Cytokines and Other Laboratory Parameters of Hospitalized COVID-19 Patients that Predict Intensive Care Unit Admission.

BACKGROUND: This study aimed to investigate the roles of cytokines and other laboratory parameters in determining the need for intensive care in COVID-19 patients. METHODS: This is a retrospective observational study. Demographic, clinical, and laboratory parameters of the patients were evaluated. Thirteen cytokines were measured along with baseline laboratory tests at admission and at 48-hour intervals: IL-1ß, IFN-α, IFN-ß, TNF-α, MCP-1, IL-6, IL -8, IL-10, IL-2p70, IL-17A, IL-18, IL-23, and IL-33. RESULTS: COVID-19 was confirmed by PCR in 116 hospitalized patients. The mean age was 55.3 ± 16.4 years. Seventy-four (63.8%) of the patients were male and 42 (36.2%) were female. Twenty-two (18.9%) patients (16 male, 6 female) were transferred to the intensive care unit. A significant increase in white blood cell (WBC), neutrophil (Neu) and lymphocyte (Lym) counts, Neu/Lym ratio (NLR), lactate dehydrogenase (LDH), INR (international normalized ratio), activated prothrombin time (aPTT), D-dimer (D-D), troponin (Trop), Pro-BNP (BNP), procalcitonin (PCT), ferritin (Fer), and alanine aminotransferase (ALT) values were observed in those requiring intensive care. A significant decrease was found in albumin (Alb) levels and Lym counts. Alb levels appeared to be protective against admission to intensive care. Except for IFN- α, IL-23, and IL-33, the baseline values of other cytokines were above the threshold values. MCP-1 and IL-6 were higher in patients requiring intensive care. CONCLUSIONS: High NLR and LDH and low Alb levels, especially with an increase in MCP-1 and IL-6, were found to be the best predictors of a serious COVID-19 infection.

Cerliponase alfa decreases Aß load and alters autophagy- related pathways in mouse hippocampal neurons exposed to fAß1-42.

Extracellular aggregation of amyloid-beta (Aß) in the brain plays a central role in the onset and progression of Alzheimer's disease (AD). Moreover, intraneuronal accumulation of Aß via oligomer internalization might play an important role in the progression of AD. Deficient autophagy, which is a lysosomal degradation process, occurs during the early stages of AD. Tripeptidyl peptidase-1 (TPP1) functions as a lysosomal enzyme, and TPP1 gene mutations are associated with type 2 late infantile neuronal ceroid lipofuscinosis (LINCL). Nevertheless, there is little information about the role of TPP1 in the pathogenesis of AD; therefore, the present study aimed to measure the decrease in intraneuronal Aß accumulation by a recombinant analog of the TPP1 enzyme, cerliponase alfa (CER) (Brineura®), and to determine whether autophagy pathways play a role in this decrease. In this study, endogenous Aß accumulation was induced by fAß1-42 (a toxic fragment of full-length Aß) exposure, and mouse hippocampal neuronal cells (HT-22) were treated with CER (human recombinant rhTPP1 1 mg mL-1). Soluble Aß, TPP1, and the proteins involved in autophagy, including mammalian target of rapamycin (p-mTOR/mTOR), p62/sequestosome-1 (p62/SQSTM1), and microtubule-associated protein 1 A/1B-light chain 3 (LC3), were evaluated using western blotting. The sirtuin-1, beclin-1, and Atg5 genes were also studied using RT-PCR. Aß and TPP1 localizations were observed via immunocytochemistry. CER reduced the Aß load in HT-22 cells by inducing TPP1 expression and converting pro-TPP1 into the mature form. Furthermore, exposure to CER and fAß1-42 induced the autophagy-regulatory/related pathways in HT-22 cells and exposure to CER alone increased sirtuin-1 activity. Based on the present findings, we suggest that augmentation of TPP1 with enzyme replacement therapy may be a potential therapeutic option for the treatment of AD.

Consequences of Information and Communication Technologies and Environmental Degradation on Health Expenditure.

This study aims to examine how the subcomponents and overall measurement of ecological footprint, as well as the use of information and communication technologies, affect health expenditures. For this study, the sample group consisted of the top 25 countries with the highest ecological footprint for the period 2000 to 2021. System GMM estimation results demonstrate that economic growth and ecological footprint have a positive impact on health expenditures. Covid-19 dummy variables, have a statistically significant and positive effect on health expenditures. On the other hand, information and communication technologies has a statistically significant but negative effect on health expenditures. The estimation results show that the Covid-19 pandemic increased health expenditures. Looking at the effect of subcomponents of environmental degradation on health expenditures, all subcomponents have a statistically significant and positive effect on health expenditures. It is seen that the most effective variable is forest products. The variable that has almost the same impact as the footprint of forest products is the carbon footprint. Carbon footprint has significant and positive impact on health expenditures, followed by fishing grounds cropland, grazing land, built-up land. The results of the study indicate which forms of pollution should be given priority by policymakers in order to prevent an increase in health expenditure resulting from environmental degradation.

Delta neutrophil index (DNI) as a potential biomarker for fetal growth restriction: insights from maternal hematological changes and neonatal outcomes.

BACKGROUND: This study investigates the role of Delta Neutrophil Index (DNI), an inflammation marker, in late-onset fetal growth restriction (LO-FGR) and its prediction of composite adverse neonatal outcomes. METHODS: A retrospective study was conducted on 684 pregnant women (456 with normal fetal development and 228 with LO-FGR) who delivered at Health Sciences University Etlik Zubeyde Hanim Women's Health Training and Research Hospital between January 1, 2015, and June 30, 2018. Composite adverse neonatal outcomes were defined as at least one of the following: 5th minute APGAR score < 7, respiratory distress syndrome (RDS), or neonatal intensive care unit (NICU) admission. RESULTS: The FGR group had significantly higher levels of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and DNI compared to controls (p < 0.05, for all). For FGR diagnosis, the DNI demonstrated the highest area under the curve (AUC = 0.677, 95% CI: 0.642-0.711) with a cut-off value of > -2.9, yielding a sensitivity of 78.41%, a specificity of 52.97%, a positive likelihood ratio (+ LR) of 1.68, and a negative likelihood ratio (-LR) of 0.37 (p < 0.001). For predicting composite adverse neonatal outcomes in the FGR group, DNI again demonstrated superior performance with an AUC of 0.635 (95% CI: 0.598-0.670), a cut-off value of > -2.2, a sensitivity of 69.90%, a specificity of 55.36%, a + LR of 1.56, and a -LR of 0.51 (p < 0.001). NLR, PLR, and MLR had AUCs below 0.55, indicating poor discriminative ability, with none reaching statistical significance. CONCLUSION: This study highlights the potential role of DNI as a promising biomarker for detecting inflammatory processes associated with LO-FGR and its complications.

The efficacy and safety of isotonic and hypotonic fluids in intravenous maintenance fluid therapy in term newborns: national multicenter observational "neofluid" study.

Objective: The objective of this study was to evaluate the efficacy and safety of isotonic and hypotonic intravenous fluids in maintenance fluid therapy for term infants. Methods: This was a multi-centre, prospective, observational study conducted in 21 participating centres from December 30, 2020, to June 30, 2023. The study included term newborns requiring parenteral fluid therapy for maintenance (NCT04781361). The fluid treatment was divided into two groups based on the concentration of sodium in the parenteral fluid, designated as hypotonic (NaCl <130 mmol/L) and isotonic (NaCl = 130-154 mmol/L). The primary outcomes were the change in mean plasma sodium (pNa) levels per hour (∆pNa mmol/L/h), the incidence of hyponatremia (pNa <135 mmol/L) and hypernatremia (pNa >145 mmol/L), and the occurrence of clinically significant changes in sodium levels (∆pNa >0.5 mmol/L/h). Results: A total of 420 patients from 21 centers were included. The ∆pNa was negative in the hypotonic fluid group and positive in the isotonic fluid group, with a significant difference between the groups [respectively -0.07 ± 0.03 (95% CI: -0.13 to -0.02); 0.04 ± 0.03 (95%CI: -0.02 to 0.09), p = 0.04]. There was no difference between the groups in terms of the development of hypernatremia or a clinically meaningful pNa increase. The hypotonic fluid group had a higher incidence of hyponatremia and a clinically meaningful sodium decrease compared to the isotonic fluid group [7.9% vs. 1.2% (OR:6.5, p:0.03)] and [12.2% vs.4.2% (OR:2.9, p = 0.03)]. Conclusion: Contrary to current understanding, this large-scale study is the first to demonstrate that the use of hypotonic fluids in maintenance fluid therapy for newborns poses a risk of hyponatremia development, whereas isotonic fluid therapy appears safe.

Synthesis and characterization of new hexahydroquinoline derivatives and evaluation of their cytotoxicity, intracellular ROS production, and inhibitory effects on inflammatory mediators.

Inflammation is a response to injury and infection in an organism. It can be categorized as acute or chronic. Chronic inflammation is the underlying cause of many diseases such as Alzheimer disease, diabetes, rheumatoid arthritis, atherosclerosis, and cardiovascular diseases. Recent studies have proven the antiinflammatory properties of 1,4-dihydropyridines (1,4-DHPs) and their derivatives, which have many biological activities including the blocking of calcium channels. In this study, 15 compounds that are condensed derivatives of 1,4-DHPs, with the general structure of hexahydroquinoline-3-carboxylate, were synthesized. These compounds, expected to show inhibitory activity against inflammatory mediators, were obtained by the reaction of 4-(difluoromethoxy)benzaldehyde, substituted/nonsubstituted 1,3-cyclohexanedione derivatives, and appropriate alkyl acetoacetate compounds in the presence of ammonium acetate as a nitrogen source according to the Hantzsch synthesis method. The structures of the synthesized compounds were elucidated by IR, 1H NMR, 13C NMR, and HRMS methods. The cytotoxic properties of the compounds were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method in the 3T3 cell line. Among the 15 compounds, the three compounds with the lowest levels of cytotoxic effects were selected for further experiments. Inflammation was induced by lipoxygenase and the effects of the selected compounds on the levels of reactive oxygen species, cytokines, and complement C3 and C9 regulatory proteins were investigated. It was found that the three selected compounds decreased the levels of transforming growth factor-beta 1 (TGF-ß1). Among these compounds, compound 3e provided the most significant decrease in this cytokine. Moreover, 3e increased both C3 and C9 levels. Molecular modeling studies also showed that 3e had better affinity for TGF-ß1. When the binding modes of these compounds in the active site of TGF-ß1 were analyzed, it was found that compound 3e had hydrophobic interactions with amino acids Leu142, Tyr84, and Ile13; halogen bond interactions with Asp92; and hydrogen bond interactions with Ser89, Gly88, and Gly14 in the active binding site. Further in vitro and in vivo studies are needed to show the possible mechanism of action of compound 3e.

Evaluation of Drug-Related Problems of Intensive Care Unit Patients by Clinical Pharmacists: A Retrospective Study.

Objectives: The study aimed to identify drug-related problems (DRPs) and risk factors associated with the emergence of DRPs in intensive care unit (ICU) patients. Materials and Methods: This retrospective study included patients in the anesthesiology and reanimation ICU of a university-affiliated tertiary care hospital. DRPs identified by clinical pharmacists were classified using the Pharmaceutical Care Network Europe Classification for DRPs version 9.1. The association between various patient-related factors, and having DRPs were evaluated. Results: In total, 222 patients were included in the study, 128 of which were male (57.7%). The number of DRPs was 388 in 135 patients (1.75 ± 2.47 DRPs per patient). The group in which at least 1 DRP was identified, the duration of hospitalization was longer than in the group in which no DRP was identified (p < 0.001). In the groups in which there was the presence of mechanical ventilation support at admission or mortality, the mean DRP count was significantly higher than that in the other group (p < 0.05). Age, duration of hospitalization, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission had positive relationships with the DRP count, but the Glasgow Coma Scale (GCS) showed a negative relationship (p < 0.05). According to the binary logistic regression analysis (p < 0.001), in which the age of the patient, GCS score, APACHE II score at admission, duration of hospitalization, and presence of mechanical ventilation support at admission were included, only the APACHE II score at admission and duration of hospitalization significantly affected the emergence of DRPs. The major problem was related to treatment effectiveness (47.9%), followed by treatment safety problems (29.9%). The major causes of these problems were dose selection (44.0%) and drug selection (36.8). Interventions were made at the drug (97.2%) and prescriber level (2.3%). The acceptance rate of interventions and resolution rate of the DRPs were 93.6% and 85.1%, respectively. The top three medications that caused DRPs the most were as follows: meropenem, colistin, and piperacillin/tazobactam. Conclusion: Clinical pharmacists can detect and treat DRPs quickly. Our analysis shows that clinical pharmacy services are needed in high-DRP wards like ICU.

Use of Cosmetics and Adverse Cosmetic Events Among Female Nurses: Need for a Cosmetovigilance System.

Objectives: Cosmetics are known to cause adverse events in users, and there is limited information on this topic both globally and in Türkiye. This study was conducted to assess the use of cosmetics, patterns, and characteristics of adverse cosmetic events (ACEs) among female nurses. Materials and Methods: This cross-sectional study was conducted from February to April 2022 among registered female nurses with at least 1 year of work experience in a tertiary care hospital in Adana, Türkiye. A validated questionnaire was used for data collection, which included 13 questions with three main sections. The first part comprised demographic variables and cosmetic uses, the second part addressed ACE, and the final section consisted of consultation types and reporting methods for adverse events adopted after experiencing ACE. Results: Of the total 158 participants, 144 were included in this study, resulting in a response rate of 91.1%. All female nurses reported using cosmetics, and 26.4% (n= 38) reported experiencing one or more cosmetic ACEs. Itching, burning, and eczema were the most frequently observed ACEs. A higher proportion of ACEs were associated with face care products (18.4%) and deodorants (13.1%). More than half (57.9%) of the nurses did not consult with healthcare professionals after experiencing ACE. Moreover, most participants (47.4%) did not report ACE to healthcare authorities. Conclusion: A considerable proportion of the participants reported ACEs. The underreporting of ACE was also highlighted in this study. The results also emphasize the need for a robust cosmetovigilance system.

A rare case of necrotizing pneumonia due to brucellosis with blood and urine culture positivity.

Brucellosis is a zoonotic infectious disease widely seen worldwide, especially in developing countries and endemic regions where livestock farming is common. Brucella primarily affects the reticuloendothelial system and joints but can also localize in the central nervous, cardiovascular, and genitourinary systems. Pulmonary and urinary involvements are very rarely reported in the literature. This article presents a 24-year-old male patient who was admitted with syncope. Initially admitted with a preliminary diagnosis of Crimean-Congo hemorrhagic fever, the first thoracic computed tomography findings of the patient were considered alveolar hemorrhage. However, due to the growth of Brucella spp. in blood and urine cultures, the patient was diagnosed with necrotizing pneumonia due to brucellosis.

First Results of Pediatric Robotic Inguinal Hernia Repair with the Senhance® Surgical System: A Matched Cohort Study.

INTRODUCTION: Inguinal hernia repair (IHR) is one of the most common procedures in pediatric surgery. In children, the application of robotic surgery is limited, meaning safety and efficacy is still to be assessed. This report is the first one worldwide that describes inguinal hernia repair in children using the Senhance® Surgical System (SSS®). The aim of this matched cohort study is to assess safety and feasibility of robot-assisted IHR (RIHR) in children, compared to conventional laparoscopic IHR (LIHR). PATIENTS AND METHODS: This pilot study included 26 consecutive patients between 3 months and 8 years old who underwent RIHR (31 IH's) with the SSS® between 2020 and 2024. These cases were matched based on gender, age, and unilateral or bilateral IH, with 26 patients (32 IH's) who underwent conventional LIHR. RESULTS: There was a significant difference in total anesthesia time, which is most likely due to the extra time needed to dock the robot in the RIHR cases. No significant difference was seen in surgical time. One recurrence (3.2%) was diagnosed in both groups. One patient in the LIHR group was readmitted on the day of discharge due to a hemorrhage. No intervention was necessary, and the patient was discharged 1 day later. DISCUSSION: In this pilot study, the use of the robotic system was safe and feasible. More experience, further improvement of the system for use in very small children, and investigation in a larger sample size with long-term follow-up is necessary to evaluate efficacy.

The prognostic significance of growth pattern, tumor budding, poorly differentiated clusters, desmoplastic reaction pattern and tumor-stroma ratio in colorectal cancer and an evaluation of their relationship with KRAS, NRAS, BRAF mutations.

Growth pattern (GP), tumor budding (TB), poorly differentiated clusters (PDC), desmoplastic reaction pattern (DRP) and tumor-stroma ratio (TSR) are prognostic histomorphological parameters in colorectal cancer (CRC). Correlations between these parameters, their individual prognostic values, and their relationship with KRAS/NRAS/BRAF mutations have not been comprehensively examined. We aimed to investigate these associations, which have not been previously explored in this combination. 126 CRC cases were included. GP, TB, PDC, DRP and TSR were evaluated by two experienced pathologists. KRAS/NRAS/BRAF mutation profile were determined using qPCR. Demographic, clinicopathological and survival data were recorded. Interrelations were investigated by statistical analysis. Infiltrative GP was more frequent in high-score TB, PDC-G3, and stroma-high tumors (p < 0.05). High-score TB was more common in PDC-G3 and stroma-high tumors (p < 0.05). Immature DRP was more frequent in stroma-high tumors (p = 0.014). Among histomorphological parameters, a significant relationship was found only between infiltrative GP and the presence of KRAS mutation (p = 0.023). Moreover, GP was significantly associated with pT, lymphatic invasion, perineural invasion (p < 0.05). Effects on survival were assessed using Kaplan-Meier method and Cox proportional hazards model. TB and PDC were identified as independent predictors of overall survival. Higher TB score (p = 0.008) and higher PDC grade (p = 0.013) lead to worse survival. Interestingly, GP, DRP, TSR or KRAS/NRAS/BRAF mutations were not associated with overall survival. Our results highlight the prognostic significance of TB and PDC. We suggest incorporating TB and PDC into routine CRC reports. The association of KRAS mutation with infiltrative GP supports its role in the acquisition of invasive behavior.

The Effect of Local Cold Therapy on Myalgia Pain.

Objective: This study aimed to assess the efficacy of local cold therapy in reducing myalgia pain levels among emergency room patients. Methods: This was a pre-test/post-test randomized controlled study. Standard treatment (non-steroid analgesic anti-inflammatory parenteral medications) was implemented with one group, while the other groups received cold therapy and standard treatment. Before local cold therapy to the painful area, a Patient Description Form including sociodemographic information and a visual analog scale indicating pain level was applied. The VAS was repeated 10 and 30 minutes after cold therapy to the back. Results: Examining the patients' pain, it was seen that there was a significant difference in pain in the patients who received cold therapy compared to the standard group, especially after ten minutes (P < .05), but after 30 minutes, no significant difference was seen (P > .05). After the intervention, the pain level after 10 minutes in the control group was 6.6, while it was 4.4 in the experimental group. Conclusions: The research showed that cold therapy has an effect on the treatment of myalgia and reduces the level of pain, especially quickly. As a result, it is recommended that research on non-pharmacologic pain management in myalgia be increased.

In vitro anticancer efficacy of Calendula Officinalis extract-loaded chitosan nanoparticles against gastric and colon cancer cells.

OBJECTIVE: This study assessed the anticancer activities of Calendula officinalis-loaded chitosan nanoparticles in gastric and colon cancer cells compared with fibroblast cells and examined the balance between ROS and antioxidants. METHODS: Considering this information, we synthesized Calendula officinalis-loaded chitosan nanoparticles (CO-CSNPs) via the ionic gelation method. Their characterizations were carried out with ZetaSizer, UV-Vis, FTIR and SEM devices including size, morphology and surface zeta potential analysis, loading capacity, encapsulation efficiency, in vitro drug release, and chemical interactions. The anticancer activities of CO, CSNPs, and CO-CSNPs were tested against AGS, Caco-2, and normal NIH-3T3 cells using an XTT assay. The anticancer effects were evaluated using DAPI staining, scratch assay, reactive oxygen species (ROS) detection and the CUPRAC method on cellular and non-cellular processes that promote anticancer mechanisms. RESULTS: Results showed that CO and CO-CNPs exhibited anticancer activity against AGS and Caco-2. Further, the formulation of CO with CSNPs enhanced the anticancer activity of CO while having no cytotoxicity on NIH-3T3. DAPI staining, scratch assay, ROS, and CUPRAC method confirmed the anticancer activity of CO and CO-CSNPs, which resulted in a reduction in the number of apoptotic cells, inhibited migration, triggered apoptotic pathway via ROS, and higher antioxidant activity. CONCLUSIONS: The results of the study indicate that CO-CSNPs are a promising therapeutic formulation for gastric and colon cancer treatment. We consider that this study will lead to the investigation of molecular mechanisms of CO-CSNPs in cancer treatment and their investigation in clinical studies.

Assessment of Macular Hole Closure Speed Using Trans-tamponade OCT and 3-Dimensional Macular Hole Segmentation in the DISCOVER Study.

Introduction: To explore opportunities for individualized postoperative positioning duration in macular hole (MH) surgery. Methods: This post hoc analysis comprised eyes that had full-thickness MH (FTMH) repair in the prospective DISCOVER intraoperative optical coherence tomography (OCT) study. Preoperative spectral-domain OCT (SD-OCT) and postoperative day 1 (POD1) trans-tamponade OCT were analyzed. Preoperative SD-OCT macular cubes were imported and analyzed using a machine learning-enhanced segmentation platform. Nine preoperative segmentation parameters were analyzed (maximum foveal height, apex area, base area, central foveal area, maximum apex diameter, maximum base diameter, maximum depth, minimum foveal width, volume). In addition, 2 new metrics-the macular hole index and tractional hole index-were calculated. POD1 trans-tamponade OCTs were obtained and evaluated for hole closure. Results: Of the 66 eyes with an FTMH, 16 (24%) had a chronic MH and 5 (8%) were reoperations from FTMH nonclosure after previous surgery. Nine eyes (14%) had an open MH on POD1 trans-tamponade OCT (6 chronic MHs [66%]; 2 reoperations [22%]); the remaining 57 MHs (86%) were closed. Multiple segmentation parameters were significantly associated with POD1 closure. Conclusions: Volumetric MH measurements and trans-tamponade POD1 OCT closure status are important in predicting MH closure speed and the need for postoperative positioning. Individualized positioning duration in MH could lower perioperative morbidity and vastly enhance quality of life.

Chondroitin Sulfate Proteoglycan 4 (CSPG4) as a Potential Biomarker for Fetal Growth Restriction: Insights from an Umbilical Cord Blood Analysis.

BACKGROUND: This study aimed to evaluate the umbilical cord blood chondroitin sulfate proteoglycan 4 (CSPG4) concentrations in pregnancies complicated with fetal growth restriction (FGR) and aimed to investigate the rela-tionship between the CSPG4 levels in these pregnancies and adverse neonatal outcomes. METHODS: This prospective case-control study was conducted between August 2023 and January 2024. The study included 80 singleton pregnancies at 35 to 39 weeks of gestation. Among these, 40 were diagnosed with FGR and 40 served as the control group. After the delivery, samples of the cord blood were collected prior to the placental delivery. RESULTS: The CSPG4 levels were significantly higher in the study group (FGR), 1,153 (1,059 - 1,261) pg/mL, than in the control group, 1,107 (873 - 1,197) pg/mL (p = 0.024). When all patients were evaluated, the CSPG4 levels showed a positive correlation with the systolic/diastolic (S/D) ratio of the umbilical arteries (r = 0.276, p = 0.013). A statistically significant negative correlation was observed between the levels of CSPG4 in the umbilical cord blood and the Apgar scores at the 1st (r = -0.256, p = 0.022) and 5th (r = -0.250, p = 0.026) minutes. The discriminatory power of the umbilical cord CSPG4 level in the determination of composite adverse neonatal outcomes was evaluated by ROC analysis and a cutoff point of > 1,091.25 pg/mL, showing a sensitivity of 93.3%, a specificity of 46.2%, and an AUC of 0.661 (95% CI: 0.547 - 0.763, p = 0.019). CONCLUSIONS: Elevated levels of CSPG4 have been observed in the umbilical cord blood in pregnancies complicated by FGR; higher levels are associated with adverse neonatal outcomes.

Long-Term Structural Changes Observed on Gonioscopy and Anterior-Segment OCT Following Gonioscopy-Assisted Transluminal Trabeculotomy.

Objectives: To evaluate the long-term structural changes of the anterior chamber (AC) angle following gonioscopy-assisted transluminal trabeculotomy (GATT). Methods: The AC angle of 10 eyes that underwent GATT at least 6 years previously was assessed for structural changes. A detailed gonioscopy was performed to determine the state of the cleft and the position of the trabecular flap. An anterior segment optical coherence tomography (AS-OCT) examination was performed on the corresponding areas on gonioscopy. Results: The typical finding of the angle following GATT was an open cleft with a visible trabecular flap. However, the gonioscopy of our patients revealed three different cleft appearances: open, closed, and segmentally open cleft. In the long-term, the trabecular flap re-approximated the incision site in some areas resulting in the appearance of a closed cleft on gonioscopy. On AS-OCT the cleft was identified when the lumen of Schlemm's canal was connected to the AC, while the position of the flap differed. The cleft was observed as open in median 4.0 (IQR: 2.8-6.0) clock hours. The cleft was found open mostly in the superior quadrants of the angle (nine eyes). No correlation was found between the extent of open cleft and the percentage of IOP reduction. Conclusion: AS-OCT, when used in conjunction with gonioscopy, was found helpful to evaluate the structural changes following GATT. As observed in the study, the cleft tended to close in some areas. It was found preserved mostly in the superior half of the angle in the long term.

Evaluation of Factors Affecting the Health-Related Quality of Life in End-Stage Renal Disease Patients Receiving Hemodialysis Treatment in Northern Cyprus.

Introduction Health-related quality of life (HR-QoL) is recognized as an important predictor of mortality and morbidity in end-stage renal disease (ESRD) patients receiving hemodialysis (HD). The goal of this study was to obtain HR-QoL scores using the Kidney Disease and Quality of Life questionnaire (KDQOL-36TM) (RAND Corporation, Santa Monica, CA) and to assess the factors affecting HR-QoL in ESRD patients receiving HD. Methods A multicenter cross-sectional study was performed using the KDQOL-36TM for the assessment of HR-QoL of ESRD patients receiving HD in Northern Cypriot state hospitals. Alongside KDQOL-36TM scores for assessing HR-QoL, sociodemographic as well as relevant laboratory data were collected. Spearman Correlations and multiple linear regression analyses using the 'stepwise' method were carried out to identify predictors of HR-QoL. Nonparametric tests were used to determine significantly (p<0.05) associated variables. Ethical approvals were received from the Northern Cypriot Ministry of Health and Eastern Mediterranean University Research and Publication Ethics Boards. Results One hundred and thirty-eight participants were recruited in this study, corresponding to 85.1% of the total study population. Participants had a mean age of 66.49 ± 13.35. 65.2% of the participants were males. Participants had low scores on most dimensions of quality of life, namely, Burden of Disease, Physical Component Summary (PCS), and Mental Component Summary (MCS) subscales. Particularly, females, unemployed patients, and patients with more comorbidities had significantly lower scores (p=0.003, p<0.001, and p=0.005, respectively). Spearman correlation analyses revealed multiple significant moderate correlations between sociodemographic data, laboratory variables, and scores. Furthermore, multiple linear regression analysis identified gender (p=0.006), total number of comorbidities (p=0.005), age (p<0.001), and patient care (p=0.019) as significant predictors of KDQOL-36TM scores. Conclusion This study has shown that the quality of life of hemodialysis patients was highly impaired. Gender, current employment status, and presence of comorbidities were all significant independent factors affecting HR-QoL mean scores. Lastly, further studies regarding the implementation of routine HR-QoL surveillance and targeted interventions are required to better understand their potential therapeutic benefits.

THE ASSOCIATION BETWEEN AMINOGLYCOSIDE EXPOSURE AND OTOTOXICITY IN CHILDREN WITH CYSTIC FIBROSIS.

INTRODUCTION: Pulmonary exacerbations increase the requirement of aminoglycoside (AG) antibiotics in people with cystic fibrosis (pwCF). Several studies have shown that AGs have a cumulative effect on ototoxicity. We aimed to investigate the relationship between AG exposure and ototoxicity by using three different methods in patients with CF. MATERIALS-METHODS: The multicenter study included 121 pwCF aged between 5-18 years with a history of parenteral AG exposure. Standard pure tone audiometry (sPTA), extended high frequency audiometry (EHF-PTA), and distortion-product otoacoustic emissions (DPOAE) tests were performed. Mitochondrial mutation analysis for m1555G>A was performed in 61 patients. RESULTS: Median age was 12.85 years and 52.1% (n=63) were male. 18.2% (n=22) of the patients had received parenteral AGs more than 5 courses/lifetime. Ototoxicity was detected in at least one of the tests in 56.2% (n= 68) of the patients. Only 10.7 % (n=13) of the patients had reported a symptom indicating ototoxicity. 30.3% (n=30) of the patients had ototoxicity in the low-exposure group while it was 45.5% (n=10) in the high-exposure group according to EHF-PTA (p>0.05). Median number of parenteral amikacin courses was significantly higher in the ototoxic group [2(1.25-5.75) vs 2(1-3); p=0.045]. No m1555A>G mutation was detected in 61 patients who screened for mitochondrial mutation analysis. CONCLUSION: As AG ototoxicity occurs primarily at high frequencies, EHF-PTA is important in early detecting otoxicity. EHF-PTA and DPOAE detected ototoxicity in some patients with normal PTA results. All pwCF with a history of AG exposure should be evaluated for hearing loss since symptoms may only be noticed in the late period.

Investigation of the Effectiveness of an Algorithm as an Auxiliary Method in Intraoperative Consultations of Central Nervous System Tumors.

OBJECTIVE: One of the most difficult areas in a surgical pathology practice is intraoperative consultation. In a previous study, we proposed an algorithm that provides a systematic approach to intraoperative consultation for central nervous system tumors. Our aim was to demonstrate the effectiveness of this algorithm. MATERIAL AND METHODS: 102 cases were selected from intraoperative consultation procedures performed at our institution between 2012 and 2020. The algorithm was tested by five observers. The observers examined the smears and frozen sections without the algorithm, and then with the algorithm. RESULTS: The percentage change in the rate of correct diagnoses made by the four observers (O) increased after using the algorithm (O2: 8%, O3: 5%, O4: 8% and O5: 13%), but decreased for only one observer (O1) (5%). The most common error made by the four observers was `grading of glial tumors` (O1: 40%; O2: 23%; O4: 40% and O5: 27.5%), and this group of errors was mostly corrected by using the algorithm (O1: 33%; O2: 3.8%; O4: 23% and O5: 10%). For two observers (O2 and O5), a statistically significant change in diagnostic levels was observed after using the algorithm (p=0.024 and p=0.040; respectively). In addition, thanks to the use of the algorithm, a high degree of agreement was found between the observers` diagnoses (77.7%, p < 0.001). CONCLUSION: In the intraoperative consultation of central nervous system lesions, algorithms can help to increase the accuracy of the diagnosis and reduce interobserver variability. This study demonstrates that an algorithmic approach is an effective method for pathologists in intraoperative consultation procedures.