A new COVID-19 prediction scoring model for in-hospital mortality: experiences from Turkey, single center retrospective cohort analysis.

OBJECTIVE: Although many studies reported prognostic factors proceeding to severity of COVID-19 patients, in none of the article a prediction scoring model has been proposed. In this article a new prediction tool is presented in combination of Turkish experience during pandemic. MATERIALS AND METHODS: Laboratory and clinical data of 397 over 798 confirmed COVID-19 patients from Gülhane Training and Research Hospital electronic medical record system were included into this retrospective cohort study between the dates of 23 March to 18 May 2020. Patient demographics, peripheral venous blood parameters, symptoms at admission, in hospital mortality data were collected. Non-survivor and survivor patients were compared to find out a prediction scoring model for mortality. RESULTS: There was 34 [8.56% (95% CI:0.06-0.11)] mortality during study period. Mean age of patients was 57.1±16.7 years. Older age, comorbid diseases, symptoms, such as fever, dyspnea, fatigue and gastrointestinal and WBC, neutrophil, lymphocyte count, C-reactive protein, neutrophil-to-lymphocyte ratio of patients in non-survivors were significantly higher. Univariate analysis demonstrated that OR for prognostic nutritional index (PNI) tertile 1 was 18.57 (95% CI: 4.39-78.65, p<0.05) compared to tertile 2. Performance statistics of prediction scoring method showed 98% positive predictive value for criteria 1. CONCLUSIONS: It is crucial to constitute prognostic clinical and laboratory parameters for faster delineation of patients who are prone to worse prognosis. Suggested prediction scoring method may guide healthcare professional to discriminate severe COVID-19 patients and provide prompt intensive therapies which is highly important due to rapid progression leading to mortality.

HFE and ALK3 act in the same signaling pathway.

Hepcidin deficiency leads to iron overload by increased dietary iron uptake and iron release from storage cells. The most frequent mutation in Hfe leads to reduced hepcidin expression and thereby causes iron overload. Recent findings suggested that HFE activates hepcidin expression predominantly via the BMP type I receptor ALK3. Here, we investigated whether HFE exclusively utilizes ALK3 or other signaling mechanisms also. We generated mice with double deficiency of Hfe and hepatocyte-specific Alk3 and compared the iron overload phenotypes of these double knockout mice to single hepatocyte-specific Alk3 deficient or Hfe knockout mice. Double Hfe-/-/hepatic Alk3fl/fl;Alb-Cre knockouts develop a similar iron overload phenotype compared to single hepatocyte-specific Alk3 deficient mice hallmarked by serum iron levels, tissue iron content and hepcidin levels of similar grades. HFE protein levels were increased in Alk3fl/fl;Alb-Cre mice compared to Alk3fl/fl mice, which was caused by iron overload - and not by Alk3 deficiency. The data provide evidence by genetic means that 1. HFE exclusively uses the BMP type I receptor ALK3 to induce hepcidin expression and 2. HFE protein expression is induced by iron overload, which further emphasizes the iron sensing function of HFE.

Effect of irradiation on the shear bond strength of self-adhesive luting cement in different preparation depths.

OBJECTIVE: The purpose of this study was to evaluate the effects of pre- and post-irradiation application on the shear bond strength of self-adhesive luting cements to dentin and enamel. MATERIALS AND METHODS: Thirty-two extracted human maxillary incisor teeth were used in this study. Teeth were divided into two main groups according to preparation depth (0.5 mm and 1 mm) as Group E and Group D and were divided into four subgroups according to treatment protocol (n = 12). Teeth were irradiated and preparation was done after radiation. Adhesive luting cement was placed on the irradiated enamel and dentin surface (Groups E1, D1). Preparation was done before irradiation and resin cement was placed on the irradiated enamel and dentin surface (Groups E2, D2). The resin cement was first placed on their enamel and dentin surfaces and then the specimens were irradiated (Groups E3, D3). Irradiation was done with a total dose of 60 Gy, applied in fractions over 6 weeks for each groups (2-Gy/day fractions, 5 days per week). Nonirradiated groups were determined as controls groups (Groups C1, C2). The shear bond strengths of adhesive luting cement were examined. RESULTS: According to the two-way ANOVA results, depth of preparation and treatment protocol and their interactions were significant on shear bond strength of resin cement (P Conclusions: This study detected significant differences between the irradiated and nonirradiated groups, probably due to the changes in the crystalline structure of dental hard tissues.

Diagnostic values for egg white specific IgE levels with the skin prick test in Turkish children with egg white allergy.

BACKGROUND: The diagnostic values for the skin prick test (SPT) diameters and egg white-specific IgE (EW-sIgE) levels that will allow us to predict the result of the oral food challenge test (OFC) in the diagnosis of egg white allergy vary by the community where the study is carried out. OBJECTIVE: This study aimed to determine the diagnostic values of SPT and EW-sIgE levels in the diagnosis of egg white allergy. METHODS: 59 patients followed with the diagnosis of egg allergy September 2013 to September 2015 were included in our retrospective cross-sectional study. The patients were investigated in terms of egg and anaphylaxis history or the requirement of the OFC positivity. The demographic, clinical and laboratory findings of the cases were recorded, and they were compared with the patients with the suspected egg allergy but negative OFC (n=47). RESULTS: In the study, for all age groups, the value of 5mm in SPT was found to be significant at 96.4% positive predictive value (PPV) and 97.8% specificity and the value of 5.27kU/L for EW-sIgE was found to be significant at 76% PPV and 86.6% specificity for egg white. The diagnostic power of the SPT for egg white (AUC: 72.2%) was determined to be significantly higher compared to the diagnostic power of the EW-sIgE (AUC: 52.3%) (p<0.05). CONCLUSION: Along with the determination of the diagnostic values of communities, the rapid and accurate diagnosis of the children with a food allergy will be ensured, and the patient follow-up will be made easier.

Effects of radiological extent on neutrophil/lymphocyte ratio in pulmonary sarcoidosis.

OBJECTIVE: Determining the severity of sarcoidosis is based on the clinical and radiological findings of the disease and the changes in pulmonary function test results. On the other hand; studies are ongoing for objective and easy markers in this respect. Neutrophil/lymphocyte ratio (NLR) is shown as a good prognostic marker for inflammation due to tissue damage in recent clinical trials. In this study, we aimed to identify the possible relationship between NLR and radiological extent of sarcoidosis. PATIENTS AND METHODS: Data of 122 patients included in the study were evaluated retrospectively in terms of age, gender, complete blood count parameters, erythrocyte sedimentation rate (ESR) and radiological findings at the time of diagnosis. RESULTS: Mean NLR and ESR were significantly different between radiological stages according to chest radiography and also total HRCT score (THS) groups according to parenchymal involvement in thorax tomography (p <0.05). Mean NLR was found to be 1.28 in stage 0, 1.65 in stage 1, 2.88 in stage 2,5.47 in stage 3 and 8.48 in stage 4; 1.63 in THS group 1, 2.01 in group 2, 3.47 in group 3 and 5.46 in group 4. There were statistically significant positive correlations between NLR and WBC, NLR and THS, NLR and ESR, THS and ESR, ESR and platelet, WBC and #neutrophil, WBC and #lymphocyte. CONCLUSIONS: Our findings suggest that NLR might be used as a prognostic marker in pulmonary sarcoidosis.

The effect of melatonin on spinal cord after ischemia in rats.

STUDY DESIGN: Experimental animal model to assess ischemic spinal cord injury (SCI) following occlusion of the thoraco-abdominal aorta. OBJECTIVES: In the present study, we aimed to investigate the role of melatonin on SCI induced by ischemia and following reperfusion. SETTING: Animal Research Laboratory, Inonu University, Malatya, Turkey. METHODS: We evaluated oxidative damage and caspase-3 activity. In total, 32 adult Wistar albino rats were divided into four groups: Group 1, control (n=8); Group 2 (n=8), those subjected to ischemia/reperfusion (IR) by clamping the thoraco-abdominal aorta; Group 3 (n=8), melatonin (50 mg kg(-1)) treated; and Group 4 (n=8), melatonin (50 mg kg(-1)) followed by ischemia. All animals were kept alive for 48 h, and then spinal cord samples were removed. We assayed oxidative damage by measuring malondialdehyde (MDA), apoptosis by measuring activated caspase-3 (using immunoblots) and intrinsic antioxidative capacity by measuring reduced glutathione (GSH) levels in the spinal cord. RESULTS: The results indicated a significant decrease in activity of caspase-3 in SCI animals after treatment with melatonin, as it significantly decreased the formation of MDA and decelerated the loss of GSH. CONCLUSION: This study suggested that melatonin could be an effective neuroprotective agent for treatment of SCI.

Local sympathetic stimulation not only have local effects in patients with Raynaud's phenomenon.

OBJECTIVE: Many other organs and system can be affected in the course of Primary Raynaud's Phenomenon (RP). Simultaneously increased vasospasm in the pulmonary vascular bed may likely affect the pulmonary function. Therefore, we investigated the effect of Raynaud's phenomenon on the respiratory functions in this study. PATIENTS AND METHODS: Between March 2014 and December 2014, 30 patients with the diagnosis of PRP more than two years and 32 age-sex matched healthy controls were enrolled into this study. Cold stimulation test (CST) was performed. Pulmonary function test were performed following 30 minutes after CST and spirometric measurements were calculated. RESULTS: There were no statistically significant differences between two groups regarding their demographic and clinical data. Mean duration of symptoms from onset to present was 3.01 ± 1.05 years. Patients with Primary RP had significantly lower FVC and higher FEV1/FVC values compared to the control groups (p = 0.015 and p=0.045, respectively). CONCLUSIONS: We found that statistically significant decrease of FVC values in patients with Primary RP compared to the healthy controls could be a impaired innervation of pulmonary system and a predictor of pulmonary vasospasm and/or pulmonary Raynaud's phenomenon, which may develop in future periods.

Human milk banking and milk kinship: perspectives of religious officers in a Muslim country.

OBJECTIVE: The present study aims to determine the knowledge, attitudes and views of the Muslim religious officers regarding infant feeding, breast milk, wet nursing, milk kinship and human milk banks (HMBs). STUDY DESIGN: A total of 401 religious officers were included in the study. Participants included 355 community service religious officers and 46 faculty religious officers. RESULTS: Two hundred fifty-four (63.3%) participants were in favor of administering donor human milk when breast milk is not available from the mothers. To the question 'What kind of human milk bank would you approve as far as the religious sensitivity is concerned?' a majority of the religious officers (71.3%) responded that they would only approve if the milk pool contained a restricted HMB where a limited number of recipients were allowed to use the mixtures in these milk pools. Only 7 (1.7%) participants advocated initiating Western-style HMBs in Turkey. CONCLUSION: Turkish religious officers have revealed that they would only approve the establishment of an alternative HMB by a maximum three donors where up to three recipients whose identities are known by one another are allowed to use donor milk from each milk pool.

From cells to muropeptide structures in 24 h: peptidoglycan mapping by UPLC-MS.

Peptidoglycan (PGN) is ubiquitous in nearly all bacterial species. The PGN sacculus protects the cells against their own internal turgor making PGN one of the most important targets for antibacterial treatment. Within the last sixty years PGN composition has been intensively studied by various methods. The breakthrough was the application of HPLC technology on the analysis of muropeptides. However, preparation of pure PGN relied on a very time consuming method of about one week. We established a purification protocol for both Gram-positive and Gram-negative bacteria which can be completely performed in plastic reaction tubes yielding pure muropeptides within 24 hours. The muropeptides can be analyzed by UPLC-MS, allowing their immediate determination. This new rapid method provides the feasibility to screen PGN composition even in high throughput, making it a highly useful tool for basic research as well as for the pharmaceutical industry.

Multiple dural arteriovenous fistulas involving the cavernous sinus, transverse sinus, sigmoid sinus and spinal drainage: CT angiography findings in 14-year-old boy.

Dural arteriovenous fistulas (DAVF) are rare and constitute 10% to 15% of all intracranial arteriovenous malformations. Only few cases of DAVFs are reported in children. Here is the first case report describing CT angiographic findings in a 14 year old child having multiple DAVFs involving spinal canal, both cavernous and cerebral sinuses.

Recurrent rhinolithiasis: a case report with review of the literature / Rinolitiasis recurrente: reporte de caso y revisión de la literatura

Rhinolith is an uncommon nasal mass and a rare entity encountered in clinical practice. The typical symptoms of rhinolith are unilateral nasal obstruction, foul smelling purulent nasal discharge and epistaxis, crusting, swelling of nose or face, anosmia, epiphora and headache. In this report, we present a case of recurrent rhinolith manifesting as an incidental finding on dental radiographs. A 26-year old male patient with a history of long standing halitosis had an operation for rhinolith seven years previously. Rhinolith in the right nasal cavity was diagnosed on rigid endoscopic examination. Rhinolith was removed by using a rigid nasal endoscope under local anaesthesia. To our knowledge, recurrence of rhinolith has not been described previously in the literature.

El rinolito es una masa nasal poco común y una entidad rara en la práctica clínica. Los síntomas comunes del rinolito son: obstrucción nasal unilateral, secreción nasal purulenta y maloliente, epistaxis, encostramiento, inflamación de la nariz o la cara, anosmia, epífora, y dolor de cabeza. Este reporte presenta el caso de un rinolito recurrente, que se presentara como un hallazgo incidental en una radiografía dental. Un paciente varón de 26 años de edad, con una larga historia de consulta por halitosis con un dentista y un otorrinolaringólogo, fue operado a causa de un rinolito hace siete años. El rinolito en la cavidad nasal derecha, fue diagnosticado mediante un examen endoscópico rígido. El rinolito fue extirpado usando un una endoscopia nasal rígida, bajo anestesia local. Hasta donde sabemos, la recurrencia de rinolitos no ha sido descrita previamente en la literatura.

A 9-year follow-up of a girl with pyridoxine (vitamin B6)-dependent seizures: magnetic resonance spectroscopy findings.

Being an extremely rare condition makes the diagnosis of pyridoxine-dependent seizures (PDS) difficult. Early diagnosis of PDS is very important to prevent unwanted clinical outcomes. Elevated levels of glutamate and decreased levels of y-aminobutyric acid (GABA) in the frontal and parietal cortices are detected in this disorder. Here we present an 18 year old girl with PDS, who was reported 9 years ago with Magnetic Resonance Spectroscopy (MRS) findings. Present and past MRS findings showed a decrease in N-acetyl-aspartate-to creatine ratio on MRS. In this case it is surprising that neuronal damage has been preceded despite the administration of accurate treatment. That can be because of delay in treatment and/or under treatment.

Recurrent rhinolithiasis: a case report with review of the literature.

Rhinolith is an uncommon nasal mass and a rare entity encountered in clinical practice. The typical symptoms of rhinolith are unilateral nasal obstruction, foul smelling purulent nasal discharge and epistaxis, crusting, swelling of nose or face, anosmia, epiphora and headache. In this report, we present a case of recurrent rhinolith manifesting as an incidental finding on dental radiographs. A 26-year old male patient with a history of long standing halitosis had an operation for rhinolith seven years previously. Rhinolith in the right nasal cavity was diagnosed on rigid endoscopic examination. Rhinolith was removed by using a rigid nasal endoscope under local anaesthesia. To our knowledge, recurrence of rhinolith has not been described previously in the literature.

Prevalence of oral mucosal lesions from birth to two years.

OBJECTIVE: The purpose of this study was to determine the prevalence of lesions of the oral mucosa from birth to two years in Turkish pediatric patients . MATERIALS AND METHODS: A total of 299 infants from newborn to two years of age were evaluated from the Outpatient Clinics of the Pediatric Department, in the Fatih University Hospital, Ankara, Turkey. The mucosal lesions were documented. The data were presented as percentages and for categorical comparisons Chi-square or Fisher's Exact test were used. A P-value less than 0.05 was considered statistically significant. RESULTS: Of the 299 infants, mucosal lesions were seen in only 65 (21.27%). In the study, the most common lesions were candidiasis (10.70%), Ebstein's pearls (2.68%), and geographic tongue (2.68%). The frequency of children with mucosal alterations was higher in the group of children from two to twelve months. CONCLUSIONS: Although the lesions that were found the most in our study were benign lesions, unrelated to systemic diseases, we still believe that oral mucosal lesions can be a sign of a systemic or dermatological disease in infants, which affects the oral feeding of the infants. Routine examination of the oral mucosa should be a part of the pediatric examination.

Spectral changes in electrical activity of pylorus due to L-NAME induced hypertrophic pyloric stenosis.

OBJECTIVES: To investigate the relation between hypertrophic pyloric stenosis (HPS) and the changes in the myoelectrical activity of the pyloric and gastric areas. METHODS: Three pregnant females, at 14 days of gestation two of which were named as D14n (NOS inhibitor group) and one was named as D14c (control). From the beginning of the study until the end of gestation, rats in D14n group received nitric oxide synthase inhibitor L-NAME for administrating their pups, and the rat in D14c group was drinking water for 21 days. The pups of each group underwent laparotomy at 42 days of their life and myoelectrical signals of their pyloric and gastric regions were recorded via bipolar electrodes and then evaluated through signal processing. RESULTS: Signal analysis showed that HPS induced pyloric segment reveals a suppressed spectral component that was detected in normal pyloric segment. The HPS induced pyloric segment also revealed higher power/ min and +/- SD compared to that of normal and gastric areas. In the pyloric segment, while the number of interstitial cells of Cajal (ICC) was lesser, the number of smooth muscle cells was higher than in the pyloric segment of controls. CONCLUSIONS: The spectral differentials depend on the type, population and condition of locally specialized muscular mechanism which can be affected from HPS. The HPS also has a relation to specific cells, such as ICC that generates NO, provoke the spontaneous pacemakers and biological slow waves (Tab. 1, Fig. 1, Ref. 19).

Diffuse edema and bilateral massive pleural effusion as the presentation of systemic lupus erythematosus.

A rare case of systemic lupus erythematosus (SLE), with massive bilateral pleural effusions and generalized edema as the first manifestations, is reported. The patient was a previously healthy 13-year-old boy. He presented with a history of fever, lack of appetite, gradually increasing fatigue, cough, diffuse edema, and moderate dyspnea. He responded well to corticosteroids with resolution of the pleural effusions, and edema. SLE should always be kept in mind in cases of massive pleural effusions and/or diffuse edema, even in the absence of other clinical manifestations of the disease.

Maternal serum and cord blood preptin levels in gestational diabetes mellitus.

OBJECTIVE: To assess preptin concentrations in pregnant women with and without gestational diabetes mellitus (GDM) and in the cord blood of their fetuses. STUDY DESIGN: In all, 31 pregnant women with GDM and 31 gestational age-matched healthy pregnant subjects participated. Maternal serum and cord blood preptin levels were measured with ELISA. The relationships between maternal serum and cord blood preptin levels, anthropometric and metabolic parameters were also assessed. RESULT: Maternal serum and cord blood preptin levels were found higher in patients with GDM compared with control pregnant women. Preptin concentration in maternal serum was positively correlated with maternal age, fasting insulin levels, 1-h blood glucose after glucose load and cord preptin concentrations at birth. However, relationships between maternal and/or cord serum preptin and fetal growth parameters at birth were not detected. CONCLUSION: Our results indicate that preptin concentrations increase in maternal serum of women with GDM. Preptin levels may provide a novel approach to identify women with GDM.

Hallermann-Streiff syndrome with hemihypertrophy.

We report on a five year old girl with Hallermann-Streiff syndrome and hemihypertrophy. Hemihypertrophy does not appear to have ever been associated with Hallermann-Streiff syndrome.

A collodion baby with hypothyroidism.

Collodion baby is a rare keratinizing congenital disorder. Although it is milder in degree than harlequin fetus, the infant is at risk for increased water loss, thermal instability, percutaneous toxicity, and infection as a result of an impaired skin barrier function. Here we report on an 11 days-old collodion baby with hypernatremic dehydratation, septicemia and congenital hypothyroidism. To our knowledge congenital hypothyroidism associated with collodion baby is reported in only one case up to date.