An evaluation of ursodeoxycholic acid treatment in prolonged unconjugated hyperbilirubinemia due to breast milk

Background/Aim

Prolonged jaundice is one of the most common problems during neonatal period. The aim of this study was to evaluate the efficiency of ursodeoxycholic acid (UDCA) treatment in newborn infants with prolonged unconjugated hyperbilirubinemia.

Materials and Methods

The present study included 27 patients who were fed by breast milk and followed up in the outpatient clinic due to prolonged jaundice without any underlying etiological factor; 10 mg/kg/day UDCA was administrated in two doses for 7 days. Furthermore, 20 newborns diagnosed with prolonged jaundice with same characteristics were enrolled as the control group. The control group was also given a placebo; demographic characteristics, liver functions tests before and after the treatment, bilirubin decrease rates, and hemogram parameters of groups were compared.

Results

Total bilirubin levels in the study and control groups before the treatment were 16.02 ± 1.41 mg/dL and 15.93 ± 1.66 mg/dL, respectively (P = 0.84). Total bilirubin levels in the study and control groups at day 7 after UDCA treatment were detected 8.18 ± 2.31 mg/dL and 13.92 ± 2.66 mg/dL, respectively (P < 0.001), and at day 14 after the treatment were 5.45 ± 2.59 mg/dL and 11.91 ± 2.83 mg/dL, respectively (P < 0.001). Furthermore, serum aspartate aminotransferase (AST) was detected <21 U/L in the ROC analysis after UDCA treatment (P = 0.04).

Conclusion

The study outcomes indicated that an efficient reduction in total bilirubin levels may be achieved, and outpatient clinic follow-up period may be reduced in patients whom UDCA was administrated. Moreover, it may be speculated that AST can be used to evaluate the efficacy after treatment. However, studies with larger sample sizes are needed for the routine use of UDCA in the treatment of prolonged jaundice.

The role of ultrasound in determining the presence and severity of carpal tunnel syndrome in diabetic patients

Carpal tunnel syndrome (CTS) is seen in 5% of the population and 14%-30% in diabetics. Although electrophysiological tests are used as the gold standard method in the diagnosis, alternative methods are being studying. We aimed to investigate whether the measurement of median nerve cross-sectional area (CSA) by ultrasound is associated with the presence and severity of CTS. This prospective, cross-sectional observational study includes 128 randomly selected T2DM patients. Electrodiagnostic study was performed for all patients to diagnose CTS. Median nerve CSA were measured with ultrasound examination. The severity of the CTS was determined by Padua method. Among 128 diabetes mellitus (DM) patients, 54 (28%) had CTS and 53 (41%) had diabetic peripheral polyneuropathy. The mean duration of DM was 11.55 years. Median nerve CSAs of the patients were significantly higher in patients with CTS (CTS (-): 10.47 ± 2.67 vs CTS: (+) 12.37 ± 3.17; p < 0.001). Median nerve CSA cutoff value of >10 mm2 predicts the diagnosis of CTS. However, minimal, mild, and moderate CTS groups had similar CSA according to Padua classification (p > 0.05 for all). CSA measurement with ultrasonography can be used as an effective method in diagnosing severe CTS disease. However, median nerve CSA values should not be used to reveal the severity of CTS, in order not to miss the demonstration of minimal, mild, and moderate groups, as well as being an indicator of only the severe CTS group.

The protective effects of ginseng on x-irradiation-induced intestinal damage in rats

Although radiotherapy is widely employed in the treatment of various malignancies in oncology patients, its use is limited by the toxic effects it causes in surrounding tissues, including the gastrointestinal system. Korean Red Ginseng (KRG) is a traditional drug reported to possess antioxidant and restorative properties in various studies. The purpose of the present study was to investigate the protective effects of KRG against radiation-associated small intestinal damage. Twenty-four male Sprague Dawley rats were randomly assigned into three groups. No procedure was performed on Group 1 (control) during the experiment, while Group 2 (x-irradiation) was exposed to radiation only. Group 3 (x-irradiation + ginseng) received ginseng via the intraperitoneal route for a week prior to x-irradiation. The rats were killed 24 h after radiation. Small intestinal tissues were evaluated using histochemical and biochemical methods. An increase in malondialdehyde (MDA) levels and a decrease in glutathione (GSH) were observed in the x-irradiation group compared to the control group. KRG caused a decrease in MDA and caspase-3 activity and an increase in GSH. Our findings show that it can prevent damage and apoptotic cell death caused by x-irradiation in intestinal tissue and can therefore play a protective role against intestinal injury in patients receiving radiotherapy.

The effects of dexmedetomidine on early acute kidney injury in severely burned rats

OBJECTIVE

Burns are a global medical and economic problem. In addition to high costs, the lengthy therapeutic process and the emotional trauma experienced by patients and their families indirectly worsen the socioeconomic damage caused. Kidney failure observed after burns is highly correlated with mortality.

MATERIALS AND METHODS

Twenty-eight male Sprague-Dawley rats (age four months, weight 250-350 g) were included in the study. They were randomly assigned into four groups consisting of seven rats each with similar mean weights. Group 1 (n=7) represented the healthy control group (C), Group 2 (n=7) the Sham+dexmedetomidine (DEX) 100 mcg/kg (three doses) (S+DEX100) group, Group 3 (n=7) the 30% Burn (B), and Group 4 (n=7) the 30% Burn+DEX 100 mcg/kg/day group (B+DEX100) (three doses). Thiobarbituric acid reactive substances (TBARS), total thiol (TT), interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) values in kidney tissues were investigated biochemically, and histopathological analyses were also performed. Nuclear factor κB (NF-κB)/p65 was measured using immunohistochemistry, and the TUNEL assay was applied to indicate apoptotic tubular epithelial cells.

RESULTS

TBARS, IL-1, and TNF-α in kidney tissues decreased in the B+DEX100 group compared to the 30% burn group, while total thiol values increased. Histopathologically, atypical glomeruli, particularly necrotic tubules, and inflammation in peritubular areas decreased in the B+DEX100 group compared to the 30% burn group. In addition, apoptotic tubular epithelial cells exhibiting TUNEL positivity and tubular epithelial cells exhibiting NF-кβ/p65 positivity also decreased in the B+DEX100 group compared to the 30% burn group.

CONCLUSIONS

Dexmedetomidine reduced apoptotic activity in rats and exhibited anti-inflammatory antioxidant effects in the burn model in this study.

The effect of single plate and double plate application on union and functional results in humeral diaphyseal nonunions

In this study, we assessed and compared the outcomes of two different fixation techniques for humeral diaphyseal fracture nonunions. A retrospective evaluation of 22 patients who underwent single-plate and double-plate fixation due to humeral diaphyseal nonunions was conducted. Union rates, union times, and functional outcomes of the patients were assessed. There was no significant difference between single- plate and double-plate fixation in terms of union rates or union times. The double-plate fixation group achieved significantly better functional outcomes. Nerve damage or surgical site infection were not encountered in either group.Due to its considerable effect on stability, double-plate fixation, offers both patients and surgeons confidence in terms of early adaptation to daily life in the postoperative period.

Impact of a clinical pharmacist-led stewardship program for the appropriate use of acid suppression therapy in older hospitalized patients: a non-randomized controlled study

BACKGROUND

The potentially inappropriate use of the proton pump inhibitors is prevalent in older adults.

AIM

To evaluate the impact of a clinical pharmacist-led stewardship program for the appropriate use of acid suppression therapy in older hospitalized patients.

METHOD

This parallel nonrandomized controlled study was conducted at an internal medicine service of a tertiary training and research hospital between September 2019 and August 2021. Older patients (≥ 65 years old and received proton pump inhibitors within 48 h of admission) were allocated to two groups according to their number of medical file records, whether odd or even, two groups: control and clinical pharmacist-led stewardship program for the appropriate use of acid suppression therapy (including medication reconciliation and medication review) during the hospital stay. Primary outcome measures were the rate of appropriate use of proton pump inhibitors during hospitalization and potentially inappropriate proton pump inhibitor use at discharge.

RESULTS

The rate of appropriate proton pump inhibitor use during hospitalization was significantly higher in the clinical pharmacist-led program (n = 100) than in the control group (n = 97) (46.4% vs. 79.0%; P < 0.001). The rate of potentially inappropriate proton pump inhibitor use at discharge was significantly lower (61.7% vs. 35.1%; P < 0.05) in the clinical pharmacist-led program among the older patients discharged with a proton pump inhibitor prescription.

CONCLUSION

A clinical pharmacist-led stewardship program for the appropriate use of acid suppression therapy improved the rate of appropriate proton pump inhibitor use and reduced the potentially inappropriate proton pump inhibitor use during the hospital stay.

TRIAL REGISTRATION

NCT05113667 (17 October 2021-registered retrospectively).

Normalization of serum TSH doesn’t represent true euthyroidism for patients on levothyroxine treatment

Introduction: To evaluate whether normalisation of serum thyroid-stimulating hormonelevels with levothyroxine is related with metabolic parameters and psychologic wellbeing. Method: The observational, case-control study was conducted from to May to July 2019 in the outpatient thyroid clinics of Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey, and compried hypothyroid patients in the euthyroid state with levothyroxine treatment and euthyroid controls. Psychological wellbeing was assessed using the General Health Questionnaire-12, and metabolic parameters with lipid levels and body composition were analysed for both the groups. Data was analysed using SPSS 25. Results: Of the 159 subjects, 110(69%) were case with a mean age of 50.1±11.7 years, and 49(31%) were controls with a mean age of 47.3±15.2 years. There was no significant difference related to thyroid-stimulating hormonel levels between the groups (p=0.191). Free throxine levels were significantly higher in the cases, while free triiodothyroinine levels were higher in the controls (p<0.001). Total cholesterol and triglycerides levels were significantly higher in the cases than the controls (p<0.05). The cases had lower basal metabolic rate and fat free mass than the controls, but the difference was not significant (p>0.05). The cases scored higher in terms of wellbeing than the controls, but the difference was not significant (p>0.05). Conclusion: Thyroid hormone replacement needs to be adjusted to provide a satisfactory treatment for hypothyroid patients with normal thyroid-stimulating hormone levels who remain clinically and biochemically asymptomatic. In symptomatic patients, peripheral parameters of hypothyroidism, such as lipid levels, ---Continue

The success of the Cystic Fibrosis Registry of Turkey for improvement of patient care

BACKGROUND

Cystic fibrosis (CF) registries play an essential role in improving disease outcomes of people with CF. This study aimed to evaluate the association of newly established CF registry system in Turkey on follow-up, clinical, growth, treatment, and complications of people with this disease.

METHODS

Age at diagnosis, current age, sex, z-scores of weight, height and body mass index (BMI), neonatal screening results, pulmonary function tests, history of meconium ileus, medications, presence of microorganisms, and follow-up were evaluated and compared to data of people with CF represented in both 2017 and 2019 registry data.

RESULTS

There were 1170 people with CF in 2017 and 1637 in 2019 CF registry. Eight hundred and fourteen people were registered in both 2017 and 2019 of whom z-scores of heights and BMI were significantly higher in 2019 (p = 0.002, p =0.039, respectively). Inhaled hypertonic saline, bronchodilator, and azithromycin usages were significantly higher in 2019 (p =0.001, p = 0.001, p = 0.003, respectively). The percent predicted of forced expiratory volume in  1 sec and forced vital capacity were similar in 2017 and 2019 (88% and 89.5%, p = 0.248 and 84.5% and 87%, p =0.332, respectively). Liver diseases and osteoporosis were significantly higher, and pseudo-Bartter syndrome (PBS) was significantly lower in 2019 (p = 0.011, p = 0.001, p = 0.001, respectively).

CONCLUSIONS

The z-scores of height and BMI were higher, the use of medications that protect and improve lung functions was higher and incidence of PBS was lower in 2019. It was predicted that registry system increased the care of people with CF regarding their follow-up. The widespread use of national CF registry system across the country may be beneficial for the follow-up of people with CF.

The effects of TNF-α inhibitors on carbon tetrachloride-induced nephrotoxicity

OBJECTIVES

Carbon tetrachloride (CCl₄), employed in various industrial fields, can cause acute damage in renal tissues. This study investigated the therapeutic effect of the TNF-alpha inhibitor Infliximab on TGF-ß and apoptosis caused by acute kidney image induced by CCl₄.

METHODS

Twenty-four male Sprague-Dawley rats were assigned into control, CCl₄, and CCl₄+ Infliximab groups. The control group received an isotonic saline solution, and the CCl₄ group 2 mL/kg CCl₄ intraperitoneally (i.p). The CCl₄+ Infliximab group was given 7 mg/kg Infliximab 24 hours after administration of 2 mL/kg CCl₄. Kidney tissues were removed at the end of the experiment and subjected to histopathological and biochemical analysis.

RESULTS

The application of CCl₄ led to tubular necrosis, inflammation, vascular congestion, and increased Serum BUN and creatinine values. An increase in caspase-3 activity also occurred in the CCl₄ group. However, Infliximab exhibited an ameliorating effect on kidney injury by causing a decrease in the number of apoptotic cells. Tissue ADA and TGF-ß values of the CCL4 group were significantly higher than the values of the control group (p = .001, p < .001 respectively) and CCL₄+ Inf group (p = .004, p = .015, respectively).

CONCLUSIONS

This study shows that Infliximab ameliorates nephrotoxicity by reducing lipid peroxidation, oxidative stress, and apoptosis in acute kidney damage developing in association with CCl₄ administration. These findings are promising in terms of the ameliorating role of TNF-alpha inhibitors in acute kidney injury.

The effects of TNF-α inhibitors on carbon tetrachloride-induced nephrotoxicity

OBJECTIVES

Carbon tetrachloride (CCl₄), employed in various industrial fields, can cause acute damage in renal tissues. This study investigated the therapeutic effect of the TNF-alpha inhibitor Infliximab on TGF-ß and apoptosis caused by acute kidney image induced by CCl₄.

METHODS

Twenty-four male Sprague-Dawley rats were assigned into control, CCl₄, and CCl₄+ Infliximab groups. The control group received an isotonic saline solution, and the CCl₄ group 2 mL/kg CCl₄ intraperitoneally (i.p). The CCl₄+ Infliximab group was given 7 mg/kg Infliximab 24 hours after administration of 2 mL/kg CCl₄. Kidney tissues were removed at the end of the experiment and subjected to histopathological and biochemical analysis.

RESULTS

The application of CCl₄ led to tubular necrosis, inflammation, vascular congestion, and increased Serum BUN and creatinine values. An increase in caspase-3 activity also occurred in the CCl₄ group. However, Infliximab exhibited an ameliorating effect on kidney injury by causing a decrease in the number of apoptotic cells. Tissue ADA and TGF-ß values of the CCL4 group were significantly higher than the values of the control group (p = .001, p < .001 respectively) and CCL₄+ Inf group (p = .004, p = .015, respectively).

CONCLUSIONS

This study shows that Infliximab ameliorates nephrotoxicity by reducing lipid peroxidation, oxidative stress, and apoptosis in acute kidney damage developing in association with CCl₄ administration. These findings are promising in terms of the ameliorating role of TNF-alpha inhibitors in acute kidney injury.

Comparison of the Modified Moberg Flap Versus First Dorsal Metacarpal Artery Flap for Thumb Pulp Reconstruction

ABSTRACT

We assessed and compared outcomes of 2 different flap techniques for thumb pulp defect reconstruction. Twenty-three patients who underwent modified Moberg and first dorsal metacarpal artery flap because of thumb pulp defect were retrospectively evaluated. Flap survival; venous congestion; cold intolerance; static 2-point discrimination (s2-PD); Semmes-Weinstein monofilament (SWM) test scores; paresthesia; defect size; time to return to work; interphalangeal and metacarpophalangeal joint flexion of the thumb; Disability of the Arm, Shoulder and Hand questionnaire scores; and follow-up time were evaluated. Flap survival, venous congestion, time to return to work, paresthesia, defect size, SWM test scores, range of motion of the proximal interphalangeal and metacarpophalangeal joints, and Disability of the Arm, Shoulder and Hand questionnaire scores were similar in both groups. Cold intolerance and s2-PD were found to be statistically better in the modified Moberg flap group. Although these techniques provided similar results, the modified Moberg was found to be superior in terms of cold intolerance and s2-PD.

Clinical findings of patients with cystic fibrosis according to newborn screening results

BACKGROUND

Cystic fibrosis (CF) is a lethal recessive genetic disease caused by loss of function associated with mutations in the CF trans-membrane conductance regulator. It is highly prevalent (approximately 1 in 3,500) in Caucasians. The aim of this study was to compare demographic and clinical features, diagnostic tests, treatments, and complications of patients with CF whose newborn screening (NBS) with twice-repeated immune reactive trypsinogen testing was positive, normal, and not performed.

METHODS

In this study, 359 of all 1,488 CF patients recorded in the CF Registry of Turkey in 2018, who had been born through the process of NBS, were evaluated. Demographic and clinical features were compared in patients diagnosed with positive NBS (Group 1), normal (Group 2), or without NBS (Group 3).

RESULTS

In Group 1, there were 299 patients, in Group 2, there were 40 patients, and in Group 3, there were 20 patients. Among all patients, the median age at diagnosis was 0.17 years. The median age at diagnosis was higher in Groups 2 and 3 than in Group 1 (P = 0.001). Fecal elastase results were higher in Group 2 (P = 0.033). The weight z-score was lower and chronic Staphylococcus aureus infection was more common in Group 3 (P = 0.017, P = 0.004, respectively).

CONCLUSIONS

Frequency of growth retardation and chronic S. aureus infection can be reduced with an early diagnosis using NBS. In the presence of clinical suspicion in patients with normal NBS, further analyses such as genetic testing should be performed, especially to prevent missing patients with severe mutations.

Geographical barriers to timely diagnosis of cystic fibrosis and anxiety level of parents during newborn screening in Turkey

BACKGROUND

Despite the availability of cystic fibrosis (CF) screening countrywide, diagnostic delay is still a crucial issue. The objectives of this study were to explore the stages of the NBS process, determine the risk factors associated with diagnostic delay and evaluate parent anxiety and experience throughout the process.

METHODS

This is a multicenter cross-sectional study. A questionnaire was completed by parents of newborns diagnosed with CF via NBS in 17 centers. Socio-demographic characteristics, parent knowledge and experiences related to NBS, sweat test availability in the region of residence, and time to the definitive CF diagnosis were assessed through this questionnaire. Parents' anxiety levels were evaluated through the State-Trait Anxiety Inventory scales 1 and 2. Delayed diagnosis (DD) was defined as a definite CF diagnosis beyond the 8th week of life. Predictors of delayed CF diagnosis were evaluated by univariate and multivariate analysis.

RESULTS

A total of 220 CF patients diagnosed via NBS were enrolled; 82 (37.3%) babies had DD. Multivariable analysis indicated that residence in the Southeast Anatolia region of Turkey (OR = 10.79, 95% CI = 2.37-49.2) was associated with a higher incidence of DD compared with other regions in Turkey. Of the total, 216 (98.1%) of the caregivers regarded the NBS program as useful and 180 (82%) reported high anxiety levels.

CONCLUSION

The organization of newborn screening should take into account regional and socio-cultural characteristics to improve the early diagnosis of CF and also reduce the anxiety level of parents.

The role of mean platelet volume in nonalcoholic fatty liver disease without cardiovascular comorbidities, obesity and diabetes mellitus

BACKGROUND

While the relation of mean platelet volume (MPV) with inflammatory diseases is obvious, its role in nonalcoholic fatty liver disease (NAFLD) without cardiovascular comorbidities, obesity and diabetes mellitus is not clear.

METHODS

A total of 249 patients (nonobese, nondiabetic and not having cardiac diseases) who underwent an abdominal ultrasonography assessment were enrolled. They were divided according to the absence (group 1) or presence (group 2) of hepatic steatosis. The patients with steatosis were further divided according to the severity of steatosis as group 2a (grade 1), 2b (grade 2) and 2c (grade 3). The demographic and laboratory features were compared between groups.

RESULTS

Hepatic steatosis was absent in 120 patients and detected in 129 patients (grade 1, 2, 3 hepatic steatosis in 75, 49 and 5 patients, respectively). BMI, aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and serum AST, ALT, triglyceride levels were significantly higher in group 2 than in group 1 (P < 0.001, P < 0.001, P < 0.001, P = 0.005, P < 0.001, respectively). BMI, serum AST and triglyceride levels were significant factors for NAFLD (P < 0.001, P = 0.018, P = 0.001). MPV was neither different between groups (P > 0.05) nor a predictor factor for NAFLD (P > 0.05).

CONCLUSION

MPV is a useless parameter to detect NAFLD without cardiovascular comorbidities, obesity and diabetes mellitus.

Role of serum adropin measurement in the assessment of insulin resistance in obesity

Obesity has recently been mentioned as a metabolic pandemic in developed and developing countries and is an important known risk factor for type 2 diabetes and cardiovascular diseases. The main mechanism responsible for obesity is insulin resistance. Adropin is a peptide-structured regulatory hormone that is suggested to play a role in insulin resistance and metabolic regulation. We aimed to evaluate the associations of serum adropin with insulin resistance and clarify the factors affecting serum adropin concentrations. The study included 50 obese patients and 22 healthy controls. Patients with chronic disease and drug use history were excluded. Serum adropin and other metabolic parameters were obtained after overnight fasting. ELISA was used to measure serum adropin concentrations. The homeostatic model assessment-insulin resistance (HOMA-IR) index was used to calculate insulin resistance. Insulin resistance was defined as HOMA-IR >2.5. Serum adropin values were found to be low in the obese otherwise healthy patient group (p<0.001). Linear regression analysis revealed that age, body mass index (BMI), waist circumference (WC), high-density lipoprotein cholesterol, fasting glucose, and HOMA-IR affect serum adropin level. In multiple regression analysis, age is the most significant factor affecting serum adropin concentration. Serum adropin concentrations were negatively correlated with BMI, WC, diastolic blood pressure, fasting glucose, and insulin. Serum adropin concentrations were low in obese patients and the optimum cut-off point for adropin to indicate HOMA-IR at 2.5 is 216.7 ng/L. The findings suggest that serum adropin may contribute to the regulation of glycolipid metabolism and insulin resistance in obese patients.

Does metformin affect mammographic breast density in postmenopausal women with type 2 diabetes

Background: Increased mammographic breast density (MBD) is known to be associated with an increased risk of developing breast cancer.Aims: In this study, we aimed to research the possible relationship between MBD and metformin use in postmenopausal women diagnosed with type 2 diabetes mellitus (T2DM).Method: The patients were divided into two groups: women with T2DM and who were on metformin and women who were newly diagnosed with T2DM and had not yet taken metformin. MBD types are evaluated by a specialist radiologist.Results: Among the 74 women, 32 (43.2%) were in the group that did not use metformin and 42 (56.8%) were in the group of patients using metformin. The duration of breastfeeding (p = .0003), fasting blood glucose (p = .0003) and HbA1c (p = .0006) were statistically significantly higher in the group not using metformin. The quantitative mean ranks of the group members' MBD's were 41.81 in the metformin naïve group and 34.21 in the group using metformin (p = .12).Conclusions: In conclusion, metformin has no statistically significant effect on MBD in postmenopausal female patients with T2DM.

Clinical features and accompanying findings of Pseudo-Bartter Syndrome in cystic fibrosis

BACKGROUND

Pseudo-Bartter syndrome (PBS) is a rare complication of cystic fibrosis (CF) and there are limited data in the literature about it. We aimed to compare clinical features and accompanying findings of patients with PBS in a large patient population.

METHODS

The data were collected from the Cystic Fibrosis Registry of Turkey where 1170 CF patients were recorded in 2017. Clinical features, diagnostic test results, colonization status, complications, and genetic test results were compared in patients with and without PBS.

RESULTS

Totally 1170 patients were recorded into the registry in 2017 and 120 (10%) of them had PBS. The mean age of diagnosis and current age of patients were significantly younger and newborn screening positivity was lower in patients with PBS (P < .001). There were no differences between the groups in terms of colonization status, mean z-scores of weight, height, BMI, and mean FEV₁ percentage. Types of genetic mutations did not differ between the two groups. Accompanying complications were more frequent in patients without PBS.

CONCLUSION

PBS was detected as the most common complication in the registry. It could be due to warm weather conditions of our country. It is usually seen in younger ages regardless of mutation phenotype and it could be a clue for early diagnosis of CF.

Insulin autoimmune syndrome - time to remember

Not required for Clinical Vignette.

Controversy about the protective role of volume in the frontal sinus after severe head trauma: larger sinus equates with higher risk of death

The "crumple zone" hypothesis suggests that the paranasal sinuses protect the brain as a zone to distribute and absorb energy after trauma to the head. We investigated the relation between the size of the frontal sinus and mortality in patients with cranial trauma. All patients with head trauma admitted to the ICU between 1 January 2016 and 20 December 2017 were reviewed retrospectively. They were divided into two groups (according to their outcome) : died and survived. The volumes of the frontal sinuses and other trauma-related variables were assessed on computed tomographs (CT) on admission. Admission CT of 33 patients (24 male, and nine female, aged between 18-92 years, mean 43) were obtained. Male patients had significantly larger frontal sinuses than female (10.24 compared with 6.6cm³). Larger sinuses were significantly associated with a worse outcome (p=0.005). The size of the frontal sinus correlates with mortality after cranial trauma. Our findings do not confirm the "crumple zone" hypothesis, and suggest that the larger the sinus, the greater the risk of death. To our knowledge this is a new finding that warrants further validation.

Lens autofluorescence ratio as a noninvasive marker of peripheral diabetic neuropathy

INTRODUCTION Diabetes and its complications are the significant cause of morbidity and mortality. Advanced glycation end products play a major role in the pathogenesis of diabetes complications. OBJECTIVES The aim of the study was to investigate the possible use of a biomicroscope (ClearPath DS‑‑120), which shows the age‑‑adjusted lens fluorescence ratio (LFR), for the diagnosis of diabetic peripheral neuropathy (DPN). PATIENTS AND METHODS A total of 160 patients with type 2 diabetes who underwent an LFR measurement were recruited to this study. DPN was defined as the presence of neuropathic pain or feet sensory loss (or both). Neurothesiometer, monofilament test, and DN4 test results were used for the diagnosis of DPN. RESULTS The LFR of 43 patients (27%) was higher than the expected levels. According to the DN4 questionnaire, 35 of 160 patients (21%) had neuropathic pain. Thirty‑‑seven patients (23%) had higher vibration perception thresholds than expected (>25 V). The monofilament test showed that 42 patients (26%) seemed to be affected by DPN. All of the tests, when considered individually, revealed that patients with higher LFR had more problems related to DPN (P <0.05). High LFR had a sensitivity of 50% and a specificity of 81% in the diagnosis of DPN. Although there was no significant difference in fasting blood glucose levels, we observed that HbA1c levels were higher and diabetes duration was longer in patients with higher LFR (P <0.05). CONCLUSIONS The measurement of LFR may have clinical utility for a noninvasive detection of DPN.

A comparison of the effects on postoperative bleeding of the intra-articular application of tranexamic acid and adrenalin in total knee arthroplasty

OBJECTIVE

To compare the efficacies of intra-articular applications of tranexamic acid and adrenaline on postoperative bleeding after total knee arthroplasty.

METHODS

The single-center, retrospective, controlled study was conducted at Selcuk University , department of orthopedic surgery and comprised data of patients who underwent primary, unilateral, cemented total knee arthroplasty between July 2012 and December 2014. Group 1 had received tranexamic acid 1g after closure of articular capsule. Group 2 had received adrenalin. Group 3, the control group, received no medication intraarticularly after total knee arthroplasty. The amount of blood collected in the drain and postoperative alterations in haemoglobin and haematocrit values were compared.

RESULTS

Of the total 90 subjects, there were 30(33.33%) in each of the three groups. The decrease of haemoglobin and haematocrit values in Group 1 was statistically significant compared to both Group 2 and Group 3 (p<0.05). The amount of blood collected in the drains was remarkably lower in Groups I and 2 compared to Group III (p<0.05). No deep venous thrombosis or pulmonary emboli were encountered across the sample.

CONCLUSIONS

Intra-articular administration of tranexamic acid was found to be beneficial and safe for the achievement of effective haemostasis after total knee arthroplasty.

Effıcacy and safety of dapagliflozin on diabetic patients receiving high-doses of insulin

OBJECTIVE

In this study we aimed to investigate the efficacy and safety of dapagliflozin addition to diabetic patients using high dose insulin.

METHODS

The current study was carried out in the outpatient diabetic clinics of Fatih Sultan Mehmet Education and Research Hospital. Thirty diabetic patients who were receiving high dose (>0,5U/kg) insulin and oral antidiabetic treatment (other than SGLT 2 inhibitors) were included in this study. Primary end point was the change in HbA1c, insulin doses and serum electrolyte from the addition of dapagliflozin 10 mg to the week 12.

RESULTS

At the end of three month BMI were obviously decreased from 33.31 ±4.51 to 32.14 ±4.66 (p: 0.001). There was also an evident decrease of insulin requirement from 76 ±23.15 U/kg to 57.60 ±17.61 U/day (p<0.001). As well as the decrease in insulin doses, there was also a significant decline in HbA1c (Δ 1.6 %) and fasting blood glucose levels (Δ68.6 mg/dl) (p<0.001). Among serum electrolyte levels slight but meaningful increase of blood urea nitrogen (BUN) and sodium (Na) levels were seen (p: 0.044 and p: 0.026). There were no significant changes in serum cholesterol levels with electrolytes such as potassium, calcium, phosphorus magnesium and vitamin D (p> 0.05).

CONCLUSION

In diabetic patients with inadequately controlled glucose regulation despite high-dose insulin therapy, dapagliflozin may be an alternative combination choice to decrease the need of insulin dose and obtain an optimal HbA1c, fasting plasma glucose levels and weight without major side effects.

Mean platelet volume changes before and after glycated hemoglobin (HbA1c) improvement in a large study population

INTRODUCTION

Diabetes mellitus (DM) is a metabolic disorder associated with both microvascular and macrovascular complications. Mean platelet volume (MPV) is a marker of platelet activity, which plays a major role in the development of vascular complications of DM. The aim of this study is to compare the MPV levels before and after the decrease of glycated hemoglobin (HbA_1c) levels in a large diabetic population.

MATERIAL AND METHODS

This was a retrospective study conducted on type 2 diabetic patients from the outpatient clinic for 1 year between 2014 and 2015 with the participation of 595 diabetic patients.

RESULTS

When we compared the basal and post-treatment values, a significant decrease of MPV and HbA_1c levels was found (HbA_1c: 9.41 ±1.98% vs. 7.43 ±1.29%, p < 0.001; MPV: 9.11 ±1.42 vs. 8.17 ±1.04, p < 0.001). There was also a positive correlation between the mean changes of MPV and HbA_1c levels after the treatment (ΔMPV: 0.93 ±0.96 vs. ΔHbA_1c: 1.96 ±1.43; p = 0.005, r = 0.115). When the participants were divided into two groups according to their basal HbA_1c levels (group A: HbA_1c ≤ 6.5% and group B: HbA_1c > 6.5%), it was clearly seen that improvement of glucose levels led to a significant decrease in MPV levels in both groups.

CONCLUSIONS

The results of this study show that better glycemic control is associated with a significant decrease of MPV levels, regardless of whether the treatment modality is insulin or oral antidiabetic.

The relationship between thyroid antibody titer and levothyroxine dose in patients with overt primary hypothyroidism

BACKGROUND

Both excess and insufficient thyroid hormone replacement may produce adverse effects in various target tissues; therefore, understanding factors that affect achievement of target TSH levels is crucial.

OBJECTIVE

Investigate the relationship between antibody titers and levothyroxine dose.

DESIGN

Retrospective, review of data in medical records.

SETTING

Thyroid center of Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.

PATIENTS AND METHODS

The study population consisted of patients that had been diagnosed as having overt primary hypothyroidism and were taking levothyroxine for at least one year. The serum TSH level for an euthyroid state was between 0.5-4 mIU/L. The levels of anti-thyroid peroxidase (TPOAb) considered positive for antibodies were < 5.6 IU/mL and for anti-thyroglobulin (TgAb) autoantibodies < 4.10 IU/ mL.

MAIN OUTCOME MEASURE

Daily levothyroxine doses of antibody-positive and negative patients and association of daily drug requirement with antibody titers.

RESULTS

The study population consisted of the 303 patients (273 females and 30 males with the mean [SD] age of 46.6 [13.2] years). In the antibody-positive group (n=210) average daily levothyroxine dose was statistically significantly higher than in the antibody-negative group (n=93) (mean of 78.8 [36.7] vs 64.2 [27.1] mg/day, P=.001, respectively). There was a low but statistically significant positive relationship between the TPOAb (r=0.217, P < .01) and TgAb levels (r=0.158, P < .05) and levothyroxine doses in the antibody-positive group.

CONCLUSION

Antibody titers are positively associated with larger levothyroxine (LT-4) replacement dosing in patients with autoimmune thyroiditis.

LIMITATION

Unknown antibody titers before starting levothyroxine use.

The Effect of Glucose Variability on QTc Duration and Dispersion in Patients with Type 2 Diabetes Mellitus

Objective:

Glycemic variability (GV) is a new term with the episodes of hyper and hypoglycemia in diabetic patients. Both prolonged QT interval and QTd are potential risk factors for malignant ventricular arrhythmias affecting the mortality of different groups of patients including diabetes mellitus. In this study, we aimed to evaluate if the glucose variability increasing the QTc interval and QTc dispersion in type 2 diabetes mellitus.

Methods:

We included 275 consecutive patients with type 2 diabetes. We quantified the GV with standard deviation (SD) and coefficient of variation (CV) from 7 point glucose measures. We investigated the relationship of GV parameters with QT parameters.

Results:

The prevalence of prolonged QTc duration was 21%, no patients have prolonged QTc dispersion (> 80 ms). SD of the patients with prolonged QTc duration was significantly higher than the others (45.14 ±24.45 vs. 37.78 ±9.03 p<0.05). There was also a significant relationship between SD and QTc dispersion (r: 0.164; p: 0.007). There were no relationship between the QT parameters and microvascular diabetic complications. SD and HbA1c levels were significantly higher on the patients having peripheral neuropathy (p<0.005).

Conclusion:

The result of this study demonstratess that increased glycemic variability is associated with prolonged QTc duration and QTc dispersion. It is important to focus on targeting optimal glycemic control with GV as an additional goal point along with the traditional following parameters such as fasting-postprandial blood glucose and HbA1c.

Oxygen saturation/minute heart rate index: Simple lung function test for children

BACKGROUND

The severity of airway obstruction can be accurately determined on spirometry in children with asthma. Other assessments may include peak expiratory flow and pulse oximetry. In the present study, we evaluated the validity and reliability of oxygen saturation/minute heart rate (SpO₂ /MHR) index in the prediction of degree of severe airway obstruction in children with asthma.

METHODS

This was a retrospective study of children aged 7-17 followed for asthma at Mersin Women and Children's Hospital. The study compared SpO₂ /MHR ratio with forced expiratory volume in 1 s (FEV₁ ) measured on spirometry, an important indicator of small airway obstruction. A total of 296 patients were included in the study, and classified either as having normal FEV1 (FEV₁ > 80% of predicted, n = 178) or severely reduced FEV₁ (FEV₁ < 60% of predicted, n = 118). Positive and negative predictive values (PPV and NPV), sensitivity and specificity of SpO₂ /MHR index in predicting low FEV₁ were calculated on receiver operating characteristics analysis.

RESULTS

An SpO₂ /MHR ratio cut-off <0.90 was associated with a PPV of 83.14%, NPV of 71.77%, sensitivity of 80.34% and specificity of 75.42% in predicting low FEV₁ .

CONCLUSIONS

SpO₂ /MHR ratio appears to be a highly useful index to assess airway obstruction in older children with asthma. Thus, it can be used as a marker of airway obstruction severity when spirometry is not available.

The effect of ezetimibe monotheraphy on mean platelet volume in patients with hyperlipidaemia: a retrospective study of 45 patients

OBJECTIVE

To investigate the effect of ezetimibe on platelet functions as a drug which increases mevalonate levels.

METHODS

This retrospective study was conducted in Istanbul, Turkey, and comprised record of normolipidaemic and hyperlipidaemic patients taken from the outpatient clinic from October 2004 to February 2015,. The results were taken from the baseline and third-month data of ezetimibe treatment. SPSS 22 was used for statistical analysis.

RESULTS

Of the total, there were 50(53%) normolipidaemic patients and 45(47%) hyperlipidaemic ones. Pre- and post-treatment values of mean platelet volume were significantly higher in the hyperlipidaemic group than controls (p<0.001). In the hyperlipidaemic group there was no significant difference between pre- and post-treatment values of mean platelet volume (8.96±0.93 vs. 8.92±0.84; p>0.05).

CONCLUSIONS

The use of ezetimibe alone should not be the first choice in hyperlipidaemia treatment.

Vitamin D Status in Infants with Two Different Wheezing Phenotypes

OBJECTIVE

To investigate vitamin D levels in patients with recurrent wheeze at early ages of childhood.

METHODS

In the present cross-sectional study, serum 25-hydroxy vitamin D [25 (OH)D], levels which is known as an indicator of vitamin D adequacy, was examined in infants with three or more wheezing attacks.

RESULTS

A total of 186 infants with recurrent wheezing were included in the study along with 118 healthy control peers. The recurrent wheezing study participants were classified into two groups according to Asthma Predictive Index (API) positivity and compared to control subjects regarding their serum vitamin D status. The API negative group had the lowest mean serum 25 (OH)D level (n = 121; 22.71 ± 10.76 ng/ml) followed by API positive group (n = 65; 24.08 ± 9.02 ng/ml) compared to healthy group (26.24 ± 11.88 ng/ml) (p < 0.05). In addition, higher vitamin D deficiency was observed in infants in API negative group (52.1 %; p < 0.01) and API positive group (38.5 %; p < 0.05) than control group (31.4 %).

CONCLUSIONS

Low levels of 25 (OH)D were detected in infants with two different phenotypes of recurrent wheeze. Vitamin D deficiency may play a role in the pathogenesis of infants with recurrent wheezing.

Determination of dosimetric properties of MgO doped natural amethyst samples

In this paper, the thermoluminescence (TL) dosimetric characteristics of MgO doped natural amethyst samples (Mg-NA) are presented. The morphologies and chemical structures of the powder form samples were identified using XRD, FTIR, SEM, SEM mapping and EDX. Comparison of the TL intensities showed that 10wt% Mg-NA was nearly 150 times more sensitive than undoped amethyst and the main dosimetric properties proved that 10wt% Mg-NA may be a promising phosphor for clinical and radiotherapy purposes.

Application of chemical mechanical polishing process on titanium based implants

Modification of the implantable biomaterial surfaces is known to improve the biocompatibility of metallic implants. Particularly, treatments such as etching, sand-blasting or laser treatment are commonly studied to understand the impact of nano/micro roughness on cell attachment. Although, the currently utilized surface modification techniques are known to improve the amount of cell attachment, it is critical to control the level of attachment due to the fact that promotion of bioactivity is needed for prosthetic implants while the cardiac valves, which are also made of titanium, need demotion of cells attachment to be able to function. In this study, a new alternative is proposed to treat the implantable titanium surfaces by chemical mechanical polishing (CMP) technique. It is demonstrated that the application of CMP on the titanium surface helps in modifying the surface roughness of the implant in a controlled manner (inducing nano-scale smoothness or controlled nano/micro roughness). Simultaneously, it is observed that the application of CMP limits the bacteria growth by forming a protective thin surface oxide layer on titanium implants. It is further shown that there is an optimal level of surface roughness where the cell attachment reaches a maximum and the level of roughness is controllable through CMP.

Myocardial injury and acute renal failure associated with lactic acidosis due to suicide attempt with metformin

Metformin-associated lactic acidosis (MALA) is one of the most important drug toxicities with a high morbidity and mortality rate. We report herein a case of suicide attempt with metformin presenting as MALA and acute renal failure on admission to emergency department and acute myocardial injury later on hospitalisation. An obvious improvement of metabolic parameters was seen in our patient provided by anti-ischaemic treatment together with bicarbonate infusion and haemodialysis. Although myocardial injury due to MALA is not a common disorder, we must be aware that metformin overdose with lack of tissue oxygenation, hypoperfusion, and arrhythmias may cause myocardial ischaemia.

Management of cervical cancer during pregnancy

Cervical cancer (CC) is the most common gynaecological cancer during pregnancy. The rarity of the disease and lack of randomised control studies have prevented the establishment of treatment guidelines. The management of CC mainly follows the guidelines for the non-pregnant disease state, expert opinions and limited case reports. Although the management of CC diagnosed during pregnancy appears to be a significant dilemma for the patients and specialists, the prognosis of CC is not influenced by pregnancy. The treatment decision should be made collaboratively with a multidisciplinary team consisting of an obstetrician, gynaecologist, oncologist and paediatrician. The concerns of the patient should be taken into account.

[Ouabain induces Rho-dependent rock activation and membrane blebbing incultured endothelial cells]

Small G protein Rho and its most studied effectors, ROCK I and ROCK II, are involved in several cellular fuctions including smooth muscle and non-muscle cell contractions, cell migration and apoptosis. Activation of ROCK I by caspase-3 and activation of ROCK II by granzyme B are essential for membrane blebbing in the execution phase of apoptosis. In contrast, it has been demonstrated that Rho signaling is critical for blebbing developed after serum removal. As it was shown by us previously, ouabain induces membrane blebbing and proteolitic cleavage of ROCK I and ROCK II via caspases in human umbilical endothelial cells. However, caspase inhibitors do not prevent ouabain-induced blebs. Ouabain induces concentration-dependent cell death and membrane blebbing in endothelial cells. The aim of this study was to identify the possible role of Rho in ouabain-induced membrane blebbing. Pretreatment of endothelial cells with a Rho inhibitor CT04 did not inhibit the ouabain-induced cell death but prevented the development ofbleb formation. These results indicate that bleb formation is dependent on Rho activity in ouabain-induced cell death in HUVECs. Taken together, these results suggest that the mechanism of membrane bleb formation might be different depending on cell type and cell death-stimuli.