Effects of VDR and CYP24A1 gene polymorphisms on the outcome of supraglottic larynx cancer.

OBJECTIVE: Vitamin D has been demonstrated to play a protective role in carcinogenesis. Polymorphisms of the vitamin D receptor (VDR) genes and 24-α-hydroxylase (encoded by CYP24A1) may affect the outcome of some cancers. This study examines the effects of the VDR gene and CYP24A1 single nucleotide polymorphisms on the outcome of supraglottic larynx cancer. PATIENTS AND METHODS: Patients diagnosed with supraglottic larynx cancer between 2017 and 2022 were enrolled. Single nucleotide polymorphisms of the VDR gene (rs2228570, rs731236, rs7975232, rs11574113, rs11168267 and rs11168266) and CYP24A1 gene (rs4809960, rs6022999, rs6068816, rs2259735 and rs2296241) were investigated. All patients were followed up for any evidence of local recurrence, regional recurrence, distant metastasis, and second primary tumor development. Cox regression analysis was performed to evaluate the prognostic value of single-nucleotide polymorphisms (SNPs). Kaplan-Meier method was used for survival analysis. RESULTS: 87 patients were included. The mean follow-up time was 45.02±24.47 months. Cox regression analysis for locoregional recurrence revealed that the hazard ratio of rs731236 GG was 2.098 (95% CI, range: 1.047-4.202, p=0.037). Locoregional recurrence for rs731236 AA, AG, and GG were 38.6%, 23.1%, and 53.3%, respectively. In the presence of rs731236 GG polymorphism, disease-specific survival was significantly shorter (47.63±7.48 months, p=0.015), and disease-free survival (45.71±6.3 months) was significantly shorter (p=0.040). Rates of metastases and second primary tumors were not significantly different between SNPs. CONCLUSIONS: This study has demonstrated the possible effects of VDR rs731236 SNP on the locoregional recurrence and prognosis of supraglottic larynx cancer.

Modified bilateral fasciaperichondrial flap for prominent ear correction

Abstract Objective: Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures. Methods: Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures. Results: Between May 2017 and May 2021, 32 ears of 17 patients were operated on dueto prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ± 0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values. Conclusion: A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction. Level of evidence: III.

Trial of a new pain assessment tool in patients with low education: the full cup test.

AIMS AND SCOPE: Pain is subjective and pain assessment depends on the patient's self-report. The measurement of pain needs simple tools, especially in patients with low education. There are limited reports about pain assessment in this type of patient. The aims of the present study were to develop a pain scale that is easy for patients with low education to understand and to evaluate its usefulness in these patients. METHODS: A total of 128 adult non-demented patients presenting with headaches or rheumatologic pain were included in this study. The first phase of the study involved 114 patients and aimed to estimate the usefulness of the full cup test (FCT) compared with the visual analogue scale (VAS). The second phase of the study involved 23 patients with headaches selected randomly from the 114 patients and assessed the usefulness of the FCT for detecting changes in pain levels. The third phase of the study involved 14 patients with low education suffering from headaches and examined the usefulness of the FCT in these patients. RESULTS: The mean VAS and FCT scores were statistically correlated and reliable and did not differ significantly. Patients with low education understood the FCT more easily than the VAS. CONCLUSION: We concluded that the FCT is useful for both assessing and differentiating changes in pain, and is suitable for assessing pain in patients with low education.

Reactive arthritis due to zoophilic (canine) sexual intercourse.

Reactive arthritis (ReA) is defined as a joint inflammation triggered by a distant infection, with no cultivable microbes in the joints. Although efforts have been made to characterize the microorganism linked to ReA, no definite common feature has so far emerged. Here we present a case of ReA which occurred after a zoophilic (canine genus) sexual intercourse.

Intra-familial spread of hepatitis B virus infection in eastern Turkey.

Hepatitis B virus (HBV) infection is a worldwide health problem. The aim of the present study was not only to determine the prevalence of HBsAg in children of HBV-infected parents but also to identify all HBSAg-positive family members to protect as many children, in the present and future, as possible. The study was carried out with the participation of 2113 family members (1205 children, 453 mothers, and 455 fathers) at Sivas SSK Hospital, Turkey. They were screened for HBV markers using standard enzyme immunoassay between September 2001 and March 2005. The prevalence of any HBV markers and HBsAg among family members of index cases was 50.5% and 30.5% respectively. HBsAg carrier rate was higher among fathers (61%) than mothers (47%), (P<0.05). The children of mother index cases had higher rates of HBsAg compared with the children of father index cases (P<0.01). Our results suggest that intra-familial childhood horizontal transmission (especially mother-to-child) is important for HBV transmission in the Turkish community, and highlights the need for screening of adult siblings and mothers of adult HBsAg carriers in addition to their spouses and children.

Fatal congenital cytomegalovirus infection following recurrent maternal infection after a 7-year interval.

It is generally accepted that the risk for fetal infection is greatest with maternal primary cytomegalovirus CMV infection and much less likely with recurrent infection. Here, we report a fatal case of congenital CMV infection following recurrent maternal infection after a 7-year interval. A 3-month-old female baby presented with fever, jaundice, vomiting and stopping breast-feeding. Physical examination revealed mild respiratory distress, hepatosplenomegaly, microcephaly and growth retardation. Laboratory examination included bilirubin concentrations Total: 7.17 mg/dl; conjugated 6.67 mg/dl, aspartate transaminase 141 IU, and alanine transaminase 499 IU. Enzyme-linked immunosorbent assay test results revealed + CMV IgM and + CMV IgG. She died on the 10th day of admission with the diagnosis of CMV hepatitis, pneumonia, and multi-organ failure. Nuclear and cytoplasmic inclusions were demonstrated in the lung, liver and brain on postmortem biopsy. This case highlights that the outcome of babies born to mothers with recurrent maternal CMV infection may be more severe and fatal than previously thought.

The knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip.

A detailed clinical examination of the newborn performed by nurse-midwife practitioners has been recommended as a standard practice throughout the most western countries. The purpose of this study was to evaluate and compare the knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip (DDH) before and after a structured lesson. The study was designed as a cross-sectional, pre- and post-test. The number of participants from primary care and secondary care nurse-midwife practitioners were 155 and 208, respectively. A structured questionnaire consisting of 28 statements of medical and practical knowledge, and traditional attitudes with regard to DDH was administered. The results determined that the pre-test scores were much lower than the post-test scores of both primary and secondary care practitioners. Although there was a lack of knowledge about DDH in both groups, the pre-test and post-test scores were higher in the primary care group compared to the secondary care group. In conclusion, the knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip are in need of improvement. This improvement may be provided by continuing education programmes.

Cardiopulmonary and metabolic functions, aerobic capacity, fatigue and quality of life in patients with multiple sclerosis.

OBJECTIVES: The objectives of this study were to evaluate cardiopulmonary and metabolic functions in patients with multiple sclerosis (MS) and to clarify the relationship between these functions and neurological deficits, respiratory involvement, fatigue and quality of life. MATERIALS AND METHODS: Twenty-five patients with MS and 15 healthy controls were included in the study. Cardiopulmonary and metabolic responses to maximum exercise were investigated with an electronically braked arm crank ergometer. A computerized gas analysis system collected and analysed expired gases during exercise. RESULTS: In the present study, significant respiratory muscle weakness, and decreased aerobic performance and cardiopulmonary and metabolic responses to maximum exercise were determined in patients with MS. CONCLUSIONS: As respiratory muscle function plays a strong role in aerobic capacity and in most of the cardiopulmonary and metabolic responses to exercise, measurement of respiratory muscle strength and endurance should also be carried out in the MS population.

Classification of carotid artery stenosis of patients with diabetes by neural network and logistic regression.

The blood flow hemodynamics of carotid arteries were obtained from carotid arteries of 168 individuals with diabetes using the 7.5 MHz ultrasound Doppler M-unit. Fast Fourier Transform (FFT) methods were used for feature extraction from the Doppler signals on the time-frequency domain. The parameters, obtained from the Doppler sonograms, were applied to the mathematical models that were constituted to analyze the effect of diabetes on internal carotid artery (ICA) stenosis. In this study, two different mathematical models such as the traditional statistical method based on logistic regression and a Multi-Layer Perceptron (MLP) neural network were used to classify the Doppler parameters. The correct classification of these data was performed by an expert radiologist using angiograpy before they were executed by logistic regression and MLP neural networks. We classified the carotid artery stenosis into two categories such as non-stenosis and stenosis and we achieved similar results (correctly classified (CC) = 92.8%) in both mathematical models. But, as the degree of stenosis had been increased to 4 (0-39%, 40-59%, 60-79% and 80-99% diameter stenosis), it was found that the neural network (CC = 73.9%) became more efficient than the logistic regression analysis (CC = 67.7%). These outcomes indicate that the Doppler sonograms taken from the carotid arteries may be classified successfully by neural network.

The relationship between cholesterol levels and depression in the elderly.

OBJECTIVE: This study was undertaken to evaluate the possible association between low levels of serum cholesterol and depression in the elderly. BACKGROUND: The alteration of cholesterol content of synoptosomal membrane in response to low serum cholesterol levels has been shown to decrease the serotonin receptors in depressed patients. Previous studies suggest that low levels of serum cholesterol may be associated with the increased risk of depression in the elderly. SUBJECTS AND METHODS: This was a cross-sectional study where 189 subjects over 65 years old of both sexes were enrolled. Serum total cholesterol, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), and triglycerides were measured. Cognitive functions were evaluated with mini mental state examination survey (MMSES) and depression was assessed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). RESULTS: Of the 189 subjects, 42 were affected by depression. Low serum cholesterol level (cut-off < or =160 mg/dl) as well as the levels of HDL-C, LDL-C and triglycerides were not associated with depression in older men or women. CONCLUSIONS: In the present cross sectional study, there was no association between depression and low serum cholesterol levels after adjusted for confounding factors. Further studies are needed to clarify this suggestion with larger number of patients.

Lipoprotein (A) levels in type 2 diabetic patients with diabetic retinopathy.

To examine a possible association between lipoprotein(a) [Lp(a)] levels and diabetic retinopathy in patients with type 2 diabetes mellitus. 100 type 2 diabetic patients were assessed with the following parameters: age, body mass index, duration of diabetes, blood pressure, fasting plasma glucose, total cholesterol, HDL-cholesterol, triglycerides, blood urea nitrogen, creatinine, Lp(a), and albumin excretion rate (AER). Retinopathy was classified as normal retina (NR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) by an ophthalmologist. The PDR group had higher cholesterol (t=-2.24, p<0.05) and creatinine (z=-2.547, p<0.05) levels than the NPDR group. The PDR group had a higher value of AER (z=-2.439, p<0.01) than the NR group. The possibility of developing diabetic retinopathy after 10 years of diabetes was found to be 6.5 fold high (OR; 6.57, 95% CI 1.74-24.79; p<0.05). The Lp(a) levels were similar in the patients with retinopathy and those without retinopathy. In the study, there was no evidence for a relationship between the serum Lp(a) levels and diabetic retinopathy in type 2 diabetic patients.

Distal muscular dystrophy of the Miyoshi type.

OBJECTIVE: Miyoshi myopathy is an autosomal recessive muscular dystrophy. It is characterized by distal muscle involvement, especially the gastrocnemius and soleus. The disease starts with weakness and atrophy of the calves. MATERIAL AND METHODS: Here we report on 2 patients, brother and sister, from a Turkish family. Onset of the disease was at the age of 20 and 26 years of age, respectively. In both siblings, there was an early and predominant involvement of the distal muscles of the lower limbs. Creatine kinase activity was elevated 50- to 100-fold above normal values. RESULTS: Electromyography revealed a myopathic pattern. Histology of the biceps muscles indicated some myopathic changes consistent with muscular dystrophy. Occurrence in only these 2 siblings with no other family members was indicative of an autosomal recessive inheritance. CONCLUSIONS: We describe the distinctive clinical features in 2 siblings of a Turkish family with MM as differential diagnosis and histological change.

Complicated retinal migraine.

Retinal migraine is not uncommon, but permanent sequelae are rare. We describe the case of a 23-year-old woman who had suffered from retinal migraine for five years. After a typical migraine attack a left nasal quadranopsia persisted. Fluorescein angiography showed a branch retinal arterial occlusion. Other causes were ruled out by appropriate laboratory techniques. Her visual field defect has persisted for eleven months.