Diagnostic Contribution of Additional Sequences to the Evaluation of Cord Lesions in Patients with Cervical Spinal Multiple Sclerosis in Turkey: A Retrospective Study.

BACKGROUND: Multiple Sclerosis (MS) is the most common cause of non-traumatic disability in young adults. Spinal cord involvement is observed in 55-75% of patients with MS. AIM: To identify the strengths and shortcomings of sagittal phase-sensitive inversion recovery (PSIR), sagittal proton density/T2-weighted (PD/T2W), and axial turbo inversion recovery magnitude (TIRM) sequences in the detection of cervical MS plaques by comparing with routine sequences (axial and sagittal T2W, sagittal T1W, sagittal TIRM, fat-suppressed contrast T1W) and therefore determine their diagnostic contributions. MATERIALS AND METHODS: A total of 48 patients in whom additional magnetic resonance imaging (MRI) sequences were obtained for the diagnosis of cervical MS were retrospectively identified and included in the study. A total of 111 MS plaques were analyzed in terms of visibility, number, size, border sharpness, and intensity ratio based on the routine and additional MRI sequences. The evaluation of the images was independently undertaken by two radiologists. RESULTS: The highest visibility was provided by sagittal PSIR, sagittal TIRM, and axial TIRM sequences (P < 0.05 for all additional sequences). Seven lesions in PD/T2W and four lesions in axial T2W sequences were unable to be detected. Lesions seen in sagittal and axial TIRM sequences were larger than the others. The sharpest borders were determined in the axial TIRM sequence, and the most diffuse borders in the PD/T2W sequence. In intensity ratio, the sagittal PSIR sequence revealed the most significant contrast difference. CONCLUSION: The sagittal PSIR sequence may improve the detection of cervical MS plaques due to the improved visibility and intensity ratios. The axial TIRM sequence may be more useful than routine axial T2W in the evaluation of visibility, border sharpness, and size measurement of MS plaques.

Investigation of the effects of swimming exercises in rats given acrylamide.

BACKGROUND: Acrylamide is a toxic substance used in industrial and laboratory processes. Acrylamide exposure has a toxic effect on many systems. Protective mechanisms should be developed against the effects caused by acrylamide. OBJECTIVE: In our study, we investigated whether exercise has a protective effect against the changes that acrylamide will cause in pancreas. METHODS: 32 adult Sprague-Dawley male rats were used. Control group was given only saline. Exercise group was applied swimming exercise for 1hour daily for 4 weeks. Acrylamide group was given 50mg/kg acrylamide by gavage for 4 weeks. Acrylamide+exercise group was applied 50mg/kg acrylamide for 4 weeks and swimming exercise for 1hour daily. After the experiment, fasting blood glucose and oral glucose tolerance test measurements were performed. Then, blood and pancreas samples were taken. RESULTS: Acrylamide exposure caused an increase in fasting blood glucose and oral glucose tolerance, a decrease in insulin levels and oxidative stress in acrylamide group. In exercise group, these values were similar to control group and no significant change was observed in acrylamide+exercise group. While there was an increase in the number of alpha cells in acrylamide group compared to the other groups, here was a decrease in the number of beta cells compared to control group. CONCLUSION: We can say that acrylamide causes changes in the islets of Langerhans by affecting alpha and beta cell numbers. The protective effect of exercise on beta and alpha cell mass was not statistically significant in the acrylamide+exercise group. When the results were examined, the decrease in oxidative stress and the higher number of beta and alpha cells in the acrylamide+exercise group compared to the acrylamide group suggested that 4 weeks of swimming exercise may have an effect on acrylamide exposure.

New approach to morphometric analysis of Huschke's foramen.

BACKGROUND: The aim of the study is to analyse the demographic and anatomical details of the Huschke's foramen (HF) which have not been previously studied and to present a new clinical perspective. MATERIALS AND METHODS: Multidetector computed tomography (MDCT) images of 495 patients were retrospectively evaluated. Presence of a HF, its' size, relations to side, age and gender were noted for every patient. Size of the foramen was measured in the axial plane, as well as on the reconstructed coronal and sagittal planes. RESULTS: Of the 495 patients 99 (20%) had HF. There was no significant difference between females and males according to the presence of the HF and the side of the HF. When the dimension of the left- and the right-sided HFs were compared, there were no significant differences on none of the axes for the patients with unilateral or bilateral HF. There was no significant linear correlation between age and the dimension in the axial axis, the dimension in the sagittal axis and the dimension in the coronal axis CONCLUSIONS: The present work presenting morphologic and statistical variables of HF provides data for further studies which will indicate risk factors of herniation through HF. By the aid of MDCT, which is sensitive method for detection of the HF because of its thin sections, high spatial resolution, and multiplanar capabilities, lesions which were previously diagnosed as dehiscence were found to be defects.

Response to doxycycline and oxytetracycline treatments in cats infected with Mycoplasma spp. and analysis of haemato-clinical findings and risk factors.

This study was planned to determine the efficacy of doxycycline and oxytetracycline in the treatment of feline Mycoplasma spp. infections and to analyze risk factors as well as clinical and haematological findings. Cats accepted to the clinic with complaints such as weakness, loss of appetite and fever were routinely examined. Clinical history of animal was demanded from the owner. An interview and a short questionnaire were conducted to owner to evaluate the risk factors associated with possible Mycoplasma status of animal. During the interview, the age, sex, breed, housing, flea infestation, worm control, external parasite control, other accompanying infections and vaccination status of cats were asked and the data recorded. Peripheral blood smears were stained with the DIFF-QUICK. Fifty positive cats were included in the study, 16 of which were treated with doxycycline (orally, 5 mg/kg twice a day) while other 34 with oxytetracycline (intramuscular injection, 10 mg/kg once a day). It was determined that all (100%) cats with Mycoplasma spp. infection had a flea infestation. Majority of cats (94%) did not receive the regular antiparasitic application and only 6 (12%) of them had complete vaccinations. Mycoplasma spp. infection was associated with younger age and outdoor access. Among the feline breed, striped cat (74%) was more prone to infection. The most common clinical signs encountered in cats were weakness (94%) and anorexia (84%). Haematological parameters revealed thrombocytopenia (86%), and anaemia (40%) in infected cats. At the end of the treatment, recovery rates for doxycycline and oxytetracycline groups were 87.5% and 67.6%, respectively. General status of these cats indicated significant improvement on the 4th day of treatment, and clinical symptoms are restored on the th day. Mycoplasmosis is an important infection for cats having anaemia, thrombocytopenia and leukocytosis. Flea infestations are risk factor for contamination of the disease. Based on our results, we recommend doxycycline treatment (5 mg/kg) for up to 21 days for elimination of Mycoplasma spp. in the blood of infected cats.

Increased risk of death associated with the use of proton-pump inhibitors in patients with dementia and controls - a pharmacoepidemiological claims data analysis.

BACKGROUND AND PURPOSE: The use of proton-pump inhibitors (PPIs) was reported to be associated with increased mortality risk and has been proposed as a potential risk factor for neurodegenerative diseases. We aimed to assess the impact of PPI use on survival in patients with dementia as compared with controls. METHODS: This register-based control-matched cohort study included 28 428 patients with dementia ascertained by the prescription of antidementia drugs and two control individuals matched by sex, age and area of residence for each patient with dementia during the study period from 1 January 2005 to 30 June 2016. Cumulative defined daily doses (DDDs) of PPIs were extracted from the health insurance prescription registries. A multivariate Cox regression model for non-proportional hazards was used to analyse mortality risk in dependence of PPI exposure, which was limited to 1 year preceding the date of cohort entry (index date) in order to avoid immortal time bias. RESULTS: The PPI exposure of 100 DDDs in the year before the index date was associated with an increased mortality risk in patients with dementia (adjusted hazard ratio, 1.07; 95% confidence intervals, 1.03-1.12), but also in controls (adjusted hazard ratio, 1.47; 95% confidence intervals, 1.31-1.64). The mortality risk in relation to PPI use was significantly lower in patients with dementia as compared with controls (P < 0.0001) and highest in the first 2 years after the index date in both cohorts. CONCLUSIONS: Our findings promote more stringent pharmacovigilance strategies to avoid PPI use in cases lacking a clear indication for therapy or where potential risks outweigh the benefits.

Genotype-guided diagnostic reassessment after exome sequencing in neuromuscular disorders: experiences with a two-step approach.

BACKGROUND AND PURPOSE: Next-generation sequencing has greatly improved the diagnostic success rates for genetic neuromuscular disorders (NMDs). Nevertheless, most patients still remain undiagnosed, and there is a need to maximize the diagnostic yield. METHODS: A retrospective study was conducted on 72 patients with NMDs who underwent exome sequencing (ES), partly followed by genotype-guided diagnostic reassessment and secondary investigations. The diagnostic yields that would have been achieved by appropriately chosen narrow and comprehensive gene panels were also analysed. RESULTS: The initial diagnostic yield of ES was 30.6% (n = 22/72 patients). In an additional 15.3% of patients (n = 11/72) ES results were of unknown clinical significance. After genotype-guided diagnostic reassessment and complementary investigations, the yield was increased to 37.5% (n = 27/72). Compared to ES, targeted gene panels (<25 kilobases) reached a diagnostic yield of 22.2% (n = 16/72), whereas comprehensive gene panels achieved 34.7% (n = 25/72). CONCLUSION: Exome sequencing allows the detection of pathogenic variants missed by (narrowly) targeted gene panel approaches. Diagnostic reassessment after genetic testing further enhances the diagnostic outcomes for NMDs.

Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula.

PURPOSE: To evaluate the added value of diffusion-weighted (DWI) magnetic resonance imaging (MRI) by comparison with T2-weighted images alone in the diagnosis of perianal fistula. MATERIAL AND METHODS: MRI examinations of 123 patients (97 men, 26 women; mean age, 41.9 years) with suspected perianal fistula were retrospectively evaluated by two radiologists. Fat-suppressed T2-weighted fast spin echo images, DWI (b values, 0 and 1000s/mm2) and fat-suppressed gadolinium chelate-enhanced T1-weighted images were evaluated for each patient by using a four-point scale. Confidence scores and sensitivities were calculated for T2-weighted images alone, the combination of DWI and T2-weighted images and the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images. The combination of gadolinium chelate-enhanced and T2-weighted images was used as reference standard. RESULTS: Perianal fistulas were present in 92/123 patients (74.8%). An almost perfect interobserver agreement was found for T2-weighted images (kappa=0.868), the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images (kappa=0.96) and the combination of DWI and T2-weighted images (kappa=0.90). The confidence scores for the diagnosis of perianal fistula for the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images were greater than those of T2-weighted images alone for observer 1 (P<0.001) and observer 2 (P=0.009). The confidence scores of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for observer 1 (P<0.001) and observer 2 (P=0.032). Sensitivity and specificity of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for both observers. CONCLUSION: DWI has a significant added value compared to T2-weighted imaging alone in the diagnosis of perianal fistula.

Pediatric Awake Craniotomy for Brain Lesions.

Awake craniotomy is a special method to prevent motor deficits during the resection of lesions that are located in, or close to, functional areas. Although it is more commonly performed in adult patients, reports of pediatric cases undergoing awake craniotomy are limited in the literature. In our clinic, where we frequently use awake craniotomy in adult patients, we performed this method in 2 selected pediatric cases for lesion surgery. At an early age, these 2 cases diagnosed with epilepsy presented cerebral lesions, but since the lesions enclosed functional areas, surgical resection was not regarded as a treatment option at this time. In these 2 pediatric cases, we successfully completed lesion surgery with awake craniotomy. The method and the techniques employed during surgery are presented concomitant with other reports in the literature.

The c.65-2A>G splice site mutation is associated with a mild phenotype in Danon disease due to the transcription of normal LAMP2 mRNA.

Danon disease (DD) is a rare X-linked multisystem disorder caused by mutations of the LAMP2 gene and characterized by intellectual disability, skeletal myopathy and cardiomyopathy. The survival time is severely reduced. Contrasting with the usual disease course, we report on a family with an exceptionally mild phenotype of DD despite having two potentially damaging LAMP2 mutations. Using RNA-Seq analysis, we showed that a c.65-2A>G splice site mutation results in the tissue-specific production of four different transcripts including the full-length mRNA in muscle tissue but not in leukocytes. We confirmed our results by immunohistochemistry and immunoblotting, showing the detection of LAMP2 protein only in muscle. The second mutation (c.586A>T, p.T196S) has been reported before to have an uncertain clinical significance. In our patients, however, neither of the two mutations seem to have a high enough functional impact to cause a severe phenotype. Overall, our study reveals that alternative splicing is a potential mechanism in DD with underlying splice site mutations of the LAMP2 gene in order to rescue the full-length mRNA. Moreover, our report of a mild phenotype complements the DD spectrum, which is of great importance for a rare disease suspected to be underdiagnosed.

Early laparoscopic cholecystectomy with continuous pressurized irrigation and dissection in acute cholecystitis.

Background. The aim of this study was to evaluate the preliminary results of a new dissection technique in acute cholecystitis. Material and Method. One hundred and forty-nine consecutive patients with acute cholecystitis were operated on with continuous pressurized irrigation and dissection technique. The diagnosis of acute cholecystitis was based on clinical, laboratory, and radiological evidences. Age, gender, time from symptom onset to hospital admission, operative risk according to the American Society of Anesthesiologists (ASA) score, white blood cell count, C-reactive protein test levels, positive findings of radiologic evaluation of the patients, operation time, perioperative complications, mortality, and conversion to open surgery were prospectively recorded. Results. Of the 149 patients, 87 (58,4%) were female and 62 (41,6%) were male. The mean age was 46.3 ± 6.7 years. The median time from symptom onset to hospital admission 3.2 days (range, 1-6). There were no major complications such as bile leak, common bile duct injury or bleeding. Subhepatic liquid collection occurred in 3 of the patients which was managed by percutaneous drainage. Conversion to open surgery was required in four (2,69%) patients. There was no mortality in the study group. Conclusion. Laparoscopic cholecystectomy with continuous pressurized irrigation and dissection technique in acute cholecystitis seems to be an effective and reliable procedure with low complication and conversion rates.

The effect of psychological support for the relatives of intensive care unit patients on cadaveric organ donation rate.

We searched to see whether psychological support for relatives of intensive care unit patients helps them to donate organs of their brain-dead relatives. After receiving ethics committee permission, first-degree relatives of 200 general intensive care unit patients were enrolled in the study. The participants were divided into 2 groups randomly: an interview group (n = 100) and a control group (n = 100). Participants were asked to complete a questionnaire. Interviews with the psychologist and patients' relatives in the interview group were therapeutic in nature and were conducted according to the relatives' psychosocial needs in an unstructured format. In the control group, the psychologist and patients' relatives were not interviewed. The study utilized demographic data, the questionnaire for relatives of patients to mention their attitude on organ donation and the reasons for this choice, and the Participant Information Form to record demographic data and relatives' degree of relationship with the patient. There was no statistically significant difference between the 2 groups when compared according to sex ratio, patient age, and duration of patients' hospital stay. Whereas in the interview group, 75% agreed to allow their relatives to be organ donors, only 32% in the control group agreed (P < .0001). Of the 200 patients enrolled in the study, 93 lost their lives: 50 from the interview group and 43 from the control group. Among the relatives whose patients had lost their lives, 78% belonging to the interview group accepted to donate the organs of their patients, whereas in the control group 13.9% accepted (P < .0001). We hope that psychological support for the relatives of the potential brain-dead donor to cope with the psychological problems to be faced can improve the rate of organ donation.

Electroconvulsive therapy during pregnancy as a possible cause of Möbius syndrome: additional clinical observation.

Möbius syndrome is a rare congenital disease with a prevalence of between 0.0002 and 0.002% of births. Minimum diagnostic criteria for this disease include congenital unilateral or bilateral facial and abducens nerve paresis. Occasionally, the cranial nerves V and VIII are affected. If cranial VIII is affected, the person experiences hearing loss. Other findings in these patients that are not part of the diagnostic criteria include the involvement of other cranial nerves, malformations of orofacial structures, reductive limb anomalies, and defects of the chest wall. We herein report a newborn case with Möbius syndrome.

The effect of early prednisolone treatment on the generalization rate in ocular myasthenia gravis.

BACKGROUND AND PURPOSE: Several small retrospective studies have observed that patients with a purely ocular manifestation of myasthenia gravis (MG) are significantly less likely to convert to a generalized disease when treated early on with corticosteroids. However, given the limited number of reported patients in the literature these findings still remain controversial. METHODS: In order to increase the number of published cases, we performed a retrospective analysis on 44 patients with newly diagnosed ocular MG who were subsequently either treated with corticosteroids or received no immunosuppressive therapy at all. The generalization rate was assessed at the end of a 2-year follow-up period. RESULTS: Whereas none of 17 treated patients generalized, 11 of 27 (41%) untreated patients developed generalized symptoms. The difference between the groups was significant (P=0.003). CONCLUSIONS: Our results agree well with previous studies on this issue. Taken together, published data indicate risk ratios for generalization of below 0.32 under corticosteroid treatment in comparison to untreated patients.

Larvicidal activity of some secondary lichen metabolites against the mosquito Culiseta longiareolata Macquart (Diptera: Culicidae).

The larvicidal activity of some lichen metabolites, (+)-usnic acid, atranorin, 3-hydroxyphysodic acid and gyrophoric acid, against the second and third instar larvae of the mosquito Culiseta longiareolata were studied. All metabolites caused high larvicidal activities. When metabolites were compared on the basis of their LC(50) values, the order of increasing toxicity was as follows: gyrophoric acid (0.41 ppm) > (+)-usnic acid (0.48 ppm) > atranorin (0.52 ppm) > 3-hydroxyphysodic acid (0.97 ppm). However, when LC(90) values were compared, the order of toxicity was (+)-usnic acid (1.54 ppm) > gyrophoric acid (1.93 ppm) > 3-hydroxyphysodic acid (4.33 ppm) > atranorin (5.63 ppm). In conclusion, our results found that lichen secondary metabolites may have a promising role as potential larvicides.

Polycythaemia in infants of diabetic mothers: ß-hydroxybutyrate stimulates erythropoietic activity.

This study tested whether elevated maternal ß-hydroxybutyrate (ß-OHB) levels contribute to polycythaemia in infants of diabetic mothers. Pregnant diabetic women (n = 27) and non-diabetic controls (n = 20) and their singleton infants were included. Maternal glycosylated haemoglobin and ß-OHB levels were studied at 34-36 weeks' gestation; levels were significantly higher in mothers with diabetes than in controls. Birth weights and cord blood levels of insulin and fetal haemoglobin were significantly higher in infants from diabetic mothers compared with control infants, as were haematocrit levels in venous blood samples taken from each infant at 4 h following delivery. Cord blood erythropoietin levels were similar in both groups. There was a positive strong correlation between maternal ß-OHB levels and polycythaemia in newborn infants, indicating that ß-OHB could activate erythropoiesis independently from intrauterine hyperinsulinaemia and/or erythropoietin levels, and may be important in the pathogenesis of polycythaemia in infants born to diabetic mothers.

MDCT Assessment of the Cochlear-Carotid Interval.

The close anatomic course between the cochlea and the carotid artery presents a possible surgical risk during increasingly popular cohlear implant surgery. The purpose of this study was to determine the normal range of the this region termed "cohlear- carotid interval" (CCI) by 64-slice multi-detector computed tomography (MDCT) in the population. The study investigated 1105 patients who had undergone temporal MDCT. The CCI measured by two observers from 0.5 mm thick coronal images with confirmation on axial and sagittal planes. Among 1105 patients and 2210 temporal sides CCI measured 0.0 mm unilaterally in eight (0.7%) and bilaterally in two patients (0.1%) with a score of ten in the total population (0.9%). Total scores ranged from 0.0 to 6 mm for right CCI and 0.0 to 5.9 mm for left CCI. The CCI showed no significant relationship with sex (P=.096) and there were no significant differences between readers (P=.457) and sides (P=.879). A positive correlation (r=0.741) was found between right and left CCI. The present study demonstrated that the CCI varies considerably between 0.0 mm and 6 mm independently of sex in the population. Understanding the importance of CCI and preoperative knowledge of thin or absent bone allows the radiologist to play a crucial role in alerting the surgeon to prevent penetration of the carotid canal during cochlear implant surgery.

Acaricidal activity of Satureja thymbra L. essential oil and its major components, carvacrol and gamma-terpinene against adult Hyalomma marginatum (Acari: Ixodidae).

The acaricidal activity of a volatile essential oil hydrodistillate of Satureja thymbra L. (Lamiaceae) and its major constituents, carvacrol and gamma-terpinene, were evaluated against field-collected unfed adult Hyalomma marginatum. The distillate was tested against this tick species at 5, 10, 20, and 40 microL/L while the two major components were each tested at 10 microL/L. Generally, tick mortality to the S. thymbra distillate increased with concentration and exposure time. Ticks exposed to vapors from cotton wicks containing at least 40 microL/L resulted in complete (100%) mortality at 3h. The lower concentrations provided >or=90% mortality at 3h post treatment with complete mortality at 24h. Knockdown was observed only in the carvacrol and gamma-terpinene treatments. Ticks exposed to carvacrol-treated wicks produced >93% knockdown at 3h but at 24h approximately 57% were dead. The gamma-terpinene treatment produced >or=90% knockdown at 105 min through 3h but at 24h only about 87% of the ticks were dead.

Effects of Two Temperature Storage Regimes on the Efficacy of 3 Commercial Gel Baits against the German Cockroach, Blattella germanica L. (Dictyoptera: Blattellidae).

BACKGROUND: To compare the effectiveness of 3 commercial gel bait formulations containing fipronil (Goliath(©) Cockroach Gel 0.05% AI), chlorpyrifos-A (Clean Bait(©) Gel, 2% AI), and chloropyrifos-B (Serpa(©) Gel 2% AI) against German cockroaches (Blattella germanica) when stored at 23(°)C and 30(°) C after treatment. METHODS: Laboratory bioassays consisted of placing groups of fifteen cockroaches (a random combination of adult, mixed sex and large nymphs-stage 6) into a 5 L cylindrical plastic container with one drop of product (avg 0.10 g ± 0.01 g) applied to a 76 mm x 26 mm glass microscope slide affixed to the bottom of each container (one product tested per container). Cumulative mortality was assessed at 6 h, 1, 2, 3, 4, and 5 d after application. To determine the further effects of storage temperature after treatment on residual activity of the gels, a drop of each product was applied to separate glass microscope slides and stored at either 23(°) C (warm) or 30(°) C (hot) under dark conditions for 0, 1, 7, 14, 30, 45, 60 and 90 d after application. RESULTS: Freshly applied baits (day 0) containing fipronil provided complete cockroach mortality (100%) within 5 d whereas chloryrifos-A and chlorpyrifos-B provided ≈72% and 88% mortality, respectively. Generally, cockroach mortality was greater when gels were stored at 30(°)C compared with 23(°) C. CONCLUSION: The fipronil gel formulation proved to be as efficacious as the chlorpyrifos gels and in some instances surpased the latter formulations depending on storage time and temperature by providing ≈90% mortality at 90 d post treatment.