Erythroferrone and hepcidin levels in children with iron deficiency anemia.

BACKGROUND: Iron deficiency anemia remains a significant public health issue in developing countries. The regulation of iron metabolism is primarily controlled by hepcidin, a key regulatory protein. During erythropoiesis, erythroferrone (ERFE), a hormone produced by erythroblasts in response to erythropoietin (EPO) synthesis, mediates the suppression of hepcidin. In this study, it was aimed to determine the correlation between erythroferrone (ERFE) and hepcidin levels in children with iron deficiency anemia. METHODS: This is a case-control study conducted at Kirsehir Ahi Evran University Training and Research Hospital Pediatrics Clinic between 1 and 31 September 2020. The study included 26 healthy children and 26 children with iron deficiency anemia. In order to evaluate iron status,whole blood count, serum iron, total iron binding capacity (TIBC), and ferritin levels were analyzed. The study measured the levels of hepcidin and erythroferrone in the serum of children diagnosed with iron deficiency before and after one month of iron treatment, as well as in a control group, using the ELISA method. Correlation between whole blood count, initial ferritin, hepcidin, ERFE and ferritin in the iron deficiency group was evaluated. RESULTS: Compared with healthy controls, the iron-deficient group had significantly lower haemoglobin (p < 0.001), MCV (p = 0.001), MCH (p < 0.001), MCHC (p < 0.001), iron (p < 0.001), ferritin (p < 0.001) and hepcidin (p = 0.001). Ferritin and hepcidin levels increased while erythroferrone levels remained unchanged after iron deficiency treatment. There was no correlation between hepcidin and ferritin levels in treatment group. CONCLUSIONS: The study found a strong and positive correlation between ferritin and hepcidin levels in iron-deficient children, but not between ERFE levels, suggesting that hepcidin is largely regulated by iron deposition levels. In addition, there was an increase in ferritin and hepcidin levels after iron treatment. The study found no significant difference in erythroferrone levels between the iron-deficient group and the control group. It is thought that this may be due to the short duration of iron treatment given to the patients with iron deficiency anemia included in the study.

The knowledge level of the healthcare professionals responsible for newborns' heel prick tests.

PURPOSE: This study was conducted to determine the level of knowledge of healthcare professionals involved in newborn heel prick tests. METHODS: The study was conducted between 10.02.2021-10.03.2021 with 147 healthcare workers working in heel prick screening in health institutions where heel prick blood samples were collected in a province and districts in the Central Anatolia region of Turkey. As a data collection tool, a questionnaire prepared by the researcher in line with the literature was used. The data were evaluated by number, percentage, mean and standard deviation analysis and chi-square analysis was performed in IBM SPSS for Windows 29.0v programme. RESULTS: The majority of healthcare professionals gave correct answers to the questions regarding the collection, storage and transfer of heel prick. It has been observed that healthcare professionals do not have sufficient information regarding the definition of Congenital Metabolic Diseases, their findings and where to refer patients whose results are suspicious.The most significance was found in the distribution of answers regarding the symptoms of the screened diseases according to occupational groups. CONCLUSION: In diseases that can be controlled with treatment and nutrition if detected early, errors in the collection, storage and transport of the sample can affect the test result and delay the diagnosis. Healthcare professionals have important responsibilities issues from genetic counseling before marriage, taking heel blood, from informing the family to caring for the diagnosed baby. PRACTICE IMPLICATIONS: This study will provide valuable information to health professionals involved in newborn screening and to future studies in this field.

A novel adaptive momentum method for medical image classification using convolutional neural network.

BACKGROUND: AI for medical diagnosis has made a tremendous impact by applying convolutional neural networks (CNNs) to medical image classification and momentum plays an essential role in stochastic gradient optimization algorithms for accelerating or improving training convolutional neural networks. In traditional optimizers in CNNs, the momentum is usually weighted by a constant. However, tuning hyperparameters for momentum can be computationally complex. In this paper, we propose a novel adaptive momentum for fast and stable convergence. METHOD: Applying adaptive momentum rate proposes increasing or decreasing based on every epoch's error changes, and it eliminates the need for momentum hyperparameter optimization. We tested the proposed method with 3 different datasets: REMBRANDT Brain Cancer, NIH Chest X-ray, COVID-19 CT scan. We compared the performance of a novel adaptive momentum optimizer with Stochastic gradient descent (SGD) and other adaptive optimizers such as Adam and RMSprop. RESULTS: Proposed method improves SGD performance by reducing classification error from 6.12 to 5.44%, and it achieved the lowest error and highest accuracy compared with other optimizers. To strengthen the outcomes of this study, we investigated the performance comparison for the state-of-the-art CNN architectures with adaptive momentum. The results shows that the proposed method achieved the highest with 95% compared to state-of-the-art CNN architectures while using the same dataset. The proposed method improves convergence performance by reducing classification error and achieves high accuracy compared with other optimizers.

Pilot study of the diagnostic value of CRP:albumin ratio for osteomyelitis in patients with diabetic foot ulcers.

OBJECTIVE: Osteomyelitis may complicate diabetic foot ulcers (DFUs). As a new inflammation-based prognostic factor, CRP:albumin ratio's significance is not known in osteomyelitis among patients with or without diabetes. METHOD: Patients with type 2 diabetes and DFUs were divided into two groups: group 1 (n=47) comprised patients without osteomyelitis, and group 2 (n=50) comprised patients with osteomyelitis. RESULTS: Erythrocyte sedimentation rate (ESR) (88.5±23.0 versus 42.0±22.2), white blood cell count (WBC) (14.7±6.9x103 versus 10.0±4.4x103), C-reactive protein (CRP) level (15.6±9.9 versus 2.4±3.3) and CRP:albumin ratio (6.6±4.9 versus 0.7±1.0) were significantly higher, and albumin level was significantly lower in group 2 compared to group 1 (p<0.001 for all). The presence of osteomyelitis was significantly and positively correlated with ESR (r=0.721; p<0.001), WBC (r=0.380; p<0.001), CRP (r=0.667; p<0.001) and CRP:albumin ratio (r=0.638; p<0.001), and negatively correlated with albumin (r=-0.590; p<0.001). A CRP:albumin ratio of 1.74 or above could predict osteomyelitis with 92.0% sensitivity, 80.9% specificity, and the best area under the curve (AUC) score (AUC=0.957; 95% CI: 0.924-0.991). ESR (odds ratio (OR): 1.071 (1.025-1.119); p=0.02) and CRP:albumin ratio (OR: 2.65 (1.437-4.885); p=0.002) were independent predictors in the final model for stepwise linear regression analyses for the estimation of osteomyelitis. CONCLUSION: CRP:albumin ratio is a cheap and repeatable inflammatory marker and can successfully detect osteomyelitis in patients with DFU.

Evaluation of macular, retinal nerve fiber layer and choroidal thickness by optical coherence tomography in children and adolescents with vitamin B12 deficiency.

PURPOSE: To investigate macular, Retinal Nerve Fiber Layer (RNFL) and choroidal thickness in children and adolescents with vitamin B12 deficiency and no neurological examination finding. METHODS: The study group includes of thirty-three children aged 8-17 years who were brought to the Pediatric outpatient clinic with the symptoms of fatigue and forgetfulness and whose Vitamin B12 levels were detected < 200 pg/ml. The control group was the 30 children and adolescents applied to the same policlinic with various symptoms and whose Vitamin B12 levels were found normal. Children and adolescents with chronic systemic/ocular disease history and myopia or hyperopia more than 4 diopters were not included in both groups. Spectral Domain-Optical Coherence Tomography (SD-OCT) was used for measurements. RESULTS: Mean Macular thickness value was 261.2 ± 17.6 in the Vitamin B12 deficiency group and 267.7 ± 17.4 in the control group. Mean value of Retinal Nerve Fiber Layer (RNFL) thickness was 103.5 ± 7.5 in the Vitamin B12 deficiency group and 104.3 ± 8.9 in the control group. The mean values of Choroidal thickness were 360.1 ± 59.8 and 316.9 ± 95.4 in Vitamin B12 deficiency and control groups, respectively. There was a statistically significant increase in choroidal thickness in Vitamin B12 deficiency group compared to controls. CONCLUSION: Statistically significant increase in the Choroidal thicknesses of children and adolescents with Vitamin B12 deficiency is important in terms of shedding light on studies that will contribute to a better understanding of the relationship between vitamin B12 and inflammation. CLINICAL TRIAL REGISTRATION: This study is an observational study.

Investigation of galectin-3 levels in diabetic foot ulcers.

OBJECTIVE: It has been shown that galectin-3 (Gal-3) promotes angiogenesis and new vessel formation. Serum Gal-3 is a risk factor for vascular complications in type 2 diabetes. The aim of this study is to compare Gal-3 levels with a range of biochemical parameters. METHOD: A prospective study consisted of individuals as a control group (group 1), patients diagnosed with type 2 diabetes without DFUs (group 2), and patients with type 2 diabetes with a DFU (group 3). Patient levels of endothelin-1 (ET-1), vascular endothelial growth factor-A (VEGF-A), nitric oxide (NO), and Gal-3 were measured. RESULTS: In total, 91 patients participated, (28 male, 63 female with a mean age of 55.83±6.35 years) Mean ET-1 (39.0±16.9), NO (17.6±7.6), VEGF-A (33.5±13.4) and Gal-3 (535.1±420.5) levels were significantly higher in group 3 compared with the other two groups (p<0.01). Furthermore, the Gal-3 level was positively and statistically significantly correlated with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ET-1 and NO levels in all groups. CONCLUSION: In our study, the level of Gal-3 was shown to be positively correlated with the VEGF-A level. Hence, Gal-3 can be considered as a defence mechanism against complications of diabetes, thus contributing to wound healing. Gal-3 may play a critical role in DFU formation and progression. Moreover, it could be suggested that Gal-3 may give an indication of prognosis, as it elevates VEGF-A levels and stimulates angiogenesis. Further studies are required to confirm the findings of this study.

Effect of hyperbaric oxygen therapy on complete blood count.

Complete blood count (CBC) is a routine diagnostic procedure for patients and a part of routine health inspection for healthy individuals. The effect of hyperbaric oxygen (HBO2) on CBC is not known. The objective of this study was to determine the effects of HBO2 on blood parameters in CBC with long-term HBO2 therapy. In this study, patients received HBO2 at the department of Underwater and Hyperbaric Clinical Medicine. CBC results were obtained at specific time points during HBO2 therapy. The study recruited a total of 140 patients who met the research inclusion criteria. Patients were treated for 55.5 ± 41 days. During the treatment period, they underwent HBO2 sessions for an average of 35.9 ± 24.9 times. Five groups were created as follows: before the treatment; between 1-20 sessions; between 21-40 sessions; between 41-60 sessions; and more than 60 sessions. The results of the present study showed that a number of alterations occurred in CBC values in patients who received HBO2. HBO2 reduces the number of platelets, but this was not clinically significant. According to the results, HBO2 does not have any effect on hemoglobin, hematocrit, red blood cells, mean corpuscular volume, mean corpuscular hemoglobin, red blood cell distribution width, mean corpuscular hemoglobin concentration, platelet count, platelet distribution width and mean platelet volume. Except for a temporary reduction in platelet count, HBO2 has no effect on CBC parameters. Medical professionals may use the outcome of this study in their routine examinations, as it suggests that the changes in CBC driven by HBO2 are not statistically significant, and could be disregarded. More research is needed to examine the effects of HBO2 on other blood parameters.

Can amputation be prevented in diabetic foot? Interdisciplinary approach to diabetic foot: a case report.

Diabetic foot ulcers may result in loss of an extremity and may even lead to mortality. The use of comprehensive foot care programs which include early screening and evaluation of problems, foot care education, preventive therapy and referral to specialists has been shown to reduce amputation rates by 49-85 [percent]. A 51-year-old woman with Type 2 diabetes under surveillance for nine months was referred from the emergency department. She presented with an entirely inflamed right foot with ulcer covering two-thirds proximal of the foot for 30 days' duration. There was extensive edema as well as cellulitis extending to the knee, fluctuating abscesses and lymphangitis to the ankle. Magnetic resonance imaging showed extensive abscesses and edema in foot compartments. After a further four weeks of antibiotics, 80 sessions of hyperbaric oxygen therapy shrank the wound from 15x15x2 cm to 3x3x0.2 cm. The wound was closed with a split thickness graft, and healing completed four months after presentation. Patients with diabetic foot deserve clinical evaluations of the whole body rather than a regional treatment. An interdisciplinary approach involving both medical and surgical treatment options should be conducted according to this perspective. It could be effective in lowering major amputation rates and even preventing amputations. Simultaneously administered effective debridement methods, utilization of minor amputations for necrotic tissue and lowering the infectious load with appropriate antibiotics, aggressive wound care with the appropriate wound care products, unconventional treatment methods like hyperbaric oxygen treatment and negative pressure wound care may help reduce amputation levels and save extremities.

Detection of aflatoxin and surface mould contaminated figs by using Fourier transform near-infrared reflectance spectroscopy.

BACKGROUND: Aflatoxins are toxic metabolites that are mainly produced by members of the Aspergillus section Flavi on many agricultural products. Certain agricultural products such as figs are known to be high risk products for aflatoxin contamination. Aflatoxin contaminated figs may show a bright greenish yellow fluorescence (BGYF) under ultraviolet (UV) light at a wavelength of 365 nm. Traditionally, BGYF positive figs are manually selected by workers. However, manual selection depends on the expertise level of the workers and it may cause them skin-related health problems due to UV radiation. RESULTS: In this study, we propose a non-invasive approach to detect aflatoxin and surface mould contaminated figs by using Fourier transform near-infrared (FT-NIR) reflectance spectroscopy. A classification accuracy of 100% is achieved for classifying the figs into aflatoxin contaminated/uncontaminated and surface mould contaminated/uncontaminated categories. In addition, a strong correlation has been found between aflatoxin and surface mould. CONCLUSION: Combined with pattern classification methods, the NIR spectroscopy can be used to detect aflatoxin contaminated figs non-invasively. Furthermore, a positive correlation between surface mould and aflatoxin contamination leads to a promising alternative indicator for the detection of aflatoxin-contaminated figs. © 2016 Society of Chemical Industry.

Reduction of side effects of hyperbaric oxygen therapy with thymoquinone treatment in rats.

INTRODUCTION: Hyperbaric oxygen (HBO2) treatment results in elevated production of reactive oxygen species (ROS) that leads to cellular damage. Thymoquinone (TQ) is reported to have anti-inflammatory and antimicrobial activity and may suppress the generation of free radicals. The goal of this study is reduction of side effects of hyperbaric oxygen therapy with thymoquinone treatment. METHODS: 30 female Sprague-Dawley rats were randomly assigned to one of three groups (n = 10 per group). Group 1 represented the control group (no treatment). Group 2 was exposed to 100% oxygen at 2.5 ATA for two sessions of two hours'duration each day for five days. Group 3 was treated identically to Group 2 and was also given thymoquinone once daily at 50 mg/kg/day by oral gavage for five days, after first session of HBO2. RESULTS: LOOH and SH levels were significantly elevated in the group receiving HBO2 treatment relative to the control group rats. Fetuin A is increased during TQ treatment. LOOH and SH levels were significantly decreased in animals treated with TQ. CONCLUSIONS: Long-term and repeated HBO2 treatment leads to damage to the lung tissue. In urgent situations or cases of severe hypoxia, repeated HBO2 sessions may be necessary, and TQ antioxidant agents may be useful for prevention of HBO2-associated injury. TQ may represent a useful therapeutic option during HBO2 treatment.

Urinary kidney injury molecules in children with febrile seizures.

OBJECTIVE: Hypoxia occurs following convulsions, and hypoxia is one of the most common causes of acute renal damage. The aim of this study was to investigate urinary levels of kidney injury molecules, including neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-ß-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP) in children with febrile seizures (FS) for the first time. METHODS: The study included 28 children with FS and 34 age and gender matched healthy children. Serum biochemistry and blood gases were measured in the serum samples. Estimated glomerular filtration rate (eGFR) was calculated. NGAL, NAG, L-FABP, and creatinine (Cr) were measured in the urine samples. The ratios of kidney injury markers to urinary Cr were used for comparisons. RESULTS: There were no significant differences in eGFR and serum chemistry values between the FS and the control group (p > 0.05). Hypoxia was detected in 67.9% of the FS patients. The FS group had significantly higher urinary kidney injury molecules to Cr ratios compared to the controls, including NGAL/Cr (17.9 ± 9.8; 6.7 ± 4.0, respectively; p < 0.001), NAG/Cr (0.55 ± 0.29; 0.21 ± 0.16, p < 0.001), and L-FABP/Cr (4.85 ± 2.93; 1.74 ± 1.16, p < 0.001). CONCLUSION: Increased urinary NGAL/Cr, NAG/Cr, and L-FABP/Cr values, in patients with FS compared to healthy controls, suggest a possible subclinical renal damage in these patients.

Erythrocyte zinc level in patients with atopic dermatitis and its relation to SCORAD index.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, pruritic inflammatory disease, characterized by a relapsing-remitting course. The pathogenesis of atopic dermatitis is not completely understood, although the disorder appears to result from the complex interaction between immune abnormalities, genetic and environmental factors. Trace elements are essential for normal functioning of the immune system. AIM: To determine zinc levels in serum and erythrocytes of patients with AD using an atomic absorption spectrometric technique and to investigate the relationship between those levels and disease activity. MATERIAL AND METHODS: Sixty-seven patients and 49 controls were enrolled into the study. The disease severity of AD patients was determined according to the Scoring Atopic Dermatitis (SCORAD) index. We measured zinc levels in serum and erythrocytes by the atomic absorption spectrophotometric technique. RESULTS: Erythrocyte zinc levels were significantly lower in AD patients than in the control group (p < 0.001), whereas serum zinc levels did not differ between the groups (p = 0.148). In the AD patient group there was a negative correlation between the SCORAD score and erythrocyte zinc levels (r = -0.791; p < 0.001). CONCLUSIONS: The negative relationship between disease severity and erythrocyte zinc levels might suggest an immunopathological link between AD progression and intracellular zinc metabolism.

Serum galectin-3 levels in children with chronic hepatitis B infection and inactive hepatitis B carriers.

BACKGROUND: Chronic hepatitis B virus (HBV) infection is common worldwide. Follow-up of patients by the use of non-invasive techniques may be valuable in clinical practice. The aim of this study was to investigate serum galectin-3 (GAL-3) levels for monitoring disease status in children with chronic HBV infection. MATERIAL/METHODS: Thirty-two patients with chronic hepatitis B (CHB), 30 inactive HBV carrier patients, and 30 matched healthy controls were enrolled in the study. We performed basic laboratory tests: serum glucose, albumin, alanine aminotransferase (ALT), aspartate aminotransferase, gamma-glutamyl transferase (GGT), total bilirubin, prothrombin time, and activated partial thromboplastin time. In addition, serum GAL-3 levels were measured by ELISA technique. RESULTS: Significantly higher serum GAL-3 levels (16.5±3.6, 1.1±0.3, 0.7±0.5 ng/ml, respectively, p<0.001) and ALT levels (80.2±30.6, 26.8±12.6, 28.1±4.4 IU/L, respectively, p<0.001) were found in the CHB group compared with the inactive carriers and the control groups. There were no significant differences in ALT levels and GAL-3 levels or between inactive HBV carriers and the control groups (p>0.05, for each). Significantly higher GGT levels were found in the CHB group (51.3±27.5 IU/L) compared with the inactive HBV carriers (35.7±10.1 IU/L) and the control group (31.3±9.5 IU/L) (p<0.001, and p=0.004, respectively). A significant correlation was found between GAL-3 and ALT levels in the CHB group (r=0.82, p<0.001). CONCLUSIONS: Our results suggest that serum GAL-3 level may be a beneficial indicator of chronicity in hepatitis B infection in children.

Urinary Kidney Injury Molecules in Children with Iron-Deficiency Anemia.

BACKGROUND: The aim of this study was to investigate the urine levels of human kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-ß-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP) in children with iron-deficiency anemia (IDA). MATERIAL AND METHODS: Thirty-five children with IDA and 32 matched healthy controls were recruited. We assessed complete blood count, serum iron, iron-binding capacity, ferritin, serum levels of urea, creatinine (Cr), sodium (Na), potassium (K), calcium (Ca), and glucose levels. Estimated glomerular filtration rate (eGFR) was calculated. Urinary NAG, NGAL, KIM-1, and L-FABP were measured and divided by urine creatinine for comparisons. RESULTS: There were no significant differences in serum urea, Cr, or eGFR between the IDA group and the control group (p>0.05, for all). IDA patients had significantly higher urine NGAL/Cr, L-FABP/Cr, KIM-1/Cr, and NAG/Cr compared with the control group (p<0.05). There were significant negative correlations between hemoglobin, hematocrit, red blood cell count, and urine NGAL/Cr, NAG/Cr, L-FABP/Cr, KIM-1/Cr levels (p<0.05). CONCLUSIONS: Higher urinary kidney injury molecule levels in IDA patients suggest a possible subclinical renal injury in pediatric IDA patients whose renal functions and serum electrolytes were normal.

Urinary early kidney injury molecules in children with beta-thalassemia major.

BACKGROUND: The aim of this study was to investigate novel urinary biomarkers including N-acetyl-ß-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and liver-type fatty acid binding protein (L-FABP) in children with ß-thalassemia major (ß-TM). MATERIALS AND METHODS: Totally, 52 patients (29 boys, 23 girls) with ß-TM and 29 healthy controls (3-17 years) were included. Various demographic characteristics and blood transfusions/year, disease duration, and chelation therapy were recorded. Serum urea, creatinine, electrolytes, and ferritin and urinary creatinine, protein, calcium, phosphorus, sodium, potassium, and uric acid in first morning urine samples were measured and estimated glomerular filtration rate (eGFR) was calculated. Routine serum and urinary biochemical variables, urinary NAG to Creatinine (U(NAG/Cr)), U(NGAL/Cr), U(KIM-1/Cr), and U(L-FABP/Cr) ratios were determined. RESULTS: Patients had similar mean serum urea, creatinine and eGFR levels compared with controls (p > 0.05 for all). The mean urinary protein to creatinine (U(Protein/Cr)) ratio was significantly higher in patients compared to the healthy subjects (0.13 ± 0.09 mg/mg and 0.07 ± 0.04 mg/mg, respectively; p < 0.001). Significantly increased U(NAG/Cr) (0.48 ± 0.58 vs. 0.23 ± 0.16, p = 0.026) and U(NGAL/Cr) (22.1 ± 18.5 vs. 11.5 ± 6.17, p = 0.01) ratios were found in ß-TM patients compared with healthy controls. However, no differences were found in serum and urinary electrolytes or U(KIM-1/Cr) and U(L-FABP/Cr) ratios between patients and controls (p > 0.05). Significant correlations were found between urinary biomarkers and urinary electrolytes (p < 0.05). CONCLUSIONS: Our results suggest that urinary NAG and NGAL may be considered to be reliable markers to monitor renal injury in ß-TM patients.

Factors affecting complication rates of percutaneous nephrolithotomy in children: results of a multi-institutional retrospective analysis by the Turkish pediatric urology society.

PURPOSE: We assessed factors affecting complication rates of percutaneous nephrolithotomy in children. MATERIALS AND METHODS: We retrospectively evaluated data on 1,205 renal units in 1,157 children treated with percutaneous nephrolithotomy at 16 Turkish centers between 1991 and 2012. Of the patients 28.3% had a history of urolithiasis. Complications were evaluated according to the Satava classification system and modified Clavien grading system. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS: A total of 515 females and 642 males were studied. Mean ± SD patient age was 8.8 ± 4.7 years (range 4 months to 17 years). Mean ± SD stone size, operative time and postoperative hospital stay were 4.09 ± 4.06 cm(2), 93.5 ± 48.6 minutes and 5.1 ± 3.3 days, respectively. Postoperative stone-free rate was 81.6%. A total of 359 complications occurred in 334 renal units (27.7%). Complications were intraoperative in 118 cases and postoperative in 241. While univariate analysis revealed that stone history, positive urine culture, operative time, length of hospitalization, treatment success, punctured calyx and location of the stone significantly affected the complication rates (p <0.05), operative time, sheath size, mid calyceal puncture and partial staghorn formation were the statistically significant parameters affecting complication rates on multivariate logistic regression analysis. CONCLUSIONS: Percutaneous nephrolithotomy is the treatment of choice for most renal calculi in children. The technique is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.

The effects of pomegranate and carvacrol on methotrexate-induced bone marrow toxicity in rats.

PURPOSE: The aim of this study was to evaluate the effects of pomegranate (PMG) extract and carvacrol (CARV) on methotrexate (MTX)-induced oxidative stress and bone marrow toxicity. METHODS: Wistar albino rats (32 rats) were divided into four groups (n=8): Group 1 was control; Group 2 was given a single intraperitoneal injection of methotrexate (20 mg/kg); Group 3 was treated with carvacrol (73 mg/kg i.p.) one day before MTX (20 mg/kg i.p.) injection; and, Group 4 received a single dose of MTX (20 mg/kg i.p) while PMG was administered orally for seven days at 225 mg/kg. After animals were euthanized, blood samples were taken to evaluate hematological parameters and oxidative stress. In addition, the femur was cropped and bone marrow was extracted for examination. RESULTS: White blood cell count, hemoglobin, hematocrit and platelet count were found to be decreased in the MTX group, but these changes were prevented in the groups that received CARV and PMG. Furthermore, decreased bone marrow cellularity was found in the groups treated with MTX, whereas the PMG and CARV groups had cellularity similar to controls. Strikingly, oxidative stress increased in the MTX group, but was ultimately decreased in the rats that received the antioxidants PMG and CARV. CONCLUSION: Carvacrol and PMG were found to be protective against methotrexate-induced oxidative bone marrow damage. Use of these antioxidants, in combination with chemotherapeutics, may help to reduce some adverse effects of methotrexate.

Usefulness of mean platelet volume and neutrophil-to-lymphocyte ratio for evaluation of children with Familial Mediterranean fever.

BACKGROUND: Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of serositis, fever, and rash. Clinical and subclinical inflammatory processes may contribute to atherosclerosis in FMF patients, with mean platelet volume (MPV) as a potential indicator for atherosclerosis risk and neutrophil-to-lymphocyte ratio (NLR) as a marker for subclinical inflammation in these patients. In this study, we investigated whether MPV can be used as an indicator for atherosclerosis risk and if NLR is a marker for subclinical inflammation in FMF patients. MATERIAL AND METHODS: The study consisted of 75 FMF patients in attack, 157 attack-free patients, and 77 healthy controls. White blood cell count neutrophil-to-lymphocyte ratio, platelet count, MPV, PDW C-reactive protein levels, and erythrocyte sedimentation rate were recorded. RESULTS: There were no significant differences between attack, attack-free, and control groups in terms of mean MPV and PDW value. NLR value was higher in the attack group. NLR value was similar in attack-free and control groups. CONCLUSIONS: We found that MPV and PDW values are similar in FMF patients and healthy controls. NLR was higher in FMF patients in the attack period. Therefore, our results suggest that MPV and PDW values do not predict atherosclerosis risk in pediatric FMF patients, and NLR may be an indicator for attack period but not attack-free period.

The MEFV mutations and their clinical correlations in children with familial Mediterranean fever in southeast Turkey.

The aim of this study was to determine the Mediterranean fever (MEFV) gene mutations and their clinical correlations in children with familial Mediterranean fever (FMF) in southeast Turkey. Clinical and laboratory characteristics of 147 (65 males, 82 females) consecutive children with FMF having a positive MEFV gene mutation were prospectively investigated. Patients with negative MEFV gene mutations or atypical FMF presentations and those from other regions of the country were excluded. Clinical manifestations and disease severity scores were recorded. The six most frequent MEFV mutations including M694V, V726A, R726H, P369S, E148Q and P369S were investigated by a reverse hybridization test method. The median age of study group was 9.0 years, median age at diagnosis was 7.8 years, median age at disease onset was 5.0 years, and median follow-up duration was 4.0 years. A positive family history of FMF and parent-to-offspring transmission was found in 58.5 and 42.2 % of families, respectively. The frequencies of independent alleles, with decreasing order, were E148Q (30.7 %), M694V (26.0 %), R761H (13.5 %), V726A (13.0 %), P369S (10.5 %) and M680I (6.3 %) in FMF patients. The M694V subgroup had higher mean disease severity score and longer attack duration compared with E148Q and other mutations subgroups (p < 0.05). Two patients with amyloidosis had the M694V homozygote genotype. In conclusion contrast to other regions and many other ethnicities of the world, the most frequent MEFV gene mutation was E148Q in southeast Turkey. The M694V mutation frequency was lower, and disease severity was relatively mild in FMF children of this region.

Identifying Diabetic Retinopathy in the Human Eye: A Hybrid Approach Based on a Computer-Aided Diagnosis System Combined with Deep Learning.

Diagnosing and screening for diabetic retinopathy is a well-known issue in the biomedical field. A component of computer-aided diagnosis that has advanced significantly over the past few years as a result of the development and effectiveness of deep learning is the use of medical imagery from a patient's eye to identify the damage caused to blood vessels. Issues with unbalanced datasets, incorrect annotations, a lack of sample images, and improper performance evaluation measures have negatively impacted the performance of deep learning models. Using three benchmark datasets of diabetic retinopathy, we conducted a detailed comparison study comparing various state-of-the-art approaches to address the effect caused by class imbalance, with precision scores of 93%, 89%, 81%, 76%, and 96%, respectively, for normal, mild, moderate, severe, and DR phases. The analyses of the hybrid modeling, including CNN analysis and SHAP model derivation results, are compared at the end of the paper, and ideal hybrid modeling strategies for deep learning classification models for automated DR detection are identified.