Insulin sensitivity and hyperprolactinemia

It has been shown that prolactin (PRL) induces glucose intolerance, hyperinsulinemia and insulin resistance in several animal species. In women with microprolactinomas, the sensitivity to insulin is lower in hyperprolactinemia than in normoprolactinemia. Thirty non-obese women with hyperprolactinemia and 30 healthy non-obese women were included into the study. Age, body weight (bw), height, body mass index (BMI), waist circumference, hip circumference and waist to hip ratio of both patients with hyperprolactinemia and control subjects were not different. Mean serum prolactin level was higher in hyperprolactinemic patients than in control group (84.5 +/- 51.1 ng/ml and 13.8 +/- 5.3 ng/ml respectively, p<0.002). Mean HOMA-(%B) index of hyperprolactinemic patients was higher than in control subjects (121 +/- 49 and 84 +/- 38, respectively, p<0.02). Mean HOMA-(%S) index was lower in hyperprolactinemic patients (56 +/- 39 and 105 +/- 55, respectively, p<0.006). Serum total testosterone, free testosterone, androstenedione, estradiol, cortisol, sex hormone binding globulin and DHEA-S levels in both hyperprolactinemic women and healthy subjects, statistically did not show any difference between the two groups. The present data indicate that hyperprolactinemia is associated with an insulin-resistant state. This resistant state may not be a result of obesity, androgenic hormones, and SHBG or pregnancy. It may be the result of serum free fatty acids (FFA) levels, decrement in the number of insulin receptors (by a down-regulation of insulin receptors) or post-binding defect in insulin action or more.

Amblyopia and refractive errors among school-aged children with low socioeconomic status in southeastern Turkey

PURPOSE

To investigate the prevalence of refractive errors and other eye diseases, incidence and types of amblyopia in school-aged children, and their relation to gender, age, parental education, and socioeconomic factors.

METHODS

A total of 21,062 children 6 to 14 years old were screened. The examination included visual acuity measurements and ocular motility evaluation. Autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus were performed.

RESULTS

There were 11,118 females and 9,944 males. The average age was 10.56 ± 3.59 years. When all of the children were evaluated, 3.2% had myopia and 5.9% had hyperopia. Astigmatism 0.50 D or greater was present in 14.3% of children. Myopia was associated with older age, female gender, and higher parental education. Hyperopia was inversely proportional with older age. Spectacles were needed in 4,476 (22.7%) children with refractive errors, and 10.6% of children were unaware of their spectacle needs. Amblyopia was detected in 2.6% of all children. The most common causes of amblyopia were anisometropia (1.2%) and strabismus (0.9%).

CONCLUSION

Visual impairment is a common disorder in school-aged children. Eye health screening programs are beneficial in early detection and proper treatment of refractive errors.

Radical vs conservative surgery for hydatid liver cysts: experience from single center

AIM

To compare the efficacy and safety of radical and conservative surgical interventions for liver hydatid disease.

METHODS

The study comprised 59 patients in two groups who had undergone radical and conservative surgical procedures for liver hydatid disease in our department between 2004 and 2009. Preoperative diagnostic tools, medical treatments, demographic and clinical characteristics, postoperative follow-up, and recurrence were compared in both groups.

RESULTS

This non-randomized retrospective study included 59 patients who had undergone liver hydatid disease surgery. The radical technique was used in 18 patients (mean age: 42.1 +/- 13.5 years, seven male, 11 female), and the conservative technique was used in 41 patients (mean age: 43.5 +/- 13.9 years, 17 male, 24 female). The follow-up period ranged from 3 to 58 mo. Although operative time was significantly shorter in the conservative group (P < 0.001), recurrence was significantly reduced in the radical group (P = 0.045). No statistically significant differences were found in terms of hospitalization duration, cyst count and size, location, postoperative complications, scolicidal solution usage, or follow-up duration between the two groups.

CONCLUSION

The more effective method for preventing postoperative recurrence is radical surgery. Endoscopic retrograde cholangiopancreatography for bile leakage in the early postoperative period may decrease the requirement for repeat surgery.

The epidemiological aspects of irritable bowel syndrome in Southeastern Anatolia: a stratified randomised community-based study

Even though studies on the epidemiology of the irritable bowel syndrome (IBS) are increasing day by day, epidemiological data are still unknown in many regions. Our objective was to determine the IBS prevalence, factors associated with this prevalence and probable risk groups in Southeastern Anatolia. The total population in the target region is approximately 6 million. A total of 3000 people (1521 females and 1479 males) randomly selected by stratified cluster sampling were interviewed face-to-face by using a questionnaire comprising demographic features and the Rome II criteria which also included probable risk factors and questions related with Bristol scale stool form. The statistical analysis was performed by using a package program called EPI INFO 2000. IBS prevalence was 10.2% according to the Rome II criteria in our region. Six hundred and twenty-five of 3000 subjects had gastrointestinal symptoms in the last 3 months. IBS rate was higher in women (12.4%) than in men (8.0%), and married subjects had higher IBS rates (11.6%) than singles (6.7%). Those differences were statistically significant (p = 0.000 for both). It was most common in the 35-54-year age group. No difference was observed in terms of settlement (rural/urban), age group, education and occupation. History of abortion in women increased the IBS risk by 1.8 times (p = 0.000 Crude odds ratios = 1.8 (1.3-2.6) 95% confidence intervals). Of the IBS patients, 48.1% had characteristics of diarrhoea-predominance, 38.9% constipation-predominance while 13.0% had none. There was a significant relation between dominant stool form and Bristol scale stool form. IBS prevalence is 10.2% in the first community-based study carried out in this specific subject in Southeastern Anatolia. The dominance of middle age and females remained significant.

Endothelial dysfunction in renal transplant patients is closely related to serum cyclosporine levels

BACKGROUND

Cyclosporine (CsA), one of the standard agents used in renal transplant recipients, has been considered to cause endothelial dysfunction and to contribute to arterial complications posttransplant. Since concentration-dependent effects of CsA on endothelial functions in humans have not been examined, this study was performed to investigate this relationship.

METHODS

Fifteen renal transplant patient and 20 healthy subjects (controls) were evaluated for brachial artery endothelial function using high-resolution vascular ultrasound just before the CsA dosage (baseline) and at the second hour after the administration. Endothelium-dependent and -independent vasodilatations (EDD and EID, respectively) were assessed by establishing of the responses to reactive hyperemia and by using sublingual nitroglycerine, respectively. CsA levels were assessed at baseline and at second hour, times when performing brachial artery measurements.

RESULTS

There were no significant differences between recipients and controls with respect to atherosclerosis risk factors. Mean EDD of recipients at baseline times were significantly less than those in controls (9.1% +/- 5.5% vs 15.2% +/- 7.2%, respectively; P < .001). CsA levels at trough and at second hour were 153.9 +/- 74.8 ng/mL and 646.8 +/- 163.2 ng/mL, respectively (P < .0001). Recipient, EDD at second hour was significantly reduced compared to baseline values (5.3% +/- 3.6% vs 9.1% +/- 5.5% respectively; P = .014) while changes in EID and in the diameter of the brachial artery between baseline and second hour were insignificant.

CONCLUSION

Endothelial dysfunction evaluated by brachial ultrasound in renal transplant recipients is closely related to CsA levels. It is more pronounced at 2 hours after CsA dosage, at the time of peak drug levels.

A head to head comparison of oral vs intravenous omeprazole for patients with bleeding peptic ulcers with a clean base, flat spots and adherent clots

AIM: To compare the effect of intravenous and oral omeprazole in patients with bleeding peptic ulcers without high-risk stigmata.

METHODS: This randomized study included 211 patients [112 receiving iv omeprazole protocol (Group 1), 99 receiving po omeprazole 40 mg every 12 h (Group 2)] with a mean age of 52.7. In 144 patients the ulcers showed a clean base, and in 46 the ulcers showed flat spots and in 21 old adherent clots. The endpoints were re-bleeding, surgery, hospital stay, blood transfusion and death. After discharge, re-bleeding and death were re-evaluated within 30 d.

RESULTS: The study groups were similar with respect to baseline characteristics. Re-bleeding was recorded in 5 patients of Group 1 and in 4 patients of Group 2 (P = 0.879). Three patients in Group 1 and 2 in Group 2 underwent surgery (P = 0.773). The mean length of hospital stay was 4.6 ± 1.6 d in Group 1 vs 4.5 ± 2.6 d in Group 2 (P = 0.710); the mean amounts of blood transfusion were 1.9 ± 1.1 units in Group 1 vs 2.1 ± 1.7 units in Group 2 (P = 0.350). Four patients, two in each group died (P = 0.981). After discharge, a new bleeding occurred in 2 patients of Group 1 and in 1 patient of Group 2, and one patient from Group 1 died.

CONCLUSION: We demonstrate that the effect of oral omeprazole is as effective as intravenous therapy in terms of re-bleeding, surgery, transfusion requirements, hospitalization and mortality in patients with bleeding ulcers with low risk stigmata. These patients can be treated effectively with oral omeprazole.

Clarifying the relationship between ABO/Rhesus blood group antigens and upper gastrointestinal bleeding

BACKGROUND AND AIM

The relationship between blood group antigens and peptic ulcer disease has been widely evaluated in the past. Data concerning the same association with upper gastrointestinal bleeding are very limited. We aimed to evaluate this association and we thought it was worthwhile to try to determine whether these components take some part in this complication.

METHODS

The study population consisted of 1,098 adults (364 patients and 734 volunteer blood donors as controls). Demographic features, comorbid illnesses, and use of aspirin/nonsteroidal anti-inflammatory drugs (NSAIDs) were recorded. Blood groups were examined by gel centrifugation method. We included only patients with bleeding from peptic ulcer disease and erosive gastropathy. Ulcers were classified by using Forrest's classification system in terms of rebleeding risk. Helicobacter pylori was examined by histology.

RESULTS

The gender distribution was similar in both groups. The ABO blood group phenotype distribution in patients and controls (respectively) was as follows: 46.2% versus 34.9% for group O, 32.4% versus 39.5% for group A, 15.7% versus 18.4% for group B, and 5.8% versus 7.2% for group AB. Blood group O was found to have higher frequency in the patient group than in the control group (P=0.004). Rh positivity was also higher in patients than in controls (P=0.007). H. pylori positivity was similar between blood groups among patients. The rebleeding and mortality rates between blood groups were also similar.

CONCLUSION

ABO blood group O had an important role in patients with upper gastrointestinal bleeding. The impact of blood group on rebleeding and mortality may be a focus for further studies.

Lichen planus and hepatitis C virus infection: an epidemiologic study

The reported prevalence of hepatitis C virus (HCV) infection in patients with lichen planus (LP) shows variations from different regions. The aim of this study was to investigate the prevalence of HCV infection in patients with LP, in Diyarbakir region of Turkey. A total of 128 patients with LP and 128 healthy controls were detected for HCV infection, using a third generation enzyme-linked immunosorbent assay. Eight of 128 patients (6.25%) with LP were found to have anti-HCV antibodies, whereas only one patient (0.78%) in control group was found to have anti-HCV antibodies. A statistically significant difference was found between LP and control group (p < 0.001). In conclusion, the coexistence of HCV infection and lichen planus is more than coincidental, and it is appropriate to screen all patients with lichen planus for HCV infection.

Autonomic dysfunction detection by an automatic pupillometer as a non-invasive test in patients recovered from COVID-19

Purpose

To recognize dysfunctions in the autonomic nervous system (ANS) with changes in dynamic and static pupillary responses in patients who recovered from coronavirus disease-2019 (COVID-19)

Methods

One month after recovery from COVID-19, patients were subjected to eye examinations. Pupillary responses were measured using a pupillometry system. Dynamic pupil parameters (i.e., pupil contraction amplitude, pupil dilatation latency, pupil contraction latency, pupil dilatation duration, pupil dilatation velocity, pupil contraction duration, pupil contraction velocity, resting pupil diameter [PD]) and static pupil parameters (i.e., mesopic PD, scotopic PD, high photopic PD, and low photopic PD) were registered.

Results

Although high photopic and scotopic PDs were significantly higher in patients recovering from COVID-19 than in healthy controls (P = 0.04 and P = 0.002), no statistically significant difference was found in mesopic and low photopic PD (P = 0.19 and P = 0.41). Regarding dynamic pupillometry parameters, resting PD and pupil contraction velocity (P = 0.04 and P = 0.02, respectively) were significantly higher in patients recovering from COVID-19 than in healthy controls (P < 0.001 and P < 0.001, respectively), whereas pupil dilatation latency and pupil contraction duration were lower in these patients than in healthy controls (P = 0.01 and P = 0.008, respectively). No significant differences in pupil contraction amplitude, pupil dilatation duration, pupil contraction latency, and pupil dilatation velocity were found between the study groups (P = 0.93, P = 0.91, P = 0.42, and P = 0.48, respectively).

Conclusion

Pupil responses, which are controlled by the ANS, were impaired in patients recovering from COVID-19. Pupillometry shows promise as a non-invasive, easy-to-apply diagnostic technology for detecting autonomic dysfunction in patients recovering from COVID-19.

Clinical trial registration

Not applicable.

Replacement of hystological findings: serum hyaluronic acid for fibrosis, high-sensitive C-reactive protein for necroinflamation in chronic viral hepatitis

Because of limitations in biopsy procedure, several non-invasive tests have been developed for predicting the histological findings in chronic hepatitis. A fibrosis (F) score 1 or above and necroinflammation [histological activity index (HAI)] score 4 or above are required to initiate the treatment in chronic viral hepatitis. Literature includes many studies on hyaluronic acid (HA) as a non-invasive procedure in predicting histological findings but lacks on high-sensitive-C-reactive protein (hsCRP). We evaluated the diagnostic value of HA and hsCRP in patients with chronic viral hepatitis. Ninety-eight subjects (42 chronic viral hepatitis, 28 cirrhosis and 28 healthy controls) were included in the study. Liver biopsies were performed on 42 chronic hepatitis patients and assessed by Ishak scoring system. All sera were stored at -70 degrees C until assay. Many laboratory parameters related to viral hepatitis, HA and hsCRP were studied following the instructions. We tried to determine a cut-off value for HA to represent > or =F1 score and that for hsCRP to represent > or =4 HAI score. Hepatitis B virus was the predominant aetiology of chronic hepatitis in our study. Mean HA levels were 113, 754 and 24 ng/ml in patients with chronic hepatitis, cirrhosis and controls, respectively (anova, p < 0.001). A HA level >64.7 ng/ml had a 100% specificity for diagnosing chronic hepatitis. A value > or =154 ng/ml had a 100% specificity, 100% positive predictive value and 90% negative predictive value for diagnosing liver cirrhosis (Area 1.00; p < 0.0001). A cut-off value of 63 ng/ml for HA had a 100% specificity for diagnosing fibrosis score > or =1 in chronic hepatitis (Area 0.86; p < 0.001). An hsCRP level >0.56 mg/dl had a 100% specificity and 12% sensitivity for diagnosing chronic hepatitis (Area 0.71; p = 0.002), while cut-off of 0.53 mg/dl had 75% specificity for diagnosing HAI > or = 4 in chronic hepatitis (Area 0.32; p = 0.132). This study supported the HA level in predicting fibrosis score > or =1 with a cut-off value of 63 ng/ml. Cut-off of 154 ng/ml had a strong worth for cirrhosis. A cut-off of hsCRP for predicting HAI score > or =4 warrants further evaluation in wider study populations. We concluded that we are a bit closer to the strategy for guiding therapy in patients with chronic hepatitis, without a liver biopsy.

How to Increase the Diagnostic Value of Malignancy-Related Ascites: Discriminative Ability of the Ascitic Tumour Markers

Making a differential diagnosis between malignant and non-malignant ascites is an important clinical issue, but cytological examination has a relatively low diagnostic sensitivity. This study aimed to find a discriminative model that distinguished between malignancy-related and non-malignant ascites. The study included 107 patients: 50 with non-malignant and 57 with malignant ascites. Ascites was analysed using a range of tumour markers and standard cytology. Standardized canonical discriminant function coefficients were used to distinguish between ascites types. The combination of carbohydrate antigen (CA) 15-3, carcinoembryonic antigen (CEA) and cytokeratin 19 fragments (CYFRA-21.1) discriminated between malignancy-related ascites and non-malignant ascites with an accuracy of 98.8% compared with an accuracy of 77.8% for cytological examination. In conclusion, the use of a discriminant function constructed from a combination of CA15-3, CEA and CYFRA-21.1 could distinguish malignant from non-malignant ascites with greater accuracy than cytological examination. Further studies in larger population groups are warranted.

Primary squamous cell carcinoma of the stomach: a case report and review of the literature

Primary squamous cell carcinoma of the stomach is extremely rare. To date, only 80 cases have been reported. A 65-year-old man with complaints of epigastric pain and cachexia for the past year is presented. He had a tumour with infiltration of the corpus and antrum of the stomach. The tumour was unresectable, and the patient died within 3 months.

Hepatitis C virus in patients with non-Hodgkin's lymphoma in southeastern Anatolia region of Turkey: a prospective case-control study of 119 patients

Hepatitis C virus (HCV) has been associated with several extrahepatic disorders including mixed cryoglobulinemia (MC), autoimmune thyroiditis, Sjogren's syndrome. Such associations have led to the suggestion that HCV may participate in the development of various immunmediated disorders. Recently, it has been hypothesised that HCV might act as a trigger for the development of monoclonal B-cell disorders such as non-Hodgkin's lymphoma (NHL). Discordant data have been reported in different geographic regions of the world. The aim of this prospective case-control study was to detect the prevalence of HCV in patients with NHL in southeastern Anatolia region of Turkey. In this study, HCV antibody prevalence and cryoglobulinemia were investigated in 119 patients with histologically diagnosed NHL. The control group consisted of 117 patients who visited the outpatient clinic of internal medicine. None of the patients had HCV antibody positive (0%) with the enzyme immunoassay and reverse transcriptase polymerase chain reaction (RT-PCR). One of the control patients had positive HCV antibody (0.9%). Our data does not support the association between HCV infection and NHL in southeastern Anatolia region of Turkey.

Diabetic papillopathy treated with intravitreal ranibizumab

In this report, we present a case of diabetic papillopathy that resolved after a single dose of intravitreal ranibizumab injection. A 50-year-old male presented with painless visual loss in his right eye. His visual acuity was 1/10 in the right eye and 10/10 in the left eye. Anterior segment examination of both eyes was unremarkable. Posterior segment of the right eye showed nonproliferative diabetic retinopathy with a swollen optic disc. Fluorescein angiography and optical coherence tomography were performed. There was dye leakage from the right optic disc. Optical coherence tomography revealed a significant increase in retinal nerve fiber layer thickness. Magnetic resonance imaging of the brain and orbit were normal. The patient received a single intravitreal ranibizumab (0.5 mg) injection. Two weeks after the injection, there was a marked regression of the disc swelling. Three months after the injection the optic disc was pallor and visual acuity was 6/10.

Fibrovascular polyp of the esophagus: diagnostic dilemma

A 51-year-old female patient was admitted to our department. She had symptoms of dysphagia, regurgitation of a fleshy mass into the mouth, and attacks of dyspnea. Every effort was made for diagnosis. At cervical exploration, upper esophageal polyp was discovered incidentally, and removed. We present this case because of rarity and emphasize the clinical presentation. The physician should be aware of the presence of this rare esophageal tumor.

Examination of the effects of COVID 19 on corneal endothelium

PURPOSE

To demonstrate the effects of the disease on the corneal endothelium in individuals recovering from COVID-19 through specular microscopy.

METHODS

Eighty individuals recovering from COVID-19 (group 1) and 72 healthy controls (group 2) were included in this prospective study. After examining visual acuity, refractive defect detection, anterior and posterior segment examinations, and specular microscopy measurements were calculated from images with at least 100 cells. The mean cell density (CD), mean coefficient of variation (CV), mean hexagonal cell percentage, mean cell area (AVG), and central corneal thickness (CCT) were evaluated.

RESULTS

The mean time from diagnosis of the disease in group 1 was 54.25 ± 6.36 days. The mean time elapsed since the PCR test became negative was 38.45 ± 6.87 days. Only four were treated in the hospital. Specular microscopy data showed that the CD was 2713.56 ± 246.25 and 2845.80 ± 299.27 in groups 1 and 2, respectively (p = 0.003). The CV values were 42.92 ± 6.79 and 40.16 ± 5.97, respectively (p = 0.009). The hexagonality were 46.51 ± 7.35 and 49.12 ± 6.87, respectively (p = 0.024). The AVG was 371.60 ± 34.64 and 353.16 ± 35.29, respectively (p = 0.007). The CCT values were 553.00 ± 73.2, and 526.84 ± 33.57, respectively (p = 0.005).

CONCLUSION

A decrease in the number of endothelial cells and hexagonal cells (polymorphism) as well as an increase in the cell area change coefficient (polymegatism) and the average cell area were observed from corneal specular microscopic examination of individuals recovering from COVID-19 in the early period of the disease. These results may be important in understanding the systemic effects of the disease.

Correlation of Tumour Markers in Ascitic Fluid and Serum: Are Measurements of Ascitic Tumour Markers a Futile Attempt?

Correlations between tumour markers in ascitic fluid and serum were investigated to determine whether ascitic fluid analysis had any diagnostic advantage over serum in 91 adults with ascites (55 malign; 36 benign). Serum and ascitic fluid were analysed for carcinoembryonic antigen (CEA), cancer antigen (CA) 125, CA19.9, CA72.4, CA15.3, α-fetoprotein (AFP) and cytokeratin-19 fragment (CYFRA). The tumour markers were skewed between the groups so were logarithmically transformed. Correlations between serum and ascitic fluid were tested using Pearson's correlation coefficient. Serum and ascitic fluid levels of CEA, CA125, CYFRA and AFP in the malign group were statistically different and CEA, CA19.9, CA5.3, CYFRA and AFP were statistically different in the benign group. For both groups, all tumour markers were highly correlated in serum and ascitic fluid, with the exception of CYFRA in the malign group. These results indicate that, where malignant ascites is suspected, analysing tumour markers in ascitic fluid does not have any advantage over serum analysis.

Does adding misoprostol to standard intravenous proton pump inhibitor protocol improve the outcome of aspirin/NSAID-induced upper gastrointestinal bleeding?: a randomized prospective study

Aspirin and nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal bleeding is recognized as an important health problem. We performed a single-center randomized clinical trial to compare the effect of high-dose intravenous proton pump inhibitor (omeprazole) alone (group 1) with omeprazole in combination with a low-dose prostaglandin analog (misoprostol; group 2) on clinical outcomes in patients with aspirin/NSAID-induced upper gastrointestinal bleeding. Additionally, we evaluated the contribution of Helicobacter pylori eradication therapy on the late consequences. Patients were recruited to the study if they had upper gastrointestinal bleeding with history of taking aspirin or other NSAIDs within the week before the onset of bleeding. All were evaluated in terms of probable risk factors. After the standard treatment protocol, patients with histologically proven H pylori infection were prescribed a triple eradication therapy for 14 days. The primary end points were recurrent bleeding, surgery requirement, and death rates before discharge and at the end of follow-up period. This study lasted for 2 years. A total of 249 patients with upper gastrointestinal bleeding were admitted, and 49.7% of these patients were users of aspirin/NSAIDs. There were 67 patients in group 1 and 56 in group 2. The distributions for gender, age, comorbidity, H pylori infection, and high-risk ulcer rate were similar in both groups. Among aspirin/NSAID users, endoscopy revealed duodenal ulcer in 47 (38.2%), gastric ulcer in 10 (8.1%), and erosive gastropathy in 33 (26.8%). The overall rebleeding occurred in 12.2%, death in 2.4% of the patients. The in-hospital death (P=.414), rebleeding (P=.925), and surgery (P=.547) rates were similar in both treatment groups. After the follow-up period of 3 months, overall rebleeding occurred in 4.1%, and death in 4.8% of the patients. The overall mortality rate was highest in those >65 years old, who were chronic low-dose aspirin users with comorbidity. One died of transfusion-related graft-versus-host disease. In this pilot study, we indicated that adding misoprostol (600 microg/day) to standardized proton pump inhibitor treatment did not improve or change the rebleeding or mortality rates of patients with upper gastrointestinal bleeding related to aspirin/NSAID use. Other prospective studies on higher doses of misoprostol are needed to establish the coeffect. One should bear in mind that all blood products must be irradiated before transfused to the host.

Prevalence of Hepatitis C in adults in the south-eastern region of Anatolia: a community-based study

Aim: There is a limited number of studies on the general population about prevalence of Hepatitis C virus (HCV) in Turkey. The estimated prevalence of HCV in the Southeastern region of the country was obtained from the data of the blood donors. There is no study reflecting the general population of this region, leading us to plan this study. Material and method: Four provinces in the Southeastern Anatolia were randomly selected and sample sizes were determined by Epi Info Programme, and blood samples were collected from 2888 individuals. Questionnaires in which demographic information and probable risk factors for Hepatitis C were investigated and were applied on subjects who gave their consent to participate in the study. Anti-HCV was examined by using Cobas Core II immunochemistry system (Roche). All positive samples were further tested for the presence of HCV RNA by RT-PCR. Crude odds ratios (OR) and 95% confidence intervals (CI) were calculated and Chi-square analyses were performed. Epi Info 2000 Programme was used to perform the analysis. Results: Of the 2888 individuals, 17 (0.6%) were anti-HCV positive and 13 (82%) of them were confirmed as positive for HCV-RNA. No difference was found between rural and urban regions with respect to HCV prevalence ( [Formula: see text] ). The prevalence of HCV in 35-44 years of age group was found to be different from those of the other age groups ( [Formula: see text] ). It was determined that the risk for HCV in this age group was 4.23 times ( [Formula: see text]; [Formula: see text];1.02-20.15; CI 95%:) higher with a prevalence rate of 1.6%. In this age group, anti-HCV was positive in 6 male (2.4%) and 2 female (0.8%), of whom 7 were living in urban (2.2%) and 1 in rural area (0.5%). The overall prevalence of HCV was not found to be different for sex ( [Formula: see text] ). Similarly, there was no difference between the married and single individuals for the prevalence ( [Formula: see text] ). Anti-HCV positivity did not change for the level of education. We could not determine any factor that might play a role in transmission of HCV. Conclusion: This is the first population-based study to be performed in order to determine the prevalence of HCV in the south-eastern region of Anatolia (Turkey). This region has a low prevalence of HCV. The extremely rare prevalence of homosexuality and intravenous drug addiction might have a role in this low prevalence.

Macular vessel density in patients recovered from COVID 19

Purpose

The purpose is to evaluate macular vascular densities (VDs) using optical coherence tomography angiography (OCTA) in patients effected by coronavirus disease-2019 (COVID-19).

Methods

The superficial (SF) and deep macular VD of 50 patients with SARS CoV2 pneumonia who had positive polymerase chain reaction (PCR) tests and who recovered after receiving treatment and 55 healthy age- and gender-matched controls were compared using OCTA. Blood inflammation parameters were also recorded.

Results

There was no statistically significant difference between the two groups in terms of age and gender (p = 0.147 and p = 0.504, respectively). Nor was there a difference with respect to smokers between the two groups (p = 0.231). In COVID-19 patients, the VDs in superior hemi quadrant, superior quadrant and inferior quadrant, were significantly lower (p = 0.033, p = 0.029 and p = 0.042, respectively) in superficial plexus. It was also significantly lower in parafovea, superior hemi and superior quadrants (p = 0.026, p < 0.001 and p = 0.004, respectively) in deep plexus. In addition, white blood cell and neutrophil counts were significantly negatively correlated with the VD of the deep parafovea, deep superior quadrant and deep superior hemi quadrant (p < 0.05). There was no difference between the patient and control groups in both superficial and deep foveal avascular zone (FAZ) (p = 0.101 and p = 0.691 respectively).

Conclusion

In COVID-19 disease, VD is low in some sectors in both SF and deep layers, but no change in FAZ. The effect of COVID 19 disease on the retina and whether it makes the retina sensitive to damage can only be understood with long-term follow-up.

Relationship between optical coherence tomography angiography and visual evoked potential in patients with multiple sclerosis

Purpose:

This study aimed to identify an easy-to-apply biomarker by correlating visual evoked potential (VEP) with optical coherence tomography angiography (OCTA) results in multiple sclerosis (MS).

Methods:

Our study was planned prospectively. Patients with MS were divided into two groups, VEP prolonged group 1 and VEP normal group 2. Age-matched and gender-matched healthy individuals (group 3) were included as the control group. Vascular density (VD) of the optic nerve head (ONH) and radial peripapillary capillaries (RPCs) were measured and recorded by OCTA. The optic nerve damage of patients was measured and recorded with a VEP device.

Results:

Thirty-two eyes were included in group 1, 50 eyes were included in group 2, and 51 healthy eyes were included in group 3. In terms of visual acuity, group 1 was significantly lower than the other groups (P < 0.001). Regardless of the prolongation of p100 latency in patients with MS, whole image, inside disc ONH VD and in the same sectors in RPC VD were found to be significantly lower than the control group (P < 0.05). Retinal nerve fiber layer thickness was found to be significantly lower in group 1 than in group 2 and group 3 (P < 0.05). There was a significant correlation between low ONH VD and RPC VD and prolonged VEP P100 (P < 0.05).

Conclusion:

VEP measurements can be correlated with OCTA measurements in patients with MS and can be used as a biomarker to determine the degree of optic nerve damage.

In vitro studies on different extracts of fenugreek (Trigonella spruneriana BOISS.): Phytochemical profile, antioxidant activity, and enzyme inhibition potential

The side effects of synthetic antioxidants make it necessary to find a natural alternative. Therefore, the current study investigates the potential of T. spruneriana as a new alternative in terms of natural bioactive components. In this context, antioxidant activity, enzyme inhibition, and phenolic compounds of different extracts including ethanol, methanol, ethyl acetate, and aqueous were identified. The results show that the ethyl acetate (113.59 ± 2.73 mg GAE/g) has the highest phenolic content, but ethanol extract has the highest scavenging activity for DPPH and TAC. The ethanol extract showed stronger inhibition on cholinesterase and α-amylase compared to other extracts. Besides, 12 bioactive compounds were characterized in T. spruneriana extracts by HPLC-DAD. Our findings support that T. spruneriana could be considered as a new source of active phytochemicals, as well as provide remarkable data on biological activities of some main enzymes playing role in the healing of hyperpigmentation, Alzheimer, and diabetes. PRACTICAL APPLICATIONS: This study reports the total content, types and amounts of bioactive compounds and potential beneficial bioactivities of the different extracts of T. spruneriana. Trigonella is abundant in nature and spread over a wide geographical area, and is used in making cheese, pastries, spices, and sausages in different countries, as well as for antidiabetic purposes. Trigonella leaves are a good source of bioactive compounds that contain compounds like quercetin, catechin, cinnamic acid, and coumaric acid, along with it have also a high content of soluble fibers and is suggested for body weight control. Apart from being the first study conducted to point out the potential of T. spruneriana as being a natural food additive, this study also demonstrated its medicinal importance by revealing the anti-hyperpigmentation, antidiabetic, neuroprotective, and antioxidant properties of T. spruneriana.

Bladder tumors: virtual MR cystoscopy

Virtual cystoscopy is a promising new technique based on computer-simulated rendering of the inner surface of the urinary bladder using volumetric magnetic resonance (MR) imaging data, thus enabling maneuvers that normally are not possible with conventional cystoscopy. Due to several distinct advantages over conventional cystoscopy such as minimal invasiveness, evaluation of the urethral orifice from a cranial point of view and an opportunity to observe diverticula formations and the inner urethral space, gadolinium-enhanced MR cystoscopy has a great potential for competing with conventional cystoscopy under some clinical circumstances. The recent improvement in MR scanners has significantly facilitated virtual cystoscopic evaluation of the urinary bladder lumen by MR imaging. Volumetric data associated with powerful postprocessing procedures allow imaging of the inner urinary bladder surface with excellent detail. In this article, imaging techniques and clinical applications of gadolinium-enhanced virtual MR cystoscopy are presented.