In vitro multitarget activity of sulfadiazine substituted triazenes as antimicrobial, cytotoxic, and larvicidal agents

Multidrug resistance (MDR) causes difficulties in the treatment of infections and cancer. Research and development studies have become increasingly important for the strategy of preventing MDR. There is a need for new multitarget drug research and advancement to reduce the development of drug resistance in drug-drug interactions and reduce cost and toxic effects. This study aimed to determine the effects of multi-target triazene compounds on antibacterial, antifungal, antiviral, cytotoxic, and larvicidal activities were investigated in vitro. A series of 12 novel of 1,3-diaryltriazene-substituted sulfadiazine (SDZ) derivatives were synthesized, and the obtained pure products characterized in detail by spectroscopic and analytic methods (FT-IR, 1 H-NMR, 13 C-NMR, and melting points). The antibacterial and antifungal activities of these derivatives (AH1-12) were determined by broth microdilution method. All derivatives have been evaluated in cell-based assays for cytotoxic and antiviral activities against Modified Vaccinia Virus Ankara. The larvicidal efficacy of these chemical compounds was also investigated by using Lucilia sericata (L. sericata) larvae. Twelve 1,3-diaryltriazene-substituted SDZ derivatives (AH1-12) were designed and developed as potent multitargeted compounds. Among them, the AH1 derivative showed the most antibacterial and antifungal activity. Besides, synthesized derivatives AH2, AH3, AH5, and AH7 showed higher antiviral activity than SDZ. All synthesized derivatives showed higher cytotoxic activity than SDZ. Also, they showed larvicidal activity at 72 h of the experiment. As a result, these compounds might be great leads for the development of next-generation multitargeted agents.

Evaluation of cytotoxic, antifungal, and larvicidal activities of different bis-sulfonamide Schiff base compounds

Schiff bases (imines or azomethines) are versatile ligands synthesized from the condensation of amino compounds with active carbonyl groups and used for many pharmaceutical and medicinal applications. In our study, we aimed to determine the cytotoxic, antifungal and larvicidal activities of biologically potent bis-sulfonamide Schiff base derivatives that were re-synthesized by us. For this aim, 16 compounds were re-synthesized and tested for their cytotoxic, antifungal and larvicidal properties. Among this series, compounds A1B2, A1B4, A4B2, A4B3, and A4B4 were shown to have cytotoxic activity against tested cancer lung cell line (A549). The most potent antifungal activity was observed in compounds A2B1 and A2B2 against all fungi. A1B1 showed the strongest larvicidal effect at all concentrations at the 72nd h (100% mortality). These obtained results demonstrate that these type of bis-substituted compounds might be used as biologically potent pharmacophores against different types of diseases.

Prognostic significance of low basal serum creatinine levels in internal intensive care unit patients

OBJECTIVE

This study aimed to show the relationship between low creatinine level and mortality in the internal Intensive Care Unit (ICU) based on the view that there may be a relationship between low creatinine level and mortality in patients admitted to the ICU.

PATIENTS AND METHODS

This retrospective, single center study was performed in the ICU. Patients older than 18 years who stayed in the ICU for more than 24 hours were included in the study. Patients were evaluated for age, gender, albumin, creatinine levels and length of hospital stay in the analysis. Patients were divided into 7 groups according to serum creatinine levels: group 1: creatinine ≤ 0.4; group 2: 0.4 < creatinine ≤ 0.6; group 3: 0.6 < creatinine ≤ 0.8; group 4: 0.8 < creatinine ≤ 1.0; group 5: 1.0 < creatinine ≤ 1.2; group 6: 1.2 < creatinine ≤ 1.4; group 7: creatinine > 1.4 mg/dL. Creatinine level of 0.7-0.8 mg/dL was considered as reference and cox regression analysis was performed.

RESULTS

Of 2,359 patients admitted to the ICU, 699 died (29.6%). Mortality relationship according to the accepted creatinine levels of the patients showed a U-shaped distribution, and ICU mortality increased in both low and high creatinine levels. At low creatinine levels (creatinine ≤ 0.4 mg/dl), the mortality rate was 71.4% for men and 10.7% for female (p < 0.001). Cox regression analysis showed that group 1 and group 2 increased mortality (HR: 0.721, 95% CI; 0.555-0.936, HR: 0.509, 95% CI; 0.285-0.909, respectively).

CONCLUSIONS

In patients admitted to ICU, lower creatinine acceptance is associated with increased ICU mortality and reduced survival.

Quantitative Evaluation of late Gadolinium Enhancement to the Differential Diagnosis of Prostate Cancer and Prostatitis in mpMRI

OBJECTIVE

To evaluate the late gadolinium enhancement ratio (LGER) quantitatively in late post-contrast images in multiparametric prostate MRI (mpMRI) for the differential diagnosis of chronic prostatitis and prostate cancer (PCa).

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Department of Radiology, Suleyman Demirel University, Isparta, Turkey, from January 2018 to October 2021.

METHODOLOGY

The data of 111 patients with a diagnosis of PCa and chronic prostatitis, were retrospectively analysed who underwent mpMRI of the prostate were retrospectively analysed. Histopathological verification was available in 57 of 57 prostate carcinoma patients and 20 of 54 chronic prostatitis cases. The detection of lesions from the images and the correlation of the detected lesions with their histopathological diagnoses were made by the joint decision of two radiologists. The LGER measurements were made independently by both radiologists. Signal intensity (SI) values of the lesions were obtained by placing a hand-drawn ROI on pre-contrast and late post-contrast images. Late enhancement ratio was calculated from the ratio of the difference between the pre- and post-contrast SI values to the pre-contrast SI values. The LGER values obtained were statistically compared between the pathologically proven PCa and chronic prostatitis patient groups.

RESULTS

The prostatitis LGER values (103.40 ± 31.54%) were significantly higher than the PCa values (79.71±27.39, p<0.001). The LGER values of lesions with a Gleason score <7 were lower than those of lesions scoring ≥7 (p = 0.004). The LGER values of PI-RADS-3 PCa lesions were lower than those of PI-RADS-4 and PI-RADS-5 (p = 0.002). In the late post-contrast phase, low signal measurements in PI-RADS-3 lesions excluded the presence of prostatitis.

CONCLUSION

Late contrast enhancement quantitative SI measurements performed in the late contrast phase of mpMRI may enable the differential diagnosis of PCa/prostatitis and a more accurate evaluation of PI-RADS scores in terms of malignancy.

KEY WORDS

Prostate cancer, Prostatitis, Gadolinium, Dynamic contrast-enhanced magnetic resonance imaging.

Protective effect of vitamin D on imidacloprid-induced testicular injury in rats

INTRODUCTION

The degenerative effects of imidacloprid via oxidative stress are known. Irisin is a recently discovered peptide with energy regulator and antioxidant effects. In addition, the antioxidant potential of Vitamin D has been reported in previous studies. The current study was performed to investigate the effect of Vitamin D on testis morphology and irisin immunoreactivity in imidacloprid-treated rats.

MATERIAL AND METHODS

Thirty-two Wistar albino male rats were divided into groups: control (n = 6), corn oil (n = 6), Vitamin D (n = 6), imidacloprid (n = 7) and imidacloprid + Vitamin D (n = 7). Testis tissues were used to evaluate the histopathological, biochemical and immunohistochemical changes. Oxidative state in testis tissue was determined with total antioxidant and oxidant status markers, total antioxidant status (TAS) and total oxidant status (TOS) respectively.

RESULTS

In microscopic examination, degenerative changes in the seminiferous tubule epithelium, interstitial edema and increased irisin immunoreactivity were observed in animals given imidacloprid. Also increased TOS and decreased TAS levels were measured in these animals. It was observed that Vitamin D improved the testicular damage histopathologically when compared to the imidacloprid group. However, increase in TAS levels and decrease in both TOS levels and irisin immunoreactivity were found insignificant in animals given Vitamin D.

CONCLUSIONS

In the present study it was observed that Vitamin D ameliorated testis injury caused by imidacloprid. Furthermore, imidacloprid was found to increase the immunoreactivity of irisin. In the light of our findings, we conclude that the use of Vitamin D could be beneficial against testicular damage caused by imidacloprid.

Multi-slice CT findings in COVID-19 pneumonia: a cross-sectional multicenter study

In this cross-sectional study of 278 patients, patients diagnosed with COVID-19 per their clinical features, laboratory, and thorax computed tomography (CT) findings were evaluated in terms of the most common characteristic findings. The lesions were classified according to the disease stage. The most common findings for each phase were investigated. The typical CT results included ground-glass opacity (GGO), unilateral involvement, and single lesions in the early stages, as well as bilateral involvement, and multiple lesions in the progressive and peak phases. Additionally, vascular dilatation was the most common finding after GGO. Basal segment dominance and peripheral-intraparenchymal-basal segment involvement were mostly seen in the peak-phase patients. Thus, we think that this finding is an essential key to determining that the disease is in the advanced stages. The crazy-paving pattern was also a typical finding in the early-stage patients. Cavitary lesions, pulmonary nodules, and mediastinal lymph nodes were not observed in the lungs.

Technological Advances Have Improved Surgical Outcome in Thyroid Surgery: Myth or Reality?

Aim

In this study, we aimed to investigate the effects of Ultrasonic Coagulation (UC), Bipolar Energy Sealing System (BESS), Intra Operative Nerve Monitoring (IONM) and surgical experience on the complications of thyroid surgery.

Method

The data of 1627 patients who underwent thyroid surgery for various indications in our department between 2009 and 2018 were analyzed retrospectively and the effects of different technological devices on complications were investigated.

Results

Transient recurrent laryngeal nerve (RLN) palsy was higher between 2009 and 2013, when IONM was not in routine use (p=0.029). There were no significant differences between two energy devices (UC and BESS) in terms of transient or permanent RLN palsy, bleeding, and transient or permanent hypocalcemia. Multivariate analysis showed that young age (0.006), female gender (0.016), surgery type (p<0.001), and lateral neck dissection (p=0.026) are independent risk factors for transient hypocalcemia.

Conclusion

The results indicate that there is no superior hemostatic device. IONM and specific branching decrease transient RLN palsy. Female gender, young age, completion thyroidectomy, and lateral neck dissection were independent risk factors for the development of transient hypocalcemia.

Analysis of root and canal morphology of fused and separate rooted maxillary molar teeth in Turkish population

Aims

To investigate the root canal anatomy and the incidence of fused roots in maxillary first molar (MFM) and maxillary second molar (MSM) teeth in the Turkish population and compare them to teeth with separate roots using cone-beam computed tomography (CBCT).

Methods

CBCT images of 616 MFMs and 703 MSMs were analyzed from 402 patients for the number of roots and the presence of fusion. The canal configuration of teeth with separate and fused roots was compared. Type of fusion and canal merging positions were determined. A P value of less than 0.05 was considered significant.

Results

Five hundred and seventy-one (92.69%) MFMs had three separate roots, one (0.16%) had four roots and the incidence of root fusion was 7.14%. An additional mesiobuccal (MB) canal was present in 79.34% of the teeth with three separate roots. There was no merging of canals in 36 of 44 teeth with fused roots. The prevalence of fusion was higher in the MSMs (23.47%). The incidence of three and four separate roots in MSM teeth was 74.68% and 1.85%, respectively. The prevalence of additional MB canals in teeth with three separate roots was 53.14%. There was no canal merging in 60% of the fused rooted teeth. There were two-merged canals in 31.52% and multiple merged canals in 8.48% of the MSMs.

Conclusions

In the Turkish population, the incidence of root fusion in the MFMs and MSMs was 7.14% and 23.47%, respectively, with more canal merging in the MSMs.

Effects of cannabinoid receptor 2 synthetic agonist, AM1241, on bleomycin induced pulmonary fibrosis

Bleomycin (BLM) is a chemotherapeutic agent that can cause pulmonary fibrosis. Little is known about the possible protective role of the CB2 receptor agonist, AM1241. We investigated the effects of CB2 receptor activation by AM1241 on BLM induced lung fibrosis in a rat model. BLM was administered via the trachea. Adult female Wistar rats were divided into five groups: saline (control group), BLM (BLM group), CB2 agonist (AM1241) + BLM (BLMA group), CB2 antagonist (AM630) and CB2 agonist (AM1241) + BLM (BLMA + A group), and vehicle (dimethylsulfoxide) + BLM (BLM + vehicle group). Hydroxyproline, collagen type 1, total protein, glutathione (GSH), malondialdehyde (MDA), interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels were measured in lung fibrosis and control tissue using standard methods. We investigated the histopathology of lung tissue to determine the extent of fibrosis. We found significantly higher levels of hydroxyproline, TNF-α, IL-6 and total protein in the BLM group compared to the BLMA group. The level of GSH also was higher in the BLMA group compared to the BLM group. Inflammation and fibrotic changes were significantly reduced in the BLMA group. Our findings suggest that CB2 receptor activation provided protection against BLM induced pulmonary fibrosis by suppressing oxidative stress and increasing cytokines.

Diabetes Care During Hajj

Diabetes mellitus affects over 463 million individuals worldwide. Religious activities such as the Hajj pilgrimage have a major impact on patients with diabetes mellitus, including increasing the risk of hyperglycaemia and hypoglycaemia. This increased risk is due to dietary changes and intense physical activity during pilgrimage while being on antidiabetic medications. Approximately 20% of the pilgrims with underlying illnesses who visit Mecca are diabetic, and complications, such as diabetic ketoacidosis, nonketotic hyperosmolar state, and fatigue/unconsciousness due to hypoglycaemia, have been observed among these patients. Diabetic patients are also at a high risk for foot complications and infections. To avoid any aggravation of the diabetes, a complete biochemical evaluation of the patient must be conducted before Hajj, and the patients must be provided contextualized educational guidance to avert these potential health challenges. This counselling should include the importance of carrying with them at all time their relevant medical history, summaries of the current treatment regimen and emergency snacks. In addition, to reduce the risk of hypoglycaemia, the dosage of insulin should be reduced in selected patients by 20% and that of sulfonylurea should be reduced as needed. Basal insulin and glucagon-like peptide 1 receptor agonists are associated with fewer complications and can be preferentially prescribed. Those patients with type 1 diabetes can continue with the use of insulin pump with suitable education prior to Hajj. For the prevention of foot problems, the use of padded socks and well-fitting shoes is recommended along with an insistence on not walking barefoot. After Hajj, the patient must be followed up, and necessary investigations must be made along with readjustment of insulin dosage in those patients for whom it was reduced. Until the pandemic situation abates, all diabetic patients should avoid making the Hajj journey.

Cardiorenal Syndrome in Type 2 Diabetes Mellitus - Rational Use of Sodium-glucose Cotransporter-2 Inhibitors

Cardiorenal syndrome (CRS) in people with type 2 diabetes mellitus (T2DM) illustrates the bidirectional link between the heart and the kidneys, with acute or chronic dysfunction of one organ adversely impacting the function of the other. Of the five subtypes identified, type 1 and 2 CRS occur because of the adverse impact of cardiac conditions on the kidneys. Type 3 and 4 occur when renal conditions affect the heart, and in type 5, systemic conditions impact the heart and kidneys concurrently. The cardiovascular and renoprotective benefits evidenced with sodium-glucose cotransporter-2 (SGLT2) inhibitors make them a potential choice in the management of CRS. Cardiovascular protection is mediated by a reduction in cardiac workload, blood pressure, and body weight; with improvement in lipid profile, uric acid levels, and adaptive ketogenesis process. Renoprotection is facilitated by reduction in albuminuria and hypoxic stress, and restoration of tubuloglomerular feedback. The favourable effect on cardiovascular complications and death, as well as renal complications and progression to end-stage kidney disease, has been confirmed in clinical trials. Guidelines endorse first-line use of SGLT2 inhibitors after metformin in patients with T2DM with high cardiovascular risk, chronic kidney disease or both. Since most trials with SGLT2 inhibitors excluded subjects with acute illness, patients with CRS subtypes 1 and 3 have not been studied adequately, making SGLT2 initiation in clinical practice challenging. Ongoing trials may provide evidence for SGLT2 inhibitor use in CRS. This review aims to enhance understanding of CRS and provide guidance for judicious use of SGLT2 inhibitors in T2DM.

Analysis of general surgery outpatient clinic admissions and operations during COVID-19 pandemic in Turkey: Reactions of 12728 patients

Covid-19 pandemic is spreading rapidly in Turkey. We aimed to examine the numbers and demographic data of patients who applied to the general surgery outpatient clinics and operated in this process. Our primary outcome is to reveal the response of general surgery patients to the Covid-19 pandemic.The first Covid-19 case in Turkey has appeared in March 11, 2020. Patients who were operated on due to a surgical emergency or trauma were evaluated separately. Patients in 3 periods were compared with each other. A total of 12728 patients were examined in general surgery outpatient clinics in 26 working days. It is seen that patients come to the outpatient clinic after the first time the Covid-19 patient is seen. All patients reduced hospitalization after the first death due to Covid-19. Women had reduced going to the hospital earlier than men. There was no change in the number of emergency surgeries. Rapid decrease was observed in the number of elective surgeries.It is not easy to control the entrance and exit of these busy hospitals. The remote diagnosis (mail, phone or video-call) and treatment methods that can be expected in the near future may be even closer with the Corona virus (Tab. 3, Fig. 4, Ref. 15). Keywords: general surgery, Covid-19, outpatient clinics, operation, reaction of patients.

Comparison of the HEART and HEARTS3 scores to predict major adverse cardiac events in chest pain patients at the emergency department

Introduction:

The aim of this study was to determine the risk assessment of acute coronary syndrome and prediction of major adverse cardiac events by HEART (History, ECG, Age, Risk factors, Troponin) and HEARTS3 (HEART + 3S = Sex, Serial 2-h ECG, and Serial 2-h delta Troponin) scoring systems in patients admitted to the emergency department with chest pain.

Methods:

This is a single-center prospective cohort study. This study was conducted in patients admitted to the emergency department with chest pain, without ST-elevation myocardial infarction, who were 18 years or older, and agreed to participate in the study. The primary endpoint is the occurrence of major adverse cardiovascular events within 30 days. The receiver operating characteristic curve was used to assess the power of HEART and HEARTS3 scores to predict major adverse cardiovascular events.

Results:

The mean age of 239 patients was 47.91 ± 13.93 years and 72.4% (173) were male. Major adverse cardiovascular events developed in 20.1% (48) of the patients. The mean HEART and HEARTS3 scores of the patients with major adverse cardiovascular events (5.67 ± 1.46 and 9.38 ± 3.91, respectively) were both statistically and significantly higher than the scores of the patients without major adverse cardiovascular events (2.33 ± 1.44 and 2.22 ± 1.39; p = 0.001). The area under the curve values of HEART and HEARTS3 scores were found to be 0.943 (95% confidence interval: 0.905–0.968) and 0.990 (0.968–0.999), respectively.

Conclusion:

In our study, the power of HEARTS3 score to predict major adverse cardiovascular events was better in the risk assessment of acute coronary syndrome in patients admitted to the emergency department with chest pain compared to the HEART score. We think that patients with a low HEARTS3 score can be safely discharged from emergency department without further cardiac examination.

A Cross-Sectional Study of Overtreatment and Deintensification of Antidiabetic and Antihypertensive Medications in Diabetes Mellitus: The TEMD Overtreatment Study

INTRODUCTION

Targeting better glycated hemoglobin (HbA1c) and blood pressure (BP) goals may endanger older adults with type 2 diabetes mellitus (T2DM). Overtreatment of T2DM and hypertension is a trending issue, although undertreatment is still common. We investigated the rates and predictors of overtreatment and undertreatment of glycemia and BP in older adults with T2DM and physicians' attitudes to deintensify or intensify treatment.

METHODS

Data from older adults (≥ 65 years) enrolled in a large nationwide T2DM survey in 2017 across Turkey were analyzed. Overtreatment of glycemia was defined as HbA1c < 6.5% plus the use of ≥ 2 oral antihyperglycemics or insulin, and BP overtreatment was defined as systolic BP (SBP) < 120 mmHg or diastolic BP (DBP) < 65 mmHg plus the use of ≥ 2 drugs. Undertreatment of glycemia was defined as HbA1c > 9%, and BP undertreatment was defined as SBP > 150 mmHg or DBP > 90 mmHg. Deintensification or intensification rates were calculated according to treatment modification initiated by the treating physician(s).

RESULTS

The rate of overtreatment in the glycemia group (n = 1264) was 9.8% (n = 124) and that in the BP group (n = 1052) was 7.3% (n = 77), whereas the rate of undertreatment was 14.2% (n = 180) and 15.2% (n = 160), respectively. In the adjusted model, use of oral secretagogues (sulfonylureas or glinides) (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.2-3.1) and follow-up at a private clinic (OR 1.81, 95% CI 1.0-3.3) were predictors of glycemia overtreatment. BP overtreatment was independently associated with the use insulin-based diabetes therapies (OR 1.86, 95% CI 1.14-3.04). There was no independent association of BP undertreatment to the study confounders. The deintensification and intensification rates were 25 and 75.6%, respectively, for glycemia and 10.9 and 9.2%, respectively, for BP.

CONCLUSIONS

The results show that one in ten older adults with T2DM are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications while they largely ignore deintensification in diabetes management. These results warrant enforced measures to improve the care of older adults with T2DM.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT03455101.

Hepatoprotective properties for Salvia cryptantha extract on carbon tetrachloride-induced liver injury

The present study was designed to determine the possible hepatoprotective effects of Salvia cryptantha (black weed) plant extract against carbon tetrachloride (CCl4)-induced hepatic injury in rats. Animals were grouped as follows: control group (Group I), CCl4 group (Group II), olive oil group (Group III), CCl4 + S. cryphantha 200 mg/kg group (Group IV), and CCl4 + S. cryptantha 400mg/kg group (Group V). Rats were injected intraperitoneally with CCl4 diluted in olive oil (50% v/v) at a dose of 1ml/kg body weight.  Bax and Caspase3 were determined by immunohistochemical staining, while apoptotic index was evaluated using TUNEL assay. Total mRNA was isolated from liver tissues, and the levels of BCL2, Caspase3, SOD, CAT, and glutathione peroxidase (GPx) were determined by using PCR, while MDA level were determined using a colorimetric assay. The antioxidant and anti-apoptotic gene transcripts were decreased in all of the control and treatment groups, while Caspase3 levels were not statistically different. The S. cryptantha plant extract treatment was also found to improve SOD, GPx, and catalase levels, while reducing the serum levels of MDA. The extract of S. cryptantha supplementation had a protective effect against CCl4-induced liver damage. S. cryptantha extract as a supplement may be useful as a hepato-protective agent to combat the toxic effects caused by CCl4 and other chemicals.

Diffusion weighted magnetic resonance imaging in the diagnosis of parotid masses. Preliminary results

Objective

To demonstrate the diagnostic potentials of MRI, diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) mapping in the detection of parotid masses correlated to the histopathological results.

Methods

Study design was retrospective. Fifteen patients with parotid gland masses were included as the study group and contralateral normal parotis glands of same patients were taken as the control group. Patients with bilateral parotid gland tumors were excluded, 7 right-sided and 8 left-sided parotid masses were included in the research. The study took place at the Department of Radiology, Ankara, Turkey, between May 2012 and September 2014.

Results

Apparent diffusion coefficient measurements of 15 parotis tumors in 1000 and 750 sec/mm²b-values with comparison to the contralateral normal gland parenchyma were demonstrated. Neurofibromas was predicted as the highest, and lipomas as the lowest ADC values. Pleomorphic adenomas, Warthin’s tumor, and normal parotid parenchyma indicate significant statistical differences from each other on the basis of mean ADC values (p<0.05).

Conclusion

The DWI and ADC mapping of parotis gland could aid in the differential diagnosis of benign and malignant masses.

22.5 MB DELETION OF 13q31.1-q34 ASSOCIATED WITH HPE, DWM, AND HSCR: A CASE REPORT AND REDEFINING THE SMALLEST DELETED REGIONS

Partial deletion of the long arm of the chromosome 13, 13q deletion syndrome is a rare chromosomal disorder characterized by severe growth and mental retardation, microcephaly, facial dysmorphism, brain malformations (holoprosencephaly, Dandy-Walker malformation), distal limb defects, eye anomalies, genitourinary and gastrointestinal tract malformations (Hirschsprung's disease). Approximately 1.2 Mb region in 13q32 was suggested as minimal critical region which is responsible for severe mental and growth retardation and brain anomalies. Here we described a male patient with de novo interstitial deletion of 13q31.1-q34 associated with short stature, microcephaly, facial dysmorphism, clinodactyly, cryptorchidism, micropenis, epilepsy, HPE, DWM, and HSCR. According to the literature review, present case indicated that smallest deleted region associated with DWM and HPE might be located at the 13q32.3, limb defects 13q34, anogenital malformations 13q33.3-34, and HSCR 13q31.1-32.1.

Impact of telephonic interviews on persistence and daily adherence to insulin treatment in insulin-naïve type 2 diabetes patients: dropout study

OBJECTIVE

The objective of this study is to evaluate the impact of sequential telephonic interviews on treatment persistence and daily adherence to insulin injections among insulin-naïve type 2 diabetes patients initiated on different insulin regimens in a 3-month period.

METHODS

A total of 1,456 insulin-naïve patients with type 2 diabetes (mean [standard deviation, SD] age: 56.0 [12.0] years, 49.1% were females) initiated on insulin therapy and consecutively randomized to sequential (n=733) and single (n=723) telephonic interview groups were included. Data on insulin treatment and self-reported blood glucose values were obtained via telephone interview. Logistic regression analysis was performed for factors predicting increased likelihood of persistence and skipping an injection.

RESULTS

Overall, 76.8% patients (83.2% in sequential vs 70.3% in single interview group, (P<0.001) remained on insulin treatment at the third month. Significantly higher rate for skipping doses was noted in basal bolus than in other regimens (27.0% vs 15.0% for premixed and 15.8% basal insulin, respectively, P<0.0001). Logistic regression analysis revealed sequential telephonic interview (odds ratio [OR], 1.531; 95% confidence interval [CI], 1.093-2.143; P=0.013), higher hemoglobin A1c levels (OR, 1.090; 95% CI, 0.999-1.189; P=0.049), and less negative appraisal of insulin therapy as significant predictors of higher persistence. Basal bolus regimen (OR, 1.583; 95% CI, 1.011-2.479; P=0.045) and higher hemoglobin A1c levels (OR, 1.114; 95% CI, 1.028-1.207; P=0.008) were the significant predictors of increased likelihood of skipping an injection.

CONCLUSION

Our findings revealed positive influence of sequential telephonic interview, although including no intervention in treatment, on achieving better treatment persistence in type 2 diabetes patients initiating insulin.

Methylenetetrahydrofolate Reductase gene polymorphism in children with allergic rhinitis

BACKGROUND

Methylenetetrahydrofolate Reductase (MTHFR) polymorphisms by impairing folate metabolism may influence the development of allergic diseases. The results of studies evaluating the relationship between MTHFR polymorphisms and atopic disease are controversial. The aim of this study was to investigate the association between the polymorphisms of C677T and A1298C for MTHFR gene and allergic rhinitis (AR) in children.

METHODS

Ninety patients followed up with diagnosis of allergic rhinitis in our clinic and 30 children with no allergic diseases were included in the study. All participants were genotyped for the MTHFR (C677T) and (A1298C) polymorphisms. Vitamin b12, folate and homocysteine levels were measured.

RESULTS

The mean age of patients was 9.2±2.9 years; 66.7% of the patients were male. There was no significant difference between patient and control groups regarding gender, age and atopy history of the family (p>0.05). The frequency of homozygotes for MTHFR C677T polymorphism in the patient and control groups was 3.3% and 10%, respectively. The frequency of homozygotes for MTHFR A1298C polymorphism among groups was 26.7% and 16.7%, respectively. The association between allergic rhinitis and polymorphisms of C677T and A1298C for MTHFR gene was not statistically significant in patients compared with controls (p>0.05). There were no statistically significant differences between the patients and the control group in terms of serum vitamin b12, folate and homocysteine levels (p>0.05).

CONCLUSION

We found no evidence for an association between allergic rhinitis and polymorphisms of C677T and A1298C for MTHFR gene in children. Further studies investigating the relationship between MTHFR polymorphism and AR are required.

Coherency strain and its effect on ionic conductivity and diffusion in solid electrolytes--an improved model for nanocrystalline thin films and a review of experimental data

A phenomenological and analytical model for the influence of strain effects on atomic transport in columnar thin films is presented. A model system consisting of two types of crystalline thin films with coherent interfaces is assumed. Biaxial mechanical strain ε0 is caused by lattice misfit of the two phases. The conjoined films consist of columnar crystallites with a small diameter l. Strain relaxation by local elastic deformation, parallel to the hetero-interface, is possible along the columnar grain boundaries. The spatial extent δ0 of the strained hetero-interface regions can be calculated, assuming an exponential decay of the deformation-forces. The effect of the strain field on the local ionic transport in a thin film is then calculated by using the thermodynamic relation between (isostatic) pressure and free activation enthalpy ΔG(#). An expression describing the total ionic transport relative to bulk transport of a thin film or a multilayer as a function of the layer thickness is obtained as an integral average over strained and unstrained regions. The expression depends only on known material constants such as Young modulus Y, Poisson ratio ν and activation volume ΔV(#), which can be combined as dimensionless parameters. The model is successfully used to describe own experimental data from conductivity and diffusion studies. In the second part of the paper a comprehensive literature overview of experimental studies on (fast) ion transport in thin films and multilayers along solid-solid hetero-interfaces is presented. By comparing and reviewing the data the observed interface effects can be classified into three groups: (i) transport along interfaces between extrinsic ionic conductors (and insulator), (ii) transport along an open surface of an extrinsic ionic conductor and (iii) transport along interfaces between intrinsic ionic conductors. The observed effects in these groups differ by about five orders of magnitude in a very consistent way. The modified interface transport in group (i) is most probably caused by strain effects, misfit dislocations or disordered transition regions.

MICROARRAY DELINEATION OF DE NOVO DUPLICATION 1q32q42 IN A CHILD SHOWING MULTIPLE ANOMALIES AND DYSMORPHISM

We present a 9 month-old baby girl with de novo pure interstitial duplication 1q. The girl has dysmorphic craniofacial features as well as neuromotor retardation, multiple subcutaneous solid tissue lesions, urogenital anomalies, cardiac defect, liver parenchyma heterogeneity and intracranial anomaly. The case of de novo duplication of 1q32q42 defined by G-banding and Microarray Comparative Genomic Hybridization (Microarray CGH) was presented with its clinical findings.

The deletion 22q13 syndrome: a new case

The deletion 22q13.3 syndrome (Phelan-McDermid syndrome) is a chromosome microdeletion syndrome characterized by neonatal hypotonia, global developmental delay, normal to accelerated growth, absent to severely delayed speech, and minor dysmorphic features. Common physical traits include long eye lashes, large or unusual ears, relatively large hands, dysplastic toenails, full brow, dolicocephaly, full cheeks, bulbous nose, and pointed chin. Behavior is autisticlike with decreased perception of pain and habitual chewing or mouthing. The loss of 22q13.3 can result from simple deletion, translocation, ring chromosome formation and less common structural changes affecting the long arm of chromosome 22, specifically the region containing the SHANK3 gene. The present case was referred at the age of 8 months because of delayed psychomotor development, hypotonia and autistic features. Clinical examination showed a small forehead, long eyelashes, epicanthal folds and lowset ears, large and broad hands and feet with short terminal phalanges. He had no eye contact and could not sit without support.

CLINICAL REPORT OF A PATIENT WITH DE NOVO TRISOMY 12q23.1q24.33

We report a patient with a rare de novo duplication of 12q23.1-12q24.33 region with a 32.7 Mb gain, having similar features seen in previously reported isolated cases of duplications of the 12q23q24 region, such as growth retardation, neuromotor retardation, corpus callosum agenesis, dysmorphic features such as, hypertelorism, epicanthus, flat nasal bridge, low-set small ears, down-turned corners of the mouth, micrognathia, cryptorchidism and limb anomalies such as pes plano valgus, prominent heels and overriding toes. Our patient has Noonan-like features, such as short stature, short neck, epicanthal folds, ptosis of eyelids, hypertelorism, pectus excavatum, widely spaced nipples and cryptorchidism. Duplication of PTPN11 gene has been postulated as a mechanism for the Noonan syndrome. Phenotypic features and the genes involved in this region are important to further delineate the 12q23q24 phenotype.

Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database

Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 ± 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: non-secretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndrome is still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries.

Influence of single hemodialysis session on serum paraoxonase-1, arylesterase activity, total oxıdant status and total antioxidant status

AIM

Chronic kidney disease(CKD) and hemodialysis (HD) are associated with increased oxidative stress. Cardiovascular diseases (CVD) are the most important cause of mortality in these patients. Increased cardiovascular risk is associated with oxidative stress. The aim of this study was to evaluate whether the duration of single session hemodialysis may affect oxidative stress parameters on the patients with end-stage renal disease (ESRD).

METHODS

Total oxidant status (TOS) and oxidative stress index (OSI) as oxidative markers and total antioxidant status (TAOS), paraoxonase1 (PON1) and arylesterase (ARES) as antioxidant markers were compared hemodialysis therapy before and after the treatment.

RESULTS

TOS levels before hemodialysis were found as 4.4±2.4 μmol H2O2 Equiv/L, TAOS 2.1±0.3 µmol trolox Equiv./L, OSI 0.2±0.1%, PON1 levels 58.5±35.6 U/L and ARES levels 22±0.2 U/L while after the HD the respective values were 1.4±1.2 μmol H2O2 Equiv/L, 1.4±0.5 µmol trolox Equiv./L, 0.1±0.1%, 54.3±31.3 U/L, 21.8±0.1 U/L. A significant decreasing was observed in TOS TAOS OSI and ARES values before the HD compared to after the HD (P=0.0001, P=0.0001, P=0.0001, P=0.031, respectively).

CONCLUSION

This study shows oxidant (TOS, OSI) and antioxidant (TAOS, ARES) markers were found to be significantly decrease after the HD compared to pre-hemodialysis. Although reverse is expected it is found that oxidants (indirectly ROS) did not increase and antioxidant reserve decreased in HD.

A patient with duplication (7)(p15.3p22.3) and deletion (7)(p22.3pter) characterized by array-CGH

We report a patient with neurodevelopmental delay, hypotonia, congenital cardiac anomaly and dysmorphic features such as macrocephaly, a large anterior fontanel, prominent forehead, short neck, downslanted and short palpebral fissures, hypertelorism, wide nasal bridge, straight, thin nose with asymmetric narrow inverted nostrils, micrognathia, low-set dysplastic ears. 7p15.3-p22.3 duplication and a 7p22.3-pter deletion were characterized by array-CGH analysed after karyotyping and FISH studies. The patient's distinctive features are consistent with the phenotypic features of 7p duplication. The genes involved in these regions are discussed for their possible relation to our patient's phenotype.

Role of matrix metalloproteinases and tissue inhibitor of matrix metalloproteinases-1 in Crimean-Congo hemorrhagic fever disease

AIM

Crimean-Congo hemorrhagic fever is a potentially fatal viral disease in humans caused by CCHF virus. We aimed to demonstrate change in serum levels of matrix metallopeinase/tissue matrix metalloproteinase inhibitor (MMP/TIMP) associated with CCHF.

PATIENTS AND METHODS

Blood specimens were collected in acute and convalescence periods from the patients presented to Cumhuriyet University Hospital, Department of Emergency and Infection Diseases with presumed as CCHF between May 2010 and September 2010. Forty-one age and gender matched healthy individuals had not any viral, bacterial, acute or chronic disease were enrolled as the controls. Blood specimens were centrifuged at 4000 rpm for 5 min with in "Hettich universal 32" centrifuge. Serum samples obtained were kept at -80°C. All the specimens were brought to room temperature during the study and MMP-1, 2, 7, 9, 10 and TIMP-1 tests were studied at one time using "RayBiotech" brand kit in "Grifols" brand "Triturus" model ELISA device. Acute, convalescence and control groups were compared in terms of the serum levels of MMP-1, 2, 7, 9, 10 and TIMP-1.

RESULTS

There was a statistically significant increase in serum levels of MMP-1, 7, 9, 10 and TIMP-1 in the convalescence period (p < 0.05) compared to the controls, while the increase in levels of MMP-2 was not statistically significant (p > 0.05). In acute period of CCHF, mean TIMP-1 levels of severe patients was significantly lower than that of the non-severe patients (207913 ± 31051 versus 231300 ± 13267, respectively, p = 0.023).

CONCLUSIONS

High serum levels of MMP and TIMP in CCHF disease were found to decrease as progressed to convalescence from the acute period. It is thought MMP and TIMP plays a significant role in pathogenesis of CCHF.