Estimation of bone mineral density with hounsfield unit measurement

OBJECTIVE

Although dual-energy x-ray absorptiometry (DXA) remains the gold standard for the measurement of bone mineral density (BMD), degenerative spine and spinal instrumentation yields inaccurate results, warranting the need for optional methods.

METHODS

Surgical options depend on the BMD of the patients, and to accommodate this need, we compared Hounsfield unit (HU) measurements obtained from computed tomography (CT) scans with the T-scores obtained from DXA scans to inquire whether HU measurements can screen for BMD. In this study, we also evaluated the relationship between body mass index and spontaneous fractures.

RESULTS

Based on the findings described in this study, we provide evidence that HU measurements obtained from CT scans can predict BMD.

CONCLUSIONS

This, therefore, allows HU measurements to be used as an effective diagnostic method in lieu of DXA scans when deciding on appropriate management of therapy for patients with spinal instrumentation or degenerative spines.

Index of cardio-electrophysiological balance and Parkinson disease

Neurodegeneration of the autonomic nervous systems due to Parkinson disease (PD) may lead to increase in the QT duration. In recent years, a new parameter index of cardio-electrophysiological balance (ICEB) was found. ICEB is a significant parameter of medicine related dysrhythmia. The purpose of this research is to assess ICEB in PD. Twenty-eight PD cases and 26 controls participated in our investigation. First diagnosed PD patients were registered in the research. The symptom progression of PD was assessed Modified Hoehn and Yahr Scale. Analyzed ECG variables are QRS, PR, QT, corrected QT (QTc) interval, ICEB and corrected index of cardio-electrophysiological balance (ICEBc). All cases had sinus rhythm. ICEB was analyzed by the ratio of QT/QRS. ICEBc was analyzed by the ratio of QTc/QRS. Twenty-eight PD cases participated in this research. Among PD cases, 15 patients were female (53.5%). The mean age of PD patients are 59.03 ± 9.94 years. There was no important difference between groups with respect to the clinical variables. The Modified Hoehn and Yahr Scale was appreciably higher in the PD group than the Control group. The heart rate of the PD group was significantly lower than that of the control group. PR intervals and QRS duration were similar in both groups. QT and QTc duration were significantly longer in PD patients. Also, the ICEB and ICEBc variables were appreciably higher in PD cases. The findings of our investigation suggest that ICEB is related to PD. ICEB can help to evaluate arrhythmia risk in patients with PD.

Assessment of Myocardial Function by Speckle Tracking Echocardiography in Patients with Acute Ischemic Stroke

Background

Acute stroke is an important cause of morbidity and mortality. Myocardial injury is an important complication of acute cerebrovascular events. Neurogenic stress cardiomyopathy (NSC) is a condition of acute myocardial systolic dysfunction that can be observed after acute cerebrovascular events.

Objective

In this study, we aimed to investigate the relationship between myocardial function assessed by two-dimensional speckle-tracking echocardiography and National Institutes of Health Stroke Scale (NIHSS) score in patients with acute ischemic stroke.

Materials and Methods

This cross-sectional study screened 97 patients (males, 42; females, 55; 65 ± 16 years) with acute ischemic stroke. Around 17 patients were excluded and 80 patients were studied. Patients were divided into two groups based on the calculated NIHSS score (Group 1, NIHSS score <16; Group 2, NIHSS score ≥16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac function was evaluated by two-dimensional speckle tracking echocardiography within 48 h of admission to the neurology care unit.

Results

There were no significant differences in the demographic parameters of patients. The absolute value of global longitudinal systolic strain (GLS) was significantly higher in Group 1 patients than in Group 2 patients (21.4 ± 2.2 vs 15.9 ± 2.7, P = 0.0281). We found that thirteen patients (22%) had normal LVEF and abnormal LV GLS in Group 1 (P = 0.036). Eight patients (36%) had normal LVEF and abnormal LV GLS in Group 2 (P = 0.042). E/e', QT on ECG, and serum troponin levels were significantly higher in Group 2 patients than in Group 1 patients (P < 0.05).

Conclusions

Our results suggest that GLS is associated with stroke severity on admission in patients with acute ischemic stroke. GLS is an indicator of myocardial deformation with a different from LVEF. GLS can detect early myocardial dysfunction despite preserved LVEF.

The Role of the Low-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio as an Atherogenic Risk Factor in Young Adults with Ischemic Stroke: A Case-Control Study

Dyslipidemia is a major atherogenic risk factor for ischemic stroke. Stroke patients tend to have high levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (HDL-C). Therefore, it is noteworthy that there has been an increase in ischemic stroke cases in young and elderly individuals in recent years. This study investigated the TC/HDL-C ratio and the LDL-C/HDL-C ratio, which may be more specific and common lipid parameters in young patients with ischemic stroke. This study aimed to demonstrate the sensitivity and specificity of TC/HDL-C and LDL-C/HDL-C ratios as atherogenic markers for young adult ischemic strokes. This trial was conducted as a retrospective case-control study. A total of 123 patients (patient group) and 86 healthy individuals (control group) aged 18-50 years were randomly selected from four different hospitals. Lipid parameters and TC/HDL-C and LDL-C/HDL-C ratios were compared between these two groups. The mean age was 38.8 ± 7.3 years in patients and 37.7 ± 9 years in controls (p > 005). The HDL-C levels were 39.1 ± 10.8 mg/dL in patients and 48.4 ± 13.8 mg/dL in controls (p < 0.001). LDL-C/HDL-C ratios were 3.23 ± 1.74 and 2.38 ± 0.87, and TC/HDL-C ratios were 5.24 ± 2.31 and 4.10 ± 1.25 in the patient and control groups, respectively (p < 0.001). The LDL-C/HDL-C and TC/HDL-C cutoff values in ROC analyses were 2.61 and 4.40 respectively; the AUCs (95% CI) were determined to be 0.680 (0.608-0.753) and 0.683 (0.610-0.755) (p < 0.001), respectively. An increased risk of stroke was observed in those with a high LDL-C/HDL-C ratio (OR = 1.827; 95% CI = 1.341-2.488; p < 0.001). Our study obtained similar results when we compared the mean TC and LDL-C levels between the two groups. However, considering the TC/HDL-C and LDL-C/HDL-C ratios, it is noteworthy that there was a significant difference between the patient and control groups.

The Effect of Prognostic Nutritional Index on Infection in Acute Ischemic Stroke Patients

Objectives: Malnutrition is frequently seen in stroke patients. Malnutrition worsens the prognosis and increases the mortality rate in acute ischemic stroke patients. Malnutrition is a significant factor not only in the initiation of infection but also in its progression. The prognostic nutritional index (PNI) is a new index that evaluates the nutrition and inflammatory status. This study aims to investigate the relationship between PNI and stroke-related infection (SRI) development during hospitalization in patients with acute ischemic stroke. Materials and Methods: Acute ischemic stroke was the primary diagnosis for 158 patients who were admitted to the neurology intensive care unit. Patients' demographic, clinical, and laboratory parameters were recorded. PNI was calculated according to the formula given below. PNI: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (mm³). PNI > 380 normal, PNI: 350-380 moderate malnutrition risk, PNI < 350 severe malnutrition risk. Results: A total of 158 patients with acute ischemic stroke were included in the study. There were 70 male and 88 female patients, whereas the mean age of the patients was 67.79 ± 14.0 years. Nosocomial infection developed in 34 (21%) of the patients. Compared to high PNI scores, patients with low PNI scores were generally older, and the National Institutes of Health Stroke Scale (NIHSS) score, atrial fibrillation, infection, mortality rate, and hospitalization rates were all significantly higher. Conclusions: In this study, we discovered that patients with poor PNI had a considerably increased rate of infection development. It is vital to evaluate the nutritional status of patients with acute ischemic stroke during hospitalization.

Neurological Evaluation of Geriatric Patients Being Treated for COVID-19

OBJECTIVE

The clinical presentation of coronavirus disease 2019 may be more severe in individuals with diagnoses such as neurodegenerative diseases and cerebrovascular disease, which may occur at an advanced age, among the underlying chronic neurological disorders. In this study, we analyzed the incidence of underlying neurological disorders, the clinical process, the effects on prognosis, duration of hospitalization, and clinical parameters such as mortality and the incidence of neurological manifestations that occurred in the study group after being infected and their relationship with the prognosis in patients hospitalized due to coronavirus disease 2019.

MATERIALS AND METHODS

This is a retrospective and single-centered study. Individuals aged 65 years and older whose diagnosis of coronavirus disease 2019 was confirmed and who were hospitalized for treatment were included in the study.

RESULTS

A total of 282 individuals were included in the study. Neurological manifestaitons were observed in 217 (77.0%) patients, and 131 (46.5%) patients had a neurological disorders in their medical history. Of the 58 patients in intensive care, 36 (12.8%) had a positive history of neurological disorders (P=.006). The incidences of diseases common in advanced age were 22 (7.8%) for dementia, 37 (13.1%) for cerebrovascular disease, and 4 (1.4%) for movement disorders. The most common symptom were myalgia in 67 (23.8%) patients.

CONCLUSION

The clinical presentation was more severe and the risk of being treated in the intensive care unit was higher in individuals with a history of neurological disorders and neurological manifestations. Furthermore, patients who developed neurological manifestations had a greater risk of mortality and longer periods of hospitalization.

Prognostic value of glucose fluctuation in patients undergoing thrombolysis or thrombectomy due to acute ischemic stroke

Background

Hyperglycemia during acute ischemic stroke is associated with worse outcomes, and this glucose altitude may persist in the initial days. In this study, we investigate the effect of glucose fluctuations in the first 4 days in patients diagnosed with acute ischemic stroke and who underwent ivr-tPA ± interventional thrombectomy or only interventional thrombectomy on stroke prognosis. Study was designed bicentered retrospective case series. Patients older than 18 years were included and those suitable for acute treatment, treatment indications, contraindications, and treatment management of hyperglycemia were selected according to the 2018 American Stroke Association guidelines. The effect of fasting glucose values of patients in the first 4 days on admission and 24th hour NIHSS scores, duration of hospitalization, disability, mortality, and prognosis were analyzed. We aimed to demostred the effect of the first 4-day glucose values measured in patients treated in a stroke center on clinical prospect.

Results

One hundred and seventy-six patients were included in the study. Group 1 included 30 (17%) patients with severe clinical condition (NIHSS at admission ≥ 16), and Group 2 comprised 146 (83%) patients with moderate and mild clinical condition (NIHSS at admission < 16). The glucose values of Groups 1 and 2 were found as follows: day 1 (admission): 178.7 ± 10.3 mg/dl and 138.3 ± 54.9 mg/dl, day 2: 197.7 ± 99.8 mg/dl and 137.6 ± 51.8 mg/dl, day 3: 186.1 ± 97.6 mg/dl and 127.5 ± 50.0 mg/dl, and day 4: 169.2 ± 85.0 mg/dl and 126.7 ± 49.3 mg/dl (p < 0.05). Mortality risk of patients with glucose ≥ 200 mg/dl was 43.5% on day 1 (p > 0.05), 57.1% on day 2, 68.4% on day 3, and 76.5% on day 4 (p < 0.05).

Conclusions

The glucose level of patients in severe clinical condition peaked on the second day and that 4 days of resilient severe hyperglycemia is a negative risk factor for sequela and mortality.

Assessment of left atrial function by strain in patients with acute ıschemic stroke left atrial function and acute stroke

OBJECTIVE

Myocardial speckle-tracking echocardiography can detect subtle abnormalities in the left atrial function. In this study, we aimed to investigate the relationship between left atrial myocardium and tissue function n assessed by two-dimensional speckle-tracking echocardiography and the National Institutes of Health Stroke Scale score in patients with acute ischemic stroke.

METHOD

The study was composed of 80 patients (45 men, 35 women, mean age: 67±15 years) with acute ischemic stroke. The patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale score (group 1, National Institutes of Health Stroke Scale score < 16; group 2, National Institutes of Health Stroke Scale score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac functions were evaluated using two-dimensional speckle-tracking echocardiography within 48 hours from admission to the neurology care unit.

RESULTS

There were no significant differences between the patients' clinical parameters. Left ventricular ejection fraction was significantly higher in group 1 than in group 2 (59.2±5.6 to 51.4±6.3, p=0.024). Left atrial longitudinal strain was significantly higher in group 1 than in group 2 (34.48±9.73 to 26.27±7.41, p=0.019). There were no significant differences between other echocardiographic parameters.

CONCLUSION

Our results suggest that left atrial longitudinal strain is associated with stroke severity during admission in patients with acute ischemic stroke. Left atrial longitudinal strain is an indicator of left atrial myocardial function.

Relation between index of cardioelectrophysiological balance and stroke severity in patients with acute ischemic stroke

Background

The index of cardioelectrophysiological balance (iCEB), measured as QT interval divided by QRS duration, has recently been defined as a new risk marker for arrhythmias. Increased or decreased iCEB is associated with malignant ventricular arrhythmias.

Aim

In this study, we aimed to investigate the relationship between iCEB and stroke severity in patients with acute ischemic stroke.

Methods

The study comprised 105 adult patients (males, 58; females, 47; 69 ± 15 years) with acute ischemic stroke. Nine patients were excluded. Patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale (NIHSS) score (Group 1, NIHSS score <16; Group 2, NIHSS score ≥16). Demographic, clinical, and laboratory data for all patients were collected. Electrocardiography (ECG) was recorded from all patients on admission to the neurology care unit. iCEB (QT/QRS) was calculated from the 12-lead electrocardiogram.

Results

There were no significant differences among the demographic parameters of patients. iCEB score was significantly higher in Group 2 patients than Group 1 patients (3.97 ± 0.61 vs 3.43 ± 0.57, P = 0.0024).

Conclusion

Our results suggested that iCEB is associated with stroke severity on admission in patients with acute ischemic stroke. It is known that high iCEB is associated with torsade de pointes (TdP), ventricular tachycardia.

Intracerebral hematoma at the basal ganglia following lumbar puncture

BACKGROUND

In patients with normal pressure hydrocephalus (NPH), lumbar puncture (LP) is an effective method for assessing both the diagnosis as well as the possible efficacy of ventriculoperitoneal shunting based on symptom improvement. However, it should be considered that there exists a low risk of complications and that these risks may result in morbidity and mortality. We present a patient who developed hematoma in the basal ganglia following LP.

CASE DESCRIPTION

A 56-year-old man presented with progressive dementia, ataxia, and urinary incontinence for 8 months. The patient received LP. He had no history of coagulopathy and had NPH findings on cranial magnetic resonance imaging. On the second day after LP, he complained of headache and had left hemiparesis, and intracerebral hematoma was observed at the basal ganglia, posterior to the lentiform nucleus.

CONCLUSIONS

Although intracerebral hematoma after LP is one of the rare complications to be more cautious about, particularly in patients with a history of chronic disease or chronic changes in imaging, a history of previous cerebrovascular events and recurrent LPs with probably less cerebrospinal fluid drainage should be planned. Moreover, it should be considered that intracerebral hematoma may develop in patients with clinical deterioration, and good clinical follow-up is required.

Pediatric Orbital Roof Intradiploic Meningioma Operated by Eyebrow Incision

INTRODUCTION

Primary intradiploic meningiomas account for <1% of all osseous calvarial lesions and are categorized as bone tumors. They are frequently observed in the frontotemporal region of the calvarium, anterior cranial fossa, and orbit. We present a case of intradiploic meningioma of the orbital roof, which is rarely observed in the pediatric age-group; it was surgically treated with a unique minimally invasive approach.

CASE PRESENTATION

A 16-year-old male with chief complaints of headache on the right side for approximately 1 year was presented to our clinic. Cranial MRI revealed an intradiploic mass with homogeneous, hypointense contrast patterns on the T1W and T2W images of the right orbital roof. A skin incision was made through the right eyebrow, and the frontal sinus anterior wall was opened by craniotomy. Gross total resection was achieved by reaching the tumor present in the orbital roof. The mass was characterized as psammomatous meningioma by a pathological examination.

DISCUSSION/CONCLUSION

In cranial oncologic surgery, lesion localization and possible pathological diagnosis are essential for the determination of the correct surgical technique. In particular, in pediatric cases, selecting a method that will reduce the need for transfusion, shorten the surgical time, minimize the chances of facial deformity, and facilitate postoperative care will ensure compliance with the correct and appropriate treatment process.

Sociodemographic and culture results of paediatric burns

Paediatric burn wounds are challenging conditions to manage for both the doctors and patients and can cause several complications entailing a complicated treatment and recovery process. This study aims to evaluate sociodemographic conditions and antibiogram culture results of paediatric burn wounds. Our study retrospectively evaluated 419 paediatric patients with burns regarding age, gender, burn area and degree, total days spent in hospital, surgical history, final condition, additional disease history, previous attempts, and culture results with their antibiotic resistances, haemogram results, C-reactive protein results, sociocultural conditions, burned region of the body, and structure of the burn. The prominent observations were an increased rate of incidence in male patients and patients with low socioeconomic conditions, the highest incidence of burns from scalding and domestic accidents, and the highest incidence of third-degree burns. Furthermore, even though the most encountered burn types were extremity burns, the burn types with the highest culture growth ratio were the perineum burns. The dominant culture growth bacterial group was coagulase-negative staphylococcus, and the ratio of medication resistance was 67.8%. It is imperative to raise awareness regarding domestic accidents to prevent paediatric burn wounds. The mortality risk can be reduced by carefully monitoring multiple organ involvement and providing timely treatment. Moreover, appropriate wound care is warranted to avoid infection from skin flora.

A Case of Neurocysticercosis in Diyarbakir

Neurocysticercosis is a major parasitic disease of the central nervous system, affecting endemic areas worldwide. It spreads through intermediary hosts, pigs and eventually men to his definitive host: humans. It causes lesions in the CNS which have different evolutive stages and can be asymptomatic or clinically evident. Imaging studies play an important role in the diagnosis of the disease and in its appropriate control.

Effects of Bemiparin Sodium Versus Dabigatran Etexilate After Anastomosis in Rat Carotid Arteries on the Development of Neointima and Thrombolytic Efficacy

BACKGROUND

Revascularization before infarct development after cerebral ischemia may affect morbidity. The success of revascularization can be less than expected because of spontaneous thrombosis or restenosis with intimal hyperplasia. The aim of this study was to compare dabigatran etexilate, a direct thrombin inhibitor, with bemiparin sodium, a second-generation low-molecular-weight heparin, after carotid artery anastomosis.

METHODS

This study used 24 randomly selected Sprague-Dawley rats. The rats were separated into 3 equal groups: group 1 (control group); group 2 (dabigatran group), in which dabigatran 10 mg/kg was orally administered for 7 days; and group 3 (bemiparin group), in which bemiparin 250 IU/kg was subcutaneously administered for 7 days. The right-side carotid artery of rats was used for anastomosis and the left-side carotid artery was used for the control. The carotid artery was explored and transected. Anastomosis was applied using 10/0 polypropylene sutures. After 7 days of treatment, the right and left carotid arteries were removed. Lumen diameter, lumen area, tunica media thickness, edema, vessel wall injury, intimal hyperplasia, thrombus, and inflammation were evaluated in tissue biopsy specimens.

RESULTS

Bemiparin used after anastomosis caused less thickening of tunica media and reduced intimal hyperplasia but did not decrease lumen diameter and area. Dabigatran increased edema and inflammation but did not prevent intimal hyperplasia.

CONCLUSIONS

Bemiparin reduced intimal hyperplasia and prevented thrombosis angiogenesis, but dabigatran did not prevent intimal hyperplasia, and its anticoagulation effect was more than the antithrombotic effect.

Meckel-Gruber Syndrome: A Case Who Lived for 5 Months

The Meckel-Gruber syndrome is a rare, congenital, and lethal malformation characterized by typical manifestations such as encephalocele, polycystic kidneys, and polydactyly. Herein, we present a case of a patient with the typical triad as well as facial, ocular, liver, and genital abnormalities who lived for almost 5 months.

Complex networks for tracking extreme rainfall during typhoons

Reconciling the paths of extreme rainfall with those of typhoons remains difficult despite advanced forecasting techniques. We use complex networks defined by a nonlinear synchronization measure termed event synchronization to track extreme rainfall over the Japanese islands. Directed networks objectively record patterns of heavy rain brought by frontal storms and typhoons but mask out contributions of local convective storms. We propose a radial rank method to show that paths of extreme rainfall in the typhoon season (August-November, ASON) follow the overall southwest-northeast motion of typhoons and mean rainfall gradient of Japan. The associated eye-of-the-typhoon tracks deviate notably and may thus distort estimates of heavy typhoon rainfall. We mainly found that the lower spread of rainfall tracks in ASON may enable better hindcasting than for westerly-fed frontal storms in June and July.

Choroid Plexus Papilloma and Factor XIII Deficiency: Case Report

Factor XIII deficiency is a rare hemorrhagic disorder that can cause spontaneous intracranial hemorrhage and bleeding after surgery. The diagnosis of factor XIII deficiency is difficult before surgical interventions, because coagulation parameters are normal in these patients. Important clinical findings are postsurgical bleeding and recurrent spontaneous intracranial hematomas. These findings should raise the clinical suspicion of factor XIII deficiency. Therefore, diagnosis of factor XIII deficiency is very important for neurologists and neurosurgeons in terms of reducing mortality and morbidity. We present an 8-month-old female patient who developed subdural hematoma after ventriculoperitoneal shunt surgery but not bleeding after choroid plexus papilloma due to FXIII deficiency.

Assessment of right atrial function with speckle tracking echocardiography after percutaneous closure of an atrial septal defect

INTRODUCTION

Speckle tracking echocardiography (STE) for two-dimensional (2D) strain analysis is a new tool to assess myocardial function. The aim of this study was to assess right atrial (RA) function using STE in patients with an atrial septal defect (ASD) before and one month after percutaneous closure.

METHODS

We prospectively examined 32 consecutive patients (nine male, 23 female) who underwent percutaneous transcatheter closure of a secundum ASD between June 2013 and December 2015. Echocardiography was performed on admission, prior to cardiac catheterization and then one month after ASD closure. Peak global RA longitudinal strain was analyzed by 2D-STE.

RESULTS

Patients' mean age was 34.6±8.2 years. The mean diameter of the occlusive devices was 18.5±7.5 mm. Right ventricular (RV) end-diastolic diameters were significantly increased but decreased significantly after ASD closure (43±5 vs. 38±4 mm, p<0.05). Left atrial (LA) diameters (40±8 vs. 37±6 mm, p<0.05) decreased significantly after the intervention, whereas left ventricular (LV) end-diastolic diameters (45±5 vs. 46±4 mm, NS) remained unchanged. Tricuspid annular plane systolic excursion increased significantly (17.6±5.4 vs. 22.3±8.1 mm, p<0.05). After closure of the defect, a significant increase was observed in longitudinal RA strain (26.5±9.6% vs. 35.3±10.5%, p<0.001).

CONCLUSIONS

After percutaneous transcatheter closure of a secundum ASD, there was an increase in RA longitudinal strain. 2D-STE strain analysis appears to be helpful for the assessment of RA function and of response to correction of volume overload after percutaneous transcatheter closure of a secundum ASD.

The Relationship between Angiotensin-II Type 1 Receptor Gene Polymorphism and Repolarization Parameters after a First Anterior Acute Myocardial Infarction

Background and Objectives

Genetic influence on T-wave peak to End (Tpe) time in patients with a first anterior acute myocardial infarction (AMI) is uncertain. A polymorphism in the angiotensin-II type 1 receptor (AT1R) gene was discovered recently. The polymorphism consists of an A or C variant, given three different possible genotypes: AA, AC, CC. The purpose of this study was to determine the effects of polymorphism of the AT1R gene polymorphism on Tpe after a first anterior AMI.

Subjects and Methods

The subjects were 142 patients (110 men, 32 women, 58±13 years) with a first anterior AMI; ten patients were excluded from this study. Based on the polymorphism of the AT1R gene, they were classified into two groups: Group 1 (AA genotype) of 91 patients and group 2 (AC and CC genotype) of 41 patients. A 12-lead resting ECG was recorded at admission to the coronary care unit in patients with anterior AMI and were manually measured with a ruler. QTc, QTd, QTcd, Tpe, Tpe/QT parameters were measured.

Results

There was no significant difference in the baseline characteristics of patients (p>0.05). We found significant reduction in QTc, QTd, QTcd, Tpe, Tpe/QT indices Group 1 (AA genotype) (mean 66±28 ms) than group 2 (AC and CC genotype) (mean 95±34 ms) (p<0.05).

Conclusion

In patients with a first anterior AMI, AT1R gene polymorphisms may influence on repolarization parameters. Although further studies are required.

Acute generalized exanthematous pustulosis induced by iodixanol (Visipaque): a serious reaction to a commonly used drug

Acute generalized exanthematous pustulosis (AGEP) is an acute sterile pustular eruption most commonly induced by medications. Although antibiotics are the most commonly accused drugs in AGEP, non-antibiotic agents may also cause this disease. We present a case of AGEP following use of iodixanol for coronary angiography in a 61-year-old woman. Given the wide use of this substance in cardiology, clinicians should be aware of this potential complication.

Effect of different analgesics on pain relief during extracorporeal shock wave lithotripsy

BACKGROUND/AIM

The aim of this study was  to compare  three drugs for pain relief during shock wave lithotripsy (SWL).

MATERIALS AND METHODS

Seventy six male patients that were treated for renal stones with SWL were included in this study. They were randomized into four groups. A different treatment protocol was used for each group.  Intramuscular (IM) diclofenac 75mg was given in group 1 (n=20), dexketoprofen, 50mg, IM in group 2 (n=20) and hyoscine 10 mg plus paracetamol 500mg, orally in group 3 (n=20). In group 4 (control, n=16) saline solution   was given 30 min before SWL. Pain during SWL was assessed using the 10-score linear visual analogue pain scale (VAS) and was compared among groups. Age, weight, height, body mass index (BMI), stone size, stone location, duration of SWL, total shock waves performed and mean energy level (kV) for each patient were recorded. A p value of <0.05 was considered statistically significant.

RESULTS

The mean patients' age was 45.4 ± 12.9 years. The highest VAS value was observed in Group 4 (8.4 ± 1), and the lowest  in Group 1 (6.25 ± 2.2).  Statistically significant  difference was noted  only when Group 1 and Group 4 were compared. The remaining groups provided similar results and there were no significant statistical differences according to VAS values. Other parameters were similar  in all groups.

CONCLUSION

In conclusion, this study shows that reducing the pain with a single dose injection of intramuscular diclofenac sodium before SWL is superior compared to others.

Acute inferior myocardial infarction in a young male patient associated with Behcet's disease and sildenafil

Behcet's disease (BD) is a multisystemic inflammatory disorder of unknown origin, presenting with mucocutaneous, ocular, articular, vascular, gastrointestinal and central nervous system manifestations. Coronary involvement is very rare in patients with BD. Sildenafil, an oral drug used to treat erectile dysfunction, was shown to cause significant cardiovascular problems including acute myocardial infarction (MI) and sudden cardiac death. Acute MI associated with BD and sildenafil has not been reported previously. We present a case of a 23-year-old male patient with an acute inferior MI associated with BD diagnosed after admission of sildenafil, who was successfully treated with thrombus aspiration and tirofiban administration.

Evaluation of erectile dysfunction in permanent pacemaker implanted patients with cardiac rhythm disorder prediagnosis

Background and aims

To evaluate the anxiety, depression and related psychogenic erectile dysfunction that might be developed before and after pacemaker implantation in patients with cardiac arrhythmias.

Material and methods

Thirty permanent pacemaker implanted male patients, were enrolled to study between September 2006 and September 2008. Erectile function domain questions of International Index of Erectile Function (IIEF‐6) and Hospital Anxiety and Depression Scale (HAD) questionnaires were applied to patients, 6 months before pacemaker implantation (BP6) and on month 1 (AP1) and 6 after application (AP6). Patients were included in a multidisciplinary cardiac rehabilitation-adaptation program with a duration of 1–2 months. Patients were evaluated in subgroups.

Results

Mean age was 51.5 ± 10.3. Most frequent diagnosis was observed as AV block in etiology. The mean IIEF values were changed 22.8→20.2→24.6 in BP6, AP1 and AP6 time frames consecutively. However, the mean HAD-Anxiety scores were evaluated as 8.1→17.0→7.3 and the mean HAD-Depression as 3.9→7.9→8.9 consecutively in the same time frames.

Conclusion

Cardiac arrhythmia plus permanent pacemaker implantation, increased anxiety and depression of patients and decreased erectile function at AP1; however, the improvement in cardiac symptoms at AP6 with the possible positive effects of rehabilitation program, helps to reduce anxiety and increased IIEF scores, although there was still a slight increase in depression levels.

Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading

We aimed to assess the effect of spermatic vein ligation on seminal total antioxidant capacity (TAC) in patients with varicocele. Twenty infertile male patients with varicocele and 20 normal fertile men (control group) were included in the study. All the male patients were diagnosed with primary infertility and varicocele. The patients with varicocele were divided into two groups as nonpalpable (GI) (eight patients) and palpable (GII-III) (12 patients) varicocele groups. All the patients underwent microsurgical spermatic vein ligation. Seminal TAC levels and sperm parameters were evaluated in all the patients. Preoperative sperm count, sperm motility, sperm morphology and seminal TAC levels with equivalent figures 3-6 months after spermatic vein ligation and the same values of the control group were compared. There was a statistically significant increase in the total seminal antioxidant capacity level after spermatic vein ligation, and there was a statistically significant increase in the sperm count, sperm motility and spermatozoa with normal morphology. However, evaluation of the patients for varicocele grade showed a statistically significant increase in the TAC level only in the GII-III varicocele group. Spermatic vein ligation can improve the total seminal antioxidant capacity levels especially in patients with middle and high grade varicocele.

Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations

OBJECTIVES

To evaluate iatrogenic urinary tract system injuries in obstetrics and gynecology operations and compare the results with the literature.

PATIENTS AND METHODS

We examined the records of patients who had obstetric and gynecology operations at the Ministry of Health, Dr. Zekai Tahir Burak Women's Health, Training and Research Hospital between June 2007 and June 2010. All the patients who were diagnosed as having urinary system injuries in either the intraoperative or postoperative period were determined.

RESULTS

During this period, 25,998 gynecologic and obstetrical operations were performed, 0.03% ureteric, 0.20% bladder, and one case of urethral injury, in a total of 0.24% urinary tract injuries were observed. The bladder was the most frequently injured organ. Total urinary tract injury rates were 0.79% (0.49% bladder, 0.24% ureteral) in gynecologic operations and 0.19% (0.18% bladder and 0.01% ureteral) in obstetric operations.

CONCLUSION

Urinary system injuries are seen in approximately 1% of all gynecologic and obstetric surgeries. The complication rates observed in our patients were comparable with the other studies in the literature. A gynecologic surgeon must become familiar with the anatomy of the urinary tract and must be aware of common intraoperative and postoperative complications to decrease the risk of morbidity.

Quality of life and difficulties of patients encountered after autologous stem cell transplantation

PURPOSE

To assess the quality of life (QoL) and difficulties of patients encountered after (at least day 100+) autologous stem cell transplantation (ASCT).

METHODS

Patients from 4 bone marrow transplantation (BMT) centers in Ankara formed the study group. Data were collected via a socio-demographic form, the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30), the Long-term BMT recovery questionnaire and a specific questionnaire adapted from Bush BMT Symptom Inventory for measuring symptom severity and symptom distress related to ASCT. Out of 114 eligible patients 67 (58.8%) responded the questionnaires and were included in the study.

RESULTS

The mean time elapsed since transplantation was 16.1 months (range 4-43). Sixteen (23.9%) patients returned to work after transplantation; the mean time from transplantation to active work was 8 months. The symptoms experienced most, interfering with the patients' daily activities related to ASCT were fatigue, dental problems, hair loss, tingling sensation /numbness in hands and feet, mouth/throat problems, taste alterations, cough and skin problems. The majority of them reported fear of infection and disease relapse. Sexual dysfunctions, difficulty of concentration and difficulties of maintaining religious activities were also reported. 76% of patients reported their current QoL was the same or better than before transplantation and rated their current health-related QoL as good to excellent (mean 64.5). Financial difficulties, fatigue, sleeping problems, and pain were the factors most rated affecting QoL.

CONCLUSION

Fear of disease relapse, economical problems and difficulties with physical activities were reported as the most difficult factors to deal with after transplantation, showing the importance of creating multidisciplinary teamwork for these groups of patients.

Adiponectin levels in coronary artery ectasia

Etiopathogenesis of coronary artery ectasia (CAE), which is defined as abnormal dilatation of a segment of the coronary artery to 1.5 times of an adjacent normal coronary artery segment, is unclear. However, it is speculated that CAE develops in the atherosclerosis process through degeneration of coronary artery media layer. Our objective in this study is to compare levels of adiponectin between cases with CAE and normal coronary anatomy, and to examine whether adiponectin plays a role in CAE etiopathogenesis. The study registered a total of 66 cases, consisting of CAE cases (group 1, n = 36) and cases with normal coronary anatomy (group 2, n = 30). Taking coronary artery diameters of the control group cases as the reference, patients with abnormal segments 1.5 times larger than the adjacent segments were accepted as CAE. Serum adiponectin levels were 4.31 +/- 2.02 microg/ml in group 1 and 6.73 +/- 4.0 microg/ml in group 2 (P = 0.02). High-sensitivity C-reactive protein was 4.8 +/- 3.8 mg/l in group 1 and 3.6 +/- 3.4 mg/l in group 2 (P > 0.05). There was a negative correlation between ectatic coronary artery diameter and plasma adiponectin level (P = 0.03; r = -0.339). It was known that adiponectin levels dropped in atherosclerotic heart disease. In this study we found low plasma adiponectin levels in acquired CAE, attributed to atherosclerosis. Therefore, we think that adiponectin might be playing a role in etiopathogenesis and progression of CAE. This in turn may indicate that hypo-adiponectinemia may be useful in revealing a realized risk in CAE. However, larger, randomized, multicenter studies are required to examine the role of adiponectin in the development of CAE.

Plasma levels of tumor necrosis factor-alpha and interleukin-6 in obsessive compulsive disorder

Aim. Recent research implicated place of an immune mechanism in the pathophysiology of obsessive-compulsive disorder (OCD). Despite increasing evidence involvement of cytokine release in OCD, results of the studies are inconsistent. The aim of this study was to evaluate the plasma levels of the cytokines; tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in OCD patients. Methods. Plasma concentrations of TNF-α and IL-6 were measured in 31 drug-free outpatients with OCD, and 31-year age and sex-matched healthy controls. TNF-α and IL-6 concentrations in blood were determined by enzyme-linked immunosorbent assay (ELISA). Results. Both TNF-α and IL-6 levels showed statistically significant increases in OCD patients compared to controls (P < .000, P < .001, resp.). In addition, the age of onset was negatively correlated with TNF-α level (r = −.402, P = .025) and duration of illness was weakly correlated with IL-6 levels (r : .357; P : .048) in patients group. Conclusion. OCD patients showed increases in TNF-α and IL-6 levels compared to the healthy controls. This study provides evidence for alterations in the proinflamatory cytokines which suggest the involvement of the immune system in the pathophysiology of OCD.

Needs of lay caregivers of bone marrow transplant patients in Turkey: a multicenter study

The purpose of this research was to identify the needs of lay caregivers of bone marrow transplant (BMT) patients throughout the BMT trajectory. The sample consisted of 58 lay caregivers of BMT patients (5 of which were inpatients) from the 4 BMT units in Ankara, Turkey. Data were collected through a demographic data form and the Psychological and Social Needs Scale. Data analysis was performed using SPSS 10.0 for Windows. Among the descriptive statistics, frequencies and percentages were used to define the characteristics of lay caregivers and responses related to information. Mean values, standard deviations, and the Pearson correlation coefficients were also calculated for the results of the subscales. Most of the lay caregivers were spouses. The rest were other family members: brother/sister, mother, son/daughter, or father. Only one lay caregiver was a friend. The most common type of BMT was autologous. Most of the surveys were completed by the lay caregivers whose patients had been out of the hospital for 100+ days after BMT. The lay caregivers were educated on the BMT process by various sources, and 67.24% of them expressed satisfaction with the information that they were given. A majority of them preferred face-to-face communication with a healthcare professional. The categories of the information provided were diagnosis and treatment, homecare after discharge, follow-ups and laboratory tests, and nutrition. They indicated a need for more information, particularly regarding homecare after discharge and diagnosis. Fear was the highest scoring psychological needs/problems of lay caregivers, whereas leisure activity deficit was highest among the social needs/problems. The information gathered from this study led us to reevaluate our healthcare services for both patients and lay caregivers to improve physical, psychological, and social aspects of the nursing care as a whole.

The Effect of Angiotensin II Type-1 Receptor Gene Polymorphisms on Doppler Blood Flow Parameters of Carotid and Brachial Arteries in Patients with Myocardial Infarction

BACKGROUND

Genetic influence on Doppler blood flow parameters of carotid and brachial arteries (BA) is uncertain. We investigated the relationship between the angiotensin II type-1 receptor (AT1R) gene polymorphism and the blood flow characteristics of common carotid arteries (CCA) and BA by color Doppler ultrasound (CDUS) in patients with a first anterior acute myocardial infarction (AMI).

METHODS AND RESULTS

Sixty-seven patients (15 women and 52 men), aged 25-77 years, with anterior AMI were studied. The AT1R genotypes were established. Based on the polymorphism of the AT1R, they were classified into three groups: AT1R AA genotype (Group1, n = 42 patients), AT1R AC genotype (Group 2, n = 17 patients), and AT1R CC genotype (Group 3, n = 8 patients). Peak-systolic velocity (PSV) and end-diastolic velocity (EDV) of right and left CCA, PSV of right BA, and intimal-medial thickness (IMT) of both CCA were measured by CDUS. All results evaluated statistically. The AT1R genotypes were distributed as follows: 63% AA, 25% AC, and 12% CC. PSV of BA and both CCA were higher in patients with CC and AC than AA (P < 0.05). Also, IMT of both CCA were also higher in the same groups (P < 0.05).

CONCLUSIONS

Our results suggest that AT1R gene polymorphism influences Doppler blood flow parameters of both BA and CCA, and IMT of CCA. Although further studies are required.

Influence of Angiotensin-Converting Enzyme I/D Gene Polymorphism on the Right Ventricular Myocardial Performance Index in Patients With a First Acute Anterior Myocardial Infarction

BACKGROUND

The genetic influence on the myocardial performance index is uncertain, so the aim of the present study was to determine the effects of polymorphism of the angiotensin-converting enzyme (ACE) gene on the right ventricular myocardial performance index (RVMPI) after a first acute anterior myocardial infarction (MI).

METHODS AND RESULTS

The subjects were 116 patients with a first acute anterior MI. Based on the polymorphism of the ACE gene, they were classified into 3 groups: deletion/deletion (DD) genotype (group 1, n=45), insertion/deletion (ID) genotype (group 2, n=58), insertion/insertion (II) genotype (group 3, n=13). Echocardiograms were used to determine the RVMPI, left ventricular myocardial performance index (LVMPI), tricuspid E/A, tricuspid deceleration time and the left ventricular diameter diastolic and diameter systolic (LVDd and LVDs). RVMPI and LVMPI were significantly higher in the ACE DD group. Tricuspid E/A, DT, LVDd and LVDs showed no differences among the 3 groups.

CONCLUSION

The ID polymorphism of the ACE gene may affect RVMPI and LVMPI after a first acute anterior MI.