COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission.

OBJECTIVE: As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters. PATIENTS AND METHODS: The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols. RESULTS: 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses. CONCLUSIONS: The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

Effect of tempol, a membrane-permeable radical scavenger, on mesenteric blood flow and organ injury in a murine cecal ligation and puncture model of septic shock.

BACKGROUND: Interventions that reduce the generation or the effects of reactive oxygen species exert beneficial effects in a variety of models of septic shock. We investigated the effect of tempol, a low-molecular-weight membrane-permeable radical scavenger, on mesenteric blood flow and organ injury in a murine cecal ligation and puncture (CLP) model of septic shock. MATERIALS AND METHODS: Forty-four Swiss albino mice were anesthetized with chloral hydrate (400 mg/kg, i.p.) and subjected to CLP (except for the sham-operated animals). The animals were divided randomly into 4 groups: the 1st group was sham operated (sham-operated group, n = 10); the 2nd group underwent CLP and was injected with saline (CLP + saline group, n = 12); the 3rd group was sham operated and treated with tempol (10 mg/kg, i.p., sham-treated + tempol group, n = 10); the 4th group underwent CLP and was treated with tempol (10 mg/kg, i.p., CLP + tempol group, n = 12). Mesenteric arterial blood flow (MABF) was measured by Doppler ultrasound. Poly(adenosine 5'-diphosphate-ribose) polymerase (PARP) activity was examined in the liver, lung, and kidneys. RESULTS: In the CLP + saline group, the MABF was significantly lower than in the sham-operated group (p < 0.001). After tempol administration, MABF values significantly increased (p < 0.05). We observed significantly stronger PARP-positive staining in the lungs and kidney glomeruli in the CLP + saline group than in those of the sham-operated group (p(lung) = 0.0148, p(glomeruli) = 0.0025). A marked reduction in PARP activity was found in the lung and kidney glomeruli of the CLP + tempol group (p(lung) = 0.0026, p(glomeruli) = 0.0085). There was no significant effect of CLP on PARP activity in the liver and kidney tubuli (p(liver) > 0.05, p(tubuli) > 0.05). CONCLUSION: Tempol improved MABF in a CLP-induced septic shock model. Although tempol could not prevent the activation of PARP in the liver and kidney tubuli, it did attenuate PARP activation in the lung and kidney glomeruli.

The role of frozen section evaluation in the diagnosis of adnexal mass.

The purpose of this study was to evaluate the accuracy of frozen section diagnosis in patients who were subjected to the exploratory laparotomy for pelvic mass. Overall, 207 patients were included in this study and the mean age of the patients was 50.9 +/- 14.9 years (range, 18-84 years). Of these patients, 98 (47%) had benign, 16 (8%) had borderline, and 93 (45%) had malignant histologies at permanent section. The diagnosis at frozen section was deferred for three patients (1.4%) and these patients were excluded from the further analyses. The overall discordance rate was 5.3%. To calculate the sensitivity and specificity values, 2 x 2 contingency tables were constructed in two ways. In the first calculation, borderline histology was considered malignant, and the sensitivity and specificity rates were 97% and 92%, respectively. In the second analysis, it was accepted as benign, and these values were 100% and 98%, respectively. To determine the possible factors related with discordant diagnoses, age, menopausal status, tumoral size, laterality of tumors, and histologic diagnoses were analyzed. Significant association was noted for size and borderline and mucinous histologies. In patients with borderline histology, the discordance rate was 40%. This value for the remaining patients was 3.2% (P < 0.001). The rate of misdiagnosis was 17.4% for mucinous tumors, whereas it was 4.8% for the remaining epithelial tumors (P = 0.03). Frozen section evaluation revealed high sensitivity and specificity values in this study. To increase the accuracy of diagnosis, further diagnostic markers are needed especially for patients with large lesions, borderline tumors, and mucinous histologies.

Assessment of human papilloma viral load of archival cervical intraepithelial neoplasia by real-time polymerase chain reaction in a Turkish population.

The purpose of this study was to determine the existence, and viral load of human papilloma virus (HPV) subtypes 16 and 18 in paraffinized cervical intraepithelial neoplasia (CIN) samples by real-time polymerase chain reaction (RT-PCR). Overall 94 women were included. Of these patients 47 (50%) had CIN I, 27 (28.8%) had CIN II, and 20 (21.2%) had CIN III. HPV positivity for these three groups were 4.2%, 14.8% and 45%, respectively. HPV positivity in CIN III patients was significantly higher than CIN I (OR = 18.41, 95% CI 3.00-145.73; p < 0.001), and CIN II patients (OR = 4.70, 95% CI 1.00-23.76; p = 0.05). The difference between CIN I and II was not significant (p = 0.18). Viral loads were 10(2), and 10(4) copy/ml for two CIN I patients; 10(2), 10(3), and 10(5) for three CIN II patients; and 10(2), 10(3), 10(4), 10(4), 10(5), 10(5), and 10(6) copy/ml for eight patients with CIN III. Viral load of the remaining one patient could not be assessed. No significant variance was noted among the groups with respect to viral load (p = 0.73). RT-PCR had important advantages of detecting, typing, and quantifying at the same time. Although HPV positivity was increased significantly by the degree of lesions, this relation was not observed for viral load.

Colonic metastasis from squamous carcinoma of the lung: report of a case and review of the literature.

We describe a rare case with metastatic involvement of the gastrointestinal tract (colonic metastasis) secondary to lung cancer. After diagnostic work-up, a left hemicolectomy was performed. Patient has been alive and healthy 9 months after operation. We report the first case with the longest survival period after the diagnosis of metastasis, although the symptomatic gastrointestinal metastases from lung cancer generally follow a poor prognosis because of their advanced state and multiplicity.

Inhibition of epidural scar tissue formation after spinal surgery: external irradiation vs. spinal membrane application.

PURPOSE: The scar tissue that forms after lumbar dissection is a severe complication and a cause of lumbar and radicular pain. It was recently shown that radiotherapy could inhibit peridural fibrosis after laminectomy. In this study, the efficiency of external irradiation was compared with spinal membrane application. METHOD AND MATERIALS: Thirty male New Zealand rabbits underwent L5 laminectomy. Ten rabbits each received a single fraction of 900-cGy external irradiation administered by 9-MeV electron beam 24 h after the surgery. Ten other rabbits each had spinal membrane applied during laminectomy. The remaining 10 rabbits constituted the control group. All of the rabbits were killed 30 days after the laminectomy. Axial histologic sections through the laminectomy defect were evaluated. Each specimen was scored for the extent and density of fibrosis and arachnoidal adherence. RESULTS: The extent and density of fibrosis and arachnoidal adherence differed significantly between the control group and the treatment groups (p < 0.05). However, the extent and density of fibrosis and arachnoidal adherence did not differ significantly between the spinal membrane and irradiation groups (p > 0.05). CONCLUSION: This preliminary study showed that high-single-fraction/low-total-dose administered postoperatively can successfully inhibit postsurgical epidural fibrosis as effectively as applied spinal membrane.

Alteration by Iloprost of the vasospastic effects of endothelin-1 in rabbit cerebral vessels.

The reversal of endothelin-1 induced cerebral vasospasm with Iloprost was studied in the rabbit. Vasospasm in the basilar artery was evaluated by angiography; cerebral ischaemia by 'red-neurone-count' on light microscopy and morphological changes by electron microscopy. A potent antagonistic effect of Iloprost against ET-1 was observed in each of the parameters measured.

Effect of Iloprost on endothelin-1-induced free radical activation in rabbit brain stem.

Iloprost, a stable analogue of prostacyclin, was used to reverse the early period of vasoconstriction provoked by Endothelin-1 by administering into the rabbit basilar artery. We observed if this produced an effect on the central nervous system parenchyma mediated by free radical system. The red neurons were counted in brain stem sections stained with haematoxylin and eosin, while superoxide dismutase and malondialdehyde levels were measured in brain stem tissue samples as a marker of reactive oxygen metabolites; both 30 and 90 min after administration of either Endothelin-1 (0.25 ng) alone or Endothelin-1 followed by Iloprost (0.5 microg/kg) into the basilar artery. Endothelin-1 significantly increased the number of red neurons, while Iloprost significantly reduced them after 30 and 90 min. However, regarding the reactive oxygen metabolites; a similar reversing effect of Iloprost was not observed although superoxide dismutase levels were significantly decreased after Endothelin-1 infusion.

del(17)(q25) in a patient with hairy cell leukemia: a new clonal chromosome abnormality.

Clonal chromosomal aberrations are reported in about 25% of the patients with hairy cell leukemia (HCL). No consistent cytogenetic abnormality has been described in HCL; most of the chromosomal changes found have been deletions and inversions, with the rare occurrence of translocations. While most of the chromosomal aberrations in HCL are common to the ones found in B cell chronic lymphocytic leukemia and other B cell lymphoproliferative disorders, there are also certain chromosomal changes that are not found in other B cell lymphoproliferative disorders. We present here a 63-year-old male patient with hairy cell leukemia with the clonal del(17)(q25), which has not previously been reported in HCL.

Polysaccharide mannan components of Candida albicans and Saccharomyces cerevisiae cell wall produce fever by intracerebroventricular injection in rats.

The cell wall mannan components of Candida albicans and Saccharomyces cerevisiae produced hyperthermic responses when injected intracerebroventricularly at doses of 10 microg in rats. Indomethacin treatment (5 mg/kg subcutaneously) completely abolished these responses. Serum interferon-gamma, tumor necrosis factor-alpha and interleukin-1beta levels showed an upward trend during the initial phase of the hyperthermic response induced by S. cerevisiae mannan. Meanwhile, serum levels of these proinflammatory cytokines did not increase at all at the initial phase of C. albicans mannan-induced hyperthermia. Histopathological examination of the brain tissue samples revealed no specific change throughout the parenchyma of rats given either mannan. These results indicate that the polysaccharide mannan components of yeasts, regardless of the pathogenicity, produce a pyrogenic response by a direct injection into the brain in rats. This response is not accompanied by proinflammatory cytokine induction in the periphery.

Uterine metastasis from infiltrating ductal carcinoma of breast in a patient receiving tamoxifen.

The established relationship between tamoxifen and the development of endometrial cancer causes differential diagnostic problems between metastatic and primary uterine neoplasms. A 45-year-old woman underwent modified radical mastectomy because of left-breast cancer. She presented with abnormal vaginal bleeding 6 years later, while still on tamoxifen therapy. The endometrial curettage revealed undifferentiated adenocarcinoma. She underwent total abdominal hysterectomy, bilateral salphingoopherectomy as well as pelvic and periaortic lymphadenectomy. Microscopic examination revealed neoplastic cells which formed sheets and duct-like structures in the endometrium. The pattern was not that of a primary endometrial tumour and an immunohistochemical staining was performed using human breast gross cystic disease fluid protein-15 (GCDFP-15) which was found out to be positive in the tumour cells. A diagnosis of metastatic ductal carcinoma of the breast in the uterus was rendered. Uterine metastasis should be kept in mind in patients with a history of breast cancer who are on tamoxifen therapy.

Inhibition of endothelium-dependent relaxation by Candida albicans.

This study examines the effects of Candida albicans on acethylcholine-induced, endothelium-dependent relaxation of thoracic aorta of rabbits, precontracted by phenylephrine (10(-7) M). Isolated vessel rings were incubated with C. albicans, Saccharomyces cerevisiae, or their mannans, and endothelium-dependent relaxation was measured by the induction of acethylcholine. Endothelium-dependent relaxation remained unaffected after 3 hours by either C. albicans or S. cerevisiae, or their mannans. After 24 hours, however, incubation with C. albicans had completely abolished relaxation, whereas relaxation was decreased by mannan of C. albicans and continued unaffected by S. cerevisiae. In contrast, no change was registered with a 24 hours incubation of C. Albicans in a sodium nitroprusside-induced, endothelium-independent, vascular smooth muscle relaxation. Microscopical investigation of the morphological structure of vessel walls revealed penetration of C. albicans on the intimal surface after 3 hours incubation and infiltration of the yeast through the vessel wall after 24 hours. No changes in vessel morphology occurred after 3 or 24 hours with S. cerevisiae or the mannan of C. albicans. These results show the ability of C. albicans to inhibit endothelium-dependent, but not endothelium-independent, relaxation of vascular smooth muscle and may have important implications for functional damage to endothelial cells and the regulation of vessel tone and blood flow.

Vertebral osteoblastoma: are radiologic structural changes necessary for diagnosis?

BACKGROUND: A case of osteoblastoma localized at the pedicle of the 10th thoracic vertebra is presented. CASE DESCRIPTION: The patient complained of nocturnal back pain not relieved by salycilates, a typical symptom of osteoblastoma. Bone scintigraphy showed a lower thoracic focus of increased osteoblastic activity; however, X-rays, computed tomography, and magnetic resonance images (MRI) were within normal limits, showing only obscure changes that were also noted in the rest of the spine. Repeat MRI with contrast revealed a focal enhancement. After pediculectomy, histopathologic examination confirmed the diagnosis of osteoblastoma. Fifteen months postoperatively, the patient is symptom-free. CONCLUSION: Our case demonstrates that some cases of osteoblastoma may not have the classical radiological appearance. Although non-contrast computed tomography and T1-weighted MRI are mildly positive in some instances, osteoblastoma is best visualized on MRI with gadolinium. Like any other neoplasm, osteoblastoma should be detected and removed early, before it can cause structural bony changes.

Comparison of uveitis induced by interleukin-8 (IL-8) and endotoxin in rabbits.

IL-8 is a potent chemoattractant which has been postulated to play a role in the cytokine cascade associated with uveitis. The authors studied the effect of intravitreal IL-8 on the induction of uveitis in the rabbit. IL-8 at varying concentrations (1 ng, 10 ng or 100 ng) or endotoxin (100 ng) was injected intravitreally within the rabbit eye. At 6, 24 and 48 hours following injection the induction of uveitis was evaluated by clinical scoring, anterior chamber (AC) leukocyte count, AC protein concentration and histopathology in 15 rabbits. Only the 100 ng concentration of IL-8 induced uveitis at 6 and 24 hours by clinical scoring and AC leukocyte count; the AC protein concentration remained normal. In contrast, endotoxin caused a severe uveitis with a significant increase in all the parameters evaluated. The authors conclude that intravitreal IL-8, in the concentrations studied, induces a limited uveitis which is detectable at six hours and resolves within 48 hours. It is characterized by leukocyte infiltration without an increased AC protein concentration. Thus, IL-8 may play a role in the cytokine cascade involved in the induction of uveitis.

Pentoxifylline inhibits overflow and reduces intestinal reperfusion injury.

The aim of this study was to determine the effects of pentoxifylline (Ptx) in reperfusion injury of the small bowel as a leukocyte stabilizer, free radical scavenger, and microcirculatory regulator. Ninety-six male Sprague-Dawley rats were used to determine the biochemical, histopathologic and blood flow changes of the reperfused small intestines after 30 minutes of a warm ischemic insult. Animals were divided into six groups: Sham (S), sham plus Ptx (SP), ischemia (I), ischemia plus Ptx (IP), reperfusion (R), and reperfusion plus Ptx (RP). Pentoxifylline was administered intraperitoneally at a dose of 50 mg/kg 15 minutes before ischemia. The superior mesenteric artery (SMA) was occluded distal to the right colic artery and collateral arcades were ligated as described by Megison. Sixty of the 96 rats (n = 10) were used to determine histopathologic changes, malondialdehyde (MDA), and myeloperoxidase (MPO) levels in tissue. Mucosal lesions were graded on a scale from 0 to 5 as described by Chiu. MDA and MPO levels of the intestinal mucosa were assayed to reflect the free radical formation and neutrophil sequestration, respectively. Thirty-six rats (n = 6) were used to measure blood flow changes of the intestine using 133Xe clearance technique. All data were presented as the mean values plus or minus the standard error of the means (means +/- sem). Although in the R group, mucosal injury score, blood flow, MPO, and MDA levels were higher significantly from the other groups (P < .05), in the RP group blood flow, MPO, and MDA levels were significantly decreased to the basal values (P < .05). Mucosal injury score of the RP group were lower than the reperfusion group but higher than the normal (P < .05). The authors conclude that pentoxifylline pretreatment before reperfusion stabilizes blood flow, decreases MPO and MDA levels to the normal, and attenuates but not completely prevents mucosal damage.

A case report of multicentric Castleman's disease with simultaneous Epstein-Barr virus infection.

Castleman's disease is a rare B-cell lymphoproliferative disorder of unknown etiology. In this report we describe a 54-year-old woman with a 10-year history of asymptomatic bilateral, multiple cervical lymph node enlargements. She was not evaluated by lymph node biopsy during this period. She had been well until four months previously. The patient presented with multiple enlarged lymph nodes and systemic symptoms including fever, sweats, weight loss, and anorexia. Two lymph nodes were biopsied, yielding a diagnosis of multicentric Castleman's disease (MCCD) of mixed hyaline-vascular and plasma cell type histology. Serologic studies revealed the simultaneous presence of an acute Epstein-Barr virus (EBV) infection. She experienced an aggressive clinical course with a fatal outcome.

Pleomorphic adenoma of an unusual size in the deep lobe of the parotid gland.

Tumors of the salivary glands in children are not as common as in adults and they are mostly benign. The most common benign epithelial neoplasm seen in children is pleomorphic adenoma. As is usually the case in the adult population, it is usually found in the superficial lobe of the parotid gland. Its localization in the deep lobe is rare. Pleomorphic adenomas of the deep lobe present with a neck mass and when it is large, it may have an intraoral extension as well. It may also assume a dumb-bell shape as it enlarges and may be observed on CT or MRI scans as a prestyloid mass. The choice of treatment depends on the localization and the size of the tumor. The method can be transoral, cervical, transmandibular, transparotid, retromandibular fossa or a combination of these. A child with an unusually large pleomorphic adenoma of the deep lobe of the parotid gland is presented in this study. The deep lobe tumor was totally removed using a combination of cervical and transmandibular approaches.

Experimental otitis media induced by coagulase negative staphylococcus and its L-forms.

In a previous study, we found 15% L-forms of bacteria (predominately coagulase negative staphylococci (CNS)) in ears which gave negative cultures by conventional methods. In this study, we used an animal model to test whether CNS and its L-forms can be pathogenic and whether L-forms have a crucial role in the tendency to secretory otitis media (SOM). We inoculated the tympanic bullas of guinea pigs, in 2 groups, with CNS and its L-forms (revertant forms). We observed that both CNS and its L-forms had the capability of causing infection. However, it was milder for the L-forms than CNS. We clearly noticed that on day 30 60% of the ears inoculated with L-forms had effusion and/or retraction of the tympanic membrane. These ears were histopathologically characterized by hypertrophied pseudostratified epithelium or stratified squamous epithelial metaplasia. The ears inoculated with the original form of CNS had only 16.66% effusion. On day 60 we observed similar findings. Thus, it might be proposed that L-forms could be responsible for chronic irritation to middle ear mucosa leading to SOM.

Antiischemic effect of ZK-118.182 in rabbits: a comparative study with iloprost.

The effects of ZK-118.182, a stable analogue of PGD2, were evaluated in an endothelin-1-induced cerebral ischemia rabbit model. Ischemia was induced by endothelin-1 injection (0.25 ng bolus) into subcavian artery and ischemic changes were assessed histologically by the number of ischemic neurons in the brain stem. ZK-118.182 (2 micrograms/kg, bolus into subclavian artery) reduced the number of ischemic neurons when injected 20 min after endothelin-1 injection, Iloprost, a stable analogue of PGI2, was also effective in reducing the number of ischemic neurons in a dose of 0.5 microgram/kg (bolus into subclavian artery). The results suggested that ZK-118.182 has a potent antiischemic effect which is comparable to that of iloprost in rabbits.

Large cavernous hemangioma of the kidney presenting as a solid renal mass.

We report a case of large renal hemangioma that completely filled the collecting system in a 43-year-old man. Most of the renal hemangiomas are small in size and this situation is extremely rare. The diagnosis and treatment of the case is discussed.