Reproductive performance with short-time controlled internal drug release (CIDR)-based synchronization protocol for fixed-time artificial insemination in nulliparous and primiparous Saanen goats.

In this study, it was aimed to evaluate the reproductive performance of primiparous and nulliparous Saanen goats following the insemination made cervically via frozen commercial buck semen with short-time controlled internal drug release (CIDR, Eazi-Breed, Pfizer)-based synchronization. In the study, a total of 50 Saanen goats, 26 of which were aged 9 months and 24 of which were aged 2 years, were used. The CIDRs including 0.33 g of progesterone were applied to all the goats for 7 days and while the CIDRs were taken out of the vagina, the 500 IU equine chorionic gonadotropin (eCG) was injected intramuscularly. The first dose was administered in a fixed-time manner with mini straws of 0.25 ml including 300x106 motile frozen spermatozoa 24 hours after the injection without making estrus detection, and the second dose insemination was applied 24 hours later. In the study, although the pregnancy rate, fecundity, prolificacy and multiple birth rate values (83%, 1.25, 1.50 and 60%) obtained in the primiparous goats were found to be higher than those found in the nulliparous age group (80%, 0.84, 1.05 and 38%), they were not statistically significant. It was concluded that the effects of the CIDR-based double-dose insemination applications in the primiparous and nulliparous Saanen breed goats in breeding season for 7 days on fertility were similar and the cervical insemination method, a quick and more practical option compared to the intrauterine insemination, could be used successfully in both age groups.

Real world results of venetoclax combined with hypomethylating agents in relapsed/refractory AML.

OBJECTIVE: Relapsed/refractory AML cases are much more resistant to chemotherapy. Venetoclax is a highly sensitive BCL-2 inhibitor. It was aimed to evaluate the effects of venetoclax therapy on real-world R/R AML survival outcomes, the effects of the cytogenetic characteristics of the patients and previous clinical applications on treatment response, and venetoclax treatment toxicity. PATIENTS AND METHODS: The study included patients who only received a venetoclax-based salvage on R/R AML patients from Turkey. The study included a total of 62 patients from 6 different centers in Turkey. Response to 2 cycles of venetoclax treatment was assessed by bone marrow blast rate. The demographic data, cytogenetic characteristics, AML type, MDS type, response rates and overall survival of the patients after venetoclax combination treatment were assessed. Median age of the patients was 65 (19-85). Mean number of prior treatments was 2.67 ±1.75. RESULTS: 13 patients (21%) had a history of allogenic stem cell transplantation. 58 (93.5%) had received HMA therapy before venetoclax. 36 patients (58.1%) had de-novo AML, and 25 (40.3%) previously had MDS. Treatment response was evaluated as complete remission (n = 21, 33.9%), partial response (n = 17, 27.4%), and treatment failure (n = 24, 38.7%). Patients in the TF group were significantly more likely to have poor cytogenetic and to have received allogeneic transplants. The mean estimated overall survival after the venetoclax treatment was 9.13 ± 0.75 months. CONCLUSIONS: The study population consisted of a group of patients who had relapsed or primary refractory disease with poor prognosis, despite numerous rounds of chemotherapy. It is our belief that the high response rates obtained with the combination of venetoclax/HMA, and having obtained positive results with poor risk patients, indicated a promising perspective for R/R AML patients.

Value of copeptin and S100B protein in the differential diagnosis of central vertigo and peripheral vertigo.

OBJECTIVE: To investigate the usefulness of copeptin and S100B levels in the differentiation of central and peripheral vertigo. METHODS: Ninety patients were included in the study. Copeptin and S100B levels were measured using the enzyme-linked immunosorbent assay method. RESULTS: The time between symptom onset and presentation to the emergency department was longer in the patients diagnosed with central vertigo. S100B and copeptin levels were significantly higher in central vertigo patients. The confirmed cut-off value was 17 for the S100B level and 1.65 for the copeptin level. CONCLUSION: Quick and reliable differentiation between central and peripheral vertigo is important to reduce the length of hospital stay of patients in the emergency department, and for patient comfort. S100B and copeptin levels are potential biomarkers in the differential diagnosis of central vertigo and peripheral vertigo for patients whose aetiology of vertigo cannot be differentially diagnosed with history-taking and physical examination.

Community-acquired hypokalemia in elderly patients: related factors and clinical outcomes.

PURPOSE: Electrolyte imbalance is a common problem affecting the elderly. Increased number of comorbidities and frequent use of drugs may contribute to increased risk of hypokalemia in the elderly. This study was performed to investigate the prevalence of community-acquired hypokalemia (CAH), risk factors for its development, related factors with hypokalemia, and morbidities and all-cause mortality rates (MR) of CAH in the elderly patients. METHODS: Total of 36,361 patients aged above 65 years were screened retrospectively. Group 1 consisted of 269 elderly patients with potassium level ≤3.5 mmol/L, and group 2 (control group) consisted of 182 subjects with potassium level between 3.6 and 5.5 mmol/L. Etiologic factors of CAH, presence of comorbidities, duration of hospital stay, hospital cost, and clinical outcomes were recorded. RESULTS: Prevalence of hypokalemia was found 3.24% in patients aged above 65 years. Duration of hospital stay, presence of ≥2 comorbid diseases, hospital cost, and MR were significantly higher in group 1 compared to group 2 (p < 0.001 for all). Loop diuretics, hydrochlorothiazides, beta agonists, inadequate oral intake, and female gender were all independent risk factors for CAH in elderly patients. Patients with ≥2 comorbid diseases were found to have greater risk of hypokalemia than the patients with <2 comorbidities. CONCLUSIONS: Length of hospital stay, hospital cost, and MR were higher in elderly with CAH. Female gender, hydrochlorothiazides, loop diuretics, and ≥2 comorbid diseases are the leading risk factors associated with CAH in elderly.

Does systemic clarithromycin therapy have an inhibitory effect on tympanosclerosis? An experimental animal study.

OBJECTIVE: To demonstrate the inhibitory effects of clarithromycin on in vitro tympanosclerosis. METHOD: Twenty-eight rats were divided into three groups: a clarithromycin group, a non-clarithromycin group and a negative control group. Those in the first two groups were injected with Streptococcus pneumoniae following a myringotomy, and tympanosclerosis was experimentally induced. Oral clarithromycin therapy was administered in the clarithromycin group. The other groups received no medical treatment. RESULTS: All eardrums in the clarithromycin and non-clarithromycin groups developed myringosclerosis, but there was only one eardrum, in the clarithromycin group, with very severe myringosclerosis. In the clarithromycin group, 11 ears showed no inflammation and there were no ears with severe inflammation. In the non-clarithromycin group, there were 11 ears with severe inflammation. The mean eardrum thickness in the clarithromycin group was 20.93 µm and in the non-clarithromycin group it was 42.71 µm. CONCLUSION: Acute otitis media and myringotomies induced tympanosclerosis, but clarithromycin reduced the severity of tympanosclerosis.

The effect of radiofrequency radiation generated by a Global System for Mobile Communications source on cochlear development in a rat model.

OBJECTIVE: This study aimed to determine the effect of radiofrequency radiation generated by 900 and 1800 MHz Global System for Mobile Communications sources on cochlear development in the rat model. METHODS: Eight pregnant albino Wistar rats were divided into three groups: control, 900 MHz and 1800 MHz. The latter two groups of pregnant rats were exposed to radiofrequency radiation for 1 hour per day starting on the 12th day of pregnancy until delivery. The rats in the control, 900 MHz and 1800 MHz groups gave birth to 24, 31 and 26 newborn rats respectively. Newborn rats in the 900 MHz and 1800 MHz groups were exposed to radiofrequency radiation for 1 hour per day for 21 days after delivery. Hearing evaluations of newborn rats were carried out using distortion product otoacoustic emissions testing. Eight newborn rats were randomly selected from each group for electron microscopic evaluation. RESULTS: Distortion product otoacoustic emission tests revealed no significant difference among the groups, but electron microscopic evaluation revealed significant differences among the groups with regard to the number of normal, apoptotic and necrotic cells. CONCLUSION: The findings indicated cellular structural damage in the cochlea caused by radiofrequency radiation exposure during cochlear development in the rat model.

A forgotten diagnosis in emergency department: tetanus.

INTRODUCTION: Tetanus is a serious and acute life-threatening disease caused by toxins of "Clostridium tetani". Although it is generally a disease of developing countries, its lower incidence is encountered also in developed countries. Since the principal treatment of this disease is known to be based on vaccination and wound care, the emergency physicians play a key role in its management. MATERIAL AND METHOD: In the present study, we reviewed its uncommon clinical course along with demographic and clinical features of five cases that have presented with various complaints to our Emergency Department. Presenting signs, demographic features, injury history, and the time from the occurrence of injury to the beginning of symptoms were evaluated. RESULTS: Four of five cases were female. The mean age of cases was 56.8 (34-73). Three of them had hand injury, one had foot injury, and the fifth case had facial injury. The initial symptoms included difficult jaw movement, back muscle spasm, and pain. Two cases died. CONCLUSION: Tetanus cases may present to ED with different symptoms. Therefore, physicians should be aware of the early signs of tetanus. Careful and meticulous wound management of cases presented to ED following an injury should be considered a significant factor, which can help in reducing the tetanus cases (Tab. 2, Ref. 18).

Platelet-rich plasma improves healing of tympanic membrane perforations: experimental study.

OBJECTIVE: The aim of this study was to investigate the effect of local application of platelet-rich plasma to perforated rat tympanic membranes, in terms of healing time and histopathological outcome. METHODS: Eighty-eight tympanic membranes of 44 rats were given a standard 3 mm perforation, and platelet-rich plasma was applied to the right tympanic membrane perforations. The left tympanic membranes were left to heal spontaneously, as controls. The 44 rats were divided into two groups. In group one, comprising 20 rats, daily otomicroscopic examination of the tympanic membrane perforations was performed. The 24 rats in group two were subdivided into four subgroups of six rats each; these subgroups were sacrificed sequentially on days three, seven, 14 and 28 for histopathological examination, regardless of tympanic membrane healing stage. RESULTS: In group one, the mean tympanic membrane healing times for tympanic membrane perforations receiving platelet-rich plasma and controls were respectively 10.2 +/- 2.1 and 13.0 +/- 2.9 days (mean +/- standard deviation). This difference was statistically significant (p < 0.001). In group two, histopathological evaluation of tympanic membrane perforation healing at days three, seven, 14 and 28 did not reveal any statistically significant difference, individually or within the four groups as a whole. CONCLUSION: These findings suggest that earlier healing of tympanic membrane perforations occurred in the platelet-rich plasma group compared with the control group. These findings suggest that platelet-rich plasma is effective in accelerating tympanic membrane perforation healing, and that it may be effective in human subjects, particularly as it is an autologous material.

The aromatase inhibitor anastrozole is associated with favorable embryo development and implantation markers in mice ovarian stimulation cycles.

OBJECTIVE: To investigate the embryonic and endometrial effects of anastrozole in preimplantation and implantation phases in FSH-induced cycles in mice. DESIGN: Blind randomized study. SETTING: University research laboratory. ANIMAL(S): Twenty-seven mature female mice. INTERVENTION(S): Single-dose anastrozole (25 mg/kg [0.75 mg]), recombinant FSH (5 IU/mL), and hCG (5 IU/mL) (n = 9); recombinant FSH (5 IU/mL) and hCG (5 IU/mL) (n = 9); or sterile saline (1 mL) (n = 9). The morning of finding the vaginal plug was designated as day 1 of embryonic development (E1). Three mice from each group were sacrificed on E1 and embryos aspirated from uterine tubes. The rest of the mice were sacrificed on E2.5-3 and uteruses removed. MAIN OUTCOME MEASURE(S): Embryo quality, endometrial histologic evaluation, and immunohistochemical analysis of tumor necrosis factor-alpha, leukemia inhibitory factor, laminin, and collagen IV staining. RESULT(S): Anastrozole use in FSH-induced cycles not only caused an increase in preimplantation receptivity and implantation but also supported release of implantation markers. The enhanced embryo development seen in this study would explain the higher implantation because embryo development is synchronized with endometrial development. CONCLUSION(S): In mice, the use of anastrozole in FSH-induced cycles has a positive effect on embryo quality and implantation. This effect might be species dependent, and human studies are needed.

Deep neck infection due to Lactococcus lactis cremoris: a case report.

This report describes the first case of deep neck infection resulting from Lactococcus lactis subsp. cremoris. The case is associated with the consumption of unpasteurized milk and occurred in a patient with a buccal mucosa tumor. Anti-infective therapy with ceftriaxone and metronidazole resulted in complete resolution.

Investigation of the vertebrobasilar arterial system in vertigo by vestibulocochlear test, SPECT and angiography.

OBJECTIVE: Perfusion of the areas of cochleovestibular structures was investigated using Tc-99m HMPAO single photon emission computerized tomography (SPECT) in the young patients with vertigo presumed to have peripheral vestibular abnormalities and compared the results with cochleovestibular test results, and vertebrobasilar angiography findings. METHODS AND PATIENTS: The study was performed on 20 patients with vertigo and 17 control subjects who had performed vertebral arteriography due to another disease. The patients with vertigo presumed to be on peripheral vestibular disorder were included in the study. Systemic and otorhinolaryngological examination were carried out. Audiovestibular function was evaluated in all patients and control subjects. Brain SPECT was performed with a one-head rotating gamma camera system from 64 projections into a 64x64 matrix, using low energy and high-resolution fan beam collimators with a sampling time of 30 s. The images taken from cerebellum, temporal, parietal and occipital lobes which are supplied by a vertebrobasilar system were compared visually with the other side and asymmetry in the perfusion was searched. After cochleovestibular tests and laboratory had been completed, vertebral arteriography was performed bilaterally in all patients. Results of digital subtraction angiography (DSA) and the vestibulocochlear test were compared with images of SPECT. Data analysis was done with Yates Chi(2) and percentages of sensitivity and specificity were calculated. RESULTS: There was vestibular test and cochlear test abnormalities in eight and ten of the patients with vertigo, respectively. SPECT imaging showed hypoperfusion and decreased regional blood flow in 12 of the patients. There was statistically significant differences between the study and control groups in SPECT (P<0.05). Five patients showed abnormal findings in DSA examinations. CONCLUSION: It is believed that SPECT may be helpful in the detection of vascular pathology in the patients with vertigo.

The effects of natural ostium and nasoantral window on mucosal regeneration after maxillary sinus surgery in rabbits.

The aims of the study were to investigate the effects of natural ostium and the nasoantral window on the mucosal regeneration after maxillary sinus surgery and to detect the changes in the mucociliary clearance during regeneration process. Twenty-eight rabbits were studied. In the study group consisting of 21 rabbits, the mucosa of each right maxillary sinus was totally removed, natural ostium was occluded with bone-wax and a nasoantral window was created, while the left sinus mucosa was removed and the natural ostium was left open without creating a nasoantral window. Maxillary sinus mucosa taken during surgery was investigated by light and electron microscopy. The study group was divided into three subgroups. The first group was followed for 2, the second for 4, and the last group for 8 weeks. At the end of these periods, the mucociliary function was evaluated scintigraphically using 99mTc-Human serum albumin. Following this investigation mucosal biopsies were taken from the right and left sinuses and the rabbits were sacrificed. In the control group consisting of 7 rabbits a small hole was opened in the anterior wall of the maxillary sinus of each rabbit and the scintigraphic evaluation was performed for this group at the end of each follow up period as well. In the histopathologic investigation, no difference was found between the natural and the nasoantral window using light microscopy, but there was a difference between them in the electron microscopic findings (p < 0.05, Chi-square test). The scintigraphic, light and electron microscopic findings and gross appearances of the sinuses are discussed.

Giant polypoid tumor of the esophagus.

A patient with a giant polypoid tumor of the esophagus, measuring 22 cm in length is described in this report. The patient presented with cough attacks and respiratory distress. Diagnostic and therapeutic intervention required aggressive airway management, radiographic and endoscopic evaluation, and definitive surgical treatment. Benign esophageal tumors are rarely seen and originate from the upper third of esophagus, frequently close to the cricopharyngeus muscle. They may attain giant proportions. A variety of clinical presentations are described, the most serious being asphyxia secondary to laryngeal obstruction. We observed a giant esophageal tumor which was interpreted as angiofibromyolipoma that caused laryngeal obstruction. We present the clinical picture and histopathological findings of the tumor.

Huge osteoma of the frontoethmoidal sinus with secondary brain abscess.

Osteomas of paranasal sinuses are usually asymptomatic. When enlarged, they may cause serious complications. We report a case of huge frontoethmoidal osteoma associated with brain abscess. If an osteoma associated with an intracerebral pathology is detected, it should be remembered that this could have been a complication of the osteoma and a detailed radiological examination should be performed to show the extent of the osteoma and to confirm any defect at the posterior wall of the sinus which may lead intracerebral complications. Such an osteoma should be operated after the abscess was resolved and patient became stable neurologically.

The advantages of MRI and MRA for diagnosing Behçet's disease and internal jugular vein thrombosis.

Behçet's disease is a multisystem disorder characterized by recurrent aphtous ulcers of mucosal membranes, skin lesions, and vasculitis. The prevalence of vascular involvement is about 25% and this is the leading cause of death in Behçet's disease. Jugular vein involvement is an unusual manifestation of Behçet's disease. Medical insertion of needles into veins or arteries can induce thrombosis or aneurysms. Thus, diagnostic studies or therapy can aggravate the disease and even be fatal. We report a patient with Behçet's disease and rare internal jugular vein thrombosis. We also demonstrate the ability of noninvasive magnetic resonance imaging and magnetic resonance angiography to aid in the diagnosis and evaluation of vascular involvement in Behçet's disease, without risking iatrogenic complications.

Effects of otitis media with effusion on the vestibular system in children.

Middle ear effusion has been considered the most common cause of vestibular disturbance in children. However, there have been only a few studies on vestibular disturbance in children with otitis media with effusion. We studied the vestibular systems of 30 children with otitis media with effusion aged 8 to 13 years and compared the results with 15 age- and sex-matched controls. A questionnaire relating to vestibular disturbance was given to patients and their parents. Spontaneous nystagmus and positional nystagmus were recorded by electronystagmography as diagnostic tests of the vestibular system. Romberg's and past-pointing tests were performed on children with otitis media with effusion and controls. After vestibular tests were completed, myringotomy was performed, and a ventilation tube was inserted. The questionnaire and the vestibular tests were repeated after the operation and during the first month after surgery. Our study showed that there was a history of vestibular disturbance in 33% of children with otitis media with effusion. Electronystagmography and Romberg's test findings demonstrated that 33% of the children had vestibular dysfunction (p < 0.05). After myringotomy with ventilation tube insertion, vestibular test results returned to normal, and symptoms related to vestibular disturbance improved. These findings confirm the assumption that middle ear effusion may affect the vestibular system, which can be resolved after myringotomy with ventilation tube insertion.

Doppler sonography of vertebral arteries and audiovestibular system investigation in leprosy.

Thirty-six patients with leprosy and 12 sex- and age-matched controls were investigated for disorders of the audiovestibular system, and vertebral artery measurements were calculated using a color Doppler ultrasound technique. Sensorineural hearing loss found to be of cochlear origin was detected in 8 of the leprosy patients. Maximal flow velocity and mean flow velocity were measured, and the total vertebral artery flow was calculated by adding flows from the right and left sides. There was a significant reduction in the total maximal peak flow velocity of the vertebral artery of the lepromatous patients compared to the controls. Doppler sonography of the vertebral artery gave useful information about some pathology seen in lepromatous patients.

Doppler sonography of vertebral arteries in patients with tinnitus.

The accuracy and the reliability of extracranial vertebral artery Doppler flow for the detection of the possible cause of the tinnitus was studied prospectively and Doppler findings were compared with controls. Vertebral artery measurements have been made in 28 patients (56 vertebral arteries) with tinnitus and 12 sex- and age-matched controls. Maximal flow velocity and mean flow velocity were measured and total vertebral artery flow was calculated by adding flows from the right and left sides. When compared with each other and controls, there was significant difference with respect to mean flow velocities of the right and left vertebral arteries in the patients with tinnitus (p < or = 0.05), and also total mean flow velocity between patients with tinnitus and controls (p < or = 0.05). It has been concluded that Doppler sonography gave useful information on the vertebral artery flow in patients with tinnitus.