Prongs or Mask for Nasal Continuous Positive Airway Pressure in Neonates: Which One Is More Comfortable?

BACKGROUND: Nasal continuous positive airway pressure (NCPAP) is a common mode of respiratory support in neonatal intensive care units. Our objective was to compare whether NCPAP given with nasal prongs compared with a nasal mask reduces the pain scores in preterm infants with respiratory distress. METHODS: Preterm infants on NCPAP due to respiratory distress were included in the study. All infants received NCPAP via the Infant Flow SiPAP. The COVERS pain scale was used to score the infants' pain. Each infant was studied alternating between nasal prongs and a nasal mask. Heart rate, respiratory rate, oxygen saturation, and transcutaneous CO2 (tcCO2) were monitored. Blood pressure and the infants' pain scores were determined every 30 minutes and the average of measurements was taken. RESULTS: The median (interquartile range) values of pain scores, respiratory rates, oxygen saturations, tcCO2 levels, and systolic blood pressures differed significantly and favored the nasal mask. CONCLUSIONS: This study demonstrates that continuous positive airway pressure via a nasal mask leads to a significant reduction in pain scores without altering the respiratory parameters of babies. On the basis of this study, it is possible to conclude that NCPAP applied via nasal mask may be a good alternative to NCPAP applied via nasal prongs.

Investigation of the pharmacological, behavioral, and biochemical effects of boron in parkinson-indicated rats.

Parkinson's disease (PD) is a progressive neurodegenerative disorder of the central nervous system. In different studies, it has been investigated that boric acid has positive effects on different mechanisms that are important in PD. The aim of our study was to investigate the pharmacological, behavioral and biochemical effects of boric acid on rats with experimental PD with Rotenone. For this purpose, Wistar-albino rats were divided into 6 groups. Only normal saline was applied subcutaneously (s.c) to the first control and sunflower oil to the second control group. Rotenone was administered (s.c) to 4 groups (groups 3-6) at a dose of 2 mg/kg for 21 days. Only rotenone (2mg/kg, s.c) was administered to the third group. Boric acid was administered intraperitoneally (i.p.) at 5 mg/kg, 10 mg/kg, and 20 mg/kg to groups 4, 5, and 6, respectively. During the study, behavioral tests were applied to the rats, and then histopathological and biochemical analyzes were performed from the sacrificed tissues. According to the data obtained, a statistically significant difference (p<0.05) was observed between the Parkinson's group and the other groups in motor behavior tests, excluding the catalepsy test. Boric acid exhibited dose-dependent antioxidant activity. As a result of the histopathological and immunohistochemical (IHC) examination, a decrease in neuronal degeneration was observed at the increasing doses of boric acid, while gliosis and focal encephalomalacia were rarely encountered. There was a significant increase in tyrosine hydroxylase (TH) immunoreactivity, especially in group 6, with a dose of 20 mg/kg of boric acid. From these results, we conclude that the dose-dependent effect of boric acid may protect the dopaminergic system with antioxidant activity in the pathogenesis of PD. However, the effectiveness of boric acid on PD needs further investigation in a larger, more detailed study using different methods.

Visual evoked potential and nerve conduction study findings in patients recovered from COVID-19.

OBJECTIVE: COVID-19 infection is associated with peripheral neuropathy. However, subclinical neurological involvement may occur anytime, and diagnostic methods that reveal this subclinical involvement are not well established. We aimed to assess the subclinical neurological involvement by visual evoked potential (VEP) measurements and nerve conduction studies (NCS) and explore the relationship between neurological electrophysiological findings and the severity of COVID-19 infection. METHODS: Seventy-six patients recovered from COVID-19 infection, and 44 healthy controls were enrolled in the study. Patients were assessed for clinical and demographic parameters. NCS and VEP analyses were performed to detect any peripheral neuropathy or optic neuropathy in both groups. RESULTS: None of the COVID-19 patients had electrophysiological evidence of peripheral neuropathy. However, patients with COVID-19 pneumonia had significant abnormalities in several peripheral nerve measurements compared to patients without pneumonia. Although P100 parameters did not differ significantly between patients and controls, 12 patients with COVID-19 had prolonged P100 latencies. CONCLUSIONS: We detected subclinical afferent visual pathway abnormality evaluated by VEP analysis. In addition, we found subtle electrophysiological features in the NCS of the patients presented with COVID-19 pneumonia. However, our findings did not fortify the diagnosis of peripheral neuropathy or optic neuropathy. Further studies are needed to determine the characteristics of COVID-19-related peripheral neuropathy/optic neuropathy whether it has distinct clinical features and disease course.

Hyperbaric oxygen therapy of soft tissue necrosis due to centipede bite in a patient with diabetes.

OBJECTIVE: The purpose of this study is to demonstrate that hyperbaric oxygen therapy (HBOT) is an option for the management of rapidly progressive tissue necrosis after centipede bites in patients with diabetes. METHOD: In this case report, we introduce a patient with diabetes with soft tissue necrosis and secondary infection due to a centipede bite, who was treated with a multidisciplinary approach including HBOT. RESULTS: In this case study, HBOT, applied in the treatment of rapidly developing cellulitis after a centipede bite in a patient with diabetes, accelerated wound healing. Deep soft tissue infection stopped progression to necrotising fasciitis and prevented possible amputation, and facilitated the patient's return to social life in a short time. CONCLUSION: HBOT can be used in combination with other local and systemic, due to its anti-venom effect and treatment of extremity-threatening infection.

[Investigation of the Relationship Between the Immune Responses due to COVID-19 Vaccine and Peripheral Bloodlymphocyte Subtypes of Healthcare Workers]. / Saglik Çalisanlarinda COVID-19 Asisina Bagli Bagisik Yanit ile Hemogram Parametreleri ve Periferik Kandaki Lenfosit Alt Tipleri Arasindaki Iliskinin Arastirilmasi.

Worldwide vaccination is the best strategy to limit the Coronavirus disease-2019 (COVID-19) pandemic. The aim of this study was to investigate the antibody levels and hemogram parameters and the prediction of T-helper, T-cytotoxic and B lymphocyte subtypes in the peripheral blood for the development of these antibodies in the selected group of healthcare workers who were vaccinated with CoronaVac® (Sinovac, China). In a previous study with the same researchers, blood samples were taken from healthcare workers one month after the second vaccination, and anti-RBD anti-severe acute respiratory syndrome coronavirus-2 (anti-SARS-CoV-2) IgG antibodies were measured by enzyme linked immunosorbent assay (ELISA) method. Test results were classified as binding antibody <25.6 BAU/mL unresponsive, 25.6-35.1 BAU/mL weak response, <35.2 BAU/mL strong response, according to the assay manufacturer's recommendations. According to these criteria, it was determined that 22 (8.3%) people had no response, 25 (9.5%) people had a moderate response, and 217 (82.2%) people had a strong response. According to these results, 30 people from each group were invited. The results of three individuals were excluded from the evaluation due to chronic illness. A total of 87 health workers were included in the study. Twenty-two of these people had no response, 25 had a moderate response, and 40 had a good response. Flow cytometry was used to examine the peripheral blood lymphocyte percentage distribution. Statistical analyzes were performed with SPSS 26 software. The conformity of the variables to the normal distribution was examined using analytical methods (Kolmogorov-Smirnov/ Shapiro-Wilk tests). Pearson's Chi-square test was used to compare categorical variables. The correlation between the antibody level and the measurement results of hemogram parameters and lymphocyte indicators was evaluated by Pearson's correlation analysis. The model was established by performing linear regression analysis with the variables correlated with the antibody level. Cases with a p value below 0.05 were considered statistically significant. The age range of the participants in the study was 22-69. The mean age was 45.5 ± 10.4 years. Antibodies against SARS-CoV-2 virus were detected by ELISA method in 65 (74.7%) of the healthcare professionals, while no antibodies were detected in 22 (25.3%) of them. Lymphocyte count (p= 0.002), CD3 count (p= 0.0004), CD4 count (p= 0.0001), CD3/CD19 ratio (p= 0.011), CD4 percentage (p= 0.004) in the antibody positive group was found to be significant. According to the level of correlation between antibody level and lymphocyte indicators, a statistically significant negative correlation was found in CD3, CD4, CD8 and CD19 positive lymphocytes, respectively, and the best correlation was observed in CD3 positive lymphocytes. The formula f (Antibody level)= y= 358002 -0.176 x CD3 + 0.469 x CD19 was created using the linear regression model. In the light of the data of this study, the central role of T and B cells in COVID-19 immunization emerges. The vaccine-related antibody level-related formula may be useful for healthcare professionals in patient follow-up. It is thought that conducting vaccine related immune response studies involving larger populations will contribute more to the literature.

Acute lung injury after exchange transfusion in two newborns with Glucose-6-phosphate dehydrogenase deficiency.

Transfusion-related lung injury (TRALI) is a condition that develops suddenly within the first six hours after a blood transfusion and it is one of the most important causes of blood transfusion-related mortality. There are few data in the literature about TRALI in the neonatal period. We present two newborn patients who developed TRALI after exchange transfusion due to high bilirubin levels. Our first case was a late preterm LGA baby and was on CPAP. The baby was intubated due to sudden deterioration after the exchange transfusion. Our second case was born at term and, an exchange transfusion was performed on the 5th day of life. He developed respiratory distress unexpectedly soon after the exchange transfusion and was intubated. Glucose-6- phosphate dehydrogenase (G6PD) deficiency was detected in both of our cases. We wanted to emphasize that TRALI should be considered in the differential diagnosis of respiratory distress that develops soon after a transfusion in the newborn period and to draw attention to that TRALI may develop more frequently in patients with G6PD deficiency.

The impact of socioeconomic factors on the healthcare costs of people living with HIV in Turkey.

BACKGROUND: This study addresses an important field within HIV research, the impact of socioeconomic factors on the healthcare costs of people living with HIV/AIDS (PLHIV). We aimed to understand how different socioeconomic factors could create diverse healthcare costs for PLHIV in Turkey. METHODS: Data were collected between January 2017 and December 2017. HIV-positive people attending the clinic who had been referred to the national ART programme from January 1992 until December 2017 were surveyed. The questionnaire collected socioeconomic data. The cost data for the same patients was taken from the electronic database Probel Hospital Information Management System (PHIMS) for the same period. The PHIMS data include costs for medication (highly active antiretroviral therapy or HAART), laboratory, pathology, radiology, polyclinic, examination and consultation, hospitalisation, surgery and intervention, blood and blood products, supplies and other costs. Data were analysed using STATA 14.2 to estimate the generalised linear model (GLM). RESULTS: The findings of our GLM indicate that age, gender, marital and parental status, time since diagnosis, employment, wealth status, illicit drug use and CD4 cell count are the factors significantly related to the healthcare cost of patients. We found that compared with people who have AIDS (CD4 cells < 200 cells/mm3), people who have a normal range of CD4 cells (≥ 500 cells/mm3) have $1046 less in expenditures on average. Compared to younger people (19-39 years), older people (≥ 55) have $1934 higher expenditures on average. Costs are $644 higher on average for married people and $401 higher on average for people who have children. Healthcare costs are $518 and $651 higher on average for patients who are addicted to drugs and who use psychiatric drug(s), respectively. Compared to people who were recently diagnosed with HIV, people who were diagnosed ≥10 years ago have $743 lower expenditures on average. CONCLUSION: Our results suggest that in addition to immunological status, socioeconomic factors play a substantial role in the healthcare costs of PLHIV. The key factors influencing the healthcare costs of PLHIV are also critical for public policy makers, healthcare workers, health ministries and employment community programs.

The determinants of employability of people living with HIV/AIDS in Turkey.

BACKGROUND: This study addresses an important field within HIV research, the factors affecting the determinants of the employability of people living with HIV/AIDS (PLHIV) in Turkey. The employability of PLHIV is now even more vital because the use of antiretroviral therapy improves the quality of life of patients. In spite of this, the related literature suggests that there are serious impediments to the employment of PLHIV who face considerable levels of discrimination based on their HIV status. METHODS: This is a cohort study of 170 PLHIV of working age, treated at the Izmir Bozyaka Education and Training Hospital. We use a univariate logistic model to determine the effects of all determinants of interest with probit/logit modeling and penalized maximum likelihood estimation to avoid bias and to test the robustness of results. RESULTS: Age, time since diagnosis, work status at diagnosis, wealth status, illicit drug use, and CD4 cell count were significantly related to the employability of PLHIV. Younger individuals had a higher probability of workforce participation. HIV-infected patients aged 19 to 39 and 40 to 54 years were 32% and 20% more likely, respectively, to be employed. Economically better-off PLHIV were more likely to participate in the labor force and HIV patients who were working at the time of diagnosis were more likely to be re-employed. Time since diagnosis was negatively associated with the employment status. Compared to recently diagnosed patients, PLHIV for more than a decade were less likely to be employed. Those with high CD4 cell counts were more likely to be employed. Illicit drug use was negatively associated with employment and drug-addicted HIV patients were less likely to be employed. Higher education did not significantly predict the employability of PLHIV. CONCLUSIONS: Our results suggest that besides immunological status, socioeconomic factors play a substantial role in the employability of PLHIV. We suggest that even if a patient is skilled, educated, and qualified for the job, other factors such as stigma and employment discrimination in the workplace may hinder employment even among highly educated PLHIV.

The role of regulatory T cells in allergic rhinitis and their correlation with IL-10, IL-17 and neopterin levels in serum and nasal lavage fluid.

PURPOSE: Allergic rhinitis (AR), is an IgE-mediated inflammation of the nose. Regulatory T cells (Tregs) and inflammatory cytokines have been shown to play a critical role in allergic airway inflammation. The aim of the study was to compare the levels of blood T lymphocyte subsets and IL-10, IL-17 and neopterin concentrations in serum and nasal lavage of patients with AR compared to healthy subjects. METHODS: The study included 38 subjects with moderate-severe AR and 36 sex- and age-matched controls. Peripheral blood CD3+, CD3+CD4+ and CD4+CD25+Foxp3 percentages were evaluated using flow cytometry. Levels of IL-10, IL-17 and neopterin were measured both in serum and nasal lavage fluid with ELISA and HPLC, respectively. RESULTS: No difference was found in the percentages of T lymphocyte subsets between the two groups (p > 0.05). Serum IL-10 levels were similar (p > 0.05), whereas nasal IL-10 was lower in AR subjects compared to control group (2.22 ± 0.91 and 3.12 ± 1.45 pg/ml, respectively) (p < 0.05). Mean serum and nasal IL-17 were higher in AR (107.7 ± 79.61 and 527.36 ± 738.7 pg/ml) than the control group (76.29 ± 28.94 and 328.9 ± 430.8 pg/ml) (p < 0.05 and p > 0.05). There were no significant differences in serum and nasal neopterin levels (p > 0.05). CONCLUSIONS: Although there were no differences in the distribution of lymphocyte subsets between the AR and control groups, the finding of higher levels of serum and nasal IL-17 and lower levels of nasal IL-10 support the cytokine imbalance in the pathogenesis of AR.

Effect of dietary boron on learning and behavior in rats administered with boric acid.

This study was designed to investigate the effect of dietary boron on spatial learning, anxiety, some vitamins and oxidative parameters in rats. Thirty-two Wistar albino male rats were used in the study. The rats were equally divided into four groups with 8 rats each: I control group: standard pellet diet only, II. group: 250 ppm boric acid, III. group: 500 ppm boric acid and IV. group: 1000 ppm boric acid added into standard pellet diet. Over a five-week period, elevated plus-maze test was used for anxiety assessment and Morris water maze test was used for evaluating spatial learning. Additionally, blood samples were obtained at the end of the experiment and were used to determine the serum levels of some vitamins and oxidative parameters. Dietary boron significantly increased weight gain (p<0.001) and food consumption in the 250 ppm and 500 ppm groups (p<0.05). Although boron supplementation had no significant effect on learning and anxiety-related behavior, it had beneficiary effects on memory retention in the 1000 ppm group (p<0.05). Biochemical analyses showed a significant decrease in the MDA levels (p<0.05) and an increase in vitamin D3 levels (p<0.01) in the 500 ppm group, a significant increase in GSH-Px activity in the 250 ppm and 500 ppm groups (p<0.05), and a decrease in vitamin E levels in all the experimental groups (p<0.05). In conclusion, our study demonstrated that dietary boron can be beneficial for health when administered at appropriate doses.

Delayed cord clamping in term large-for-gestational age infants: A prospective randomised study.

AIM: To compare the post-natal effects of delayed cord clamping (DCC) and early cord clamping (ECC) in term large-for-gestational age (LGA) infants. METHODS: This prospective randomised study included 51 term LGA infants. The umbilical cords of these infants were clamped at 15 s in group 1 (ECC group (n = 26)) and at 60 s in group 2 (DCC group (n = 25)). Data for Apgar scores, cord blood, pH and lactate values, second haematocrit, 24th bilirubin levels, duration of hospital stay and admission to the neonatal intensive care unit (NICU) were recorded. RESULTS: The demographic characteristics of the infants in the study group were not significantly different. No statistically significant difference was observed in the post-natal haematocrit and bilirubin levels between the groups. Six infants (group 1, n = 3; group 2, n = 3) were diagnosed with polycythaemia (P = 0.79); however, these infants remained asymptomatic, and no treatment was required. One infant in each group developed hyperbilirubinemia, which required phototherapy (P = 1.00). The infant with hyperbilirubinemia in the DCC group presented with asymptomatic polycythaemia. Three neonates in the DCC group required admission to the NICU for transient tachypnoea. CONCLUSIONS: No significant increase in the rate of post-natal complications of DCC in term LGA infants was observed in the study. However, before recommending DCC on a routine basis, studies with a larger sample size and long-term follow-up are required to elucidate the risks and benefits of DCC in this group of infants.

Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study.

OBJECTIVE: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

Coexistence of Papillitis and Posterior Placoid Chorioretinopathy as the Presenting Symptoms of Syphilis-Human Immunodeficiency Virus Coinfection.

A 27-year-old male was presented with a decrease in vision in the left eye. Best-corrected visual acuity was 10/10 in the right eye and counting fingers at 2 m in the left eye. On fundus examination, the left optic disc was oedematous and there was a wide yellowish, well-defined placoid lesion between the temporal vascular arcades with mild vitreous inflammation. However, a small yellowish well-defined placoid lesion was detected in the inferior temporal region of the macula in the right eye. He was diagnosed with posterior placoid chorioretinopathy (PPC), papillitis, and neurosyphilis after performing fundus fluorescein angiography, fundus autofluorescence imaging, optical coherence tomography, serology for human immunodeficiency virus (HIV) and syphilis, and cerebrospinal fluid examination. Intravenous penicillin treatment was commenced as soon as the diagnosis was established. Seven days after treatment initiation, lesions were partially regressed. PPC and papillitis are rare manifestations of ocular syphilis. In addition, neurosyphilis may also accompany these manifestations. Therefore, syphilis should be considered in the differential diagnosis of patients who have PPC or papillitis and all patients should be tested for HIV coinfection and neurosyphilis.

Reference ranges for serum immunoglobulin (IgG, IgA, and IgM) and IgG subclass levels in healthy children

Background/aim: The serum immunoglobulin levels are used routinely in clinical practice because they provide key information on the humoral immune status. This study aimed to determine the age-related reference values of serum immunoglobulin levels in healthy children. Materials and methods: A total of 330 healthy children, aged between 0 and 18 years, were included in this study. The serum immunoglobulin levels were measured using a nephelometric method in a total of 11 groups, each group consisting of 30 individuals, and IgG subclasses in 6 groups of children aged more than 2 years. Results: The serum IgG levels were high during the newborn period, decreased until the sixth month, and again increased to a maximum level at the age of 18 years. The level of IgA was found to be extremely low in the newborn period and then increased with age. While the lowest value was in the newborn period for serum IgM level, the highest value was in the 16- to 18-year-old period. The IgG subclasses varied depending on the age groups. Conclusion: The updated reference intervals of immunoglobulin levels in children may be used for the accurate diagnosis of immune deficiencies.

The impact of economic and social factors on the prevalence of hepatitis B in Turkey.

BACKGROUND: Viral Hepatitis is one of the major global health problems, affecting millions of people every year. Limited information is available on the impact of social and economic factors on the prevalence of Hepatitis B virus (HBV) in Turkey. This study, contrary to other studies in the literature, was undertaken with the aim of examining the Majority of the excluded data come from the volunteers. METHODS: There are medical and the social-economic factors affecting the prevalence of HBV. This research, while taking medical factors as control variables, clarify the social and economic factors affecting the prevalence of HBV by utilising clinical data with the use of the Binary Probit Model (BPM). The BPM estimation is a powerful tool to determine not only the factors but explain also the exact impacts of each factor. RESULTS: The estimations of the BPM shows that economic and social variables such as age, gender, migration, education, awareness, social welfare, occupation are very important factors for determining HBV prevalence. Compared to the youngest population, the 46 to 66+ age group has a higher prevalence of HBV. The male respondents were 5% more likely to develop HBV compared to females. When region-specific differences are taken into account, migrating from the poorest parts of the country such as the eastern and south-eastern regions of Turkey are approximately 16% more likely to be infected. The welfare indicators such as a higher number of rooms in the respondent's house or flat decreases the probability of having HBV and, relatively higher income groups are less likely to develop HBV compared to labourers. The Self-employed/Business owner/Public sector worker category are approximately 10% less likely to develop HBV. When people are aware of the methods of prevention of HBV, they are 6% less likely to be infected. Previous HBV infection history increases the probability of having HBV again B by 17%. CONCLUSIONS: These findings strongly suggest that the impact of social and economic factors on the prevalence of HBV is vital. Any improvements in these factors are likely to reduce prevalence of HBV.

Effects of quercetin and surgicel for preventing adhesions after gynecological surgery: A rat uterine horn model.

AIM: Postoperative pelvic adhesions are significant health care problems causing chronic pelvic pain, infertility and intestinal obstruction after abdominal or pelvic surgery. We investigated the effects of quercetin and Surgicel for the prevention of adhesions after gynecological surgery. METHODS: A double blind, randomized, controlled experimental study was designed. Forty female Wistar Hannover rats were divided into five groups: control, sham operated, quercetin, Surgicel, and quercetin + Surgicel. The control group received medication used for the surgical procedure only. The sham group received a laparotomy only. The quercetin group received 15 mg/kg quercetin in addition to undergoing the standard surgical procedure, and the injuries in the surgical group were covered with a single, 1 cm2 layer of Surgicel (oxidized regenerated cellulose). The quercetin + Surgicel group received both 15 mg/kg quercetin and a single, 1 cm2 layer of Surgicel. Adhesions were scored 14 days after the first surgical procedure. RESULTS: The extent, severity, degree, total adhesion, inflammation and fibrosis scores of the control group were significantly higher than those of the quercetin, Surgicel, and quercetin + Surgicel groups. There was no significant difference between the Surgicel and quercetin groups in degree, but all other parameters were significantly higher in the Surgicel than in the quercetin group. The quercetin + Surgicel group had lower adhesion scores than the quercetin group. CONCLUSIONS: Quercetin, Surgicel and quercetin + Surgicel treatment may be useful for preventing pelvic adhesions.

Metastatic progression of breast cancer along with decreased mitochondrial cell death priming of breast cancer cells: a case report.

Metastatic breast cancer remains to be a major cause of cancer-related deaths in women. Exploring the molecular mechanisms to identify targetable alterations in progressing breast cancer and developing functional tools to predict therapy response in these patients are needed. In this report, we present a case of breast cancer patient who progressed following surgery and adjuvant endocrine therapy. Radiological and pathological analyses revealed metastasis to liver and brain. Paired liquid biopsies demonstrated acquired ERBB2 mutations in addition to TP53 and PIK3CA mutations, which were also present before progression. BH3 profiling test demonstrated decreased mitochondrial cell death priming in CTCs of the patient after progression. In conclusion, novel personalized treatment strategies are needed to monitor metastatic breast cancer patients for better clinical benefit.

The effect of glutathione treatment on the biochemical and immunohistochemical profile in streptozotocin-induced diabetic rats.

This study investigated the possible role of glutathione (GSH) in diabetic complications and its biochemical safety in experimental diabetic rats. Serum biochemical parameters and the histology of the pancreas were investigated. Seven rats were separated as controls. To create the diabetes in rats, 45 mg/kg single-dose streptozotocin (STZ) was administered i.p. The treatment was continued for 1 month. STZ was administered to the diabetes + GSH group, then reduced GSH, dissolved in isotonic salt solution (200 mg/kg), was applied i.p. two times a week. The GSH group received i.p. GSH. Serum biochemical parameters were determined by autoanalyzer. Immunohistochemical procedures were used to determine the percentage of the insulin-immunoreactive ß-cell area in the islets of Langerhans. The biochemical parameters changed to different degrees or did not change. Pancreatic cells of the control and GSH groups were healthy, but in the diabetic and GSH-treated diabetic groups we found damage in different numbers. The results from these analyses show that GSH supplementation can exert beneficial effects on pancreatic cells in STZ-induced diabetic rats and can safely be used for therapy in and protection from diabetes and complications of diabetes.

Intestinal perforation after intravitreal low dose ranibizumab injection for the treatment of type 1 retinopathy of prematurity: A case report.

PURPOSE: To report a newborn patient with gastrointestinal (GIS) perforation after intravitreal ranibizumab (RBZ) treatment. CASE REPORT: The patient was born at 31 gestational week and hospitalized with the diagnosis of small for gestational age and prematurity. In the follow up he underwent GIS surgery due to necrotizing enterocolitis (NEC) and was diagnosed with retinopathy of prematurity (ROP). At 43 weeks of postmenstrual age, he developed intestinal perforation after 12 h of the second low-dose RBZ injection. According to our knowledge, this is the first report of GIS perforation due to low-dose intravitreal RBZ treatment in an infant with severe ROP. CONCLUSION: The risk of GIS perforation should be taken into consideration during the application of intravitreal vascular endothelial growth factor antagonist agents, especially in newborns with previous GIS surgery and a history of NEC, and these patients should be carefully monitored for GIS complications.