy cows without subclinical mastitis. This was also the case when the orotic acid concentrations in dairy cows with subclinical mastitis were compared with those dairy cows without subclinical mastitis. In conclusion, ghrelin and orotic acid occur in particularly high concentrations in subclinical mastitis, and might, therefore, be required in greater amounts for tissue repair and may be also used as a indicator for subclinical mastitis.

Global attention to Turkey due to desertification

Desertification has recognized as an environmental problem by many international organizations such as UN, NATO and FAO. Desertification in Turkey is generally caused by incorrect land use, excessive grazing, forest fires, urbanization, industry, genetic erosion, soil erosion, salinization, and uncontrolled wild type plants picking. Due to anthropogenic destruction of forest, steppe flora gradually became dominant in Anatolia. In terms of biodiversity, Turkey has a significant importance in Europe and Middle East. Nine thousands plant species naturally grown in Turkey, one third of them are endemic. Also, endemic species of vertebrates, thrive in the lakes and marshy areas. The studies of modelling simulation of vegetation on the effects of Mediterranean climate during the Roman Classical period by using vegetation history showed that, in 2000 years BP, Mediterranean countries were more humid than today. Turkey is a special place on the global concern in terms of desertification because of biodiversity, agricultural potential, high population, social and economical structure, topographical factors and strategic regional location. Communication among scientists, decision makers and international non-profit organizations must be improved.

Pathological effects of Arcobacter cryaerophilus infection in rainbow trout (Oncorhynchus mykiss Walbaum)

Arcobacter cryaerophilus was isolated from naturally infected rainbow trout (Oncorhynchus mykiss Walbaum), and its pathogenicity was tested by intramuscular injection into 40 healthy 1-year-old rainbow trout at 16 degrees C. The lethal dosage of 50% end point (LD50) for A. cryaerophilus was calculated 2.25 x 10(4) viable cells. Experimental infection caused deaths with gross clinical abnormalities such as degenerated opercula and gills, liver damage, haemorrhagic kidney and serous fluid in swollen intestines. The counts of A. cryaerophilus in kidney, liver and gills of experimentally infected fish ranged from 1.59 x 10(10) colony forming units (cfu)/g to 7.41 x 10(12) cfu/g. The means of erythrocyte (RBC) count, haematocrit level, serum cholesterol, triglyceride, albumin and total protein concentrations in the blood of the experimentally infected rainbow trout group were significantly lower than in the healthy fish. Leukocyte (WBC) counts of the experimentally infected rainbow trout were significantly higher than those of healthy fish. The present work shows that the selected blood characteristics may be good indicators of response to infections in rainbow trout.

Table-moving contrast-enhanced magnetic resonance angiography in the evaluation of lower extremity peripheral arterial bypass grafts

The aim of this study was to investigate the utility of table-moving contrast-enhanced three-dimensional MR angiography in the evaluation of lower extremity peripheral arterial bypass grafts. Twenty-two lower extremity peripheral arterial grafts (13 autologous saphenous vein, 7 polytetrafluoroethylene and 2 Dacron) in 18 patients were evaluated. Preoperative diagnosis were occlusive arterial segments in 14 cases, 4 aneurysms in 2 cases (3 aneurysms in one case) and traumatic femoral artery injury in 2 cases. 1.5T superconductive magnet was used with torso-phase and whole body coil system on MRI examinations. Lower extremity peripheral arterial grafts were evaluated and anastomosis sites were classified into five groups as normal, insignificant stenosis (< 50%), significant stenosis (> 50%), occlusion and ectatic or aneurysmatic appearance. Contrast-enhanced MR angiography imaging of 66 segments of 22 graft patients were of high quality. No difficulties were confronted in the radiological evaluation of peripheral bypass grafts. Graft stenosis as detected in five grafts. Stenotic segments were at the proximal (n = 4) and distal (n = 3) anastomosis sites. Total occlusion was shown in three grafts. Ectasia or aneurysm was seen in only one graft. In lower extremity peripheral bypass graft patients, table-moving contrast enhanced MR angiography can be used in the evaluation and follow-up of the vascular lesions.