Determination of the optimal position of the lower extremity for femoral nerve block with ultrasonographic measurements: a prospective volunteer-based study.

OBJECTIVE: The aim of the study was to determine the optimal position for femoral nerve block (FNB) under ultrasound guidance. PATIENTS AND METHODS: We included fifty volunteers between 18-65 years of age in this study. The distances from the skin to the landmarks, which were taken as a reference for the ultrasound-guided FNB (apex point of the femoral artery = F12, lateral point = F9, and lower point = F6), were measured and compared in 3 different positions given to the lower extremity (neutral position: P1, 45° abduction: P2, and flexed knee: P3). The ease of application and the quality of the ultrasound images were evaluated at each measurement by assigning a subjective observer score and comparing them in three positions. RESULTS: All three measurement points were found to be closest to the skin at position P3. However, the distances from F9 (p = 0.023) and F6 (p = 0.006) to the skin were significant. A significant difference was found between P1 and P3 in terms of the distance from F9 (p = 0.027) and F6 to the skin (p = 0.007). P3 was determined to be the position with the highest score for clarity of the ultrasonography images and ease of detection of the measurement points (p < 0.001). As the scores of ease of access to the femoral nerve (FN) and image clarity increased, the distance from the measurement point to the skin surface decreased, which was statistically significant. CONCLUSIONS: The ideal position for ultrasound-guided FNB is the P3 position. As an alternative for patients with limited mobility, the P2 position can be used.

The comparison of 1-year results for mini and wide-size cap grafts applied to nasal tips.

OBJECTIVE: In the present study, we evaluated patient satisfaction with cap grafts by Rhinoplasty Outcomes Evaluation (ROE) scores. Mini cap and wide cap grafts were applied. PATIENTS AND METHODS: A total of 80 patients who underwent a rhinoplasty operation with cap graft application to the tip region were included in the study. According to the cap graft size, there were two groups: Group 1 consisted of 40 patients with cap graft size ≤7 cm (mini cap group). Group 2 comprised 40 patients with cap grafts ≥8 cm (wide cap group). Patients in groups 1 and 2 underwent evaluations based on the following criteria at preoperative, postoperative-1st month, and postoperative-1st year intervals: (1) Rhinoplasty Outcomes Evaluation Questionnaire (ROE), (2) tip projection (cm), (3) nasal dorsum length (cm), (4) tip projection ratio (Goode), (5) nasofrontal angle, and (6) nasolabial angle. RESULTS: Postoperative 1st-month and 1st-year ROE scores of the wide cap group were significantly higher than those in the mini cap group (p<0.05). Preoperative tip projection ratio (Goode) values of the wide cap group were considerably higher than those in the mini cap group (p<0.05). There were no significant differences between tip projection, nasal dorsum length, nasofrontal angle, and nasolabial angle values of the mini cap and wide cap groups (p>0.05). Correlation tests showed that as preoperative ROE scores decreased, postoperative-1st month and 1st-year ROE scores increased (p<0.05). Postoperative 1st-month and postoperative 1st-year's ROE scores increased together (p<0.05). In the wide cap group, postoperative 1st-month and postoperative 1st-year's ROE scores increased compared to the mini cap group (p<0.05). As postoperative 1st-year nasolabial angle values increased, postoperative 1st-year ROE scores also increased (p<0.05). CONCLUSIONS: We found that patients who received wide-cap rhinoplasty had increased postoperative ROE scores and higher satisfaction rates during the first month and first year. Postoperative higher nasolabial angle values were related to higher ROE scores and patient satisfaction in the postoperative 1st year.

Hyperpigmentation on head and neck caused by polymyxin B: A rare case.

Polymyxin B was widely used to treat drug-resistant gram-negative bacteria and showed a better antibacterial effect. However, it is associated with some side effects. It should be remembered that polymyxin B may cause hyperpigmentation, albeit rare. This is a case report of a 68-year-old male patient who developed hyperpigmentation following treatment of a chest infection with polymyxin B. He was a known patient with chronic kidney diasease and chronic obstructive pulmonary disease followed up in the intensive care unit due to acute exacerbation of COPD. Later, polymyxin B treatment was started due to the development of pneumonia caused by the multidrug-resistant Acinetobacter baumannii. On the second day of polymyxin B treatment, hyperpigmentation developed in the face and neck region. The fact that the patient had chronic kidney disease possibly facilitated the development of skin hyperpigmentation due to the cumulative effect of polymyxin B. Hyperpigmentation which a rare side effect of polymyxin B may occur in those with underlying kidney disease.

Comprehensive biomarker analysis of patients with idiopathic pulmonary fibrosis and interstitial lung disease with healthy individuals.

OBJECTIVE: Interstitial lung diseases (ILDs) are a group of diffuse parenchymal lung disorders that can be idiopathic [idiopathic pulmonary fibrosis (IPF)] or associated with other diseases and are characterized by varying degrees of inflammation and fibrosis with poor prognosis. Several indicators are essential in diagnosing these individuals and differentiating between IPF and ILD. PATIENTS AND METHODS: The study involved 44 IPF patients, 22 ILD (non-IPF) patients, and 24 healthy people. We aimed to compare ILD (non-IPF) and IPF patient groups with each other and with healthy people in terms of interleukin (IL)-1, tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase (MMP)-1, MMP-7, galectin (Gal)-3, IL-6, Krebs von den Lungen-6 (KL-6), total antioxidant status (TAS), total oxidant status (TOS), pyruvate kinase (PK), complete blood count (CBC), ferritin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) features. Furthermore, it was intended to assess the patient groups in terms of visual semi-quantitative score (VSQS) (IPF alone), respiratory function tests (RFT), and 6-minute walk test (6MWT), also potential correlations between these tests and the previously indicated parameters. RESULTS: MMP-1, MMP-7, Gal-3, IL-6, KL-6, forced vital capacity (FVC), % FVC, forced expiratory volume in 1 second (FEV1), % FEV1, TAS, TOS, and PK values significantly elevated in IPF and ILD. Weight, IL-1, MMP-1, MMP-7, Gal-3, IL-6, KL-6, % FVC, FEV1, % FEV1, eosinophil count, and % red blood cell distribution width (RDW) values differed between IPF and ILD. VSQS, 6MWT, and PK were substantially linked with MMP-1, MMP-7, Gal-3, IL-6, and KL-6 in IPF. CONCLUSIONS: The factors investigated can be helpful in the diagnosis and distinction of IPF and ILD. In addition to focusing on the inflammatory environment in IPF and ILD patients, oxidant and antioxidant interactions must be studied.

Retinal nerve fiber layer and ophthalmic artery blood flow parameters in pseudoexfoliation syndrome and pseudoexfoliative glaucoma.

OBJECTIVES: To investigate the relationship between ophthalmic artery (OA) blood flow parameters and retinal nerve fiber layer (RNFL) thickness in eyes with pseudoexfoliation (PEX). METHODS: We compared PEX eyes without glaucoma (group A, n=53) and those with glaucoma (group B, n=18) with control eyes (group C, n=44). Subsequently, eyes in groups A and B were compared. Finally, OA color Doppler imaging measurements were recorded, and peripapillary RNFL analysis was performed. RESULTS: The total RNFL measurements differed significantly among the groups (P=0.012), being thicker in group C than in group A (P=0.010) and significantly different between group B and groups A and C (both P=0.001). The peak systolic velocity (PSV) and end diastolic velocity (EDV) measurements of groups A and B were lower than those of group C (PSV: P=0.001 and P=0.001, respectively; EDV: P=0.001 and P=0.001, respectively). No significant difference was noted in resistive index (RI) measurements (P=0.370). In group B, significant negative correlations were noted between total RNFL and PSV (r=-0.743; P=0.001) and between total RNFL and EDV (r=-0.691; P=0.001), but not between total RNFL and RI measurements (P=0.548). CONCLUSIONS: Pseudoexfoliation syndrome (PXS) with or without glaucoma was associated with a decrease in the PSV and EDV values of the OA. An extensive study may be needed to further explore the role of PXS in OA blood flow parameters. Total RNFL thickness values were lower in eyes with PEX than in those without.

The effect of TAP block use in postoperative analgesic in cesarean section.

OBJECTIVE: TAP (transversus abdominis plane) block is an important parameter of multimodal analgesia in the control of postoperative pain in cesarean section cases. In our study, we aimed to compare the analgesic consumption, patient satisfaction rate, vital signs, and visual analog scale (VAS) scores of ASA II patients with and without TAP block in cesarean surgery. PATIENTS AND METHODS: This study was designed as a retrospective review of prospectively collected data and an open-label and randomized clinical trial. The files of 180 patients who underwent elementary cesarean section between January 2019 and December 2019 were analyzed. The ASA score, anesthesia method, age, weight, height, parity, TAP block application, VAS score, analgesia duration, the additional analgesic requirement for maintenance, patient satisfaction, postoperative nausea, vomiting, urinary retention, and other complications were recorded. The 180 patients included in the study were divided into 6 groups: Group 1 - General anesthesia, Group 2 - General anesthesia + TAP block, Group 3 - Spinal anesthesia, Group 4 - Spinal anesthesia + TAP block, Group 5 - Epidural anesthesia, and Group 6 - Epidural anesthesia + TAP block. RESULTS: There was no significant difference between the groups in terms of demographic variables. The VAS scores of the first 24 hours were significantly different for Group 1. VAS scores in the 1st and 3rd hours were significantly higher in Group 1 than in the other groups. The groups without TAP block had significantly higher VAS scores at the 12th hour. Furthermore, the VAS score in Group 6 at 24 hours was significantly the lowest, and the earliest analgesic requirement was in Group 1. When the number of analgesic needs of the patients in 24 hours was examined, Group 1 was found to be significantly the highest, and Group 6 was significantly the lowest of all groups. CONCLUSIONS: The epidural anesthesia + TAP block Group had the lowest VAS score, the fewest analgesic requirements, the longest analgesia length, and the highest patient satisfaction.

Investigation of ideal ointment combination to use in septorhinoplasty or nasal flap surgeries.

OBJECTIVE: We aimed to create an ideal ointment combination to provide fast wound healing with the highest patient comfort after nasal surgery and nasal flap surgery. MATERIALS AND METHODS: Twenty-one male Wistar rats were included. The flap survival method was used. The rats' healing process was evaluated in all groups. After having the same surgical procedure, the following ointments were applied to flap borders twice a day for seven days in each of the groups. In group 1 (Control, n=7), Dexpanthenol 5% (Dex); in group 2, Dex, Ciprofloxacin 0.5 % (Cip) and Ephedrine hydrochloride 1% (Eph); in group 3, Dex+Cip+Eph and Ketoprofen 2.5% (Ket) was applied. On the seventh postoperative day, the size of the necrosis on the flap was evaluated. RESULTS: Median necrotic areas on skin flaps were 36.00% sq mm in group 1, 23.00% sq mm in group 2, and 5.00% sq mm in group 3. Flap necrosis areas on skin flaps were group 3

Comparison of immune modulatory properties of human multipotent mesenchymal stromal cells derived from bone marrow and placenta.

Multipotent mesenchymal stromal cells (MSC) can be isolated from many tissues, including bone marrow (BM) and placenta (PL). Human placenta can be obtained readily without invasive procedures. There may be differences, however, in differentiation capacity and immunomodulation by MSC isolated from BM or PL. The early pregnancy factor (heat shock protein 10; EPF/Hsp10) is a small protein that exhibits immunomodulatory properties. We compared BM- and PL-MSC, and assessed their efficacy for suppressing T-cell proliferation in vitro and the role of EPF/Hsp10 in this process. PL-MSC were collected from whole placenta after removal of the amniotic and chorionic membranes followed by serial enzymatic digestions. The PL-MSC were compared to BM-MSC, obtained from healthy donors. Differentiation capacity, cytokine secretion, expression and secretion of immunomodulatory molecules, immunophenotype and real time proliferation were assessed using cytokine arrays, ELISA assays, flow cytometry, immunohistochemical staining and western blotting. Whereas BM-MSC consisted of a homogeneous cell population with strong expression of mesenchymal markers, PL-MSC consisted of a mixed population of cells with variable CD73, CD90 and CD105 expression. PL-MSC exhibited a significantly greater proliferation rate than BM-MSC. The presence of both stem cells and more mature cells in the PL-MSC cultures resulted in decreased differentiation capacity and reduced efficacy of immune suppression in co-cultures with T-cells. Although robust intracellular expression of EPF/Hsp10 in both BM- and PL-MSC was observed, secretion of the protein in response to immune activating stimuli remained below detectable levels. Secretion of pro-inflammatory cytokines was significantly greater in BM-MSC than PL-MSC, whereas no difference was observed in the secretion of hematopoiesis supporting growth factors. Development of culture methods for isolation of pure populations of PL-MSC may improve the quality of the product and reproducibility of results.

Early Endoscopy Decrease the Length of Hospital Stay and the Costs in Patients with Upper Gastrointestinal Bleeding.

BACKGROUND: Acute gastrointestinal (GI) bleeding is a common cause of hospitalization. There are conflicting results regarding the effectiveness of early endoscopy in patients with upper GI bleeding. OBJECTIVE: The study aimed to determine the benefit of early endoscopy and the epidemiological characteristics of patients presenting to the emergency department with non-variceal acute upper GI bleeding. METHODS: Patients over 18 years of age who presented to the emergency department with upper GI between 2015 and 2016 and underwent endoscopy were included in the study. The patients were divided into two groups: early endoscopy group (endoscopy within the 24 h) and late endoscopy group (endoscopy after 24 h). RESULTS: Of 104 patients, 57.7% were man, and the mean age was 66.27 ± 17.64 years. Of the patients who underwent endoscopy, 80 (76.9%) were in the early endoscopy group. There was no difference in blood transfusion needs (P = 0.388), re-bleeding (P = 0.137), the need for surgery, and mortality rates with regard to the timing of endoscopy. The results of the receiver-operating characteristics curve analysis revealed patients with a GBS ≥ 9 were taken as high-risk, and a prognosis analysis was performed accordingly. However, in patients undergoing early endoscopy, a difference was detected with respect to the length of hospital stay (P = 0.011) and treatment costs (P = 0.030). In the comparison with the admission time (working/non-working h) and variables, there were no significant differences in the length of hospital stay (P = 0.230), transfusion needs (P = 0.348), re-bleeding frequency (P = 0.905), and treatment costs (P = 0.094). CONCLUSION: Endoscopy within 24 h in the setting of acute upper non-variceal GI bleeding is associated with an increase in the length of hospital stay and treatment costs, but is not associated with re-bleeding, transfusion needs, need for surgery, and mortality.

Trauma patients and whole-body computerized tomography imaging: Location of CT-Scan and factors affecting mortality.

OBJECTIVE: : We aimed to study the factors affecting the mortality of trauma patients who underwent whole-body computerized tomography (CT) on Emergency department (ED) time frames in a developing emergency care system. Materials and Methods: This is a retrospective analysis of adult patients who received WBCT from August to November for two consecutive years (2014 and 2015). Non-parametric statistical methods were used to compare the patients who died and survived. The Backward logistic regression model was used to define factors significantly affecting mortality. RESULTS: : During 2014, 200 patients out of 827 (24.1%) received WBCT. During 2015, 263 patients out of 951 (27.6%) received WBCT. Four hundred sixteen patients were entered into the analysis. The overall mortality was 3.4% (7% in 2014 and 1% in 2015, P = 0.002). Significant factors found in backward logistic regression model defining factors affecting mortality were ISS (p < 0.0001), Glasgow Coma Scale (GCS) (p = 0.001). CT location (outside the ED in 2014, inside the ED in 2015) showed a very strong trend for affecting mortality (p = 0.054). Patients who had WBCT in the ED had lower ISS (p < 0.0001). CT imaging in the ED decreased ED to CT time 15.5 minutes (p < 0.0001), but admission time was 75.5 minutes longer. CONCLUSIONS: ISS and GCS were the main factors predicting mortality in patients who received WBCT. Patients received more WBCT imaging and physicians showed a tendency to order WBCT for less severe patients when the CT located in the ED. CT location did not show a significant effect on mortality, but on some operational time frames.

Quantitative and visual analysis of idiopathic pulmonary fibrosis with different methods: the relationship between clinical correlation and mortality risk model.

OBJECTIVE: To test the correlation between the visual semi-quantitative score (VSQS) and different quantitative computed tomography (QCT) analyses and pulmonary physiology variables, and to determine the performance of these types of analyses on the Gender, Age, and Physiology (GAP) model for the prediction of mortality risk of idiopathic pulmonary fibrosis (IPF). PATIENTS AND METHODS: High-resolution computed tomography (HRCT) images of IPF patients were reviewed and the VSQS was calculated. Evaluations were made of the QCT score of interstitial lung disease (ILD) using four different previously defined methods. Respiratory function tests (RFT) and the 6-minute walk test (6MWT) were applied to all the patients. The GAP model was used to evaluate the mortality risk. The performance of the VSQS score and QCT methods on the GAP model to predict the mortality risk of the disease was calculated with ROC analysis. RESULTS: The study included 40 patients who met the criteria. A statistically significant correlation was determined between all the quantitative and semi-quantitative measurement results (p<0.001). A significant correlation was determined between the VSQS and QCT parameters and the RFT and 6MWT. In the ROC analysis, method 4 of the QCT parameters (a value of the voxels between -700 and -950 HU) and the VSQS showed the best performance in the differentiation of stage I, stage II, and stage III, according to the GAP model. CONCLUSIONS: The selection of a quantitative method was useful in the evaluation of spread in patients with IPF. According to the GAP model, VSQS performed best in predicting mortality risk. Furthermore, method 4 of the QCT parameters, which shows well-aerated lungs, were deemed to have good potential for the estimation of mortality risk.

Effect of different clinical practices on postoperative pain in permanent mandibular molar teeth with symptomatic apical periodontitis: A randomized controlled clinical trial.

AIMS: This clinical study aimed to evaluate the effect of different clinical practices with endodontic emergency treatment on postoperative pain in mandibular permanent molar teeth with symptomatic apical periodontitis. METHODS: In the present study, root canal treatment was applied to 100 patients who met the inclusion criteria. Patients were randomly assigned to 5 groups (control, nonsteroidal anti-inflammatory drug [NSAID], NSAID and antihistaminic drug combination, placebo drug, and intracanal cryotherapy) using a web program. In the first visit, after preparation with the WaveOne Gold file system, calcium hydroxide (Ca(OH)2) medicament was placed on the root canals. However, after the treatment of the patients was completed, six patients patients were excluded from the study because they did not come to the control appointment 7 days later. After the removal of Ca(OH)2 medicament in the second session, the root canals were obturated according to cold lateral condensation technique and final restorations of the teeth were performed. Patients' preoperative and postoperative pain values (4-8-12-24-48 and 72 hours) determined by visual analog scale (VAS) were recorded. The data were analyzed statistically using analysis of variance, Kruskal-Wallis test, Friedman test, Wilcoxon test, and Chi-square test. RESULTS: According to the results of our study; there was no significant difference between the groups in terms of age, gender, preoperative pain, and postoperative analgesic requirement (P > 0.05). In all groups, there were significant differences between the values of different times (P < 0.05). While initial pain values were higher than the hours after treatment (P < 0.05), there was no significant difference between postoperative pain values (P > 0.05). When the groups in terms of pain scales measured at different times compared with each other; in all times there was no significant difference between the groups (P > 0.05). CONCLUSION: It was observed that all clinical practices significantly reduced preoperative pain.

Early Bactericidal Activity Trial of Nitazoxanide for Pulmonary Tuberculosis.

This study was conducted in treatment-naive adults with drug-susceptible pulmonary tuberculosis in Port-au-Prince, Haiti, to assess the safety, bactericidal activity, and pharmacokinetics of nitazoxanide (NTZ). This was a prospective phase II clinical trial in 30 adults with pulmonary tuberculosis. Twenty participants received 1 g of NTZ orally twice daily for 14 days. A control group of 10 participants received standard therapy over 14 days. The primary outcome was the change in time to culture positivity (TTP) in an automated liquid culture system. The most common adverse events seen in the NTZ group were gastrointestinal complaints and headache. The mean change in TTP in sputum over 14 days in the NTZ group was 3.2 h ± 22.6 h and was not statistically significant (P = 0.56). The mean change in TTP in the standard therapy group was significantly increased, at 134 h ± 45.2 h (P < 0.0001). The mean NTZ MIC for Mycobacterium tuberculosis isolates was 12.3 µg/ml; the mean NTZ maximum concentration (Cmax) in plasma was 10.2 µg/ml. Negligible NTZ levels were measured in sputum. At the doses used, NTZ did not show bactericidal activity against M. tuberculosis Plasma concentrations of NTZ were below the MIC, and its negligible accumulation in pulmonary sites may explain the lack of bactericidal activity. (This study has been registered at ClinicalTrials.gov under identifier NCT02684240.).

Correction to: Abstracts : 31st European Congress of Pathology.

Regrettably the following abstract was omitted from the original publication; the abstract was submitted ahead of the submission deadline, and should have been included in the original set of abstracts.

Red cell distribution width levels in Parkinson's disease patients.

Parkinson's disease (PD) is a neurodegenerative disorder with motor and non-motor impairment. It has been known for a while that oxidative stress, protein changes and mitochondrial dysfunction have the role of contribution to the pathogenesis. Disturbance of red blood cell function may play a role in the pathophysiology of neurodegenerative diseases such as Huntington's, Parkinson's and Alzheimer's disease. RDW was found to be strongly associated with inflammatory markers in diseases such as acute pancreatitis, myocardial injury and hepatocellular carcinoma. The data about RDW levels and PD are scarce. In this study, we aimed to investigate the RDW values and their relationship with the severity of the disease in patients with Parkinson's disease. 94 patients with Parkinson's disease were included into the study, 97 healthy individuals without history of PD were considered as control group. The United Parkinson's Disease Rating Scale (UPDRS) and the modified Hoehn and Yahr staging scale were used to assess the severity of PD. Although RDW levels were significantly higher than the healthy subjects, there was not any relation between the severity of PD, duration of the disease, RDW levels, other blood parameters, mean UPDRS score or mean mH&Y score. In conclusion, RDW levels are higher than the healthy subjects in PD patients but there is no relation between RDW levels and disease duration. Larger studies are needed to explain the role of RDW as an inflammatory marker.

Epithelium-off corneal cross-linking in progressive keratoconus: 6- year outcomes.

PURPOSE: To evaluate the long-term results of corneal collagen cross-linking (CXL) with epithelium removal in patients with progressive keratoconus. METHODS: This retrospective study included 27 eyes of 18 patients who underwent CXL surgery for progressive keratoconus between April 2009 and March 2012. Best-corrected visual acuity (BCVA), manifest refraction spherical equivalent (SE), maximum keratometry reading (K max), mean of the minimum and maximum keratometry readings (mean-K), central corneal thickness (CCT), and anterior and posterior elevation at the apex preoperatively and year 1, 3 and 6 were evaluated and compared. P values<0.05 were considered to be statistically significant. RESULTS: Mean BCVA was 0.35±0.28 logMAR preoperatively and 0.23±0.20 logMAR 6 years after the procedure (P=0.01). Mean SE decreased from -4.3±2.45 diopters (D) to -3.91±2.12 D (P=0.03). Mean K max decreased from 49.6±3.2 D to 48.6±2.8 D (P=0.04), and mean-K decreased from 47.6±2.5D to 46.9±2.6 D (P=0.04). CCT decreased insignificantly from 466.5±32.1µm to 465.4±26.6µm (P=0.65). Mean anterior elevation at the apex decreased from 12.8±7.9 to 12±8.3µm (P=0.04), and posterior elevation decreased from 27.1±17.4µm to 26.8±18.5µm (P=0.27). Mean-K, max-K, BCVA and CCT showed no change over the last 5 years. After the first year, no significant change was observed in BCVA, SE, max-K, mean-K and CCT, which were therefore considered stable. On the other hand, anterior and posterior elevation readings continued to decrease up to 6 years after CXL. CONCLUSION: Based on our 6-year results, CXL can halt progression of keratoconus and reduce the need for keratoplasty.

Frequency of psychiatric disorders in nonemergent admissions to emergency department.

OBJECTIVES: Repeated admissions of patients with undiagnosed psychiatric problems in emergency departments (ED) is a major contributor to patient unsatisfaction and overcrowding in EDs. We evaluated the presence of psychiatric disorders in non-emergent admissions in the ED of a tertiary care hospital. MATERIALS AND METHODS: This cross-sectional study was carried out in Eskisehir Osmangazi University Hospital between December 2015 and March 2016. The study group consists of 4320 non-emergent patients (31% of all admissions to non-emergent ED). Psychiatric assessments of patients were done using the Primary Care Evaluation of Mental Disorders (PRIME-MD) scale prior to their discharge from the ED. The Mann-Whitney U, Kruskal-Wallis and Chi-square tests, as well as multivariate logistic regression, were performed for statistical analysis. RESULTS: The mean age was 30 ± 11.7 years years ranging from 18 to 78 years. Among non-emergent cases, 44% had at least one psychiatric disorder. The most frequent psychiatric disorder was mood disorder (major and minor depression). Females with a comorbid disease and lower education level had increased risk for mood disorders, anxiety disorders, and somatoform disorders. Single males with a comorbid disease had increased risk for alcohol dependence. CONCLUSIONS: Undiagnosed patients with psychiatric disorders appear to be frequent users of medical emergency department services. These results might be helpful in developing more effective strategies to serve the mental health needs of the undiagnosed. People's awareness of psychiatric disorders should be increased.

Effect of aflibercept on persistent macular edema secondary to central retinal vein occlusion.

PURPOSE: To evaluate the efficacy of switching treatment from intravitreal ranibizumab to intravitreal aflibercept on the treatment of refractory macular edema secondary to central retinal vein occlusion (CRVO). METHODS: In this retrospective study; 12 eyes with refractory macular edema secondary to CRVO after multiple monthly repeated intravitreal 0.5mg/0.05mL ranibizumab injections prior to switching therapy to intravitreal 2mg/0.05mL aflibercept, between March 2012 and April 2016 were reviewed. The follow-up time was 12 months. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), central retinal volume (CRV) and injection interval between baseline and month 1, 3, 6 and 12 after switching therapy to aflibercept were reviewed and evaluated. RESULTS: Mean baseline CRT decreased from 516±101 mic. to 252±114 mic. at month 12 (P=0.008). Mean baseline CRV decreased from 8.74±2.13 mm3 to 6.82±1.64 mm3 at month 12 (P=0.005). Baseline BCVA improved from 0.73±0.21 to 0.53±0.17 logMAR at month 12 (P=0.004). Mean BCVA gain was two logMar lines (10 letters) at month 12. After switching therapy to aflibercept; the mean injection interval increased significantly from 1.34 months at baseline to 1.86 months at month 12, by an increase of 0.52 months (P=0.02). CONCLUSION: Intravitreal aflibercept is evaluated to be presenting significant visual and anatomical improvements in patients with persistent macular edema due to CRVO despite previous intravitreal ranibizumab.

Change in choroidal thickness after intravitreal injection for treatment of neovascular age-related macular degeneration: Ranibizumab versus aflibercept.

PURPOSE: To compare the changes in subfoveal choroidal thickness after intravitreal ranibizumab or aflibercept injections for neovascular age-related macular degeneration (nAMD). METHODS: In this retrospective study, 28 eyes with nAMD treated with 3 consecutive monthly injections of ranibizumab (IVR) and 24 eyes with nAMD treated with 3 consecutive monthly injections of aflibercept (IVA) between September 2012 and June 2016 were reviewed. The follow-up time was 6 months. Changes in two groups' best-corrected visual acuity (BCVA) and subfoveal choroidal thickness by using enhanced depth imaging optical coherence tomography at 1st, 3rd and 6th months were recorded and compared. RESULTS: Choroidal thickness decreased significantly in eyes treated with IVR (P=0.015, 0.01 and 0.01, respectively) or IVA (P=0.001, 0.001 and ˂0.001, respectively) at 1, 3 and 6 months examination but IVA treated eyes presented a significantly further reduction in choroidal thickness when compared with ranibizumab (P=0.03, 0,04 and 0.03, respectively). There was no significant difference between aflibercept and ranibizumab group when change in BCVA from baseline compared at 1, 3 and 6th months (P=0.54, 0.06 and 0.37, respectively). There was no correlation between change in choroidal thickness and the BCVA outcomes in either group. CONCLUSIONS: Subfoveal choroidal thickness decreased significantly after both of IVR and IVA injections in patients with nAMD. In conclusion, intravitreal injections of ranibizumab or aflibercept affect not only neovascular lesion but also the underlying choroid.

Can platelet-rich plasma be used safely in intra-abdominal operations?

OBJECTIVES: In this study, it was aimed to investigate whether or not platelet­rich plasma (PRP) causes intra-abdominal adhesions and therefore, whether or not PRP can be used safely in intra-abdominal operations. METHODS: Of the total of 35 animals, 5 were used as donors for the preparation of platelet­rich plasma (PRP). The surgical procedures were performed on the remaining 30 animals. These rats were randomized and divided into 3 groups of 10. In Group 1, no adhesion induction was performed. Adhesion was induced by cecal abrasion and peritoneal resection model in Groups II and IIII. In Group 2, no treatment was given. In Group 3, 1 cc PRP was applied on the cecum. The rats were sacrificed on postoperative day 21. RESULTS: According to adhesion scores, the difference between the sham and PRP groups was not statistically significant. There was also no significant difference between the control and PRP groups, but the adhesion scores in the PRP group was lower than those in the control group. On histopathological evaluation, the difference between the sham and PRP groups was not statistically significant. There was also no significant difference between the control and PRP groups, but the average fibrosis and inflammation scores in the PRP group were lower than those in the control group. CONCLUSION: The results of the present study have demonstrated that PRP neither reduced nor exacerbated postoperative adhesions. Thus, PRP can be used safely in experimental and clinical studies where it will be applied intra-abdominally (Tab. 2, Fig. 3, Ref. 11).