Impact of Intranasal Splint Removal Time on Postoperative Complications after Septoplasty

BACKGROUND

Various types of nasal tampons are used for packing after septoplasty. Intranasal splints are widely used as they are more advantageous than other materials regarding the lower complication rates of synechia, and lesser pain during removal. However, there is no consensus on the timing of intranasal splint removal after septoplasty operations.

AIM

In this study, we aimed to investigate the effects of removal time of intranasal splints on postoperative complications after septoplasty.

METHODS

One hundred patients who had septoplasty were randomly divided into two groups according to splint removal time. In group I, the splints were removed on the third postoperative day and in group II, splints were removed on the seventh postoperative day. Pain during splint removal was evaluated by visual analog scale (VAS). Complications of hemorrhage, septal hematoma, crusting, mucosal injury, and infection were recorded during splint removal and compared. In the first postoperative month, hemorrhage, crusting, mucosal injury, infection, synechia, and in the second postoperative month, synechia and perforation rates were compared between two groups.

RESULTS

Mucosal crusting was significantly higher in group II during splint removal. There was no statistically significant difference between the two groups regarding the complication rates and pain scores. Our findings showed no significant difference in pain scores during splint removal and postoperative complications between the two groups except for mucosal crusting.

CONCLUSION

Based on our findings, although there is no consensus on the optimal time for splint removal, earlier removal of splints can be considered a favorable option after septoplasty operations.

Long-duration immediate postoperative knee flexion positioning results in better functional outcomes after total knee arthroplasty

OBJECTIVE

This study aimed to evaluate the effects of affected knee flexion for 24 vs. 72 hours on blood loss, pain, range of motion, and functional outcomes after total knee arthroplasty.

PATIENTS AND METHODS

The present study included 46 participants with a mean age of 64.33 ± 6.70 years. The affected knee of the first 23 participants, based on the order of operations, was positioned at 70° flexion for 24 hours, and the knee of the next 23 participants was positioned at 70° flexion for 72 hours. Participants were evaluated before the operation and on postoperative day 3 and week 6. Pain, edema, range of motion, time up and go test scores, and Western Ontario McMaster Universities Arthritis Index scores, hemoglobin, and hematocrit were measured before the operation and on postoperative at day 3 and week 6.

RESULTS

We found that the calculated blood loss was 575.07 ± 282.44 and 578.39 ± 297.11 mL in patients who underwent short- and long-duration flexion positioning, respectively (p = 0.921). The active flexion angles at postoperative week 6 were 83.61° ± 22.03° and 105.91° ± 13.06° in the short- and long-duration flexion groups, respectively (p < 0.01). Furthermore, the Western Ontario and McMaster Universities Arthritis Index scores at postoperative week 6 were 35.52 ± 24.71 and 17.17 ± 15.37 in the short- and long-duration flexion groups, respectively (p < 0.01).

CONCLUSIONS

Long-duration flexion positioning after total knee arthroplasty may lead to better middle-term flexion range of motion and physical function scores than short-duration flexion positioning.

The relationship between temporal muscle thickness and disease activity in Cushing's disease

OBJECTIVE

This study aimed to investigate the relationship between hypercortisolism and temporal muscle thickness (TMT) in Cushing's disease (CD).

METHODS

A retrospective review of medical records was conducted for patients with CD who presented to our clinic between 2012 and 2022. Biochemical data and TMT measurements from sella imaging were evaluated during diagnosis and the first postoperative year.

RESULTS

A total of 44 patients were included in the study, with an average age of 43.9 years, of which 38 were female. The mean TMT at the time of diagnosis was 19.07 ± 1.71 mm, with no significant difference between males and females (p = 0.097), and no correlation between the TMT and age at diagnosis (p = 0.497). There was an inverse relationship between TMT and serum cortisol levels, 24-h UFC, and midnight salivary cortisol at the time of diagnosis of CD (p < 0.05, for all). One year after surgery, TMT significantly increased in all patients compared to baseline (p < 0.001). Furthermore, patients who achieved postoperative remission had significantly higher TMT values compared to those who did not achieve remission (p = 0.043). Among the patients who achieved remission, those who achieved remission through surgery had significantly higher TMT compared to those who could not reach remission with surgery and patients who started medical treatment and achieved biochemical remission (p = 0.01). Patients with severe myopathy and sarcopenia had significantly lower TMT values than the others (p < 0.001).

CONCLUSION

Temporal muscle thickness was found to be associated with disease activity and disease control in Cushing's disease.

Protective effects of Silymarin on testicular torsion/detorsion in rats

OBJECTIVE

The present research aimed to study the possible protective effects of Silymarin on testicular I/R injury in a rat model evaluated through histopathology and biochemical parameters.

MATERIALS AND METHODS

This research investigated the impact of Silymarin on IR damage in male Wistar albino rats. Animals were divided into three groups: group 1 (sham), group 2 (IR), and group 3 (IR+Silymarin).

RESULTS

There were no notable differences in the levels of malondialdehyde (MDA), myeloperoxidase (MPO), and glutathione (GSH) across the three groups (p=0.260, p=0.486 and p=0.803, respectively). Contrarily, the total antioxidant status (TAS) levels exhibited significant variations between groups (p=0.001). The total oxidant status (TOS) levels also differed significantly between groups (p=0.004). The tissue evaluations uncovered substantial differences in the Johnson score, which is used to gauge testicular damage. A distinct contrast was seen between Group 1 and Group 2, and also between Group 2 and Group 3, with an all-encompassing p-value lower than 0.01. The same significant disparities were found for the percentages of Bax and Annexin V immunostaining (p<0.01 for each), reflecting the inflammation and apoptosis brought about by ischemia-reperfusion and the protective effects of the treatment.

CONCLUSIONS

The outcomes of the current investigation showed that Silymarin could be a valuable agent for reducing testicular tissue damage following I/R injury.

The cause of depression in adolescence: peer bullying

OBJECTIVE

Depression affects adolescents worldwide and often predicts more serious disease manifestations in later lifetimes. Peer victimization or bullying, another form of child abuse, increases symptoms of depression. In this paper, the relationship between peer bullying and depression in adolescence was investigated.

SUBJECTS AND METHODS

Each adolescent who was admitted to the adolescent unit completed forms referred to as the 'Depression Scale For Children' and the 'Multidimensional Peer Victimization Scale'. Sociodemographic features and results of the scales' evaluation were studied. SPSS 16.0 program was used for statistical analysis. The p-value below 0.05 was considered statistically significant.

RESULTS

239 adolescents, 120 of whom were male, were investigated. A positive relationship was determined among total and sub-scale scores of peer victimization-determining scale and depression scale scores. A negative relationship was determined between height, weight, age of the child, and sub-scale score of threat/intimidation. Both the total score of the peer victimization-determining scale and sub-scale scores of ridicule, open attack, and relational attack pertaining to patients with depression proved to be significantly higher than in those without depression.

CONCLUSIONS

The awareness of educators and parents, notably adolescents, must be raised in regard to peer victimization, and activities for increasing the communicative skills of adolescents and for allowing them to be able to express their emotions should also be performed. Identifying and preventing peer victimization, one of the causes of depression, and launching the treatment process for this are the first steps to be taken in terms of a healthy adulthood.

Impact of titanium-prepared platelet-rich fibrin in type 1 fascia graft tympanoplasty on graft survival and hearing outcomes

Background

Type 1 fascia graft tympanoplasty (T1FGT) is the mainstay surgical approach for the treatment of tympanic membrane perforations. The most widely used graft material is temporal muscle fascia, and graft take rates are reported differently. The methods to enhance graft take are still being investigated. Aim: The aim of our study was to investigate the effect of titanium-prepared platelet-rich fibrin (T-PRF) on graft take and hearing outcomes in T1FGT.

Materials and Methods

Fifty-seven ears eligible for T1FGT were involved in the study and prospectively evaluated. T-PRF was applied with T1FGT in 27 ears. Thirty ears in the other group underwent only T1FGT. The patients underwent an otomicroscopic and audiometric examination in preoperative and postoperative 2nd week, 1st month, and 6th month. Both groups were evaluated in terms of hearing levels, infection, and graft take rates.

Results

Two patients in the T1FGT + T-PRF group and seven patients in the T1FGT group had postoperative perforation (graft take rate: 92.6% versus 76.7%). The graft take rate was found to be increased in the T-PRF group although the difference was not statistically significant. In the T1FGT group, the percentage of infection was higher than in the T1FGT + T-PRF group. When the preoperative and postoperative 6th-month audiometry was compared, a statistically significant hearing gain was obtained for both groups.

Conclusion

In the treatment of tympanic membrane perforations, T-PRF applied over the fascia graft was shown to increase graft take rates and decrease the probability of infection. Further studies with larger samples are needed to demonstrate the effects of PRF.

INCREASED DIETARY INTAKE AND SERUM LEVELS OF ADVANCED GLYCATION END PRODUCTS (AGES) ARE ASSOCIATED WITH DIABETIC MACULAR EDEMA

Aim

Diabetic macular oedema (DME) can develop at all stages of diabetic retinopathy, causing visual impairment and blindness. Modern diets are high in advanced glycation end products (dAGEs), derived from processing methods, exerting a pivotal role in promoting diabetic retinopathy risk. In present study, we investigate the relationship between dietary and serum levels of AGEs and DME in type 2 diabetic subjects.

Methods

This case-control study was conducted between July 2018 and February 2019 on 50 case subjects with DME and 40 healthy controls without DM without DME. The sociodemographic characteristics, nutritional status, and anthropometric measurements were evaluated. The advanced glycation end products (AGEs) and receptor for AGEs (sRAGE) levels in serum were analysed.

Results

The AGEs levels of the DME group were higher than in the control group (p <0.05). sRAGE levels were higher in the DME group, but not statistically significant (p >0.05). The dietary intake of AGEs was higher in the DME group (p <0.05). It was found that an increase in neck circumference increased the risk of DME (p <0.001).

Conclusion

A positive correlation was found between DME and AGEs, dAGE, neck circumference, and waist circumference. For the validity of these results, studies, including controlled nutrition interventions, are needed.

POS0602 PULMONARY RHEUMATOID NODULES: DOES SEROLOGIC STATUS MATTER?

Background

The frequency of pulmonary rheumatoid nodules closely relates to the diagnostic modality and changes from <0.4% to 32%. Also, it is known that seropositive RA patients tend to have more extra-articular disease.

Objectives

We aimed to compare the disease and pulmonary rheumatoid nodule characteristics of seropositive and seronegative RA patients.

Methods

In this study, all RA patients - according to ICD-10 code - and had at least one chest computerized tomography (CT) were examined and revealed 4117 individual patients. First, RA diagnosis was confirmed according the patients’ history, physical examination, radiography and laboratory assessment. Then, chest CTs were examined by an experienced radiologist. To classify pulmonary nodules as ‘’pulmonary rheumatoid nodule’’, following inclusion and exclusion criteria were used; For inclusion: 1) nodules with changing dimension on follow-up, 2) At least two nodules with different dimensions, 3) Cavitary nodule at any chest CT. For exclusion: 1) Solitary nodules OR all nodules ≤ 5mm and without follow-up OR no change on follow-up. Biggest nodule was named as dominant nodule. Then, patients were grouped according to rheumatoid factor and anti-CCP status as seropositive (RF ± anti-CCP) and seronegative. Demographics, comorbidities, RA-spesific treatments and nodule characteristics were compared.

Results

Of 680 RA patients who had pulmonary nodule in chest CT, 208 (30.6%) patients were classified as having pulmonary rheumatoid nodule. 167 (80.3%) patients were seropositive. Demographic and comorbidity characteristics were similar among seronegative and seropositive patients (Table 1). Regarding RA-spesific treatments, methotrexate, leflunomide and rituximab were prescribed more frequently in seropositive patients. For nodule characteristics, seropositive patients had higher number of nodules (5 [1-48] vs 3 [1-27]; p=0.004), bigger dominant nodule (8 [3-95] vs 6 [3-45] mm; p=0.011), and higher percentage of cavitary nodule (28.7% vs 12.2%; p=0.03). Localization of the nodule was compareble.

Table 1.

Comparison of demographic, disease and nodule characteristics of seropositive and seronegative patients (n=208)

Seropositive (n=167, 80.3%)Seronegative (n=41, 19.7%)P valueFemale, n(%)113 (67.7)28 (68.3)0.94Age at the time of CT (median, min-max)61 (24-83)59.7 (20-83)0.28Smoking (n=73)26 (43.3)4 (30.8)0.40- Never smoked34 (56.7)9 (69.2)- Ever smokedComorbidity (n=188)127 (84.7)30 (78.9)0.40- Hypertension72 (55.0)18 (58.1)0.91- Diabetes (n=166)25 (18.5)7 (22.6)0.79- CAD (n=165)30 (22.6)7 (21.9)0.93- Heart Failure (n=164)15 (11.4)6 (18.8)0.41- COPD (n=163)20 (15.2)1 (3.2)0.13- Asthma (n=160)15 (11.6)5 (16.1)0.54- CKD (n=169)20 (14.5)8 (25.8)0.22- ILD (n=202)54 (33.1)10 (25.6)0.37RA-spesific treatments (ever)90 (72.6)16 (55.2)0.07- Methotrexate (n=153)105 (64.0)12 (30.8)0.001- Leflunomide (n=208)117 (70.5)25 (61.0)0.06- Hydroxchloroquine (n=169)65 (47.4)11 (36.7)0.28- Sulfasalazine (n=167)39 (39.0)6 (27.3)0.30- TNFi (n=122)41 (39.8)2 (9.5)0.008- Rituximab (n=124)11 (9.9)2 (8.0)0.77- Tofacitinib (n=136)12 (11.9)2 (10.5)0.86- Abatacept (n=120)9 (8.5)2 (8.7)0.98- Tocilizumab (n=129)Number of nodules at baseline CT (median, min-max)5 (1-48)3 (1-27)0.004Diameter of dominant nodule (median, min-max) (mm)8 (3-95)6 (3-45)0.011Localization of dominant nodul64 (38.3)15 (36.6)0.84- Left or right?64 (38.3)12 (29.3)0.48◦ Left51 (30.5)16 (39.0)0.28- Upper, middle or lower?52 (31.1)13 (31.7)◦ Upper69 (41.3)21 (51.2)◦ Middle22 (13.2)7 (17.1)◦ Lower76 (45.5)13 (31.7)-Peripheral, central or subpleural◦ Peripheral◦ Central◦ SubpleuralCavitation48 (28.7)5 (12.2)0.03Calcification54 (32.5)12 (29.3)0.69

CAD: Coronary artery disease, CKD: Chronic kidney disease,; ILD: Interstitial Lung Disaese,

Conclusion

Autoantibodies seem to have impact on the characteristics of pulmonary rheumatoid nodules. As there were different prescription patterns were seen in our study, effects of these treatment differences need to be determined.

References

Disclosure of Interests

None declared

z+: Neutron cross section separation from wide-angle uniaxial polarization analysis

We introduce a simple method to extract the nuclear coherent and isotope incoherent, spin incoherent, and magnetic neutron scattering cross section components from powder scattering data measured using a single neutron beam polarization direction and a position-sensitive detector with large out-of-plane coverage. The method draws inspiration from polarized small-angle neutron scattering and contrasts with conventional so-called "xyz" polarization analysis on wide-angle instruments, which requires measurements with three orthogonal polarization directions. The viability of the method is demonstrated on both simulated and experimental data for the classical "spin ice" system Ho₂Ti₂O₇, the latter from the LET direct geometry spectrometer at the ISIS facility. The cross section components can be reproduced with good fidelity by either fitting the out-of-plane angle dependence around a Debye-Scherrer cone or grouping the data by angle and performing a matrix inversion. The limitations of the method and its practical uses are discussed.

Biofilm formation, icaABCD genes and agr genotyping of Staphylococcus aureus from fish and ground beef

A total of 46 Staphylococcus aureus isolates from fish and ground beef were tested for the agr types, icaABCD genes, and biofilm formation at 12, 25 and 37 °C by the microtiter plate and the MTT assays. All isolates were positive for the icaABD genes, while 97.8% were positive for the icaC. All isolates produced biofilms at 37 and 25 °C, but 93.5% of them were also biofilm producers at 12 °C. There was no significant difference in biofilm formation between 25 and 37 °C using the crystal violet assay (P > 0.05). However, statistically significant differences were detected between 12 and 25 °C as well as 12 and 37 °C (P < 0.05). All isolates were significantly different in biofilm production by the MTT assay at all tested temperatures. Furthermore, a relationship between the presence of the icaABCD genes and biofilm formation was observed. The agr type I was the most prevalent (54.4%) among the isolates, followed by agr type II (41.3%) and agr type III (9.6%). In this study, the S. aureus isolates exhibited biofilm formation ability responsible for persistence of bacteria in foods, which may lead to food spoilage and human health problems.

Research on High School Students’ and Teachers’ Mental Health Literacy Levels in Istanbul, Turkey

Background

Mental health literacy (MHL) is critical to reduce health inequality and for raising awareness and early recognition of mental illnesses. This study among students and teachers in Istanbul, Turkey, aimed to (1) determine the knowledge levels towards mental illnesses, (2) identify barriers to help-seeking behaviors and (3) assess stigmatizing attitudes towards mental illnesses.

Methodology

A cross-sectional, descriptive study design was used, and 810 high school students and 241 teachers were included in our study between Mar-Jul 2019. Data was collected through the Mental Health Literacy Questionnaire and the Beliefs towards Mental Illness Scale.

Results

Students' recognition percentages of depression, schizophrenia and social phobia vignettes were found to be 27.5%, 47.7% and 6.2%, respectively. Teachers' were found to be 46.5%, 42.7% and 26.1%, respectively. A statistically significant relationship was found between students' correct recognition of vignettes and gender, age group, mother education levels, and father education levels (p &lt; 0,005). Female sex, older age, and having a parent with higher level of education were more likely to correct identify the vignettes. Among teachers, a significant relationship was found between correct recognition of vignettes and gender (p &lt; 0,005). Females were more likely to correct identify the vignettes. Regarding the BMI subscales, students' average score was 21,6±9,8 for “poor social and interpersonal skills and incurability”, 19,9±6,9 for “dangerousness”, 1,5±2,3 for “shame” and 42,9±16,2 for total scale and the teachers' average scores were 23,6±10,1, 21,3±6,6, 1,2±1,7 and 46,2±16,6 in the same order.

Conclusions

The findings show that efforts are needed among both pupils and teachers in order to encourage help seeking behavior and to increase the belief that the solution of mental health problems is possible. Strengthening accessible mental health services and reducing stigma towards mental illnesses are also crucial.

Epidemiological findings on Hepatitis C infection in a tertiary level hospital in mid-northern Anatolia in Turkey: A four-year analysis

The hepatitis C virus (HCV) is a blood-borne pathogen that causes acute or chronic infection of the liver, sometimes leading to serious liver damage and fatality. The objective of this study was to evaluate HCV prevalence in patients attending the Regional Training and Research Hospital for Medical Examination and Surgery in Samsun Province of Turkey between 2014 and 2017. Blood specimens taken from 152 596 patients were screened for HCV infection by using the anti-HCV assay. Seropositive samples were subjected to polymerase chain reaction (PCR) testing in order to determine whether the HCV infection was active. Genotyping was then performed. Overall, HCV seropositivity and active HCV infection were 2.76% and 2.05%, respectively. Foreign nationals accounted for 5.61% of the seropositive samples and 1.37% of active HCV infective samples. We further report that 2017 was the year with the highest seroprevalence which was 3.64%. HCV genotype 1 was the most common genotype detected in residents of Samsun Province at 89.86%, followed by Genotype 3 at 4.54%. This study provides important information on the levels of HCV infection in the Samsun region of Turkey. The data indicate that there was a rising trend of HCV infection between 2014 and 2017.

A Two-year Clinical Comparison of Three Different Restorative Materials in Class II Cavities

OBJECTIVES

The aim of this clinical study was to evaluate the clinical performance of Class II restorations of a high-viscosity glass ionomer material, of a bulk-fill composite resin, and of a microhybrid composite resin.

METHODS AND MATERIALS

One hundred nine Class II restorations were performed in 54 patients using three different restorative materials: Charisma Smart Composite (CSC; a conventional composite resin), Filtek Bulk Fill Posterior Restorative (FBF; a high-viscosity bulk-fill composite), and Equia Forte Fil (EF; a high-viscosity glass ionomer). Single Bond Universal adhesive (3M ESPE, Neuss, Germany) was used for both conventional and bulk-fill composite resin restorations. The restorations were evaluated using modified US Public Health Service criteria in terms of retention, color match, marginal discoloration, anatomic form, contact point, marginal adaptation, secondary caries, postoperative sensitivity, and surface texture. The data were analyzed using the chi-square, Fisher, and McNemar tests.

RESULTS

Eighty-four restorations were evaluated at two-year recalls. There were clinically acceptable changes in composite resin restorations (FBF and CSC). In addition, no statistically significant difference was observed between the clinical performances of these materials in terms of all criteria (p>0.05). However, there was a statistically significant difference between the EF group and the FBF and CSC groups in all parameters except for marginal discoloration, secondary caries, and postoperative sensitivity (p<0.05).

CONCLUSIONS

The tested bulk-fill and conventional composite resins showed acceptable clinical performance in Class II cavities. However, if EF is to be used for Class II restoration, its use should be carefully considered.

The first serological report for genotype C bovine parainfluenza 3 virus in ruminant species of mid-northen Turkey: Traces from the past

Bovine parainfluenza 3 virus (BPI3V)is one of the most important respiratory pathogens and a leading cause of serious respiratory illnesses in cattle, both independent of and in connection with other pathogens involved in the bovine respiratory disease complex (BRDC). In this study, we aimed to identify the historical circulation of genotype C bovine BPI3V (BPI3Vc) in Turkey using the archival serum samples of domestic ruminants that had been collected from six provinces of northern Anatolia in Turkey between 2009-2010. A total of 896 sera from cattle (n=442), sheep (n=330), and goats (n=124) were randomly selected and screened with a virus neutralization test in order to detect antibodies for BPI3Vc. The overall seropositivity rate was 21.09%, with seropositivity rates for cattle, sheep, and goats of 21.04%, 20.00%, and 24.19%, respectively. Neutralizing antibody titers for selected samples ranged between 1/4 to 1/512. This study represents the first serological study conducted using the first BPI3V isolate of Turkey.

Management of symptomatic urachal cysts in children

Aim

We report the results of the surgical treatment of symptomatic urachal cysts.

Materials and Methods

The medical records of patients who underwent urachal cyst excision between 2012 and 2017 were reviewed retrospectively at our hospital. The age, sex, presenting complaint, method of diagnosis, average cyst diameter, surgical procedure, and postoperative complications of each patient were recorded.

Results

Twenty-seven patients who had urachal cyst were included in this study; 5 out of 27 patients were treated conservatively and the rest of patients were treated surgically, made up of 16 males (72%) and 6 females (28%). The average age of the patients was 7 years (range: 1-17). The most common reason for referral was abdominal pain in 12 patients (54%), discharge in 6 patients (28%), fever in 2 patients (9%), and an abdominal mass in 2 patients (9%). An ultrasound scan was performed in all patients as an initial imaging study. The average cyst diameter was 1.5 cm (range: 1-6 cm). Laparotomy was performed in 16 patients, with 6 patients undergoing laparoscopic excision. Postoperative wound infection developed in two patients.

Conclusions

Patients with urachal cysts may be managed conservatively initially. However, patients who do not show any clinical and radiological signs of regression, or those who have large cysts, should undergo surgical excision through laparotomy or a laparoscopic approach.

Diverticular disease and posture during defecation : a prospective comparative study

BACKGROUND AND STUDY AIMS

Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation.

PATIENTS AND METHODS

This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662).

RESULTS

The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis.

CONCLUSION

Sitting during defecation seems to increase the risk of CD.

Ameliorative potential of Lavandula stoechas in metabolic syndrome via multitarget interactions

ETHNOPHARMACOLOGICAL IMPORTANCE

Decoction and infusion prepared from aerial parts of Lavandula stoechas L. (L. stoechas) have been traditionally used as remedy against several components of metabolic syndrome (MetS) and associated disorders including type II diabetes and cardiovascular diseases by Anatolian people.

AIM OF THE STUDY

The aim is to elucidate the potential ameliorative effects of L. stoechas aqueous extracts on insulin resistance and inflammation models through multitarget in vitro approaches and also to elucidate mechanism of action by analyzing transcriptional and metabolic responses.

MATERIALS AND METHODS

An aqueous extract was prepared and fractionated to give rise to ethyl acetate (EE) and butanol (BE) extracts. The anti-insulin resistance effects of BE and EE were evaluated on palmitate induced insulin resistance model of H4IIE, C2C12 and 3T3L1 cells by using several metabolic parameters. Specifically, whole genome transcriptome analysis was performed by using microarray over 55.000 genes in control, insulin resistant and EE (25 µg/mL) treated insulin resistant H4IIE cells. Anti-inflammatory effects of both extracts were analyzed in LPS-stimulated RAW264.7 macrophages.

RESULTS

Both EE and BE at low doses (25-50 µg/mL) significantly decreased hepatic gluconeogenesis in H4IIE cell line by suppressing the expression of PEPCK and G6Pase. In C2C12 myotubes, both extracts increased the insulin stimulated glucose uptake more effectively than metformin. Both extracts decreased the isoproterenol induced lipolysis in 3T3L1 cell line. Moreover, they also effectively increased the expression of lipoprotein lipase protein level in insulin resistant myotubes at low doses. EE increased the protein level of PPARγ and stimulated the activation AKT in insulin resistant H4IIE and C2C12 cell lines. The results obtained from biochemical assays, mRNA/protein studies and whole genome transcriptome analyses were found to be complementary and provided support for the hypothesis that EE might be biologically active against insulin resistance and act through the inhibition of liver gluconeogenesis and AKT activation. Besides, LPS induced inflammation in RAW264.7 macrophages was mainly inhibited by EE through suppression of iNOS/NO signaling, IL1β and COX-2 genes. HPLC-TOF/MS analysis of EE of L. stoechas mainly resulted in caffeic acid, apigenin, luteolin, rosmarinic acid and its methyl ester, 4-hydroxybenzoic acid, vanillic acid, ferrulic acid and salicylic acid.

CONCLUSION

Data suggest that EE of L. stoechas contains phytochemicals that can be effective in the treatment/prevention of insulin resistance and inflammation. These results validate the traditional use of L. stoechas in Anatolia against several metabolic disorders including metabolic syndrome.

Assessment of knowledge and attitudes of dental students in regard to child abuse in Turkey

INTRODUCTION

Child abuse is a serious public problem. Signs of abuse are often present in the oro-facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to investigate dental students' knowledge about and attitudes towards child abuse.

MATERIAL AND METHODS

This study was performed at the Faculty of Dentistry of the Ondokuz Mayis University. The data were collected through a self-report questionnaire administered to dental students (137 female/111 male) in three different dental classes (third, fourth and fifth study years) and grouped by considering those students who have been training in the school year of 2013. The definition of physical and social indicators of abuse, awareness regarding legal and ethical responsibilities, students' experience and requests made by students were evaluated by the students' response to questions put in the questionnaire. Descriptive statistics and chi-square tests were performed to analyse the questionnaire data.

RESULTS

The questionnaire completion rate was 100%. About 67.74% of the third year, 40.71% of the fourth year and 16.67% of the fifth year believed that they could detect child abuse cases. However, results indicated a major lack of knowledge of social indicators, signs of physical abuse and reporting procedure amongst all respondents. The assessment of the total correct answers exhibited significant differences amongst third-, fourth- and fifth-year students' answers. Fifth-year students had the highest rate of correct responses (P < 0.05). Most students wanted to receive more knowledge about this topic.

CONCLUSION

Dental students in Turkey are not sufficiently prepared for their role in diagnosing suspected cases of child abuse.

The LDL/HDL ratio and atherosclerosis in ankylosing spondylitis

OBJECTIVES

In ankylosing spondylitis (AS) patients, cardiac and vascular involvement may manifest as atherosclerosis and coronary artery disease. Systemic inflammation, oxidative stress, increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol constitute a significant risk for atherosclerosis. This study investigated the relationship between carotid intima-media thickness (CIMT), LDL/HDL ratio, total oxidant status (TOS; an indicator of oxidative stress) and ischemic modified albumin (IMA; an ischemic marker in AS patients).

PATIENTS AND METHODS

Sixty AS patients were diagnosed using the Modified New York Criteria; 54 age- and gender-matched participants were included as controls. CIMT, LDL/HDL ratio, TOS and IMA were measured using the most appropriate methods.

RESULTS

IMA was higher in AS patients compared to controls (p < 0.0001). TOS was also increased in AS patients (p = 0.005); as was CIMT (p < 0.0001). The LDL/HDL ratio was also greater in AS patients compared to controls (p = 0.047). A positive correlation was found between CIMT and LDL/HDL ratio among AS patients.

CONCLUSION

Elevated CIMT, IMA and TOS levels suggest an increased risk of atherosclerotic heart disease in AS patients. The LDL/HDL ratio was higher in AS patients compared to controls, and there was a correlation between LDL/HDL ratio and CIMT, albeit statistically weak. Therefore, the LDL/HDL ratio is not a reliable marker to predict atherosclerotic heart disease in AS patients.

Protective effects of taurine against renal ischemia/reperfusion injury in rats by inhibition of gelatinases, MMP-2 and MMP-9, and p38 mitogen-activated protein kinase signaling

Dysregulated expression of matrix metalloproteinases (MMPs) is closely associated with the pathogenesis of renal ischemia/reperfusion injury (I/R). The production of excessive reactive oxygen species (ROS) causes tissue damage. Increased ROS production causes activation of p38 mitogen-activated protein kinase (MAPK) signaling, which participates in gene regulation of MMPs, especially MMP-2 and MMP-9 (gelatinases). Taurine (2-aminoethanesulfonic acid) in mammalian cells functions in bile acid conjugation, maintenance of calcium homeostasis, osmoregulation, membrane stabilization, and antioxidation, antiinflammatory, and antiapoptotic action. We investigated the effects of taurine and the possible role of p38 MAPK signaling on regulation of MMP-2 and MMP-9 in a renal I/R injury model in rats. Rats were divided into three groups: sham, I/R, and I/R + taurine treated. After a right nephrectomy, I/R was induced by clamping the left renal pedicle for 1 h followed by 6 h reperfusion. Taurine was administered 45 min prior to induction of ischemia. Renal function was assessed by serum creatinine and blood urea nitrogen (BUN) levels. Tubule injury and structural changes were evaluated by light microscopy. Malondialdehyde (MDA) levels were analyzed by high performance liquid chromatography (HPLC). Superoxide dismutase (SOD) activity levels were measured using a colorimetric kit. mRNA expression of MMP-2 and MMP-9 was determined by real-time polymerase chain reaction. MMP-2 and MMP-9 activities were measured using a fluorimetric kit. Phosphorylated p38 (p-p38) and total p38 MAPK protein expressions were evaluated by western blot. Taurine pretreatment significantly attenuated renal dysfunction and histologic damage, such as renal tubule dilation and loss of brush borders. The pretreatment also decreased the MDA level and attenuated the reduction of SOD activity in the kidney during I/R. Taurine pretreatment also decreased significantly both MMP-2 and MMP-9 mRNA expression and MMP-9 activity induced by I/R. In addition, the activity of p38 MAPK signaling was down-regulated significantly by taurine administration. Inhibition of MMP-2 and MMP-9 expression and MMP-9 activity caused by taurine may be associated with suppression of p38 MAPK activation during I/R induced renal injury in rats. Therefore, taurine administration may prove to be a strategy for attenuating renal I/R injury.

Molecular characterization and detection of enterotoxins, methicillin resistance genes and antimicrobial resistance of Staphylococcus aureus from fish and ground beef

A total of 120 samples including 40 freshwaterfish(Oncorhynchus mykiss), 40 seawater fish (Sparus aurata) and 40 ground beef samples were examined for the presence of Staphylococcus aureus. The isolates were identified using biochemical tests and a PCR for the species-specific fragment (Sa442) and thermonuclease gene (nucA). The presence of staphylococcal enterotoxin genes (sea, seb, sec, sed and see), toxin genes (eta, etb, tsst), methicillin resistance gene (mecA) and some phenotypic virulence factors was also tested. Genotypic characterization of the isolates was analyzed by PCR-RFLP of the coa gene. Overall, 36 (30%) meat samples were contaminated with S. aureus. Of the 36 isolates, 3 (8.3%) were found to be positive for enterotoxin genes. Only 1 isolate (5.9%) from ground beef had the sea gene. In addition, 1 (12.5%) of the freshwater fish and 1 (9.1%) of the seawater fish carried both the sea and sed genes. The presence of seb, sec, see, eta, etb and tsst was not detected among the isolates of S. aureus. The amplified coa gene revealed five different clusters. Seven and six distinct RFLP patterns were obtained with AluI and HaeIII digestion, respectively. All isolates were found to be positive for slime, hemolytic and DNase activity while 41.7% of them were beta-lactamase positive. The presence of methicillin resistance was neither detected by PCR nor the disk diffusion method. A total of 94.4% of the isolates were resistant to at least one antimicrobial while 44.4% of them were resistant to at least two or more antimicrobials.

Atherogenic index of plasma may be strong predictor of subclinical atherosclerosis in patients with Behçet disease

OBJECTIVES

Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. The purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients.

PATIENTS AND METHODS

A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated.

RESULTS

cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (β = 0.232, p = 0.018). In the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients.

CONCLUSION

Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.

Erythropoietin stimulates the coronary collateral development in patients with coronary chronic total occlusion

Objective

Erythropoietin (EPO) improves cardiac function and induces neovascularisation in post-myocardial infarction heart failure. The aim of this study was to analyse the association between the serum erythropoietin level and coronary collateral development in patients with coronary artery disease and chronic total occlusion.

Methods

A total of 168 patients consisting of 117 with coronary artery disease (CAD, (62 with chronic total occlusion (CTO), 55 without CTO)) and 51 with healthy coronary arteries were included in the study. The patients were assigned as coronary artery disease without CTO (group 0), CAD with CTO (group 1: poor collateral development, group 2: good collateral development) and normal coronary arteries (group 3).

Results

There was a significant positive correlation between serum EPO levels and the Rentrop scores in angiography (r = 0.243, p = 0.001). Similarly, a positive correlation was found between serum EPO levels and the Syntax scores (r = 0.253, p = 0.001). Echocardiography revealed a negative correlation between serum EPO levels and the cardiac ejection fraction (r = −0.210, p = 0.006).

Conclusions

Serum EPO is a useful biomarker for coronary collateral development in patients with CTO.

Atherogenic index of plasma may be strong predictor of subclinical atherosclerosis in patients with Behçet disease

OBJECTIVES

Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. The purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients.

PATIENTS AND METHODS

A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated.

RESULTS

cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (β = 0.232, p = 0.018). In the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients.

CONCLUSION

Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.

The LDL/HDL ratio and atherosclerosis in ankylosing spondylitis

OBJECTIVES

In ankylosing spondylitis (AS) patients, cardiac and vascular involvement may manifest as atherosclerosis and coronary artery disease. Systemic inflammation, oxidative stress, increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol constitute a significant risk for atherosclerosis. This study investigated the relationship between carotid intima-media thickness (CIMT), LDL/HDL ratio, total oxidant status (TOS; an indicator of oxidative stress) and ischemic modified albumin (IMA; an ischemic marker in AS patients).

PATIENTS AND METHODS

Sixty AS patients were diagnosed using the Modified New York Criteria; 54 age- and gender-matched participants were included as controls. CIMT, LDL/HDL ratio, TOS and IMA were measured using the most appropriate methods.

RESULTS

IMA was higher in AS patients compared to controls (p < 0.0001). TOS was also increased in AS patients (p = 0.005); as was CIMT (p < 0.0001). The LDL/HDL ratio was also greater in AS patients compared to controls (p = 0.047). A positive correlation was found between CIMT and LDL/HDL ratio among AS patients.

CONCLUSION

Elevated CIMT, IMA and TOS levels suggest an increased risk of atherosclerotic heart disease in AS patients. The LDL/HDL ratio was higher in AS patients compared to controls, and there was a correlation between LDL/HDL ratio and CIMT, albeit statistically weak. Therefore, the LDL/HDL ratio is not a reliable marker to predict atherosclerotic heart disease in AS patients.

Gastrointestinal tract duplications in children

AIM

Gastrointestinal tract duplications (GTD) are rare congenital abnormalities that can occur anywhere along the gastrointestinal tract. These anomalies may present as a single, multiple, or a vague pathologies. Diagnosing and treating these diseases may be difficult in some patients. We aimed to present 32 patients who were followed and treated in our clinic.

PATIENTS AND METHODS

This study included the patients between 2000 and 2013. Evaluations included clinical presentations, diagnostic strategies and algorithms, surgical procedures and associated anomalies, and presence of ectopic tissue, complications, and prognosis.

RESULTS

Common clinical presentations included vomiting (n=8; 25%), palpable abdominal mass (n=4; 13%). Twenty-eight patients (2 of them antenatally) were diagnosed preoperatively while four of them were diagnosed at surgery. Ileal duplications constituted the most common type (34%) while the least common ones were located in appendix, thoracoabdomen and rectum. One of our patients was present with a gastric duplication which was closely interconnected to a tubular duplication of esophagus, which had never been encountered in the literature before.

CONCLUSIONS

It is crucial to note that duplications are likely to occur in various types and numbers and also may accompany other anomalies. Computed Tomography (CT) remains the method of choice since Magnetic Resonance (MR) is likely to cause the use of sedation and analgesia at very young ages and it may also be relatively costly despite being more sensitive in soft tissues. Mucosal stripping is an ideal method for the patients requiring restricted surgery. The antenatal asymptomatic cases can be operated after their 6th months of age.

Predictors of reintervention after coronary artery bypass grafting

AIM

Percutaneous and surgical reintervention after coronary artery bypass grafting (CABG) is frequent. The purpose of this study was to determine the predictors of reintervention in patients with symptoms of recurrent ischemia after coronary artery bypass graft surgery (CABG).

PATIENTS AND METHODS

The data of 20000 patients who had coronary angiography (CAG) from 2003 to 2010 in our centre were retrospectively analysed. 485 of these patients with CABG who had CAG were included in this study. Demographic characteristics, the presence of coronary artery disease (CAD), risk factors for CAD, electrocardiographic (ECG) changes, troponin and CKMB levels, and left ventricular function were evaluated in terms of time elapsed after CABG.

RESULTS

Reintervention was performed significantly more frequent in patients with acute coronary syndrome, diabetes mellitus (DM), hypertension (HT), family history of CAD, ECG changes, positive troponin level, elevated CKMB, ejection fraction (EF) > 50% and in smoker patients (p < 0.05). Multivariate backward logistic regression analysis revealed that DM, smoking, family history of CAD, HT, ECG changes and patients with EF > 50% were found the independent predictors of reintervention.

CONCLUSIONS

Reintervention after CABG is especially higher in patients with risk factors for atherosclerosis and those who have ECG changes and normal EF. Knowledge of these risk factors is useful in the determination of CAG requirement and modification of risk factors for  atherosclerosis may play an important role in reducing reintervention.

Universal newborn hearing screening; automated transient evoked otoacoustic emissions

OBJECTIVE

The purpose of this study is to describe the results of universal newborn hearing screening (UNHS) in 2229 newborns and to assess the effectiveness of a two-stage automated transient evoked otoacoustic emission (a-TEOAE) test protocol.

MATERIALS AND METHODS

Between May 2007 and January 2008, a universal newborn hearing screening program, instituting two-stage a-TEOAE, was evaluated. The hearing status of the newborns who failed the two-stage screening tests were evaluated with the auditory brainstem response (ABR) test during the diagnostic stage. The risk factors for hearing loss determined by the Joint Committee on Infant Hearing Loss (JCIH) and prematurity, consanguineous marriage, and birth type as presumptive risk factors were recorded.

RESULTS

During the study period, 2229 newborns were screened. Sensorineural hearing loss (SNHL) was identified in 8 newborns. Fourteen newborns were lost to follow-up. One hundred thirty six newborns were high-risk neonatal intensive care unit (NICU) patients. The prevalence of SNHL was 2.9% (4/136) in NICU newborns, and 0.19% (4/2079) in the well-baby nursery. SNHL prevalence in the study group overall was found to be 0.36% (8/2215). Craniofacial anomalies and family history of hearing loss were found to be significantly related to SNHL in newborns. Prematurity and consanguinity that are not listed among JCIH risk factors were also found to be statistically significantly related with SNHL.

CONCLUSIONS

This is the first report of a universal hearing screening program in the Eastern Black Sea region of Turkey. Two-stage a-TEOAE is an efficient and feasible hospital-based screening protocol in newborns.

Spoilage potentials and antimicrobial resistance of Pseudomonas spp. isolated from cheeses

Pseudomonas spp. are aerobic, gram-negative bacteria that are recognized as major food spoilage microorganisms. A total of 32 (22.9%) Pseudomonas spp. from 140 homemade white cheese samples collected from the open-air public bazaar were isolated and characterized. The aim of the present study was to investigate the biochemical characteristics, the production of extracellular enzymes, slime and β-lactamase, and antimicrobial susceptibility of Pseudomonas spp. isolated from cheeses. The identified isolates including Pseudomonas pseudoalcaligenes, Pseudomonas alcaligenes, Pseudomonas aeruginosa, Pseudomonas fluorescens biovar V, and P. pseudoalcaligenes ssp. citrulli were found to produce extracellular enzymes, respectively: protease and lecithinase production (100%), and lipase activity (85.7, 42.9, 100, and 100%, and nonlipolytic, respectively). The isolates did not produce slime and had no detectable β-lactamase activity. The antimicrobial susceptibility of the isolates was tested using the disk diffusion method. Pseudomonas spp. had the highest resistance to penicillin G (100%), then sulphamethoxazole/trimethoprim (28.1%). However, all Pseudomonas spp. isolates were 100% susceptible to ceftazidime, ciprofloxacin, amikacin, gentamicin, and imipenem. Multidrug-resistance patterns were not observed among these isolates. In this study, Pseudomonas spp., exhibiting spoilage features, were isolated mainly from cheeses. Isolation of this organism from processed milk highlights the need to improve the hygienic practices. All of the stages in the milk processing chain during manufacturing have to be under control to achieve the quality and safety of dairy products.