Serum ADMA, endothelial dysfunction, and atherosclerosis in hypervolemic hemodialysis patients

Background/aim: Asymmetric dimethyl arginine (ADMA) is a strong predictor of cardiovascular disease and mortality in patients under hemodialysis treatment. We aimed to investigate the relationship among volume status, endothelial dysfunction, and ADMA in hemodialysis patients. Materials and methods: A total of 120 patients with a history of hemodialysis treatment were included. ADMA and CRP were measured. Echocardiographic evaluation and carotid artery intima-media thickness (CIMT) measurements were performed. Patients were divided into two groups according to clinical evaluation, ultrafiltration rate, vena cava inferior diameter (VCI), and cardiothoracic index (CTI); the two groups were hypervolemic and normovolemic. Results: The hypervolemic group included 61 patients while the normovolemic group included 59 patients. CIMT was higher in the hypervolemic group, but this result was not statistically significant (0.95 mm versus 0.85 mm, P = 0.232). There was a statistically significant difference between the hypervolemic and normovolemic groups in terms of ADMA (P < 0.001) (0.69 ± 0.57 µmol/L and 0.41 ± 0.04 µmol/L, respectively). Positive correlations were observed between serum ADMA, VCI, CTI, CRP, CIMT, and cardiac mass (P < 0.001, P = 0.016, P < 0.001, P = 0.006, P = 0.022, respectively), and negative correlations were observed between ADMA and ejection fraction and albumin (P = 0.024, P = 0.024, respectively). In multiple linear regression analysis, ADMA was independently associated with age, systolic blood pressure, CTI, and volume status. Conclusion: ADMA may be a potential determinant of hypervolemia as well as atherosclerosis in patients under hemodialysis treatment.

The effects of light sources with different spectral structures on ocular axial length in rainbow trout (Oncorhynchus mykiss).

Every day, we are acquiring more and more clues regarding the effects of different spectral structures (SS) of light on ocular axial length (OAL). As a step towards understanding this association, this study sought to characterise the effects of light sources of different SS on OAL in fish through comparisons with indoor daylight. The experimental design was completely randomised with 4 treatments and 2 replications. Three hundred and fifty two rainbow trout (Oncorhynchus mykiss) were housed in 8 tanks and fed for 71 days. Differences in the mean values of ocular elongation were determined at the end of the experiment. The daylight group was exposed to indoor daylight in the hatchery environment, the red group was exposed to long wavelength light (600-650 nm), the green group was exposed to mid-wavelength light (495-570 nm) and the blue group was exposed to short wavelength light (420-495 nm). The values of the OALs in fish grown under the same light intensity, but with light of different spectral characteristics, demonstrated significant differences (p < 0.05). The mean OAL in the daylight group was determined as 3.64 ± 0.40 mm, as 3.70 ± 0.35 mm in the red group, as 3.53 ± 0.34 mm in the green group and as 3.42 ± 0.29 mm in the blue group. The mean OAL in the blue group was significantly shorter compared to the red (p = 0.003) and the daylight groups (p = 0.02). When compared with the long wavelength light and indoor daylight, the effect of short wavelength light on OAL in fish was observed to be negative. Exposure to light with modified SS of in indoor environments may be effective in stopping ocular elongation.

Evaluation of hemodialysis patients and hemodialysis health workers with COVID-19 IgM and IgG antibody test; a multicenter study from Eskisehir, Turkiye.

OBJECTIVE: Hemodialysis (HD) patients are a population at high risk for exposure to the severe respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Undiagnosed mild or asymptomatic SARS-CoV-2 infection in HD patients can make these patients a potential source of infection. In our study, we aimed to evaluate the entire spectrum of SARS-CoV-2 infection with the IgM and IgG rapid antibody kit in HD patients and healthcare providers working in HD unit. METHODS: 633 HD patients and 134 health workers from all dialysis centers (three private and three public) in Eskisehir were included in the study. Blood samples obtained from participants were allowed to clot for 30 min at room temperature at 15°C using a serum separator tube. Then it was centrifuged at 1000 g at 2-8°C for 15 min. The supernatant was collected and the samples were stored at -20°C until use. Serum samples stored at the end of the study were studied with the A.B.T.™ Biotechnology COVID-19 Rapid IgG-IgM Diagnostic Test. Routine examination was measured by standard methods. All participants were evaluated by serological analysis of IgG and IgM antibodies against the SARS-CoV-2 recombinant antigen. RESULTS: Two symptomatic HD patients (0.27%) were diagnosed with SARS-CoV-2 infection by real-time reverse-transcription-polymerase-chain - reaction test and chest tomography. In 15 (2.36%) of 633 asymptomatic patients, antibody was positive against the SARS-CoV recombinant antigen (IgG in 13, both IgG and IgM in 2), while no antibodies were detected in 134 health workers. CONCLUSION: We have shown that most HD patients with SARS-CoV-2 experience the disease asymptomatically, and that antibody testing plays an important role in identifying patients with asymptomatic infection.

Posterior iris fixation of the iris-claw intraocular lens implantation through a scleral tunnel incision.

PURPOSE: To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for aphakia correction. DESIGN: Noncomparative, interventional case series. METHODS: A secondary posterior iris fixation of the Artisan iris-claw IOL (Ophthec BV, Groningen, The Netherlands) was implanted for aphakia correction in the authors' clinical practice. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), astigmatism, manifest refraction, lens position, pigment dispersion, and intraocular pressure (IOP) were evaluated in 32 consecutive eyes of 32 patients. RESULTS: BSCVA was 20/40 or better in 28 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was -0.70 diopters (D; standard deviation [SD], 0.47 D) at six months after surgery. Mean prediction error was -0.13 D (SD, 0.28 D), and mean absolute prediction error was 0.26 D (SD, 0.15 D). Preoperative mean astigmatism was -1.08 D (SD, 0.55 D; range, 0.0 to -2.0 D). At six months after surgery, mean astigmatism was -2.1 D (SD, 0.81 D; range, -0.75 to -3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultrasound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada), was parallel to the iris plane. CONCLUSIONS: Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes without capsule support.

Effects of pretreatment with different topical vasodilators on blood flow in the internal mammary artery: a prospective randomized study.

BACKGROUND: This study was conducted to investigate how brief pretreatments with 4 different vasodilators applied topically at normal body temperature affect blood flow in the internal mammary artery. METHODS: One hundred patients who had an internal mammary artery mobilized as a pedicle for coronary artery bypass grafting were randomly assigned to one of 5 groups of equal size (20 subjects in each). Each group of pedicles was treated with a different topical solution: normal saline (control), nitroglycerin, diltiazem, papaverine, or adenosine. Internal mammary artery flow and hemodynamic measurements were recorded immediately after harvesting and after 5 minutes of immersion in a tube filled with test solution (50 mL at 37 degrees C). Results for each study variable were compared within and between groups, and posttreatment-to-pretreatment ratios were also calculated and compared. RESULTS: All 4 vasodilator groups showed a significant increase in internal mammary artery flow rate from pretreatment to posttreatment, whereas the saline group did not. There were no significant differences among the 5 groups' pretreatment flow rates (P = .526) or posttreatment flow rates (P = .194). The mean ratio values (posttreatment-to-pretreatment) for flow rate were 1.08 +/- 0.17 in the saline group, 1.74 +/- 0.17 with nitroglycerin, 1.77 +/- 0.49 with diltiazem, 1.82 +/- 0.59 with papaverine, and 1.57 +/- 0.54 with adenosine. Post hoc analysis revealed that the mean ratio values for flow rate in the 4 vasodilator groups were significantly higher than the corresponding ratio in the saline group. CONCLUSIONS: Brief treatment of the internal mammary artery with topical vasodilators at normal body temperature significantly increases blood flow in this vessel. The data from this study are particularly valuable in relation to off-pump surgery, in which this vessel is usually anastomosed soon after it is harvested.

Surgical approach for Stanford type A aortic dissection in a patient with Marfan syndrome and pectus excavatum.

Acute Stanford type A aortic dissection in a patient with severe pectus excavatum constitutes a surgical emergency and presents a major challenge for the surgeon. Decisions must be made regarding the operative approach and whether the pectus excavatum should be corrected during the same session. Herein, we describe a case of acute aortic dissection in a patient who had Marfan syndrome with severe pectus excavatum. Combined partial upper sternotomy and left anterior thoracotomy provided excellent surgical exposure, and the aortic root and ascending aorta were completely replaced. The procedures were successful, and the patient recovered. Technical and surgical considerations led us to postpone concomitant correction of the pectus excavatum.

[Contact lenses as a migraine trigger]. / Migren tetikleyicisi olarak kontakt lensler.

We aimed to investigate the relationship between contact lens (CL) usage and migraine attacks. Our patient who began using CL with different base curves experienced discomfort and burning of the eyes. The ocular complaints were followed by migraine attacks. The frequency of migraine attacks decreased significantly when the flatter base curve was selected. We assessed the potential causal relationship between CL and migraine.

Psychophysical assessment of koniocellular pathway in patients with schizophrenia versus healthy controls.

This study was designed to perform psychophysical assessment of koniocellular pathway in patients with schizophrenia versus healthy controls. A total of 26 patients diagnosed with schizophrenia and 15 healthy controls were included. Snellen Visual Acuity Chart scores and Short Wavelength Automated Perimetry (SWAP) visual field testing including global visual field indices [mean deviation (MD), pattern standard deviation (PSD), test time (min)], reliability parameters [false negative responses (%), false positive responses (%) and fixed losses (%)] and average threshold sensitivity [central (parafovea), peripheral area, and four quadrants] were recorded in both groups. Significantly lower MD scores, higher PSD scores and lower average threshold sensitivity at each location across the visual field were noted in schizophrenia relative to control group. In conclusion, our findings revealed a deficit in koniocellular pathway with impaired SWAP global indices and lower threshold sensitivity at each location across the visual field among chronic schizophrenic patients as compared with control subjects. Our findings emphasize potential application of SWAP outside its original intended purpose as a glaucoma test, to provide deeper understanding of the specific contribution of lateral geniculate nucleus to the visual and cognitive disturbances of schizophrenia.

Topical vasodilators for preventing radial artery spasm during harvesting for coronary revascularization: comparison of 4 agents.

BACKGROUND: There is still controversy about which vasodilator solution is best for storing radial artery (RA) conduits prior to coronary artery bypass grafting. The aim of this pilot study was to investigate how 4 different topical vasodilators applied during RA harvesting affect blood flow with the vessel in situ. MATERIALS AND METHODS: The subjects were 85 patients who underwent RA harvesting in preparation for coronary artery bypass grafting. Each case was assigned to 1 of 5 groups (17 RAs each) that were treated with different solutions: normal saline (control), nitroglycerin, diltiazem, papaverine, and adenosine. Standard clinical concentrations were used. The RA was partially harvested (pedicle attached proximally) and flow rates and hemodynamic parameters (mean arterial pressure, heart rate, central venous pressure) were recorded at 2 time points: (1) pretreatment and (2) after 5 minutes of immersion in 60 mL of treatment solution. Results were compared within and between groups, and post-treatment-to-pretreatment ratios were calculated for each variable. RESULTS: There were no significant differences among the groups' mean pretreatment flow rates (P = .979) or mean posttreatment flow rates (P = .069). All except the diltiazem group showed a significant rise in mean flow rate from pretreatment to posttreatment. The mean posttreatment-to-pretreatment ratios for RA flow rate were 1.28 +/- 0.39 in the saline group, 1.85 +/- 0.72 in the nitroglycerin group, 1.31 +/- 0.48 in the diltiazem group, 1.37 +/- 0.64 in the papaverine group, and 1.23 +/- 0.42 in the adenosine group. Only the mean flow ratio in the nitroglycerin group was significantly higher than that in the saline group (P = .003). The mean flow ratios in the other vasodilator groups were not statistically different from the flow ratio in the saline group. CONCLUSIONS: These preliminary results indicate that topical application of nitroglycerin solution effectively prevents perioperative spasm of the RA in patients undergoing coronary artery bypass surgery. The authors recommend this solution for preparation and storage of RA grafts. Randomized controlled trials with power analysis will give more definitive information.

Contact lenses, migraine, and allodynia.

Clinical trials and electrophysiologic studies demonstrated increased perceptual sensitivity in patients suffering from migraines. At least, one triggering factor is described in 85% of migraine patients. The aim of this report was to investigate the relationship between contact lens (CL) usage and migraine attacks in two cases. Two patients who were diagnosed with migraine reported that the frequency of migraine attacks increased after they switched to using CL with different base curves (BCs). These two patients, who began using CL with different BCs experienced discomfort and dryness of the eye. The ocular complaints were followed by migraine attacks. CL intolerance was also developed during migraine attack in one of the cases. The frequency of migraine attacks decreased and allodynia relieved significantly when flatter BCs were selected. CL related stimulus could have triggered the migraine attack. CLs should be well fitted in migraine patients with allodynia.

Methylene blue-related corneal edema and iris discoloration.

We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

The beneficial effects of Momordica charantia (bitter gourd) on wound healing of rabbit skin.

Momordica charantia (MC; bitter gourd) is a traditional herbal commonly used for its antidiabetic, antioxidant, contraceptive and antibacterial properties. In the current study, the authors aim to observe the topical effect of MC cream on the wound-healing process in rabbits. Moreover, they compare the healing potential with conventional creams used therapeutically. Towards this aim, 28 New Zealand rabbits were divided into four groups and excision wounds (7 cm²) were made on their backs. Open wound dressing was carried out daily for 28 days among the experimental groups with the application of dekspanthenol (Bepanthen®; BP group, n = 7), nitrofurazon (Furacin®; FR group, n = 7) and olive oil extract of MC (MC group, n = 7). No application was made to the control group. At the end of day 28, areas of the skin with initial wound area were en bloc dissected and prepared for histopathological and stereological analysis. Inflammatory cells were abundant in the control group and cream application led to a decrease in the number of these cells, especially in the MC group. The highest number of fibroblasts was detected in the MC group. Furthermore, the MC group displayed the highest fractions of epidermis to papillary dermis, fibroblasts to reticular dermis and collagen fibres to reticular dermis. The MC group also presented a high density of blood vessels, moderate density of collagen fibres and mature fibroblasts. The BP group showed better epithelialisation compared with the FR group, but the latter provided more effective reorganisation of the dermis. Different cream supplements caused healthy and fast wound healing according to untreated controls and the results show that administration of the MC extract improves and accelerates the process of wound healing in rabbits in comparison with the BP and FR extracts.

Assessment of corneal endothelial cell density in patients with keratoconus not using contact lenses.

PURPOSE: To assess the corneal endothelial cell density (ECD) in keratoconus patients with no history of contact lens use. SETTING: Yuzuncu Yil University, School of Medicine and Van Training and Research Hospital, Department of Ophthalmology, Van, Turkey. DESIGN: Cross-sectional controlled study. METHODS: The eyes of 65 patients with the diagnosis of keratoconus with no history of contact lens wear and the eyes of 40 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock Cornea Module (HRT3/RCM). The average ECD from the two groups were then compared. RESULTS: Of the cases with keratoconus, 44 (67.7%) were men and 21 (32.3%) were women. The mean age was 20.9±6.8 (range=10-41) years. Of the controls, 28 (70%) were men and 12 (30%) were women. The mean age was 23.9±5.8 (range=14-35) years. Of the 65 eyes with keratoconus, 19 (29.2%) had mild keratoconus, 21 (32.3%) had moderate keratoconus, and 25 (38.5%) had severe keratoconus. The mean ECD was 2731.6±303.2 cells/mm2 in cases with keratoconus and 2664.9±319.5 cells/mm2 in controls. There was no difference between the densities (unpaired t-test, P=0.4). No significant relationships were found between the ECD data and central corneal thickness or steepest keratometric. CONCLUSIONS: Endothelial cell density was unaltered in keratoconic patients without a history of contact lens use when compared with healthy controls. Change in ECD is independent from the central corneal thickness and the stage of keratoconus.

A Behcet's Disease Patient with Right Ventricular Thrombus, Pulmonary Artery Aneurysms, and Deep Vein Thrombosis Complicating Recurrent Pulmonary Thromboembolism.

Intracardiac thrombus, pulmonary artery aneurysms, deep vein thrombosis, and pulmonary thromboembolism are rarely seen symptoms of Behcet's disease. A 20-year-old female patient was admitted for complaints of cough, fever, palpitations, and chest pain. On the dynamic thorax computed tomograms (CT) obtained because of significantly enlarged hilar structures seen on chest radiograms, aneurysmal dilatation of the pulmonary artery segments bilaterally, chronic thrombus with collapse, and consolidation substances compatible with pulmonary embolism involving both lower lobes have been observed. It is learned that, four years ago, the patient had been diagnosed with Behcet's disease and received colchicine treatment but not regularly. The patient was hospitalized. On the transthoracic echocardiogram, a thrombosis with a dimension of 4.2 × 1.6 cm was recognized in the right ventricle. On abdomen CT, aneurysmal iliac veins and deep vein thrombus on Doppler ultrasonograms were diagnosed. At the controls after three months of immunosuppressive and anticoagulant therapies, some clinical and radiological improvements were recognized. The patient suspended the treatment for a month and the thrombus recurred. We present our case in order to show the effectiveness of immunosuppressive and anticoagulant therapies and rarely seen pulmonary thromboembolism in recurrent Behcet's disease.

Assessment of keratocyte density in patients with keratoconus not using contact lenses.

PURPOSE: To assess the keratocyte density (KD) in the cornea of patients with keratoconus not using contact lenses. METHOD: In this pilot study, the eyes (n = 68) of 35 patients with the diagnosis of keratoconus, who did not use contact lenses and the eyes(n = 70) of 35 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock cornea module (HRT3/RCM). The cases with keratoconus and controls were compared with regard to KD in the anteroposterior stromal layers. RESULTS: Of the cases with keratoconus, 15 (42.9%) were men and 20 (57.1%) were women. The mean age was 21.1 ± 11.1 (range =14-41) years. Of the controls, 26 (73.9%) were men and 9 (26.1%)were women. The mean age was 23.9 ± 12.9 (range = 14-35) years.Of the 68 eyes with keratoconus, 22 (28.2%) had mild keratoconus, 23 (35.9%) had moderate keratoconus, and 23 (35.9%) had severe keratoconus. The mean anterior stromal KD was 651.4 ± 89 cells per square millimeter in cases with keratoconus and 879.4 ± 75 cells per square millimeter in controls (P < 0.05). The mean anterior stromal KD decreased by 25.9% in corneas with keratoconus. The mean posterior stromal KD was found to be 363.6 ± 74 cells per square millimeter in cases with keratoconus and 469.7 ± 56 cells per square millimeter in controls (P< 0.01). The mean posterior stromal KD decreased by 22.6% in corneas with keratoconus. The anterior stromal KD was higher than the posterior stromal KD (P < 0.001). No significant relationships were found between the stromal KD data and central corneal thickness or steepest keratometric. CONCLUSIONS: The KD in the anterior and posterior corneal stroma was decreased in patients with keratoconus, but without the use of contact lens, compared with healthy controls. This density difference was independent from the central corneal thickness and the stage of keratoconus.

Methylene blue-related corneal edema and iris discoloration / Edema de córnea e descoloração de íris associados ao azul de metileno

ABSTRACT We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

RESUMO Paciente do sexo feminino com 70 anos de idade desenvolveu edema da córnea e descoloração da íris após o uso inadvertido de 1% de azul de metileno em vez de 0,025% de azul tripano para corar a cápsula anterior do cristalino durante a cirurgia de catarata por facoemulsificação. Foi realizada irrigação abundante quando detectou-se que o corante incorreto tinha sido usado. Edema da córnea e descoloração íris que ocorreu no período pós-operatório precoce persistiu durante 24 meses de seguimento; no entanto, a ceratoplastia não foi necessária. O uso intracameral de 1% de azul de metileno tem efeitos citotóxicos sobre o endotélio da córnea e epitélio da íris. A irrigação abundante durante pelo menos 30 minutos, utilizando um mantenedor de câmara anterior pode resultar em um prognóstico melhor.

Role of Scheimpflug imaging in the diagnosis and management of keratitis caused by caterpillar seta.

A 16-year-old boy presented with a history of an accidental hit to the left eye by a butterfly (Lepidoptera). One seta fragment was found to be embedded into the cornea and inflammation secondary to penetration of caterpillar seta was seen around the seta fragment. Scheimpflug imaging was performed in the area showing caterpillar seta. Corneal infiltration was imaged as a hyper-reflective area. Lesion dimensions were measured with calipers. Scheimpflug imaging is a potential tool for localization of corneal lesions, monitoring the progress of the injury and evaluating the treatment response objectively.