Evaluation of the relationship between speckle tracking echocardiography and arrhythmia markers Tp-e interval and Tp-e/QTc in patients with arterial hypertension.

OBJECTIVE: The prolongation of the Tp-e interval, which is defined as the interval from the peak to the end of the T wave on electrocardiography (ECG), is considered a non-invasive predictor of malignant ventricular arrhythmia development. In our study, we aimed to compare the Tp-e interval and Tp-e/QTc ratios on ECG and subclinical myocardial dysfunction evaluated by left ventricular global longitudinal strain (LV-GLS) imaging in patients receiving treatment for hypertension. PATIENTS AND METHODS: Two-dimensional speckle tracking echocardiography was performed in 102 consecutive hypertensive patients with blood pressure values regulated by treatment. The normal left ventricular global longitudinal strain (LV-GLS) limit was accepted as < -18%. The patients were divided into two groups: those with normal (≥ -18%) LV-GLS and those with impaired LV-GLS (< -18%). Comparisons between the groups were made by measuring ventricular repolarization parameters, such as QT, QTc, and Tp-e intervals, and Tp-e/QT and Tp-e/QTc ratios. RESULTS: While the mean age of the patients with impaired LV-GLS was 55±6 years, the mean age of the normal LV-GLS group was 58±9 years (p=0.101). The Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly higher in the impaired LV-GLS group than in the normal LV-GLS group (p<0.05 for all). A positive correlation was observed between the ventricular repolarization parameters and LV-GLS values. This positive correlation was statistically significant in terms of the Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios. CONCLUSIONS: The Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were increased in hypertensive patients with impaired LV-GLS, and therefore a close follow-up in terms of increased arrhythmia risk is required in this patient group.

Identification of transformation products during Doxylamine chloramination for NDMA mitigation.

N-nitrosodimethylamine (NDMA) is a disinfection byproduct that forms at the presence of an organic nitrogen precursor. Doxylamine, an antihistaminic pharmaceutical, is a precursor of NDMA and has been shown to form NDMA in the presence of chloramine. In this study, the effect of Doxylamine as an NDMA precursor has been further studied during chloramination. The end product and byproducts during chloramination were investigated using a high-resolution mass spectrometer by taking samples at different time intervals. Results suggest that NDMA is not the only end product forming during chloramination of Doxylamine and several transformation products that do not end up as NDMA may form. A group of these transformation products have been selected based on their relative amounts during chloramination with time and notated as Focus Tentative Transformation Products (FTTPn). The identification of these byproducts will make it easier to study the conditions during chloramination that may favour these 'known' transformation products with the use of less sophisticated analytical instruments. Then, it might lead to the establishment of chloramination protocols that will minimise the formation of NDMA from its precursors.

Frequency of fragmented QRS on ECG and relationship with left ventricular dysfunction in patients with subclinical hypothyroidism.

OBJECTIVE: Subclinical hypothyroidism (SH) is a biochemical definition that has been proven to be associated with cardiovascular diseases. Fragmented QRS (fQRS) is defined as an electrocardiographic (ECG) reflection of cardiac fibrosis. It is associated with increased cardiovascular mortality and morbidity. In this study, we aim to evaluate the presence and frequency of fQRS in SH patients and determine the relationship between fQRS presence and left ventricular dysfunction by using the myocardial performance index (MPI). PATIENTS AND METHODS: Our study included 50 newly diagnosed SH and 50 healthy participants with similar demographic characteristics. We compared demographic characteristics, laboratory findings, electrocardiographic and echocardiographic measurements of the study population. SH patients were evaluated as two groups in the subgroup analysis: [fQRS(+) SH] with fQRS and [fQRS(-) SH] without fQRS. We analyzed the correlation of thyroidstimulating hormone (TSH) levels with demographic characteristics, electrocardiographic and echocardiographic data. Independent predictors of fQRS presence were evaluated by logistic regression analysis. RESULTS: The mean age of SH patients was 44 ± 8 years, and 46% (n = 23) of the patients were women. In the control group, the mean age was 45 ± 11 years, and 52% (n = 26) of the participants were women. MPI was found to be significantly higher in the SH group compared to the control group (0.53 ± 0.07 vs. 0.41 ± 0.08, p< 0.001). fQRS was found to be significantly higher in the SH group compared to the control group (p= 0.004). In echocardiographic measurements, isovolumic relaxation time (IVRT) was found to be significantly longer in the fQRS(+) SH group (105.6 ± 21.8 ms vs. 91.1 ± 24.4 ms, p < 0.001), while isovolumic contraction time (IVCT) was not significantly different between the groups. Ejection time (ET) was significantly longer in the fQRS (-) SH group (286.9 ± 32.1 ms vs. 274.2 ± 30.6 ms; p = 0.011). MPI was 0.57 ± 0.12 in the fQRS (+) SH group and 0.48 ± 0.06 in the fQRS (-) SH group, which was significantly higher (p = 0.001). TSH was found to be 8.82 ± 4.58 in fQRS (+) SH group and 5.73 ± 3.10 in fQRS (-) SH group (p = 0.003). It was found that MPI (r = 0.302, p < 0.001) and fQRS (r = 0.321, p < 0.001) were significantly positively correlated with TSH. TSH levels [OR = 1,645, 95% CI = 1,322 to 2,067 (p = 0.001)], IVRT [OR = 1,502, 95% CI = 1,119 to 95% (p = 0.003)], and MPI [OR = 1,408, 95% CI = 0.989 - 1.806 (p = 0.001)] were found to be independent predictors of the presence of fQRS. CONCLUSIONS: The frequency of fQRS in SH patients was found to be higher than in the healthy population. MPI values were higher in fQRS (+) SH patients compared to fQRS (-) SH patients, resulting indirectly having a higher risk of tendency to left ventricular systolic/diastolic dysfunction. MPI and fQRS had a significant positive correlation with TSH. TSH, IVRT, and MPI were found to be independent predictors of the presence of fQRS in SH patients.

Quantitative Analysis of the Olfactory System in COVID-19: An MR Imaging Study.

BACKGROUND AND PURPOSE: Anosmia or hyposmia, often accompanied by changes in taste, is recognized as a common symptom that can assist in the diagnosis of coronavirus disease 2019 (COVID-19). The pathogenesis of olfactory dysfunction in COVID-19 is not yet fully understood. MR imaging represents a useful anatomic imaging method for the evaluation of olfactory dysfunction associated with varying etiologies, including viral infection, trauma, and neurodegenerative processes. This case-control study was conducted to compare quantitative measurements of olfactory anatomic structures between patients diagnosed with COVID-19 associated with persistent olfactory dysfunction and healthy controls. MATERIALS AND METHODS: This study has a retrospective design. Cranial MR imaging was performed on all participants in both the patient and control groups. The bilateral olfactory bulb volume, olfactory tract length, and olfactory sulcus depth were measured in all patients. RESULTS: A total of 116 people aged 18-60 years, including 36 patients diagnosed with COVID-19 and 80 controls, were included in the study. All measured values were compared between the patient and control groups. The right, left, and total olfactory bulb volume values were significantly lower in the patient group than in the control group. The patient group also had significantly lower right and left olfactory sulcus depth and olfactory tract length values compared with those in the control group. CONCLUSIONS: MR imaging findings can be used to demonstrate olfactory injury in patients with COVID-19. The olfactory pathway may represent an alternative route for virus entry into the central nervous system.

Maternal steroid levels and the autistic traits of the mother and infant.

BACKGROUND: Prenatal sex steroids have been associated with autism in several clinical and epidemiological studies. It is unclear how this relates to the autistic traits of the mother and how early this can be detected during pregnancy and postnatal development. METHODS: Maternal serum was collected from pregnant women (n = 122) before or during their first ultrasound appointment [mean = 12.7 (SD = 0.7) weeks]. Concentrations of the following were measured via immunoassays: testosterone, estradiol, dehydroepiandrosterone sulphate, progesterone; and sex hormone-binding globulin which was used to compute the free fractions of estradiol (FEI) and testosterone (FTI). Standardised human choriogonadotropin (hCG) and pregnancy-associated plasma protein A (PAPP-A) values were obtained from clinical records corresponding to the same serum samples. Mothers completed the Autism Spectrum Quotient (AQ) and for their infants, the Quantitative Checklist for Autism in Toddlers (Q-CHAT) when the infants were between 18 and 20 months old. RESULTS: FEI was positively associated with maternal autistic traits in univariate (n = 108, Pearson's r = 0.22, p = 0.019) and multiple regression models (semipartial r = 0.19, p = 0.048) controlling for maternal age and a diagnosis of PCOS. Maternal estradiol levels significantly interacted with fetal sex in predicting infant Q-CHAT scores, with a positive relationship in males but not females (n = 100, interaction term: semipartial r = 0.23, p = 0.036) after controlling for maternal AQ and other covariates. The opposite was found for standardised hCG values and Q-CHAT scores, with a positive association in females but not in males (n = 151, interaction term: r = -0.25, p = 0.005). LIMITATIONS: Sample size of this cohort was small, with potential ascertainment bias given elective recruitment. Clinical covariates were controlled in multiple regression models, but additional research is needed to confirm the statistically significant findings in larger cohorts. CONCLUSION: Maternal steroid factors during pregnancy are associated with autistic traits in mothers and their infants.

Effects of balneological outpatient treatment on clinical parameters and serum cytokine levels in patients with chronic low back pain: a single-blind randomized controlled trial.

This study aimed to investigate the effects of balneological outpatient treatment (hydrotherapy and peloidotherapy) on clinical status and serum cytokine levels in patients with chronic low back pain (CLBP). Seventy-four patients with CLBP who accepted to participate to the study were randomly divided into two groups. The study group was given ten sessions (in 2 weeks) of hydrotherapy, peloidotherapy, and home exercise, while the control group was given only home exercise. All patients were assessed before and at the end of therapy, at the 1st and 3rd months. The primary outcomes were pain intensity on the visual analog scale (VAS) (VAS-pain, VAS-rest, VAS-exercise) and Oswestry Disability Index (ODI). The secondary outcome measures included patient's and physician's global assessment (VAS-PGA), (VAS-DGA), finger-to-floor distance (FFD), modified Schober test, Short Form-36 (SF-36), and the use of analgesic drug. Venous blood samples were drawn from all patients before/1st day and after therapy/12th day to measure serum interleukin (IL)-6 and IL-10 levels. Significant improvement was observed in the study group in VAS-pain, VAS-rest, VAS-exercise, VAS-PGA, VAS-DGA, ODI, and SF-36 parameters after treatment and improvement maintained for 3 months. In the control group, significant improvement was observed in VAS-pain, VAS-exercise, VAS-PGA, VAS-DGA, and ODI scores on the 12th day and continued for 3 months. Decrease in pain, pain during rest and exercise, modified Schober test, VAS-PGA, VAS-DGA, ODI scores, and the increase in SF-36 pain and general health scores showed superiority in favor of the study group in all evaluations. There was a significant increase in IL-10 values from baseline at the end of treatment in the study group. The use of non-steroidal anti-inflammatory drug (NSAID) was significantly lower in the study group compared with the use of NSAID in the control group in the 3rd month. Balneological outpatient treatment improved clinical status in CLBP patients. Although no significant correlation was clearly determined between IL-10 levels and pain score, this effect might be related to the observed increase in the anti-inflammatory cytokine IL-10 levels that was observed only in the study group.

COULD COVID-19 TRIGGER TYPE 1 DIABETES? PRESENTATION OF COVID-19 CASE PRESENTED WITH DIABETIC KETOACIDOSIS.

COVID-19 is a viral disease that is recognized now as a pandemic by the World Health Organization. It is known that some viral infections may trigger autoimmune diseases. It has been revealed that COVID-19 may also lead to the pathogenesis of some autoimmune diseases, including Type 1 DM (T1DM) and autoimmune thyroid diseases. Here, we aimed to present a young female patient with COVID-19, who we followed up in our clinic, who presented with diabetic ketoacidosis (DKA), and developed Hashimoto's disease during the treatment process. In order to emphasize that COVID-19 may trigger the emergence of T1DM, that it may mask nonspecific DKA symptoms like nausea and vomiting, that it may cause delay in diagnosis of DKA, and also to emphasize the importance of evaluating other autoimmune diseases accompanying COVID-19, we found it appropriate to present this case.

Appendiceal intussusception caused by mucinous cystadenoma presenting as acute appendicitis.

While appendiceal intussusception is an uncommon pathological condition, mucinous cystadenoma of the appendix is a particularly rare entity. We report a case of appendiceal intussusception induced by a mucinous cystadenoma presenting as acute appendicitis. A 37-year-old woman was admitted with a one-day history of acute onset, right lower abdominal pain. Computed tomography showed swelling of the appendix, a pathological mass in the ileocolic region and oedematous pericolonic fat stranding. Emergency laparotomy via a McBurney incision revealed that the base of the appendix was swollen and intussuscepting into the caecum. Palpation of the caecum demonstrated an intraluminal mass, 6cm in size, at the appendicocaecal junction. After extension of the McBurney incision, a caecotomy was performed to investigate the mass, following which a cauliflower-like tumour started to protrude. En bloc excision was undertaken of both the appendix and the tumorous mass with a clear surgical margin to send for frozen section analysis. The biopsy samples indicated a mucinous neoplasm. Ileocaecal resection was therefore performed with ileocolic anastomosis. The resected specimen contained a tumour arising from the appendix. The tumour measured 5.3cm x 5cm x 3cm in the caecal cavity and the appendix had invaginated into the caecum at its base. The cut surface of the appendix showed the mucinous tumour projecting into the caecal cavity. Microscopic examination revealed a low grade mucinous cystadenoma.

Sunitinib versus pazopanib for patients with metastatic renal cell carcinoma: 2 Turkish hospital experience. / Sunitinib versus pazopanib para el tratamiento del carcinoma de células renales metastásico: experiencia en 2 hospitales turcos.

INTRODUCTION: Sunitinib (SUN) and pazopanib (PAZ) are 2 oral tyrosine kinase inhibitors against vascular endothelial growth factor. Their efficacy and safety in metastatic renal cell carcinoma has been proven with phase iii studies. However, real world data is limited. The objective of this study is to assess the clinical benefit of SUN and PAZ in routine practice. METHODS: We reviewed the medical records of 79 metastatic renal cell carcinoma patients treated with SUN (50mg/day on 4/2-schedule) or PAZ (800mg/day continuously). Patients were assessed retrospectively at 2 Turkish hospitals between 2006 and 2016. RESULTS: For the entire cohort median age of patients was 60 (28-87) years and 70% of them were male. The objective response rate and disease control rate in SUN/PAZ groups were 34/37% (P=.96) and 78/87% (P=.046), respectively. With a median follow up duration of 15 months, median progression-free survival and overall survival in SUN/PAZ groups were 8/8 months (P=.83) and 22/21 months (P=.53), respectively. The common all grade toxicities for SUN vs. PAZ were fatigue (59 vs. 74%), skin changes (44 vs. 44%), anemia (35 vs. 42%), hypothyroidism (37 vs. 19%; P=.02) and hypertension (33 vs. 50%). In patients treated with SUN, total grade 3-4 toxicities (mean number of toxic events per patients) were 0.71, whereas in patients treated with PAZ, total grade 3-4 toxicities were 0.11 (P<.001). SUN was associated with an increased incidence of grade 3-4 fatigue (P=.007), anemia (P=.001) and hypothyroidism that needed therapy (P=.02). Dose reduction in 49 and 24% of patients (P=.02), and treatment cessation in 37 and 26% of patients (P=.37) were required in the SUN and PAZ groups, respectively. CONCLUSIONS: In our study, there was no difference in terms of survival outcomes between 2 agents. However, patients treated with SUN had more grade 3-4 adverse events which prompted dose reduction.

Prenatal Diagnosis of Organic Acidemias at a Tertiary Center.

The aim of this study was to share our experience in the prenatal diagnosis (PND) of organic acidemias (OAs) in our clinic. This study consisted of 10 cases in whom an invasive prenatal diagnostic test (IPNDT) was performed by a single physician for the PND of OAs. Median maternal age, parity, gestational week of IPNDT, prenatal test indications, OA types, method of IPNDT, IPNDT results and gestational outcomes were evaluated. Targeted mutation analysis was performed in fetal DNA for the specific mutations by using polymerase chain reaction (PCR) and direct Sanger sequencing. The diagnosis was confirmed by genetic targeted mutation analysis after birth. Median maternal age, parity and gestational week of IPNDT values were 30 (range 21-35), one (range 0-4) and 11.5 (range 11-17), respectively. Indications for IPNDT were mother being a carrier of the disease for one case (10.0%) and at least one child with OA in the family for nine cases (90.0%). Organic acidemia types investigated were maple syrup urine disease (MSUD), methylmalonic acidemia (MMA) and isovaleric acidemia (IVA) in five (50.0%), three (30.0%) and two (20.0%) patients, respectively. Chorion villus sampling (CVS) was done in seven (70.0%) patients and amniocentesis was performed in three (30.0%) patients. Eight fetuses (80.0%) were found to be healthy and two fetuses (20.0%) were found to be affected (one case with IVA and one case with MMA). The two pregnancies (20.0%) with affected fetuses were terminated. Prenatal diagnosis of OAs is critical. Appropriate prenatal counseling should be given to families with known risk factors.

Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: A prospective study.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis. METHODS AND RESULTS: Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 ± 12.42 were prospectively enrolled. On B-mode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Δ) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 ± 7.54 to 33.54 ± 6.41 kg/m2 (p < 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 ± 1.95 mm vs. 7.41 ± 1.87 mm; p < 0.001 and 0.74 ± 0.13 mm vs. 0.67 ± 0.11 mm; p < 0.001 respectively). A significant correlation between ΔEFT and ΔBMI (r = 0.431, p < 0.001) was shown. ΔCIMT is significantly correlated with ΔEFT, ΔBMI and Δ systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p < 0.05 for all). In multivariate stepwise linear regression analysis; among variables only ΔBMI was the independent predictor of ΔEFT (ß = 153, p = 0.001). CONCLUSION: Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients.

Therapeutic Effects of Islamic Intercessory Prayer on Warts.

The present study aimed to examine the therapeutic effects of Islamic intercessory prayer on warts. Forty-five participants who are mostly Muslims and infected with warts were randomized into three groups: Group-1 (uncertain, with intercessory prayer), Group-2 (uncertain, no intercessory prayer), and control group (informed, no intervention). Stress symptoms were also measured before and after prayer sessions for these three groups. The results revealed that there were no significant differences between the groups in terms of healing. Although participants believed in the therapeutic effects of prayer, when participants did not trust the intercessor, prayer had no effect on warts.

The role of genetics in coronary artery bypass surgery patients under 30 years of age

Aim: We undertook genetic assessment of coronary artery disease (CAD) in 20 patients aged 30 years or less undergoing coronary artery bypass grafting (CABG) surgery, to investigate the prognostic value of pre-defined genes.Methods: Twenty patients, who underwent CABG surgery between December 2001 and May 2013, were retrospectively analysed to find out the role their genetic make-up played in their disease. We used three genetic diagnostic tests, the plasminogen activator inhibitor (PAI)-1 gene, the A1/A2 polymorphism of glycoprotein IIIa (GpIIIa) gene, and common polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene.Results: The mean age of patients was 26.35 ± 3.51 (19­30) years, and 90% were male (n = 18). One patient had diabetes, three had hypertension, 11 (55%) had dyslipidaemia and 16 (80%) were smokers. Eight of the patients (40%) had left ventricular ejection fraction (LVEF) < 50%, and functional capacity was poor in only two (10%) patients (NYHA III­ IV). Follow up was completed in all patients (100%). We found five homozygous and 11 heterozygous mutations in the MTHFR gene, which predisposes individuals to coronary artery disease or deep-vein thrombosis. Eight patients were found to have a GpIIIa gene polymorphism, which is associated with increased risk of myocardial infarction (MI). Fifteen patients had a polymorphism in the promoter region of the PAI-1 gene, which is a major inhibitor of the fibrinolytic system. Conclusion: MTHFR C677T polymorphism, and GpIIIa and PAI-1 genes are risk factors for CAD. In young patients, genetic studies promise to revolutionise early diagnosis, treatment and prevention of CAD and MI

Therapeutic effect of Castellani's paint in patients with an itchy ear canal.

OBJECTIVE: To examine the effects of Castellani's paint on symptomatic relief and skin flora in patients with an itchy external ear canal. METHODS: Subjective pruritus scores, and erythema and desquamation scores, were noted in 61 patients with an itchy external ear canal. External ear canal skin swabs were taken for bacterial and fungal cultures. Patients were then randomly divided into three groups: either Castellani's paint (group one) or steroid ear drops (group two) were instilled, or non-impacted cerumen was removed (group three). Patients were re-assessed at one month after the initial visit. RESULTS: After treatment, subjective pruritus scores were significantly lower in all groups, erythema scores were significantly decreased in group one, and desquamation scores were significantly reduced in groups one and two, when compared with pre-treatment scores. Reproduction density of bacteria including normal flora was decreased in group one. However, the types of bacteria that constitute the normal flora of the external ear canal were unchanged. CONCLUSION: Castellani's paint can be administered safely, effectively and easily, without affecting the type of external ear canal skin bacteria, in patients with an itchy external ear canal.

HEMATOLOGICAL MARKERS OF THE NO-REFLOW PHENOMEN ON IN-PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION.

The study aims to investigate hematological parameters of the no-reflow phenomenon (NRP) developed in patients underwent primary percutaneous coronary intervention (pPCI) due to diagnosis of ST elevation myocardial infarction (STEMI). The study sample consisted of a total of 90 patients, of which 44 patients who underwent pPCI and developed NRP without anemia and chronic renal failure (mean age was 64; 34 males and 10 females) were included in the experimental group, and the control group consisted of 46 patients with normal reperfusion flow (mean age was 58; 34 males and 12 females). In both groups, Red blood-cell Distribution Width (RDW), Mean Platelet Volume (MPV), plateletcrit (PCT), Platelet Distribution Width (PDW), and neutrophil count were observed. The demographic characteristics of both groups were similar, except the higher mean age of the experimental group (age; 64.0±12.6; 58.0±12.5). No correlation was found between development of no-reflow and incidence of risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, family history and gender. In the no-reflow group, RDW level (16.2%±2.1; 14.2%±0.7, p<0.001), MPV level (7.9±1.2; 7.3±0.8, p<0.05), PDW level (18.1±1.2; 17.4±1.2, p<0.05), PCT level (0.2±0.06 vs 0.17±0.05) and neutrophil count (9.9±3.7; 7.1±3.3, p<0.001) was found to be higher than the control group. According to logistic regression analysis, RDW (OR; 23.4, <95% Cl 4.6-118.9, p<0.001), PDW (OR; 2.8, <95% Cl 1.2-6.4, p<0.05) and neutrophil count (OR; 1.4, Cl 1.1-1.9, p<0.05) were found to be the predictors of NRP development. Hemogram is a cheap and easy to apply test. In our study, a relationship between the NRP development and RDW, PDW, MPV, PCT, and neutrophil counts was found in patients who underwent pPCI. At the same time, RDW, PDW, and the neutrophil count were found to be predictors of no-reflow development.

Comparing the short-term outcomes and complications of monopolar and bipolar transurethral resection of non-muscle invasive bladder cancers: a prospective, randomized, controlled study / Comparación de los resultados a corto plazo y complicaciones de la resección transuretral monopolar y bipolar de tumores vesicales no músculo-infiltrantes: estudio prospectivo, randomizado, controlado

OBJECTIVES: To compare perioperative outcomes and complications of plasmakinetic bipolar and monopolar transurethral resection of bladder tumors (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC). METHODS: Between March and December 2015, a total of 130 consecutive patients underwent TURBT for NMIBC. Patients were equally randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome of this study was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was efficacy of both TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues that without any thermal damage. RESULTS: Complete tumor resection rate was higher in B-TURBT than M-TURBT (89.2% vs 78.5%, respectively), but the difference was not significant (p = 0.152). No significant differences were found between the muscle tissue sampling rates (64.6% vs 72.3%, p = 0.345) and the numbers of patients with thermal tissue damage (7 patients vs 3 patients, p = 0.194). Obturator jerk was detected in 21.5% of the patients in M-TURBT group and 4.6% of the patients in B-TURBT group, and this difference was statistically significant (p = 0.013). Bladder perforation was significantly higher in M-TURBT group than B-TURBT (21.5 % vs 6.1%, p = 0.039). CONCLUSIONS: Bipolar TURBT had significantly lower obturator jerk and bladder perforation than monopolar. B- TURBT is a reasonable treatment modality in patients with NMIBC

OBJETIVO: Comparar los resultados perioperatorios y las complicaciones de la resección transuretral bipolar plasmaquinética y monopolar de tumores vesicales en pacientes con carcinoma vesical no musculo-infiltrante (CVNMI). MÉTODOS: Entre marzo y diciembre del 2015, un total de 130 pacientes consecutivos fueron sometidos a RTU de tumor vesical por CVNMI. Los pacientes fueron randomizados por igual en los grupos de RTU monopolar (RTU-M) y RTU bipolar (RTU-B). El objetivo primario del estudio era evaluar la seguridad de la operación incluyendo la contractura del obturador, perforación vesical, retención por coágulos, infección urinaria febril y síndrome post RTU. El objetivo secundario era evaluar la eficacia de ambos procedimientos de RTU, incluyendo la resección completa del tumor, obtención de tejido muscular profundo y de los tejidos cualificados sin lesión térmica. RESULTADOS: La tasa de resección completa del tumor fue superior en el grupo de RTU-B frente al de RTU-M (89,2% vs 78,5%, respectivamente), pero la diferencia no fue significativa (p = 0,152). No se encontraron diferencias significativas entre las tasas de obtención de la capa muscular en las muestras (64,6% vs 72,3%, p = 0,345) ni en el número de pacientes con lesión térmica tisular (7 pacientes frente a 3 pacientes, p = 0,194). Se detectó contractura del obturador en el 21,5% de los pacientes en el grupo de RTU-M y 4,6% de los pacientes del grupo de RTU-B, y esta diferencia era estadísticamente significativa (p = 0,013). La perforación vesical fue significativamente mayor en el grupo de RTU-M frente al de RTU-B (21,5% vs 6,1%, p = 0,039). CONCLUSIONES: La RTU bipolar de tumor vesical tiene una incidencia de contractura del obturador y perforación significativamente menores que la de la monopolar. La RTU-B del tumor vesical es una modalidad de tratamiento razonable en pacientes con CVNMI

Laboratory in complicated appendicitis prediction and predictive value of monitoring.

OBJECTIVES: The purpose of the study was that monitoring, which is used in diagnosis of acute appendicitis, and laboratory values, were evaluated for verifying diagnosis of complicated appendicitis and these parameters revealed cut-off values in complicated acute/non-complicated appendicitis. METHODS: 195 patients, who had had an operation for acute appendicitis between January 2012 and March 2015 and who were proved to have acute complicated/non-complicated appendicitis from the results of histopathology consideration, were included in this study. Patients' age, preoperative serum, WBC, CRP, NLR and BT with USG results were evaluated.    RESULTS: Among the groups, there were no meaningful differences in the sense of age. Meaningful difference was obtained in between (p > 0.05), WBC, NLR, CRP and appendix diameter values.Serum in WBC >13800 (AUC = 0.614, p = 0.006, %95 GA: 0.541-0.682), in NLR > 4.87 (AUC = 0.641, p = 0.001, %95 GA: 0.569-0.708), in CRP > 5.98 (AUC = 0.651, p 11 mm (AUC = 0.630, p = 0.002, %95 GA: 0.558-0.698) values were obtained. The values that were obtained, were confirmed to be descriptive in analysis of complicated appendicitis and non-complicated appendicitis.According to the obtained cut-off values, serum WBC, diameter of appendicitis, NLR and CRP values', (OR) ratios were calculated for complicated appendicitis by being classified (odds ratio respectively; 3.103 (1.713-5.621), 2.765 (1.496-5.109), 3.025 (1.665-5.494), 2.313 (1.295-4.130)). CONCLUSION: It is important that treatment options are evaluated to be able to discriminate complicated appendicitis fast and with a high accuracy. In the case that serum WBC is higher than 13800. CRP is higher than 5.98, NLR is higher than 4.87 and appendicitis diameter is longer than 11mm, inflammation of appendicitis is complex with gangrene, perforation and abscess and it emphasizes the suggestion of surgical treatment option to patients (Tab. 4, Fig. 1, Ref. 28).

DETERMINATION OF VOLUME OVERLOAD BY BIOELECTRICAL IMPEDANCE ANALYSIS AND NT-PROBNP IN DIABETIC PRE-DIALYSIS PATIENTS.

INTRODUCTION: Diabetic chronic kidney disease has more fatal clinical progresses and this situation can be related to volume overload, which is seen more commonly in diabetic chronic kidney disease patients than in non-diabetic chronic kidney disease patients. Therefore, we examined the effect of diabetes mellitus on volume overload in newly diagnosed stage 5 chronic kidney disease patients whose volume overloads were not showing signs of improvement from renal replacement therapy. METHOD: One hundred and five patients (46 diabetic, 59 non-diabetic) with end-stage chronic kidney disease, who had glomerular filtration rate (GFR) under 15 mL/min for at least three months were enrolled in this prospective study. We determined the body volume overload and configuration using a bioimpedance device. NT-proBNP levels were recorded. RESULTS: There was a statistically significant difference between diabetic and non-diabetic groups according to overhydration (OH, p=0.003), extracellular water (ECW, p=0.045), intracellular water (ICW, p<0.001) and OH/ECW (p=0.003). In addition, there was a statistically significant difference between groups in terms of N-terminal Pro-brain Natriuretic Peptide (NT-proBNP levels, p=0.008). DISCUSSION: We compared diabetic and non-diabetic end-stage chronic kidney disease patients who were not in renal replacement therapy yet. We found more volume overload and extracellular fluid volume in the diabetic group.

Is there a difference in mad honey poisoning between geriatric and non-geriatric patient groups?

OBJECTIVE: This study aims to investigate the demographic, toxicological characteristics of the mad honey intoxication at ages 65 and above, to analyze the electrocardiographic parameters, and to compare with the mad honey intoxication at ages below 65 years. PATIENTS AND METHODS: Eighty-two patients, who had been treated and followed-up between June 2013 and November 2014 in the Emergency Service of the Findikli State Hospital, Turkey, due to diagnosis of mad honey intoxication, were included in our observational study. Age, gender, toxicological characteristics, laboratory parameters, heart rates, systolic and diastolic blood pressures, laboratory analyses and electrocardiographic data of the patients were recorded and analyzed. Patients with known coronary artery disease, chronic renal failure, arrhythmias, valvular heart disease, history of thyroid disease and electrolyte imbalance were not included in the study. RESULTS: Eighty-two (80.5% was male and the mean age was 53 ± 15 years) patients followed-up due to mad honey intoxication were included in our study. There were 64 (78%) patients aged below 65 years, and 18 (22%) patients aged 65 and above. The mean heart rate was 45 ± 7 beats/min, systolic blood pressure was 83 ± 12 mmHg and diastolic blood pressure was 52 ± 9 mmHg on admission. The onset of symptoms of the patients was found as 0.84 hours on average after mad honey consumption, the average amount of honey consumed was 3.7 ± 1.1 tablespoons, and the mean recovery time of the symptoms was found to be 1.04 hours. The most common presenting symptoms were nausea-vomiting in 82 (100%) patients and dizziness in 73 (89%) patients. Patients were found to consume mad honey mostly for achieving a remission in gastrointestinal complaints (n=18, 22%), and for utilizing its blood pressure lowering properties (n=11, 13.4%), in addition to the dietary consumption. Looking at the heart rates of the patients on admission to the emergency service, 65 (79.3%) patients had normal sinus rhythm/sinus bradycardia, 12 (14.6%) patients had a 1st degree atrioventricular block, 3 (3.7%) patients had nodal rhythm, 1 (1.2%) patient had atrial fibrillation and 1 (1.2%) patient had preexcitation. There were no significant pathological findings in the routine laboratory examinations of patients. It was found that all patients achieved normal sinus rhythm and normal blood pressure values after medical treatment, and were discharged approximately 5.65 hours after observation and follow-up. In our study, prolonged intensive-care need, pacemaker need and mortality caused by mad honey intoxication were not found. In the comparison of data of all patients above and below 65 years of age, there was a statistically significant finding that the geriatric patients consume mad honey mostly for hypotensive purposes and gastrointestinal complaints; in addition, the symptoms were starting early and the recovery period was longer in geriatric patients. CONCLUSIONS: The mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and atrioventricular block. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension. And, in addition to the primary cardiac, neurological and metabolic disorders, mad honey intoxication should also be considered in the differential diagnosis. In geriatric patients admitted due to mad honey intoxication, the mad honey is usually consumed to reduce blood pressure and resolve gastrointestinal problems; and, their symptoms begin early, and last longer after mad honey consumption. In terms of other parameters, the geriatric age group has similar characteristics to non-geriatric age group.

The effects of tranexamic acid and 6% hydroxyethyl starch (HES) solution (130/0.4) on postoperative bleeding in coronary artery bypass graft (CABG) surgery.

BACKGROUND: The addition of 6% hydroxyethyl starch (HES) into Ringer lactate priming solution may have adverse effects on hemostasis in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) with or without the use of tranexamic acid. METHODS: In a prospective, randomized clinical trial, 132 patients were assigned to receive 20 ml/kg of Ringer priming solution with or without tranexamic acid (TA) (Group RS-TA, n=34 and Group RS-noTA, n=32) or 10 ml/kg of 6% HES plus 10 ml/kg of RS priming solution with or without intravenous tranexamic acid (Group HES-TA, n=35 and Group HES-noTA, n=31). Estimated blood loss, chest tube drainage, amount of blood products, hemoglobin, hematocrit, platelet and coagulation parameters were examined before and 24 hour after surgery. RESULTS: For Group HES with tranexamic acid, when compared to other groups, estimated blood loss, postoperative 24 hour drainage loss and blood product transfusions were less (P=0.023; P=0.003; P=0.001; respectively) and hemoglobin, hematocrit values at 12 and 24 hours after surgery increased in comparison to other groups (P=0.041, P=0.034, P=0.004, P=0.001; respectively). Platelet concentrations were similar between groups (P>0.05). CONCLUSIONS: In CABG, the administration of tranexamic acid in HES 130/0.4 prime solution study group decreased estimated blood loss and chest tube drainage in comparison to patients receving Ringer prime solution with or without tranexamic acid postoperatively however, no effects on renal functions or postoperative complications were shown.