Assessment of pulmonary arterial stiffness in patients with cirrhosis: A prospective cohort study.

INTRODUCTION: In the current literature, several studies show that PAS (pulmonary artery stiffness) is associated with RV (right ventricular) dysfunction, PAH (pulmonary arterial hypertension), and disease severity in subjects with structural cardiac disease, HIV (human immunodeficiency virus), and chronic lung disease. Hence, our main aim was to use PAS to show the early changes in the pulmonary vascular region in subjects with cirrhosis. MATERIAL AND METHODS: In this prospective cross-sectional study, 39 subjects who were being followed up with cirrhosis and 41 age- and sex-matched healthy subjects were included in this study. For each case, the PAS value was obtained by dividing mean peak velocity of the pulmonary flow by the PfAT (pulmonary flow acceleration time). RESULTS: The measured PAS was 23.62 ± 5.87 (Hz/msn) in cirrhotic participants and 19.09 ± 4.16 (Hz/msn) in healthy cases (P < .001). We found a positive statistical significance between PAS and RVSP (right ventricle systolic pressure)/sPAP (systolic pulmonary arterial pressure) (r = .395; P = .013). PAS was an independent predictor that was associated with cirrhosis disease according to multivariate LR (logistic regression) analysis (OR: 1.209; 95% CI: 1.059-1.381; P = .005). CONCLUSION: Based on the study results, we consider that PAS may help in the early detection of findings in the pulmonary vascular area, even if the RV function findings or sPAP is within the normal range.

The Association between Serum 25-Hydroxyvitamin D3 Levels and Pro-Inflammatory Markers in New-Onset Type 2 Diabetes Mellitus and Prediabetes.

In this study, we aimed to reveal the pro-inflammatory effects of serum 25-hydroxyvitamin D3 (Vit D) deficiency and insufficiency in new-onset type 2 diabetes mellitus (T2DM) and prediabetes. We recruited 84 prediabetes patients, 94 new-onset T2DM patients and 113 healthy participants. We measured the levels of C-reactive protein (CRP), fibrinogen, ferritin, interleukin-1ß (IL-1ß), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), nuclear factor kappa-B (NF-κB) and mitogen-activated protein kinase (MAPK) in the serum of the participants. ANOVA Bonferroni and Kruskal-Wallis Dunn tests were used to compare the inflammation markers and vitamin D levels between the groups. Based on covariance analysis with age, gender and BMI, the Vit D levels of the T2DM group were significantly lower (p < 0.003). Pro-inflammatory markers and CRP were significantly higher in prediabetic and diabetic subjects. In the prediabetes group, IL-1ß, IL-6, IL-8, TNF-α and MAPK were significantly higher in those with Vit D insufficiency and deficiency groups. In the T2DM group, IL-1ß, IL-6, IL-8, TNF-α, NF-κB, MAPK and CRP were significantly higher in those with Vit D insufficiency and deficiency. Our study emphasizes the pro-inflammatory effects of Vit D deficiency and insufficiency in new-onset type 2 diabetes mellitus and prediabetes.

[Foreign body which resembles concha bulloza in the middle meatus: a case report]. / Orta meatusta konka bullozaya benzer yabanci cisim: Olgu sunumu.

Diagnosis of foreign body in the nasal cavity may be difficult because it has a wide variety of presentations. Concha bullosa is defined as the pneumatization of the middle concha in various degrees. A 43-year-old female patient was admitted to our clinic with the complaint of breathing difficulty through her right nostril which had been going on for the last year. She had had some medical treatments previously in some different medical centers, there wasn't purulent discharge with unpleasant odour, bleeding and halitosis in the nose and there wasn't a history of a blow to the nose or a history of previous facial, nasal or dental surgery. In the computed tomography there was an image resembling concha bullosa. Transnasal endoscopic approach was used, under general anesthesia, in the patient, whose physical examination results, laboratory findings and allergy test results were normal. Endoscopic sinus surgery was performed including polypectomy, right uncinektomy and the foreign body was removed from the middle meatus using a forceps. No complications were observed in the follow-up control one month later.

[Evaluation of septoplasty patients with health status scale, rhinomanometry and computed tomography]. / Septoplasti hastalarinin yasam kalitesi ölçegi, rinomanometri ve bilgisayarli tomografi ile degerlendirilmesi.

OBJECTIVES: We evaluated disease-specific health status prior to and after septoplasty in patients with nasal septal deviation (NSD), and sought correlation between diagnosis and laboratory findings (anterior rhinomanometry and computed tomography). PATIENTS AND METHODS: The study included 39 patients (8 females, 31 males; mean age 41 years; range 18 to 59 years) with a diagnosis of NSD. Prior to septoplasty, all patients were evaluated by coronal paranasal sinus computed tomography (CT), anterior rhinomanometry and the Nasal Obstruction Symptom Evaluation (NOSE) scale. Rhinomanometry and the NOSE scale were repeated three months after septoplasty. RESULTS: Compared to the preoperative values, the patients exhibited a significant decrease in NOSE scores, and in rhinomanometry, significantly increased nasal airflow and decreased total nasal airway resistance (p<0.05). No relationship was found between pre-and postoperative NOSE scores and total nasal airway resistance, and between preoperative NOSE scores and the severity of NSD assessed by CT (p>0.05). CONCLUSION: The NOSE scale is a reliable tool to assess health status of patients with nasal obstruction symptoms. The diagnosis of NSD does not require rhinomanometry or computed tomography.

[Investigation of Helicobacter pylori colonization in pharyngeal and palatine tonsils with rapid urease test and immunohistochemical analysis]. / Farengeal ve palatin tonsil örneklerinde hizli üreaz testi ve immünhistokimyasal analiz yöntemiyle Helicobacter pylori varliginin arastirilmasi.

OBJECTIVES: We investigated the presence and frequency of Helicobacter pylori in palatine and pharyngeal tonsil tissues of children. PATIENTS AND METHODS: The study included 20 patients (15 males, 5 females; mean age 8.2 years; range 5 to 13 years) with chronic or recurrent tonsillitis and/or snoring. Of these, 17 patients underwent adenoidectomy and tonsillectomy, two patients underwent adenoidectomy and tonsillectomy with bilateral ventilation tube insertion, and one patient underwent adenoidectomy with bilateral ventilation tube insertion. H. pylori colonization was sought in all tonsillar specimens by rapid urease test and immunohistochemical analysis. RESULTS: Rapid urease test showed H. pylori colonization in the palatine and pharyngeal tonsil specimens of one patient (5%), whereas immunohistochemical analysis showed four H. pylori-positive patients (20%), whose pharyngeal tonsil (n=2) or palatine tonsil (n=2) specimens were individually affected. CONCLUSION: The presence of H. pylori in both palatine and pharyngeal tonsil tissues of children suggests that these tissues can be a reservoir for H. pylori.

[The results of specific immunotherapy for house dust mites in patients with allergic rhinitis]. / Alerjik rinitli hastalarda ev tozu akarlarina karsi uygulanan spesifik immünterapi sonuçlari.

OBJECTIVES: We evaluated three-year clinical and laboratory results of specific immunotherapy (SIT) for allergenic house dust mite species, Dermatophagoides pteronyssinus and D. farinae. PATIENTS AND METHODS: The study included 26 patients (6 males, 20 females; mean age 28 years; range 17-56 years) who had allergic rhinitis and were found to be sensitive to D. pteronyssinus and D. farinae. Due to unresponsiveness to other treatment modalities, the patients received subcutaneous SIT for three years. Symptoms (nasal stuffiness, rhinorrhea, itching, sneezing, headache, eye symptoms, and smelling) were graded before and at the end of SIT, and blood eosinophilia, total IgE and specific IgE levels were determined. RESULTS: At the end of three years, the number of patients that showed strong positivity to D. pteronyssinus and D. farinae decreased from 26 (100%) to 3 (11.5%) (p=0.0001) and from 18 (69.3%) to 4 (15.4%) (p<0.005), respectively. There were significant decreases in blood eosinophilia, total IgE and specific IgE levels, and in the severity of all symptoms related to the nose, head, and eye. CONCLUSION: Specific immunotherapy reduces symptoms in patients with allergic rhinitis. It is an effective treatment method for allergic rhinitis if performed by trained physicians in carefully selected patients.

Dystrophic-Anagen Effluvium Occurring During Pegylated Interferon-α-2a/Ribavirin Therapy.

INTRODUCTION: Various types of dermatological manifestations have been reported due to hepatitis C virus (HCV) infection and anti-HCV therapy. Some of them have been described during IFN-based therapies. PEG-IFN-α-2a/RBV combination is used as the international standard of treatment for HCV infection for a long time. The combination therapy yields an adverse-event profile similar to standard interferon (IFN) therapy. Some of these adverse effects are rheumatologic, neuropsychiatric and dermatological manifestations including alopecia. CASE PRESENTATION: We reported a 43-year-old woman with dystrophic anagen effluvium (DAE), rheumatoid arthritis and Hashimoto thyroiditis, which were developed under the combination therapy for chronic HCV infection. CONCLUSIONS: Although some cases of alopecia areata (AA) and telogen effluvium (TE) were reported in literature, no case of DAE associated with PEG-INF-α-2a /RBV combination therapy was reported previously.

Evaluation of emm gene types, toxin gene profiles and clonal relatedness of group A streptococci.

The aim of this study is to evaluate antibiotic susceptibilities, emm gene types, toxin gene profiles and clonal relatedness of group A streptococci (GAS) isolates obtained from patients and carriers. A total of 79 clinical isolates from patients and 60 isolates from carriers were included in the study. Emm typing, toxin gene detection for speA, speB, speC, speG and smeZ genes and pulsed-field gel electrophoresis (PFGE) was performed. Twenty-one distinct emm types were detected; the most common types were emm12, emm89, emm1, emm77, emm4 and emm3. The detection rates of both emm types and the toxin genes didn't differ significantly between patients and carriers. The presence of speA and smeZ was significantly higher in emm1 and speG was significantly lower in emm4 when compared to the other emm types. The rate of clustering obtained with PFGE wasn't significantly different in patients and carriers. As a result, twelve of the 21 emm types detected in this study were covered by the 26-valent vaccine, constituting 77.7% of the emm typeable isolates; however the emm4 type which is one of the most common types in the present study is not among this coverage.

Atypical retroauricular pain: a case report.

Retroauricular pain is rarely seen in clinical practice. We present a 29-year-old man who suffered from an intractable and atypical retroauricular pain. The pain was refractory to medications (anticonvulsant drugs, selective serotonin reuptake inhibitors, and amitriptyline). Therefore, a local anesthetic injection for nerve block was done, despite the fact that the causative nerve could not be identified. We believe that this case report is important as we could not find another patient reported in literature with regard to similar headache characteristics and treatment strategy.

Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation.

OBJECTIVE: To evaluate the effects of peritonsillar injection of levobupivacaine with epinephrine in children undergoing adenotonsillectomy, through an intraindividual study. PATIENTS AND METHODS: 20 children (age 6-13 years) undergoing elective tonsillectomy with or without adenoidectomy were enrolled in this prospective, randomized, intraindividual trial. After entubation and just prior to incision, 3 ml of 0.25% levobupivacaine with epinephrine was injected into one peritonsillar region while 0.9% saline was being used for the contralateral side. Amount of intraoperative blood loss, duration of tonsillectomy, postoperative pain, otalgia and hemorrhage were assessed for each side separately. Visual analog scale was used for postoperative pain assessment. Heart rate and mean arterial pressure during and after operation were also observed. The follow-up period after surgery was 10 days. RESULTS: Median visual analog scale values for the levobupivacaine with epinephrine injected side was significantly lower than the saline injected side, during the first postoperative 16h (p<0.05). There were also significant differences between the intraoperative blood losses of the two sides (p<0.05). However; no significant differences were observed with respect to duration of surgery, postoperative otalgia and hemorrhage (p>0.05). CONCLUSION: Preincisional injection of levobupivacaine with epinephrine decreases early postoperative pain and intraoperative blood loss as well.

Anesthesia induction with sevoflurane and propofol: evaluation of P-wave dispersion, QT and corrected QT intervals.

The present study compared the effects of anesthesia induction with sevoflurane and propofol on hemodynamics, P-wave dispersion (Pwd), QT interval and corrected QT (QTc) interval. A total of 72 adult patients were included in this prospective study. All patients had control electrocardiograms (ECGs) before anesthesia induction. Anesthesia was induced with sevoflurane inhalation or intravenous propofol. Electrocardiography for all patients was performed during the 1(st) and 3(rd) minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. There was no significant difference in Pwd and QT and QTc intervals on control ECGs. In the sevoflurane group, except for control ECGs, Pwd and QTc interval on all ECGs were significantly longer than those in the propofol group (p < 0.05). We conclude that propofol should be used for anesthesia induction in patients with a predisposition to preoperative arrhythmias, and in those whose Pwd and QTc durations are prolonged on preoperative ECGs.