Focality in childhood absence epilepsy

BACKGROUND AND PURPOSE

Childhood absence epilepsy (CAE) has a typical electroencephalography (EEG) pattern of generalized 3 Hz spike and wave discharges (SWD). Focal interictal discharges were also documented in a small number of documents. The aim was to investigate the amplitudes of interictal 3 Hz SWD within the 1st second in drug-naïve CAE patients. In this way, areas with maximal electronegativity at the beginning of clinically generalized discharges will be documented.

METHODS

The EEG records of children with drug-naïve CAE were evaluated retrospectively by two child neurologists first for 3 Hz SWD. Then, a machine-learning model evaluated the amplitudes of 3 Hz in the 1st second of SWD. Maximum electronegativity areas were documented and classified as focal, bilateral, and generalized.

RESULTS

One hundred and twelve 3 Hz SWD were evaluated in 11 patients. Among discharges within the 1st second, maximum electronegativity areas were documented as focal for 44 (39.2%), bilateral for 8 (7.1%), generalized for 60 (53.5%). Among focal electronegativity areas, mostly right central, left occipital and midline parietal areas were documented in 12 (10.7%), 7 (6.2%), and 6 (5.3%), respectively. Eight (7.1%) of the maximum electronegativity areas were detected bilaterally, of which 7 (6.2%) originated from the frontopolar areas.

CONCLUSIONS

Focal maximal electronegativity areas were frequently observed in drug-naïve CAE patients, comprising approximately half of non-generalized discharges. Focal discharges might be misleading in diagnosis. Focal areas within the brain may be responsible for and contribute to absence seizures that appear bilaterally symmetrical and generalized clinically. Although its clinical implication is unknown, this warrants further study.

The effect of interleukin-20 on periodontal tissue destruction in individuals with periodontitis

BACKGROUND AND OBJECTIVE

Periodontitis is an inflammatory disease that destroys periodontal tissues. Interleukin-20 (IL-20), on the other hand, is known as a potent angiogenic, chemotactic, and pro-inflammatory cytokine associated with various chronic inflammatory disorders. IL-20 has a significant role in the regulation of osteoclastogenesis and osteoblastogenesis. This study aimed to evaluate the effect of IL-20 on periodontal destruction.

METHODS

In this study, a total of 60 participants were included, 30 of whom were systemically and periodontally healthy (control group), and 30 were systemically healthy but had periodontitis (periodontitis group). Gingival crevicular fluid (GCF) and serum samples were collected from the participants for biochemical analysis. Enzyme-linked immunosorbent assay was used to determine the levels of IL-20, tumor necrosis factor (TNF)-α, IL1β/IL-10, RANKL/osteoprotegerin (OPG), and matrix metalloproteinase-8 (MMP8). For statistical analysis, the independent t-test, Pearson correlation coefficients, and the Chi-square test were used.

RESULTS

GCF IL-20, RANKL, RANKL/OPG, serum IL-20, RANKL, RANKL/OPG, MMP-8, TNF-α, IL-1B, and IL-1β/IL-10 values were found to be statistically significantly higher in the periodontitis group than in the control group. GCF OPG and serum IL-10 values were found to be statistically significantly higher in the control group than in the periodontitis group. No statistically significant difference was observed between the groups in serum OPG values. A statistically significantly positive correlation was observed between serum IL-20 value and serum RANKL, RANKL/OPG, MMP-8, TNF-α, IL-1β values, and periodontal clinical parameters. The ROC curves showed: AUC = 0.788 for GCF IL-20, and AUC = 1.000 for serum IL-20.

CONCLUSION

According to the results of the study, IL-20 was found to be associated with periodontitis. The role of IL-20 in periodontal pathogenesis is related to osteoclastogenesis and collagen degradation. It is conceivable that IL-20 may increase bone destruction by both affecting the RANKL/OPG ratio and proinflammatory cytokines.

A new marker of coronary collateral flow in patients presenting with acute myocardial infarction

OBJECTIVE

Multimerin-2 is an adhesion substrate between pericytes and basal membranes during angiogenesis. The present study aimed to assess the relationship between serum Multimerin-2 and coronary collateral flow grade.

PATIENTS AND METHODS

Between April 2022 and August 2022, 88 patients with subacute ST-elevation myocardial infarction were included in this study. The main inclusion criteria were patients who present 12-48 hours after symptom onset and aged between 18 and 90 years. The patients were divided into two groups according to the Rentrop classification: poor collateral group (Rentrop grade 0-1) and good collateral group (Rentrop grade 2-3). Biochemical and hematological parameters were measured before coronary angiography.

RESULTS

Serum Multimerin-2 levels were found to be significantly different between the two groups, and levels were higher in the Rentrop 2-3 group than in the Rentrop 0-1 group (3,527.9 ± 1,194.2 pg/ml and 946.7 ± 249.1 pg/ml; p < 0.00). Receiver operating characteristic curve analysis indicated that the area under the curve was 0.918 (p = 0.001), and the best cut-off value of 849 pg/ml had a sensitivity of 90.1% and a specificity of 84.1% for predicting Rentrop grade 2-3 coronary flow. The number of patients with low left ventricular ejection fraction (LVEF) by echocardiography at 30 days was significantly higher in patients with poor collateralization.

CONCLUSIONS

Multimerin-2 levels were found to be higher in patients with Rentrop grade 2-3 coronary flow than Rentrop grade 0-1 coronary flow after myocardial infarction. We detected a potential relationship between MMR-2 and good coronary collateral formation.

Evaluation of Retinal Vascular and Structural Alterations in Pediatric Idiopathic Intracranial Hypertension Patients without Papilledema

PURPOSE

The aim of this study was to evaluate retinal structural and microvascular alterations using optical coherence tomography-angiography (OCTA) in pediatric idiopathic intracranial hypertension (IIH) patients with regressed papilledema.

METHODS

This study included 40 eyes of 21 IIH patients and 69 eyes of 36 healthy controls. Radial peripapillary capillary (RPC) vessel density and peripapillary retinal nerve fiber layer (RNFL) thickness were evaluated by XR Avanti AngioVue OCTA (Optovue, Fremont, CA, USA). The data were obtained from measurement zones that are automatically divided into two equal hemispheres (superior and inferior) and eight quadrants (superior-temporal, superior-nasal, inferior-temporal, inferior-nasal, nasal-superior, nasal-inferior, temporal-superior, temporal-inferior). Initial cerebrospinal fluid (CSF) pressure, grade of papilledema, and duration of follow-up were recorded.

RESULTS

There were significant differences in RPC vessel densities and RNFL thicknesses between the study groups (p ˃ 0.05). Significantly higher RPC vessel density measurements were observed in the patient group for the whole image, peripapillary, inferior-hemi, and whole nasal quadrants (p < 0.05). Except for the temporal-superior, temporal-inferior, inferior-temporal, and superior-temporal quadrants, the RNFL in all regions was significantly thicker in the IIH group than in the control group (p ˂ 0.001).

CONCLUSIONS

RNFL thickness and RPC vessel density were significantly different between the IIH patient and control groups, suggesting that retinal microvascular and subclinical structural changes that were potentially secondary to CSF pressure can persist after the resolution of papilledema. However, our results should be confirmed by further longitudinal studies investigating the progress of these alterations to determine their effects on peripapillary tissues.

Dexmedetomidine alleviates vacuolization and necrosis in tubular epithelial cells induced by aortic cross-clamping

OBJECTIVE

Acute kidney injury (AKI) is one of the main causes of mortality in patients undergoing emergency surgery due to an abdominal aortic aneurysm. This study aimed to determine the potential nephroprotective characteristics of dexmedetomidine (DMD) for the establishment of a standard therapeutic method for AKI.

MATERIALS AND METHODS

Thirty Spraque Dawley rats were allocated to 4 groups: control, sham, ischemia-reperfusion, and ischemia/reperfusion (I/R)+dexmedatomidine.

RESULTS

Necrotic tubules, degenerative Bowman's capsule and vascular congestion were observed in the I/R group. In addition, there was an increase in tissue malondialdehyde (MDA), interleukin (IL)-1 and IL-6 levels in tubular epithelial cells. In contrast, we observed decreased tubular necrosis, IL-1, IL-6 and MDA levels in the DMD treatment group.

CONCLUSIONS

DMD has a nephroprotective effect against acute kidney injury resulting from I/R, which is related to aortic occlusion used in the treatment of ruptured abdominal aortic aneurysms.

Neuroprotective effects of Geranium Robertianum L. Aqueous extract on the cellular Parkinson's disease model

OBJECTIVE

In recent years, botanical medicines alone or in conjunction with existing therapies have attracted considerable popularity as an alternative treatment for Parkinson's Disease (PD). For instance, Geranium robertianum L. (Geraniaceae family) has been used in folk medicine for its antioxidant and anti-inflammatory properties. However, its neuroprotective potential has not been well demonstrated.

MATERIALS AND METHODS

Herein and for the first time, we have investigated the in vitro neuroprotective effects of leaf extract of G. Robertianum over a wide dose range (0-200 µg/mL) on the PD model using retinoic acid (RA)-differentiated SHSY-5Y cells and 1-methyl-4-phenylpyridinium (MPP+)-induced neurotoxicity. The neuroprotective effects were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and lactate dehydrogenase (LDH) release assays. The antioxidant activity of the extract was measured by total antioxidant status (TAS) and total oxidant status (TOS). The effect of leaf aqueous extracts on acetylcholinesterase (AChE) activity was also determined. Finally, cell death mechanisms were analyzed by flow cytometry.

RESULTS

Our results showed that G. Robertianum leaf extract ameliorated cytotoxicity and oxidative damage by MPP+. Moreover, G. Robertianum extract exhibited a protective activity against MPP+ induced apoptosis.

CONCLUSIONS

The current findings could lead to a promising new candidate for a possible cure of Parkinson's disease through neuroprotective mechanisms with respect to antioxidant and apoptosis inhibitory properties of G. Robertianum water extracts.

A Near-Global Slowing of Background Activity and Epileptic Discharges in Children With Mild to Moderately Symptomatic COVID-19 Infection: An Electro-Neurophysiological Study

Background. To assess the functional involvement of the central nervous system (CNS) via quantitative electroencephalography (EEG) analysis in children with mild to moderate COVID-19 infection who were otherwise previously healthy children. Methods. This prospective, case-control study was conducted between June and September 2020. Sleep EEG records of at least 40 min were planned for children who tested positive for COVID-19 using real-time PCR analysis and within 4-6 months post-recovery. All of the EEG analyses in this study were performed on an Ubuntu 20.04.2 LTS Operating System with the developed software using Python 3.7.6. The quantitative analysis of the epileptic discharges within the EEG records was performed using random forest after elimination of the artifacts with a model training accuracy of 98% for each sample data point. The frequency analysis was performed using the Welch method. Results. Among the age and sex-matched groups, the global mean frequency was significantly lower among the COVID-19 patients, with a P-value of 0.004. The spike slow-wave and sharp slow-wave indices were significantly higher in the patients when compared to the controls. The mean frequency values were significantly lower in almost all of the electrodes recording the frontal, central, and occipital areas. For the temporal and parietal areas, those significantly low mean frequencies were limited to the right hemisphere. Conclusion. A near-global involvement of background activity with decreased frequency, in addition to epileptic discharges, was recorded in mild to moderately COVID-19 infected children post-infection.

Clinical and demographic characteristics of children and adolescents with acute vertigo symptoms: A cross-sectional study

Background/aim

Vertigo is one of the rarely diagnosed disorders during childhood due to insufficient description of the children regarding their experiences to the physicians. The clinical features of children and adolescents admitted by acute vertigo symptoms were investigated to elaborate the subject retrospectively.

Materials and methods

Between January 2017–July 2019, records of cases admitted with acute vertigo complaints to pediatric neurology were retrospectively examined.

Results

Of 761 patients, mean age was 13.8 years, 64% (n = 487) were women, 22.6% (n = 172) of which were children (1–11 years). A total of 37.3% of the cases (n = 284) had unknown etiology of acute vertigo symptoms, 39.6% (n = 301) had acute vertigo, and 23.1% (n = 176) were considered with no organicity problems but a group of the families stopped cooperating to the full extent in the study. Among all the patients, 25.6% (195/761) had paroxymal vertigo, 6.8% (52/761) had migraine-associated vertigo, 4.5% (34/761) had psychogenic vertigo, and 2.6% (20/761) had epileptic vertigo. Epileptic vertigo was significantly higher in younger children (mean age = 10.6, F(3) = 8874, P < .001), and the ratio of its occurence was also higher among children (60%, χ2 (3) = 20.347, P < .001).

Conclusion

Vertigo complaints are 1.7 times more common among the girls. Epileptic vertigo is significantly higher among the children. Among younger children, it seems important to consider epilepsy when vertigo emerged.

Use of hyperbaric oxygen therapy of purpura fulminans in an extremely low birth weight preterm: A case report

Purpura fulminans (PF) is a rare and fatal complication of septic shock or diffuse intravascular coagulation (DIC) resulting in skin and soft tissue necrosis. PF can be caused by congenital or acquired protein C (PC) or protein S (PS) deficiency. The most common cause of PF in a neonate is sepsis. In our extremely low birth weight preterm case, due to PF that started in the right-hand fingers, examination was made and protein S deficiency was detected as well as MTHFR (A1298C) and Factor V Leiden (R506Q) homozygous mutations. While being unresponsive to fresh frozen plasma (FFP) and unfractionated heparin (UFH) therapy, we want to highlight the curative treatment with hyperbaric oxygen (HBOT), which has not previously been used in extremely low birth weight preterm infants for this purpose.

Male Nursing Students' Social Appearance Anxiety and Their Coping Attitudes

This study aimed at examining social appearance anxiety levels of male nursing students and their coping attitudes and identifying the relationship between them. A cross-sectional research approach was adopted in a study population of 180; the sample comprised 129 students. Data were collected using a socio-demographic information form, the Social Appearance Anxiety Scale (SAAS), and the Assessment of Coping Attitudes Inventory (COPE). The average age of students was 20.54 ± 1.49 years. The male students' average score obtained from the SAAS measure was 32.64 ± 13.07, while that of the COPE Inventory was 138.11 ± 14.47. Significant correlations were detected between students' SAAS scores and COPE scale scores. There were negative relationships between social anxiety scores and COPE subscales of positive reinterpretation and growth ( p < .05), use of instrumental social support ( p < .05), active coping ( p ≤ .01), and planning ( p ≤ .01). In contrast, there were positive relationships between social anxiety scores and COPE subscales of mental disengagement ( p ≤ .01), denial ( p ≤ .01), behavioral disengagement ( p ≤ .01), restraint ( p ≤ .01), use of emotional social support ( p < .05), substance use ( p ≤ .01), and acceptance ( p < .05). The conclusion was that male students who do not perceive themselves as having an ideal body image face high social appearance anxiety. There is a prejudice that social appearance anxiety has negative effects on these students' self-confidence. In this context, this research revealed concrete results about how male nursing students have battled the prejudices that they have faced throughout their student life.

Gastroprotective effect of apricot kernel oil in ethanol-induced gastric mucosal injury in rats

We investigated the gastroprotective effect of apricot kernel oil on ethanol induced gastric ulcer in rats. Male Wistar albino rats were divided into control, ethanol and apricot kernel oil + ethanol groups. The fatty acid composition of apricot kernel oil was determined using GC-MS. A gastric ulcer index was defined as the area percentage of the gastric mucosa consisting of ulcerated tissue. Gastric tissue was investigated by TUNEL staining for apoptosis, immunohistochemical iNOS staining, measurement of gastric IL-10 and IL-6 expression by ELISA and assays of catalase, malondialdehyde and superoxide dismutase. The ethanol group exhibited a higher gastric ulcer score, increased IL-6 level, increased number of inducible nitric oxide synthase-positive and TUNEL positive cells, and a higher MDA level compared to the control group. The apricot kernel oil + ethanol group exhibited significantly fewer gastric lesions compared to the ethanol group. Apricot kernel oil protects rat gastric mucosa against ethanol induced injury by its anti-inflammatory, anti-oxidative and anti-apoptotic effects, and might be useful for reducing the severity of gastric ulcers.

The effect of gadolinium-based contrast agents on rat testis

Previous studies have reported that repeated administrations of linear gadolinium-based contrast agents lead to their accumulation in the brain and other tissues in individuals with normal renal functions. The purpose of this prospective animal study was to investigate the effect of multiple administrations of macrocyclic ionic (gadoteric acid) and linear nonionic (gadodiamide) gadolinium-based contrast agents (GBCAs) on rat testis tissue and to compare these molecules in terms of tissue damage. Thirty-two male Sprague-Dawley rats were kept without drugs for 5 weeks after administration of 0.1 mmol mg^-1 kg^-1 (0.2 ml/kg) gadodiamide and gadoteric acid for 4 days over 5 weeks. Biochemical, histopathological and immunohistochemical changes in testis tissue were evaluated at the end of 10 weeks. When used in repeated clinical doses, gadolinium was observed to increase apoptosis in the Leydig cells of the rat testis, and to increase serum Ca⁺² levels and reduce testosterone levels (p < .05). Although the difference was not statistically significant, a greater loss of spermatozoa and immature germinal cell accumulation were observed in the seminiferous tubule lumen in the GBCA groups compared with the control and saline groups (p > .05). Both linear and macrocyclic contrast agents have toxic effects on testis tissue, irrespective of the type of drug.

Effect of caffeic acid phenethyl ester on oxidant and anti-oxidant status of liver and serum in a rat model with acute methanol intoxication

BACKGROUND

Methanol toxicity is one of the major public health problems because it can cause severe morbidity and mortality. Methanol intoxication causes changes in the balance between the production of free radicals and antioxidant capacity.

AIMS

We aimed to investigate the effects of caffeic acid phenethyl ester (CAPE) on the total oxidant status, total antioxidant status (TAS), and oxidative stress index (OSI) parameters of the liver and the serum in a rat model of acute methanol intoxication.

MATERIALS AND METHODS

Rats were treated with intraperitoneal (i.p.) Methotrexate (MTX) for 7 days. On the 8th day, i.p. Methanol was administered in the methanol, ethanol and CAPE groups. Four hours after methanol treatment, ethanol was injected i.p. in the ethanol group; CAPE (i.p.) in the CAPE group; serum physiologic i.p. in other groups. After 8 hours, rats were killed and the serum and the liver samples were obtained for biochemical analyses.

RESULTS

The OSI value was significantly higher in the methanol group compared to the ethanol and CAPE groups. Serum TAS levels of the methanol group were significantly different compared to the control group, but not compared to the MTX group. The amelioration of oxidative stress was greater in the CAPE group compared to the ethanol group but was not statistically significant.

CONCLUSION

This study demonstrates that CAPE treatment ameliorates oxidative stress in the serum and liver in a rat model of acute methanol intoxication.

Prognostic significance of standardised uptake value (SUVmax ) measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with small cell lung cancer

Certain prognostic factors for small cell lung cancer (SCLC) have been validated, but the prognostic role of 18F-FDG PET/CT still remains unclear. The aim of this study was to evaluate the prognostic significance of 18F-FDG PET/CT in patients with SCLC. We reviewed 142 patients with pathologically proven SCLC who underwent pre-treatment 18F-FDG PET/CT. Standardised uptake value (SUV_max ) and other potential prognostic variables were chosen for analysis. The mean age of the study population was 58.2 ± 10.1 years (range, 25-84), and 124 (87.3%) patients were men. The median SUV_max value was 11.6 (4.0-29.3). Among the variables included in the univariate analysis, performance status (P = 0.001), disease stage (P < 0.001), administration of thoracic radiotherapy (TRT; P < 0.001), albumin level (P = 0.030) and LDH level (P < 0.001) showed prognostic significance. Further, multivariate analysis showed that performance status (P = 0.007), albumin level (P = 0.002), LDH level (P < 0.001) and administration of TRT (P = 0.001) were independent prognostic factors for survival. In conclusion, performance status, TRT, LDH level and albumin level were identified as important prognostic factors, while 18F-FDG PET/CT uptake of the primary lesions did not have any prognostic significance for survival in patients with SCLC.

Cerebral vasculitis as a major manifestation of rheumatoid arthritis

OBJECTIVE AND IMPORTANCE

Cerebral vasculitis (CV) is a rare described complication of rheumatoid arthritis (RA). Although the most frequent neurological manifestations of RA are peripheral neuropathy and cervical spinal cord compression due to subluxation of the cervical vertebrae, CV can be seen especially in patients with seropositive and long-standing RA.

CLINICAL PRESENTATION

We report two cases of CV associated with RA. Both patients had no extraarticular manifestations and RA clinics were under control. Our first case is a 30-years-old woman with seropositive RA for 15 years who had suddenly onset left facial and upper extremity weakness. In magnetic resonance imaging (MRI) DWI, hyperintensity in frontotemporal region due to acute ischaemia was detected. The new lacuner acute ischaemic lesions in right precentral gyrus, bilateral frontoparietal and corpus callosal region were detected in the control MRI. The cerebral MR angiography and transcranial doppler findings were consistent with CV. The patient responded favourably to pulse methylprednisolone and oral azathiopurine treatments. The second patient is a 52-year-old man who had been RA for 29 years. He admitted to our neurology clinic with speech difficulty and right upper extremity minimal weakness. Magnetic resonance imaging DWI showed left parietooccipital acute ischaemia which was progressed within a week and a new right parietooccipital ischaemia was added. His cerebral MR angiography and cerebral angiography were concordant with CV. The cyclophosphamide therapy was started since the cerebral ischaemia was progressed during pulse methylprednisolone and he responded well to this therapy.

CONCLUSION

CV due to RA is an uncommon serious complication which can be life-threatening. Therefore clinicians should be aware of the possibility of CV especially in progressive strokes in RA.

Testicular torsion in spinal cord injury: a case report

STUDY DESIGN

Case report.

OBJECTIVE

To describe a case of testicular torsion in spinal cord injury (SCI).

SETTING

Physical Medicine Rehabilitation Training and Research Hospital in Turkey.

METHODS

We present the first case of testicular torsion in SCI along with its clinical presentation and follow-up results.

RESULTS

Testicular torsion is a rare condition. No case was reported in people with SCI so far. The main difficulty in the diagnosis is that the nociceptive pain is below the injury level and the acute condition could be overlooked.

CONCLUSION

Testicular torsion is an acute condition for which early diagnosis is critical in the treatment. The case we describe adds new pitfalls in the diagnosis of this rare condition in people with SCI from the perspective of nociceptive pain below the injury level.

Use of passive samplers in pollution monitoring: a numerical approach for marinas

Triolein-containing semipermeable membrane devices (SPMDs) and butyl rubber (BR) based sorbents were employed as passive samplers in 14 coastal stations of Turkey including shipyards and marinas to characterize time-integrated levels of polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) and their relationship to potential pollution sources. Passive samplers of SPMDs and BR sorbents were deployed for 30days in the spring of 2012. The maximum concentrations of total PAH and PCB compounds sequestered by SPMDs were 3338 ng g(-1) SPMD and 4247 pg g(-1) SPMD. (END)-I and DDT-related compounds were dominant OCP compounds for most of the sites in passive samplers. Total PAH concentrations in SPMDs were found 1.2 to 8 times higher than the concentrations in BRs. However, BR sorbents were able to sample some PAHs which could not be sampled by SPMDs. The concentrations of PCBs and OCPs in BRs were similar or higher than SPMDs. SPMD-data were used to estimate the average ambient water concentrations of the contaminants. Two existing theoretical approaches have been used to derive the concentrations of hydrophobic pollutants in the ambient waters. The results were found very similar and range from 7318 to 183864 pg L(-1) for PAHs, from 2 to 186 pg L(-1) for PCBs, and from 98 to 848 pg L(-1) for OCPs. Furthermore, a simple numerical model was designed to estimate the boat-related water concentrations in marinas by using the seawater data supplied by SPMDs. The model was mainly built on the water concentration and the capacities of a particular marina and then applied to two sites in the second marina. A good correlation was found between the model outputs and SPMD-water data.

Micro-organic pollutants and biological response of mussels in marinas and ship building/breaking yards in Turkey

Concentrations of PAHs, PCBs and OCPs in sediments and mussels (caged and/or native) were determined at 16 stations in six major sites of coastal Turkey. The biological effects of pollution were evaluated using sediment toxicity tests and enzyme activity assays. EROD, PROD, GST, AChE, CaE, and GR activities were evaluated using the digestive glands of mussels. The total PAH concentrations in the sediments varied between nd and 79,674 ng g(-1) dw, while the total OCP concentrations were in the range of nd to 53.7 ng g(-1) dw. The total PAH concentrations in mussels varied between 22.3 and 37.4 ng g(-1) ww. The average concentrations of total PCBs in mussels were 2795 pg g(-1) ww in the shipyard, 797 pg g(-1) ww in Marina 2 and 53 pg g(-1) ww in Marina 1 stations. The results of whole-sediment toxicity tests showed a strong correlation between toxicity test results and pollutant concentrations. Selected cytosolic enzyme activities in digestive glands differed significantly depending on localities. These differences in enzyme activities were mainly related to the different pollutant levels of the sampling sites. The micro-organic contaminant profile patterns, toxicity tests and biomarker studies showed that shipyards and shipbreaking yards are the major potential sources of organic pollution in coastal areas.

An unusual case of neurobrucellosis presenting as demyelination disorder

Brucellosis is a public health problem in most countries in the Mediterranean. Involvement of the central nervous system is seen in 4-13% of patients with brucellosis. A 13-year-old girl was admitted because of gait disturbance, diplopia, and dizziness. Her complaints began about 1.5 years ago. The second symptomatic episode repeated about three months ago and the third two months ago. In total, attacks repeated 3 times over 1.5 years. The magnetic resonance imaging (MRI) and the clinical features mimicked multiple sclerosis. The patient was given pulse steroid treatments. After steroid treatment, her gait disturbance and diplopia improved over the short term. Following positive developments, her symptoms recurred. The tests were repeated; the MRI showed increasingly high signal abnormalities, and Brucella melitensis was grown in cerebrospinal fluid. The patient was started on an oral combination of rifampin, doxycycline, and ciprofloxacin. MRI findings improved markedly after nine months of treatment. Although neurobrucellosis is associated rarely with demyelination in adults, this finding has not been reported previously in children or adolescents. Additionally, this case is the first in terms of involvement of the corpus callosum in neurobrucellosis. In this article, we present an unusual case of neurobrucellosis.

Inhibin immunization in Norduz sheep

Abstract. The objective of this study was to investigate the possibility of increasing ovulation rate in Norduz sheep by immunization against inhibin-based peptide immunogens. A total of 18 primiparious Norduz ewes were used for this experiment. Eight ewes have received two times inhibin α-subunit 1-32 porcine vaccine with 3 weeks interval. The rest was kept as control. Antibody binding test by standard ELISA method did not provide reliable information. However, ultrasonographic inspection showed that significantly high number of follicle with 5 mm and larger diameter (P<0.01) has developed in immunized ewes. Moreover, 3 of immunized ewes have lambed twin. However, twin birth was not observed in control group.

Effects of sugammadex and rocuronium mast cell number and degranulation in rat liver

We investigated the effect of rocuronium- and sugammadex-induced mast cell increase and degranulation in rat portal triads. Forty-two rats, in six groups, received either rocuronium 1 mg.kg(-1); sugammadex 15 mg.kg(-1); sugammadex 100 mg.kg(-1); rocuronium 1 mg.kg(-1) and 5 min later, sugammadex 15 mg.kg(-1); rocuronium 1 mg.kg(-1) and 5 min later, sugammadex 100 mg.kg(-1); or isotonic saline. Total mast cell numbers were significantly higher with rocuronium only, than in all other groups (p<0.003), although in all active groups, the number was greater than the control. Total mast cell number was significantly higher with rocuronium and low-dose sugammadex compared with low-dose sugammadex only. The number of tryptase-positive mast cells with rocuronium only was significantly higher than in all other groups (p<0.003). Tryptase-positive mast cell numbers in both groups receiving both rocuronium and sugammadex were significantly higher compared with both groups receiving sugammadex only. Rocuronium increased mast cell numbers, and degranulation was mitigated by sugammadex. These results suggest that sugammadex may be beneficial in treatment of rocuronium-induced anaphylaxis.

Hashimoto encephalopathy causing drug-resistant status epilepticus treated with plasmapheresis

Hashimoto encephalopathy is a rare, clinically heterogenous condition. Its treatment is based on corticosteroids. A previously normal 12-year-old boy was admitted to our pediatric emergency department with status epilepticus. He experienced a recurrence of status epilepticus after pentobarbital withdrawal, and required repeated resumptions of drug-induced coma. He manifested acute personality changes. His limbic encephalitis markers were normal, but his level of anti-thyroid peroxidase antibody was high. A diagnosis of Hashimoto encephalopathy was considered. Our patient responded to plasmapheresis instead of corticosteroid treatment. This case report is the first, to the best of our knowledge, of plasmapheresis because of Hashimoto encephalopathy in a child.

Giant seminoma in an undescended testis presenting as an abdominal wall mass

Seminomas in undescended testes may present as abdominal wall tumours. A unilateral testis tumour in a 29 year old man with ipsilateral undescended testis is presented and relevant literature is reviewed.

A 29 year old man presenting with a tender left lower abdominal mass was admitted to our clinic and initial diagnostic tests followed by abdominal computerized tomography (CT) and positron emission tomography/computerized tomography (PET/CT) were performed. Abdominal CT clearly demonstrated the tumour location between the lower left abdominal subcutaneous layer and the external oblique fascia. He underwent surgery and the tumour was resected via en-bloc excision.

Pathological diagnosis of the resected specimen was consistent with classical seminoma and no distant metastasis was detected with PET/CT. He was referred to oncology clinic after discharge.

Tumours of undescended testis can present as an abdominal wall mass and clinicians must be aware of their existence.

Treatment challenges in pediatric stroke patients

Aim. In this study we presented our experience of 18 years on the etiology, risk factors, prophylactic and acute treatment, the effect of treatment to recurrence rate of patients with stroke. Methods. The population included 108 patients who had been treated for stroke at Pediatric Neurology Department of Ankara University with the diagnosis of arterial ischemic stroke and sinovenous thrombosis between January 1992 and August 2010. Forty-one girls (38%) and 67 boys (62%) with mean symptom age 3.1 ± 4.04 years, (0–18 years old) were followed up with a mean period of 4.9 ± 3.78 years (0–17 years). Results. 30 patients had no risk factors, 34 patients had only one risk factor and 44 patients had multiple risk factors. Recurrence was seen in three patients. There was no any statistical correlation between the recurrence of stroke and the existence of risk factors (P = .961). Seventeen patients received prophylactic treatment; 2 of them without any risk factors, 3 had one risk factor, 12 patients, who constituted the majority of our patients, had multiple risk factors (P = .024). Conclusion. With this study we showed that the right prophylaxis for right patients reduces the rate of recurrence.

Venous Thromboembolism Risk and Thromboprophylaxis Among Hospitalized Patients

Objectives: To evaluate venous thromboembolism (VTE) risk and use of thromboprophylaxis in the acute care hospital setting. Methods: A total of 1701 patients hospitalized for acute or exacerbated chronic medical illnesses or elective major surgery at 11 different hospitals across Turkey were included in the study. Patients at risk and VTE prophylaxis application were retrospectively identified based on medical charts. Results: According to the American College of Chest Physicians (ACCP) criteria, overall 35.6% (606 of 1701) of the patients were identified to be at VTE risk. Venous thromboembolism-risk was observed in 64.9% of surgical and 23.8% of medical patients, the latter being lower than global Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) study results; while prophylaxis was prescribed in 39.0% and 38.5% of them, respectively. Contraindication to anticoagulant prophylaxis was observed in 8.7% of medical and 8.8% of surgical patients. Conclusions: VTE remains a risk factor among patients hospitalized across Turkey, since identification as well as prophylaxis of patients at VTE risk seems to be neglected.

Effect of micronized zeolite addition to lamb concentrate feeds on growth performance and some blood chemistry and metabolites

This study was conducted to determine the effects of the addition of micronized zeolite (MZ) on the fattening performance, blood parameters, faecal ash and nitrogen levels of lambs fed concentrate feeds intensively. For two months 25 four-month-old Merino x Ile de France crossbred male lambs (21.1 ± 1.32 kg live weight) were fed 100 g alfalfa hay and a mixed concentrate diet containing 0%, 1%, 2% or 3% additional MZ. At the end of the study, bodyweight gain and feed consumption were not affected by the treatments. Similarly, the addition of up to 2% MZ to the diet did not affect slaughter weight, hot carcass or cold carcass weights, but they decreased at 3% MZ inclusion. No differences were observed between the groups in terms of blood urea nitrogen, plasma glucose, serum creatinine, triglyceride, sodium, potassium and chlorine concentration. However, serum total protein, calcium and phosphorus concentrations were affected by MZ supplementation. The addition of MZ to the ration did not affect the faecal dry matter content and total nitrogen level, yet it increased the ash content of the faeces. Consequently, it was demonstrated that the addition of up to 2% MZ to lamb grower feed does not have a negative impact on performance and carcass yield of the animals, but affects serum total protein, calcium and phosphorus concentrations.