Could the Cerebral Involvement of COVID-19 Disease be Related to Microstructural Changes that are not Reflected in Conventional MRI Images?

In patients with COVID-19, neurodegeneration may develop before clinical symptoms appear. Diffusion-weighted (DW) MRI is an important technique for analyzing microstructural changes such as gliosis. In this study, a quantitative evaluation of microstructural changes in the brain with apparent diffusion coefficient (ADC) values in patients presenting with a headache after the COVID-19 disease was analyzed and compared. DW MR images of patients of 20 COVID-19 patients (13 females, 7 males) who required imaging due to headache; 20 controls (16 females, 4 males) were retrospectively reevaluated. ADC measurements were taken from 16 regions of the brain, including right and left symmetrical in patients with COVID-19 infections and control groups. All regions of interest (ROIs) were taken from the hypothalamus, parahippocampus, thalamus, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, and medulla oblongata posterior. ADC values in the dentate nucleus right (784.6 ± 75.7 vs. 717.25 ± 50.75), dentate nucleus left (768.05 ± 69.76 vs. 711.40 ± 52.99), right thalamus (731.15 ± 38.14 vs. 701.60 ± 43.65), left thalamus (744.05 ± 39.00 vs. 702.85 ± 28.88), right parahippocampus (789.10 ± 56.35 vs. 754.75 ± 33.78), right corpus striatum (710.00 ± 39.81 vs. 681.55 ± 39.84) were significantly higher than those in the control group. No significant changes were observed in other areas. A significant increase in ADC values at many levels in the brain in patients with COVID-19 disease and headache was observed. Thus, this study indicates that cerebral involvement in COVID-19 disease may be related to microstructural changes that are not reflected in conventional MRI images.

Knowledge level of medical students about ionising radiation used for diagnostic purpose in radiology: a survey study.

People exposed to ionising radiation may develop harmful somatic and genetic effects in their anatomical structures. Technological advancements, particularly in radiological devices, research and examinations result in a significant increase in the number of radiological investigations. This large number of radiological examinations increased the number of patients affected by ionising radiation. This study aims to evaluate the medical students' knowledge of ionising radiation and, examine the level of knowledge of medical students on the awareness and safety of ionising radiation exposure, emphasises the importance of radiation curricula internship programmes. This study is a survey application. The chi-square test is used. As a result, the intern's knowledge of ionising radiation increased significantly after the internship in a radiology unit. Although it has been significantly increased, it is still insufficient. This gap can be filled by incorporating radiology unit internship programmes into the curriculum of medical faculty education programmes.

The effects of long-term doppler ultrasound exposure in the prenatal period on renal tissue physiology in rats.

Doppler ultrasonography (DUSG) is widely used for fetal evaluations. This study investigated the effects of new generation Doppler ultrasound application at different frequencies during pregnancy on postnatal renal development. Six pregnant female rats were divided into three groups. No procedure was performed on the first (control) group. In the second group, transabdominal DUSG was performed continuously for 15 min every day from the first day of gestation until birth. In the third group, DUSG was applied for 15 min every two days. Twenty-four male pups were sacrificed after 60 days. Renal tissues were then collected and subjected to biochemical, histopathological, and immunohistochemical evaluation. Malondialdehyde, glutathione, urea, Ca, K, and Cl levels increased in the DUSG groups compared to the control group (p < .05). Histopathologically, tubular damage increased in the DUSG groups compared to the control group (p < .05). Immunohistochemically, an increase was determined in Caspase-3 expression in the DUSG groups compared to the control group (p > .05). The DUSG groups also exhibited an increase in the superficial areas of the proximal and distal tubules, although the difference compared to the control group was not significant (p > .05). Multiple administrations of new generation DUSG to pregnant rats resulted in deleterious effects on the development of postnatal renal tissue. This shows that DUSG should be applied for as short a time as possible and that re-exposure should be avoided.

Effects of long-term Doppler ultrasound exposure on cochlea and cochlear nucleus in prenatal period in an experimental model.

BACKGROUND: New generation Doppler ultrasonography (DUSG) application effects on cochlea and cochlear nucleus (CN) are unclear. We aimed to investigate the effects of new generation DUSG application at different frequencies in prenatal period on cochlea and CN in rats. OBJECTIVE: Twenty-four pregnant female rats were divided into three groups (n = 8). Group 1 was the control group and was not subjected to any treatment. Group 2 was determined as the USG every day (USGED) treatment group. Group 2 has received DUSG application every day from the 4th to 18th day (20 min/15 per day). Group 3 has received DUSG application as "2 days/one dose as every other day application" (USG2D1) from the 4th to 18th day (20 min/8 every other day). Twenty-four female rats were sacrificed in 21 days. Also, 24 pups were sacrificed after two days. First day after born, the cochlear activities of the right ears of all pups were examined using DPOAEs. Second day, neural tissues from CN were evaluated histopathologically and immunohistochemically. RESULTS: There was no any statistical difference between the groups in respect of histopathologically. USGED group showed mild caspase-3 positive neurons and glial cells. However, there was no significant difference between the USGED and other groups (p>.05). Similarly, the rats applied with USG2D1 had mild caspase-3 expression, but no significant difference between the USG2D1 and other groups (p>.05). Differences in DPOAE amplitudes, and therefore in cochlear activity, between the groups were revealed. The decrease in cochlear activity between the groups involved frequencies at 2, 8, 16, and 32 kHz (p<.05). CONCLUSIONS: Multiple administration of new generation DUSG to pregnant rats has not shown harmful effects on the cochlear neural tissue. High frequencies are more sensitive in cochlea to apply DUSG.

How important is susceptibility-weighted imaging in mild traumatic brain injury?

BACKGROUND: Mild traumatic brain injury (mTBI) is a public health problem that is recognized as a 'silent epidemic' in its late stages due to undiagnosed axonal damage rated 13 and above on the Glasgow Coma Scale (GCS). Injury-related microhemorrhages often cannot be detected on computed tomography (CT) scans and conventional magnetic resonance imaging (MRI). This study aims to investigate whether susceptibility-weighted imaging is feasible in mTBI patients. METHODS: Fifty-eight patients with GCS scores of 14 and 15 and with symptoms of brief mental fogs, impairment of concentration, memory loss, headache, dizziness, or imbalance after brain injury were examined at the emergency service. A brain CT scan and MRI containing diffusion-weighted and susceptibility-weighted imaging (SWI) sequences were performed on the patients whose symptoms did not seem to alleviate after the sixth hour. Thirteen patients were excluded from this study because of advanced age, diabetes, a history of hypertension or its chronic sequelae, or acute cerebrovascular disease; 45 patients were included in this study. RESULTS: The patients' CT results were normal, and no diffusion restrictions were observed. The SWI revealed microhemorrhages in seven patients (15.6%). Five of these patients had hyperintense areas in conventional sequences corresponding to the hemorrhages spotted in the SWI. In three of the five patients, these pockets of hemorrhages were higher in number and size in comparison with conventional in the SWI sequence. CONCLUSION: Susceptibility-weighted imaging, which can be used to assess the presence and severity of microhemorrhages due to diffuse axonal injury, is recommended for determining the cause of symptoms in patients with mTBI, to continue targeted treatment and prevent complications that may develop.

Rationalization of Using the MR Diffusion Imaging in B12 Deficiency.

CONTEXT: The structural imaging of brain does not demonstrate any changes in the vast majority of patients with vitamin B12 deficiency, even in the advanced stages. AIMS: We investigated the microstructural changes in the brain with diffusion imaging among patients with biochemical evidence of B12 deficiency. PATIENTS AND METHODS: We retrospectively analyzed all diffusion-weighted MRI images between the periods 2014-2016 who had biochemical evidence of B12. The age-sex matched controls were chosen from the group with normal B12 levels. Patients with pathological findings in conventional MRI images were excluded from the study. RESULTS: About 37 patients were recruited (22 women, 15 men; mean age, 34.1 ± 9.9 years; age range). They were about thirty-four age-and sex-matched controls (with normal B12 levels), which were also included in the study. The mean apparent diffusion coefficient (ADC) value of amygdala (773.8 ± 49.9 vs. 742.2 ± 24.2, P = 0.01), hypothalamus (721.3 ± 39.2 vs. 700.2 ± 38.2, P = 0.02), striate cortex (737.6 ± 77.6 vs. 704.3 ± 58.2, P = 0.04), suprafrontal gyrus (740.7 ± 46.9 vs. 711.6 ± 40.7, P = 0.007) and medulla oblongata-olivary nucleus (787.3 ± 56.4 vs. 759.7 ± 46.2, P = 0.02) were significantly higher in B12 deficiency group compared to controls, whereas ADC values were similar at hippocampus, thalamus, insula, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, cerebral pedicle, tegmentum, pons, and posterior medulla oblongata. CONCLUSIONS: Our study indicates that a significant increase in ADC values occurs in multiple brain regions in patients with vitamin B12.

Is There A Relationship Between Three-Dimensionally Measured Baker's Cyst Volume and Knee Pathologies?

OBJECTIVE: Baker's cyst (BC) is also known as popliteal cyst. To evaluate its effect on intra-articular pathology, it is important to have the exact volume of the cyst. As BC may change its shape due to mass effect of the surrounding anatomic structures, it is difficult to measure the exact volume of BC. This study examined the relationship between three-dimensionally measured BC volume and symptomatic intra-articular knee pathologies. MATERIALS AND METHODS: The magnetic resonance (MR) images of 45 patients with symptomatic knees were retrospectively examined.The BC volumes were measured via volumetric analysis. The joint effusion was examined in the sagittal plane in T2-proton density-weighted images. The medial plicae were assessed in accordance with the modified Sakakibara classification. Using the MR images, the meniscuses were classified in accordance with the meniscus rupture classification of Stoller et al. The cartilaginous lesions were analyzed using an MR grading system.In this study, correlations between the following measures were analyzed: BC volume and effusion level, medial plica presence, medial femoral condyle, medial tibial condyle, lateral femoral condyle and lateral tibial condyle cartilage degeneration, and medial meniscus anterior horn, medial meniscus posterior horn, lateral meniscus anterior and posterior horn ruptures. RESULTS: Cartilage degeneration, medial plicae, increase in intra-articular effusion, and increase in the BC volume were found to be statistically significant (p<0.01). CONCLUSION: Cartilage degeneration, medial plicae, and increase in intra-articular effusion may increase the BC volume. We believe that this study may contribute to clinicians in understanding the relationship between BC volume changes and pathologies causing intra-articular knee symptoms.

Effects of Gadodiamide and Gadoteric Acid on Rat Kidneys: A Comparative Study.

BACKGROUND: Gadolinium-based contrast agents are complex chelates to provide contrast in NRI. However, recent studies have highlighted the deposition of free Gd+3 ion in various tissues. PURPOSE: To evaluate the histopathological and immunohistochemical changes on rat kidney tissue following both macrocyclic (gadoteric acid) and linear (gadodiamide) agents under the hypothesis that gadolinium-based contrast agents (GBCA) lead to toxic, free Gd+3 accumulation in tissues. STUDY TYPE: The local Animal Care Committee approved the prospective animal study. ANIMAL MODEL: Thirty-two healthy Sprague-Dawley male rats were administered 2 mmol/kg gadodiamide and gadoteric acid for the first 4 days for 5 weeks. Group 1 received no drug (control, n = 8) and Group 2 (n = 8) was administered 0.1 ml/kg saline. Group 3 was administered 0.1 mmol/kg gadodiamide and Group 4 (n = 8) was administered 2 mmol/kg gadoteric acid. ASSESSMENT: Biochemical, histopathological, and immunohistochemical changes in testis kidney tissue were evaluated at the end of 10 weeks. STATISTICAL TESTS: Differences between groups were analyzed using the nonparametric Kruskal-Wallis test followed by one-way analysis of variance and the Tamhane test, also followed by Turkey's HSD test. RESULTS: Gadolinium increased serum urea, Ca+2 , and Caspase-3 positive tubular cell number. Larger Bowman capsules shrank proximal and distal tubules were revealed in the gadodiamide and gadoteric acid groups compared to the control group (P < 0.05). Histopathologic examination showed significantly more interstitial fibrosis, amyloid deposits, and vasocongestion in the gadodiamide group than the gadoteric acid and control groups, while the gadoteric acid group demonstrated significantly more leukocytic infiltration with atrophied proximal and distal tubules than the gadodiamide and control groups (P < 0.05). DATA CONCLUSION: GBCA administration causes significant histopathologic changes in kidney tissue. This study advocates additional investigation to assess the in vivo safety of GBCAs. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:382-389.

Intestinal nonrotation and left-sided perforated appendicitis.

Acute appendicitis is the most common cause of acute abdominal pain, requiring emergency surgery. Approximately one third of cases have pain unexcepted location due to its various anatomical location. Acute appendicitis is a very rare cause of left lower quadrant pain; if it occurs, a few congenital anomalies should be considered such as Situs Inversus totalis and Midgut Malrotation (MM). MM is a rare congenital anomaly; it occurs due to error in process of rotation or fixation of intestines around the superior mesenteric vessels and it refers to nonrotation or incomplete rotation of intestines. Here we report a case who presented with left lower abdominal pain and was diagnosed with acute perforated appendicitis with intestinal nonrotation. Clinicians should be aware that intestinal nonrotation may be presented with left lower quadrant pain and complicated by acute appendicitis.

The Efficacy of Magnetic Resonance Imaging for the Diagnosis of Superior Semicircular Canal Dehiscence.

OBJECTIVE: This study aimed to evaluate the efficacy of magnetic resonance imaging (MRI) for diagnosing superior semicircular canal dehiscence (SSCD). MATERIALS AND METHODS: The radiological records of patients who were admitted to our clinic with complaints of otologic and neuro-otologic symptoms between October 2014 and December 2015 were retrospectively reviewed. Among these patients, those who underwent both computed tomography and MRI and were reported to have SSCD in the temporal bone on at least one side were included in the study group. MRI records of patients with a confirmed diagnosis were then assessed for the presence of SSCD. RESULTS: The left and right semicircular canals of 52 patients were evaluated in this study. The sensitivity and specificity of MRI in the diagnosis of SSCD was 89.06% and 90%, respectively. The positive and negative predictive values were 93.44% and 83.72%, respectively. CONCLUSION: The use of multiplanar reformats and angulation techniques during MRI assessment of patients with neuro-otologic symptoms can improve the diagnostic process for patients with SSCD. This may allow early diagnosis of the disease by using just one imaging method, which would also reduce the costs per patient during the diagnosis period.

Submandibular Lateral Ectopic Thyroid Tissue: Ultrasonography, Computed Tomography, and Scintigraphic Findings.

Ectopic thyroid can be encountered anywhere between the base of tongue and pretracheal region. The most common form is euthyroid neck mass. Herein, we aimed to present the findings of a female case with ectopic thyroid tissue localized in the left submandibular region. A 44-year-old female patient, who underwent bilateral subtotal thyroidectomy four years ago with the diagnosis of multinodular goiter, was admitted to our hospital due to a mass localized in the left submandibular area that gradually increased in the last six months. Neck ultrasonography, contrast-enhanced computed tomography, and scintigraphic examination were performed on the patient. On thyroid scintigraphy with Tc-99m pertechnetate, thyroid tissue activity uptake showing massive radioactivity was observed in the normal localization of the thyroid gland and in the submandibular localization. The focus in the submandibular region was excised. Pathological examination of the specimen showed normal thyroid follicle cells with no signs of malignancy. The submandibular mass is a rarely encountered lateral ectopic thyroid tissue. Accordingly, ectopic thyroid tissue should also be considered in the differential diagnosis of masses in the submandibular region.

Cardiac injuries caused by blunt trauma: an autopsy based assessment of the injury pattern.

Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common, particularly as a result of rapid deceleration in high-speed vehicular accidents, over the past 2-3 decades. The high mortality rate of cardiac injuries and possible late onset complications make blunt cardiac injuries an important challenging point for legal medicine. One hundred and ninety cases with blunt cardiac injuries in a period of 3 years were analyzed retrospectively in terms of patterns of cardiac injury, survival times, and demographic profiles of the cases in this study.

Methanol intoxication: pathological changes of central nervous system (17 cases).

The nervous system has increased susceptibility for methanol intoxication. The aim of this study is to investigate various central nervous system lesions of methanol intoxication in 17 cases autopsied in the mortuary department of the Council of Forensic Medicine in Istanbul, Turkey. The reasons of methanol intoxication in the cases was likely the unwitting ingestion of methanol while drinking illegal alcohol. Survival times ranged from several hours to days. In 8 cases (47%), cerebral edema and in 9 cases (53%) at occipital, temporal and parietal cortex, basal ganglia and pons, petechial bleeding was observed. In addition to these findings, hemorrhagic necrosis were observed in thalamus, putamen, and globus pallidus in 5 cases (29.4%) and, in cerebral cortex in another 3 cases (17.6%). In 3 of the cases (17.6%) in which cerebral edema was found, herniation findings accompanied to the situation and in 2 cases (11.7%), pons bleeding was observed. Around the basal ganglia, in 2 of the cases with hemorrhagic necrosis, the situation ended with a ventricular compression. In 7 cases (41%), the associated findings of chronic ischemic changes in cortical neurons, lacunae formation, degeneration of granular cell layer of the cerebellum, and reactive gliosis were considered as the results of chronic alcoholism.

Suicide among children and adolescents in a province of Turkey.

Despite well-documented increases in completed suicides among children, accurate knowledge of the characteristics of these suicides is very limited. The aim of this study was to investigate general characteristics of suicide among children and adolescents in the province of Istanbul and to evaluate obtained results in the light of the literature. Data were collected from autopsy records of the Morgue Department of Institute of Forensic Medicine, Istanbul. General characteristics of completed suicides among children and adolescents between 2001 and 2005 were retrospectively reviewed. The study included 176 suicides aged 9-19 years. The overwhelming majority of the suicides (92%) were aged 15-19 years. More than half of the suicides (60%) were male. The most frequent means of suicide was hanging (55%) followed by firearms (20%) and jump or descent from height (15%).

[Assessment of smoking related pathologic changes and MMP-9, TIMP-1 expressions of the lung]. / Akcigerde sigaraya bagli patolojik degisimler, MMP-9 ve TIMP-1 ekspresyonlarinin degerlendirilmesi.

The impact of smoking on the peripheral airways, the determining field of respiratory functions in the lungs, is well known. Fifty two cases were included in the study; autopsy cases of non-cardiopulmonary related deaths with a smoking history, and cases with lung resection, known as smokers. Ten cases without a smoking history and a systemic disease were used as a control group at the histopathological examination. Parenchymal samples were taken from the central and peripheral airways (1st, 2nd, 3rd division) and from each lob. In addition, age, gender, amount and duration of smoking (package/year) were considered and histopathological changes of the lung are evaluated under the light microscope. The relations of all parameters to each other are evaluated and compared with the control group. On the distal airways with small diameter, Respiratory Bronchiolitis (RB) was determined in 14 (26.9%) cases, and Respiratory Bronchiolitis-associated interstitial lung disease (RB-ILD) in 16 (30.7%) cases. Two (3.8%) cases were diagnosed as Desquamative Interstitial Pneumonia (DIP). MMP-9, a matrix metalloproteinase known for its role in the development and repair of obstructive diseases of the lung related to smoking, and TIMP-1, an inhibitor, were used on the lung samples by means of immunohistochemical method. MMP-9 and TIMP-1 expressions of all cases were compared statistically with the existing pathological findings and the control group. MMP-9, TIMP-1 were expressed from the alveolar macrophages, endothelial and epithelial cells. Considering the MMP-9 and TIMP-1 density of alveolar macrophages, no statistically significant differences were found among the RB, RBILD and DIP case groups. However; despite of the significant MMP-9 expression of the DIP cases, TIMP-1 expression could not be determined. Compared to the control group, a more intensive and widespread positive reaction on MMP-9 was found in the alveolar macrophages. In conclusion, although there was no significant relation between the level and duration of smoking and the MMP-9 and TIMP-1 expressions, alveolar macrophages were found to be more important in lung damage related to smoking and the MMP-9 expression from these cells to be more intensive than the control group.

Quality assessment of perinatal and infant postmortem examinations in Turkey.

An autopsy examination is important in identifying the cause of death and as a means of auditing clinical and forensic practice; however, especially in perinatal and infantile age groups determining the cause of death leads to some difficulties in autopsy practice. In this study, 15,640 autopsies recorded during the years 2000-2004 in the Mortuary Department of the Council of Forensic Medicine were reviewed. Autopsy findings of 510 cases between 20 completed weeks of gestation and 1 year of age were analyzed retrospectively. The quality of each necropsy report was assessed using a modification of the system gestational age assessment described by Rushton, which objectively scores aspects identified by the Royal College of Pathologists as being part of a necropsy. According to their ages, the cases were subdivided into three groups. Intrauterine deaths were 31% (158 cases), neonatal deaths were 24% (123 cases), and infantile deaths were 45% (229 cases) of all cases. Scores for the quality of the necropsy report were above the minimum acceptable score with 44% in intrauterine, 88% in neonatal and infantile deaths.

Sudden death due to eosinophilic endomyocardial diseases: three case reports.

Eosinophils are associated with various disorders, such as allergic or hypersensitivity reactions, parasitic diseases, connective tissue diseases, certain neoplastic diseases (Hodgkin's disease, lymphomas, and carcinomas), and various immune deficiency states. Eosinophils can infiltrate any tissue and can cause tissue damage. Heart, has been demonstrated to be the most extensively involved and toxicity of eosinophils is well-established on cardiac tissue. We describe 3 cases with extensive eosinophilic infiltration without endomyocardial fibrosis. All patients died after a short clinical course with rapidly progressive heart failure. Bronchial asthma, hydatid disease and drug reaction were considered as possible etiologies of eosinophilia in case 1 and case 2. Case 3 was considered to fall into the "idiopathic hypereosinophilic syndrome" in which no underlying causes for eosinophilia could be identified.

Sudden death in infancy due to bicuspid aortic valve.

Symptoms of bicuspid aortic valve usually occur in the age group of 50-70 years, but rarely, it can also lead to sudden unexpected death in infancy and early childhood. The autopsy of a 2-month-old baby boy, found dead in his cot, revealed the heart weight as 25 g, and the macroscopic examination showed the circumference of the aortic valve consisting of two leaflets as 8 mm. The thickness of the left ventricle, right ventricle, and septum was measured as 8, 7, and 10 mm, respectively. Microscopically, the heart revealed hypertrophic changes of myocytes. Subendocardial areas displayed necrosis of myocytes, and severe and diffuse ischemic changes characterized by loss of myofibers and vacuolization. Interstitial pneumonia was identified in the lungs. Death occurred as a result of a congenital bicuspid aortic valve obstructing the left ventricular outflow tract complicated by lung infection. As there are only a few reported cases in infancy, and congenital bicuspid aortic valve can lead to sudden unexpected death, this case is presented to the forensic community.

[Pulmonary and systemic fat embolism as a cause of death in forensic autopsy practice]. / Adli otopsilerde ölüm nedeni olarak akciger ve sistemik yag embolizmi.

BACKGROUND: The aim of this study was to evaluate the possible correlations between the grade of fat embolism and age, gender, severity of trauma and post-traumatic survival time. METHODS: Thirty-one cases with pulmonary and/or systemic fat embolism, auotopsied at the Morgue Department of Council of Forensic Medicine were evaluated retrospectively. RESULTS: Twenty-eight cases (90%) died due to trauma and its complications. Nineteen cases (61%) were injured in motor vehicle-related accidents. Post-traumatic survival time varied between 0-384 hours (61.6+/-86.2 hours). Abbreviated injury scale (AIS) was 8.1+/-3.9 and injury severity score (ISS) was 26.5+/-19.7 SD. Twenty-four (77%) cases were determined as isolated pulmonary fat embolism and 7 (23%) cases as systemic fat embolism on histopathological examination. Possible correlations between the grade of fat embolism and age, gender, severity of trauma and post-traumatic survival time were evaluated statistically with using Chi-square and Spearman's correlation tests. CONCLUSION: There were no correlations between the grade of fat embolism and age, gender, the severity of trauma. Post-traumatic survival time and the severity of trauma had a very weak negative correlation without any statistical significance.