DNA fragmentation, chromosomal aberrations, and multi-toxic effects induced by nickel and the modulation of Ni-induced damage by pomegranate seed extract in Allium cepa L

This study was designed to assess the recovery effect of pomegranate seed extract (PSEx) against nickel (Ni)-induced damage in Allium cepa. Except for the control group treated with tap water, five experimental groups were exposed to 265 mg L-1 PSEx, 530 mg L-1 PSEx, 1 mg L-1 NiCI2, 265 mg L-1 PSEx + 1 mg L-1 NiCI2, and 530 mg L-1 PSEx + 1 mg L-1 NiCI2, respectively. The toxicity of Ni was examined through the analysis of physiological (germination percentage, weight gain, and root length), cytotoxicity (mitotic index), genotoxicity (micronucleus, chromosomal anomalies, and Comet test), and biochemical (malondialdehyde, proline, chlorophyll a and chlorophyll b contents, the activities of superoxide dismutase and catalase) parameters. Meristematic cell defects were also investigated. The NiCl2-DNA interaction was evaluated through spectral shift analysis. Values of all physiological parameters, mitotic index scores, and chlorophyll contents decreased while micronucleus frequency, DNA tail percentage, chromosomal anomalies, proline, MDA, and enzyme activities increased following Ni administration. According to the tail DNA percentage scale, Ni application caused "high damage" to DNA. Ni-induced chromosomal anomalies were fragment, sticky chromosome, vagrant chromosome, bridge, unbalanced chromatin distribution, reverse polarization, and nucleus with bud. NiCl2-DNA interaction caused a hyperchromic shift in the UV/Vis spectrum of DNA by spectral profile analysis. Ni exposure impaired root meristems as evidenced by the formation of epidermis cell damage, flattened cell nucleus, thickened cortex cell wall, and blurry vascular tissue. Substantial recovery was seen in all parameters with the co-administration of PSEx and Ni. Recovery effects in the parameters were 18-51% and 41-84% in the 265 mg L-1 PSEx + 1 mg L-1 NiCI2 and 530 mg L-1 PSEx + 1 mg L-1 NiCI2 groups, respectively. The Comet scale showed that PSEx applied with Ni reduced DNA damage from "high" to "moderate." Ni-induced thickened cortex cell wall and blurry vascular tissue damage disappeared completely when 530 mg L-1 PSEx was mixed with Ni. PSEx successfully reduced the negative effects of Ni, which can be attributed to its content of antioxidants and bioactive ingredients.

Effects of infliximab against carbon tetrachloride-induced spleen toxicity in rats

OBJECTIVE

Carbon tetrachloride (CCl4) is a non-polar molecule used in industry in grain curing, insect-killing and especially in the production of chlorofluorocarbons. It is estimated that an average of 70,000 industry workers in Europe are exposed to this toxic compound.

MATERIALS AND METHODS

Twenty-four male Sprague-Dawley rats were randomly allocated into four groups: control group (saline only, Group I), infliximab (INF) group (Group II), CCl4 group (Group III) and CCl4+INF group (Group IV).

RESULTS

While there was an increase in the numerical density of CD3, CD68, and CD200R positive T lymphocytes and macrophages in the CCl4 administration group (p=0.000), this was not the case in the CCl4+INF administration group (p=0.000).

CONCLUSIONS

TNF-α inhibitors have a protective effect against CCl4-induced spleen toxicity/inflammation as seen by the reduction in CD3, CD68, CD200R positive T lymphocytes and macrophages.

An overlooked complication of the inguinal hernia repair: Dysejaculation

The objective of this study was to investigate the rate of post-herniorrhaphy dysejaculation in the current literature. A comprehensive search of PubMed, Medline, Google Scholar, and Google databases was performed using the keywords "groin hernia and chronic pain," "inguinal hernia and chronic pain," "dysejaculation," and "ejaculatory pain." The eligible studies were evaluated in terms of ejaculatory pain and surgical technique used. Ten studies with 122 patients were eligible for the analysis. The rate of ejaculatory pain for a total of 5521 patients was found to be 2.2%. The incidence of postoperative ejaculatory pain was found to be 2.1% following laparoscopic techniques and 1.1 % following open repair. Open techniques were not related to the increased frequency of dysejaculation. Sufficient data could not be obtained from the studies for the ejaculatory pain, and thus, no statistical evaluation was performed. Dysejaculation is a common cause of postoperative morbidity after inguinal hernia repair. Attention to technical details of the primary operation may reduce the incidence of dysejaculation.

The effects of bariatric surgical procedures on the improvement of metabolic syndrome in morbidly obese patients: Comparison of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass

OBJECTIVE

The objective of this study was to evaluate patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of weight loss, metabolic parameters, and postoperative complications.

MATERIAL AND METHODS

Data on patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy with a diagnosis of morbid obesity between January 2012 and June 2014 were retrospectively evaluated. Patients were compared in terms of age, sex, body mass index, duration of operation, American Society of Anesthesiologists score, perioperative complications, length of hospital stay, and long term follow-up results.

RESULTS

During the study period, 91 patients (45 laparoscopic Roux-en-Y gastric bypass and 46 laparoscopic sleeve gastrectomy) underwent bariatric surgery. There was no difference between the two groups in terms of preoperative patient characteristics. Both groups showed statistically significant weight loss and improvement in co-morbidities when compared with the preoperative period. Weight loss and improvement in metabolic parameters were similar in both groups. The duration of operation and hospital stay was longer in the laparoscopic Roux-en-Y gastric bypass group. Furthermore, the rate of total complications was significantly lower in the laparoscopic sleeve gastrectomy group.

CONCLUSION

Laparoscopic sleeve gastrectomy is a safe and effective method with a significantly lower complication rate and length of hospital stay than laparoscopic Roux-en-Y gastric bypass, with similar improvement rates in metabolic syndrome.

Migration of mesh into gastric lumen: A rare complication of vertical banded gastroplasty

The problem of revision of failed vertical banded gastroplasty (VBG) has become a common situation in bariatric surgery. Sleeve gastrectomy (SG) has been recently used to revise failed restrictive procedures. This study presents a patient that is treated with Roux-n-Y gastric bypass because of mesh migration after SG for revision of failed VBG.

Two photon absorption properties of four coordinated transition metal complexes of tetraarylazadipyrromethene compounds

New tetraarylazadipyrromethene metal complexes with four coordinate metals (cobalt(ii), nickel(ii), copper(ii) and zinc(ii)) and with three moieties (4-methylphenyl,4-methoxyphenyl and 1-naphthyl) were designed and synthesized targeting applications utilizing two photon absorption. The effects of metals with filled or unfilled d orbitals and substituents with various electron donor properties on the charge transfer mechanism and two photon absorption properties of tetraarylazadipyrromethene compounds were investigated by ultrafast pump-probe spectroscopy and open aperture Z-scan experiments as well as density functional theory (DFT) calculations. Ultrafast transient absorption spectra provide evidence of an efficient photoinduced intramolecular charge transfer between the ligand and metals which is independent of filled or unfilled d orbitals of metals. Although zinc has filled d orbitals, its complexes possess an absorption maximum including a shoulder which is attributed to partial ligand to metal L(π) → M(d*) charge transfer character (LMCT). Due to the charge transfer mechanism, metal complexes of tetraarylazadipyrromethene compounds exhibited two photon absorption properties in the femtosecond regime at 800 nm wavelength. The greatest two photon absorption cross section value was measured as 2690 GM for Zn(L(2))2 and 2374 GM for Co(L(3))2 complexes.

Enhancement of two photon absorption properties and intersystem crossing by charge transfer in pentaaryl boron-dipyrromethene (BODIPY) derivatives

Indication of charge transfer and an intersystem crossing mechanism for the B4 compound by using ultrafast pump probe spectroscopy.

Coagulation parameters and platelet function analysis in patients with acromegaly

OBJECTIVE

Acromegaly is associated with increased cardiovascular morbidity and mortality. The data about the evaluation of coagulation and fibrinolysis in acromegalic patients are very limited and to our knowledge, platelet function analysis has never been investigated. So, we aimed to investigate the levels of protein C, protein S, fibrinogen, antithrombin 3 and platelet function analysis in patients with acromegaly.

METHODS

Thirty-nine patients with active acromegaly and 35 healthy subjects were included in the study. Plasma glucose and lipid profile, fibrinogen levels, GH and IGF-1 levels and protein C, protein S and antithrombin III activities were measured in all study subjects. Also, platelet function analysis was evaluated with collagen/ADP and collagen-epinephrine-closure times.

RESULTS

Demographic characteristics of the patient and the control were similar. As expected, fasting blood glucose levels and serum GH and IGF-1 levels were significantly higher in the patient group compared with the control group (pglc: 0.002, pGH: 0.006, pIGF-1: 0.001, respectively). But lipid parameters were similar between the two groups. While serum fibrinogen and antithrombin III levels were found to be significantly higher in acromegaly group (p fibrinogen: 0.005 and pantithrombin III: 0.001), protein S and protein C activity values were significantly lower in the patient group (p protein S: 0.001, p protein C: 0.001). Also significantly enhanced platelet function (measured by collagen/ADP- and collagen/epinephrine-closure times) was demonstrated in acromegaly (p col-ADP: 0.002, p col-epinephrine: 0.002). The results did not change, when we excluded six patients with type 2 diabetes in the acromegaly group. There was a negative correlation between serum GH levels and protein S (r: -0.25, p: 0.04)) and protein C (r: -0.26, p: 0.04) values. Likewise, there was a negative correlation between IGF-1 levels and protein C values (r: -0.39, p: 0.002), protein S values (r: -0.39, p: 0.001), collagen/ADP-closure times (r: -0.28, p: 0.02) and collagen/epinephrine-closure times (r:-0.26, p: 0.04). Also, we observed a positive correlation between IGF-1 levels and fibrinogen levels (r: 0.31, p: 0.01).

CONCLUSION

Acromegaly was found to be associated with increased tendency to coagulation and enhanced platelet activity. This hypercoagulable state might increase the risk for cardiovascular and cerebrovascular events in acromegaly.

Gastrointestinal stromal tumor and leiomyoma of the ileum mimicking adnexal mass: a report of two cases

Adnexal masses are formations seen in women of all ages; they most often include cystic elements. Medical history, physical examination, different imaging methods, and tumor marker determinations must be used together for preoperative evaluation of an adnexal mass. Both benign and malignant tumors of the small intestine are more rarely encountered than malignant tumors of other gastrointestinal system components; although advanced imaging methods and other diagnostic techniques are used, they do not always allow these tumors to be differentiated from adnexal masses. We report here on two cases operated on with the preliminary diagnosis of an adnexal mass, in which the presence of a gastrointestinal stromal tumor and a leiomyoma of the ileum, respectively, was established.

Validation of a severity grading score (SGS) system for predicting the course of disease and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF)

We aimed to validate a severity grading score (SGS) system for predicting the course of disease and fatality in Crimean-Congo hemorrhagic fever (CCHF). This SGS was established using several variables that were assumed to be associated with mortality and had clinical importance. We included patients diagnosed with CCHF from different centers. Patients who had symptoms of CCHF for <5 days were included. The patients were grouped into three categories according to mortality risk. An SGS ≤4 showed no association with mortality [n = 323 (79.9 % of the total study population), and all survived]. An SGS between 5 and 8 points was classified into the intermediate risk group (20 %), and 14 of 70 patients in this group died. An SGS ≥9 was classified as the high risk of mortality group and 11 of 11 patients in this group died (p = 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for an SGS >9 points at admission were 96, 100, 97, 100, and 44 %, respectively. This SGS system may help appropriate the triage of patients, decrease the cost of treatment, and improve the functionality of healthcare staff. The present study is the first investigation about the validation of an SGS system in patients with CCHF.

Clinical evaluation of submerged and non-submerged implants for posterior single-tooth replacements: a randomized split-mouth clinical trial

The aim of this study was to evaluate clinical and radiographic results of submerged and non-submerged implants for posterior single-tooth replacements and to assess patient-based outcomes. Twenty patients were included in the study. A split-mouth design was used; implants inserted using a submerged technique were compared to those inserted with a non-submerged technique. Implants were restored with metal-ceramic crowns after 3 months. Reconstructions were examined at baseline, 6, 12, and 24 months. Standardized radiographs were made. Radiographic crestal bone level changes were calculated, as well as soft tissue parameters, including pocket probing depth, bleeding on probing, plaque index, and gingival index. Results were analyzed by two-way repeated measures of variance (ANOVA). To evaluate patient-based outcomes, patients were asked to complete a questionnaire at the 6-month follow-up; the Wilcoxon paired signed rank test was used to compare scores. The data of 18 patients were reviewed. During 24 months, non-submerged implants (0.57 ± 0.21 mm) showed significantly lower bone loss than submerged implants (0.68 ± 0.22 mm) (P<0.01). Patient satisfaction with non-submerged implants (median 87.5) was significantly higher than with submerged implants (median 81.5) (P<0.01). Non-submerged implants showed comparable clinical results to submerged implants and resulted in higher patient satisfaction due to decreased surgical intervention.

Is vitamin D supplementation a new hope for the therapy of the septic shock?

Vitamin D is mainly known for its traditional role in the bone mineralization and calcium homeostasis. Recent studies have shown that vitamin D receptors (VDR) are present in almost all the tissues and cells in the human body. In addition, several studies have revealed that vitamin D is important in immunomodulation, regulation of inflammation and cytokines, cell proliferation, cell differentiation, apoptosis, angiogenesis, muscle strength, and muscle contraction. Patients with sepsis have high mortality rate and high deficiency in vitamin D. In addition, septic patients have decreased vitamin D binding-protein (DBP) levels which further exacerbate the vitamin D deficiency. The role of vitamin D treatment in sepsis syndrome has been evaluated in animal model of sepsis where 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] administration was associated with improved blood coagulation parameters in sepsis associated with a disseminated intravascular coagulation. Vitamin D treatment in vitro has also been demonstrated to modulate levels of the systemic inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6), as well as inhibit the lipopolysaccharide (LPS)-induced activation and vasodilation of vascular endothelium. Vitamin D may enhance the induction of the antimicrobial peptides, cathelicidin and b-defensin, which have been described on mucosal and epithelial surfaces acting as the body's first line of defense against viral and bacterial pathogens. Vitamin D supplementation may divert attention from relatively simple, natural, and low-costmethods of preventing severe sepsis and septic shock. Further prospective, randomized and controlled clinical trials of adjunctive vitamin D therapy in patients who are vitamin D deficient are needed in the management of human sepsis syndrome.

[Percutaneous treatment of a ruptured sinus Valsalva aneurysm with double orifices]

An aneurysm of the sinus of Valsalva (SVA) may rupture into the cardiac cavities and cause abnormal connections between these cavities and the aorta. The right atrium and/or right ventricle are the cavities into which the SVA is most commonly observed to rupture. A 30-year-old patient presented to our cardiology clinic with the complaint of dyspnea. His physical examination revealed a thrill localized in the 5th intercostal space on the right edge of the sternum and systolic-diastolic murmur beginning from the aortic focus and spreading to the neck and back along the right edge of the sternum. The echocardiographic and invasive examinations revealed two defects leading to a passage from the right sinus Valsalva to the right ventricle. While the left-to-right shunt ratio was calculated as 3.8, the anatomic locations and dimensions of the defects were found to be eligible for percutaneous closure. Using the Amplatzer Duct Occluder I device, the defects were closed in two sessions. Although the classical treatment method of ruptured SVA is surgical repair, percutaneous closure devices may be used as a reliable alternative method in suitable patients.

Use of drugs subject to controlled prescriptions: a retrospective analysis

OBJECTIVE

Use of drugs that may lead to abuse or dependence are subject to controlled prescriptions (CPs) in many countries, and these are closely monitored by health authorities. According to national regulations in Turkey, CPs may be red coloured (RCPs) or green coloured (GCPs). The aim of this study was to evaluate the use of such drugs in Istanbul.

STUDY DESIGN

Retrospective case-control study.

MATERIAL AND METHODS

During the study period (01/01-31/12 2009), 502874 CPs were reported. Among these, 4000 CPs each month were randomly selected and evaluated.

RESULTS

The majority of GCPs were issued to women (55.6%), while the majority of RCPs were issued to men (68.4%). GCPs were most frequently prescribed by physicians working in private hospitals (33.6%) while RCPs by physicians working in university hospitals (39.7%). GCPs were mostly prescribed by psychiatrists (37.6%) while for RCPs were child and adolescent psychiatrists (35.9%). Psycholeptics (ATC code N05) were the most prescribed controlled drugs (CDs) (43.8%). Methylphenidate (53.9%) was the mostly prescribed on RCPs and alprazolam (39.6%) was on GCPs.

CONCLUSION

We demonstrate that utilization of CDs shows demographical and institutional differences. These data could be of help to improve surveillance of CDs as well as to train prescribers and patients.

Comparing the efficacy of preemptive intravenous paracetamol on the reducing effect of opioid usage in cholecystectomy

BACKGROUND

The purpose of the present study was to determine the post-operative analgesic effects of preemptive intravenous (iv) paracetamol and the amount of reduction in tramadol (Contramal(®)) consumption.

MATERIALS AND METHODS

Following local research ethics committee approval, ASAI-II, 300 patients were assigned in a randomized manner into three groups: Group I (preemptive) received iv paracetamol 1 g/100 mL 10 min before skin inscision and 100 mL of saline solution at the end of the operation, Group II (post-operative) received 100 mL of saline solution 10 min before skin inscision and iv paracetamol 1 g/100 mL at the end of the operation and Group III (placebo) received 100 mL of saline solution 10 min before skin insicision and 100 mL of saline solution at the end of the operation as well. The time to first analgesic requirement use and 24 h total analgesic consumption were recorded. Visual analog scale (VAS) pain scores were obtained from all patients at 15, 30, min 1, 2, 4, 6, 8, 12 and 24 h after the end of the operation.

RESULTS

Time to first analgesic requirement was significantly longer in Group I and Group II, compared to Group III (P < 0.05). Time to first analgesic requirement was significantly longer in Group I compared to Group II (P < 0.05). Total analgesic consumption and postoperative VAS pain scores recorded were significantly lower in Group I and II, compared to Group III. Total analgesic consumption and postoperative VAS pain scores recorded were significantly lower in Group I compared to Group II (P < 0.05).

CONCLUSION

In conclusion, preemptive iv paracetamol provided effective and reliable pain control after cholecystectomy surgeries and reduced post-operative pain scores, the need for and use of supplementary opioids and the time to first request of analgesics.

A case of multiorgan resection for locally advanced stomach cancer

Extensive surgical resection may be required in locally advanced gastric cancers, with involvement of other organs. Our purpose was to present a case where vascular reconstruction was performed during multiple organ resections in a patient with locally advanced gastric cancer. An emergent laparotomy was performed on a patient who presented with upper gastrointestinal system hemorrhage; and he was diagnosed with locally advanced gastric cancer. Total gastrectomy, D II dissection, pancreaticoduodenectomy, transverse colectomy and end-to-end anastomosis were performed. Additionally, the superior mesenteric vein was partially excised and re-implanted to the portal vein. Neither recurrence nor distant metastasis was observed during the post-operative follow-up. Adjacent organ resections may be necessary for a curative treatment in locally advanced gastric cancer. In addition, partial resection and reconstruction may be required for extensive vascular invasion.

Evaluation of controlled prescriptions with a diagnosis of surgical intervention

OBJECTIVE

Drugs subject to control (DSC) are commonly used in the preoperative, per-operative and postoperative periods. In this study, details of DSC use, that are required to be prescribed to green prescriptions (GP) or red prescriptions (RP), for a surgical diagnosis were evaluated.

MATERIAL AND METHODS

Controlled drug prescriptions (CDP) between January to December 2009 were investigated in the archives of the Istanbul Local Health Authority. 660 CDPs indicating a surgical diagnosis were retrospectively evaluated and those prescribed by surgical departments (SD)were compared to those written by internal medicine departments (ID).

RESULTS

SD physicians prescribed 72.7% of CDPs and 89.5% of prescriptions were for GP, and 10.5% were for RP. The physicians of SD were found to prescribe more RP than ID physicians. Most of the CDPs were written for women (58.8%) and mostly in private hospitals (40.9%). Among all the physicians, orthopedic surgeons prescribed these drugs the most (20.9%). Tramadol was the most common drug found in CDPs (55.5%).

CONCLUSION

DSCs, which have difficult prescription procedures, are used frequently in surgical interventions. The study shows that not only SD physicians, but also ID physicians prefer CDP. The study provides important clues to the usage patterns of DSCs. Recently evolving health care systems including prescriptions should use these findings obtained from the study.

Erectile dysfunction and depression in patients with chronic lead poisoning

In this retrospective study, we aimed to evaluate the relationship between erectile dysfunction (ED) and chronic lead intoxication (CLI) as well as the role of depression in this relationship. We compared the findings of 26 male patients with CLI and 24 male patients as the control group between November 2008 and January 2009. The blood lead levels and smoking index of patients were evaluated for both groups. The International Index of Erectile Dysfunction-erectile function domain (EFD) and Beck Depression Inventory (BDI) were obtained and reviewed in both groups. The mean blood lead levels of patients in the CLI and control groups were 42.1 and 3.2 μg dl(-1) respectively (P < 0.01). The mean interval of lead exposure of patients in CLI group was 71.5 (6-360) months. EFD scores of patients in CLI group were significantly lower, and number of patients with ED in CLI group was statistically higher (P < 0.05). BDI scores of patients in CLI group were significantly higher (P < 0.05). We detected a mildly negative and statistically significant relationship between the EFD scores and blood lead levels (r = -0.453 and P < 0.05). Our results showed that the increased frequency of ED is an independent factor in CLI group.