Eye and hair color prediction of human DNA recovered from Lucilia sericata larvae

Forensic entomological evidence is employed to estimate minimum postmortem interval (PMImin), location, and identification of fly samples or human remains. Traditional forensic DNA analysis (i.e., STR, mitochondrial DNA) has been used for human identification from the larval gut contents. Forensic DNA phenotyping (FDP), predicting human appearance from DNA-based crime scene evidence, has become an established approach in forensic genetics in the past years. In this study, we aimed to recover human DNA from Lucilia sericata (Meigen 1826) (Diptera: Calliphoridae) gut contents and predict the eye and hair color of individuals using the HIrisPlex system. Lucilia sericata larvae and reference blood samples were collected from 30 human volunteers who were under maggot debridement therapy. The human DNA was extracted from the crop contents and quantified. HIrisPlex multiplex analysis was performed using the SNaPshot minisequencing procedure. The HIrisPlex online tool was used to assess the prediction of the eye and hair color of the larval and reference samples. We successfully genotyped 25 out of 30 larval samples, and the most SNP genotypes (87.13%) matched those of reference samples, though some alleles were dropped out, producing partial profiles. The prediction of the eye colors was accurate in 17 out of 25 larval samples, and only one sample was misclassified. Fourteen out of 25 larval samples were correctly predicted for hair color, and eight were misclassified. This study shows that SNP analysis of L. sericata gut contents can be used to predict eye and hair color of a corpse.

Effect of the MiR-99b and MiR-135b on peritoneal carcinomatosis and liver metastasis in colorectal cancer

AIM

This study aimed to evaluate the expression levels of miR-99b and miR-135b in peritoneal carcinoma and liver metastases associated with Colorectal Cancer (CRC), assess their association with the intracellular signaling pathway proteins Kirsten Rat Sarcoma Virus (KRAS) and Akt, and investigate their effects on survival.

MATERIALS AND METHODS

Changes in the KRAS gene and Akt proteins, expression levels of miR-99b and miR-135b, and factors affecting survival were compared between colorectal cancer-associated peritoneal carcinomatosis and liver metastasis.

RESULTS

The expression levels of miR-99b and miR-135b and the immunohistochemical grade classification score of Akt were higher in colorectal cancer, peritoneal carcinomatosis, and liver metastasis than in normal tissues (p < 0.05). MiR-99b expression was highest in CRC, whereas miR-135b expression was highest in peritoneal carcinomatosis (p < 0.05). The expression level of miR-99b decreased and that of miR-135b increased in peritoneal and liver metastases compared with that in the tumor tissue. MiR-99b, Akt, and recurrence were risk factors that affected the overall survival rate in the model of clinical predictions (p = 0.045, p = 0.006, and p = 0.012, respectively).

CONCLUSION

While the expression of miR-99b was highest in the primary tumor, its decrease in liver metastasis and peritoneal carcinomatosis suggests that miR-99b has a protective effect against liver metastasis and peritoneal carcinomatosis. However, the detection of miR-135b expression was highest in peritoneal carcinomatosis and liver metastasis compared with that in the colorectal cancer tissues suggesting that it facilitates peritoneal carcinomatosis and liver metastasis. Furthermore, miR-99b, KRAS mutations, and Akt are risk factors for the overall survival of colorectal cancer.

Perirenal fat thickness as a risk factor for postoperative complications in elective colorectal cancer surgery

Visceral obesity is an important factor that increases the risk of complications after colorectal cancer surgery. As calculating visceral fat is difficult and time-consuming, more practical fat measurements that are not time-consuming have been introduced. This study aimed to investigate the effects of perirenal fat thickness on postoperative complications and prognosis in patients undergoing surgery for colorectal cancer. Perirenal fat thickness was measured from the dorsal aspect of the left kidney on preoperative computerized tomography of patients who underwent surgery for colorectal cancer. The effects of perirenal fat thickness on postoperative complications were investigated. Diagnostic test performance was examined using the Roc Curve test to determine the cutoff value for the perirenal fat thickness values according to the complication findings of the patients. The cutoff value of perirenal fat thickness was found to be above 25.1, according to the presence of complications in the patients. Those with a perirenal fat thickness greater than 25.1 mm were considered to have high perirenal fat thickness values, and those with a low perirenal fat thickness value were considered low. Multivariate analysis revealed that increased perirenal fat thickness is an independent risk factor for postoperative complications. We believe that perirenal fat thickness measurement, as an indicator of visceral fat volume, can be used to identify patients at high risk of developing complications after colorectal cancer surgery. This may change the disease management and affect the patient information process.

The protective effects of hesperidin pretreatment on kidney and remote organs against renal ischemia-reperfusion injury

OBJECTIVE

As an antioxidant and anti-inflammatory agent, Hesperidin was investigated to prove whether it prevents damage to the kidney and lung tissues of rats undergoing renal ischemia-reperfusion injury.

MATERIALS AND METHODS

Four groups of rats were set, including eight subjects each as Group 1 (control), Group 2-RIR (renal ischemia reperfusion), Groups 3 and 4 as pretreatment groups (50 HES, 100 HES).

RESULTS

According to our results, Hesperidin pretreatment improved the biochemical and histopathological parameters in kidney and lung tissues of rats with ischemia-reperfusion injury. Besides, a 100 mg/kg dose of Hesperidin was found to be more beneficial to the rats than 50 mg/kg.

CONCLUSIONS

The study suggests that Hesperidin is protective against renal and lung tissues of rats that underwent ischemia-reperfusion injury.

Nutrition and oral health in children with recently and previously diagnosed celiac disease

OBJECTIVES

To evaluate the nutritional and oral health status of children with previously diagnosed celiac disease (CD) who follow a gluten-free diet and recently diagnosed CD patients.

MATERIALS AND METHODS

Previously and recently diagnosed groups were formed from children with CD, aged 4 to 15 years. A questionnaire was completed about the children's dental history and nutritional and oral hygiene habits. All the children underwent an oral examination, and dmft-DMFT indices were determined. Dental plaque status, periodontal health, and dental enamel defects were recorded. Oral soft tissues were examined for the presence of lesions. Unstimulated salivary flow rate and pH value were evaluated.

RESULTS

A statistically significant difference was determined between the previously and recently diagnosed patients in terms of toothpaste preference (p=0.003), frequency of going to the dentist (p=0.039), and the types of dental treatment they had received (p=0.001). A statistically significant difference was determined between the previously and recently diagnosed patient groups in terms of dmft values (p=0.005).

CONCLUSIONS

Children with CD should be directed to a pediatric dentist to improve oral and dental health, relieve the symptoms of oral mucosal lesions, be informed about enamel defects, and be encouraged to use gluten-free oral care products.

CLINICAL RELEVANCE

The collaboration of pediatric gastroenterologists and pediatric dentists can prevent the progression of oral symptoms in children with CD and eliminate long-term complications in terms of both oral health and multisystemic problems.

Maggot Treatment of Necrotic Toe Developed After Traumatic Subtotal Amputation

Maggot debridement therapy (MDT) has been used for years in the treatment of chronic wounds and necrotic tissues. We report a case of subtotally amputated third toe that was treated with MDT after reattachment and developing complete necrosis. The necrotic toe was replaced with viable tissue and the wound healed completely after 2 weeks of MDT application. This case points out the regenerative effects of MDT besides its mechanical debridement effect on the necrotic tissue.

Mask-Associated Dry Eye (MADE) in healthcare professionals working at COVID-19 pandemic clinics

Background

Healthcare professionals working at COVID-19 pandemic clinics have to work with masks during long hours. After the widespread use of masks in the community, many mask-related side effects were reported to clinics. The increase in the number of applicants with dry eye symptoms due to mask use in ophthalmology clinics has led to the emergence of the concept of mask-associated dry eye (MADE). We think that it would be valuable to evaluate ocular surface tests with a comparative study using healthcare professionals working in pandemic clinics, which we think is the right study group to examine the effects of long-term mask use.

Aims

We aimed to evaluate the mask-associated dry eye (MADE) symptoms and findings in healthcare professionals who have to work prolonged time with face masks in coronavirus disease 2019 (COVID-19) pandemic clinics.

Patients and Methods

In this prospective, observational comparative clinical study, healthcare professionals who use the mask for a long time and work in COVID-19 pandemic clinics were compared with an age and sex-matched control group consisting of short-term masks users, from April 2021 to November 2021. All participants underwent the Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (T-BUT), Oxford staining score, Schirmer's test I, and meibography with infrared transillumination.

Results

The long-term mask user group consisted of 64 people, while the short-term mask user group consisted of 66 people (260 eyes, total). The OSDI score and Schirmer I measurement were not statistically different between the two groups. T-BUT was statistically significantly shorter in the long-term group (P: 0.008); lid parallel-conjunctival fold, Oxford staining score, and upper and lower lid meibography score were found to be significantly higher in the long-term group (P < 0.001, P: 0.004, P: 0.049, P: 0.044, respectively).

Conclusion

Healthcare professionals with longer mask-wearing times are at greater risk of ocular surface damage. It may be considered to prevent this damage by blocking airflow to the ocular surface, such as by wearing a face mask properly or fitting it over the nose with surgical tape. Those who have to work with a mask for a long time during the COVID-19 pandemic should keep in mind the ophthalmology follow-up for eye comfort and ocular surface health.

Predictive value of Tp-e interval, Tp-e/QT, and Tp-e/QTc for disease severity in patients with liver cirrhosis

OBJECTIVE

The cardiovascular system is one of the most affected systems in the liver cirrhosis (LC) process, especially due to the tendency to arrhythmia. Since the data about the relationship between LC and novel electrocardiography (ECG) indexes are lacking, we aimed to investigate the association between LC and Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio.

PATIENTS AND METHODS

The study included 100 patients in the study group (56 male, median age 60) and 100 in the control group (52 female, 60 median age) between January 2021 and January 2022. ECG indexes and laboratory findings were analyzed.

RESULTS

The patient group had significantly higher heart rate (HR), Tp-e, Tp-e/QT, and Tp-e/QTc compared to the control group (p < 0.001 for all). There was no difference in terms of QT, QTc, QRS (depolarization of ventricles, involving Q, R, and S waves on ECG) duration, and ejection fraction between the two groups. Kruskal-Wallis test results revealed that there was a significant difference between Child stages in terms of HR, QT, QTc, Tp-e, Tp-e/QT, Tp-e/QTc, and QRS duration. There was also a significant difference between the model for end-stage liver disease (MELD) score groups in terms of all these parameters except for Tp-e/QTc. In the ROC analyses of Tp-e, Tp-e/QT and Tp-e/QTc to predict the Child C, the AUC values were 0.887; (95% CI: 0.853-0.921), 0.730; (95% CI: 0.680-0.780), and 0.670; (95% CI: 0.614-0.726), respectively. Similarly, AUC values for the MELD score > 20 were 0.877; (95% CI: 0.854-0.900), 0.935; (95% CI: 0.918-0.952), and 0.861; (95% CI: 0.835-0.887); (p < 0.001 for all).

CONCLUSIONS

Tp-e, Tp-e/QT, and Tp-e/QTc values were significantly higher in patients with LC. These indexes can be useful for arrhythmia risk stratification and to predict the end-stage of the disease.

Clinical significance of the largest histopathological metastatic lymph node size for postoperative course of patients undergoing surgery for gastric cancer

Aim

The aim of this study was to investigate the effect of the largest metastatic lymph node (MLN) size on postoperative outcomes of patients with stage II-III gastric cancer (GC).

Methods

A total of 163 patients with stage II/III GC who underwent curative surgery were included in this single-center retrospective study. The lymph nodes were counted, each lymph node was analyzed for metastatic involvement by histopathological examination, and the diameter of the largest metastatic lymph node was recorded. The severity of postoperative complications was assessed by Clavien-Dindo classification system. Two groups of 163 patients were defined according to ROC analysis with cut-off value of histopathologically maximum MLN diameter. A comparative analysis of demographic and clinicopathological characteristics of the patients and their postoperative outcomes were performed.

Results

The median hospital stay was significantly longer in patients with major complications compared to patients without major complications [18 days (IQR: 13-24) vs. 8 days (IQR: 7-11); (p < 0.001)]. The median MLN size was significantly larger in deceased patients compared to survived [1.3 cm (IQR: 0.8-1.6) vs. 0.9 cm (IQR: 0.6-1.2), respectively; (p < 0.001)]. The cut-off value of MLN size predicting mortality was found as 1.05 cm. MLN size ≥1.05 cm had nearly 3.5 times more negative impact on survival.

Conclusions

The largest metastatic lymph node size had a significant association with survival outcomes. Particularly, MLN size over 1.05 cm was associated with worse survival outcomes. However, the largest MLN was not shown to have any effect on major complications. Further prospective and large-scale studies are required to draw more precise conclusions.

Clinical significance of the histopathological metastatic largest lymph node size in colorectal cancer patients

Background

The metastatic lymph nodes (MLN) are interpreted to be correlated with prognosis of the colorectal cancers (CRC). The present retrospective study aimed to investigate the clinical significance of the largest MLN size in terms of postoperative outcomes and its predictive value in the prognosis of the patients with stage III CRC.

Methods

Between May 2013 and December 2018, a total of 101 patients who underwent curative resection for stage III CRC retrospectively reviewed. All patients were divided into two groups regarding cut-off value (<1.05 cm and ≥1.05 cm) of maximum MLN diameter measured histopathologically. A comparative analysis of demographic and clinicopathological characteristics of the patients and their postoperative outcomes were performed.

Results

Two groups carried similar demographic data and preoperative laboratory variables except the lymphocyte count, hematocrit (HCT) ratio, hemoglobin level and mean corpuscular volume (MCV) value (p<0.05). The patients with MLN diameter ≥1.05 cm (n=46) needed more erythrocyte suspension and were hospitalized longer than the patients with a diameter <1.05 cm (n=55) (p=0.006 and 0.0294, respectively). Patients with MLN diameter < 1.05 cm had a significantly longer overall survival than patients with MLN diameter ≥ 1.05 cm (75,29 vs. 52,57 months, respectively). Regarding the histopathologic features, the patients with MLN diameter ≥1.05 cm had larger tumor size and higher number of MLN than those with diameter <1.05 cm (p=0.049 and 0.001).

Conclusion

The size of MLN larger than 1.05 cm may be predictive for a poor prognosis and lower survival of stage III CRC patients. The largest MLN size may be a proper alternative factor to the number of MLNs in predicting prognosis or in staging CRC patients.

Histopathological, immunohistochemical and biochemical evaluation of electroacupuncture treatment of nervus radialis and nervus ulnaris injuries in rabbits

The aim of this study was to evaluate the efficacy of electroacupuncture in acute and chronic phases of radial and ulnar nerve injuries in histopathological, immunohistochemical and biochemical aspects. In the study, the rabbits were divided into four groups namely acute nerve injury (ANI) group, chronic nerve injury (CNI) group, positive control (PC) group and negative control (NC) group. In the ANI, CNI and PC groups, damage was created on the nervus radialis and nervus ulnaris by applying pressure for 60 seconds using a hemostatic forceps under anesthesia. No damage was created in the NC group. Fifteen sessions of electroacupuncture were applied to the rabbits in the ANI, CNI, and NC groups every other day using LI-4 (Large Intestine Meridian-4, He Gu), LI-10 (Large Intestine Meridian-10, Shou San Li), LR-3 (Liver Meridian-3, Tai Chong), and ST-36 (Stomach Meridian-36, Zusanli) electroacupuncture points. Electroacupuncture was not applied to the rabbits in the PC group. Decapitation was performed under general anesthesia at the end of electroacupuncture applications. After the euthanasia procedure, the samples obtained were evaluated for histopathological, immunohistochemical and biochemical parameters. In conclusion, degenerative foci in the treatment groups were found to be fewer than in the PC group whereas NGF and S-100 immunoreactivity were higher in the treatment groups than in the PC group. Whereas no statistically significant difference was observed between the treatment groups and the NC group in terms of oxidative stress factors, there was a statistically significant difference between the treatment groups and the PC group. In light of all these data, we have concluded that electroacupuncture is an effective treatment method for peripheral nerve injuries.

Long-term predictive value of cardiac biomarkers in patients with COVID-19 infection

OBJECTIVE

Several studies have investigated the association between cardiac biomarkers and short-term prognosis in the COVID-19 infection. However, the data on the predictive value of cardiac biomarkers to predict long-term prognosis in COVID-19 infection are limited. We aimed at determining the relationship between N-terminal brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-TnI) as cardiac biomarkers and in-hospital/long-term outcomes in COVID-19 infection.

PATIENTS AND METHODS

The study included a total of 916 patients with confirmed COVID-19 infection. The primary outcome was in-hospital and 1-year mortality. The secondary outcome was intensive care need at admission or the need to be transferred to the intensive care unit later on.

RESULTS

The study included 498 (54.4%) males and 418 (45.6%) females with a mean age of 55.1±18.5 years. The patients with known heart failure (HF), COVID-19-related HF, acute renal failure (ARF), chronic kidney disease (CKD), diabetes mellitus, hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD)/asthma, high CO-RADS score (≥ 4), lower EF, higher hs-TnI, and NT-proBNP levels had increased in-hospital and 1-year mortality. After multivariate analysis, NT-proBNP, hs-TnI, CKD, ARF, diabetes mellitus, and CAD were independent predictors of in-hospital and 1-year mortality. After ROC analysis, NT-proBNP cut-off levels of 1022.50 (sensitivity 87.5%, specificity 87.1%) and 1008 (sensitivity 88.6%, specificity 88.0%) were found to predict in-hospital and 1-year mortality, respectively. Hs-TnI cut-off levels of 49.6 (sensitivity 88.6%, specificity 88.9%) and 34.10 (sensitivity 83.8%, specificity 84.1%) were found to predict in-hospital and 1-year mortality, respectively.

CONCLUSIONS

The current study suggests that NT-proBNP and hs-TnI can be used as valuable cardiac biomarkers to predict short-term and long-term parameters in COVID-19 infection.

Comparative Analysis of Preoperative Ratio Based Markers in Predicting Postoperative Infectious Complications After Gastrectomy

AIM

Postoperative infections (POIs) are associated with prolonged postoperative recovery, delayed adjuvant therapy, psychological problems, and poor long-term outcomes. The study aims to cross-compare the ratio-based preoperative parameters to predict POIs in patients with D2 gastrectomy for gastric cancer.

MATERIALS AND METHODS

A retrospective cohort and single-center study evaluated the data of 293 patients who underwent curative gastrectomy between January 2007 and November 2019 in a tertiary hospital in Istanbul. A receiver operating characteristic (ROC) curve was used to assess the ability of laboratory values to predict clinically relevant POIs. The predictive capacity of the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and CRP-albumin ratio (CAR) was calculated by the area under the curve. Then, the cutoff points were determined for all 4 indexes.

RESULTS

POIs developed in 77 (26.2%) patients. Patients with POI had higher Charlson comorbidity index (CCI) scores and a longer length of hospital stay. ROC curve analysis revealed that NLR, LMR, and CAR were significantly effective in predicting POI, while PLR was ineffective. LMR was the best ability to predict the POI. According to multivariate analysis, CCI score 3, NLR&gt; 3.8, and LMR 2.34 were independent risk factors influencing the POI.

CONCLUSION

Preoperative LMR was most predictive for POI. Although CAR predicted the development of the POI, it was not superior to LMR and NLR. PLR did not have any prediction for POI. In addition, increased comorbidity (CCI 3) was an independent risk factor for POI.

External Ophthalmomiasis Cases in Şırnak

Dermatological cases caused by myiasis make up approximately 20% of travel diseases. Ocular involvement occurred in approximately 5% of these myiasis cases. The conjunctival involvement of Oestrus ovis (O. ovis) larvae, which is the active agent in most ocular infestation cases in humans, causes external ophthalmomyiasis. External ophthalmomyiasis was diagnosed because of O. ovis first-stage larvae that were removed from the conjunctiva of three patients who applied to the Şırnak State Hospital Eye Clinic with complaints of foreign body sensation, burning, stinging, watering, and redness in the eyes and swelling of the eyelids in July and October. All symptoms of the patients disappeared within a few days after the removal of the larvae. Ophthalmomyiasis due to O. ovis must be kept in mind in the differential diagnosis of patients presenting with similar eye complaints in areas where sheep and goat husbandry is performed intensely.

Estudio descriptivo de anomalías congénitas encontradas en rumiantes en la región de Elazig en Turquía

Las malformaciones  congénitas son anomalías de estructura, formación o función observables al nacer que provocan grandes pérdidas económicas en  la industria ganadera.. En este estudio, se investigó la incidencia de las principales anomalías congénitas encontradas en el último año (junio de 2020-junio de 2021) en rumiantes en la región de Elazig. según especie, raza, edad,  sexo, número de preñeces, examen rectal y método de concepción empleado . Se evaluaron un total de 79 anomalías congénitas encontradas en 73 animales . De 73 animales con anomalías congénitas,  la mayoría  eran terneros (84, 93%) y  machos (68,49%). Se determinó que el tipo de anomalía más común en los terneros fue la hernia umbilical (21,51%) mientras que en corderos y cabritos fue la atresia anal.  La mayoría de estas anomalías  se formaban principalmente en los órganos de la pared abdominal y órganos del sistema gastrointestinal (46,84%). . Las anomalías congénitas en terneros y corderos eran más frecuentes cuando provenían de las  madres de primera preñez , mientras que en los cabritos cuando las madres tenían su segunda preñez La mayoría de los rumiantes menores con anormalidades congénitas provenían de madres con gestaciones múltiples. El examen rectal realizado en las vacas durante los primeros estadios de la gestación, fue probablemente uno de los factores predisponentes para la formación de malformaciones congénitas en esta especie. Se requieren más estudios que incluyan la participación de laboratorios de diagnóstico para mejorar la caracterización de las anormalidades congénitas y contribuir a la implementación de medidas de prevención y control en los rodeos de estas especies en nuestra región.

Impact of preoperative prognostic nutritional index levels on morbidity in colorectal cancer surgery

AIM

The prognostic nutritional index (PNI) is a valuable parameter that indicates the immunonutritional status of patients with malignant tumors.

MATERIAL AND METHODS

Patients operated for colorectal cancer between January 2013 and December 2019 were analyzed retrospectively. The relationship between PNI and morbidity was investigated in the 314 patients included in the study. Based on previous studies, the PNI cutoff value was set at 45, and the patients were duly divided into two groups: PNI <45 and PNI ≥45. The demographic and clinicopathological characteristics, as well as postoperative complications in the two groups, were compared.

RESULTS

There was no statistical difference in gender, localization, T stage, N stage, perineural invasion, lymphovascular invasion, stage, Ca19-9 values, and body mass index(BMI) between the two groups. In contrast, there was a statistically significant difference in age, complications, and CEA values. (p=0.008, p<0.001, p=0.043, respectively). The median age was lower in patients with high PNI scores than in the low PNI group (61 vs. 64 years). When the patients were examined for complications, 36 (37.1%) patients were observed in the high PNI group, compared to 155 (71.4%) in the low PNI group. In terms of overall survival, the mean life expectancy was 68.112 2.646 months for patients with low PNI group, compared to 84.626 2.701 months in the high-PNI group, and the difference was statistically significant (p=0.001).

CONCLUSION

This study's findings suggest that the preoperative prognostic nutritional index may indicate postoperative complications and prognosis. The most significant benefit of this marker is that it can be improved preoperatively and practically.

KEY WORDS

Nutritional Status, Morbidity, Colorectal Neoplasms.

The effect of hip dysplasia on some biochemical parameters, oxidative stress factors and hematocrit levels in dogs

In this study, it was aimed to investigate the effect of hip dysplasia on some biochemical parameters, oxidative stress factors and hematocrit values in dogs. Hematocrit values (HTC), serum calcium (Ca), phosphorus (P) levels, serum alkaline phosphatase (ALP), creatine kinase (CK) activities and oxidative stress factors were evaluated in a total of 27 dogs with healthy hip joints (n: 11) and hip dysplasia (n: 16). There was no statistically significant difference between the two groups in terms of HCT, Ca and P values (p˃0.05). ALP and CK activities were found to be statistically significantly increased in the group with hip dysplasia compared to the control group with a healthy hip joint (p˂0.05). While malondialdehyde (MDA) level, one of the oxidative stress factors, was increased in the group with hip dysplasia, decreased glutathione (GSH) levels, catalase (CAT) and glutathione peroxidase (GSH-Px) activities were significantly decreased. There was no significant difference between the two groups in terms of superoxide dismutase (SOD) level. As a result, it was determined that oxidative stress factors differ in dogs with hip dysplasia compared to dogs with the healthy hip joint.

Hepatic bridge and round ligament of the liver during cytoreductive surgery: a retrospective cohort

PURPOSE

The hepatic bridge as an anatomical variation may lead to recurrence and treatment failure in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by constituting an obscure region during surgery. This report aimed to highlight the relationship between the hepatic bridge and various prognostic factors in peritoneal carcinomatosis.

METHODS

Data of 101 patients who underwent CRS/HIPEC for peritoneal carcinomatosis in a single centre were retrospectively reviewed. Demographic characteristics, primary origin of peritoneal carcinomatosis, classification of hepatic bridge, Peritoneal Cancer Index (PCI) score, and completeness of cytoreduction (CC) score were analysed.

RESULTS

The tumour was proven histopathologically in 18 (28.6%) of 63 patients who underwent distal round ligament (DRL) resection. The PCI score was found to be significantly higher in patients with tumour in DRL compared to the ones without tumour (p < 0.001). The median PCI score of patients with implant positive DRL was 18 (12-20) and this score was 3 (2-6) for patients with implant negative DRL (p < 0.001). The ROC curve concerning the risk of an implant penetrating the round ligament revealed the optimal cut-off value of PCI at 10 with 88.9% sensitivity and 79.3% specificity.

CONCLUSION

The round ligament should be removed, regardless of the PCI score, as a standard in mucinous adenocarcinoma of the appendix and malignant peritoneal mesothelioma. DRL should be removed when PCI is equal or higher than 10 for PC due to colorectal and ovarian cancers.

Prognostic significance of the metastatic lymph node ratio compared to the TNM classification in stage III gastric cancer

Background

We aimed to evaluate a comparative analysis of the prognostic value of the metastatic lymph node ratio (LNR) and pN (TNM) in stage III gastric cancer.

Patients and Methods

A total of 159 stage III gastric cancer patients with curative gastrectomy were retrospectively analyzed. Cutoff values for LNR were designated according to 25%, 50% and 75% percentiles, 0.07, 0.20 and 0.44 respectively. The LNR was divided into four groups as 0 > LNR1 ≤ 0.07; 0.07 > LNR2 ≤0.20; 0.20 > LNR3 ≤0.44; 0.44 > LNR4 ≤1.

Results

The mean age of the patients was 61.1 ± 11.3 years. Male predominance was apparent (73.6%). The 1-year overall survival and recurrence rates were 73.6% and 33.6%, respectively. The univariate cox regression analysis demonstrated age and LNR were the main variables that affected overall survival (OS) (p < 0.05). Harvested lymph nodes less than 16 did not affect OS (p = 0.255). The results of the multivariate cox regression analysis revealed that only LNR was an independent prognostic factor (P < 0.001), while pN was not (p > 0.05). Similar results, as with overall survival, could not be revealed clearly for disease free survival (DFS).

Conclusions

LNR was an independent significant prognostic factor and superior to pN staging in predicting OS but not for DFS in stage III gastric cancer patients. The high LNR levels in our research were found to be associated with poor survival rates. The percentile system we used to determine cutoff values may be considered as a reliable method. Similarly, LNR also provides a reliable prognostic parameter in future staging systems to help guide treatment algorithm plans.

The tick fauna in Istanbul, Turkey, from 2013 to 2017 and identification of their pathogens by multiplex PCR: an epidemiological study

Ticks may carry several pathogens as vectors and their pathogen load may vary due to differences in geography, climate and vegetation. In this study, we collected ticks from 39 districts of Istanbul (Turkey) between May and October, from 2013 to 2017, and identified them under stereo-microscope. In addition, we investigated the pathogens that the ticks carry (Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Rickettsia sp. and Babesia sp.) by using multiplex polymerase chain reaction (PCR) method. We collected a total of 875 ticks from the ground and from various animals and kept them at 4 °C until experiments. We identified 248 Rhipicephalus bursa (28.3% of the total), 205 (23.4%) Rhipicephalus annulatus, 197 (22.5%) Haemaphysalis concinna, 149 (17.0%) Rhipicephalus sanguineus, 24 (2.7%) Hyalomma marginatum, 21 (2.4%) Ixodes ricinus, 13 (1.5%) Rhipicephalus kohlsi, 5 (0.6%) Hyalomma anatolicum, 5 (0.6%) Hyalomma aegyptium, 5 (0.6%) Dermacentor niveus and 3 (0.3%) Ixodes hexagonus. We included a total of 328 questing ticks in the study: 63 R. bursa, 63 R. sanguineus, 63 R. annulatus, 63 H. concinna, 24 H. marginatum, 21 I. ricinus, 13 R. kohlsi, 5 H. anatolicum, 5 H. aegyptium, 5 D. niveus and 3 I. hexagonus. Multiplex PCR indicated that 80 (24.4%) ticks were infected with Rickettsia sp., 5 (1.5%) with B. burgdorferi and 1 (0.3%) with Babesia sp. Our study indicated that Rickettsia is more common in ticks collected around Istanbul.

Awareness and wound assesment decrease surgical site infections

Objective: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine prac- ticality of SSI risk assessment methods (SENIC and NNIS) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure and evaluation of the contribution of wound assesment to the reduction of wound infection.

Material and Methods: Patients were followed with a prospective data chart through four year. Correlation of SENIC and NNIS together with ASEPSIS were performed.

Results: During the study period, 275 SSI occurred. SSIs were determined within the 21 days-period after operations. Correlation between SENIC with ASEPSIS (rs= 0.41, p< 0.001) was found better than that for NNIS with ASEPSIS (rs= 0.37, p< 0.001). Type of operation (emergency vs. elective), body mass index, operation class and American Society of Anesthesiologists scores were found independently predictive factors for SSI. The forth year SSI rate was found to be significantly lower than the other years (p< 0.001).

Conclusion: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS method. In addi- tion, surgical wound assesment and awarness of the wound infection rates, have decreased the SSI rates over the years.

The Effect of Bacterial Colonization and Maggot Debridement Treatment on Wound Healing in Chronic Venous Leg Ulcers

BACKGROUND

The debridement of necrotic and infected tissues, which prolong the wound healing process, is important for the preparation of the wound bed. Therefore, wound-bed preparation and debridement are vital components of venous leg ulcer management. We aimed to present a perspective to evaluate the clinical and microbiological efficacy of Maggot Debridement Therapy (MDT) in the treatment of chronic leg ulcers caused by venous insufficiency.

METHODS

Thirty-eight patients with chronic venous leg ulcers who were referred to our unit with an MDT request were included in the study. Lucilia sericata larvae were applied to the wounds two days a week until the necrotic tissue was cleared. Swab samples were regularly taken before and immediately after each larval application for wound culture. Changes in the percentage of wound surface area and growing pathogenic microorganisms were recorded during the follow-up period.

RESULTS

The sample consisted of 38 patients with 55 venous leg ulcers. The mean initial ulcer surface area was 99.1 cm2 (range 3 - 500). Complete debridement was achieved in all ulcers in the 2nd week, on average. Twenty-five ulcers (45.5%) were completely debrided with two one-week MDT sessions. Complete wound healing occurred in 42 ulcers (76.4%) after an average of seven MDT sessions. Microorganisms isolated from the wounds significantly decreased immediately after the first MDT session.

CONCLUSIONS

Although many methods are used in the treatment of venous leg ulcers, they are often not effective. MDT, which is coming into widespread use today, is a simple and effective method in the treatment of these ulcers. Its effects such as biodebridement, disinfection, and growth stimulation can encourage the rapid healing of chronic venous leg ulcers.

Prognostic Factors in Operated T3-T4 Gastric Cancer

OBJECTIVE

To investigate the prognostic factors affecting survival in patients with a deep gastric wall invasion of T3-T4 advanced gastric cancer.

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Department of Gastroenterological Surgery, Kartal Koşuyolu High Specialty Training and Research Hospital, between November 2006 and December 2018.

METHODOLOGY

A retrospective review was made of 252 patients; and the clinicopathological characteristics and survival status in the presence of T1-T2 and T3-T4 patients were investigated. The cumulative survival of the two groups was analysed with a Kaplan-Meier test, and the differences were analysed with a log-rank test. The prognostic factors for T3-T4 patients were established through a stepwise Cox regression analysis.

RESULTS

Of the total, 52 (20.6%) patients had T1-T2 and 200 (79.4%) had T3-T4 gastric wall invasion. Statistical differences were noted in the Lauren classification as gender, tumor size, presence of lymph node involvement, presence of vascular and perineural invasion, and overall survival (p <0.001). A univariate analysis of the prognostic factors affecting survival in T3-T4 patients revealed a difference in the tumor localisation, tumor size, the presence of involved lymph nodes, perineural invasion, and vascular invasion. A multivariate analysis of the prognostic factors affecting survival identified differences in tumor size, the presence of involved lymph nodes and perineural invasion.

CONCLUSION

The most significant prognostic factor affecting survival in patients with T3-T4 gastric cancer, based on the depth of gastric wall invasion, was the tumor size, lymph node involvement and perineural invasion. Key Words: Advanced gastric cancer, Prognostic factor, Survival.

Efficacy of maggot debridement therapy on refractory leg ulcers of Behçet disease: an open-label study

BACKGROUND

Cutaneous ulcers of Behçet disease (BD) are rare but have high morbidity and resistance to conventional therapies. An important and essential aspect of ulcer management is debridement. Regarding maggot therapy (MT), excretions of the green bottle fly, Lucilia sericata, have been shown to have the ability to remove necrotic debris and promote healing.

AIM

To evaluate the efficacy of MT for cutaneous ulcers of BD.

METHODS

In this open-label trial, patients with BD with refractory leg ulcers suitable for MT were enrolled. Maggot application was performed until complete debridement was achieved, and all patients were followed up for 12 months afterwards to assess the total healing of ulcers.

RESULTS

In total, 24 patients with 32 ulcers were enrolled. Using MT, 91.6% of all ulcers were completely debrided. Mean time to debridement was 14.9 days and mean number of cycles required was 5.3. Mean ulcer size was decreased by 23% with treatment. Time to debridement was positively correlated with pretreatment ulcer size and ulcer duration (P = 0.01 and P < 0.01) but not with ulcer depth, comorbidities, smoking, age or sex (P > 0.05 for all). During follow-up, 79.1% of all ulcers healed completely. Mean time required for total healing was positively correlated with ulcer duration, pretreatment and post-treatment ulcer area, ulcer depth and mean time to total debridement (P < 0.03, P = 0.00, P = 0.04 and P < 0.01, respectively).

CONCLUSIONS

To our knowledge, the findings presented in this first and unique study may provide key answers about factors affecting success rate of MT in BD cutaneous ulcers.

A Retrospective Study of Cutaneous and Visceral Leishmaniasis in Istanbul, Turkey

INTRODUCTION

Leishmaniasis is a vector-borne disease caused by flagellated protozoans of the genus Leishmania. This study aimed to evaluate the epidemiological status of Visceral Leishmaniasis (VL) and Cutaneous Leishmaniasis (CL) among patients admitted to a university hospital in Istanbul, located in western Turkey.

METHODOLOGY

This study included 160 and 77 patients with a pre-diagnosis of VL and CL, respectively, between January 2001 and December 2017. Detailed demographic data, including age, gender, nationality and the number and location of lesions were collected and recorded from the patient registries.

RESULTS

Among 160 bone marrow specimens that suspected as VL, 22 (13.7%) of the specimens that were evaluated with both culture and Giemsa staining detected as positive. Furthermore, 29 (37.7%) of the 77 patients suspected for CL showed evidence of Leishmania.

CONCLUSIONS

The increase in human immigration from neighbouring countries (with a high incidence of leishmaniasis) to Turkey might increase the risk of spreading the disease. This situation could result in a higher prevalence in metropolitan cities like Istanbul, where the country's population is concentrated.

The risk factors of intraoperative hyperlactatemia in patients undergoing laparoscopic colorectal surgery

AIM

The aim of this study is to determine the incidence of intraoperative hyperlactatemia and its risk factors in patients undergoing laparoscopic colorectal surgery.

MATERIAL AND METHODS

We retrospectively enrolled 75 patients who underwent laparoscopic resection for colorectal cancer. Initial lactate levels were determined from blood gas analysis before the incision. The end lactate values were recorded after the termination of the pneumoperitoneum. Hyperlactatemia defined as lactate levels between 2 mmol/L and 5 mmol/L without evidence of acidosis. The patients were divided into two groups as normolactatemia and hyperlactatemia according to lactate values at the end of the surgery.

RESULTS

Of the 75 patients, 45 (60.0%) had higher lactate levels than normal at the end of the surgery. The median age of the study population was 62 (24-84) years. Forty (53.3%) of the patients were male. Most of the patients in the study had colon cancer origin [56 cases (74.7%)]. Univariate logistic regression analysis for a possible independent risk factor in terms of hyperlactatemia showed that Charlson comorbidity index (CCI) ≥ 3, body mass index (BMI) ≥ 30 kg/m2, the operative time, and the tumor size were significant (p < 0.05). Multivariate analysis found that only BMI ≥ 30 kg/m2 and the operative time were significant (p = 0.004, and p < 0.001, respectively).

CONCLUSION

According to our work, obesity (BMI ≥ 30 kg/m2) and the operative time in laparoscopic colorectal surgery were independent risk factors for intraoperative hyperlactatemia at the end of the operation. Therefore, clinicians should be vigilant about the inevitable consequences of surgery by making appropriate preparation.

KEY WORDS

Colorectal cancer, Lactate, Hyperlactatemia, Laparoscopy.

Prognostic effect of perineural invasion in successive years in patients with locally advanced gastric cancer

Aim

The present study evaluates the prognostic significance of perineural invasion (PNI) on 2-year, 5-year, and overall survival in patients undergoing gastrectomy and D2 lymphadenectomy due to locally advanced gastric cancer.

Materials and Methods

Included in the study were 231 patients who underwent surgery between November 2006 and October 2018 due to stage 1B and over locally advanced gastric cancer, whose records were reviewed retrospectively.

Statistical Analysis

The variables in the presence or absence of PNI were compared between the two groups with a Chi-square test, a Fisher's exact test, a likelihood ratio, and a Mann-Whitney U test. Overall survival data were evaluated with a Kaplan-Meier test. Prognostic factors were evaluated with a stepwise Cox regression analysis.

Results

PNI was identified in 167 (72.3%) of the patients. The 2-year, 5-year, and overall survival rates at the end of the follow-up period were 85.9%, 70.3%, and 64.1% in those without PNI, and 52.7%, 38.3%, and 36.5% in those with PNI, respectively. In a multivariate analysis, PNI appeared to be a significant prognostic factor for 2-year survival (P = 0.04) but had no effect on 5-year and overall survival.

Conclusions

Survival was shorter in patients with PNI than in patients without PNI, and PNI had no effect on overall survival, although it was found to be of prognostic significance for 2-year survival.

The risk of post-polypectomy bleeding among patients receiving antithrombotic agents: A prospective observational study

BACKGROUND

In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding.

OBJECTIVES

The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy.

DESIGN AND SETTING

Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey.

METHODS

Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded.

RESULTS

The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05).

CONCLUSION

This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.

Sarcopenia is associated with increased severe postoperative complications after colon cancer surgery

INTRODUCTION

Studies have shown that sarcopenia is associated with poor outcomes in patients with gastrointestinal cancer undergoing surgery. We aimed to investigate the relationship between postoperative complications of sarcopenic patients who had been operated on for colon cancer and the effects on short-term mortality.

MATERIAL AND METHODS

In this study, patients who had undergone colon cancer surgery between January 2013 and December 2018 were collected retrospectively. Sarcopenia was diagnosed by the skeletal muscle index (SMI) derived from a preoperative computed tomography scan. Multiple logistic regression analysis was performed to determine whether sarcopenia is associated with postoperative major complications (POMC).

RESULTS

The study included 160 patients with a mean age of 62.4 ±12.6 years. Clavien-Dindo grade 1-2 (minor) complications were not significantly different between the groups (p = 0.896). However, grade ≥ 3 (major) complications were detected in 13 (17.8%) patients in the sarcopenic group (SG) and in 5 patients in the non-sarcopenic group (NSG) (5.7%) (p = 0.016). Length of intensive care unit (ICU) stay was longer in SG (p = 0.002) and there was no difference between 1-month and 6-month mortality rates (p = 0.273 and p = 0.402, respectively). According to univariate analyses, sarcopenia and age over 65 years were related to POMC. In multivariate analyses, sarcopenia (odds ratio = 3.039; 95% confidence interval 1.008-9.174; p = 0.048) and advanced age (odds ratio = 3.246; 95% confidence interval 1.078-9.803; p = 0.036) were found to be independent risk factors for POMC.

CONCLUSIONS

This study showed that while sarcopenia is a risk factor for POMC, sarcopenia also prolongs the duration of ICU stay. Also sarcopenia has no effect on short-term mortality.

Ophthalmomyiasis Externa: A Case Report

Ophthalmomyiasis is the infestation of the eye with fly larvae. Oestrus ovis is one of the most common causes of ophthalmomyiasis worldwide. Herein, we describe a case of external ophthalmomyiasis caused by Oestrus ovis in an 18-year-old female living in the city centre of Istanbul and who had no history of contact with any animal.

Relation between Sarcopenia and Surgical Site Infection in Patients Undergoing Gastric Cancer Surgery

Background: Sarcopenia is a syndrome that can have negative consequences after gastric cancer (GC) surgery. This study aims to determine the effect of sarcopenia on surgical site infection (SSI) that develops after open GC surgery. Patients and Methods: In this retrospective design study, data were collected for patients who underwent GC surgery between January 2013 and August 2019. The diagnosis of sarcopenia was made according to the skeletal muscle index (SMI) calculated from pre-operative computed tomography images. Patients with sarcopenia and those without sarcopenia were compared in terms of SSIs; the risk factors for SSI were also analyzed. Results: One hundred forty-nine patients were included in the study and had a mean age of 59.3 years. Post-operative complications developed in 59 patients (39.6%) and SSIs in 28 patients (18.7%). Sarcopenia was detected in 57 (38.3%) patients; the mean age was 59.9 years in the sarcopenic group (SG) and 58.9 years in the non-sarcopenic group (NSG; p = 0.55). The mean SMI was 382.5 mm²/m² and 646.2 mm²/m² in the SG and NSG, respectively (p < 0.001). A relation between SSIs and sarcopenia was detected; 17 patients in the SG (29.8%) versus 11 patients in the NSG (11.9%; p = 0.007). Surgical site infection was not found to be statistically significantly related to obesity, hypoalbuminemia, intra-operative blood loss, or duration of operation, although the sarcopenic obesity patients were found to have the highest SSI rate (40%). Conclusion: The present study identified a relation between sarcopenia and SSIs occurring after GC surgery. The authors believe that studies seeking to reduce the incidence of SSIs, which are a leading cause of morbidity after GC surgery, should be supported.

Evaluating the effect of tumor size on survival and its prognostic significance among gastric cancer patients

Purpose. This study investigates the prognostic significance of tumor size and its effect on survival among patients undergoing gastrectomy and D2 lymph node dissection due to gastric cancer. Materials and Methods. The clinicopathological characteristics of 320 patients who were operated due to gastric cancer between November 2006 and September 2019 were assessed retrospectively, of which 271 were included in the present study. A receiver-operating characteristic curve (ROC) analysis was carried out to identify the tumor size cut-off value. Patients were divided into small-size and large-size tumor groups. Clinicopathological characteristics were assessed using Chi-square and Mann-Whitney U tests, while survival was assessed with a Kaplan-Meier log-rank test. Results. The cut-off gastric cancer tumor size value was calculated as 4.75 cm. A statistical difference was noted in the tumor depth of wall invasion (p<0.001), the number of positive lymph nodes removed (p<0.001), vascular invasion (p=0.001) and perineural invasion (p=0.001) of the two groups. Survival was poorer in patients with large-size tumors than in those with small-size tumors (62 months vs. 88 months, respectively; p<0.001), and tumor size was associated with wall invasion depth (p<0.001) and Borrmann’s classification (p=0.002). A univariate analysis revealed tumor size to be a prognostic factor for survival (p=0.001), while no such finding could be established in a multivariate analysis (p=0.637). Conclusion. Tumor size is a prognostic marker for gastric cancer, and a preoperative assessment in this regard may suggest neoadjuvant therapy.

The Distribution of Intestinal Parasites in Patients Presenting to a University Hospital in Istanbul: A Seven-year Retrospective Analysis

Objective

The purpose of this study was to determine the intestinal parasite distributions in patients who applied to the Parasitology Laboratory of Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, by evaluating the parasites retrospectively.

Methods

Normal saline and stool lugol were applied for direct examination of stool samples that were sent for parasite examination; cellophane band samples were evaluated microscopically. The samples suspected to have protozoa were evaluated using modified acid fast and trichrome staining methods. We evaluated the parasitological examination results of patients who applied to our laboratory between January 2012 and December 2018.

Results

A total of 2.96% of the 20,948 patients who applied had parasites in their faeces. Blastocystis spp. was detected at the highest rate (63.23%), followed by Giardia intestinalis (17.26%), Enterobius vermicularis (12.58%), Taenia saginata (2.42%), Cryptosporidium spp. (1.94%) and Entamoeba histolytica/dispar (1.45%).

Conclusion

Although the prevalence of intestinal parasitic infections has decreased when compared to previous years, it still remains important. For this reason, solving infrastructure problems, providing information on personal hygiene and sanitation rules are among the most important tasks needed to reduce the prevalence of intestinal parasites.

Risk factors for persistent elevation of perioperative lactate levels in gastric cancer surgery

Background: The impact of high-risk surgery on tissue perfusion can be indirectly assessed by measuring lactate levels during surgery and intensive care unit (ICU) stay. While consistently high values are associated with poor prognosis, transient elevations do not mean poor clinical outcomes. Therefore, intraoperative and early postoperative blood lactate monitoring is essential for cancer patients. Aims and Objective: This study aimed to determine the risk factors of persistently elevated lactate levels in the intraoperative and postoperative period in patients with elective gastric cancer surgery. Materials and Methods: We retrospectively enrolled 293 patients who underwent curative resection for gastric cancer. Lactate values of all patients were examined during surgery and ICU-stay at 3rd, 6th, 12th, and 18th hours. All lactate values above 2 mmol/L were considered elevated. The patients were divided into two groups as those with perioperative persistently increased lactate levels and those without. Results: Of the 293 patients, 60 (20.5%) had higher lactate levels in the perioperative period. According to multivariate logistic regression analysis, the operative time had the highest significance rate (p = 0.020) out of two significant variables, followed by the BMI ≥ 30 kg/m2 (p = 0.048). Besides, patients with perioperative hyperlactatemia had prolonged hospital stays (p = 0.034). Conclusions: Operative time and obesity (BMI ≥ 30 kg/m2) were independent risk factors for persistent lactate elevation in the perioperative period. Also, perioperative hyperlactatemia extended the length of hospital stay.

Factors affecting a persistent increase in the perioperative lactate levels in colorectal cancer surgery and its impact on postoperative outcomes

High lactate concentration is a sign of tissue hypoxia in the perioperative period. Therefore, close monitoring of blood lactate is essential in cancer patients undergoing surgery. The first aim of this study is to determine the factors affecting the perioperative consistently high lactate levels in patients undergoing colorectal cancer (CRC) surgery.

The prognostic value of different lymph node classification systems in stage III colorectal cancer patients

AIM

Prognostic significance assessment of different lymph node classification systems in stage III colorectal cancer patients.

MATERIAL AND METHODS

A total of 85 stage III colorectal cancer patients, who had undergone surgery between January 2013 and December 2018, were divided into 3 different groups comprising of lymph node ratios (LNR) and log odds of positive lymph nodes (LODDS) as per the cutoff values of 25 and 75 percentile threshold values. They were accordingly classified as: LNR1 <0.069, LNR2 0.069-0.24, LNR3 >0.24 and LODDS1 <-0.99; -0.99≥ LODDS2 <-0.47; LODDS3 ≥-0.47. Further the LNR was assessed according to the cutoff values proposed by Berger et al. The pN statuses of all patients were also categorized as pN1 and pN2 in line with the AJCC 8th Edition. The Kaplan-Meier test and Cox regression analysis were performed to analyze the relationship among the LNR, LODDS, pN and overall survival.

RESULTS

While 55 patients included in the study had tumors in their colons, the localization of the tumors of 30 patients was the rectum. The means for survival time was 63.3 months +/- 3.6 [95% CI(56.2-70.4)]. When univariate analyses were conducted for the factors affecting 3 and 5-year survival of the patients, it was ascertained that there was a significant relationship only between perineural invasion (PNI) and survival. Accordingly, the 3-year survival of those with PNI was found to be 31.4% in comparison to 56% of those without PNI (p=0.025), while the figure was 5.7% for the 5-year survival of the former group and 22% for the latter (p=0.040). When the relation between the survival time of the patients and the LNR classification conducted according to the staging system developed by Berger et al. was studied, no significant relationship could be found (p>0.05). Similarly, and 0.321 respectively.

CONCLUSION

Although numerous studies have shown that there was a significant relationship between high LNR and increased survival, as opposed to the results of our study, the greatest obstacle before LNR's survival prediction is the absence of a consensus for standard cutoff values.

KEY WORDS

Colorectal cancer, Lymph node classification systems, Lymph node ratio.

A Case of Cutaneous Leishmaniasis Caused by Leishmania infantum

<p>Leishmania is a disease that is transmitted via Phlebotomine sand flies. Two clinical forms of leishmaniasis are observed in humans: Visceral and cutaneous leishamniasis. The latter is very widespread in our country and may resolve by itself with scar formation. Whereas visceral leishmaniasis can be lethal if left untreated. Recently, molecular studies have shown that agents causing visceral leishmaniasis may cause cutaneous leishmaniasis and vice-versa.</p> <p>A 34-year-old female patient from Kahramanmaraş was sent to the microbiology laboratory with a pre-diagnosis of leishmaniasis. The smear taken from the patient was stained with Giemsa and was viewed by using a light microscopy. The materials taken via swab were examined with Real Time PCR and High Resolution Melting Analysis (HRMA).</p> <p>Leishmania amastigotes were viewed by using microscopy and diagnosis was confirmed. Real Time PCR was positive for Leishmania and HRMA showed that the agent was L. infantum.</p> <p>As our county has a bridging role between Asia and Europe, we should be aware of the recent epidemiological changes about Leishmania infections. We wanted to present this case becasue the causative agent of cutaneous leishmaniasis was L. infantum in this case and the disease resolved without treatment.</p>

Regulation of MMP 2 and MMP 9 expressions modulated by AP-1 (c-jun) in wound healing: improving role of Lucilia sericata in diabetic rats

AIMS

Lucilia sericata larvae have been successfully used on healing of wounds in the diabetics. However, the involvement of the extraction/secretion (ES) products of larvae in the treatment of diabetic wounds is still unknown. Activator protein-1 (AP-1) transcription, composed of c-jun and c-Fos proteins, has been shown to be the principal regulator of multiple MMP transcriptions under a variety of conditions, also in diabetic wounds. Specifically, MMP-2 and MMP-9's transcriptions are known to be modulated by AP-1. c-jun has been demonstrated to be a repressor of p53 in immortalized fibroblasts. The aim of the present study is to investigate the effects of L. sericata ES on the expression of AP-1 (c-jun), p53, MMP-2, and MMP-9 in wound biopsies dissected from streptozotocin induced diabetic rats.

METHODS

The expression levels of MMP-2, MMP-9, c-jun and p53 in dermal tissues were determined at days 0, 3, 7 and 14 after wounding, using immunohistochemical analysis and quantitative real-time PCR.

RESULTS

The treatment with ES significantly decreased through inflammation-based induction of MMP-2 and MMP-9 expression levels in the wounds of diabetic groups, compared to control groups at the third day of wound healing. At the 14th day, there were dramatic decreases in expression of c-jun, MMP-9, and p53 in ES-treated groups, compared to the diabetic group (P < 0.001, P < 0.05 and P < 0.01, respectively).

CONCLUSION

ES products of L. sericata may enhance the process of wound healing in phases of inflammation, proliferation, and re-epithelization, essentially via regulating c-jun expression and modulating MMP-2 and MMP-9 expressions.

Real-time PCR using high-resolution melting analysis technology for diagnosis of Leishmania and determination of types of clinical samples

Background/aim

Leishmaniasis is a disease group carried by Phlebotomus and Lutzomyia sand flies infected with Leishmania and is mostly observed in rural areas. In this study, using high-resolution melting analysis (HRMA), we aim to identify the active types of leishmaniasis, which are inadequately identified by classical methods.

Materials and methods

Samples of 85 patients were examined in the study. Six of the patients were suspected of having visceral leishmaniasis (VL) and 79 cutaneous leishmaniasis (CL). The slides prepared from the samples were stained with Giemsa stain and examined under a light microscope. The results were compared with those determined in real-time PCR. When the real-time PCR result was positive for Leishmania , we determined the type by HRMA.

Results

Among 85 Leishmania amastigote samples, 28 (32.9%) of them were detected and accepted as positive by microscopic examination. On the other hand, 25 (29.4%) of the 85 samples were found as positive using real-time PCR. In addition, when 25 Leishmania-positive samples were examined by HRMA, the results showed that 21 (84%) were L. tropica, 3 (12%) were L. major, and 1 (4%) was L. infantum.

Conclusion

Based on our findings, we conclude that using real-time PCR and HRMA is useful in determining the cause of the disease in leishmaniasis.

Diagnostics of intestinal parasites by light microscopy among the population of children between the ages of 4-12 in eastern Turkey

Intestinal parasitic infections are among important health problems in developing countries. In societies living in low socioeconomic conditions, it has been neglected and mostly affects children. It is important to determine the prevalence and type of intestinal parasites in order to determine the intervention strategies for these infections. Therefore, the aim of this study is to evaluate intestinal parasite prevalence and IgE levels and the factors associated with the region in which the children population live, in Sirnak province, in the eastern of Turkey. A total of 357 symptomatic children aged 4 to 12 years, who were admitted to the Paediatric Polyclinic of Sirnak State Hospital, were examined prospectively. The collected stool samples were examined with direct wet-mount and concentration method under light microscope. In addition, total serum IgE levels were compared among 223 children with parasitic disease and 134 children without parasitic disease. One or more intestinal parasites were detected in 223 out of the 357 children participating in the study. The ratio of single, double, and triple parasitic infections in children was 32.5 %, 22.4 % and 7.6 %, respectively. The most common parasites determined in the study were Taenia spp. (39.9%), Enterobius vermicularis (38.6%) and Giardia intestinalis. (30 %). The difference between IgE levels determined in both groups was not regarded to be statistically significant. This study indicated that that intestinal polyparism is very common in children living in the province of Sirnak, which is located in the east of Turkey, neighbouring Iraq and Syria in the South. For this reason, sustainable control measures are urgently needed to improve personal hygiene and sanitation, to provide a healthy infrastructure and to improve the quality of existing water resources.

The antibacterial effect of peritoneal fluid in experimental peritonitis

BACKGROUND

In our study, the effects of peritoneal fluid on some Gram-negative and Candida albicans in experimental peritonitis rats were studied. The primary objective of the present study was to understand the effect of peritoneal fluid on microorganisms causing intra-abdominal infections.

METHODS

Twenty male Sprague-Dawley rats weighing between 250 and 300 g were used in the study. The rats were randomly divided into two groups consisting of 10 animals. The operative procedures were performed under sterile conditions. In group I, sham laparotomy was done. In group II, the distal part of the cecum was ligated, and cecum perforation was performed. Peritoneal fluid samples at baseline and 2 and 4 h were extracted using a Pasteur pipette during laparotomy under anesthesia.

RESULTS

Peritoneal fluid was ineffective on Citrobacter freundii, Proteus mirabilis, and Enterobacter aerogenes. It inhibited the growth of Klebsiella pneumoniae for 8 h. However, growth was significantly increased in the passages obtained after 24 h. The growth of C. albicans decreased in the passages that were extracted after 4 and 8 h and increased in the passages obtained after 24 h (p<0.05). It was found that the number of Escherichia coli and Pseudomonas aeruginosa colonies that were grown in 2 h decreased, and no growth was detected in the passages obtained after 2 h (p<0.05).

CONCLUSION

Proliferating colony counts of E. coli and P. aeruginosa decreased after 2 h, and there was no proliferation in subsequent cultures. Peritoneal fluid exhibits a bactericidal effect under appropriate conditions. It also exhibits peritoneal bactericidal activity against E. coli, the major pathogen in intra-abdominal infections.

Pancreatic extragastrointestinal stromal tumor invading the duodenum

Extragastrointestinal stromal tumors that arise in the pancreas are extremely rare and managing them can be difficult, particularly if located in the head of pancreas. This case report aims to contribute to the existing data in the literature regarding extragastrointestinal stromal tumors with rare and unusual locations. We present a 56-year-old man who presented with recurrent mild right upper quadrant abdominal pain. Abdominal computed tomography and magnetic resonance imaging revealed a mass lesion with a diameter of 10 cm localized in the head of pancreas. Pancreaticoduodenectomy with complete tumor excision was performed. He was discharged on the postoperative day 14. Only 15 extragastrointestinal stromal tumors cases have been reported. Of these 15 cases, tumors were located in the head of pancreas in six cases. Here we report the seventh case of pancreatic extragastrointestinal stromal tumor arising in the head of pancreas and also the largest of these seven tumors.

Myiasis Phenomenon in a Patient Receiving Maggot Debridement Therapy

OBJECTIVE

Classical treatment was administered on the wound on the left foot of the patient, but no improvement was observed. When advised to undergo amputation, the patient came to the wound care unit to treat the larval wound. It was observed that the wound had been wormed while the patient was undergoing larval treatment. Interestingly, this incidental encounter was thought to be appropriate for case presentation.

METHODS

The larvae seen in the left hand of the patient were removed using forceps and sent to a laboratory. The larvae as well as adult flies obtained from them were examined directly and stereomicroscopically, their photographs were captured, and they were typed.

RESULTS

The larvae in the third stage and adult flies were identified as Sarcophaga sp.

CONCLUSION

Hygiene deficiency, inadequate sanitation, and improper wound care are important factors responsible for myiasis formation. We believe that myiasis can be avoided if adequate sanitation and hygiene and appropriate and regular wound care are provided.

Emergency cases following elective colonoscopy: Iatrogenic colonic perforation

Objective

Our aim in this study was to present the cases of our patients who contracted colonic perforation during elective colonoscopy and became emergency cases; we also discuss treatment modalities along with literature reports on the subject.

Material and Methods

Cases of patients who contracted iatrogenic colonic perforation following endoscopy of the colorectal system between January 2009 and December 2015 at Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital's Endoscopy Unit were reviewed retrospectively.

Results

Within the duration of the study, 5.586 patients underwent colonoscopies at our hospital; 7 (0.12%) of these patients contracted iatrogenic colonic perforation. Three (42.8%) of these patients were male, four (57.2%) were female, and their mean age was 69 years (46 to 84). Six (85.7%) patients were diagnosed intraoperationally, while one (14.3%) patient was diagnosed 12 hours after the procedure. The perforation area was the sigmoid colon in six patients and the ascending colon in one patient; all patients underwent surgery. Four patients were discharged with no complications. One of the remaining three patients had enterocutaneous fistula, one had acute renal failure, and one died of sepsis.

Conclusion

The progress of perforation due to colonoscopy varies according to the underlying diseases, the mechanism of perforation formation, the treatment modality used, and the experience of the physicians treating the patient. Special attention should be paid to senior and comorbid patients receiving therapeutic procedures during colonoscopy.

Spontaneous rectus sheath hematoma in cardiac in patients: a single-center experience

BACKGROUND

This study presents the relationship between mortality and spontaneous rectus sheath hematoma (RSH) in inpatients receiving anticoagulant and antiaggregant treatment for cardiac pathology at cardiology and cardiovascular surgery clinics.

METHODS

Within the scope of our study, the cases of 27 patients who were diagnosed with spontaneous RSH between January 2010 and December 2015 at Kartal Kosuyolu High Speciality Training and Research Hospital were retrospectively evaluated.

RESULTS

Of the 27 patients, 19 (70.4%) were female and 8 (29.6%) were male. The mean age was 63±12 (32-84) years. All the patients had at least one comorbidity that necessitated follow-up. Fourteen patients received only anticoagulant treatment, 8 received only antiaggregant treatment, and the remaining 5 received both types of treatment. Physical examination of all patients revealed painful palpable masses in the lower quadrants of the abdomen. According to the results of computed tomography (CT) scans, which showed the size and localization of the masses, 7 of the cases were classified as Type I, 6 as Type II, and 14 as Type III. Although 23 of the cases received medical treatment, the remaining 4 patients received surgical treatment. Eight (29.6%) patients suffered mortality.

CONCLUSION

RSH is rare, but its prevalence is increased among patients receiving anticoagulant and antiaggregant treatment for cardiac reasons. The mortality rate markedly increased among patients who contracted RSH during hospitalization for cardiac reasons, had comorbidities, and experienced additional complications due to extended hospitalization.