Dry eye in primary care: the relationship between digital display device usage and dry eye syndrome (DES) in medical students.

OBJECTIVE: As digital display devices become more and more indispensable, associated health problems have started to increase. We aimed to investigate the frequency and relationship of digital display device usage behaviours and dry eye syndrome (DES) in medical students. METHODS: An observational, cross-sectional study was conducted on medical school students who voluntarily participated in our study online, about the duration and variety of their digital screen use, usage patterns, and protective measures, together with the Ocular Surface Disease Index (OSDI) questionnaire. Where necessary, the Schirmer-I, tear break-up time, and fluorescein staining tests were carried out. RESULTS: Of the 255 participants, 75.3% (n = 192) were female, 63.1% (n = 161) had no refractive vision defects, and 45.9% used smartphones for more than 5 h a day. According to the OSDI scores for DES screening, only 36.1% of the participants were normal, 17.3% had mild DES, 20.4% had moderate DES, and 26.3% had severe DES. A positive correlation was found between digital display usage time in hours per day and a high OSDI score. As the distance between the eye and the screen decreased, the DES score increased, which is significant for computer, e-book, and tablet use (P < 0.005). The DES rate of the 25 participants who underwent further evaluation was 40% for the tear break-up time test and 52% for the fluorescein staining test. CONCLUSION: The high prevalence of DES due to digital screen use among medical school students highlights the importance of DES screening as a preventive measure in family medicine.

Etiological causes in patients with acute urticaria and angioedema: A cross-sectional study.

BACKGROUND: Acute urticaria and angioedema are emergency dermatological conditions associated with various etiologic factors. OBJECTIVE: To determine the etiological causes in patients with acute urticaria and angioedema, and to investigate whether more than one etiological cause was present, along with the patients' laboratory values. METHODS: The study was conducted in a tertiary hospital with one center. Etiological causes and laboratory parameters in 284 patients diagnosed with acute urticaria and angioedema were retrospectively studied. RESULTS: A total of 284 patients were included in the study. The mean age of the patients was 42.7 ± 15.6 years, where 163 (57.4%) were women and 121 (42.6%) were men. Acute urticaria and angioedema occurred together in 149 (52.5%) patients. At least one precipitating factor among the predisposing risk factors was present in 220 (77.5%) patients, and more than one precipitating factor was found in 51 (18%) patients. Medication use was found in 157 (55.3%) patients and infection in 54 (19%). The development of urticaria after food consumption was noted in nine (3.2%) individuals. A history of infection and medication intake was present in 50 (17.6%) patients. A joint history of food consumption and medication intake was present in only one patient. Elevated C-reactive protein level was found in 178 (62.7%) patients and elevated anti-streptolysin O titer in 41 (14.4%) patients. Vitamin B12 deficiency was found in 116 (40.8%) patients and vitamin D deficiency in 254 (89.4%). CONCLUSION: Acute urticaria and angioedema may occur as a result of multiple etiological factors, in which different triggers may be present simultaneously.

The effectiveness of intradermal sterile water injection for low back pain in the emergency department: A prospective, randomized controlled study.

AIM: Low back pain (LBP) is a common musculoskeletal complaint among emergency department (ED) admissions. In this study, it was aimed to compare the effectiveness of systemic treatment with intradermal sterile water injection (ISWI) treatment protocol combined with systemic therapy in patients with LBP of unclear chronicity. METHODS: A prospective randomized, unblinded, controlled clinical study was conducted on patients admitted to the ED for LBP of unclear chronicity. One hundred twelve patients were randomly assigned to two groups; Group ISWI (n = 56) administered ISWI in the LBP region of patients along with systemic intravenous dexketoprofen therapy, while the other group (n = 56) received only systemic intravenous dexketoprofen therapy. The treatment methods' effectiveness was compared by measuring the pain intensity with the Visual Analog Scale (VAS) at admission, 10th minutes, 20th minutes, 30th minutes, and 24 h later. Also, opioid and analgesic consumptions in 24 h after treatment and patient satisfactions were compared. RESULTS: In the treatment of LBP, ISWI treatment was found to be more effective in relieving pain than systemic therapy alone (p < 0.001). Also, it was observed that opioid consumption in the ED and analgesic consumption within 24 h after treatments were decreased in the ISWI group (p < 0.001). The patient satisfaction in the ED was statistically increased (p < 0.001). DISCUSSION: In this unblinded study, ISWI with systemic therapy improved pain outcomes more than systemic therapy alone. Further research is needed to determine whether this was due entirely to placebo effect.

Local edge-enhanced active contour for accurate skin lesion border detection.

BACKGROUND: Dermoscopy is one of the common and effective imaging techniques in diagnosis of skin cancer, especially for pigmented lesions. Accurate skin lesion border detection is the key to extract important dermoscopic features of the skin lesion. In current clinical settings, border delineation is performed manually by dermatologists. Operator based assessments lead to intra- and inter-observer variations due to its subjective nature. Moreover it is a tedious process. Because of aforementioned hurdles, the automation of lesion boundary detection in dermoscopic images is necessary. In this study, we address this problem by developing a novel skin lesion border detection method with a robust edge indicator function, which is based on a meshless method. RESULT: Our results are compared with the other image segmentation methods. Our skin lesion border detection algorithm outperforms other state-of-the-art methods. Based on dermatologist drawn ground truth skin lesion borders, the results indicate that our method generates reasonable boundaries than other prominent methods having Dice score of 0.886 ±0.094 and Jaccard score of 0.807 ±0.133. CONCLUSION: We prove that smoothed particle hydrodynamic (SPH) kernels can be used as edge features in active contours segmentation and probability map can be employed to avoid the evolving contour from leaking into the object of interest.

Texture based skin lesion abruptness quantification to detect malignancy.

BACKGROUND: Abruptness of pigment patterns at the periphery of a skin lesion is one of the most important dermoscopic features for detection of malignancy. In current clinical setting, abrupt cutoff of a skin lesion determined by an examination of a dermatologist. This process is subjective, nonquantitative, and error-prone. We present an improved computational model to quantitatively measure abruptness of a skin lesion over our previous method. To achieve this, we quantitatively analyze the texture features of a region within the lesion boundary. This region is bounded by an interior border line of the lesion boundary which is determined using level set propagation (LSP) method. This method provides a fast border contraction without a need for extensive boolean operations. Then, we build feature vectors of homogeneity, standard deviation of pixel values, and mean of the pixel values of the region between the contracted border and the original border. These vectors are then classified using neural networks (NN) and SVM classifiers. RESULTS: As lower homogeneity indicates sharp cutoffs, suggesting melanoma, we carried out our experiments on two dermoscopy image datasets, which consist of 800 benign and 200 malignant melanoma cases. LSP method helped produce better results than Kaya et al., 2016 study. By using texture homogeneity at the periphery of a lesion border determined by LSP, as a classification results, we obtained 87% f1-score and 78% specificity; that we obtained better results than in the previous study. We also compared the performances of two different NN classifiers and support vector machine classifier. The best results obtained using combination of RGB color spaces with the fully-connected multi-hidden layer NN. CONCLUSIONS: Computational results also show that skin lesion abrupt cutoff is a reliable indicator of malignancy. Results show that computational model of texture homogeneity along the periphery of skin lesion borders based on LSP is an effective way of quantitatively measuring abrupt cutoff of a lesion.

Abrupt skin lesion border cutoff measurement for malignancy detection in dermoscopy images.

BACKGROUND: Automated skin lesion border examination and analysis techniques have become an important field of research for distinguishing malignant pigmented lesions from benign lesions. An abrupt pigment pattern cutoff at the periphery of a skin lesion is one of the most important dermoscopic features for detection of neoplastic behavior. In current clinical setting, the lesion is divided into a virtual pie with eight sections. Each section is examined by a dermatologist for abrupt cutoff and scored accordingly, which can be tedious and subjective. METHODS: This study introduces a novel approach to objectively quantify abruptness of pigment patterns along the lesion periphery. In the proposed approach, first, the skin lesion border is detected by the density based lesion border detection method. Second, the detected border is gradually scaled through vector operations. Then, along gradually scaled borders, pigment pattern homogeneities are calculated at different scales. Through this process, statistical texture features are extracted. Moreover, different color spaces are examined for the efficacy of texture analysis. RESULTS: The proposed method has been tested and validated on 100 (31 melanoma, 69 benign) dermoscopy images. Analyzed results indicate that proposed method is efficient on malignancy detection. More specifically, we obtained specificity of 0.96 and sensitivity of 0.86 for malignancy detection in a certain color space. The F-measure, harmonic mean of recall and precision, of the framework is reported as 0.87. CONCLUSIONS: The use of texture homogeneity along the periphery of the lesion border is an effective method to detect malignancy of the skin lesion in dermoscopy images. Among different color spaces tested, RGB color space's blue color channel is the most informative color channel to detect malignancy for skin lesions. That is followed by YCbCr color spaces Cr channel, and Cr is closely followed by the green color channel of RGB color space.

Third-hand smoke perception and awareness among medical students: a survey study.

Third-hand smoke (THS) is tobacco smoke impurities that adhere to indoor materials such as clothing, dust, and surfaces and are released into the air. It is a major public health concern that, if unaddressed, could cause future harm. The aim of this study was to assess medical students' knowledge of THS and to increase awareness. In March and April 2023, students enrolled in the medical programs at the School of Medicine for the 2022-2023 academic year were contacted using an online Google survey method and asked to complete the survey questions. The survey included questions on participants' sociodemographic characteristics and the Beliefs about Third-Hand Smoke Scale (BATHS-T). The median age of the 351 students who voluntarily participated in the study was 20.0 (IQR = 2.0) years, 55.3% were female and 16% were smokers. The mean score of the answers given by the participants to the scale questions asking their level of knowledge about third-hand smoke was 35.3 ± 5.9. The least known question was "cigarette smoke particles can stay in a room for weeks". The most frequently answered question was "breathing the air in a room where people smoked yesterday can damage the health of babies and children". Scale scores were significantly higher for participants who did not have smokers living in their home, who did not allow smoking in their home, and who reported having information about passive smoking. Medical students had sufficient knowledge and awareness of third-hand smoke. Third-hand smoke should be included in training to increase knowledge and awareness of medical students as part of preventive medicine practice.

The potential association between herpes zoster and COVID-19 vaccination.

Objective: Little is known about the dermatological manifestations associated with COVID-19 vaccines. The aim of the study was to determine how many cases of herpes zoster (HZ) occurred after COVID-19 vaccination and to see if there was a possible link. Methods: A retrospective cohort study was performed by archive scan between 2016 and 2020, and between January 2021 and January 2022. Patients diagnosed with HZ were enrolled and their demographic and medical history including age, sex, previous systemic disease, history of COVID-19 vaccination prior to HZ symptom onset, COVID-19 vaccine type as mRNA or inactive, time to HZ onset after vaccination, and number of COVID-19 vaccines before HZ symptom onset were recorded. Results: The average annual number of HZ cases from 2016 to 2020 was 271, but the number of HZ cases in 2021 was 338, reflecting an increase. The number of HZ patients with a known history of COVID-19 vaccination in 2021 was 117 and their mean age was 57.6 ± 14.2 years. Females were 59.8% (n = 70) and 28.2% (n = 33) had chronic diseases. A positive history of COVID-19 vaccination was present in 35.9% (n = 42) of HZ patients, 11.1% (n = 13) had received mRNA vaccines and 24.8% (n = 29) had received inactive COVID-19 vaccine. Mean time to HZ after COVID-19 vaccination was 24.6 ± 16.3 days. Conclusion: An important finding of this study is the high rate (35.9%) of COVID-19 vaccination among people diagnosed with HZ. As COVID-19 vaccination may be associated with reactivation of varicella zoster virus, the vaccination history should be obtained in HZ patients.

Use of bee venom in preventive medicine: An experimental hepatic encephalopathy study in rats.

OBJECTIVES: Bee venom is used for medicinal purposes, including the treatment of neurological and liver diseases, but its use as a primary health care approach for preventive purposes requires further exploration. The aim of this study was to provide the first investigation into the possible protective effects of bee venom against hepatic encephalopathy, a serious neurodegenerative disease. MATERIALS AND METHODS: An experimental animal study was conducted in which healthy albino Sprague-Dawley rats were randomized into three groups: healthy, control and bee venom groups. All rats were tested for locomotor activity at the beginning and end of the study. No intervention was made in the healthy group, whereas hepatic encephalopathy was induced in the control and bee venom groups by the administration of thioacetamide (TAA) (200 mg/kg/day). The bee venom group also received bee venom (5 mg/kg/day) subcutaneously every day for 14 days prior to the TAA administration. RESULTS: The results for the final locomotor activity tests were statistically better in the bee venom group than in the control group, supporting a beneficial effect of prophylactic bee venom application. Blood ammonia levels and liver weights, determined as indicators of inflammation, were lower in the bee venom group than in the control group and were close to levels in the healthy group, but not statistically significant. CONCLUSIONS: Bee venom administration has protective effects against the development of hepatic encephalopathy and offers a promising therapeutic opportunity in preventive medicine.

Relationships Between Disease Severity and the C-reactive Protein/Albumin Ratio and Various Hematological Parameters in Patients With Acne Vulgaris.

OBJECTIVE: Acne vulgaris, an inflammatory disease, was investigated in this study with the claim that the C-reactive protein (CRP)/albumin ratio and some hematological parameter ratios have the potential to be used as inflammatory markers to monitor disease severity and prognosis. METHODS: A descriptive cross-sectional study was conducted with two groups of patients aged 18-65 years, 61 patients diagnosed with acne vulgaris and 35 healthy control patients, and routine hemogram and biochemical parameters were compared. The Global Acne Severity Index was used to determine the severity of acne vulgaris. RESULTS: The median age of acne patients was 22.0 (IQR=5.0) and the median age of healthy volunteers was 30.0 (IQR=14.0). There were 75.4% (n=46) women in the acne group and 77.1% (n=27) women in the control group. Among the acne patients, 42.6% (n=26) had mild acne, and 41% (n=25) had moderate acne severity. A significant difference was found between the study groups in terms of CRP/albumin ratio, CRP, monocyte/lymphocyte ratio (MLR), lymphocyte/albumin ratio (LAR), and monocyte/CRP ratio (MCR) according to laboratory test results and calculated test ratios (p<0.05). The area under the curve (AUC) value of the CRP/albumin ratio in the receiver operating characteristic (ROC) analysis between the acne and control groups was 0.660, and its cut-off value was found to be 0.236 with 68.6% sensitivity and 68.9% specificity. CONCLUSION: This study is the first to compare the CRP/albumin ratio with the severity of acne vulgaris in the literature. CRP/albumin ratio and MCR may serve as inflammatory markers that can be used to monitor the severity of acne vulgaris.

How to diagnose COVID-19 in family practice? Usability of complete blood count as a COVID-19 diagnostic tool: a cross-sectional study in Turkey.

OBJECTIVE: COVID-19 is currently diagnosed in hospital settings. An easy and practical diagnosis of COVID-19 is needed in primary care. For this purpose, the usability of complete blood count in the diagnosis of COVID-19 was investigated. DESIGN: Retrospective, cross-sectional study. SETTING: Single-centre study in a tertiary university hospital in Erzurum, Turkey. PARTICIPANTS: Between March 2020 and February 2021, patients aged 18-70 years who applied to the hospital and underwent both complete blood count and reverse-transcription-PCR tests for COVID-19 were included and compared. Conditions affecting the test parameters (oncological-haematological conditions, chronic diseases, drug usage) were excluded. OUTCOME MEASURE: The complete blood count and COVID-19 results of eligible patients identified using diagnostic codes [U07.3 (COVID-19) or Z03.8 (observation for other suspected diseases and conditions)] were investigated. RESULTS: Of the 978 patients included, 39.4% (n=385) were positive for COVID-19 and 60.6% (n=593) were negative. The mean age was 41.5±14.5 years, and 53.9% (n=527) were male. COVID-19-positive patients were found to have significantly lower leucocyte, neutrophil, lymphocyte, monocyte, basophil, platelet and immature granulocyte (IG) values (p<0.001). Neutrophil/lymphocyte, neutrophil/monocyte and IG/lymphocyte ratios were also found to be significantly decreased (p<0.001). With logistic regression analysis, low lymphocyte count (OR 0.695; 95% CI 0.597 to 0.809) and low red cell distribution width-coefficient of variation (RDW-CV) (OR 0.887; 95% CI 0.818 to 0.962) were significantly associated with COVID-19 positivity. In receiver operating characteristic analysis, the cut-off values of lymphocyte and RDW-CV were 0.745 and 12.35, respectively. CONCLUSION: Although our study was designed retrospectively and reflects regional data, it is important to determine that low lymphocyte count and RDW-CV can be used in the diagnosis of COVID-19 in primary care.

Analysis of Interleukin-17, Interleukin-23, neopterin and Nesfatin-1 levels in the sera of Hashimoto patients.

Background: Hashimoto's thyroiditis (HT) is an autoimmune disorder affecting the thyroid gland and may present as goiter or atrophic thyroiditis that may result in various metabolic and inflammatory disorders. The aim of this study is to determine the changes in serum levels of interleukin-17 (IL-17), IL-23, neopterin, and nesfatin-1 parameters in HT patients and to evaluate the possible relationship among these parameters. Methods: 90 HT patients and 30 healthy individuals were included in this study. Demographic data of the patients included in the study were recorded and detailed physical examinations were performed. IL-17, IL-23, neopterin, and nesfatin-1 levels were measured in the serum samples of the participants by the ELISA method.

Evaluation of the Relationship Between Aquaporin-1, Hepcidin, Zinc, Copper, and Iron Levels and Oxidative Stress in the Serum of Critically Ill Patients with COVID-19.

Our study aims to determine the relationship between hepcidin, aquaporin (AQP-1), copper (Cu), zinc (Zn), iron (Fe) levels, and oxidative stress in the sera of seriously ill COVID-19 patients with invasive mechanical ventilation. Ninety persons with and without COVID-19 were taken up and separated into two groups. The first group included seriously COVID-19 inpatients having endotracheal intubation in the intensive care unit (n = 45). The second group included individuals who had negative PCR tests and had no chronic disease (the healthy control group n = 45). AQP-1, hepcidin, Zn, Cu, Fe, total antioxidant status (TAS), and total oxidant status (TOS) were studied in the sera of both groups, and the relations of these levels with oxidative stress were determined. When the COVID-19 patient and the control groups were compared, all studied parameters were found to be statistically significant (p < 0.01). Total oxidant status (TOS), oxidative stress index (OSI), and AQP-1, hepcidin, and Cu levels were increased in patients with COVID-19 compared to healthy people. Serum TAC, Zn, and Fe levels were found to be lower in the patient group than in the control group. Significant correlations were detected between the studied parameters in COVID-19 patients. Results indicated that oxidative stress may play an important role in viral infection due to SARS-CoV-2. We think that oxidative stress parameters as well as some trace elements at the onset of COVID-19 disease will provide a better triage in terms of disease severity.

Evaluation of amino acid profile in serum of patients with Covid-19 for providing a new treatment strategy.

Background: Amino acids have an important role in metabolism and may affect COVID-19-related outcomes. In our study, the amino acid serum level of hospitalized COVID19 patients was evaluated to determine a new treatment strategy. Methods: The amino acid profile covering 43 amino acids in 68 subjects, comprising 30 (14 men and 16 women) controls and 38 (16 men and 22 women) COVID-19 patients, were examined. The amino acid profiles of the participants were screened by LC-MS/MS. Results: Compared with the control group, serum levels of 27 amino acids increased in the patient group. Alpha-aminopimelic acid, sarcosine, and hydroxyproline amino acids were considerably higher in the control group than in the patient group (p<0.0001). There was no notable difference among control group and the case group for 13 amino acids (p≥0.05). A significant positive correlation was seen among the control and the patient groups in the mean amino acid values (r=0.937; p<0.0001). Conclusions: These results postulated a clear picture on the serum levels of amino acid in the COVID-19 patients. Serum amino acids measured in hospitalized COVID-19 patients can explain the patient's metabolic status during the disease.

An antihypertensive agent benidipine is an effective neuroprotective and antiepileptic agent: an experimental rat study.

BACKGROUND: Benidipine is an L, N and T type calcium channel blocker drug that is widely used as an antihypertensive drug. OBJECTIVE: For the first time in the literature, it was aimed to investigate the effectiveness of benidipine in controlling epileptic seizure and preventing the development of neurodegeneration in epilepsy. METHODS: An experimentally epilepsy model was produced with pentylenetetrazole, and rats were divided into seven groups, in different benidipine treatment doses or with valproic acid combinations. The epileptic activities of all rats were recorded according to the Fisher&Kittner classification. Biochemical parameters, histopathological Caspase-3 activity, Wyler hippocampal sclerosis, gliosis and neuronal degenerations were investigated. RESULTS: It was found that in the post-hoc analysis of epileptic activities, there was a similar antiepileptic scores among the treatment groups. IL-1 level was found to be significantly lower in the benidipine 4 mg/kg group, and TNF-alpha was lower in the group given valproic acid+benidipine 2 mg/kg (p<0.05). The other biochemical parameters were not found to be significant. Neural degeneration levels in the brain tissues were statistically significant (p<0.001). Compared with the healthy group, the most neural degeneration was in the control group, the least neural degeneration was in the valproic acid+benidipine 4 mg/kg group. CONCLUSIONS: For the first time in the literature, benidipine, alone or combined with valproic acid, were found to have a statistically significant antiepileptic efficacy, and provided neuroprotection when combined with valproic acid. Benidipine will be a promising agent in the treatment of epilepsy with its antiepileptic and neuroprotective effects.