THE USEFULNESS OF MONITORING THE NEUTROPHIL TO LYMPHOCYTE RATIO IN PATIENTS WITH PERIPHERAL VERTIGO.

The purpose of this study was to evaluate the usefulness of the neutrophil to lymphocyte ratio (NLR) in a differential diagnosis and follow-up of patients with peripheral vertigo. Twenty patients with benign positional paroxysmal vertigo (BPPV) and 20 patients diagnosed with vestibular neuritis (VN) were included in the study. Serum samples were analysed at the initial presentation and on the seventh day of admission retrospectively. The WBC (white blood cell) count was 10500±2100 /mm3, the neutrophil count was 4700±1100/mm3, the lymphocyte count was 5000±1200/mm3 and the NLR was 0.9±0.2 in the VN group. In patients with BPPV, the WBC count was 9200±1300/mm3, the neutrophil count was 5200±1200/mm3, the lymphocyte count was 3100±1200/mm3 and the NLR was 1.9±0.9. The NLR was lower in patients with VN than in patients diagnosed with BPPV. The WBC and lymphocyte count was significantly higher in the patients with VN than in the patients diagnosed with BPPV. Within the first week of admission, the WBC and lymphocyte counts in patients with VN decreased, and the NLR was more elevated than at the admission. It is highly recommended that NLR is used in the diagnosis and follow-up of the most commonly observed aetiological factors of peripheral vertigo, BPPV and VN.

Efficacy of medical therapy in the prevention of residual dizziness after successful repositioning maneuvers for Benign Paroxysmal Positional Vertigo (BPPV).

OBJECTIVES: The aim of this study was to investigate the efficacy of trimetazidine, betahistine, and ginkgo biloba extract in the treatment of residual dizziness after successful repositioning maneuvers for benign paroxysmal positional vertigo. METHODOLOGY: This was a randomized controlled clinical trial. Complete clinical data were analyzed from 100 patients (27 men and 73 women; mean age 52.16 ± 13.2 years, range 11-80 years) with BPPV who underwent succcessful repositioning maneuvers and then received betahistine, trimetazidine, gingko biloba extract, or no medication (n = 25 for each group) for 1 week. On days 1, 3, and 5 after the repositioning maneuver, scores obtained from the Dizziness Handicap Inventory (DHI) questionnaire were compared. RESULTS: There were no statistically significant differences in the premedication DHI scores of patients with residual dizziness among the four groups (p > 0.005). After 3 and 5 days of treatment, the mean DHI scores of the groups receiving medication did not differ significantly from the the mean DHI score of the control group (p > 0.005). CONCLUSIONS: Our study results suggest that betahistine, trimetazidine, and gingko biloba extract do not alleviate residual dizziness after successful repositioning maneuvers.

Relationship between genuine and pseudohalitosis and social anxiety disorder.

Halitosis is described as offensive breath caused by various factors such as periodontal diseases, bacterial coating of tongue, systemic disorders and different types of foods. Pseudohalitosis is a situation that patients complain of oral malodor even though they do not have offensive odour. The purpose of this study was to compare the relationships between social anxiety estimations and both pseudohalitosis and genuine halitosis cases. Liebowitz Social Anxiety Scale (LSAS) and questionnaire regarding halitosis were applied to 100 participants. Halitosis was determined using organoleptic method, gas chromatography and portable sulphur monitor. anova test and 2-tailed Spearman's rank-order correlation coefficient were used to determine the differences and relations between groups. With reference to LSAS, 62% of participants had anxiety. Among these patients, 98% had genuine halitosis (P < 0·05). The mean measurements of VSC values were 248·65 ppm in halimeter, 298·02 ppm of H2 S, 95·33 ppm of CH3 SH and 47·00 ppm of (CH3 )2 S in gas chromatography. Halitosis was present in 90% of participants, and it was absent in 10% by organoleptic assessment. There was a significant correlation between organoleptic and halimeter measurements. Moreover, statistically significant relationship was detected between anxiety and halitosis. Genuine halitosis patients exhibit social anxiety, so it can be said that there is a causal relationship between halitosis and anxiety. Comparison of the results of objective measurements (sulphur monitor, gas chromatography, organoleptic method) was statistically significant; therefore, it can be said that these methods can be used in diagnosis of halitosis with high accuracy.

Arterial blood gas analysis predicts futile recanalization in mechanical thrombectomy-treated acute ischemic stroke patients: a multicenter study.

OBJECTIVE: It is known that providing recanalization alone in large vessel occlusions is not sufficient to provide a good 90-day clinical outcome. It is advocated that neuroprotection should be increased before endovascular treatment and that the penumbra should be protected from reperfusion damage after recanalization. However, the effects of blood gas parameters before and after mechanical thrombectomy on clinical outcomes are not clear. The objective of this study is to assess the effectiveness of serial blood gas measures in accurately predicting futile recanalization at an early stage. PATIENTS AND METHODS: This study is a multicenter inquiry that collected data in a prospective manner and analyzed it retrospectively. Patients with a 2b-3 thrombolysis in cerebral infarction (TICI) score after mechanical thrombectomy for recanalization were consecutively analyzed from July 2022 to March 2023. Arterial blood gas parameters, including pH, oxygen saturation (SaO2), partial carbon dioxide pressure (PaCO2), partial oxygen pressure (PaO2), lactate, and bicarbonate (HCO3), were measured at four time points: before mechanical thrombectomy treatment (preoperative), immediately after recanalization (postoperative 1st), during the 3rd hour (postoperative 3rd), and at the 5th hour (postoperative 5th). The patients were categorized into groups based on their modified Rankin Scale (mRS) scores. RESULTS: The study included 136 patients with an average age of 69.71±11.22. The postoperative 1st-hour SaO2 values were lower in the mRS 3-6 group (p=0.038). The postoperative pH and lactate mean were greater in the mRS 3-6 group than in the 0-2 group (p=0.038 and 0.018, respectively). In logistic regression, a unit rise in lactate increased poor functional outcomes 1,632 times (p=0.024). Early neurological recovery was associated with decreased postoperative 3rd-hour lactate (p=0.014). The mean postoperative PaO2 (average of 1, 2, 3 PaO2) was higher in those with symptomatic cerebral bleeding (p=0.044). CONCLUSIONS: Monitoring lactate and pH levels in AIS patients who have had mechanical recanalization can be utilized to predict mortality and morbidity, especially in the first five hours after the procedure. Graphical Abstract: https://www.europeanreview.org/wp/wp-content/uploads/Graphical-abstract-8.jpg.

Vancomycin-variable enterococci in sheep and cattle isolates and whole-genome sequencing analysis of isolates harboring vanM and vanB genes.

Background: Vancomycin resistance encoded by the vanA/B/M genes in enterococci is clinically important because of the transmission of these genes between bacteria. While vancomycin resistance is determined by detecting only vanA and vanB genes by routine analyses, failure to detect vanM resistance causes vancomycin resistance to be overlooked, and clinically appropriate treatment cannot be provided. Aims: The study aimed to examine the presence of vanM-positive enterococcal isolates in Ankara, Turkey, and to have detailed information about them with sequence analyses. Methods: Caecal samples were collected from sheep and cattle during slaughter at different slaughterhouses in Ankara, Turkey. Enterococci isolates were identified, confirmed, and analyzed for the presence of vanA/B/M genes. Antibiotic resistance profiles of isolates were determined by the broth microdilution method. A whole genome sequence analysis of the isolates harboring the vanM and vanB genes was performed. Results: 13.7% of enterococcal isolates were determined as Enterococcus faecium and Enterococcus faecalis. 15% of these isolates contained vanB, and 40% were vanM-positive. S98b and C32 isolates were determined to contain 16 CRISPR-Cas elements. 80% of the enterococci isolates were resistant to nitrofurantoin and 15% to ciprofloxacin. The first vanM-positive vancomycin-variable enterococci (VVE) isolates from food-producing animals were identified, and the S98b strain has been assigned to Genbank with the accession number CP104083.1. Conclusion: Therefore, new studies are needed to facilitate the identification of vanM-resistant enterococci and VVE strains.

Should coronary catheter laboratories be used in the treatment of ischemic stroke? Endovascular treatment in acute ischemic stroke performed by interventional cardiologists.

OBJECTIVE: The aim of this study was to investigate the technical success and in-hospital outcomes of endovascular thrombectomy (ET) in acute ischemic stroke (AIS) patients performed by interventional cardiologists. PATIENTS AND METHODS: ET for AIS provides fast, effective and safe recanalization. Insufficient number of catheter laboratories for stroke interventions and experienced interventional neurologists are limiting the widespread application of such a promising treatment method. RESULTS: 123 patients with AIS and eligible for ET were evaluated retrospectively. 65 patients were female (52.8%) and the mean age of the patients was 71.5 ± 11.9 years. Most of the patients had a middle cerebral artery (MCA) occlusion (112 patients, 91%). Successful recanalization (thrombolysis in cerebral infarction grading 2b or higher) was achieved in 109 patients (88.6%). Access site complication was observed only in 3 patients (2.4%). Intracranial bleeding was observed in 17 patients (13.8%) and only 8 of them were symptomatic (6.5%). In-hospital death occurred in 19 patients (15.4%). The initial National Institutes of Health Stroke Scale (NIHSS) was 16.8±3.3 (median 18) which improved significantly to 10.4±7.2 (median 11) at 24 hours (p<0.001). Dramatic neurologic improvement was observed in 60 of 123 patients (48.8%). The modified rankin score of the patients was significantly lower at discharge compared to admission (4.2±0.7 vs. 2.9±2, p<0.001). CONCLUSIONS: ET in AIS can be performed safely with high success rates by trained interventional cardiologists within the stroke team. Until the number of stroke centers is sufficient, endovascular treatment of AIS can be supported by experienced interventional cardiologists.

How childhood trauma and emotions influence essential tremor and its severity in Sakarya Province.

OBJECTIVE: Essential tremor (ET) is among the most common central nervous system disorders. It is characterised by symmetrical and bilateral postural tremor, usually affecting the hands. Alongside such motor symptoms, psychiatric symptoms, such as anxiety and depression, often occur. This study aimed to investigate how anxiety, depression and childhood trauma influence ET patients' tremor frequency and severity. PATIENTS AND METHODS: The participants comprised 85 patients and 70 control volunteers. Participating patients have been admitted to our clinic for hand tremor complaints and diagnosed with ET, according to the Washington Heights Inwood Genetic Study of Essential Tremor (WHIGET) diagnosis criteria, and they returned for follow-up for at least one year after their initial treatment. Patients with thyroid dysfunction, Parkinson's disease, central nervous system pathology, a history of smoking or alcohol use or a history of drug use that may cause tremor were excluded from the study. Patients' demographic data, such as their age and gender, age at disease onset, disease duration, family history and tremor severity were recorded. The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Childhood Trauma Questionnaire (CTQ) were applied to all patients. RESULTS: Statistically significant differences were found in BDI score averages and BAI score averages between the patient and control groups (p = 0.002; p = 0.001) and physical abuse, emotional neglect and sexual abuse scores on the CTQ scale (p = 0.001, p = 0.007 and p = 0.001, respectively). CONCLUSIONS: Childhood mental trauma and emotional mood disorders are more common among ET patients. However, these disorders do not appear to affect ET severity.

Specialist physicians battle against the COVID-19 pandemic: the relationship between specialist physicians working conditions and levels of burnout during the COVID-19 pandemic.

OBJECTIVE: This study was planned to determine the burnout levels of physicians during the COVID-19 pandemic, and to contribute to taking the necessary measures by determining the associated factors. MATERIALS AND METHODS: This research was designed via Google Online Form as an online survey with questions of Sociodemographic Data Form, Maslach Burnout Inventory and Beck Anxiety Inventory and was conducted with 40 specialist physicians actively working at the Sakarya University Training and Research Hospital. The same questionnaire was re-applied online after two months, and 24 out of 40 physicians were accessed. The SPSS 25 (IBM, Armonk, NY, USA) program was used for the analysis of the data. RESULTS: According to the Maslach Burnout Inventory applied in the pre-test, it was found that the feeling of personal accomplishment was high, emotional burnout was normal, and depersonalization was low. Anxiety and burnout were found to be positively correlated, and there were no statistically significant differences in the average values of the pre-and post-test Maslach Burnout Inventory and Beck Anxiety Inventory scores. CONCLUSIONS: Detecting possible burnout in physicians working in a pandemic, identifying associated factors and taking required measures can be beneficial both for physicians and society from a biopsychosocial perspective.

Predictive value of systemic immune-inflammation index for cerebral reperfusion and clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment.

OBJECTIVE: The systemic immune inflammation (SII) index has been an excellent prognostic indicator in patients with acute ischemic stroke (AIS). In this study, we assessed the utility of the SII in predicting the prognosis and reperfusion status of patients with AIS who underwent endovascular treatment (EVT). PATIENTS AND METHODS: 123 consecutive AIS patients were enrolled in our study. The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of SII for predicting unsuccessful cerebral reperfusion. Multivariate logistic regression analysis analyzed the association between SII and unsuccessful reperfusion rate after EVT. RESULTS: The median value of SII was significantly higher in patients with unsuccessful reperfusion compared to patients with successful reperfusion [2,029 (1,217-2,771) vs. 1,172 (680-2,145) respectively, p=0.003)]. A ROC curve analysis showed that the best cut-off value of SII for predicting unsuccessful reperfusion status was 1,690, with sensitivity and specificity of 71% and 69%, respectively. The area under the curve (AUC) was 0.673 (95% CI; 0.552-0.793). Multivariate analysis demonstrated that SII ≥ 1,690 value was an independent predictor of unsuccessful cerebral reperfusion and unfavorable clinical outcome after EVT (Hazard ratio - H.R.=3.713, 95% CI: 1.281-10.76, p=0.016, HR=2.28, 95% CI: 1.06-4.88, p=0.035, respectively). CONCLUSIONS: We suggested that SII is a potential indicator to predict the unsuccessful cerebral reperfusion and unfavorable clinical outcome for patients with AIS undergoing EVT.

Comparison of COVID-19 patients who underwent thrombectomy with those in the pre-pandemic period in terms of etiology and prognosis.

OBJECTIVE: We aimed at determining the effectiveness of mechanical thrombectomy (MT) in patients with major vessel occlusion and infected with COVID-19, evaluating its clinical outcome and comparing it with non-COVID patients. PATIENTS AND METHODS: During the pandemic, 729 patients who underwent MT in stroke centers due to Acute Ischemic Stroke (AIS) with large vessel occlusion were evaluated. This study included 40 patients with a confirmed COVID-19 diagnosis by a positive PCR test between March 11, 2020, and December 31, 2020. These patients were compared to 409 patients who underwent MT due to major vessel occlusion between March 11, 2019, and December 31, 2019. RESULTS: Of the patients with AIS who are infected with COVID-19, 62.5% were males, and all patients have a median age of 63.5 ± 14.4 years. The median NIHSS score of the COVID-19 group was significantly higher than that of the non-COVID-19 groups. Dissection was significantly more in the COVID-19 group. The mortality rates at 3 months were higher in the COVID-19 groups compared to non-COVID-19 groups. CONCLUSIONS: This study revealed an increased frequency of dissection in patients with COVID-19. COVID-19-related ischemic strokes are associated with worse functional outcomes and higher mortality rates than non-COVID-19 ischemic strokes.

An unusual cause of dysphonia: laryngeal verruca vulgaris.

PROBLEMS/OBJECTIVES: Verruca vulgaris of the larynx (VVL) is an uncommon lesion with clinical and histopathological features that are easily misdiagnosed as verrucous carcinoma, and thus may lead to unnecessary surgery. This case study investigated clinical and pathological features that might distinguish VVL from other keratotic laryngeal lesions. METHODOLOGY: A 35-year-old man presented with a 3-month history of progressive hoarseness and superficial, keratotic, vocal cord lesions. The verrucoid configuration of the surface and lack of nuclear atypia enabled treatment by local excision. The biopsied lesion was sectioned and examined by immunohistochemistry, and in situ hybridization. RESULTS: The patient was disease-free up to 1 year and 6 months after surgery. The exophytic, keratotic lesions of the larynx had features of cutaneous verruca vulgaris. No human papilloma virus was detected. CONCLUSIONS: We described histopathological features of VVL that will facilitate its distinction from laryngeal keratosis, squamous papillomas, verrucous hyperplasia, and verrucous carcinoma.

Shorter time to begin of QRS fragmentation predicts non-response to cardiac resynchronization therapy in non-ischemic heart failure patients. / El inicio rápido de la fragmentación del QRS predice la no respuesta a la terapia de resincronización cardíaca en pacientes con insuficiencia cardíaca no isquémica.

OBJECTIVE: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Presence of fragmented QRS (f-QRS) on 12-lead electrocardiogram (ECG) has been shown to be associated with non-response to CRT. The aim of this study was to evaluate whether onset of fragmentation (Q-f interval) is important for CRT response. METHODS: This is a single-center retrospective analysis of prospectively collected data of 38 non-ischemic dilated cardiomyopathy patients (18 men, mean age 63±12 years) with f-QRS on 12-lead ECG who underwent CRT. Duration of fragmentation, ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and time interval from Q wave to the onset of QRS fragmentation (Q-f interval) were measured. RESULTS: The baseline clinical, echocardiographic findings of patients with responders (24 patients, 63%) and non-responders showed no statistically significant difference, except for longer f-QRS duration, increased ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and shorter time interval from Q wave to the onset of QRS fragmentation (Q-f interval) in patients not responding to CRT. In multivariate analysis, Q-f interval was determined as an independent predictor of response to CRT (OR 1.240, 95% CI: 1.049-1.467, P=.012). In ROC curve analysis, the best cut-off value for Q-f interval to predict responders was 32.5ms with a sensitivity and specificity of 83.3% and 85.7%, respectively (AUC 0.899, 95% CI: 0.797-1.000, P=.001). CONCLUSIONS: Shorter time from onset of QRS to beginning of fragmentation is a simple ECG marker to predict non-responsive patients to CRT.

A fully automatic end-to-end method for content-based image retrieval of CT scans with similar liver lesion annotations.

PURPOSE: The goal of medical content-based image retrieval (M-CBIR) is to assist radiologists in the decision-making process by retrieving medical cases similar to a given image. One of the key interests of radiologists is lesions and their annotations, since the patient treatment depends on the lesion diagnosis. Therefore, a key feature of M-CBIR systems is the retrieval of scans with the most similar lesion annotations. To be of value, M-CBIR systems should be fully automatic to handle large case databases. METHODS: We present a fully automatic end-to-end method for the retrieval of CT scans with similar liver lesion annotations. The input is a database of abdominal CT scans labeled with liver lesions, a query CT scan, and optionally one radiologist-specified lesion annotation of interest. The output is an ordered list of the database CT scans with the most similar liver lesion annotations. The method starts by automatically segmenting the liver in the scan. It then extracts a histogram-based features vector from the segmented region, learns the features' relative importance, and ranks the database scans according to the relative importance measure. The main advantages of our method are that it fully automates the end-to-end querying process, that it uses simple and efficient techniques that are scalable to large datasets, and that it produces quality retrieval results using an unannotated CT scan. RESULTS: Our experimental results on 9 CT queries on a dataset of 41 volumetric CT scans from the 2014 Image CLEF Liver Annotation Task yield an average retrieval accuracy (Normalized Discounted Cumulative Gain index) of 0.77 and 0.84 without/with annotation, respectively. CONCLUSIONS: Fully automatic end-to-end retrieval of similar cases based on image information alone, rather that on disease diagnosis, may help radiologists to better diagnose liver lesions.

Relationship of hematologic markers with IL-17 and IL-1 beta in patients with rheumatoid arthritis.

OBJECTIVES: In this study, we aimed to investigate the relationship of NLR (Neutrophil lymphocyte ratio), MPV (mean platelet volume), PDW (distribution width) rates in rheumatoid arthritis (RA) patients with IL-17 and IL-1 beta which are within the cytokines playing an important role in etiopathogenesis and activity of the disease. PATIENTS AND METHODS: Fifty-seven RA patients diagnosed according to RA classification criteria of ACR/EULAR 2010 and 37 controls were included into the study. WBC (white blood cell), NEU (neutrophil), PLT (platelet), LYM (lymphocyte) values in complete blood count received from routine blood examination of patients were recorded, and NLR, PLR (platelet lymphocyte ratio) rates were recorded. IL-17 and IL-1 beta were studies in serum samples. Disease activity of RA patients was evaluated with Disease Activity Score (DAS28). Age, gender, disease age, BMI (body mass index), medications used, co-morbid diseases, smoking of the patients were recorded. RESULTS: Fifty-seven RA patients (46 (80.7%) females, 11 (19.3%) males), and 34 patients (24 (70.6% females and 10 (29.4) males) as a control group were involved. Demographic characteristics were similar between two groups, and statistically significant difference was not detected between patient and control groups in terms of gender, age, and BMI (p> 0.05). We found higher NLR, MPV, PDW, IL-17 values in RA patients compared to control group (p< 0.05). There was a positive correlation of NLR with DAS28, CRP. While erythrocyte sedimentation rate (ESR) had negative correlation with MPV and PDW, it had positive correlation with PLT. We found positive correlation of C-reactive protein (CRP) with NLR and PLT. We could not find correlation of IL-1 beta and IL-17 with hematologic markers. CONCLUSION: In this study, we investigated the relationship of IL-17 and IL-1 beta which play an important role in pathogenesis of RA patients with the parameters analyzed in routine complete blood count, providing information about disease activity such as DAS 28, CRP, and ESR. We illuminated on an issue which has not discussed before by looking from a different angle. More extensive, follow-up studies are needed to emphasize the importance of these parameters and to reveal the relationship between cytokines during the follow-up of the disease activity.

Evaluation of Mediterranean diet adherence in patients with a history of coronary revascularization. / Evaluación de la adherencia a la dieta mediterránea en pacientes con antecedentes de revascularización coronaria.

INTRODUCTION: Lifestyle modification is an important component of the secondary prevention strategies; and a healthy diet is one of the cornerstones in management of the coronary heart disease. We aimed to investigate the dietary habits of the patients with history of coronary revascularization, characteristics of the ones with good adherence by using alternate MedDiet questionnaire. METHODS: We included outpatients who had a history of coronary revascularization at least 6 months prior to enrollment. Each participant filled out a questionnaire to collect the data of demographics and clinical characteristics. Alternate MedDiet score was calculated to evaluate the Mediterranean style dietary adherence. Alternate MedDiet was originally based on 14-item questionnaire; we adjusted it to our population (max 13 points). RESULTS: We enrolled 226 consecutive outpatients (age 61.7±10.9 years, 72% males). The median duration after revascularization was 60 months. A total of 112 (49.6%) patients had previous percutaneous coronary intervention (PCI), 77 (34.1%) had coronary by-pass graft surgery (CABG), and 36 (15.9%) had both revascularization procedures. The median MedDiet score was 6. Patients were stratified into two subgroups (MedDiet score ≥7 vs. <7). A total of 61 (26.9%) patients had MedDiet score ≥7. By univariate analysis, good MedDiet scores were associated with older age, waist circumference, body mass index, high education level, regular follow-up, duration after first revascularization and revascularization with CABG+PCI. In the multivariate analysis, high education level (P=.002, OR=8.212, 95%CI: 2.155-31.291) and duration after revascularization (P=.034, OR=1.007, 95%CI: 1.001-1.013) were independent predictors of good MedDiet scores. CONCLUSION: The adherence rate to a healthy diet was low in patients with previous coronary revascularization. MedDiet score seems to be practical and useful item to evaluate the dietary habits in outpatient setting. Mediterranean diet adherence rates were associated with high education level, and duration after revascularization.

Three singleton deliveries with healthy children from one couple after cryo-tESE and ICSI.

UNLABELLED: We report on a couple who delivered three healthy babies in three deliveries after cryo-TESE combined with ICSI. The male patient suffers from congenital bilateral absence of the vas deferens (CBAVD). METHODS: Three testicular sperm extraction (TESE) operations were performed in the male accompanied by six stimulated ICSI cycles in the female patient. Altogether, 59 oocytes were retrieved. Fifty-one oocytes (86%) were in metaphase II and 38 fertilized regularly (75%). Sixteen embryos, in the 3-6 cell stage, were transferred to the uterus. RESULTS: The first, fifth and sixth embryo transfers of fresh embryos led to intact intrauterine singleton pregnancies. The pregnancy and implantation rates with fresh embryos were 50% and 20%, respectively. CONCLUSIONS: TESE or microscopic epididymal sperm aspiration in patients with CBAVD in combination with a healthy female partner is likely to yield very good results in ICSI/ET. As azoospermia can be caused by cystic fibrosis and cystic fibrous transmembrane conductance regulator gene mutation range varies dramatically in patients of different ethnic groups.

Tp-e interval and Tp-e/QT ratio in patients with celiac disease.

OBJECTIVES: Celiac disease is a chronic immune-mediated disease of the small intestine. It has been known that dilated cardiomyopathy and ischemic coronary artery disease have become more frequent in patients with celiac disease. The aim of the study was to assess Tp-e interval and Tp-e/QT ratio in patients with celiac disease. MATERIAL AND METHODS: This study was conducted at a single center in collaboration with gastroenterology and cardiology clinics. Between January 2014 and June 2015, a total of 76 consecutive patients were enrolled (38 patients with celiac disease and 38 control subjects). Tp-e interval, Tp-e/QT and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. RESULTS: Tp-e interval (64.2±11.0 vs. 44.5±6.0; p<0.001), Tp-e/QT ratio (0.18±0.02 vs. 0.13±0.02; p<0.001) and Tp-e/QTc ratio (0.16±0.02 vs. 0.11±0.01; p<0.001) were significantly higher in patients with celiac disease than control subjects. There was a significant positive correlation between Tp-e/QTc ratio and disease duration in patients with celiac disease (r=0.480, p=0.003) and also there was a significant positive correlation between Tp-e/QTc ratio and erythrocyte sedimentation rate (r=0.434, p<0.001). CONCLUSIONS: Our study showed that Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in patients with celiac disease. Whether these changes increase the risk of ventricular arrhythmia deserve further studies.

Are carriers for MEFV mutations "healthy"?

OBJECTIVE: We aimed to compare whether carriers for the MEFV mutations display an increase or decrease in certain features. We compared the frequency of a number of inflammatory symptoms and diseases in carriers and a control population. METHODS: A questionnaire was designed to be applied to parents of children with FMF and a control group of parents. Clinical features and some diseases including the frequency of febrile episodes, abdominal pain, arthralgia, prophylaxis with penicillin, acute rheumatic fever, rheumatoid arthritis, vasculitis, spondyloarthropathy, urinary tract infection, asthma, allergy, irritable bowel disease, appendectomy and tonsillectomy were inquired. 676 parents of 440 children with FMF were surveyed in this study. Controls (n: 774) were selected as parents of healthy children. RESULTS: The presence of febrile episodes more than four per year, arthralgia, past diagnosis for acute rheumatic fever, rheumatoid arthritis and prophylaxis of penicillin, acute rheumatic fever, and rheumatoid arthritis were significantly higher in asymptomatic parents for the MEFV mutations compared to controls. The frequency of allergy was found to be significantly lower in the asymptomatic parents as compared to controls. There was no significant difference at the frequency of urinary tract infection and tonsillectomy between the parents of the patents and controls. CONCLUSIONS: We suggest that one MEFV mutation may indeed be conferring a heightened inflammation as suggested by the increased frequency in inflammatory symptoms. The carrier status for MEFV mutations seem to be unique, in that they cause an alteration in the state of "health".