The effects of Dapagliflozin on monocyte-HDL ratio and neutrophil-lymphocyte ratio among patients with type-2 diabetes mellitus

OBJECTIVE

The present study attempted to explore the effects of starting dapagliflozin for glycemic control in Type-2 diabetes mellitus (DM) patients on the monocyte high-density lipoprotein ratio (MHR) and neutrophil-leukocyte ratio (NLO) as oxidative and inflammation markers.

PATIENTS AND METHODS

We retrospectively investigated the medical files of Type-2 DM patients administered dapagliflozin for at least 12 weeks. Then, we recorded the patients' demographics and compared their pre- and post-treatment biochemical and hemogram parameters.

RESULTS

We retrospectively evaluated the data of 210 patients. The results revealed that the levels of fasting blood glucose (FBG; p < 0.001), hemoglobin A1c (HbA1c; p < 0.001), high-density lipoprotein cholesterol (HDL-c; p = 0.011), triglyceride (p = 0.002), and monocytes (p = 0.019) and MHR (p < 0.001) significantly decreased among the patients following dapagliflozin treatment when compared to the pre-dapagliflozin period.

CONCLUSIONS

MHR is considered a practical, inexpensive inflammation marker for diabetics using dapagliflozin. However, we could not conclude NLR to be a significant inflammation marker, which, in turn, may suggest the need for comprehensive, prospective research.

Evaluation of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on Eustachian tube function with audiological tests: A randomized clinical trial

OBJECTIVES

Maxillary expansion improves the hearing function. This trial aimed to examine the effects of Eustachian tube function (ETF) with audiological tests in orthodontic patients who underwent rapid maxillary expansion (RME) or alternate rapid maxillary expansion and constriction (Alt-RAMEC) treatment.

METHODS

Forty individuals (mean age = 13.35 years) included in the trial had a healthy eardrum, no history of orthodontic treatment, maxillary constriction, mandibular constriction and were not affected by acute or chronic otitis. Patients were randomly assigned to one of two groups (n = 20 each): the RME protocol or the Alt-RAMEC protocol. ETF was evaluated using Williams' test at three time points: before expansion (T0), after expansion (T1), and in the 3rd month of retention (T2).

RESULTS

In the RME group, Eustachian tube dysfunction (ETD) was observed in 18 of 40 ears before expansion (T0). The RME group showed significant improvement in tube function in the 3rd month of retention (T2) (p = 0.003). In the Alt-RAMEC group, ETD was observed in 22 of the 40 ears at baseline (T0). Significant improvements in tubal function were observed in the Alt-RAMEC group after expansion (T1) (p = 0.008) and in the 3rd month of retention (T2) (p < 0.001). In the RME group, 17 of 18 ears recovered, while in the Alt-RAMEC group, 21 of 22 ears recovered.

CONCLUSION

Eustachian tube function improved in the RME and Alt-RAMEC groups compared to the pre-expansion period.

REGISTRATION

This trial was not registered.

Factors leading to dissemination of cutaneous anthrax: an international ID-IRI study

Background

Although anthrax is a rare zoonotic infection, it still causes significant mortality and morbidity. In this multicenter study, which is the largest anthrax case series ever reported, we aimed to describe the factors leading to dissemination of cutaneous anthrax.

Methods

Adult patients with cutaneous anthrax from 16 referral centers were pooled. The study had a retrospective design, and included patients treated between January 1, 1990 and December 1, 2019. Probable, and confirmed cases based upon CDC anthrax 2018 case definition were included in the study. A descriptive statistical analysis was performed for all variables.

Results

A total of 141 cutaneous anthrax patients were included. Of these, 105 (74%) patients had probable and 36 (26%) had confirmed diagnosis. Anthrax meningitis and bacteremia occurred in three and six patients, respectively. Sequelae were observed in three patients: cicatricial ectropion followed by ocular anthrax (n = 2) and movement restriction on the left hand after surgical intervention (n = 1). One patient had gastrointestinal anthrax. The parameters related to poor outcome (p < 0.05) were fever, anorexia, hypoxia, malaise/fatigue, cellulitis, fasciitis, lymphadenopathy, leukocytosis, high CRP and creatinine levels, longer duration of antimicrobial therapy, and combined therapy. The last two were seemingly the consequences of dissemination rather than being the reasons. The fatality rate was 1.4%.

Conclusions

Rapid identification of anthrax is crucial for prompt and effective treatment. Systemic symptoms, disseminated local infection, and high inflammatory markers should alert the treating physicians for the dissemination of the disease.

The role of oxidized phospholipids in COVID-19-associated hypercoagulopathy

OBJECTIVE

There is more pronounced hypercoagulation in COVID-19 infection than in other viral lung infections. Oxidized phospholipids (OxPLs) appear in COVID-19-infected lungs due to oxidative stress, after which they promote the induction of tissue factor (TF) expression and inflammatory programmers in monocytes, as well as activate endothelial cells to recruit and bind to monocytes. Therefore, we aimed to demonstrate the role of OxPLs in inflammatory and procoagulant responses in COVID-19 infection.

PATIENTS AND METHODS

Patients with a positive SARS-CoV-2 polymerase chain reaction test and ten healthy donors were included in the study. Peripheral blood was drawn at inclusion for OxPAPC, IFN-γ, and CCL2 serum level measurements. Clinical data were collected from electronic patient medical files. The serum levels of OxPAPC, IFNγ, and CCL2 were measured by immune assays.

RESULTS

Seventy-two patients were included in the study. OxPAPC and CCL2 were higher in the patients than in the controls (<0.003 and 0.011, respectively). INF-γ did not significantly differ between groups. There was no difference between the patients with lung involvement and those without CCL2, INF-γ, and OxPAPC. D-dimer, CRP, and ferritin were higher in the patients with lung involvement. Serum levels of INF-γ and CCL2 were positively correlated with each other (r:0.757, p<0.0001), but no correlation was detected between OxPAPC and INF-γ or CCL2. There was no correlation between OxPAPC and hematologic or biochemical parameters.

CONCLUSIONS

OxPAPC, which is thought to contribute to hypercoagulability, was found to be high in the patients with Covid-19 infection. The role of OxPLs in COVID-19-associated hypercoagulopathy should be investigated further in experimental models and in larger patient groups.

P–641 Pubertal high-fat diet interferes with the ovarian kisspeptin ligand and receptor expressions regulating female fertility

Study question

Does chronic high-fat diet affect ovarian dysfunctions via changing of kisspeptin and kisspeptin receptor expressions?

Summary answer

Ovarian kisspeptin and kisspeptin receptor expressions are significantly affected by the chronic high-fat diet.

What is known already

Regarding the hypothalamic-pituitary-gonadal (HPG) roles of kisspeptin, it appears that it directly stimulates LH secretion from the pituitary, consecutively stimulates ovulation in the female. There are also studies showing that kisspeptins can increase GnRH release, serum FSH, LH, and testosterone (in vivo), and regulate ovulation in women who have reached sexual maturity through the central control of the HPG axis.

Fatty acids can act as nutritional signals that regulate the HPG axis, and elevated levels of circulating saturated fatty acids associated with high-fat diet (HFD)-feeding has been shown to induce ovarian dysfunction. HFD consumption induces ovarian dysfunction in rodents.

Study design, size, duration

4-week-old female rats obtained from Akdeniz University Experimental Animals Unit. Animals were kept in standard conditions; fed with control diet consisting of standard laboratory food (13.5% of total energy from oil) or HFD (60% of total energy from oil) for 8 weeks. Experimental procedures were performed at the age of 12 weeks (250–275 g live weight). Live weights and food consumption of the animals in both groups were calculated weekly and recorded during the experiment.

Participants/materials, setting, methods

At the end of the experimental period, the animals were sacrificed and tissues were obtained. Sections were taken from paraffin-embedded tissues. Immunohistochemical staining for KISS1 and GPR54 were performed in both groups’ ovaries. Tissue collecting, processing, and immunohistochemical staining were performed at the histology and embryology department of Akdeniz University Faculty of Medicine.

Main results and the role of chance

There was a significant increase in body weights of the HFD group during the experiment period compared to the control group.

As a result of immunohistochemical staining, kisspeptin expression is specifically localized to the corpora lutea of the control ovaries. However, kisspeptin expression in the corpora lutea of the HFD ovaries was increased regardless of the ovarian follicles.

KISS1R expression was located in the cytoplasm of oocytes. HFD group also expressed the KISS1R in the oocytes with increasing intensity.

Limitations, reasons for caution

The study design included pubertal age limit of the samples. The functional reproductive period in different mammal species should be considered.

Wider implications of the findings: We suggest that chronic exposure of female rats to a high-fat diet may induce ovarian Kisspeptin expression while kisspeptin receptor expression is not affected in oocytes. Clinical implications should be considered.

Trial registration number

B.30.2.AKD.0.05.07.00/99

Effects of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on nasal mucociliary clearance : A randomized clinical trial

PURPOSE

This parallel trial aimed to evaluate the changes in nasal mucociliary clearance (MCC) after a rapid maxillary expansion (RME) protocol or an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol in orthodontic patients.

METHODS

This trial included 36 patients with a mean age of 14.38 years, with a narrow maxillary arch, bilateral posterior crossbite, no narrowing of the mandibular arch, no previous orthodontic treatment, and no nasal or systemic disease. Patients were randomly distributed into two groups (n = 18 each)-one group was treated with the RME protocol and the other group was treated with the Alt-RAMEC protocol. MCC was evaluated using the saccharine transit time (STT) test, which was measured for each individual before expansion (T0), after expansion (T1), and after a 4-month retention phase (T2). The study was single blinded, and blinding was applied only to the outcome assessor. The primary objective was to evaluate the effect of the Alt-RAMEC and RME protocols on MCC. The secondary objective was to determine the relationship between age, sex, and MCC. The χ ² test and independent samples t‑test were used to evaluate the data.

RESULTS

The STT decreased after expansion and retention in the RME group. In the Alt-RAMEC group, the STT decreased after expansion and slightly increased after retention. When the RME and Alt-RAMEC groups were compared, the STT showed a significant difference after expansion and retention (p < 0.05). No significant relationship was observed between age and sex and STT (p > 0.05).

CONCLUSION

This study demonstrated that the Alt-RAMEC protocol improved MCC and had a positive effect on nasal physiology by increasing the nasal volume more than that achieved by RME.

Evaluation of complete blood count parameters, cell ratios, and cell volume indices in mushroom poisonings

OBJECTIVE

Mushroom poisoning is still a significant health-care problem, with the potential to affect blood parameters. The present study analyses the effect of mushroom poisoning on complete blood cell parameters, cell ratios, and cell volume indices and the effect of the mentioned parameters on prognosis/hospital length of stay.

METHODS

The study involved the retrospective assessment of 48 patients who became symptomatic after ingesting mushrooms. Patients who were 18 years and above and who spent at least one day in hospital were included in the study. The control group comprised individuals with similar characteristics to the patient group. The complete blood cell parameters, platelet indices (mean platelet volume, plateletcrit (PCT)), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio levels were compared between the two groups, and these ratios were analyzed for any correlation with length of hospital stay.

RESULTS

NLR was significantly higher and PCT was significantly lower in the mushroom-poisoned group, while all other parameters were similar between the groups. NLR had a positive correlation and PCT had a negative correlation with length of hospital stay.

CONCLUSION

NLR and PCT levels can provide information about prognosis and can aid in the prediction of hospital stay in mushroom-poisoned patients. Further investigations are needed to investigate effects of intoxication on hematological system elements.

Analysis of corneal astigmatism with NIDEK axial length scan in caucasian cataract surgery candidates

Aims and Objectives

The aim of the study was to analyze and quantify the pattern of corneal astigmatism in Caucasian cataract surgery patients using a new optical biometer (axial length [AL] Scan, NIDEK Co., Gamagori, Japan).

Patients and Methods

The datasets of cataract surgery patients acquired between March 1, 2014, and April 15, 2016, were collected and analyzed. The corneal power (flat keratometry, steep keratometry, and mean keratometry), negative cylinder power, and axis of astigmatism were recorded. Keratometry values were optically measured by optical low coherence interferometry (AL-Scan, NIDEK Co., Ltd.,) before cataract extraction.

Results

The study comprised 1233 eyes of 838 consecutive cataract candidates with a mean age of 66.8 ± 10.7 years (range 40-97 years). The mean keratometry value and corneal astigmatism were 43.69 ± 1.61 D and 0.84 ± 0.70 D, respectively. Corneal astigmatism of 1.00 D or greater was found in 344 eyes (27.9%), and 548 eyes (44.4%) had against-the-rule astigmatism. A trend toward decreasing J0 and J45 with age was found by linear regression models. The per-year increase in age was associated with a J0 and J45 decrease of 0.002 D and 0.001D, respectively.

Conclusion

This study provides the distribution of astigmatism axis and power for cataract patients in age subsets from Turkey.

Enhanced degradation of micropollutants by zero-valent aluminum activated persulfate: assessment of toxicity and genotoxic activity

Advanced oxidation of the aqueous Triton™ X-45 (TX-45), iopamidol (IOPA), ciprofloxacin (CIP) and bisphenol A (BPA) solutions via activation of persulfate (PS) with zero-valent aluminum (ZVA) was investigated. The study aimed at assessing the effectiveness of the PS/ZVA process in terms of target micropollutants (MPs) and toxicity abatements in raw surface water (RSW) and distilled water (DW). TX-45, CIP and BPA were completely degraded after 90-minute, 120-minute and 40-minute treatment, respectively, with PS/ZVA in DW, whereas 95% IOPA removal was achieved after 120-minute (MPs = 2 mg/L; ZVA = 1 g/L; PS = 0.25 mM for CIP and BPA; PS = 0.50 mM for TX-45 and IOPA; pH = 3). TX-45 (59%), IOPA (29%), CIP (73%) and BPA (46%) removal efficiencies decreased after 120-minute PS/ZVA treatment in RSW. In DW, Vibrio fischeri toxicities of original (untreated) MPs were found as: CIP (51%) > BPA (40%) > TX-45 (15%) > IOPA (1%), and as BPA (100%) > CIP (66%) > IOPA (62%) > TX-45 (35%) in RSW. Acute toxicities of MPs and their degradation products fluctuated during PS/ZVA treatment both in DW and RSW samples and resulted in different relative inhibition values after 120-minute. The original and PS/ZVA-treated TX-45, IOPA and BPA in DW exhibited neither cytotoxic nor genotoxic effects, whereas CIP oxidation ended up in degradation products with genotoxic effects.

CSF flow patterns in the brain in patients with neuro-Behçet disease and Behçet disease

OBJECTIVE

In the etiopathogenesis of Behcet disease (BD) and Neuro-Behcet disease (NBD), vascular eclipse occurs in both the arteries and veins. The disease affects all vascular structures. The present study evaluates the use of Phase Contrast (PC) Cerebral Spinal Fluid (CSF) Flow Magnetic Resonance Imaging (MRI), a non-invasive technique for measuring CSF dynamics, for determining the level of aqueducts that are influenced in BD and NBD.

PATIENTS AND METHODS

The quantitative evaluation of CSF flow in BD and NBD was performed using images obtained at the level of the cerebral aqueduct on the semi-axial plane. The PC-MRI angiography technique was used.

RESULTS

There is no distinctive difference between BD and NBD that can be distinguished by the aqueduct diameters of both conditions. A clear increase in aqueduct diameter occurred BD and NBD group when compared to the control group. While there were no differences found between the BD group and the control group regarding peak velocity, average velocity, forward flow, reverse flow, net forward flow, and flow, there were distinctive increases in these various factors in the NBD group.

CONCLUSIONS

Using the non-invasive PC-MRI technique, this study found that in BD and NBD patients, changes occurred in CSF flow figures. Increases in CSF parameters were also observed in NBD patients, a finding which may be helpful for future distinction between BD and NBD during diagnosis.

Epidemiological and Molecular Studies on Lumpy Skin Disease Outbreaks in Turkey during 2014-2015

This study was carried out to explore epidemiological and molecular features of lumpy skin disease virus (LSDV) in the Aegean, Central Anatolian and Mediterranean regions of Turkey, to evaluate the risk factors associated with LSDV infection and to investigate the financial impact of LSD and potential role of the Culicoides spp. in the transmission of LSDV. Samples were obtained from 611 cattle, each from different farms, and each clinically suspected to be infected with LSDV during the months of July 2014 and June 2015. Culicoides spp. were trapped from April to June 2015. Genetic characterization of the local LSDV field isolates was conducted by sequencing G-protein-coupled chemokine receptor gene segment. Real-time PCR high-resolution melting analysis was used for distinguishing each type of capripoxviruses. Viral DNA was detected in 448 of the 611 animals and Culicoides midges. Three hundred and ninety-three of the 448 affected farms were surveyed. The morbidity and mortality rates detected were 12.3% and 6.4%, respectively. Phylogenetic analysis showed that the field isolates in this study were clustered together with other Africa and Middle East isolates. Genotyping of isolates from infected cattle has revealed the presence of LSDV. A generalized mixed linear model showed that there were positive associations between LSDV infection, European breeds, small-sized family-type farms and nearness of farm to a lake. The financial cost of disease presence in surveyed cattle farms was estimated to be 72.75 GBP per head. The sequence analysis of the mitochondrial cytochrome oxidase subunit I gene showed that the species of Culicoides in LSDV-positive pools was Culicoides punctatus. Detection of LSDV in Culicoides punctatus suggests that it may have played a role in transmitting LSDV. Furthermore, movement of infected animals into disease-free areas increases the risk of the transmission of LSD. Control strategies for LSDV infection should include consideration of the risk factors identified in this study.

Assessment of hearing via otoacoustic emission in patients that underwent spinal anesthesia

OBJECTIVE

In this study, our aim is to show the differences between the preoperative and postoperative otoacoustic emissions (OAE) value in patients, who underwent spinal anesthesia.

PATIENTS AND METHODS

The presented study was carried out as a randomized, double-blinded, prospective study upon the approval of Ethics Committee of Medicine School, Erciyes University. The study was conducted in accordance with the Helsinki Declaration. The study involved 39 ASA I-II patients (aged 18-65 years), who underwent varicectomy operation in the Cardiovascular Surgery Department. For each of the patients, 3 OAE measurements were performed; the day before surgery, during surgery and the 1st day after surgery.

RESULTS

Significant differences were detected between the 2000 F2 measurements performed before, during and after the surgery (p<0.05). The differences originated from measurements performed before and during surgery. Significant differences were detected among 3000 F1 measurements performed before, during and after surgery (p<0.05). Hearing loss is one of the late complications of spinal anesthesia. In this study, we observed the differences between the preoperative and postoperative OAE values. The incidence of hearing loss detectable with auditory measurements has been reported to vary between 10 and 50%. Of these, 25% is clinically relevant or recognizable. However, it is considered to be a subjective test, because it is influenced from mental, motor and psychological status of the patient. But the management in hearing loss following spinal anesthesia is still controversial. Hearing loss is generally spontaneously resolved within a few days. However, there are case reports of hearing loss lasting for months.

CONCLUSIONS

In this study, we observed differences between some preoperative and postoperative OAE values.

Plasma amino acid profile in autism spectrum disorder (ASD)

OBJECTIVE

In our study, we aimed to reveal pathophysiologic mechanisms in ASD by comparing plasma amino acid levels between patients and healthy controls while considering vitamin B12 and D levels.

PATIENTS AND METHODS

The study included 21 patients aged 2-18 years-old who were followed with a diagnosis autism spectrum disorder (ASD) and 21 age and sex-matched healthy children from our outpatient clinic as control group.

RESULTS

The study included 42 children and adolescents aged 2-18 years-old (19 girls and 23 boys). There were no significant differences in terms of body weight and height between the groups. We found significant differences in levels of ammonium, phosphoethanolamine, histidine, homocysteine, carnosine, methionine, cystathionine, cystine, threonine, 3-methyl histidine and phenylalanine/tyrosine ratio between patient and control groups. Both vitamin B12 and D were significantly lower in the ASD group compared to controls. In the variance analysis with vitamin B12 and D as covariates, significant differences persisted for only phosphoethanolamine (p=0.04), cystathionine (p<0.001), cystine (p=0.006) and threonine (p=0.02).

CONCLUSIONS

Further studies are needed on the amino acids that show variations in children with ASD in order to reveal their role in the etiology and therapeutic use in ASD.

Role of circulating nesfatin-1 in the underweight children with poor appetite

OBJECTIVE

To investigate serum concentration of nesfatin-1 in underweight children who have poor appetite, and its association with anthropometric markers of malnutrition.

PATIENTS AND METHODS

We recruited 50 underweight children and adolescents (aged 2-18 years) who presented with loss of appetite. Thirty age- and sex-matched controls were also included in the study. Fasting serum nesfatin-1 concentrations were measured by using Enzyme-Linked Immunosorbent Assay (ELISA) technique.

RESULTS

Mean nesfatin-1 level was significantly higher in underweight children when compared to controls (p<0.001). There was no correlation between serum nesfatin-1 levels and anthropometrics markers.

CONCLUSIONS

Our results suggest that nesfatin-1 might have an important role in regulation of food intake and pathogenesis of loss of appetite in children.

The contribution of computed tomography to nasal septoplasty

PURPOSE

The aim of this study was to determine the contribution of computed tomography (CT) scanning to nasal septoplasty.

METHODS

The study included 76 patients, on whom septoplasty was planned to be performed because of deviated nasal septum. The patients were divided into 2 groups: those who had a CT scan (group 1, study group) and those who did not have a CT scan (group 2, control group) before septoplasty. Pathologic anatomic structures accompanying deviated septum and surgical interventions performed in addition to septoplasty were determined. The patients were asked the degree of improvement in nasal air passage obstruction, and 2 groups were compared with each other.

RESULTS

Group 1 included 40 patients, and group 2 had 36 patients. In group 1, the pathologic findings determined along with deviated septum were concha bullosa in 14 patients, retention cyst of the maxillary sinus in 2 patients, paradox middle nasal concha in 2 patients, inferior concha hypertrophy in 18 patients, frontal osteoma in 1 patient, antrochoanal polyp in 1 patient, and chronic sinusitis (maxillary, ethmoidal, frontal) in 7 patients. Lateral resection was performed for concha bullosa; out-fracture with submucosal cauterization was performed on the patients with inferior concha hypertrophy, and endoscopic sinus surgery was performed for the patients with chronic sinusitis and antrochoanal polyp.

CONCLUSIONS

Computed tomography is able to recognize some pathologic findings that cannot be found on physical examination and is helpful to decide the location and the type of the surgery. Additional surgical interventions owing to CT performed before the septoplasty are much more helpful to relieve the patient's nasal air passage obstruction.

Oxaliplatin and ototoxicity: is it really safe for hearing?

BACKGROUND/AIM

Oxaliplatin is an effective and widely used chemotherapeutic agent in the treatment of many solid tumors. The most common side effects are peripheral neuropathy, gastrointestinal toxicity, and neutropenia. There have been some case reports about ototoxicity with oxaliplatin, but no clinical trials. In this trial, we explored whether or not oxaliplatin has ototoxic effects.

MATERIALS AND METHODS

A total of 18 patients, 14 with colorectal cancer and 4 with pancreatic cancer, were included in this study. Four patients (22%) were treated with a capecitabine and oxaliplatin (CapeOx) regimen, and 14 patients (78%) were treated with fluorouracil, leucovorin, and oxaliplatin (FOLFOX-6). Patients' pretreatment and posttreatment hearing levels were assessed with high-frequency audiometry and otoacoustic emission tests.

RESULTS

The median time between the first and the last oxaliplatin doses was 3.2 months (range: 2-7 months). There was no hearing loss in tests conducted for both ears of patients at frequencies of 500, 1000, 2000, 4000, 6000, 8000, 12,000, and 16,000 Hz. There was no difference between the pretreatment and posttreatment otoacoustic emission tests.

CONCLUSION

Oxaliplatin is a reliable agent in terms of ototoxicity.

The evaluation of serum N-terminal prohormone brain-type natriuretic peptide, troponin-I, and high-sensitivity C-reactive protein levels in children with congenital heart disease

Although advanced diagnostic and treatment methods are available, congenital heart disease (CHD) holds an important place among the causes of death within the first year of age. Therefore, several prognostic factors are needed for diagnosis and monitoring of these patients. In this study, which includes 66 CHD patients and 38 healthy control children, serum cardiac troponin-I (cTnI), high-sensitivity C-reactive protein (Hs-CRP), and N-terminal prohormone brain-type natriuretic peptide (NT-proBNP) levels were analyzed for their prognostics values. The patient groups were categorized and then evaluated as cyanotic ( n = 16), acyanotic ( n = 50), symptomatic ( n = 23), asymptomatic ( n = 43), and isolated ventricular septal defect (VSD)-isolated atrial septal defect (ASD) groups. Cyanotic group was statistically compared with acyanotic group, symptomatic group with asymptomatic group, and VSD group with ASD group. Between the cyanotic, acyanotic, and control groups; between symptomatic and asymptomatic groups; and between the VSD and ASD groups, significant difference was not showed for age ( p > 0.05). NT-proBNP was found to be significantly higher in the cyanotic group than acyanotic and control group, in the symptomatic group than asymptomatic group; and in the patient group than healthy control group ( p < 0.05). Between the groups of VSD and ASD, significant difference was not showed ( p > 0.05). The same comparison results for TnI and Hs-CRP were not significant ( p > 0.05). TnI and Hs-CRP were only found significantly higher in the patient group than healthy control group ( p < 0.05). Eventually, we think that NT-proBNP, Hs-CRP, and TnI might be used for clinical management and estimation of outcome of these disorders in the future and these also might be able to modify existing strategies, but much more studies are needed.

A male newborn with Simpson-Golabi-Behmel syndrome, presenting with metopic synostosis, anal atresia, and total anomalous pulmonary venous return

Simpson-Golabi-Behmel syndrome is a clinical condition described by Simpson, characterized with multiple congenital anomalies and caused by Glypican 3 (GPC3) mutations of the X-linked gene. Typical findings such as overgrowth, hypoplastic changes of hands and feet, visceromegaly, cleft palate and macrocephalic distinctive facial features and multiple organ anomalies might be observed. GPC3 mutation is claimed to generally cause metopic synostosis. This case was reported because even though a lot of anomalies accompanying Simpson-Golabi-Behmel syndrome had been noticed, combination of metopic synostosis, has not been reported before.

Effects of high-frequency bio-oxidative ozone therapy in temporomandibular disorder-related pain

OBJECTIVE

It was the aim of this study to compare the efficacy of ozone therapy and drug treatment in patients with painful temporomandibular joint (TMJ) disorder (TMD).

SUBJECTS AND METHODS

A total of 63 patients with TMD were enrolled; 33 were treated with bio-oxidative therapy and 30 with a ketoprofen tablet thiocolchicoside capsule 2 × 1 for 7 days. Maximum voluntary interincisal mouth opening (MMO) was measured in millimeters using a scale and recorded during the pre- and posttreatment periods. The patients evaluated their subjective pain using a visual analogue scale (VAS). Data were analyzed using the Mann-Whitney U test, the Kolmogorov-Smirnov test, and the independent t test.

RESULTS

The mean MMO of the group that received ozone therapy during the pretreatment period was 46.51 ± 8.2 mm, and it immediately increased to 48.78 ± 7.5 mm after 1 week of ozone therapy, which was statistically significant (p = 0.04). For those who received medication, the mean MMO during the pretreatment period was 46.30 mm, and at the end of 1 week it was 46.9 mm. In the ozone group, 29% of patients showed a gradual decrease in their VAS pain scores compared to pretreatment values (6.3 ± 2.1 to 3.0 ± 2.2). In the medication group, 24% of patients showed a significant decrease in VAS pain scores during the follow-up period (6.9 ± 1.4 to 5.0 ± 1.5).

CONCLUSION

This study showed that bio-oxidative therapy was a more effective treatment than medication therapy for relieving TMJ pain.

Canalicular adenoma of the palate

Canalicular adenomas are uncommon, benign epithelial neoplasm of the salivary glands that usually involve the upper lip and the buccal mucosa of elderly people. Differential diagnosis of the canalicular adenoma versus adenocarcinoma is important because it may result in unjustified radiotherapy or extensive and aggressive surgery. Despite the benign nature of canalicular adenomas, complete surgical removal and a regular clinical follow-up are recommended. The current study describes the diagnostic procedures, surgical management, and follow-up of a canalicular adenoma involving the palate of a 79-year-old man.

Determination of trace metal ions by AAS in natural water samples after preconcentration of pyrocatechol violet complexes on an activated carbon column

A simple preconcentration method is described for the determination of Cu, Mn, Co, Cd, Pb, Ni and Cr in water samples by flame AAS. Trace metal ions in water were sorbed as pyrocatechol violet complexes on activated carbon column at the pH range of 4-8, then eluted with 1 M HNO(3) in acetone. The effect of major cations and anions of the natural water samples on the sorption of metal ions has been also investigated. The concentration of the metal ions detected after preconcentration was in agreement with the added amount. The present method was found to be applicable to the preconcentration of Cu, Mn, Co, Cd, Pb, Ni and Cr in natural water samples with good results such as R.S.D. from 3 to 8% (N=10) and detection limits under 70 ng l(-1).

Ischaemia-modified albumin elevation after percutaneous coronary intervention reflects albumin concentration rather than ischaemia

Background

Percutaneous coronary intervention (PCI) is accepted as a model of myocardial ischaemia in studies of ischaemia markers, especially of ischaemia-modified albumin (IMA). However, there is concern that IMA levels may reflect changes in albumin concentrations rather than myocardial ischaemia also during PCI.

Methods

Twenty-one consecutive patients (17 men and 4 women) undergoing single-vessel percutaneous coronary angioplasty were enrolled in the study. IMA and albumin levels were measured together with myoglobin, creatine kinase 2 and cardiac troponin I, before (Group 1), immediately after (Group 2) and 6 h after (Group 3) the procedure of PCI.

Results

The IMA levels of Group 2 were significantly higher than those of Group 1 and Group 3 ( P < 0.05 for both). However, correction of IMA by multiplying with the (individual albumin concentration of the patient/median albumin concentration of Group 1) ratio gave no statistical differences between the groups ( P > 0.05). There were strong negative correlations between IMA levels and albumin concentrations within individual groups ( r = −0.757, P < 0.001; r = −0.712, P < 0.001; and r = −0.705, P < 0.001 for Group 1, Group 2 and Group 3, respectively).

Conclusion

The results confirm the close dependency of IMA results on albumin concentrations. Therefore, IMA results reflect albumin concentrations rather than myocardial ischaemia also in PCI. This situation and lack of standard reference materials for the albumin cobalt binding assay can lessen the diagnostic performance of IMA.

The frequency of consanguineous marriage in eastern Turkey

The frequency of consanguineous marriage in Eastern Turkey:

OBJECTIVE

The rate of consanguineous marriage (CM) varies depended on different factors such as race, characteristics of population, and religion and moral features in different countries. Gene frequency and genetic structure are changed by CMs. The aim of the present study is to assess the prevalence of CM and its effects on miscarriage, stillbirth, congenital malformation and ratio of newborn death.

METHODS

This study was performed in Van region, Eastern Turkey, between September 2005 and April 2006. A total of 650 families from 24 districts chosen in accordance with the number of inhabitants were included in this study. First cousin marriages were accepted as a first degree CMs, sesquialter and second cousin marriages as second degree and marriages between distant relatives were accepted as a third degree CM. Monthly income of the families was classified in accordance with minimum wage determined by government.

RESULTS

Of all families, 224 (34.4%) had CM, and 168 (75%) had first-degree consanguinity. A lower CM rate was found in mothers who graduated from secondary school or upgrading (p < 0.01). However, no relationship was found between CM and fathers' education level. While a low CM rate was found in families who had two or less children (p < 0.01), high rate was observed in families who had five or more children. In addition, a high rate of miscarriage, stillbirth and mental-motor retardation was found in families with CM (p < 0.05). The rate of child mortality between the aged 0-2 years was found to be higher in families with CM (p < 0.01). The higher CM rate was observed in families who married due to pressure or insistence of their families than married voluntarily (p < 0.05).

CONCLUSION

Our study showed that CM rate was very high, 34.4%, in our region Eastern Turkey.

Impact of calcineurin inhibitors on bone metabolism in primary kidney transplant patients

OBJECTIVE

Posttransplant bone disease and bone metabolism markers were investigated in primary kidney transplant recipients receiving calcineurin inhibitor (CNI) based triple immunosuppression. We examined the safety profile and independent potential of CNIs on bone formation and bone resorption. The study also attempted to correct for modifiable and nonmodifiable factors that impact on posttransplantation bone metabolism, such as age, renal function, rejection, steroid dosage, and secondary hyperparathyroidism.

MATERIALS AND METHODS

Serum alkaline phosphatase and osteocalcin were used as indices of bone formation and urinary deoxypyridinoline as a marker for bone resorption. Bone mineral density (BMD) data were assessed in all patients. Osteocalcin and deoxypyridinoline data were correlated with BMD scores to predict the clinical utility and sensitivity of these tests. Sixty-six patients among 300 kidney transplant recipients were enrolled as eligible candidates based upon more than 12 months' posttransplantation follow-up excellent graft function (GFR values >60 mL/min), and intact parathormone levels <100 pg/mL.

RESULTS

Mean follow-up was 1395.3 +/- 179.3 days and 1488.9 +/- 225.1 days for cyclosporine (CsA) and FK506 groups, respectively. Mean values for alkaline phosphatase and osteocalcin were 108.8 +/- 6.0 versus 98.4 +/- 9.7 U/L and 10.1 +/- 1.2 versus 9.8 +/- 1.5 ng/mL for the CsA and FK506 groups, respectively. Both CsA and FK506 caused mild osteoblastic proliferation and matrix mineralization activity, as reflected by increased osteocalcin and alkaline phosphatase levels in 22.6% and 12.5% of patients, respectively. This bone formation activity was counterbalanced by a three-fold increase in urine deoxypyridinoline levels in both groups. Mean deoxypyridinoline levels were, respectively, 13.8 +/- 4.4 versus 11.3 +/- 2.1 nM/mMCr in the CsA and FK506 groups. Thirty-four (68%) patients in the CsA and 10 (62.5%) in the FK506 groups had elevated deoxypyridinoline levels. A strong correlation existed between deoxypyridinoline levels and BMD scores for the CsA group (P < .0001). Despite the presence of relatively greater elevations in deoxypyridinoline and BMD values among CsA-treated patients, there was no significant difference in terms of bone resorption potential of both groups. No correlation existed between iPTH values (<65 pg/mL or among 65 to 98.2 pg/mL) at any time versus osteocalcin, alkaline phosphatase, deoxypyridinoline, or BMD levels. The symptomatic bone disease and fracture rates were 0% in this series.

CONCLUSION

Calcineurin inhibitor-based immunosuppression with low maintenance doses of glucocorticoids induces slight bone formation but relatively potent, clinically relevant bone resorption.

Two-day induction with thymoglobulin in kidney transplantation: risks and benefits

INTRODUCTION

The aim of this study was to develop an induction protocol to reduce allograft rejection with fewer posttransplant infections and malignancies.

METHODS

In this prospective randomized study, a T- and B-cell depletion protocol, consisting of IV thymoglobulin (ATG 5 mg/kg/d) plus methylprednisolone (500 mg/d) plus azathiopurine (2 mg/kg/d), was on days 0 and 1 after renal transplantation. CyA was introduced at day 3.39 among patients undergoing either primary living related (n = 16) or cadaveric (n = 23) transplants excluding recipients of full-HLA-matched sibling, or five- and six-HLA-matched cadaveric donor kidneys. The adequacy of immunosuppression was evaluated by flow cytometric analysis for total, CD3+ (T-cell), and CD19+ (B-cell) lymphocytes.

RESULTS

The acute rejection rate was 6% and 37/39 patients are alive with functioning grafts at an average follow-up of 14.5 months. The overall patient and graft survival rate was 95%. Their mean creatinine value was 1.27 mg/dL. Six patients (16%) required hospitalization due to serious infections. The two deaths were attributed to septicemia and brain abcess caused by unusual agents, namely, Rhodococcus equi and Sporobolomyces. One patient presented with a cutaneous Kaposi sarcoma in the 11th month posttransplant.

CONCLUSION

A Two-day induction protocol with thymoglobulin yields acceptable acute rejection rates among renal transplants. However, caution is necessary for adverse events, particularly atypical bacterial and fungal infections.

[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.

The effect of alternate-day low dose prednisolone on bone age in children with steroid dependent nephrotic syndrome

Radius, ulna, short bones (RUS), carpal (CARP) bone age (BA), tibial cortico-diaphyseal (C/D) ratio and trabecular aspect were assessed in 19 children with steroid dependent nephrotic syndrome and 15 age matched healthy children. Both RUS and CARP BA were significantly lower than in the controls. Trabecular aspect and tibial C/D ratio did not show any statistical significance. There was a positive correlation between HSDS and RUS BA delay (r = -0.476, p < 0.05); CARP BA delay and RUS BA delay (r = 0.563, p < 0.01) and RUS BA and CARP BA (r = 0.891, p < 0.001). In conclusion, RUS and CARP BA are both retarded and positively correlated in steroid dependent nephrotic children.

The application of a double voltage modulation technique to a glow discharge source with a supplementary electrode

The Ar spectral lines are suppressed in glow discharge source atomic emission spectroscopy by a double voltage modulation technique with a supplementary electrode. The voltage is modulated between two levels, typically 350 and 700 V. At the lower voltage level mainly the Ar emission occurs where at the higher voltage level both the Ar and the metal atoms sputtered from the sample contribute to the emission. The power supply of the supplementary electrode is switched on when the glow discharge passes from operation at 700 V to 350 V. The intensity of argon gase lines is regulated by the current applied to the supplementary electrode at that period. Therefore, there is no need for electronical amplification and lower voltage adjustment of two operation modes. This modified DVM technique has been applied to the determination of Si and Cu in Al- samples. The suppression of Ar lines is possible, and the elements can be determined without Ar interferences.

Ritodrine tocolysis and neonatal intraventricular-periventricular hemorrhage

Betamimetic drugs are commonly used for tocolytic therapy. To determine their potential role in periventricular-intraventricular neonatal hemorrhage (IVH), 103 preterm births with cranial ultrasonography results were evaluated for the history of betamimetic therapy. The study group was divided into three subgroups according to the cause of the preterm delivery: 44 patients were accepted as tocolysis failure (group A); 53 patients were too late for tocolysis (group B), and these latter cases were taken as controls for group A; for the remaining 6 patients, tocolysis was contraindicated due to fetomaternal reasons (group C), and these cases were not included in the analysis. In group A, 32 patients got ritodrine, 6 patients got combined therapy including ritodrine plus magnesium sulfate or nifedipine. When cases in group A who got ritodrine only or combined therapy are compared with the no-treatment group, no significant difference in neonatal IVH incidences could be found (p > 0.005). Ritodrine does not appear to affect the incidence of neonatal IVH.

Organochlorine pesticide residues in human milk in Kayseri

In this study: dichlorodiphenyltrichloroethane (DDT) and its metabolites [DDT + dichlorodiphenyl-dichloroethylene (DDE)], BHC (HCH) and their main isomers such as alpha, beta, gamma BHC, aldrin and its metabolite dieldrin, heptachloride, heptachloride epoxide, were investigated in 51 samples of breast milk of 51 lactating women during 1988. The ages of the mothers, who were working in agriculture, ranged from 17 to 33 y (mean 24.2 y). The concentrations of hexachlorobenzene (HCB), alpha BHC, beta BHC, gamma BHC, heptachloride, aldrin, heptachloride epoxide, pp'DDE, dieldrin, op'DDT, pp'DDT were found as 84 +/- 23, 96 +/- 20, 522 +/- 120, 156 +/- 20, 198 +/- 130, 47 +/- 9, 11 +/- 4, 2389 +/- 280, 6.7 +/- 3, 70 +/- 12, 410 +/- 60 micrograms kg-1 milk, fat, respectively, measured by gas chromatography (GC) method. The concentrations of chlorinated pesticides in human milk samples from Kayseri were compared with similar data obtained from other countries. The amounts of total BHC and aldrin derivatives were below the acceptable daily intake (ADI), whereas the amount of total DDT derivates was above, of the World Health Organization (WHO).

Bilateral parotid duct fistula. Case report

Parotid duct fistulas (PDFs) are rare and have various causes such as gunshot wounds and human and animal bites; they may also be congenital. We have not found previous publications on bilateral PDF. Our patient, although young, also had generalized pigmentation characteristic of aging and thick, dry, wrinkled skin, as well as pyoderma. Biochemical analysis was performed on discharge from the patient's face, and histopathologic and immunologic studies were done. The fistulas were treated by intraoral fistulization. Cephalosporins were given to the patient for 5 days postoperatively to treat the pyoderma.

Pendred's syndrome

Although 5% of all cases of congenital deafness are caused by Pendred's syndrome, there are few reports in the literature. Seven patients with Pendred's syndrome in three families living in the same village were detected. For that reason, the syndrome is reviewed in light of the literature. The sex distribution of the patients with Pendred's syndrome and their families was recorded. We tested for thyroxine, triiodothyronine, thyroid-stimulating hormone, triiodothyronine resin uptake, and perchlorate, and performed caloric testing. In one patient, subtotal thyroidectomy was performed. In the histopathologic study, a thyroid nodule filled with colloid was found. Chromosome studies showed no anomalies in any patient. Five of the patients were deaf-mutes. We observed that the parents were cousins in all three families. These families also had healthy children, and the existence of the syndrome in both sexes points to an autosomal recessive trait.