The effect of Thyroid Autoimmunity on Dyslipidemia in patients with Euthyroid Hashimoto Thyroiditis.

BACKGROUND & OBJECTIVE: The relationship between thyroid disorders and dyslipidemia has now been clearly demonstrated, but the relationship between thyroid autoimmunity and dyslipidemia in euthyroid patients is still controversial. Our aim in this study was to determine whether there is a risk of dyslipidemia in our patients with euthyroid hashimoto thyroiditis. METHODS: Fifty-five autoantibody positive hashimoto patients and 55 antibody negative control groups who came to Sakarya University Medicine Faculty Endocrinology Outpatient Clinics between January 2018 and November 2019 were included in our case control study. The groups were similar in terms of age, cardiovascular risk factors and BMI. Both groups were compared according to the lipid profile results. RESULTS: All type of lipids; including LDL (p = 0.008), HDL (p = 0.041), triglyceride (p = 0.045) and total cholesterol (p = 0.002), were higher in the patient group, and these differences were statistically significant. Anti-TPO and Anti-TG antibody titers and lipid levels were evaluated by separate correlation analysis. There was a significant positive correlation between Anti-TPO and LDL (r = 0.331, p <0.001), triglyceride (r = 0.267, p = 0.005) and total cholesterol (r = 0.316, p = 0.001), however no significant correlation was observed between Anti-TPO and HDL. Similarly, there was a significant positive correlation between Anti-TG and LDL (r = 0.318, p = 0.001), triglyceride (r = 0.218, p = 0.022), and total cholesterol (r = 0.301, p = 0.001), but HDL correlation relationship was not detected. CONCLUSION: The relationship between thyroid autoimmunity and dyslipidemia has been demonstrated in our study even in the euthyroid phase. Whether antibody positive patients should be followed more closely for dyslipidemia and cardiovascular events is still controversial. This question will be answered with larger randomized controlled trials.

The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients.

OBJECTIVES: We aimed to determine the effect of short-term intensive insulin therapy (SIIT) on long-term glycemic control in newly-diagnosed Type-2 diabetes mellitus (nT2DM) patients. METHODS: In this retrospectively study conducted at Sakarya University Medical Faculty Training and Research Hospital Outpatient Clinic between 2016 and 2019, 65 nT2DM patients were enrolled soon after their SIIT was initiated and were followed for at least a year. Intensive insulin treatment was discontinued after three or 12 months in a total of 65 (23-73-year-old) patients who had been newly diagnosed with T2DM. Intensive insulin therapy was discontinued when glycemic control and the target Glycated Hemoglobin (HbA1c) level had been attained, after which oral anti-diabetic drug (OAD), long-term insulin, and diet therapies were pursued. RESULTS: There was a significant decrease in mean HbA1c from 11.25±1.96% to 6.67±1.07%. Fasting plasma glucose (FPG) was found to be an independent predictor of whether intensive insulin therapy could be discontinued after three months in a model that included FPG, HbA1c, and body mass index measured at baseline. Patients with FPG>13.8 mmol/L were 7.6 times more likely to require intensive insulin therapy beyond three months. There were significant decreases in HbA1c and low-density lipoprotein-cholesterol concentration, but no change in C-peptide between baseline and 3 months of therapy. CONCLUSION: These results demonstrate that in nT2DM patients, intensive insulin therapy could be effective on long-term glycemic control and high FPG prior to three months of SIIT may predict poor long-term glycemic control.

Predictors of multiple readmissions or death in the first year after Nissen fundoplication in children.

PURPOSE: Nissen fundoplication (NF) is commonly performed in children with gastro-esophageal reflux disease (GERD). Patients undergoing NF often have co-morbidities. Reported outcomes of NF vary considerably. This study investigated which factors might predict multiple readmissions or death in the first year following NF at our institution. METHODS: A retrospective chart review of 187 children who underwent NF at our institution between January 2004 and December 2015 was undertaken. Underlying medical conditions, age, weight, presence of malnutrition, length of hospital stay prior to surgery and type of surgery were recorded. Patients who had more than one admission in the first post-operative year were compared to those who had one or none, and patients who died within the first post-operative year were compared to those who did not. RESULTS: Risk factors for multiple readmissions were underlying cardiac disease (p = 0.011), esophageal atresia (EA) (p = 0.011), and esophageal stricture (p = 0.0002). Risk factors for death included younger age (p = 0.028), need for gastrostomy tube (GT) (p = 0.01) and prolonged pre-operative hospital admission (p = 0.0003). CONCLUSION: This study identified multiple factors associated with readmission and death in the first year after NF. These findings will help with the counseling patients and caregivers regarding expectations following NF.

Similar subclinical enthesitis in celiac and inflammatory bowel diseases by ultrasound suggests a gut enthesis axis independent of spondyloarthropathy spectrum.

Objective: Higher subclinical enthesitis on US has been reported in IBD and celiac disease, separately. The objective of this study was to compare IBD and celiac disease for enthesitis on US. Higher enthesitis scores in IBD compared with celiac disease would support a shared pathogenic mechanism between IBD and spondyloarthritis, whereas similar scores may suggest a general impact of gut inflammation on the enthesis. Methods: Patients with IBD, celiac disease and healthy controls (HCs) were recruited and 12 entheses were scanned by US, blind to the diagnosis and clinical assessment. Elementary lesions for enthesitis were scored on a scale between 0 and 3, for inflammation, damage and total US scores. Results: A total of 1260 entheses were scanned in 44 patients with celiac disease, 43 patients with IBD and 18 HCs. The three groups were matched for age and BMI. Patients with celiac disease and IBD had higher inflammation scores than HCs [10.4 (6.5), 9.6 (5.4) and 5.6 (5.2), respectively, P = 0.007) whereas damage scores were similar. Both age and BMI had significant effects on the entheseal scores, mostly for inflammation scores but when controlling for these the US enthesopathy scores were still higher in celiac disease and IBD. Conclusion: The magnitude of subclinical enthesopathy scores is similar between celiac disease and IBD in comparison with HCs. These findings suggest that the common factor between both diseases and enthesopathy is abnormal gut permeability, which may be modified by the genetic architecture of IBD leading to clinical arthropathy.

Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review.

The objective of this article is to evaluate the appropriate timing of tracheostomy in patients with prolonged intubationregarding the incidence of hospital-acquired pneumonia, mortality, length of stay in intensive care unit (ICU) and duration of artificial ventilation. The study included published articles yielded by a search concerning timing of tracheostomy in adult and pediatric patients with prolonged intubation. The search was limited to articles published in English language in the last 30 years (between 1987 and 2017). For the 690 relevant articles, we applied our inclusion and exclusion criteria and only 43 articles were included. 41 studies in the adult age group including 222,501 patients and 2 studies in pediatric age group including 140 patients met our criteria. Studies in adult age group were divided into three groups according to the methodology of determining the cut off timing for early tracheostomy, they were divided into studies that considered early tracheostomy within the first 7, 14 or 21 days of endotracheal intubation, while in pediatric age group the cut off timing for early tracheostomy was within the first 7 days of endotracheal intubation. There was a significant difference in favor of early tracheostomy in adults' three groups and pediatric age group as early tracheostomy was superior regarding reduced duration of mechanical ventilation, with less mortality rates and less duration of stay in ICU. Regarding hospital-acquired pneumonia, it was significantly less in adult groups but with no significant difference in pediatric age group (3 patients out of 72 pediatric patient with early tracheostomy had pneumonia compared to 11 patients out of 68 with late tracheostomy). Studies defining early tracheostomy as that done within 7 days of intubation had better results than those defining early tracheostomy as that done within 14 or 21 days of intubation. In conclusion, early tracheostomy within 7 days of intubation should be done for both adults and pediatric patients with prolonged intubation.

Arterial Blood Supply of the Nose: An Angiographic Study.

OBJECTIVE: To define anatomical variations associated with arterial blood supply of the nose which has clinical implications on the management of different disorders, especially intractable posterior epistaxis. STUDY DESIGN: Case series. METHODS: Selective angiography of external and internal carotid arteries of 100 patients scheduled for routine angiography was done. RESULTS: Different anatomical variations were documented. The ophthalmic artery can arise from the middle meningeal artery in 1% while ethmoidal arteries can be absent in 5%. The maxillary artery courses as 2 loops in the pterygopalatine fossa in 64% of cases where the descending palatine artery originates before the first loop or on its top so that caution is needed in controlling epistaxis. The sphenopalatine artery has different patterns of branching and may have more than 2 branches in 18% of cases. In 19% of cases, there is cross-circulation between both sides through the nasal blood supply. CONCLUSION: Angiographic study of the nose is a very helpful tool for accurate knowledge of anatomical variations of the arteries with a tremendous effect on our surgical approaches and techniques for the management of different diseases in the nasal region, especially intractable posterior epistaxis.

The Association of Vitamin D Status and Vitamin D Replacement Therapy with Glycemic Control, Serum Uric Acid Levels, and Microalbuminuria in Patients with Type 2 Diabetes and Chronic Kidney Disease.

OBJECTIVE: To evaluate the relationship of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid (SUA) levels, and microalbuminuria (MAU) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). Subjectsand Methods: A total of 1,463 patients with T2DM and CKD (aged 14-88 years), 927 females and 536 males, were included in this study. The serum data of 25-hydroxyvitamin D, i.e., 25(OH)D, level, SUA, hemoglobin (Hb)A1c, creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio (UACR) were obtained from the medical records. The Mann-Whitney U test, the χ2 test, the Mantel-Haenszel test, and linear regression models were used for data analysis. RESULTS: Vitamin D deficiency and insufficiency were evident in 770 (52.0%) and 357 (24.0%) patients, respectively. Median HbA1c levels (7.3 [IQR 3.9] vs. 6.5 [IQR 2.3]%; p < 0.01) were significantly higher in patients deficient in vitamin D than in those with a normal vitamin D status. A significantly low level of vitamin D was noted with a high UACR (ß -0.01; 95% CI -0.01 to -0.001; p = 0.017) and HbA1c (ß -1.1; 95% CI -1.6 to -0.6; p < 0.001), but with low levels of SUA (ß 1.3; 95% CI 0.5-2.2; p = 0.002). Vitamin D replacement was associated with a significantly low level of HbA1c (7.4 [2.7] vs. 6.7 [1.9]%; p < 0.001]. CONCLUSION: In this study, there was a high prevalence of hypovitaminosis D among T2DM patients with CKD, with a higher UACR, higher HbA1c, and lower SUA being noted as playing a role in predicting a decrease in vitamin D levels and potential benefits of vitamin D replacement therapy on glycemic control in T2DM management.

Association of vitamin D insufficiency/deficiency with thyroid artery Doppler ultrasonography in patients with Hashimoto thyroiditis.

BACKGROUND & OBJECTIVE: During the course of the autoimmune thyroid diseases, ultrasonography change parallel to histopathology. Vitamin D is associated with autoimmune diseases and thus can affect thyroid blood flow. Our aim was to investigate the relationship between vitamin D insufficiency/deficiency and thyroid hemodynamic indices in patients with Hashimoto thyroiditis. METHODS: A total of 93 patients who presented to Sakarya University Endocrinology outpatient clinic from April to September 2016 and diagnosed with Hashimoto thyroiditis were included in this study. Clinical and serologic data, thyroid antibodies and 25(OH)D3 were evaluated. Mean peak systolic velocity(mPSV), mean end-diastolic velocity (EDV), mean resistive index (RI) flows of superior and inferior thyroid arteries were measured with B-mode Doppler ultrasonography. RESULTS: Vitamin D insufficiency/deficiency was detected in 59 (63.4%). TPO Ab and TgAb levels were found higher in patients with vitamin D insufficiency/deficiency. In the normal vitamin D group, superior thyroid artery mPSV (32.21±6.73cm/s) and EDV(13.27±2.80 cm/s) were higher than in the low vitamin D group [mPSV (28.32±8.99cm/s) and EDV(10.67±3.68 cm/s)] (P=0.034, P=0.001, respectively). Inferior thyroid artery EDV value was higher in the normal compared to the low vitamin D group (0.032). RI measured in all arteries were higher in the vitamin D insufficient/deficient group compared to the Vitamin D normal group (p=0.001). CONCLUSION: Vitamin-D insufficiency/deficiency has led to reduced parenchymal blood supply and increased micro-vascular resistance in Hashimoto thyroiditis patients.

Midkine in vitamin D deficiency and its association with anti-Saccharomyces cerevisiae antibodies.

OBJECTIVES AND DESIGN: The growth factor midkine (MK) is a protein that is involved in cancer, inflammation, immunity. Vitamin D is a potent immunomodulator. Anti-Saccharomyces cerevisiae antibody (ASCA) is reported in autoimmune disorders, some of which are among the causes of vitamin D deficiency. The objective of this study was to investigate a possible association of MK and ASCA with vitamin D deficiency. MATERIALS AND METHODS: 208 adults presented to internal medicine outpatient clinic for history and physical examination has been studied. Serum biochemistry, vitamin D, MK, ASCA-IgG and -IgA, IL-1ß, IL-6, IL-8, TNF-α, PDGF, VEGF were obtained. RESULTS: Vitamin D deficiency was 74.2%. Serum MK level was significantly higher in vitamin D-deficient compared to vitamin D-sufficient individuals (1138.1 ± 262.8 vs 958.6 ± 189 pg/mL, respectively; P < 0.009). Serum MK levels were also significantly higher in both ASCA-IgG and -IgA positives compared to negatives (1318.5 ± 160.3 vs 1065.5 ± 256.1, P = 0.008 and 1347.7 ± 229.7 vs 1070.1 ± 250.9 pg/mL, P = 0.011, respectively). Vitamin D was significantly lower in ASCA positives (P = 0.044).Vitamin D showed positive correlation with IL-1ß (r 0.338, P < 0.009) and negative correlation with VEGF (r -0.366, P < 0.004). CONCLUSIONS: MK was significantly elevated in vitamin D deficiency and associated with ASCA positivity which was significantly increased in vitamin D deficiency. These findings suggested that molecular mechanism of vitamin D deficiency may be related with some inflammatory processes.

A Controversial New Approach to Address Hematological Parameters in Hashimoto's Thyroiditis.

BACKGROUND: Hashimoto's thyroiditis (HT) is a common autoimmune disorder. Genetic, environmental, and immunological factors all play a role in the pathogenesis of HT, but the effects of lymphocytes and platelets on the pathophysiology of HT are still unknown. In this study, we evaluated the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) in HT groups and HT subgroups with low cardiovascular risks. METHODS: This study included 92 patients with HT and 38 control subjects. Among the HT patients, three subgroups were formed according to thyroid function: overt (n = 12), subclinical (n = 38), and euthyroid (normally functioning thyroid; n = 42). RESULTS: Age and gender distributions were similar between the patient and control groups. Body mass index was higher in the patient group than in the control group. The C reactive protein level was higher in patients than controls (p = 0.064). The thyroid stimulating hormone (TSH) level was higher and the mean free thyroxine level lower in the patient group than in the control group (p < 0.05). There were no differences between the groups with regard to leukocytes, neutrophils, platelets, or MPV (p > 0.05). The NLR and PLR were significantly different in one subgroup of HT patients relative to healthy subjects (p < 0.05). However, we did not find any statistical differences in the MPV among the three subgroups (p = 0.547). A positive correlation was found among the NLR, anti-thyroglobulin (TG) antibodies, and anti-thyroid peroxidase (TPO) antibodies (p < 0.01), although there was a negative correlation between the PLR, TSH, anti-TPO, and anti-TG (p < 0.001). CONCLUSIONS: A single marker or panel of biomarkers is not a consistent indicator of HT, but NLR combined with PLR testing may offer a more reliable diagnosis.

Agreement of serum potassium measured by blood gas and biochemistry analyzer in patients with moderate to severe hyperkalemia.

PURPOSE: Several studies investigated the agreement between central laboratory biochemistry analyzers and blood gas analyzers for potassium measurements. However, data are scarce when the potassium level is moderate to severely high. We aimed to evaluate the agreement between central laboratory biochemistry analyzers and blood gas analyzer in terms of serum potassium level measurement because differences in potassium at this level translate into very different clinical actions. BASIC PROCEDURES: This was a retrospective medical record review study in which patients who presented to the emergency department and had serum potassium levels ≥6mmol/L were included. Patients who did not have simultaneous potassium measurement by blood gas analyzer were excluded. We included all patients meeting potassium criteria irrespective of their underlying disease or comorbidities. We evaluated agreement between the measurement methods with Pearson correlation, Bland-Altman plot, and Sign test. MAIN FINDINGS: A total of 118 blood sample pairs were included. The mean serum potassium level measured by biochemistry analyzer was 6.78±0.79mmol/L, whereas it was 6.16±0.86mmol/L by blood gas analyzer (P<.001, Sign test). There was a strong correlation (P<.001, r=0.864) between the 2 methods, but agreement was relatively poor. Blood gas analyzer tended to measure potassium significantly lower than measured by biochemistry analyzer. The mean difference between the methods was 0.62±0.43mmol/L. PRINCIPAL CONCLUSIONS: In patients with moderate to severe hyperkalemia, blood gas analyzer and biochemistry analyzer gives significantly different serum potassium results which may be clinically important.

SEVERE HYPONATREMIA, EPISTAXIS, AND FLUOXETINE.

Hyponatremia is one of the most common electrolyte abnormalities and can be life threatening. Fluoxetine is a serotonin reuptake inhibitor and may rarely cause hyponatremia. Furthermore, fluoxetine may rarely increase the risk of bleeding events. We report a 66-year old woman who presented with severe hyponatremia and epistaxis associated with the use of fluoxetine.

Neutrophil to lymphocyte ratio might help prediction of acute myocardial infarction in patients with elevated serum creatinine.

BACKGROUND AND OBJECTIVE: Diagnostic performance of troponin assays is affected by renal insufficiency. Neutrophil to lymphocyte ratio(NLR) is an independent predictor of acute coronary syndrome. Our objective was to evaluate performance of NLR in diagnosing acute myocardial infarction (AMI) among patients with elevated serum creatinine. METHODS: Patients with elevated creatinine levels evaluated for coronary artery disease were included (n=284). Patients were divided into two groups according to having AMI or non-specific chest pain. AMI diagnosis was made based on clinical and laboratory data, including serial EKG and cardiac enzymes, ECHO and coronary angiography. RESULTS: Troponin, neutrophil, and NLR were found to be higher in patients with AMI, compared to patients without AMI (P= 0.001, P= 0.001 and P=0.028, respectively). ROC curve analysis for NLR in diagnosing AMI was significant (AUC: 0.607; P=0.003). Sensitivity, specificity, LR +, LR-, PPV and NPV for NLR>7.4 were found as 42.3%, 74.7%, 1.68%, 0.77%, 77% and 40%, respectively. Logistic regression analysis revealed that patients whose NLR>7.4 were 2.18 times as likely to have AMI. CONCLUSIONS: NLR can be used as an independent predictor of AMI in patients with renal insufficiency. This seems to get more important in the era of high sensitivity troponin assays. Our results might also help in early diagnosis of AMI in this high risk population while serial cardiac enzyme results are pending.

Evaluation of Factor V G1691A, prothrombin G20210A, Factor XIII V34L, MTHFR A1298C, MTHFR C677T and PAI-1 4G/5G genotype frequencies of patients subjected to cardiovascular disease (CVD) panel in south-east region of Turkey.

Cardiovascular disease (CVD) risk factors, such as arterial hypertension, obesity, dyslipidemia or diabetes mellitus, as well as CVDs, including myocardial infarction, coronary artery disease or stroke, are the most prevalent diseases and account for the major causes of death worldwide. In the present study, 4,709 unrelated patients subjected to CVD panel in south-east part of Turkey between the years 2010 and 2013 were enrolled and DNA was isolated from the blood samples of these patients. Mutation analyses were conducted using the real-time polymerase chain reaction method to screen six common mutations (Factor V G1691A, PT G20210A, Factor XIII V34L, MTHFR A1298C and C677T and PAI-1 -675 4G/5G) found in CVD panel. The prevalence of these mutations were 0.57, 0.25, 2.61, 13.78, 9.34 and 24.27 % in homozygous form, respectively. Similarly, the mutation percent of them in heterozygous form were 7.43, 3.44, 24.91, 44.94, 41.09 and 45.66%, respectively. No mutation was detected in 92 (1.95%) patients in total. Because of the fact that this is the first study to screen six common mutations in CVD panel in south-east region of Turkey, it has a considerable value on the diagnosis and treatment of these diseases. Upon the results of the present and previous studied a careful examination for these genetic variants should be carried out in thrombophilia screening programs, particularly in Turkish population.

Screening of common and novel familial mediterranean fever mutations in south-east part of Turkey.

Familial mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder (MIM# 249100), particularly common in populations of Mediterranean extraction. MEFV gene, responsible for FMF, encoding pyrin has recently been mapped to chromosome 16p13.3. In the present study, 3,341 unrelated patients with the suspicion of FMF in south-east part of Turkey between the years 2009 and 2013 were enrolled and genomic sequences of exon 2 and exon 10 of the MEFV gene were scanned for mutations by direct sequencing. We identified 43 different type of mutations and 9 of them were novel. DNA was amplified by PCR and subjected to direct sequencing for the detection of MEFV gene mutations. Among the 3,341 patients, 1,598 (47.8 %) were males and 1,743 (52.1 %) were females. The mutations were heterozygous in 806 (62.3 %), compound heterozygous in 188 (14.5 %), homozygous in 281 (21.8 %) and mutations had complex genotype in 17 (1.32 %) patients. No mutation was detected in 2,051 (61.4 %) patients. The most frequent mutations were M694V, E148Q, M680I(G/C) and V726A. We could not find any significant differences between the two common mutations according to the gender. Molecular diagnosis of MEFV is a useful tool in clinical practice, thus a future study relating to genotype/phenotype correlation of FMF in more and larger group in Turkish population involving the whole MEFV gene mutations is necessary.

Fatigue and Impact Properties of Kenaf/Glass-Reinforced Hybrid Pultruded Composites for Structural Applications.

To address the weight, cost, and sustainability associated with fibreglass application in structural composites, plant fibres serve as an alternative to reduce and replace the usage of glass fibres. However, there remains a gap in the comprehensive research on plant fibre composites, particularly in their durability for viable structural applications. This research investigates the fatigue and impact properties of pultruded kenaf/glass-reinforced hybrid polyester composites tailored for structural applications. Utilising kenaf fibres in mat form, unidirectional E-glass fibre direct roving yarns, and unsaturated polyester resin as key constituents, pultruded kenaf/glass hybrid profiles were fabricated. The study reveals that pultruded WK/UG alternate specimens exhibit commendable fatigue properties (18,630 cycles at 60% ultimate tensile strength, UTS) and fracture energy (261.3 kJ/m2), showcasing promise for moderate load structural applications. Notably, the pultruded 3 WK/UG/3WK variant emerges as a viable contender for low-load structural tasks recorded satisfactory fatigue properties (10,730 cycles at 60% UTS) and fracture energy (167.09 kJ/m2). Fatigue failure modes indicate that the stress applied is evenly distributed. Ductile failures and delaminations during impact test can be attributed to damping and energy absorbing properties of kenaf fibres. Moreover, incorporating kenaf as a hybrid alternative demonstrates substantial reductions in cost (35.7-50%) and weight (9.6-19.1%). This research establishes a foundation for advancing sustainable and efficient structural materials and highlights the significant role of materials design in shaping the future of engineering applications.

The effect of oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing: a retrospective analysis of diabetic haemodialysis patients.

BACKGROUND: Diabetes is an important reason for end-stage renal failure and diabetic foot wounds worsen the life qualities of these patients. Protein and amino acid support accelerates the wound healing. The purpose of this retrospective study is to examine the effect of beta-hydroxy-beta-methylbutyrate, arginine and glutamine (Abound) supplementation on the wound healing. METHODS: A total of 11 diabetic dialysis patients were included in this retrospective study aiming to evaluate the effect of the diet support with beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing in diabetic dialysis patients. Pre-treatment and post-treatment wound depth and wound appearance were scored in accordance with the "Bates-Jensen" wound assessment tool. The results of 4-week treatment with beta-hydroxy-beta-methylbutyrate, arginine and glutamine (Abound) support were evaluated in terms of wound healing. RESULTS: The mean age of patients was 66 (SD: 10, range: 51-81) and 9 (81.8%) of them were males. After the 4-week treatment, in accordance with the Bates-Jensen scoring, healing was observed on the wound depth score of 7(63.6%) patients and on wound appearance score of 8(72.7%) patients out of 11. While the wound depth score of 4(36.4%) cases and wound appearance score of 3(27.3%) cases remained the same, no deterioration was observed on any cases throughout the follow-up period. CONCLUSION: In conclusion, our findings revealed that Abound treatment makes a positive contribution to the wound healing in diabetic dialysis patients.

Role of steroids in reducing postoperative edema in rhinoplasty: a meta-analytic study.

The study aimed at verifying the use of steroids to decrease postoperative edema after rhinoplasty. The study included published articles yielded by the Medline database search concerning role of steroids in rhinoplasty. The search was limited to articles published in English in the last three decades. The search was done on 1/2/2012. For the 15 relevant articles, we applied our inclusion and exclusion criteria and only four articles were included. The data collected from each article were statistically analyzed utilizing meta-analytic Review manager (RevMan 5.1) software (Version: 5.1.0.0). Perioperative steroid use significantly reduces postoperative edema of the upper and lower eyelids on the first and third days postoperative, with no significant effect after third day. The results indicated that steroids should be given for patients undergoing rhinoplasty for decreasing periorbital edema postoperatively especially in the first 3 days, however, it has little effect after the third day.

Management of iatrogenic tegmen plate defects: our clinical experience and surgical technique.

The objective of our study is to present our recommended approach for surgical management of iatrogenic tegmen plate defects. Patients diagnosed to have symptomatic iatrogenic tegmen plate defects were treated by one of the authors using a one-stage trans-mastoid standardized surgical procedure at Ain Shams University Hospitals. Patients' information records included history, complete examination, computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bone, and the followup data after the procedure to assess the final outcome in each case. Twelve patients with symptomatic iatrogenic tegmen plate defects were included in our study. The tegment plate defect size in the 12 patients varied from 2.2 to 15 mm (mean 5.6 ± 1.3). Postoperative followup of the patients ranged from 6 months up to 2 years (mean 1.6 ± 0.8). One patient only developed wound infection and was treated with antibiotics and regular dressings, with no other immediate postoperative complications (intracranial hematoma or meningitis). In the entire patient group, no local recurrence of middle fossa encephalocele was recorded. Our surgical trans-mastoid approach using multilayered autologous grafts is successful in closing iatrogenic tegmen plate defects more than 2.2 mm and less than 15 mm.

The necessity of post-maneuver postural restriction in treating benign paroxysmal positional vertigo: a meta-analytic study.

The objective of this article is to verify the role of postural restrictions after repositioning maneuvers in treating patients with benign paroxysmal positional vertigo (BPPV). The study included published articles yielded by a Pubmed search concerning post-maneuver postural restriction in treating BPPV. The search was limited to articles published in English language in the last three decades. The search was done on 1/11/2011. For the 18 relevant articles, we applied our inclusion and exclusion criteria and only 9 articles were included. The data collected from each article were statistically analyzed utilizing meta-analytic Review Manager (RevMan 5.1) software. (Version: 5.1.0.0). There were no significant differences between patients instructed with postural restriction after undergoing repositioning maneuver and patients left free to move after undergoing repositioning maneuver with regard to the presence or absence of post-maneuver symptoms. In conclusion, post-maneuver restrictions do not add to the success of the treatment of BPPV and there is no reason to submit patients to these impractical instructions.