Effects of freezing of gait on balance in patients with Parkinson's disease.

OBJECTIVES: The aim of the study was to evaluate the effects of freezing of gait (FOG) on static and dynamic balance. METHODS: Twenty patients with Parkinson's disease with and without FOG [PD+FOG (68,6±6,39 years) and PD-FOG group (70,6±4,57 years)] and 10 healthy individuals (68,4±4,92 years) with similar demographic characteristics were included in the study. Balance was compared between the three groups. Balance was evaluated with clinical tests Limits of stability (LoS) and body sway were measured using the E-LINK FP3 Force Plate and the Korebalance Balance Evaluation System, which measure the balance in static and dynamic conditions. Center of pressure (COP) change and average sway velocity were evaluated with the Zebris RehaWalk system. RESULTS: Total and subscale scores of the Unified Parkinson's Disease Rating Scale were significantly higher in the PD+FOG group (p<0.05). The balance test results for both groups were similar (p>0.05). The PD+FOG group performed worse on the computerized static balance tests, the COP analysis, and the dynamic balance total score than the other two groups (p<0.05). The PD+FOG group had significantly greater sustained weight deviation than the healthy controls (p<0.05). Patients with Parkinson's disease had a lower LoS in the posterior direction than healthy controls (p<0.05). DISCUSSION: FOG affects the dynamic balance more negatively than the static balance. In addition, FOG reduces LoS in the posterior direction and increases body sway in the anterior-posterior direction, which can lead to falls.

The neutralization effect of montelukast on SARS-CoV-2 is shown by multiscale in silico simulations and combined in vitro studies.

Small molecule inhibitors have previously been investigated in different studies as possible therapeutics in the treatment of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In the current drug repurposing study, we identified the leukotriene (D4) receptor antagonist montelukast as a novel agent that simultaneously targets two important drug targets of SARS-CoV-2. We initially demonstrated the dual inhibition profile of montelukast through multiscale molecular modeling studies. Next, we characterized its effect on both targets by different in vitro experiments including the enzyme (main protease) inhibition-based assay, surface plasmon resonance (SPR) spectroscopy, pseudovirus neutralization on HEK293T/hACE2+TMPRSS2, and virus neutralization assay using xCELLigence MP real-time cell analyzer. Our integrated in silico and in vitro results confirmed the dual potential effect of montelukast both on the main protease enzyme inhibition and virus entry into the host cell (spike/ACE2). The virus neutralization assay results showed that SARS-CoV-2 virus activity was delayed with montelukast for 20 h on the infected cells. The rapid use of new small molecules in the pandemic is very important today. Montelukast, whose pharmacokinetic and pharmacodynamic properties are very well characterized and has been widely used in the treatment of asthma since 1998, should urgently be completed in clinical phase studies and, if its effect is proved in clinical phase studies, it should be used against coronavirus disease 2019 (COVID-19).

Binary-QSAR guided virtual screening of FDA approved drugs and compounds in clinical investigation against SARS-CoV-2 main protease.

With the emergence of the new SARS-CoV-2 virus, drug repurposing studies have gained substantial importance. Combined with the efficacy of recent improvements in ligand- and target-based virtual screening approaches, virtual screening has become faster and more productive than ever. In the current study, an FDA library of approved drugs and compounds under clinical investigation were screened for their antiviral activity using the antiviral therapeutic activity binary QSAR model of the MetaCore/MetaDrug platform. Among 6733-compound collection, we found 370 compounds with a normalized therapeutic activity value greater than a cutoff of 0.75. Only these selected compounds were used for molecular docking studies against the SARS-CoV-2 main protease (Mpro). After initial short (10 ns) molecular dynamics (MD) simulations with the top-50 docking scored compounds and following molecular mechanics generalized born surface area (MM/GBSA) calculations, top-10 compounds were subjected to longer (100 ns) MD simulations and end-point MM/GBSA estimations. Our virtual screening protocol yielded Cefuroxime pivoxetil, an ester prodrug of second-generation cephalosporin antibiotic Cefuroxime, as being a considerable molecule for drug repurposing against the SARS-CoV-2 Mpro.

Color Doppler imaging of ocular hemodynamic changes in patients with rheumatoid arthritis unrelated to disease activity.

We aimed to investigate how orbital blood flow rates in patients with rheumatoid arthritis (RA) are affected by the active and remission phase of the disease. This prospective study included a total of 56 patients with RA (study group) and 24 control individuals (control group). All RA patients were divided into two groups, as active (Group 1) and remission (Group 2) according to the disease activity index (DAS 28) score. For each eye, retrobulbar vascular structures were evaluated [central retinal artery (CRA), posterior ciliary artery (PCA), and ophthalmic artery (OA)], respectively. The peak systolic velocity (PSV) and end-diastolic velocity (EDV) values were obtained for each artery and the vascular resistance index (RI) measurement was calculated. The median RI of the OA was 0.70 (0.57; 0.79) in the control group, 0.77 (0.55; 0.87) in group 1, and 0.73 (0.47; 0.87) in group 2. The median RI in the PCA was 0.70 (0.56; 0.82) in the control group, 0.76 (0.52; 0.88) in the group 1, and 0.74 (0.52; 0.86) in the group 2. The median RI of CRA was 0.73 (0.48; 0.81) in the control group, 0.71 (0.64; 0.81) in group 1, and 0.68 (0.61; 0.85) in group 2. The RI value was a significant difference between control and group 1 (p < 0.05). Active and remission RA patients had different effects on the flow rate of eye blood vessels.

Contribution of real-time elastography in diagnosis of polycystic ovary syndrome.

PURPOSE: We aimed to assess the feasibility and reproducibility of real-time elastography (RTE) for displaying the effects of morphological changes in the ovary in polycystic ovary syndrome (PCOS). METHODS: Forty-eight patients diagnosed with PCOS and 48 healthy women were enrolled in the study. Ultrasonography and RTE were performed on the 3rd day of the menstrual cycle. Evaluations were performed independently by two radiologists. Ovarian volume, number of follicles, elasticity pattern, and strain ratio were measured. Elasticity patterns were assessed as hard (type 1; blue or blue-green), moderate (type 2; green or green-yellow) or soft (type 3; red or orange-red). RESULTS: Both radiologists determined the elasticity pattern as mostly type 1 in the PCOS group and type 3 in the control group (P < 0.01). The mean strain ratios obtained by the first and second radiologist were 6.1±1.8 (2.7-10.1) and 6.0±1.5 (3.0-9.0) in PCOS and 3.3±1.2 (1.7-7.2) and 3.2±0.9 (1.7-6.8) in the control group, respectively (P < 0.001). Interobserver agreement was moderate for the elasticity pattern (κ=0.48) and good for the strain ratio (intraclass correlation coefficient, 0.77). A strain ratio of 3.8 was determined as the optimized cutoff point by receiver operating curve analysis. Strain ratio was correlated with the ovarian volume and the number of detected follicles (P < 0.001). CONCLUSION: Elasticity pattern and strain ratio can help identify morphological changes that make PCOS ovaries stiffer than normal ovaries.

Abnormal sonographic appearances of the yolk sac: which can be associated with adverse perinatal outcome?

AIMS: The present study aimed to determine whether yolk sacs with abnormal sonographic appearance are associated with adverse perinatal outcomes in both early and late gestation. MATERIAL AND METHODS: A total of 305 viable singleton pregnancies with gestational age of 6 to 9 weeks were prospectively evaluated with respect to perinatal outcomes and sonographic characteristics of the yolk sacs. RESULTS: An abnormal yolk sac was found in 66 pregnancies. In pregnancies with enlarged yolk sacs a miscarriage occurred in 37.5% of cases (3/8). The pregnancies with a yolk sac diameter >/= 5 mm had a significantly higher risk of miscarriage (p = 0.005). The risk of miscarriage was statistically similar between the pregnancies with regular and those with irregular yolk sacs (p = 0.73). Miscarriage occurred in 3.8% of pregnancies with irregular yolk sacs (2/52) and none of pregnancies with echogenic yolk sacs (0/6). Adverse perinatal outcomes were not associated with either irregular or echogenic yolk sacs. CONCLUSIONS: An enlarged yolk sac visualized before the 7th week of gestation is strongly associated with a significantly increased risk for spontaneous miscarriage. The presence of an echogenic or irregular yolk sac appears to be unrelated to adverse perinatal outcome.

Unusual manifestation of acute retrocecal appendicitis: pericholecystic fluid.

Subhepatic-retrocecal appendicitis is a rare entity in which the diagnosis is challenging. In patients presenting with right abdominal pain with atypical clinical, laboratory and ultrasound (US) findings, acute appendicitis should be eliminated with computed tomography (CT). Multi-detector CT (MDCT) can be used effectively for the diagnosis of retrocecal appendicitis without additional preparation or focused examination. Here, we present a patient with acute subhepatic-retrocecal appendicitis in whom the clinical and US findings mimicked acute cholecystitis. To the best of our knowledge, there is no previous report related to acute appendicitis presented only with pericholecystic fluid that could be diagnosed with MDCT. Retrocecal-subhepatic appendicitis is a rare condition that might present with atypical clinical, laboratory and radiological signs. US is usually insufficient for the definitive diagnosis. In this situation, MDCT could be a rapid and efficient tool for localizing the appendix and for the differential diagnosis.

Frequency of a persistent yolk sac and its relationship with the gestational outcome.

OBJECTIVES: This study aimed to determine the frequency of a persistent yolk sac in pregnancies at 12 to 13 weeks and to investigate whether a persistent yolk sac is associated with an adverse gestational outcome. METHODS: This study reviewed a total of 282 women who had normal singleton pregnancies with a gestational age of 12 weeks to 13 weeks 6 days and who were consecutively admitted to the study center for first-trimester screening (for chromosomal abnormalities) between April 2010 and February 2011. A persistent yolk sac has been defined as a yolk sac that has achieved a diameter of 5.6 mm or greater without losing its internal pressure at the 12th week of pregnancy or later. RESULTS: A persistent yolk sac was detected by sonography in 25 pregnancies. The average diameter of the persistent yolk sacs ± SD was 6.3 ± 0.2 mm (range, 5.6-8.0 mm). The frequency of a persistent yolk sac in pregnancies at 12 weeks was significantly higher than that at 13 weeks (P = .017). A persistent yolk sac was not associated with adverse perinatal outcomes, including abnormal sonographic findings, isolated structural defects, poor obstetric outcomes, and perinatal mortality. CONCLUSIONS: Although yolk sacs mostly disappear toward the end of the first gestational trimester, they may sometimes persist even to the 13th week of gestation. The persistence of the yolk sac seems to be unrelated to an adverse perinatal outcome.

Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures.

OBJECTIVE: The purpose of this study is to describe the elastographic appearance of the Achilles tendon in healthy subjects and patients with surgically repaired complete ruptures. MATERIALS AND METHODS: Nineteen Achilles tendons of 16 amateur footballers with surgically repaired complete ruptures and their contralateral asymptomatic Achilles tendons were assessed with ultrasound and real-time sonoelastography. Additionally, 40 asymptomatic Achilles tendons of 20 healthy amateur footballers were assessed. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to the elasticity features: type 1, blue (hardest tissue); type 2, blue/green (hard tissue); or type 3, green (intermediate tissue). In addition, three subtypes were determined: homogeneous, relatively homogeneous, and heterogeneous. RESULTS: Most of the Achilles tendons of the patients with surgically repaired complete ruptures were detected to have type 2 elasticity (64.9%), and the remaining had type 1 (35.1%). In contrast, most of the healthy tendons had type 2 (64.2%), and the remaining had either a type 3 (20.8%) or a type 1 (15%) elastographic pattern. All of the ruptured tendons had a heterogeneous structure, whereas all of the healthy Achilles tendons had a homogeneous or relatively homogeneous structure. CONCLUSION: In sonoelastography, the recognition of normal tendon structure will be useful in assessing pathologies of the Achilles tendon. Additionally, in patients with excellent American Orthopedic Foot and Ankle Society (AOFAS) scores and surgically repaired complete ruptures, a hard and heterogeneous pattern of tendon structure may be a natural consequence of tendon healing.

Prevalence of scrotal calculi and their relationship with pain.

PURPOSE: The purpose of this study was to determine the frequency of scrotal calculi in men referred for scrotal ultrasonography (US), to identify any associated pathologies, and to investigate if any relationship exists between scrotal lithiasis and pain. MATERIALS AND METHODS: This was a retrospective study in which 4084 scrotal US examinations in 3435 men were evaluated. Scrotal US was performed using a high-frequency linear transducer. Forty patients were questioned as to whether scrotal pain was present. Patients were asked to grade their scrotal pain intensity using the Numerical Rating Scale. RESULTS: Sixty-seven of the 3435 patients with scrotal US examinations had scrotal calculi with a mean size of 3.7 ± 1.4 mm (range, 1.6-7 mm). Twenty patients with scrotal calculi had no scrotal pain. Nine patients with scrotal pain (22.5%) had no US or clinical abnormalities except scrotal calculi. CONCLUSION: The frequency of scrotal calculi was 1.95%. Approximately one-quarter of patients with scrotal calculi and pain had no additional abnormalities. Therefore, scrotal calculi should be considered in the differential diagnosis of scrotal pain.