Analysis of factors on voice quality in thyroidectomy patients.

OBJECTIVE: Vocal cord paralysis (VCP) is a serious complication in thyroidectomy operations; however, its management remains unclear. The present study evaluated the voice parameters of patients who underwent surgery using Intraoperative Neurophysiologic Monitoring (IONM). PATIENTS AND METHODS: A total of 52 patients (41 females and 11 males) who underwent a total thyroidectomy operation were evaluated using objective and subjective voice analysis examinations before and after surgery. Acoustic parameters, such as Fundamental Frequency (F0), Shimmer, Jitter, Noise-to-Harmonic ratio (NHR), and aerodynamic parameters, including S/Z ratio and maximum phonation time (MPT), were analyzed. Objective findings, including the VHI-10 (Voice Handicap Index) and V-RQOL (Voice-Related Quality of Life), were also analyzed. The relationship between voice parameters and IONM values was investigated. RESULTS: The objective analysis (acoustic and aerodynamic parameters) showed no difference (p>0.05). However, the subjective analysis, which involved the VHI-10 and V-RQOL measures, revealed a significant difference before and after the operation (p<0.05). The Spearman correlation analysis showed that the NHR postoperative 1st-month parameter negatively correlated (rho=-0.317, p<0.059), while the F0 postoperative 6th-month parameter positively correlated (rho=0.347) with the amplitude difference before and after dissection (Right R2-R1 difference) for the right RLN measured in IONM. CONCLUSIONS: Patients who are planning to undergo a thyroidectomy procedure should undergo voice assessment during both the preoperative and postoperative periods. IONM could improve voice quality outcomes.

Acquired changes in thickness and length of patellar tendon after primary total knee arthroplasty: a prospective ultrasonographic study with over 4 years of follow-up.

Previous literature has reported changes in the length or thickness of the patellar tendon (PT) following primary total knee arthroplasty (TKA). This study aims to determine the structural changes in both the length and thickness of the PT after primary TKA using ultrasound (US) and to investigate the association between these changes and clinical outcomes after a minimum follow-up of 48 months. This prospective study used the US on 60 knees of 32 patients (aged 54-80, mean 64.8±7 years) before and after primary TKA to evaluate changes in both the length and thickness of the patellar tendon. Clinical outcomes were assessed with HSS and Kujala scores. At the latest follow-up evaluation, there was a significant overall shortening of PT by 9.1% (p<0.001), in addition to significant global thickening by 20% (p<0.001). Besides, there was significant thickening by 30% in the proximal 1/3 (p<0.01) and 27% in the middle 1/3 (p<0.01) segments of PT. There was a significant negative correlation between the thickening identified in all three parts of the tendon and both clinical outcome measures (p<0.05). The results show the presence significant changes in PT in terms of length and thickness after primary TKA; in addition, increased thickness in PT was more strongly and significantly associated with inferior clinical outcomes, including functionality and anterior knee pain, than shortness in PT. This study also suggests that the US is a viable, non-invasive method for documenting PT changes in both length and thickness after TKA with serial scans.

Author Correction: Impact of Enoxaparin +α Lipoic acid combination on oxidative stress, follicle development and apoptotic damage in ovarian ischemia reperfusion model.

Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (18): 6583-6592-DOI: 10.26355/eurrev_202209_29758-PMID: 36196708, published online on 30 September, 2022. After publication, the authors applied a correction to the Funding statement: "This Project was supported by the Scientific Research Projects Coordination Unit at Hatay Mustafa Kemal University. Project Number: 18. M. 088." There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/29758.

Neuroprotective effects of amantadine for experimental acute carbon monoxide poisoning.

OBJECTIVE: Amantadine is known to have a neuroprotective effect in many neurological diseases. This study aims at investigating the neuroprotective effect of amantadine in rats exposed to carbon monoxide (CO) poisoning. MATERIALS AND METHODS: Rats were maintained under standard experimental laboratory conditions and randomized into 4 different groups of 7 each namely control, amantadine only, CO exposure, and amantadine + CO exposure. For immunohistochemical analysis, tissues taken from the prefrontal and hippocampal regions were taken into formalin and kept for at least one day. Afterward, the tissue was followed and blocked for paraffin blocking. N-Methyl D-Aspartate (NMDA) levels in homogenates were studied by the Enzyme-Linked Immunosorbent Assay (ELISA) method. Superoxide dismutase (SOD) and catalase (CAT) activities in the supernatants were studied with commercial kits. Nitric oxide (NO) and Asymmetric Dimethyl Arginine (ADMA) levels were studied by the ELISA method. Enzyme activity values were calculated by dividing the protein values in the supernatants and normalizing them. RESULTS: CAT, SOD, NMDA, ADMA, and NO levels were statistically significantly different between the groups (p < 0.05). According to post-hoc pairwise comparison test results, the values of the control and amantadine groups for CAT, SOD, NMDA, ADMA, and NO parameters were significantly higher than that of CO group. Similarly, values in the control and amantadine groups were considerably higher than values for the amantadine + CO group. NMDA values were significantly lower in group amantadine + CO than in CO group (p: 0.049). CONCLUSIONS: Apoptosis and endothelial damage after CO poisoning is a complex process, and amantadine administration has a limited contribution in preventing this process.

Impact of Enoxaparin +α Lipoic acid combination on oxidative stress, follicle development and apoptotic damage in ovarian ischemia reperfusion model.

OBJECTIVE: With this study we aimed at investigating the impact of enoxaparin (E) and α-lipoic acid (α-LA) on ischemia/reperfusion (I/R) damage in an experimental ovarian torsion (T) detorsion (D) model. MATERIALS AND METHODS: The study comprised 80 female albino rats aged 12 weeks. They were divided into 8 groups as follows, with 10 rats in each group: Group 1 (Sham), Group 2 (Ischemia, 3 hours), Group 3 (I/R, 6 hours reperfusion), Group 4 (I/R, 3 days reperfusion), Group 5 (I/R, E, 6 hours), Group 6 (I/R, E, 3 days), Group 7 (I/R, E+α-LA, 6 hours), and Group 8 (I/R, E+α-LA, 3 days). Immediately after detorsion, enoxaparin (0.5 mg/kg/day, sc) or α-LA (100 mg/kg/day, ip) were administered. Ovarian levels of malondialdehyde (MDA), glutathione peroxidase (GPx), and catalase were measured. In addition to total Antioxidant Status (TAS) and Total Oxidative Stress (TOS), the Oxidative Stress Index (OSI) was calculated. Serum levels of AMH, FSH, LH, E2, and progesterone were measured. Ovarian samples were histopathologically examined and they underwent Tag staining for apoptosis. RESULTS: Compared with the sham group, there was a significant increase in TOS, OSI, and MDA levels in I/R group (p<0.001). Compared to Group 2, a significant increase was determined in TOS and OSI in Group 3 (p<0.05). In Group 4, a significant increase was found compared to Group 2 (p<0.01). The lowest level of I/R damage and the highest level of antioxidants were found in Group 2, 7, and 8. The highest values of TOS, OSI, and MDA were found in Group 3, Group 4, Group 5, and Group 6 (p<0.001). When the sham group and Group 4 were compared, it was found that AMH and E2 levels decreased (p<0.001), while FSH levels increased (p<0.001). In Group 6, AMH and E2 values were significantly decreased compared to the sham group (p<0.001). In the histopathological examination, the findings were observed to be parallel to those of the biochemical markers. CONCLUSIONS: Combined use of α-Lipoic acid and enoxaparin prevents oxidative stress and ovarian damage due to ischemia-reperfusion injury better than the use of drugs alone.

Ocular findings in patients with attention deficit and hyperactivity.

AIM: To evaluate ocular findings, contrast sensitivity, color perception, and macular and retinal nerve fiber layer (RNFL) thickness in patients with attention-deficit/hyperactivity disorder (ADHD). MATERIALS AND METHODS: This prospective study included a group of 37 patients aged 6-16 years diagnosed with combined ADHD and a healthy control group of 37 children. The participants underwent an ophthalmological examination. Color vision testing was administered using the Ishihara plates test. Contrast sensitivity test was performed using the Functional Acuity Contrast Test. Macular thickness and RNFL thickness were measured by spectral-domain optical coherence tomography. RESULTS: No significant difference was found between the patient and control groups with regard to ocular findings, color vision, and convergence insufficiency (p > 0.05). Contrast sensitivity level was significantly lower at four out of five spatial frequencies (1.5, 3, 12, and 18 cpd) in the patient group compared to the control group. The RNFL thickness in nasal quadrant and macular thickness was significantly higher in the healthy control group compared to the ADHD group. CONCLUSION: Contrast sensitivity levels and the nasal quadrant RNFL thickness were significantly lower in the patient group compared to the control group. Based on the findings of the study, we suggest that the level of contrast in the tools used by ADHD patients in daily life settings should be enhanced.

Upper Zone of Growth Plate and Cartilage Matrix (UCMA) Levels in Patients with Chronic Kidney Disease

Abstract Chronic kidney disease (CKD) is an important health problem across the world affecting the adult population with an enormous social and economic burden. Calcium regulation is also affected in patients with CKD, and related to several disorders including vascular calcifications, mineral bone disorders, and cardiovascular diseases (CVD). Upper zone of growth plate and cartilage matrix (UCMA) is vitamin K-dependent protein (VKDP) and acts as a calcification inhibitor in the cardiovascular system. The molecular mechanism of UCMA action remains unclear in CKD. In the current study, we aimed to investigate serum total UCMA levels and its association with calcium metabolism parameters in CKD patients including hemodialysis (HD) patients. Thirty-seven patients with CKD stage 3-5, 41 HD patients, and 34 healthy individuals were enrolled in this cross-sectional study. Serum UCMA and calcification related protein levels (Matrix Gla Protein (MGP), Osteocalcin (OC), and Fetuin-A) were analyzed with enzyme-linked immunosorbent assay (ELISA). Calcium mineral disorder parameters (Serum Ca, P, iPTH) were quantified with routine techniques. We, for the first time, report the potential biomarker role of UCMA in CKD including HD. Serum total UCMA levels were significantly higher in patients with CKD including HD patients than the healthy controls. Also, serum UCMA levels showed negative correlations with serum calcium, and eGFR, while showed positive relationships with P, iPTH, MGP, OC. Increased total UCMA levels may have a role in the Ca metabolism disorder and related to the pathogenesis of Vascular Calcification in patients with CKD.

Psychiatric disorders and symptoms severity in pre-school children with cow's milk allergy.

BACKGROUND: Psychiatric disorders are seen frequently in atopic diseases. The present study aims to evaluate the frequency of psychiatric disorders and the severity of psychiatric symptoms in pre-school children with cow's milk allergy. METHODS: The parents of the pre-school children with cow's milk allergy were interviewed in person and asked to fill out the Early Childhood Inventory-4 form. RESULTS: The cow's milk allergy group included 40 children (27 male, 13 female) with mean age, 44.5±14.7 months, and the control group included 41 children (25 male, 16 female) with mean age, 47.6±15.2 months. It was established that 65% of the group with cow's milk allergy received at least one psychiatric diagnosis, while 36.6% of the control group received at least one psychiatric diagnosis, with a statistically significant difference (p=0.02). Within the psychiatric disorders, attention deficit hyperactivity disorders (odds ratio: 4.9, 95% CI: 1.472-16.856, p=0.006), oppositional defiant disorder (odds ratio: 5.6, 95% CI: 1.139-28.128, p=0.026), and attachment disorder (odds ratio: 4.8, 95% CI: 1.747-13.506, p=0.004) were found significantly higher compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores, calculated by using the Early Childhood Inventory-4 form, attention deficit hyperactivity disorders severity (p=0.006) and oppositional defiant disorder severity (p=0.037) were found to be higher in the cow's milk allergy group. CONCLUSION: Psychiatric disorders are frequent and severe in pre-school children with cow's milk allergy.

Psychiatric disorders and symptoms severity in preschool children with atopic eczema

BACKGROUND: To compare with a control group the frequency of psychiatric disorders and severity of psychiatric symptoms in preschool children with atopic eczema. METHODS: The study included children between the ages of 3-5 who were diagnosed to have atopic eczema. The parents of the children with atopic eczema were interviewed in person and were asked to fill in 'The Early Childhood Inventory-4' form. This form assesses the psychiatric disorders and symptoms severity in children between the ages of 3-5. RESULTS: The atopic eczema group included 80 patients (38 male, 42 female) with a mean age of 48.4 ± 15.7 months and the control group included 74 patients (41 male, 33 female) with a mean age of 49.9 ± 15.19 months. It was established that 68.8% of the group with atopic eczema received at least one psychiatric diagnosis. Between the psychiatric disorders, ADHD (Odds ratio: 2.57, 95% CI: 1.049-6.298, p = 0.035), enuresis and encopresis (Odds ratio: 2.39, 95% CI: 1.121-5.097,p = 0.022) and attachment disorder (Odds ratio: 2.03, 95% CI: 1.046-3.953, p = 0.035) were found to be significantly higher when compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores calculated by using ECI-4, ADHD severity (p = 0.043), conduct disorder severity (p = 0.001), anxiety disorders severity (p < 0.001), eating disorders severity (p = 0.011) and tic disorder severity (p = 0.01) were found to be higher in the atopic eczema group. CONCLUSION: Psychiatric illnesses are frequent in preschool children with atopic eczema

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Psychiatric disorders and symptoms severity in preschool children with atopic eczema.

BACKGROUND: To compare with a control group the frequency of psychiatric disorders and severity of psychiatric symptoms in preschool children with atopic eczema. METHODS: The study included children between the ages of 3-5 who were diagnosed to have atopic eczema. The parents of the children with atopic eczema were interviewed in person and were asked to fill in "The Early Childhood Inventory-4" form. This form assesses the psychiatric disorders and symptoms severity in children between the ages of 3-5. RESULTS: The atopic eczema group included 80 patients (38 male, 42 female) with a mean age of 48.4 ± 15.7 months and the control group included 74 patients (41 male, 33 female) with a mean age of 49.9 ± 15.19 months. It was established that 68.8% of the group with atopic eczema received at least one psychiatric diagnosis. Between the psychiatric disorders, ADHD (Odds ratio: 2.57, 95% CI: 1.049-6.298, p=0.035), enuresis and encopresis (Odds ratio: 2.39, 95% CI: 1.121-5.097, p=0.022) and attachment disorder (Odds ratio: 2.03, 95% CI: 1.046-3.953, p=0.035) were found to be significantly higher when compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores calculated by using ECI-4, ADHD severity (p=0.043), conduct disorder severity (p=0.001), anxiety disorders severity (p<0.001), eating disorders severity (p=0.011) and tic disorder severity (p=0.01) were found to be higher in the atopic eczema group. CONCLUSION: Psychiatric illnesses are frequent in preschool children with atopic eczema.

The effects of perceived USB-delay for sensor and embedded system development.

Perceiving delay in computer input devices is a problem which gets even more eminent when being used in healthcare applications and/or in small, embedded systems. Therefore, the amount of delay found as acceptable when using computer input devices was investigated in this paper. A device was developed to perform a benchmark test for the perception of delay. The delay can be set from 0 to 999 milliseconds (ms) between a receiving computer and an available USB-device. The USB-device can be a mouse, a keyboard or some other type of USB-connected input device. Feedback from performed user tests with 36 people form the basis for the determination of time limitations for the USB data processing in microprocessors and embedded systems without users' noticing the delay. For this paper, tests were performed with a personal computer and a common computer mouse, testing the perception of delays between 0 and 500 ms. The results of our user tests show that perceived delays up to 150 ms were acceptable and delays larger than 300 ms were not acceptable at all.

Evaluation of adiponectin and lipoprotein(a) levels in cardiac syndrome X.

AIMS: Low adiponectin and high lipoprotein(a) [Lp(a)] levels are associated with endothelial dysfunction, atherosclerosis, and coronary artery disease. Cardiac syndrome X (CSX) is characterized by anginal symptoms, positive stress test, and documentation of normal epicardial coronary arteries with angiography. In this study we aimed to investigate the relationship between CSX and circulating levels of adiponectin and Lp(a). PATIENTS AND METHODS: We enrolled 53 female patients with CSX and 33 patients as the control group. The diagnosis of CSX was made according to presence of angina, findings suggestive of ischemia during stress electrocardiography or myocardial perfusion scintigraphy, and documentation of normal coronary arteries in coronary angiography. The control group consisted of patients with atypical angina and normal stress electrocardiography test results. Both groups were matched in terms of hypertension, diabetes mellitus, and metabolic syndrome. RESULTS: Adiponectin levels were significantly decreased in patients with CSX (4.57 µg/ml vs. 13.18 µg/ml; p=0.001); however, Lp(a) levels were significantly increased (36.30 mg/dl vs. 7.24 mg/dl; p < 0.001). Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) concentrations did not differ between the case group and the control group (p=0.14, p=0.62, p=0.64, respectively). There was no significant difference between groups in terms of age, body mass index, waist circumference hypertension, hyperlipidemia, diabetes mellitus, or metabolic syndrome. In multivariate analysis, Lp(a) and adiponectin were found to be independent predictors of CSX. An Lp(a) level of > 21 mg/dl had 84 % sensitivity and 96 % specificity {area under the curve (AUC)= 0.922, p < 0.0001, 95 % CI [0.842-0.970]} and an adiponectin level of ≤ 5.18 µg/ml also had 58.7 % sensitivity and 82.1 % specificity (AUC=0.726, p=0.0003, 95 % CI [0.609-0.823]) for detecting CSX. CONCLUSION: We detected low adiponectin and high Lp(a) levels in patients with CSX and these findings may be related to the microvascular injury in CSX.

Antioxidant effect of erdosteine and lipoic acid in ovarian ischemia-reperfusion injury.

OBJECTIVE: To investigate the effects of erdosteine and alpha lipoic acid (ALA) in a rat model of ovarian ischaemia-reperfusion injury. STUDY DESIGN: Forty-eight female Wistar albino rats were separated, at random, into six groups of eight rats. The groups were classified as: sham, torsion, detorsion, detorsion+erdosteine 100mg/kg, detorsion+alpha lipoic acid (ALA) 100mg/kg, and detorsion+erdosteine+ALA. The investigators executing the biochemical and histological analyses were blinded to the randomization until the end of the study. RESULTS: The TOS (Total Oxidant Status) and OSI (Oxidative Stress Index) levels are higher in the Torsion and Detorsion groups when compared with the ones in the Sham group (p<0.05). Strong correlation was found between OSI and total histological score in the sham, torsion and detorsion groups (r=0.765, p<0.001). The mean levels of TOS and OSI in the rats that received erdosteine and/or ALA were significantly lower compared with the sham, torsion and detorsion groups (p<0.05). Mean TOS and mean OSI were lower in the detorsion+erdosteine+ALA group compared with the detorsion+erdosteine and detorsion+ALA groups (p<0.05). In comparison with the detorsion group, the numbers of primordial follicles (p=0.006) and primary follicles (p=0.036) were increased in the groups that received erdosteine and/or ALA. CONCLUSIONS: Erdosteine and ALA decreased ischaemia-reperfusion injury in an experimental rat ovarian torsion model; combination treatment had a greater effect than either agent alone. Treatment with erdosteine and/or ALA was found to preserve the loss of reproductive capacity normally observed after ovarian torsion.

Coronary rupture and pseudoaneurysm formation after extravascular migration of a paclitaxel eluting stent implanted in the left circumflex coronary artery.

As the implantation of drug eluting stents (DES) has become one of the most common clinical practices in interventional cardiology, the complications secondary to this procedure appear to have emerged increasingly over the past decade, with many cases of development of new coronary artery true aneurysms after DES implantation being reported. Here we present a case of coil embolization of a coronary pseudoaneurysm which presumably formed after extravascular migration of a DES.

A 9-year follow-up of a girl with pyridoxine (vitamin B6)-dependent seizures: magnetic resonance spectroscopy findings.

Being an extremely rare condition makes the diagnosis of pyridoxine-dependent seizures (PDS) difficult. Early diagnosis of PDS is very important to prevent unwanted clinical outcomes. Elevated levels of glutamate and decreased levels of y-aminobutyric acid (GABA) in the frontal and parietal cortices are detected in this disorder. Here we present an 18 year old girl with PDS, who was reported 9 years ago with Magnetic Resonance Spectroscopy (MRS) findings. Present and past MRS findings showed a decrease in N-acetyl-aspartate-to creatine ratio on MRS. In this case it is surprising that neuronal damage has been preceded despite the administration of accurate treatment. That can be because of delay in treatment and/or under treatment.

May long term oxcarbazepine treatment be lead to secondary hyperparathyroidism?

BACKGROUND AND PURPOSE: The adverse effects of newer antiepileptic drugs are not well-known. This study assessed the impact of oxcarbazepine (OXC) treatment on bone turnover. METHODS: Forty-four children with idiopathic focal (and/or secondarily generalized) epilepsy who had been treated with OXC for more than 1 year were compared with 33 healthy, age- and sex-matched children. Serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, osteocalcin, calcitonin, and 25-hydroxyvitamin D, and bone mineral density were measured to evaluate and compare bone mineralization between the two groups. RESULTS: The serum levels of calcium, osteocalcin, 25-hydroxyvitamin D, and bone mineral density did not differ significantly between the study and control groups. However, serum levels of parathyroid hormone, alkaline phosphatase, phosphorus, and calcitonin differed significantly between the two groups. CONCLUSIONS: These findings suggest that OXC treatment leads to secondary hyperparathyroidism with high-turnover bone disease and/or impaired intestinal calcium absorption.

Comparison of total thyroidectomy, bilateral subtotal thyroidectomy and Dunhill operations in the treatment of benign thyroid disorders.

AIM: The surgical treatment of benign thyroid disease is still controversial. Many treatment modalities have been described for the surgical management of various thyroid diseases, including excision, bilateral subtotal thyroidectomy (BST), near-total thyroidectomy, and total thyroidectomy (TT). METHODS: Hospital records were reviewed for 2863 patients who underwent thyroid surgery for presumed multinodular goiter (MNG) between 1990 and 2009. However, due to the inefficiency of the hospital archive system, we were able to access detailed personal and surgical information for only 803 patients. RESULTS: Of the 803 patients, 227 (28.3%) underwent DP, 228 (28.4%) BST and 348 (43.3%) TT operations. While there were no complications in 683 (85.1%) of the 803 operations, complications developed with 120 (14.9%). A definite difference between TT and the other (BST and DP) types of operation in relation to complications. The duration of hospital stay was 2.2±0.4 days for the BST group, 2.2 ± 0.4 days for the DP group and 2.3 ± 0.7 days for the TT group. There was a significant difference among all three groups. Recurrence rates of the operations performed were 35 (15.3%), 20 (8.8%) and 4 (1.15%), respectively, for BST, DP and TT. There was significant difference between the recurrence rates of TT and BST, and between TT and DP. CONCLUSION: When the frequency of complications in recurrent operations and the malignity possibility of the thyroid tissue left behind are taken into consideration, we believe that TT will be more beneficial in the surgical treatment of benign thyroid disorders.

Effect of proanthocyanidin, arginine and glutamine supplementation on methotrexate-induced gastrointestinal toxicity in rats.

Methotrexate is a folate antagonist that is commonly used as an antitumor and antiarthritic drug. The aim of this study was to investigate the possible roles of exogenous glutamine (Glu), arginine (Arg) and proanthocyanidin (PA) on gut protection from methotrexate-induced intestinal damage in rats. Experimental rats were separated into eight groups. The first (sham) group received a 0.9% NaCl solution alone. The second group received intraperitoneal injections of methotrexate (20 mg/kg/day) administered on day 4 of the experiment and continued for 5 days. Rats in the other six groups were administered PA, Glu, Arg, Glu+PA, Arg+PA or Glu+Arg orally by gavage together with methotrexate and animals were sacrificed on day 8 of the experiment. All animals were sacrificed 4 days after methotrexate injection for histopathological analysis, tissue glutathione peroxidase, malondialdehyde and superoxide dismutase assays. Proanthocyanidin and Glu decreased the severity of intestinal injury and oxidant injury as evident by histopathology and changes in malondialdehyde levels. Histological analysis confirmed that PA and to a lesser extent Glu supplementation were more favorable than Arg for the protection of the small intestine from methotrexate-induced injury.

Evaluation of pertussis immunity status in schoolchildren immunized with whole-cell vaccine.

It has recently been reported that the worldwide increase in the number of pertussis cases is a result of the waning of whole-cell vaccine-induced immunity. Thus, in this study, we aimed to investigate the pertussis immunity status of primary and secondary school students in a district of Ankara, Turkey. A total of 997 healthy students, aged 9-17 years, who had been immunized with four doses of whole-cell pertussis vaccine were included in the study. The subjects were divided into two age groups: 9-14 and 15-17 years. To determine the immune status, serum levels of IgG anti-pertussis toxin (aPT) antibody were tested by in-house ELISA and arbitrarily evaluated as non-immune [< 10 ELISA units (EU)/ml], immune (10-100 EU/ml), and recent infection (> 100 EU/ml). Serum samples of 997 students (559 females, 438 males) aged between 9 and 17 years (mean 13.02 +/- 2.25, median 13 years) were tested. Non-immune, immune and recent infection levels of aPT were found in 27.3%, 59.3% and 13.4% of individuals, respectively. The immune group did not have statistically significant differences between males and females (P = 0.68). In the 9-14 and 15-17 years age groups, serum aPT antibody levels 10 EU/ml were 73.1% and 72.2%, respectively, which did not represent any statistical difference (P = 0.81). Students aged 15-17 years had a higher immunity rate than the 9-14 years group, and the percentage of students with recent infection in the 9-14 years group was higher than the 15-17 years group (P < 0.001). The peak age of non-immunized subjects was 9 years (47.0%), and decreased to a minimum at age 12-13 years, and began to increase again from age 13-14 years. In contrast, the ratio of recent infection was least at age 9-10 years, began to increase, and reached a peak at 12 years, and then decreased. On the other hand, it was observed that household size and monthly income were not associated with the immunity status (P = 0.65, P = 0.37, respectively). The results of the present study show that levels of antibody against pertussis decreased in the younger age groups and, as a result, there is an increase in the number of pertussis cases. Thus, in order to decrease the incidence of pertussis and protect infants, we recommend the application of booster doses at regular intervals.

Acute coronary syndrome triggered by honeybee sting: a case report.

A 56-year-old previously healthy man was admitted to our hospital with a severe chest pain that started shortly after being stung by a honeybee. He did not have any allergic symptoms and there was no cutaneous or respiratory evidence of allergy on physical examination. Electrocardiographic and biochemical markers were consistent with an acute coronary syndrome. Coronary angiography demonstrated a significant thrombotic lesion in the right coronary artery. Here, a rare and unexpected event is presented, the development of acute coronary syndrome after a bee sting.