Protracted or recurrent COVID-19 associated cytokine storm in a patient with chronic lymphocytic leukemia receiving rituximab-based chemotherapy.

A 52-year-old male patient who was diagnosed with chronic lymphocytic leukemia two years ago; admitted to our hospital with complaints of fever (>38C), shortness of breath, and fatigue. He was receiving fludarabine, cyclophosphamide, and rituximab (FCR) regimen for one year after two courses of cyclophosphamide, vincristine, and prednisolone (CVP) regimen. The patient was diagnosed with COVID-19 associated cytokine storm and tocilizumab 800 mg was administered in addition to corticosteroids. Significant improvement was observed in both clinical and laboratory parameters and his hypoxemia resolved. The patient whose complaints recurred on the 13 th day of discharge was admitted to the hospital again with severe hypoxemia (oxygen saturation < 90) and fever (>38C). Pulse steroid (250 mg methylprednisolone for three days, followed by 40 mg/day) and anakinra 400 mg/day intravenously were started. Despite the treatment, the patient progressed to respiratory failure and died on the sixth day of second hospitalization.

Investigation of the effect of telmisartan on experimentally induced peripheral nerve injury in rats.

AIM: The aim of this study was to investigate the effects of telmisartan on nerve healing in a rat peripheral nerve injury model. MATERIAL AND METHOD: Thirty adult male Wistar albino rats were divided into five groups: healthy, axonotmesis, anastomosis, axonotmesis+10 mg/kg telmisartan and anastomosis+10 mg/kg telmisartan. Walking track analyses were performed 4 weeks after the surgery. The right sciatic nerves of all the animals were examined histopathologically, stereologically and molecularly. RESULTS: Many badly damaged axons were detected in the axonotmesis group, in addition to enlarged spaces between the axons. In the anastomosis group, both ir- regular and degenerated axons at different severities were observed. The sections of the telmisartan group after the axonotmesis were similar to those of the healthy group. The sections of the telmisartan group after the anastomosis were similar to those of the healthy group and the telmisartan group after the axonotmesis. Interleukin-1 beta (IL-1ß) gene expression increased in both the axonotmesis and the anastomosis groups when compared with the healthy group. Telmisartan had a significant down-regulatory effect on IL-1ß expression. Caspase-3 mRNA expression was significantly increased in the anastomosis group, and the administration of telmisartan in this group significantly decreased this rise in caspase-3 mRNA expression. As a functional outcome, telmisartan also increased the walking distance of the rats after axonotmesis and anastomosis. CONCLUSION: The histopathological, stereological, functional and molecular data suggest that telmisartan improves nerve regeneration in peripheral nerve injuries by inhibiting inflammatory cytokine IL-1ß and apoptotic caspase-3.

Effect of Ramadan fasting on serum concentration of apelin-13 and new obesity indices in healthy adult men.

BACKGROUND: The aim of this study was to determine how Ramadan fasting (RF) affected the recently described new obesity indices [visceral adiposity index (VAI), waist circumference to height ratio (WHtR), body adiposity index (BAI)], and serum concentration of apelin-13 (RF) in healthy adult men. MATERIAL AND METHODS: For this purpose, 42 healthy adult men were selected. Anthropometric parameters were measured and a sample of venous blood was obtained for biochemical assays on the first and last days of Ramadan. When all subjects were evaluated, all anthropometric parameters changed except VAI. Serum apelin-13, triglyceride (TG), HDL-cholesterol (HDL-C), and insulin levels did not change. When patients were divided into 3 groups according to body mass index (BMI), BAI decreased in normal-weight subjects and WHtR decreased in other groups, but VAI and apelin-13 did not change in any groups. RESULTS: We demonstrate for the first time that while some anthropometric parameters changed, VAI and serum apelin-13 levels did not change with RF. BMI, waist circumference (WC), TG, and HDL-C were evaluated together in calculation of VAI. TG, VAI, and HDL-C remained unchanged by RF. Even if body weight (BW) and BMI decreased, apelin-13 was not affected by RF. The data on serum apelin-13 may have been influenced by the small-percentage decrease in BW, as well as insignificant improvements in metabolic parameters such as lipid profiles, glucose, and insulin. CONCLUSIONS: We found that Ramadan fasting in healthy adult men was associated with significant decreases in BW, BMI, WHtR, and BAI, but we found no significant changes in VAI and serum apelin-13 concentrations.

Protective effects of alpha-lipoic acid on experimental sciatic nerve crush injury in rats: assessed with functional, molecular and electromicroscopic analyses.

AIM: The present study aimed to demonstrate protective effects of alpha lipoic acid on experimental sciatic nerve crush injury model assessed with functional and electronmicroscopy analyses. METHODS: In this study, groups were; Group 1; sham operated, Group 2; applied only sciatic nerve crush (Control), Group 3; Sciatic nerve crush + treated ALA 25 mg/kg (received orally) and Group 4; Sciatic nerve crush + treated ALA 50 mg/kg. Subsequently, sciatic nerves crush injury induced by forceps. At the second and fourth week, all animals were evaluated for sciatic functional index (SFI) and histomorphometric analyses with electronmicroscopy. RESULTS: The SFI was significantly increased for both ALA-treated groups 30 days post-injury compared with control groups. The elecronmicroscopy results demonstrated that the axon diameter, the myelin diameter, the area of regenerating axon and miyelin were better in the treatment group than in the control group. Also ALA decreased IL-1ß and Caspase 3 levels that increased in SNC group. CONCLUSIONS: These results suggest that ALA neuroprotective agent for peripheral nerve injury (PNI) and promoted peripheral nerve regeneration via its anti-inflammatory and antiapoptotic effects.

Evaluation of Posterior Ocular Blood Flow in Diabetic Retinopathy Patients Without Macular Edema Using Optical Coherence Tomography Angiography.

AIM: The objective of this study is to investigate and compare the superficial and deep vascular structures of the retina, as well as the changes in the choriocapillaris (CC) and optic disc microvasculature, using optical coherence tomography angiography (OCTA) in patients diagnosed with diabetes mellitus (DM) without diabetic retinopathy (DR), patients with non-proliferative and proliferative DR, and healthy individuals. MATERIALS AND METHODS: This prospective study conducted between July 2020 and July 2021 included patients diagnosed with type 2 DM without DR, as well as patients with mild nonproliferative, moderate nonproliferative, and proliferative DR without macular oedema. A control group of 25 age- and gender-matched healthy individuals was also included. OCTA parameters of the patients were examined. RESULTS: In the DR groups, compared to the control group, there was a significant decrease in macular superficial, deep, and CC perfusion areas as the severity of DR increased (p<0.001). The vascular density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) exhibited a statistically significant decrease in all quadrants of the DR group compared to the control group (p = 0.033 for SCP in the fovea, p<0.001 for all other quadrants). The superficial and deep FAZs showed a significant expansion in the DR group compared to the control group (p = 0.003 for superficial FAZ, p<0.001 for deep FAZ). As the severity of DR increased, there was a statistically significant decrease in the perfusion areas of the optic nerve head (ONH), radial peripapillary capillary (RPC), and vitreous segments (p<0.001 for ONH, p = 0.031 for RPC, p<0.001 for vitreous). There was a statistically significant decrease in RPC VD in all quadrants as the severity of DR increased. Moreover, as the severity of DR increased, a statistically significant decrease in the VD of the ONH was observed in all quadrants except for the inferior nasal (p = 0.094), inferior temporal (p = 0.111), superior temporal (p = 0.18), and temporal (p = 0.284) quadrants. CONCLUSION: Our study demonstrated the involvement of macular and optic nerve perfusion areas (PA) and VD in diabetic patients. OCTA proved to be a valuable and noninvasive imaging modality, providing an easy and repeatable assessment of posterior segment vascular changes in patients with DR.

The evaluation of the effect of Nd-YAG capsulotomy on posterior ocular vascular structures by Optical coherence tomography angiography.

BACKGROUND: We aimed to examine the changes in retinal, choroidal and optic nerve head vascular structures after Nd-YAG laser application due to posterior capsule opacification after cataract surgery by Optical coherence tomography angiography (OCTA). METHODS: Fifteen eyes of 15 patients who have posterior capsule opasification and underwent Nd-YAG laser capsulotomy were included in the study. OCTA imagings of patients were made before and one hour, one week and one month later after the laser procedure. RESULTS: No significant change was determined before and after capsulotomy in macular thickness measurements, flow areas and vessel densities (all p > 0.05). Optic nerve head vessel densities and flow areas didn't differ preoperatively and postoperatively (p > 0.05). CONCLUSIONS: Nd-YAG laser capsulotomy for posterior capsule opacification has no detectable effect on macular and optic nerve flows and vessel densities.

Endovascular treatment for anterior cerebral artery occlusions.

BACKGROUND: We sought to examine the feasibility, safety and preliminary efficacy of anterior cerebral artery (ACA) occlusions in patients undergoing endovascular treatment. METHODS: Four hundred five consecutive patients with large-vessel occlusion treated with endovascular treatment were analysed to identify all patients with acute ACA occlusion who underwent endovascular treatment. RESULTS: Twenty had ACA occlusion (primary ACA occlusion: 9, rescue ACA occlusion: 11), 395 patients had other occlusions (internal carotid artery and MCA). The median [IQR] mRS score in the third month was significantly higher in the ACA-rescue occlusion group versus the ACA-primary occlusion group. The rate of haematoma in patients with ACA-occlusions was significantly higher compared with the ACA-primary occlusion group. Moreover, the three-month mortality rate was higher in patients with ACA-rescue than the patients with ACA-primary. CONCLUSIONS: Although endovascular treatment can be considered in patients with primary ACA occlusions, our data suggest that future clinical trials are needed to determine the efficacy of endovascular treatment for ACA occlusions. Unfavourable outcomes in our study were considered to occur in the rescue ACA occlusions.

The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome.

The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the normal values, 42 hands of 21 healthy women were also studied. There was a significant improvement of sensory and motor nerve conduction values when compared to baseline values (P < 0.01). At the end of follow-up period, the median sensory distal latency and the sensory latency differences between the median and the ulnar nerve were improved 35 and 65%, respectively. The maximum, mean F-wave amplitudes and chronodispersion showed a slight improvement with respect to baseline values and controls, but statistical significance was not achieved after treatment. Although no statistically significant improvements were observed in SSR parameters, slightly decreased amplitudes and increased habituation of SSR were noted at the end of the treatment. The present study shows that the local steroid injection results in improvement in NCSs values, but the F-wave parameters were not effectual in short-term outcome of CTS treatment. These findings suggest that the sensory latency differences between the median and the ulnar wrist-to-digit 4 are better parameters in the median nerve recovery after treatment than the median sensory distal latency. Furthermore, the SSR does not seem to be a sensitive method in follow-up of CTS treatment.

Endovascular treatment for M3 occlusions.

INTRODUCTION: Endovascular treatment (ET) is a beneficial treatment for M1-2 occlusions of the middle cerebral artery. Mortality and disability rates are high if large vessel occlusions are not treated. While these rates are lower in M3 occlusions, important branch blockages can lead to disability. Endovascular treatment of small vessel occlusions is difficult, and there are no studies on the effectiveness of endovascular treatment for M3 occlusions. Accordingly, in this study, our aim was to assess the feasibility, safety, and preliminary efficacy of endovascular therapy for M3 occlusions. METHODS: This study involved a retrospective analysis of a prospectively collected from two centres for acute ischemic stroke of the anterior system between July 2015 and April 2020. Demographic, radiologic, procedural and outcome variables were collected for patients who underwent endovascular therapy for acute ischemic stroke of the anterior system. RESULTS: Complete or near complete reperfusion (mTICI 2b-3) of the M3 occlusion was achieved in 15 cases (38.5%). Complete (mTICI 3) reperfusion was achieved in 24 cases (61.5%). Twenty-six patients were treated for primary M3 occlusion, while 13 patients with M3 occlusion were treated as a rescue strategy after successful treatment of a proximal greater vascular occlusion. Complete or near complete reperfusion (mTICI 2b-3) of primary occlusion was achieved in eight cases (30.8%), and complete (mTICI 3) reperfusion was achieved in 18 cases (69.2%). In addition, complete or near complete reperfusion (mTICI 2b-3) of rescue M3 occlusion was achieved in seven cases (%53.8), while complete (mTICI 3) reperfusion was achieved in six cases (46.2%). Only one patient with primary M3 occlusion had ICH due to extravasation. The patient's neurological examination one month later was normal. CONCLUSIONS: This retrospective study demonstrates that endovascular treatment of M3 occlusions is safe, effective and reliable.

The evaluation of patients with optic disc edema: A retrospective study.

OBJECTIVE: Optic disc edema is among major problems that neuro-ophthalmology clinics encounter. We intended to analyze patients with optic disc edema in this article. METHODS: Data related to the main complaint, associated systemic disease, visual acuity, characteristics of optic disc swelling, other ocular findings, topical or systemic drugs, treatment methods, follow-up examination, and related data of the patients were obtained retrospectively. RESULTS: There were 77 female and 23 male patients in the study. Optic disc edema was detected bilaterally in 65 patients, unilaterally in 35 patients. The duration of the symptoms until the first application was 19.82±17.18 (0-90) days. There were no systemic disorders in 74 patients but diabetes mellitus in 11 patients, hypertension in four patients, coronary artery disease in three patients, urticaria in two patients, lymphoma in one, multiple sclerosis in one patient, mastoiditis in one patient, scleroderma in one, and pregnancy in two patients were detected. While 93 patients had no additional ocular findings, 2 had uveitis, 1 had corneal dystrophy, 1 had keratoconus, 1 had cataract, 1 had previous cataract surgery, and 1 had peripheral retinal degenerations. The major etiology of the optic disc edema was idiopathic intracranial hypertension, which was detected in 44 patients. In all these patients, bilateral optic disc edema was observed and 43 patients were given oral acetazolamide and one patient oral topiramate. CONCLUSION: The presence of optic nerve edema should be absolutely evaluated in patients presenting with symptoms of vision loss and increased intracranial pressure. The early diagnosis with fundoscopic examination may increase visual acuity in these patients.

Root canal reconstruction using biological dentin posts: A 3D finite element analysis.

Background. Several types of post have been developed for clinical use. A biological dentin post obtained from an extracted tooth eliminates the problems arising from material differences and reduces the fracture rate in teeth undergoing root canal treatment. This study used finite element analysis to compare a biological dentin post with posts made of two different materials. Methods. Three 3D models of the upper central incisor were created, and stainless-steel, glass fiber and biological dentin posts were applied to these models. The restoration of the models was completed by applying a composite as the core structure and a ceramic crown as the superstructure. Using finite element stress analysis in the restoration models, a 100-N force was applied in the vertical and horizontal directions and at a 45º angle, and the suitability of the biological dentin post was evaluated by comparing the data. Results. Under the applied forces, the greatest stress accumulation was seen in the models with the stainless steel post. Because the stainless steel post was more rigid, stress forces accumulated on the surface instead of being transmitted to the tooth tissue. In the models with the glass fiber and biological dentin posts, the post material responded to the stratification in tandem with the dental tissue and did not cause excessive stress accumulation on the tooth or post surfaces. Conclusion. The results showed that biological dentin posts prevent the accumulation of stresses that might cause fractures in teeth undergoing root canal treatment. In addition, the physical compatibility and biocompatibility of a biological dentin post with the tooth imply that it is a good alternative to the types of post currently used.

Posterior ocular blood flow in preeclamptic patients evaluated with optical coherence tomography angiography.

OBJECTIVE: The aim of the present study was to examine the effects of preeclampsia on posterior ocular blood flow through optic coherence tomography angiography (OCTA). STUDY DESIGN: The study included preeclamptic pregnant women (group PPW), healthy pregnant women (group HPW) and control non-pregnant women (group CNPW). The blood flow area of retina, optic nerve head and choriocapillaris were assessed through OCTA. RESULTS: Retinal superficial blood flow area (RSBFA) was similar in group PPW, HPW and CNPW (p = 0.101); likewise, there was not any difference in retinal superficial parafoveal vessel density (RSPFD) between the groups (p = 0.685). There was not any difference detected in retinal deep blood flow area (RDBFA) in group PPW, HPW and CNPW), likewise retinal deep parafoveal vessel density (RDPFD) was found similar between the groups (p = 0.184). The choriocapillaris blood flow area (CBFA) was different between the groups (p = 0.000) and less in the group PPW than in group HPW. The CBFA was 1.875 ±â€¯0.05 mm2 in group the PPW, 1.928 ±â€¯0.05 mm2 in the group HPW and 1.464 ±â€¯0.06 mm2 in the group CNPW. Similarly, the optic nerve head blood flow area was lower in the group PPW compared to the group HPW (1.567 ±â€¯0.38 mm2, 1.690 ±â€¯0.20 mm2 and 1.592 ±â€¯0.25 mm2 in the group PPW, group HPW and group CNPW respectively; p = 0.002). CONCLUSION: Posterior segment ocular blood flow may be diminished in preeclamptic women. OCTA may enable to monitor ocular blood flow dynamics and give important clues in the diagnosis of retinal vascular pathologies accompanied by systemic diseases.

Early and long period follow-up results of low glycemic index diet for migraine prophylaxis.

OBJECTIVES: The role of dietary restriction in the management of patients with migraine is still a controversial topic in the headache field. The aim of this study was to evaluate the efficacy of dietary restriction on migraine attacks. METHODS: Patients diagnosed with migraine without aura according to the International Classification of Headaches were enrolled. Our study included 350 migraine patients evaluated at the neurology headache outpatient clinic. They were randomly divided into two groups: diet group as the study group and medication group as the control group. We told migraine patients to make lifestyle changes, especially those with low glycemic index in the diet group. On the other hand, propranolol, amitriptyline, flunarizine, and topiramate were used for the prophylaxis in the medication group. The frequency and severity of attacks [using the visual analog scale (VAS)] were recorded before starting dietary restriction and 1 and 3 months after the dietary restriction. RESULTS: There were 350 participants in this study. After 3 months, a total of 147 patients (male/female: 17/130, mean age: 34.7±5.9) were evaluated in the diet group. The control group consisted of 147 age- and sex-matched, randomly selected patients with migraine without aura. In the first month after dietary restriction, monthly attack frequency significantly decreased in both groups but not the VAS score. The mean scores of VAS significantly decreased later in the diet group compared with those in the medication group (after 3 months). CONCLUSION: The results of the study revealed that low glycemic index diet intake can be an effective and reliable method to reduce migraine attacks.

Working hand syndrome: A new definition of non-classified polyneuropathy condition.

The aim of this paper was to define an unexplained non-classified polyneuropathy condition as a new neurological disease. This new diagnosis of occupation related polyneuropathy has been named as "WORKING HAND SYNDROME (WHS)."This study collected and compared clinic and electrophysiological analyze data from healthy controls, WHS patients, carpal tunnel syndrome (CTS) patients and polyneuropathy patients. The WHS patients presented to the clinic with pain, numbness, tingling, and burning sensations in their hands that increased significantly during rest and nighttime. However, there was no weakness in the muscles, and the deep tendon reflexes were normal in this disease. The patients had all been working in physically demanding jobs requiring the use of their hands/arms for at least 1 year, but no vibrating tools were used by the patients. All of the cases were men. I supposed that overload caused by an action repeated chronically by the hand/arm may impair the sensory nerves in mentioned hand/arm. In patients with these complaints, for a definitive diagnosis, similar diseases must be excluded. Nonetheless, the specific electrophysiological finding that the sural nerves are normal on the lower sides, as well as the occurrence of sensory axonal polyneuropathy in the sensory nerves without a significant effect on velocity and latency in the work-ups of the upper extremity are enough to make a diagnosis.In conclusion, WHS has been defined as a polyneuropathy and occupational disease. Patients with WHS present with pain, numbness, tingling, and burning sensations in their hands that increases significantly during rest and nighttime. They also use their arms/hands for jobs that require heavy labor. The neurological examinations of patients with WHS are normal. Only the sensory nerves in the upper extremities are affected. This article is suggested to serve as a resource for patients, health care professionals, and members of the neurology community at large.

Should we use the serum vaspin level for the diagnosis and/or prognosis of subarachnoid hemorrhage?

BACKGROUND: We aimed to investigate whether vaspin, a member of the serine protease family, could be used as a marker for the severity and prognosis of subarachnoid hemorrhage (SAH). METHODS: Fifty-two consecutive patients (mean age, 51.46±3.2 years; 61.5% male) admitted to the emergency service of our hospital and hospitalized at our clinic with the diagnosis of aneurysmal SAH between 2012 and 2014 were included in the study and followed up for six months for outcome. The control group consisted of 52 healthy individuals of similar age and gender. RESULTS: During the 6-month follow-up, 8 of 52 patients died, and 18 (34.6%) patients had poor the Glasgow Outcome Score (GOS) scores. In 20 (38.46%) patients, acute hydrocephalus developed, and external ventricular drainage was performed. In the study group, the mean vaspin level was significantly higher than control group (157.88±33.6 pg/mL and 109.59±45.68 pg/mL, respectively; P<0.01). The mean vaspin level was 215.18±12.36 pg/mL in the non-survival group and 147.47±24.43 pg/mL in the survival group. Furthermore, it was 195.99±21.10 pg/mL in patients with poor outcome in terms of GOS, and 137.71±17.61 pg/mL in those with good outcome. The vaspin levels significantly increased with worsening of GOS, the World Federation of Neurological Surgeons (WFNS) grading system, and Fisher scores and increasing plasma C-reactive protein levels (P<0.01 for all). CONCLUSIONS: In conclusion, vaspin can play a role as a new marker in the diagnosis, severity assessment, and prognosis of SAH.

Correlation with Platelet Parameters and Genetic Markers of Thrombophilia Panel (Factor II g.20210G>A, Factor V Leiden, MTHFR (C677T, A1298C), PAI-1, ß-Fibrinogen, Factor XIIIA (V34L), Glycoprotein IIIa (L33P)) in Ischemic Strokes.

An important type of arterial thrombosis, ischemic stroke is associated with increased mortality risk, severe disability and life quality impairment. In this study, we analyzed mean platelet volume, platelet count values and genetic thrombophilia markers of patients who have ischemic stroke history and searched the relationship with genetic predisposition of ischemic strokes and platelet parameters. A retrospective, clinical trial was performed by reviewing the ischemic stroke history (except cryptogenic events) of 599 patients and 100 controls. The results of the genetic thrombophilia panel were used to classify the study group and control group into low and high risk for thrombophilia groups. The high-risk group included patients homozygous/heterozygous for Factor II g.20210G>A or Factor V Leiden mutations with/without any other polymorphism. The low-risk group included patients heterozygous or homozygous for MTHFR (C677T, A1298C), PAI-1, ß-fibrinogen, Factor XIIIA (V34L) and glycoprotein IIIa (L33P) polymorphisms or negative in terms of both mutations and polymorphisms. The results of study showed us that high-risk group mutations are important risk factors for ischemic stroke but low-risk group polymorphisms are not significant. According to platelet parameters, although there was a significant difference between MPV and PLT values of ischemic stroke and control group, thrombophilia mutations and polymorphisms have not a significant effect on MPV and PLT values in ischemic stroke patients.

Ocular surface disorders and tear function changes in nodulo-cystic acne.

The aim of this study was to investigate the ocular surface disorders and tear function changes in patients with nodulo-cystic acne. Eighty-seven patients with nodulo-cystic acne vulgaris and 50 healthy subjects were included in the study. All subjects underwent full ocular examinations. Subjective ocular complaints were recorded. Corneal staining with fluorescein, tear film break-up time (BUT), and Schirmer test were applied. Abnormal tear film BUT and abnormal Schirmer scores were significantly more common in the acne group than in the control group. The tear film BUT was abnormal in 18 (20.7%) cases in the patient group and in 2 (4%) subjects in the control group (p=0.007). The mean Schirmer score was abnormal in 7 (8%) and decreased in 18 (20.7%) acne patients, and it was decreased in only 3 (6%) control subjects (p=0.005). Corneal punctuate epithelial erosions were detected in 3 (3.4%) acne patients, but not any of the control subjects. However, the difference between the groups was not statistically significant (p=0.184). Subjective ocular complaints were present in 28 cases (32.2%) in the patient group. Five (10%) subjects in the control group had such complaints (p=0.003). Tear function tests are also significantly altered in patients with nodulo-cystic acne. Our data suggest that severe acne patients should be referred to an ophthalmologist.

Impression cytology changes and corneoconjunctival calcification in patients with chronic renal failure.

OBJECTIVE: To evaluate the relationship between corneoconjunctival calcification and conjunctival squamous metaplasia in patients with chronic renal failure (CRP). STUDY DESIGN: We studied impression cytology in 45 CRF patients on regular hemodialysis and 30 age- and sex-matched controls. Specimens were obtainedfrom the temporal bulbar conjunctiva using cellulose acetate filter paper. The samples were fixed in a mixture of 70% ethyl alcohol, 37% formaldehyde and glacial acetic acid and then stained with a combination of periodic acid- Schiff and Gill's modified Papanicolaou stain and graded by a masked observer. Corneoconjunctival calcification was graded by the Porter-Crombie classification. RESULTS: Of 45 study patients, 4 (9%) disclosed grade 0, 23 (51%) grade 1, 14 (31%) grade 2 and 4 grade 3 (9%) impression cytology changes. There was a statistically significant difference between the patient and control groups (p < 0.001). Calcium deposits were more frequent and extensive in CRF patients than in controls (p = 0.01). There was no correlation between impression cytology and calcium deposit grades (p = 0.128). However the presence of conjunctival inflammation correlated with the existence of extensive squamous metaplasia (p < 0.001). CONCLUSION: The severity of conjunctival changes in CRF patients on regular hemodialysis are not related to calcium deposition but to acute conjunctival inflammation.

Investigation of nitric oxide in pterygium.

BACKGROUND: The aim of this study was to investigate the presence of nitric oxide in pterygium. METHODS: Twenty nasal pterygium tissue samples were collected from 20 surgery patients in Kahramanmaras Sutcuimam University hospital. For control purposes, nasal conjunctivas from 10 patients undergoing limbal extracapsular cataract extraction were also collected. All specimens were preserved at -70 degrees C until analysis. The specimens were tested for the presence of nitric oxide and superoxide dismutase with the Griess and Fridovich methods, respectively. RESULTS: The mean age of the patients in the control group was 45.6 (+/- 13.2) years, and 53.7 (+/- 15.8) years in the pterygium group. We found that nitric oxide and superoxide dismutase levels were significantly higher in the control group (p < 0.05). The level of superoxide dismutase was 747.8 +/- 524.4 units/mg of protein in the normal conjunctiva and 184.2 +/- 163.9 units/mg of protein in the pterygium group. The nitric oxide level was 1.5 +/- 0.9 micromol/mg of protein in the normal conjunctiva and 0.4 +/- 0.4 micromol/mg of protein in pterygium. INTERPRETATION: The low level of nitric oxide may have some role on pterygium development.