Anxiety and depression among patients with familial Mediterranean fever

BACKGROUND

Familial Mediterranean fever (FMF) is a systemic autoinflammatory disease that requires lifelong treatment and is associated with several comorbidities, including mental health disorders such as anxiety and depression. FMF and mental health necessitate further research; hence, this study aims to observe anxiety and depression and their relationship with several variables in patients with FMF.

METHODS

As the study population, 360 FMF patients were surveyed between June and October 2022. Surveys included inventories assessing anxiety and depression, i.e., the Beck's Depression Inventory (BDI), the Beck's Anxiety Inventory (BAI), and the State-Trait Anxiety Inventory (STAI).

RESULTS

Mean scores for STAI-Y1 (state), STAI-Y2 (trait), BAI, and BDI were 42.2 ± 12.0, 45.9 ± 10.6, 24.0 ± 13.9, and 13.1 ± 8.99, respectively. Medication-adherent patients had significantly lower scores on STAI-Y1 (41.5 ± 11.4 vs. 45.2 ± 14.0; p-value: 0.04). M694V homozygous patients exhibited significantly lower scores in the BDI (12.4 ± 9.37 vs. 13.2 ± 8.93; p-value: < 0.001) and BAI (17.0 ± 12.1 vs. 25.1 ± 13.9; p-value: 0.001). The patients with an exon-10 mutation demonstrated significantly lower scores compared to patients with an exon‑2 mutation (17.9 ± 12.3, 29.6 ± 13.3; p-value: < 0.001).

CONCLUSION

The patients with FMF had mild depression and moderate anxiety scores. A higher level of education and medication adherence were associated with lower levels of anxiety. Likewise, the patients with genotypes associated with severe disease courses had lower levels of anxiety. We suggest that physicians should be more attentive to patients with a milder disease course and ensure that these patients are provided with sufficient treatment and knowledge about their disease.

Subfatin, asprosin, alamandine and maresin-1 in cerebral ischemia, intracranial and subarachnoid hemorrhages

OBJECTIVE

Cerebrovascular diseases (CVDs) remain an important public health issue due to the increasing number of deaths worldwide. Changes in the synthesis and release of peptides in CVDs may play an important role in elucidating the physiopathology of the disease. Therefore, this study was to investigate the fate of maresin-1 (MaR-1), subfatin (SUB), asprosin (ASP), and alamandine (ALA) levels in patients with cerebral infarction (CI), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH) evaluated within the scope of CVDs, and voluntary healthy controls.

PATIENTS AND METHODS

The study participants were divided into 4 groups: CI patients, ICH patients, SAH patients, and healthy volunteers. The diagnosis of CVDs was made based on the National Institutes of Health Stroke Scale (NIHSS), Intracerebral Hemorrhage Score (ICHS), Botterel-Hunt-Hess Scale (BHHS), and cranial computed tomography (CT). The levels of MaR-1 (ng/mL), SUB (ng/mL), ASP (ng/mL), and ALA (pg/mL) in the blood samples collected from the participants were studied using the ELISA method. Other parameters included in the study were obtained from the patient records of our hospital.

RESULTS

The comparison of MaR-1 [(control 1.38 ± 0.14), SAH (0.98 ± 0.087), CI (0.67 ± 0.04), ICH (0.51 ± 0.03)], SUB [(control (13.2 ± 1.4), SAH (10.1 ± 1.2), CI (7.9 ± 0.8), ICH (5.8 ± 0.5)], and ALA [(control (67.2 ± 7.9), SAH (58.2 ± 4.3), CI (42.1 ± 3.7), and ICH (34.2 ±3.9)] values revealed a significant decrease compared to the control values. The comparison of the ASP values of SAH, CI, and ICH patients and control values (11.6 ± 1.2) showed significantly higher asprosin values in SAH (13.8 ± 1.1), CI (15.4 ± 1.2) and ICH (28.9 ± 2.8) patients. Similarly, systolic blood pressure (SBP), diastolic blood pressure (DBP), and glucose levels of CKD patients were also high.

CONCLUSIONS

Decreased MaR-1, SUB, ALA and increased ASP compared to the control values may play a role in the physiopathology of these diseases. MaR-1, SUB, ALA, and ASP differences between SAH, CI and ICH patients may also guide clinicians along with SBP, DBP and glucose values.

Does onlay mesh placement in emergency laparotomy prevent incisional hernia? A prospective randomized double-blind study

PURPOSE

The objective of this study is to assess the effectiveness and safety of onlay mesh closure of emergency midline laparotomy to prevent incisional hernia.

METHODS

This is a prospective randomized double-blind study and was carried out in the General Surgery Clinic, Konya City Hospital, from August 1, 2020 to August, 1, 2021. The study included 108 patients who were randomly grouped in 2 groups: patients with conventional abdominal closure and closure using additional onlay mesh (1:1). The follow-up period was for a year. The primary outcome was the incidence of incisional hernia and secondary outcomes were clinical data like complications, hospital length of stay, re-operations.

RESULTS

It was observed that incisional hernia was present in 14 patients (27.4%) in conventional abdominal closure group and was in 2 patients using mesh (4%), (p = 0.001). Clavien-Dindo 3B complications were in rise in conventional closure group (p = 0.02). Of all complications, burst abdomen was significantly more common in conventional closure group (p = 0.04). The rate of surgically treated complications were higher in conventional closure group (p = 0.02). Clavien-Dindo 3A complications were more common in patients with contaminated wound in mesh group (p = 0.02).

CONCLUSION

The use of mesh while closing the abdomen in emergency midline laparotomy reduces the risk of incisional hernia. Thus, to lower the risks of incisional hernia and its complications, prophylactic mesh can be used in high-risk patients.

Evaluation of Telemedicine awareness, knowledge, attitude, skill levels of physicians and students

Background

The increase in the use of information and communication technologies around the world brings about developments and changes in the provision of health services. It is accepted that telemedicine applications will facilitate health services for patients and health personnel. This study aimed to evaluate the telemedicine awareness, knowledge, attitude and skill levels of physicians and medical school students.

Methods

This cross-sectional study was conducted between July and August 2021. A questionnaire form was prepared using the relevant literature then filled online by the participants. Telemedicine Awareness, Knowledge, Attitudes and Skills Questionnaire was used in the research. The universe of the research consisted of medical faculty students and physicians across Turkey. In the study, 933 people were reached by using the purposeful snowball sampling method, one of the non-probability sampling methods. Mann Whitney-U test, Kruskal Wallis test, Spearman correlation analysis and Multiple Linear Regression analysis were used.

Results

Of the participants, 442 (47.4%) were female, 497 (53.3%) were medical students, and 436 (46.7%) were physicians. Their ages ranged from 18 to 59, with a mean of 28.0±8.8 years. The median (min-max) scores obtained from the Telemedicine Awareness (TA) sub-section were 18(0-24), 51.3% of them had scores above the median score. TA sub-section had a moderate positive correlation (r = 0.559, p &lt; 0.001) with knowledge sub-section and a weak positive correlation (r = 0.208, p &lt; 0.001) with skill level sub-section. TA scores were higher among men, physicians and those who want to participate in a telemedicine training program. TA increased as the level of computer and internet knowledge increased (F = 29.171, R2=0.197, p &lt; 0.001).

Conclusions

It can be said that TA is at a moderate level among medical students and physicians in Turkey. TA increased as the level of computer and internet knowledge, telemedicine knowledge and skills increased.

Key messages

Odontogenic and nonodontogenic cysts: An analysis of 526 cases in Turkey

PURPOSE

The aim of this study was to determine the age, gender, and sites of different types of odontogenic cysts (OCs) and non-OCs (nOCs) (seen in eastern Anatolian population in Turkey.

MATERIALS AND METHODS

The following data were collected from the clinical records and histopathology reports of the Department of Oral and Maxillofacial Surgery and the Department of Oral Pathology, Ataturk University, Turkey, during a period of 10 years. They were analyzed descriptively in terms of incidence, age, sex, cyst type, and site.

RESULTS

A total of 526 cysts were diagnosed during a 10-year period. Of these, 330 (62.7%) were in males, and 196 (37.3%) were in females, the male:female ratio was 1.7:1. There were 509 (96.8%) OCs and 17 (3.2%) nOCs. There were 406 (77.2%) inflammatory OCs and 103 (19.6%) developmental OCs. Radicular cysts were the most frequent (66.4%), followed by dentigerous (19.2%) and residual (10.8%) cysts. Only nasopalatine duct cyst was found as nOC in this study (3.2%).

CONCLUSION

The distribution of jaw cysts in the Turkish Eastern Anatolian population is relatively similar to that of other populations reported in previous studies in the literature, in which most OCs were of inflammatory origin. However, the relative rates of cysts were higher than those reported in other studies.

Benign tumors and tumor-like lesions of the oral cavity and jaws: An analysis of 709 cases

PURPOSE

The purpose was to examine the prevalence, gender, age and site(s) of odontogenic and nonodontogenic benign tumors, and tumor-like lesions occurring in the oral cavity and jaws in a Turkish population, particularly, in the Eastern Turkey, and to compare findings of this study with other reports.

MATERIALS AND METHODS

The data were collected from the files of the Department of Oral and Maxillofacial Surgery and the Department of Oral Pathology, Ataturk University, Turkey, during a 10-year period from January 2005 to January 2015. They were analyzed descriptively regarding prevalence, age, sex, lesion type, and site.

RESULTS

A total of 709 benign tumor and tumor-like lesions of the oral cavity, and jaws were selected during a period of 10 years. One hundred and twenty-one of these lesions (17%) were odontogenic benign tumors while 588 (83%) were nonodontogenic benign tumor and tumor-like lesions.

CONCLUSIONS

This study revealed that the distribution and characteristics of benign tumors and tumor-like lesions of oral cavity and jaws in the Turkish population, particularly including the Eastern region of Turkey have some differences as well as similarities with the findings of studies in different populations.

Giant cervical myoma associated with urinary incontinence and hydroureteronephrosis

Cervical leiomyomas compromise fewer than 5% of all uterine leiomyomas. Cervical myomas exacerbates surgical difficulties, such as poor operative field, difficult suture repairs, and blood loss. When performing myomectomy for cervical myomas, care must be taken to avoid injuries to neighboring structures in the pelvic cavity.These structures include the bladder in front of the cervix, the rectum behind the cervix, and the uterine arteries and ureters on both sides. Myomectomy for cervical myoma is empirically difficult and frequently problematic. The authors report a case of giant cervical myoma presenting with urinary incontinence.

Reverse shoulder arthroplasty combined with a latissimus dorsi and teres major transfer for a deficit of both active elevation and external rotation. Results of 15 cases with a minimum of 2-year follow-up

PURPOSE

Our aim was to assess the clinical and radiological outcomes of reverse shoulder replacements performed in association with a latissimus dorsi and teres major tendon transfer in cases of irreparable posterosuperior cuff tears including the teres minor tendon. Our hypothesis was that the tendon transfers would improve the clinical results of arthroplasty by restoring active external rotation.

METHODS

Fifteen procedures in 14 patients were performed through a single deltopectoral approach. Both tendons were fixed to the proximal anterolateral aspect of the humeral metaphysis. Mean age at the time of surgery was 67.5 years (range 53 to 82 years). All had severe cuff tear arthropathy (Hamada stage 3 or 4) and severe atrophy or fatty infiltration of the infraspinatus and teres minor on preoperative MRI or CT-scan (Goutallier stage 3 or 4). Preoperative and postoperative functions were assessed by Constant score. Satisfaction was assessed by the Simple Shoulder Test (SST). At follow up, radiographs were examined for radiolucent lines, osteolysis and scapular notching.

RESULTS

The average follow-up after surgery was 33.2 months (range 24 to 60 months). The mean absolute Constant score improved significantly (P=10(-5)) from 23.7±11.5 preoperatively to 61.1±11.9 postoperatively. Forward flexion and external rotation with the arm at the side improved significantly, respectively from 64.7±35.6° preoperatively to 126±34.4° postoperatively (P<10(-5)) and from -8.7±21.3° to 27.3±12.2° (P<0.0005). Internal rotation was not affected. The mean SST improved from 1.9±1.6 points preoperatively to 7.6±1.8 points postoperatively (P<0.0005). Twelve patients were very satisfied or satisfied (including one with a bilateral procedure) and 2 were unsatisfied with the final result. At final follow-up, radiographs showed no radiolucent lines around the implants nor scapular notching.

CONCLUSION

The combined procedure helped restoration of active elevation and external rotation in cases of massive cuff tear including the teres minor tendon.

LEVEL OF EVIDENCE

Therapeutic Level IV.

Complex proximal humeral fractures: a prospective study of 22 cases treated using the "Bilboquet" device

INTRODUCTION

Despite recent improvements in surgical devices, complex proximal humerus fractures internal fixation still encounters frequent mechanical failures.

HYPOTHESIS

The aim of this study was to confirm that the Bilboquet device (a design mimicking the cup-and-ball game) helps solving mechanical difficulties associated with these fractures internal fixation and to present a simplified version of the original surgical procedure.

PATIENTS AND METHOD

This non-randomised prospective study included 22 fractures in 22 patients, mean age: 70 years. According to the Neer classification there were three-part fractures in seven cases and four-part fractures in 15 cases. Fractures were all reduced and treated by internal fixation in a simplified surgical procedure using the Bilboquet device.

RESULTS

Mean postoperative follow-up was 34 months. The mean Constant score was 66 and the weighted Constant score was 86. Mean active forward elevation was 108° and mean active external rotation was 28°. No per- or postoperative complications occurred. Initial reduction of the tuberosity was incomplete in four cases. Union was obtained in all fractures. There was no secondary tilting of the head, and no migration or pseudarthrosis of the tuberosities. Five patients developed postoperative avascular necrosis of the humeral head.

DISCUSSION

The Bilboquet staple component provides a supporting platform for the entire humeral head area. This peripheral stabilization associated with tension band wiring explains the lack of secondary displacement in these cases. Although the Bilboquet device provides a solution to the mechanical problems of complex fractures of the proximal humerus, it does not solve the problem of secondary avascular necrosis of the humeral head, which occurred in 23% of the patients in this series and in 33% of patients in the four-part fractures subgroup.

LEVEL OF EVIDENCE

IV (non-randomised prospective study).

Results of latissimus dorsi tendon transfer in primary or salvage reconstruction of irreparable rotator cuff tears

INTRODUCTION

This study intends to evaluate latissimus dorsi tendon transfer outcomes inpatients with irreparable rotator cuff tears, irrespective of the fact that this procedure had been used primarily in 17 patients (Group I) or as a revision of a previously shoulder surgery in eight patients (Group II).

PATIENTS AND METHODS

Twenty-five patients (14 males and 11 females), mean age 55.8 years were treated using this procedure. Tears involved both supraspinatus and infraspinatus in 21 cases. The latissimus dorsi flap was harvested through an axillary approach and reattached on the greater tuberosity, using suture anchors. Outcome was assessed at a mean follow-up duration of 22 months (12 to 60 months) based on objective measures (Constant and Murley scores) as well as on subjective criteria (patient's satisfaction).

RESULTS

Active forward elevation (AFE) improvement as well as external rotation and absolute Constant score gains were all significant. This amelioration was more important in patients with a preoperative AFE below 80 grades and this without any significant difference between group I and II. Subjectively, 84% of the Group I patients were satisfied with their outcome versus 50% of patients in Group II.

DISCUSSION AND CONCLUSION

In patients with irreparable rotator cuff tears, clinical results of latissimus dorsi tendon transfer showed significant pain level reduction, and gains in active range of motion both in forward elevation and external rotation. We did not find a significant difference between primary or revision repairs.

LEVEL OF EVIDENCE

Level IV retrospective therapeutic study.

Myoglobin-catalyzed tyrosine nitration: no need for peroxynitrite

The nitration of tyrosine residues in protein to yield 3-nitrotyrosine derivatives has been suggested to represent a specific footprint for peroxynitrite formation in vivo. However, recent studies suggest that certain hemoproteins such as peroxidases catalyze the H(2)O(2)-dependent nitration of tyrosine to yield 3-nitrotyrosine in a peroxynitrite-independent reaction. Because 3-nitrotyrosine has been shown to be present in the postischemic myocardium, we wished to assess the ability of myoglobin to catalyze the nitration of tyrosine in vitro. We found that myoglobin catalyzed the oxidation of nitrite and promoted the nitration of tyrosine. Both nitrite oxidation and tyrosine nitration were H(2)O(2)-dependent and required the formation of ferryl (Fe(+4)) myoglobin. In addition, nitrite oxidation and tyrosine nitration were pH-dependent with a pH optimum of approximately 6.0. Taken together, these data suggest that the acidic pH and low oxygen tension produced during myocardial ischemia will facilitate myoglobin-catalyzed, peroxyntrite-independent formation of 3-nitrotyrosine.