Management of patients with colorectal cancer in COVID-19 pandemic hospital.

INTRODUCTION: During the COVID-19 pandemic, both the channelling of manpower into the COVID-19 services and efforts to limit viral spreading of the disease have led to rescheduling and prioritizing oncological cases that are considered as cases of emergency and any postponement of the cases can lead to health problems. In this study, we aimed to show that the surgical treatment of COVID-19 (-) colorectal cancer patients can be performed in a hospital which was declared as a pandemic hospital. METHOD: In our study, we included patients who underwent surgery for colorectal cancer in the general surgery clinic between the dates 03.20.2020 and 05.20.2020, when the hospital was declared COVID-19 pandemic hospital. Emergency colorectal cancer surgeries such as ileus and perforation were excluded from the study. RESULTS: While in the status of pandemic hospital, 80 COVID-19 (+) and 563 COVID-19 (+) suspicious patients were treated. Between 10 March 2020 and 15 May 2020, 12 colorectal cancer patients were operated in the General Surgery Clinic of BAIBU Faculty of Medicine, as well. CONCLUSION: We think that with our study we have shown that during the COVID-19 pandemic, the surgical treatment can be performed for patients with colorectal cancer by eliminating COVID-19 suspicions (Tab. 1, Ref. 14).

Comparison of the effects of bispectral index-controlled use of remifentanil on propofol consumption and patient comfort in patients undergoing colonoscopy.

BACKGROUND AND STUDY AIMS: In endoscopic procedures, propofol can be safely administered either alone or in conjunction with remifentanil. The aim of the study is to compare the effects of the administration of propofol alone and the administration of remifentanil in addition to propofol on patient and endoscopist satisfaction, preoperative hemodynamic response, and propofol consumption. MATERIALS AND METHODS: A totally 60 patients were enrolled in the study. Propofol group (Group 1): A 0.4-mg/kg propofol bolus and 1 mg/kg/h maintenance infusion of propofol until a bispectral Index value of 70-75 was achieved. Propofol + remifentanil group (Group 2) received a 0.4 mg/kg propofol bolus dose and maintained with a 0.5 mg/kg/h infusion of propofol + 0.2 mcg/kg/min infusion of remifentanil. The infusion dose of remifentanil was maintained, and the propofol infusion dose was titrated until a BIS value of 70-75 was achieved. RESULTS: In Group 1 (colonoscopic intervention 1 and 5 min) and Group 2 (colonoscopic intervention 10 min.), main blood pressure (MBP) value has a significant decrease. Hypotension occurred in 6 patients in group 1, while 12 patients in group 2. No significant difference was found between the Patient's endoscopist' satisfaction, MBP and heart rate. Propofol consumption was greater in group 1 than in group 2. When the Ramsay sedation levels of Group 1 and Group 2 were compared, a statistically significant difference was observed. CONCLUSIONS: The addition of remifentanil to propofol may be an alternative to the use of alone propofol for sedation in colonoscopic interventions.

Serum omentin levels predicts mesenteric ischemia.

BACKGROUND: Acute mesenteric ischemia (AMI) is an intestinal vascular disease with high mortality. Clinical diagnosis of acute mesenteric ischemia is difficult. Adipose tissue is an important mediator of metabolism and inflammation.Omentin is produced by visceral adipose tissue and decreased serum levels of omentin are associated with poor metabolic outcomes. We aimed to investigate whether serum omentin level predicts early diagnosis of AMI before development of transmural ischemia. METHODS: Twenty-four Sprague Dawley rats weighted about 200-250 gr grouped in 3 experimental groups as sham, transient ischemia and permanent ischemia. Each group consisted of 8 rats. Blood samples were evaluated to determine serum urea, creatinine, omentin and C-reactive protein (CRP) levels. A blinded histological examination performed with the same histologist for hemotoxileneosine painted ileal tissue samples. RESULTS: Mean serum omentin level in sham group (27.5±4.67) was significantly elevated compared to rats in Ischemia-reperfusion (IR) group (10.9±9.01).The difference reached the statistical significance (p=0.004). Serum omentin levels were not correlated to urea, creatinine or CRPlevels. CONCLUSION: Omentin levels may be a biochemical indicator to detect AMI. However, further human studies are needed (Tab. 3, Fig. 3, Ref. 34).

Could red cell distribution width be a marker in Hashimoto's thyroiditis?

AIMS: Hashimoto's Thyroiditis (HT) is the most common autoimmune thyroiditis worldwide and characterized with lymphomonocytic inflammation of the thyroid gland. Red cell distribution width (RDW) reflects erythrocyte anisocytosis and besides it increases in iron deficiency anemia, recent studies reported that RDW was also associated with conditions characterized with overt or subclinical inflammation. We aimed to answer whether RDW increased in Hashimoto's thyroiditis. METHODS: Patients with HT admitted to outpatient clinic of our hospital were included to the study. Patients with anemia (especially iron deficiency), diabetes mellitus, chronic inflammatory disease and on medication that may affect hemogram results (e. g., aspirin) excluded from the study. Patient characteristics, thyroid stimulating hormone (TSH), Free T3 (FT3), Free T4 (FT4), Anti-thyroid peroxidase (Anti-TPO), Anti-Thyroglobulin (Anti-TG), leukocyte count (WBC), Hemoglobin (Hb), Hematocrit (Htc), mean corpuscular volume (MCV), RDW and platelet count (PLT) values of the study cohort were obtained from computerized database of our institution. RESULTS: There was no significant difference between study and control groups in terms of WBC, Hb, Htc, MCV, PLT, PDW and FT3 levels. However, FT4 level was significantly lower and TSH was significantly higher in study group compared to controls. RDW was significantly increased in study group compared to control group. CONCLUSION: We suggest that elevated RDW values in patients without iron deficiency anemia may require further evaluation for HT, especially in female population.

Effects of the inflammatory response on serum omentin levels in early acute and chronic pancreatitis.

BACKGROUND AND AIMS: Acute pancreatitis is an acute inflammation of the parenchyma of the pancreas. Several adipokines have been investigated in acute pancreatitis, and these cytokines contribute to inflammation in acute pancreatitis. However, not enough data exist regarding omentin in injuries of the pancreas. Because of a possible common pathogenesis, we aimed to study the association between pancreatic damage and serum omentin levels. MATERIALS AND METHODS: Twenty-four Sprague Dowley rats weighing 200-250 g were randomly placed into three groups: a sham group (n=8), an acute pancreatitis group (n=8), and a chronic pancreatitis group (n=8). Both rats in the sham group underwent laparotomy, and 0.1 cc of saline solution was injected through the pancreatic canal. On the seventh day, a blood sample was obtained by abdominal aorta puncture, and the pancreas was resected for histological examination. In the acute and chronic pancreatitis groups, 0.1 cc of 4.5% Sodium Taurocholote was injected through the pancreatic canal. Blood samples were obtained and pancreatic resection was performed after 24 hours for the acute pancreatitis group and after 7 days for the chronic pancreatitis group. RESULTS: Serum omentin levels of rats with chronic pancreatitis (49.37±2.82 ng/ml) were increased compared to both acute pancreatitis (37.79±1.24 ng/ml) (p<0.01) and sham rats (22.49±1.4 ng/ml) (p<0.01). In addition, the omentin level of rats with acute pancreatitis was significantly increased compared to the sham group (p<0.01). CONCLUSIONS: The elevation in omentin levels in rats in the early stage of pancreatitis was due to the anti-inflammatory effects of omentin; hence, elevated omentin levels improved insulin resistance and caused a significant reduction in glucose levels.

Effects of N-acetyl cysteine on lipid levels and on leukocyte and platelet count in rats after splenectomy.

INTRODUCTION: Many of studies have shown that increased lipid levels play a significant role in the pathogenesis of atherosclerosis after splenectomy. We investigated the effects of N-acetyl cysteine (NAC) on lipid parameters and leukocyte and platelet (PLT) levels following splenectomy. MATERIALS AND METHODS: 32 Sprague-Dawley rats weighing from 200 to 250 g were placed into four experimental groups. For 42 days post-operatively, all rats were fed standard rat food and water and the rats in the first group ( n = 8) received no intraperitoneal infusion. Rats in the second group ( n = 6) were given a 50 mg/kg saline solution (SF); those in the third group ( n = 8) received 50 mg/kg NAC and the rats in the fourth group ( n = 8) were administered a 100 mg/kg NAC infusion intraperitoneally. RESULTS: All parameters other than white blood cell count were significantly different between the four groups. There were no significant differences between the control and SF groups in terms of total cholesterol and PLT levels. Triglyceride (TG), very-low-density lipoprotein (VLDL) and high-density lipoprotein (HDL) levels were significantly elevated in the SF group compared with the control rats. There was no statistically significant difference between the SF and NAC 50/100 groups in terms of low-density lipoprotein levels. Total cholesterol, TG, HDL and VLDL levels were significantly reduced and the PLT level was significantly elevated in the NAC 50 and NAC 100 groups compared with the SF group. CONCLUSION: Serum VLDL and TG levels should be monitored in patients after splenectomy. For reduction in these lipid parameters, early NAC treatment should be initiated. More prospective larger studies are needed to confirm our results.

Serum amyloid A and Omentin levels in acute appendicitis: a preliminary study for a novel diagnostic approach.

BACKGROUND: The diagnosis of acute appendicitis is based on medical history and physical examination. Serum (S) amiloid A (AA) levels are elevated in many inflammatory conditions. Omentin is a recently discovered adipokine showing decreased levels associated with inflammatory conditions. We aimed to measure SAA and omentin levels in patients with acute appendicitis. MATERIALS AND METHODS: 36 patients with a diagnosis of acute appendicitis and 30 healthy subjects were enrolled to this research study. A statistical analysis was performed using IBM SPSS Statistics Version 16.0 (SPSS Inc.®, Chicago, IL, United States). RESULTS: Patients in study group were significantly older than healthy control subjects (p=0.013). Body mass index of the patients with acute appendicitis (23.2 ± 1.3) was greater than that of the control group (22.7 ± 1), but the difference did not reach the statistically significance (p=0.076). ). Mean level of SAA was significantly raised in study group compared to healthy control subjects (p< 0.001). Mean omentin level was significantly lower in study group compared to healthy subjects (p=0.013). CONCLUSIONS: In conclusion, although diagnosis of acute appendicitis is mostly based on clinical findings, omentin and especially SAA measurement in serum may help surgeons to avoid negative laparatomy.

Evaluation of the olfactory memory after spinal anesthesia: a pilot study.

BACKGROUND: The aim of this study was to investigate the effect of spinal anesthesia (SA) on olfactory memory using Brief-Smell Identification TestTM (B-SIT). PATIENTS AND METHODS: This, prospective, clinical study was performed on 40 ASA physical status I-III patients, between 18-65 years of age undergoing a planned elective minor surgery under SA. All participants were preoperatively informed about B-SIT and the mode of application of the test according to the information in the book. B-SIT was applied to each patient preoperatively and the scores were recorded. B-SIT was reapplied to all patients on the 1st and 2nd postoperative days and the scores were recorded. Moreover, development of postdural puncture headache (PDPH) and/or neurological symptoms (such as hearing loss, diplopia) were checked. RESULTS: Postoperative headache was observed in 7 of the participants and 3 of them was diagnosed to have PDPH. No statistically significant difference was observed in the olfactory memory evaluation of the patients suffering from headache and the 3 patients diagnosed with PDPH. No statistically significant difference was observed in the correct odor answer ratio between the preoperative and postoperative 1st and 2nd days (p > 0.05). CONCLUSIONS: We confirm that SA does not affect olfactory memory. Further studies are necessary to confirm the results of our pilot study in a larger sample.

Mean platelet volume in nasal polyps / Volumen medio de las plaquetas en los pólipos nasales

BACKGROUND: Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in haemostasis, tissue repairing and inflammation. However, to our knowledge, there are no reports in the literature that study the association between platelet parameters and nasal polyps. SUBJECTS AND METHODS: Forty-three patients with nasal polyps and forty-nine healthy controls were enrolled in the study, retrospectively. Laboratory data ofpatients with nasal polyp were obtained at the time of diagnosis. RESULTS: There were no statistically significant differences between the two groups in terms of white blood count, haemoglobin, haematocrit and platelet count. The mean platelet volume (MPV) value of the nasal polyp group was significantly lower than the control group (p = 0.025). Mean eosinophil count was significantly elevated in the nasal polyp group compared to the control group (p < 0.001). CONCLUSIONS: Reduction in MPV may be an indicator for nasal polyp formation. Further studies with a larger study population are needed to detect the possible correlation between eosinophil count and MPVvalues in patients with nasal polyps.

ANTECEDENTES: Muchos estudios en literatura señalan que las inflamaciones relacionadas con los pólipos nasales dependen en su mayoría de los eosinófilos y sus productos inflamatorios. Además de los eosinófilos, las plaquetas pueden jugar un papel en el desarrollo de los pólipos nasales. Las plaquetas participan en la hemostasia, la reparación de tejidos, y la inflamación. Sin embargo, que sepamos, la literatura existente no reporta estudios acerca de la asociación entre los parámetros de las plaquetas y los pólipos nasales. SUJETOS Y MÉTODOS: Cuarenta y tres pacientes con pólipos nasales y cuarenta y nueve controles sanos se inscribieron en el estudio, de forma retrospectiva. Se obtuvieron datos de laboratorio de los pacientes con pólipos nasales en el momento del diagnóstico. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre los dos grupos en términos de glóbulos blancos, hemoglobina, hematocritos y conteo de plaquetas. El valor medio de las plaquetas (MPV) del grupo con pólipos nasales fue significativamente menor que el del grupo control (p = 0. 025). El conteo medio de eosinófilos fue significativamente elevado en el grupo con pólipos nasales en comparación con el grupo control (p < 0.001). CONCLUSIONES: La reducción de MPVpuede ser un indicador para la formación de pólipos nasales. Se necesitan estudios adicionales con una mayor población de estudio para detectar la posible correlación entre los valores de MPV y el conteo de eosinófilos en pacientes con pólipos nasales.

Mean platelet volume in nasal polyps.

BACKGROUND: Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in haemostasis, tissue repairing and inflammation. However, to our knowledge, there are no reports in the literature that study the association between platelet parameters and nasal polyps. SUBJECTS AND METHODS: Forty-three patients with nasal polyps and forty-nine healthy controls were enrolled in the study, retrospectively. Laboratory data of patients with nasal polyp were obtained at the time of diagnosis. RESULTS: There were no statistically significant differences between the two groups in terms of white blood count, haemoglobin, haematocrit and platelet count. The mean platelet volume (MPV) value of the nasal polyp group was significantly lower than the control group (p = 0.025). Mean eosinophil count was significantly elevated in the nasal polyp group compared to the control group (p < 0.001). CONCLUSIONS: Reduction in MPV may be an indicator for nasal polyp formation. Further studies with a larger study population are needed to detect the possible correlation between eosinophil count and MPV values in patients with nasal polyps.

Direct ophthalmoscopy in pediatric emergency care.

Thorough knowledge about the basic ophthalmic examination is instrumental in the emergency department (ED) to determine the severity of eye emergencies and to develop a plan for treatment, including the possible need for an ophthalmology consultation. The direct ophthalmoscope is undoubtedly the most practical instrument available to a pediatric emergency physician for ophthalmic examination. However, the information elicited by its use is dependent on the quality of the instrument and the competency of the user. A greater understanding of the range of possibilities of the direct ophthalmoscope as a diagnostic tool will facilitate more efficient care of the pediatric patient.

Corneal graft outcome study.

PURPOSE: To determine overall 2- and 5-year corneal graft survival rates and to identify risk factors for corneal graft failure in our patient population. METHODS: A retrospective chart review of 696 patients undergoing corneal transplantation performed by a single surgeon at The Toronto Western Hospital over a 7.5-year period. RESULTS: A total of 468 eyes met the inclusion criteria for this study. Overall, the 2- and 5-year graft survival rates were 78.8% and 64.5%, respectively. In a univariate analysis, patient age, gender, history of glaucoma, preoperative diagnosis, type of operative procedure, and postoperative factors all were shown to be significantly associated with graft survival. In a multivariate analysis, six independent predictors of graft failure were identified: preoperative diagnosis, neovascularization of the graft, the presence of peripheral anterior synechiae, gender, occurrence of one or more rejection episodes, and age of the recipient at the time of corneal transplantation. CONCLUSIONS: Risk of graft failure can vary substantially within a population of patients receiving a corneal transplant. The outcomes of this study concur with the risk factors for corneal graft failure in the literature and can be used as prognostic guidelines for both surgeons and patients.

Organization and chromosomal localization of the murine Testisin gene encoding a serine protease temporally expressed during spermatogenesis.

The recently characterized human serine protease, Testisin, is expressed on premeiotic testicular germ cells and is a candidate type II tumor suppressor for testicular cancer. Here we report the cloning, characterization and expression of the gene encoding mouse Testisin, Prss21. The murine Testisin gene comprises six exons and five introns and spans approximately 5 kb of genomic DNA with an almost identical structure to the human Testisin gene, PRSS21. The gene was localized to murine chromosome 17 A3.3-B; a region syntenic with the location of PRSS21 on human chromosome 16p13.3. Northern blot analyses of RNA from a range of adult murine tissues demonstrated a 1.3 kb mRNA transcript present only in testis. The murine Testisin cDNA shares 65% identity with human Testisin cDNA and encodes a putative pre-pro-protein of 324 amino acids with 80% similarity to human Testisin. The predicted amino-acid sequence includes an N-terminal signal sequence of 27 amino acids, a 27 amino-acid pro-region, a 251 amino-acid catalytic domain typical of a serine protease with trypsin-like specificity, and a C-terminal hydrophobic extension which is predicted to function as a membrane anchor. Immunostaining for murine Testisin in mouse testis demonstrated specific staining in the cytoplasm and on the plasma membrane of round and elongating spermatids. Examination of murine Testisin mRNA expression in developing sperm confirmed that the onset of murine Testisin mRNA expression occurred at approximately day 18 after birth, corresponding to the appearance of spermatids in the testis, in contrast to the expression of human Testisin in spermatocytes. These data identify the murine ortholog to human Testisin and demonstrate that the murine Testisin gene is temporally regulated during murine spermatogenesis.

Effect of macrophage activation on resistance of mouse peritoneal macrophages to infection with herpes simplex virus types 1 and 2.

To define the effect of heterogeneity of murine peritoneal macrophages (M phi) on intrinsic resistance to herpes simplex virus (HSV) infection, several M phi populations were characterized for their response to infection with HSV type 1 (HSV-1) and HSV-2. Steady-state resident M phi (Res M phi) were compared in parallel with M phi activated with Corynebacterium parvum (now designated Propionibacterium acnes) (CP M phi) and thioglycollate-elicited inflammatory M phi (TG M phi). Res M phi were completely non-permissive for productive virus infection and showed no c.p.e. The intrinsic resistance of CP M phi to HSV infection was similar to that of Res M phi, in that the infection was non-productive for infectious virus, but CP M phi showed marked c.p.e. TG M phi showed semi-permissiveness, with virus yields at least 10-fold higher than those in Res M phi and CP M phi, and marked c.p.e. The three distinct intrinsic response patterns were maintained regardless of whether M phi were derived from CD-1 or B6C3F1 mice, or whether the infecting virus was HSV-1 or HSV-2. To define the level at which M phi restrict HSV replication, immunofluorescence assays for viral antigens and hybridization analyses for viral DNA were performed. All M phi populations showed immediate early and early virus polypeptides. Res M phi and CP M phi showed no viral DNA replication, but TG M phi showed moderate levels of viral DNA synthesis that paralleled the infectious virus titres produced. Investigation of the mechanism for the heterogeneous intrinsic antiviral response among the M phi revealed that interferon was not involved, because antiserum to mouse alpha/beta interferon did not alter the intrinsic resistance patterns. Induction of c.p.e. in M phi required live, replication-competent HSV. The involvement of tumour necrosis factor (TNF) in c.p.e. was found to be unlikely; no significant amounts of TNF were detected in the culture medium of the M phi, and inclusion of anti-TNF antibody did not inhibit c.p.e.