The frequency of thyroid dysfunction in patients with a diagnosis of depressive disorder.

Objective: Thyroid dysfunctions are among the most common endocrine disorders in society. An increase or decrease in thyroid hormone levels may present with neurological and/or psychiatric symptoms. In this study, we aimed both to determine the prevalence of this disorder in our region by determining the frequency of thyroid dysfunction in patients diagnosed with major depressive disorder in our outpatient clinic and to raise awareness during the evaluation process of patients. Material and Method: Thyroid-stimulating hormone (TSH) levels of 1035 patients diagnosed with major depressive disorder in our hospital between January 2020 and January 2022 were retrospectively scanned from the hospital information management system and those outside the reference ranges (0.38-5.33 mIU/L) were determined. Results: It was observed that TSH was not within the reference ranges in approximately 7% of the patients diagnosed with depressive disorder. 1035 patients were included in the study. When the blood results of 1035 patients included in the study were examined retrospectively, 32 of them had TSH values below 0.38 mIU/L. TSH value was found to be above 5.33 mIU/L in 44 of them. Conclusion: Obtained data have shown that thyroid dysfunctions can be encountered frequently in patients presenting with depressive complaints. It is thought that the evaluation of patients with depressive complaints in terms of thyroid dysfunction, and the treatment of the underlying thyroid dysfunction will contribute to the regression of psychiatric symptoms.

Characteristics of maxillary sinus ostia and their correlation with anatomic variations of the osteomeatal complex: Indications for sinus floor elevation.

Background: Knowledge of the anatomy and variations of the maxillary sinus is essential for reducing oral surgery complications, such as sinus floor elevation, and increasing surgery success. The CBCT images of 385 patients were examined. Materials and Methods: The prevalence, localization, and height of PMO (Primer Maxillary Ostium) and AMO (Accessory Maxillary Ostium) were evaluated with respect to sex, dentition, dental treatment, Schneiderian membrane (SM) thickness, concha bullosa, Haller Cells, and septal deviation. Results: The PMO was present in 87.3% of all patients. Further analysis showed that the mean PMO diameter was 1.42 ± 0.62 mm. Although 11.6% of the PMO was in the inferior region, 60.4% was in the middle and 28% in the superior region. The effect of age and SM on the height and diameter of the PMO was found to be statistically significant. An AMO was present in 20% of the CBCT images. The mean AMO diameter was 2.55 ± 1.25 mm. Although 45.4% of the AMO was in the inferior region, 48% was in the middle and 6.6% was in the superior region. Moreover, SM thickness seemed to influence the height. A significant positive relationship was found between the PMO and AMO height. Also, a significant relationship was observed between the presence of the AMO and septum deviation. Conclusion: The presence of the AMO, PMO diameter, and height should be added to the preoperative evaluation criteria for the success of sinus floor evaluation. Specifically, sinonasal and demographic conditions should be carefully examined preoperatively for the long-term success of the surgery.

Temporal relationship between thromboembolic events and myeloproliferative neoplasm diagnosis: is it associated with mortality risk?

OBJECTIVE: The aim of this study is to investigate the temporal relationship between the first occurrence of thromboembolic events (TEE) and the timing of myeloproliferative neoplasm (MPN) diagnosis and to determine risk factors for TEE-related mortality in MPN. PATIENTS AND METHODS: A total of 138 BCR-ABL-negative MPN patients with TEE, diagnosed from January 2010 to December 2019, were included in this retrospective cohort. Patients were compared according to mortality and subjects were classified into three groups with respect to having suffered index TEE before, during, or after MPN diagnosis. RESULTS: The mean age of surviving patients was 57.5±13.8, while those who had died had a mean age of 72.0±9.0 (p<0.001). Males represented 56.5% of patients with mortality and 60.9% of those without mortality (p=0.876). TEE was detected in 26.0% of MPN patients, and TEE-related mortality rate was 16.7%. There was no relationship between mortality and the classification of patients according to index TEE (p =0.884). High age (p<0.001) and danazol use (p=0.014) were independently associated with TEE-related mortality. CONCLUSIONS: The temporal relationship between TEE and MPN diagnosis was not found to influence mortality. Older patients and danazol recipients should be considered to have a higher risk of TEE-related mortality.

The relationship between neutrophil/lymphocyte ratio and uric acid levels in multiple sclerosis patients.

BACKGROUND: In this study, we aimed to determine whether neutrophil / lymphocyte ratio (NLR), obtained by dividing the number of neutrophils by the number of lymphocytes, and uric acid (UA) levels in multiple sclerosis (MS) patients vary compared with healthy controls and to establish correlations among these changes themselves as well as between such changes and MS subtypes, immunomodulatory drug use, the duration of the disease and prognosis. METHODS: 150 patients who presented to our hospital and were diagnosed with MS and 150 healthy volunteers were retrospectively included in our study. EDSS score (Expanded Disability Status Scale) was used to assess the disability of the patients. RESULTS: Compared to healthy volunteers, MS patients had lower UA levels (p < 0.001) and higher NLR values (p = 0.02). In addition, UA levels were higher in patients with a low EDSS score or those on immunomodulating drugs (p < 0.001, p = 0.04, respectively). NLR value was lower in patients with a low EDSS score (p < 0.001). There was a negative correlation between NLR value and UA (r = ‒0.23, p = 0.003). Similarly, UA level decreased with increasing EDSS score and duration of disease (r = ‒0.38, p < 0.001; r = ‒0.17, p = 0.02, respectively). CONCLUSION: Evaluating the NLR value, recognized as a new marker for inflammation in MS, together with the UA value, thought to be protective in MS, might be more effective than evaluating these parameters alone in demonstrating disability in patients (Tab. 4, Ref. 28). Text in PDF www.elis.sk Keywords: neutrophil/lymphocyte ratio, uric acid, multiple sclerosis, inflammation, Expanded Disability Status Scale.

The effect of foot reflexology on procedural pain before heel lancing in neonates.

OBJECTIVE: This study was designed to investigate the effect of foot reflexology on alleviating term neonates' invasive pain caused by heel lance. METHODS: In this quasi-experimental study, 60 healthy neonates were recruited and divided into a reflexology group (n=30) and a control (n=30) group. The study design was quasi-experimental since the randomisation method was not used in the assignment of newborns to the groups. While the reflexology group received foot reflexology for an average of 20min before heel lance, the control group received no intervention. The elicited data were analysed using descriptive statistics and independent t-test. RESULTS: The reflexology and the control groups were similar in terms of age, gestational week, Apgar score, weight, height, and sex (P>0.05). The Neonatal infant pain scale (NIPS) scores of the newborns in the reflexology group after the heel lance procedure were found to be significantly lower than those in the control group (P<0.05). It was also found that reflexology had a significant effect on the neonates' heart rate before heel lance (P<0.05) and a borderline effect during heel lance. Moreover, it was observed that the application of foot reflexology shortened the experimental-group neonates' crying periods after the procedural pain (P<0.05). However, reflexology had no statistically significant effect on the duration of heel lance in both groups (P>0.05). CONCLUSION: The application of foot reflexology before invasive procedures, such as heel lance in newborns, is an effective non-pharmacological method for reducing invasive pain. Thus, reflexology could be used to reduce neonates' pain and soothe them during painful procedures such as heel lance.

Modulation of cigarette smoke extract-induced human bronchial epithelial damage by eucalyptol and curcumin.

Smoking is one of the most important leading death cause worldwide. From a toxicological perspective, cigarette smoke serves hazards especially for the human being exposed to passive smoke. Over the last decades, the effects of natural compounds on smoking-mediated respiratory diseases such as COPD, asthma, and lung cancer have been under investigation, as well as the mechanistic aspects of disease progression. In the present study, the protective mechanism of eucalyptol (EUC), curcumin (CUR), and their combination on BEAS-2B cells were investigated in vitro to understand their impact on cell death, oxidative cell injury, and inflammatory response induced by 3R4F reference cigarette extract (CSE). According to the present findings, EUC, CUR, and their combination improved cell viability, attenuated CSE-induced apoptosis, and LC3B expression. Further, CSE-induced oxidative damage and inflammatory response in human bronchial epithelial cells were remarkably reduced by the combination treatment through modification of enzymatic antioxidant activity, GSH, MDA, and intracellular ROS levels as well as nitrite and IL-6 levels. In addition, nuclear translocation of Nrf2, a regulatory protein involved in the indirect antioxidant response, was remarkably up-regulated with the combination pre-treatment. In conclusion, EUC and CUR in combination might be a potential therapeutic against smoking-induced lung diseases through antioxidant and inflammatory pathways and results represent valuable background for future in vivo pulmonary toxicity studies.

Evaluation of the relationship between stylohyoid complex morphology and maxillary/mandibular position using cone beam computed tomography.

BACKGROUND: The aim of this study was to examine the morphologic features of the stylohyoid complex (SHC) and its relation to maxillomandibular position using three-dimensional cone beam computed tomography (CBCT) images. MATERIALS AND METHODS: CBCT images from 157 individuals (74 females, 83 males) were analysed in this study. SHC length, width, and sagittal and transverse angles were measured. The subjects were grouped as skeletal class I, II, and III in order to determine the relative positions of the maxilla and mandible in the sagittal plane and as hypodivergent, normodivergent, and hyperdivergent according to the vertical rotation of the mandible in relation to the skull base. Mann-Whitney U and Kruskal-Wallis H tests were used for statistical analysis. RESULTS: Mean SHC length was 23.56 ± 8.05 mm on the right side and 22.0 ± 6.51 mm on the left; mean SHC width was 3.31 ± 1.40 mm on the right and 2.93 ± 1.30 mm on the left. Mean sagittal angle was 27.43 ± 6.75° on the right side, 27.70 ± 6.51° on the left; mean transverse angle was 70.39 ± 4.59° on the right side and 71.79 ± 4.99° on the left. The only significant difference based on skeletal classification was greater SHC length among males compared to females in the class III group (p < 0.05). CONCLUSIONS: No significant relationship was observed between SHC morphology and position of the maxilla or mandible. However, the gender difference observed among class III subjects suggests that SHC morphology may be affected by craniofacial morphology. Maxillofacial surgeons should investigate this anatomical landmark variation before surgical interventions involving this region, such as temporomandibular joint procedures.

Determination of Compassion Levels of Nurses Working at a University Hospital.

This study was conducted to determine the compassion levels of nurses working in a university hospital. The study sample consists of 227 nurses who were available and participated in the research voluntarily during the study. The study data were collected by using "Nurse Description Form" and "Compassion Scale (CS)." In the analysis of the study data, number, percentage, mean and independent T test and ANOVA test were used. The total mean score of CS of the nurses was found as 97.02 ± 10.67. There was no statistically significant difference between gender, marital status and weekly work hours of the nurses and their total CS score means and total sub-scale score means. On the other hand, there was a statistically significant difference between the age variable of the nurses and the sub-scale of "separation," between the education level of the nurses and their total CS score means. As a result, it was found that the level of compassion of the nurses was moderate and the level of education affected the compassion levels of the nurses.

Matrix metalloproteinase-7 in periodontitis with type 2 diabetes mellitus.

BACKGROUND AND OBJECTIVE: Elevated levels of matrix metalloproteinase-7 (MMP7) have been observed in serum samples of subjects with type 2 diabetes mellitus (T2DM) and in gingival tissues of subjects with periodontitis. The aim of the present study was to collect in vivo and in silico evidence on the role of MMP7 in the interplay between T2DM and generalized periodontitis (GP). MATERIAL AND METHODS: The extent of MMP7 expression and localization were immunohistochemically analyzed in gingival tissues of patients with GP with T2DM (T2DM/GP, n = 11), systemically healthy patients with GP (n = 7), and systemically and periodontally healthy controls (n = 11). An in silico network model was built to determine the interactions between MMP7 and T2DM pathways. Regulation of neutrophil transmigration by MMP7 was analyzed in a knock-out mice model. RESULTS: In human gingival tissues, the proportion of cells with robust MMP7 expression was elevated in patients with T2DM/GP in comparison to controls (P = .014). According to the in silico analysis, "hydroxyl radical" and "hydrogen peroxide" compounds were among the most central nodes of the network, and were within the shortest paths connecting "glucose" to "MMP7." In MMP7 knock-out mice, an intense accumulation of neutrophils was observed in the gingival epithelium as compared to wild-type mice (P = .0001). CONCLUSION: Elevated MMP7 expression in gingival tissues of patients with T2DM/GP is related to the activation of reactive oxygen species by hyperglycemia. Suppression of MMP7 expression results in impaired neutrophil transmigration in gingiva.

Research on Sleep Quality and the Factors Affecting the Sleep Quality of the Nursing Students.

PURPOSE: This research has been conducted in order to examine the quality of sleep and the factors affecting the sleep quality. MATERIAL/METHODS: The sample of this descriptive research is comprised of 223 volunteer students studying at Uludag University Faculty of Health Sciences Department of Nursing. Research datas have been collected through personal features survey and Pittsburg Sleep Quality Index(PSQI). RESULTS: The average result derived from the sample is 6.52±3.17. To briefly explain the average of the component scores: subjective sleep quality 1.29±0.76, sleep latency 1,55±0.94, sleep duration 0.78±0.99, habitual sleep activity 0.47±0.90, sleep disturbances 0.99±0.09, use of sleeping medication 0.12±0.48, daytime dysfunction 1.29±0.90. It has been observed that there is a meaningful discrepancies between average PSQI results and smoking habits of the students, total daily sleeping hours, efficient waking up times, average daily coffee consumption(p<0.05). According to the analyses there is no meaningful discrepancies between the age,gender, where the students live,snoozing during the morning classes, the existence of chronic diseases and daily average tea consumption.(p>0.05)Conclusions: According to the findings in the light of this research; nursing students have low sleep quality.

Pomegranate juice causes a partial improvement through lowering oxidative stress for erectile dysfunction in streptozotocin-diabetic rat.

Erectile dysfunction (ED) is associated with diabetes mellitus (DM). Pomegranate juice (PJ) is a potent antioxidant in diabetes induced oxidative stress. The aim of this study was to evaluate whether the administration of PJ ameliorates ED in streptozotocin (STZ)-diabetic rat model. Adult male Sprague-Dawley rats were divided into three groups (n=10-12, each): (1) Control, (2) STZ (25-35 mg kg-1, intravenously, 10 weeks) induced DM, and (3) PJ (100 mg kg-1 day-1, 10 weeks) treated DM rats. The in vivo erectile [a ratio of intracavernosal pressure (ICP)/mean arterial pressure (MAP)] and ex vivo corpus cavernosum (CC) responses were evaluated. Immunohistochemistry and Masson's trichrome staining were performed. Malondialdehyde (MDA) levels were measured. The ICP/MAP value in diabetic rats was lower than controls, which was partially improved by PJ treatment. Electrical field stimulation (EFS)-induced relaxant responses in CC from the diabetic group were significantly decreased that were ameliorated by treatment. Phenylephrine- and EFS-induced contractions were not altered in diabetic rats. PJ treatment normalized raised MDA levels of diabetic CC samples. Although the intensities of endothelial nitric oxide synthase (NOS) and neuronal NOS enzymes were decreased, inducible NOS protein levels were stronger in diabetic slides than controls. This is the first study to show that PJ treatment ameliorates partially ED and completely oxidative stress and fibrosis in a diabetic rat model. Our results highlight the success of antioxidant mechanism of PJ in ED with diabetes and open the way for future understanding in alternative treatment combinations with PDE5 inhibitors.

Investigation of the effects of propofol and vitamin C administration on erythrocyte deformability in rats with streptozotocin-induced diabetes mellitis.

PURPOSE: In the current study we aim to investigate the effects of vitamin C and profol on red blood cell deformability in diabetic rats. MATERIALS AND METHODS: Twenty- eight Wistar Albino rats were included in the study after streptozocin (60 mg/kg) treatment for 4 weeks of observation for diabetes presence. Twenty-eight rats were allocated to 4 groups. In group DP (n = 7) 150 mg.kg-1 of propofol was injected intraperitoneally. In group DP-vit C (n = 7) rats 100 mg/kg of vitamin C (Ascorbic acid, Redoxon® 1000 mg/5 mL - Roche) were applied one hour before administrating 150 mg.kg-1 of propofol, while rats in control group (n = 7), and diabetic control group (n = 7) received intraperitoneally physiological saline. Deformability measurements were achieved by using erythrocyte suspensions with hematocrit level of 5 % in PBS buffer. RESULTS: Erythrocyte deformability was significantly higher in diabetic control group than in control and vitamin C plus propofol groups (p = 0.00, p = 0.025, respectively). Erythrocyte deformability indexes were found similar in control group and vitamin C plus propofol group (p = 0.949). Relative resistance was increased in diabetic rat model. CONCLUSIONS: Erythrocyte deformability was damaged in rats with diabetes. This injury might lead to further problems in microcirculation. Application of propofol did not alter red cell deformability in diabetic rats. Vitamin C supplementation seems to reverse those negative effects and variations in erythrocyte deformability (Fig. 2, Ref. 57).

The prognostic value of plasma Δ-copeptin levels in patients with isolated traumatic brain injury.

PURPOSE: Traumatic brain injury (TBI) is one of the most common causes of death among trauma patients. Earlier prediction of possible poor neurological outcomes, even upon admission to the emergency department, may help to guide treatment. The aim of this prospective study was to assess the predictive value of plasma copeptin levels for early morbidity and mortality in patients with isolated TBI. METHODS: This prospective study comprised 53 patients who were admitted to the emergency department with isolated TBI. Forty-two of these patients (group I) survived at least 1 month after the TBI; the other 11 (group II) did not. Plasma levels of copeptin were measured in these TBI patients at admission and 6 h after trauma, and were compared with those of healthy volunteers (group III). RESULTS: At admission, the copeptin levels of the TBI patients (groups I and II combined) were not statistically significantly different from those of the control group (III). The copeptin levels 6 h after trauma were also not statistically significantly different from those at admission. Δ-Copeptin levels (the difference between the copeptin level at the 6th hour after trauma and that at admission) were higher in the patients who died within a month of the TBI. Further, Δ-copeptin levels were higher in patients who showed no improvement in the modified Rankin score when compared with patients with an improved modified Rankin score. The best cutoff point for Δ-copeptin was 0.51 ng/ml for predicting mortality and 0.23 ng/ml for predicting improvement in the modified Rankin score. CONCLUSIONS: Plasma Δ-copeptin levels may help physicians predict the prognoses of patients suffering from traumatic brain injury.

Asymmetric light propagation in chirped photonic crystal waveguides.

We report numerical and experimental investigations of asymmetric light propagation in a newly designed photonic structure that is formed by creating a chirped photonic crystal (PC) waveguide. The use of a non-symmetric distribution of unit cells of PC ensures the obtaining of asymmetric light propagation. Properly designing the spatial modulation of a PC waveguide inherently modifies the band structure. That in turn induces asymmetry for the light's followed path. The investigation of the transmission characteristics of this structure reveals optical diode like transmission behavior. The amount of power collected at the output of the waveguide centerline is different for the forward and backward propagation directions in the designed configuration. The advantageous properties of the proposed approach are the linear optic concept, compact configuration and compatibility with the integrated photonics. These features are expected to hold great potential for implementing practical optical rectifier-type devices.

The evaluation of effects of lornoxicam on blood flow and erythrocyte deformability in comparison with iv paracetamol in rats.

BACKGROUND: Lornoxicam and iv paracetamol are commonly preferred to be used for postoperative analgesia. Although Aspirin is a well known non-steroid anti-inflammatory drug that decreases the erythrocyte deformability, there is no study comparing lornoxicam and iv paracetamol regarding their effects on erythrocyte deformability recorded in literature. The aim of this study was to compare the effects of lornoxicam and IV paracetamol on blood perfusion and erythrocyte deformability on rats. METHODS: Twenty male Wistar Albino rats were randomly divided into three groups as Lornoxicam group (Group L), IV paracetamol group (Group P), and control group (Group C). Intraperitoneal administrations were done in all groups except Group C. Liver and renal blood flows were conducted by laser Doppler and euthanasia was performed via intraabdominal blood uptake. Erythrocyte deformability was measured using a constant flow filtrometer system. RESULTS: Lornoxicam increased the relative resistance which shows the erythrocyte deformability in rats (p<0.05). The comparison of Groups C and P revealed no statistically different results (p=0.731) while Group L revealed statistically higher results than Group C (p=0.022). No statistically significant differences were found between groups L and P (p=0.073). Liver and renal blood flow values in Group L were just numerically decreased not statistically whilst no statistically significant difference was found between the three groups. CONCLUSIONS: Lornoxicam have lead to functional disorders related to tissue perfusion as a result of both decreased blood flow and erythrocyte deformability (Fig. 3, Ref. 21). Full Text in PDF www.elis.sk.

Y-stent-assisted coil embolization of wide-neck intracranial aneurysms. A single center experience.

This report evaluated the short and midterm results of the safety and effectiveness of the treatment technique with hybrid and non-hybrid Y-configured, dual stent-assisted coil embolization of wide-neck intracranial aneurysms, and reviewed the literature concerning this technique. Nine patients, eight with unruptured and one with ruptured aneurysms were included in the study. Of aneurysms embolized with a hybrid (with two different stents) and non-hybrid (with two identical stents) technique, three were located in the anterior communicating artery, three at the tip and one at the distal site of basilar artery, and two in the middle cerebral artery. All aneurysms included the orifices of bifurcation vessels. All aneurysms were stented and embolized during the same session. While Neuroform and Enterprise stents were used in the hybrid technique, two Enterprise stents were used in the non-hybrid technique. Dual Y-stent assisted coil embolization was performed successfully in eight of nine patients (88.9%), including five patients (55.6%) with hybrid and three patients (33.3%) with non-hybrid technique. No procedural complication, no mortality and no minor or major neurological complications were seen during the angiographic or clinical follow-up. When an attempt was made at passing the second stent through the first Enterprise stent, the stent protruded inside the aneurysm in one patient (11.1%). Hybrid or non-hybrid dual Y-stent-assisted coil embolization in the treatment of ruptured or unruptured wide-neck and complex intracranial aneurysms is a safe and effective method from the viewpoint of short and midterm results.

Complete clinical recovery of a central pontine and extrapontine myelinolysis delayed onset in a child with acute myeloblastic leukemia.

Central pontine myelinolysis (CPM) is a demyelinating disease of the pons often associated with the demyelination of extrapontine areas of the central nervous system. It typically occurs 0.5-7 days after a rapid increment in serum Na level in hyponatremic patients and may lead to death. A 2.5-year-old child with a diagnosis of acute myeloblastic leukemia developed febril neutropenia, diarrhea, gastrointestinal hemorrhage followed by pulmonary aspergillosis. He could not tolerate enteral nutrition. He was given broad spectrum antibiotics and antifungal treatment. Laboratory tests showed electrolyte abnormalities including hyponatremia, hypokalemia and hypophosphatemia in a chronic course. Twenty three days after a rapid correction of hyponatremia (16 mEq/L/24 h) he revealed flask quadriparesis, disphagia, mutism, irregular respiratory pattern and loss of cough and gag reflex. Cranial magnetic resonance showed central pontine and extrapontine myelinolysis. He required mechanical ventilation and then he regained his neurologic functions. He completed chemotherapy protocol and underwent hematopoietic stem cell transplantation. After 2.5 years of the occurrence of CPM he is in completely normal physical and neurological status. CPM is a very severe but rare disorder in children with underlying disease. In the presence of multiple etiologic factors it may reveal a delayed onset and optimum outcome can be seen even in the severe clinical presentation with adequate intensive support.

A single centre experience in circumcision of haemophilia patients: Izmir protocol.

Haemophiliacs and their families consider that circumcision is a very important step to become a member of society and it is a social obligation for men in Turkey. Although bleeding risk is high, almost all haemophiliacs would like to be circumcised in Turkish society. The aim of this study was to evaluate our experience in circumcision of haemophilia patients and define efficacy, safety and complication rates of our protocol, called 'Izmir protocol'. In this study, we retrospectively reviewed medical records of 50 patients with haemophilia who underwent circumcision at our hospital according to Izmir protocol between 1996 and 2009. Oral tranexamic acid and fibrin glue were used in all children. One hour before the operation, first dose of factor concentrate was given. After reaching a plasma factor level of around 90-100%, the prepuce was incised circumferentially and excised using Gomco clamp or open technique under general anaesthesia. Intermittent injections of factor concentrate were given every 12 for 48 h. While the first two doses were given at higher amount to achieve or continue plasma factor level at 90-100%, in the last three doses, the aim was to maintain the plasma factor level at 50-60%. Forty-eight hours after the circumcision, patients were discharged. Three patients (6%) showed bleeding complication and all were resolved easily. All had at least one excuse from the protocol (Lower doses of factor concentrates was used in 2, tranexamic acid was not used in 2). Izmir protocol is safe, cheap and easy to carry out.

The value of early treatment in patients with haemophilia and inhibitors.

Development of inhibitors to infused factor concentrates represents a major clinical and economic challenge in the treatment of haemophilic patients. It has been shown that a delay in initiation of treatment leads to requirement of a larger number of injections to stop the bleeding but this has never been formally linked to costs associated with the bleeding. The objectives of this study were to assess the relationship between time to initiation of NovoSeven and total costs, number of doses administered and time to bleeding resolution in mild to moderate bleeding episodes. Data on time to treatment initiation, time to bleeding resolution and on all resource use related to the bleeding were extracted from medical records in Turkey for 129 bleeding episodes. Regression analysis was used to assess the impact of time to treatment on outcomes. Longer time to treatment initiation increased both total costs associated with the bleeding, the number of doses needed and the time to bleeding resolution. Treatment in hospital was associated with significantly longer time to treatment, higher costs and longer time to bleeding resolution as compared with home treatment or outpatient treatment. When controlling for other bleeding characteristics, the cost of bleedings treated in hospital was more than 150% higher. This study shows that treatment with NovoSeven should be initiated as soon as possible after the onset of bleeding in order to minimize costs and optimize outcomes. Home treatment reduces time to treatment initiation and also reduces costs related to the bleeding.

Appendicular tuberculosis: review of 155 published cases and a report of two cases.

PURPOSE: This paper provides an overview of the literature on appendicular tuberculosis (ATB) between 1909 and 2010. METHODS: We present two cases of primary ATB and a literature review of studies on ATB published in English and accessed via the Pubmed and Google Scholar databases. RESULTS: One hundred fifty-five published cases of ATB were reviewed, and two patients with primary ATB, treated and followed in our clinic, were reported. The age range of the patients (62 females, 60 males and 33 with unnoted gender) was between 2 and 60 years, with a mean age of 27.1 ± 10.6 years. Of the patients who had applied to hospital, 59 had acute right lower quadrant pain, 46 had recurrent right lower quadrant pain, 19 had generalized pain, and 10 had chronic abdominal symptoms suggestive of subacute intestinal obstruction, while 47 patients were operated on with a diagnosis of acute appendicitis, 24 with recurrent appendicitis, 19 with TB peritonitis, 14 with mass in the right lower quadrant, 13 with subacute intestinal obstruction, and 7 with ATB. While appendectomy was not performed on 4 patients, one or more of the following procedures were done in the other 151 cases: appendectomy, hemicolectomy, ileocecal resection, or cecectomy. Different anti-tubercular treatment regimens with durations varying from 3 weeks to 18 months were applied to 60 patients. During the follow-up period of 3 weeks to 15 years, mortality occurred in 14 patients, sinus in five, and fistula in one patient. Secondary ATB was detected in 86 patients, primary ATB in 50, and no differential diagnosis could be made in 19 cases. CONCLUSIONS: Tuberculosis is a systemic disease with localized manifestations; therefore, anti-TB therapy must be initiated in any patient whose pathologic specimen reveals tuberculosis.