Evaluation of the retina, choroid and optic disc vascular structures in individuals with a history of COVID-19.

INTRODUCTION: In this study, we aimed to detect changes in posterior segment structures and vascular density caused by COVID-19 using an optical coherence tomography angiography (OCTA) device. MATERIALS AND METHODS: The study included 20 eyes of 20 patients no systemic or ocular disease who were followed at the Ophthalmology Clinic of Health Sciences University Antalya Training and Research Hospital. The OCTA images of these individuals taken prior to contracting COVID-19 and six months after recovery were examined. RESULTS: The mean choriocapillaris blood flow was 2.00±0.13mm2 before COVID-19 and 2.08±0.23mm2 after the disease, and the mean subfoveal choroidal thickness was 247.33±7.65µm before the disease and 273.08±4.92µm after the disease, indicating a statistically significant difference (P=0.003, P=0.001, respectively). The mean retinal nerve fiber layer thickness before and after COVID-19 were 119.33±3.88 and 117.50±3.92µm, respectively, representing a statistically significant decrease (P<0.001). CONCLUSION: This is the first study in the literature to evaluate the post-COVID-19 changes in the vascular structures of the eye compared to the pre-disease values. In this study, we found statistically significant changes in choriocapillaris blood flow, subfoveal chroidal thickness and retinal nerve fiber layer thickness after COVID-19 infection. Further research with a greater sample size is needed to explore the effect of COVID-19 on these parameters.

Visual or computer-based measurements: Which is important for the interpretation of an athlete's electrocardiography?

SUMMARY OBJECTIVE: Preparticipation screening of athletes by electrocardiography is the most crucial step in determining sudden cardiac death risk factors. Several electrocardiography interpretation software programs have been developed for physicians practicing in this field. Our study aimed to assess cardiopoint sudden death screening module by comparing its findings with two cardiologists using Seattle and International criteria. METHODS: A total of 303 licensed national athletes (37% females) were enrolled. electrocardiographies were examined by the cardiopoint sudden death screening module using Seattle criteria and cardiologists. The consistency between cardiologists and software was compared, and the confidence assessment of the module was tested. RESULTS: With regard to Seattle criteria, moderate consistency was found between the cardiopoint sudden death screening module and the 1st (κ=0.41) and 2nd cardiologist (κ=0.59). Consistency between two cardiologists was moderate (κ=0.55). When we applied International criteria, there was moderate consistency between the module and the 1st cardiologist (κ=0.42), and good consistency between the module and the 2nd cardiologist (κ=0.63). Consistency between the two cardiologists was good (κ=0.62). CONCLUSION: The cardiopoint sudden death screening module had similar agreement with cardiologists based on both criteria. However, the software needs to be updated according to International criteria. Using computer-based measurements for preparticipation screening will help to save time and provide standardization of electrocardiography interpretation.

Respiratory-gated 18F Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging in Evaluation of Primary Gastric Lesions and Gastric Lymph Nodes in Patients with Gastric Cancer.

AIMS: To evaluate the added value of respiratory-gated positron emission tomography (PET) in 18F fluorodeoxyglucose (FDG) PET/magnetic resonance imaging (MRI) in the visual and semi-quantitative assessment of primary gastric lesions and gastric lymph nodes for patients with gastric cancer. MATERIALS AND METHODS: In total, 102 upper abdominal respiratory-gated and whole-body 18F FDG PET/MRI of 88 patients with gastric cancer were evaluated visually and semi-quantitatively. For 41 patients who underwent surgery, histopathological and PET findings were compared. Three PET images were obtained from upper abdominal PET data: non-Q static (non-QS) PET from all counts, respiratory-gated Q static (QS) PET from counts in the end-expiration phase of breathing, shortened 4 min (S4min) PET that was reconstructed to obtain similar counts to QS PET. The semi-quantitative parameters (standardised uptake values, metabolic tumour volume, total lesion glycolysis) of primary lesions for each PET image, the sizes of primary lesions and the patient's body mass index were recorded. According to lymph node stations, the presence and numbers of positive lymph nodes and visual scores of lymph nodes for each PET image were recorded. RESULTS: The patients with smaller gastric lesions (≤30 mm) or higher body mass index (>30) had significantly higher standardised uptake value percentage changes in QS PET compared with non-QS PET (all P < 0.05). The third (lesser curvature), fourth (greater curvature) and sixth (infra-pyloric) lymph node stations had significantly higher visual scores in the QS PET than in the others. The fourth lymph node station had a significantly higher number of FDG-positive lymph node in the QS PET than in the non-QS and the whole-body PET images. In the fourth station, sensitivity, positive predictive value, negative predictive value and accuracy increased in the QS PET compared with the others. CONCLUSION: Respiratory-gated PET/MRI was found to be significantly superior in the evaluation of especially the fourth lymph node station, smaller gastric lesions and in the patients with a higher BMI compared with the non-respiratory-gated PET images.

Diverticular disease and posture during defecation : a prospective comparative study.

BACKGROUND AND STUDY AIMS: Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation. PATIENTS AND METHODS: This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662). RESULTS: The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis. CONCLUSION: Sitting during defecation seems to increase the risk of CD.

Circumcision and its potential effects on children's mental health state / Circuncisión y sus efectos potenciales sobre el estado de salud mental infantil

Objectives. Circumcision is one of the oldest elective surgical interventions in the history of mankind. Though many studies have been conducted on the surgical complications of circumcision, the potential effects on the mental state of the children has not been satisfactorily reviewed. In this prospective study, we analyzed potential effects of circumcision on their mental state, anxiety levels and moods using updated scales. Material and methods. One hundred and two male children aged between 6 and 8 and their families were included in the study. Children with their families completed sociodemographic data form Anxiety Sensitivity Index For Children, the Strengths and Difficulties Questionnaire (SDQ), Depression Scale for Children during the preoperative period. All children received oral 0.5mg/kg midazolam as a premedication before circumcision procedure. Circumcisions were performed under general anesthesia in the operating room. During the 6th week of the postoperative period, the children and their families were returned to the facility and parents were asked to complete the questionnaire again. Results. Mean score of the preoperative depression scale was statistically and significantly higher than the mean postoperative depression scale score (P=0.001; P<0.01). Pre-, and post-operative depression scale scores of the children with divorced parents showed a higher statistical significance higher than those of the children whose family togetherness was not broken (P=0.001; P<0.01). Conclusion. Before circumcision, in all children to be circumcised a tendency to depression and an increase in anxiety were observed regardless of the presence of subgroups. At the end of the study, it was found that low socioeconomic level, disrupted family dynamic, and/or the presence of mental disease in a parent could increase the predisposition to pre and post-operative depression. At this stage the main factor determining the level of anxiety is the procedure of circumcision itself (AU)

Objetivos. La circuncisión es una de las intervenciones quirúrgicas electivas más antiguas de la historia de la humanidad. Aunque muchos estudios se han realizado sobre las complicaciones quirúrgicas de la circuncisión, su efecto potencial sobre el estado mental de los niños no se ha aclarado mucho. En este estudio prospectivo se analizaron los efectos potenciales de la circuncisión en su estado mental, los niveles de ansiedad y estados de ánimo que por medio de escalas actualizadas. Material y métodos. Ciento dos niños varones de edades comprendidas entre los 6 y los 8 años y sus familias fueron incluidos en el estudio. Los niños con sus familias completaron el formulario de datos sociodemográficos Ansiedad Índice de Sensibilidad Para los niños, Capacidades y Dificultades (SDQ), escala de depresión para los niños durante el período preoperatorio. Todos los niños recibieron por vía oral 0,5mg/kg de midazolam como premedicación antes de procedimiento de circuncisión. Las circuncisiones se realizaron bajo anestesia general en la sala de operaciones. Durante la sexta semana del postoperatorio, los niños y sus familias regresaron y completaron las mismas encuestas una vez más. Resultados. La media de puntuación de la escala de depresión preoperatoria fue estadística y significativamente más alta que la puntuación media postoperatoria escala de depresión (p=0,001; p<0,01). Las puntuaciones pre y post operatorias en la escala de depresión de los niños con padres divorciados mostraron una mayor significación estadística que las de los niños cuyo núcleo familiar no estaba roto (p=0,001; p<0,01). Conclusión. Antes de la circuncisión, en todos los niños que iban a ser circuncidados se aprecia una tendencia a la depresión y el aumento de la ansiedad, independientemente de la presencia de subgrupos. Una vez concluida la investigación, se observó que un bajo nivel de ingresos, una dinámica familiar desequilibrada y/o la presencia de un trastorno mental en un progenitor podrían predisponer a la depresión pre y postoperatoria. En esta etapa el factor principal que determina el nivel de ansiedad es el procedimiento de la circuncisión sí mismo (AU)

A standardized scoring system in the prediction of success and complications of percutaneous nephrolithotomy: guy´s Stone scoring system / Utilización de un sistema de puntuación estandarizado en la predicción del éxito y complicaciones de la nefrolitectomía percutanea: escala stone del Guy`s

OBJECTIVES: In this study, our aim was to determine the role of Guy's stone scoring system (GSS) in the prediction of percutaneous nephrolithotomy (PNL) success and its ability to foresee potential complications in consideration of Clavien grading system (CGS). Material and Methodos: The data of 244 patients who underwent PNL between January 2009 and May 2014 were retrospectively examined. Renal stones were evaluated using GSS with the aid of the patients' preoperative radiological evaluations and their postoperative complications were assessed with CGS. Arch. Esp. Urol. 2015; 68 (9): 710-717 Keywords: Guy's Stone score. Percutaneous nephrolithotomy. Modified Clavien grading system. Stone-free rate. RESULTS: Mean age of the patients (men, n=166; 68% and women, n=78; 32%) was 46.50±13.12 years (range, 16-80yrs). Clinically significant residual stones were not detected in 195 (79.9%) patients, while they were found in 49 (20.1%) patients. Guy's stone scores of 1, 2, 3 and 4 points were estimated in 21.3, 37.7, 29.9, and 11.1% of the cases, respectively. Based on modified Clavien complication grading system, complications were categorized as Clavien grade 1, 2 and 3 in 81.9, 17.2, and 0.8% of the cases, respectively. Clavien Grade 4 and 5 complications were not encountered. A statistically significant correlation was found between Guy's Stone scores and Clavien grades (p < 0.05)- A statiscally and highly significant difference was detected between Guy's Stone scores of the cases with respect to residual stones (p = 0.001; p < 0.01). CONCLUSIONS: Our study findings have revealed that GSS is a successful and easily applicable method for the prediction of success and likelihood of complications of PN

OBJETIVOS: En este estudio nuestro objetivo era determinar el papel de la escala de puntuación STONE de Guy`s (GSS) en la predicción del éxito de la nefrolitotomía percutánea (NLP) y su capacidad de preveer potenciales complicaciones considerando el sistema de gradación de Clavien. MATERIAL Y MÉTODOS: Los datos de 244 pacientes sometidos a NLP entre enero del 2009 y mayo del 2014 fueron evaluados retrospectivamente. Las litiasis renales fueron evaluadas utilizando el GSS con la ayuda de las pruebas radiológicas preoperatorias y las complicaciones postoperatorias se evaluaron con la escala de Clavien. RESULTADOS: La edad media de los pacientes (varones n=166, 68%; y mujeres n=78, 32%) fue 46.50±13.12 años (rango, 16-80 años). En 195 pacientes (79.9%) no se detectaron litiasis residuales clínicamente significativas, mientras que en 49 pacientes (20.1%) sí se encontraron. Con la escala STONE de Guy`s se estimaron puntuaciones de 1,2,3 y 4 puntos en 21.3%, 37.7%, 29.9% y 11.1% de los casos respectivamente. En base a la escala de complicaciones de Clavien modificada las complicaciones fueron categorizadas como Clavien grados 1,2 y 3 en 81.9%, 17.2% y 0.8% de los casos respectivamente. No se encontraron complicaciones de Grado 4 y 5 de Clavien. Se encontró una correlación estadísticamente significativa entre las puntuaciones de la escala STONE de Guy`s y los grados de Clavien (p < 0.02). Se detectó una diferencia estadística y altamente significativa entre las puntuaciones del STONE de Guy`s de los casos con respecto a las de las litiasis residuales (p = 0.001; p < 0.01). CONCLUSIONES: Los hallazgos de nuestro estudio han revelado que la escala Stone de Guy`s es un método exitoso y fácilmente aplicable para la predicción del éxito y la probabilidad de complicaciones de la NLP

Serum levels of nitrate, nitrite and advanced oxidation protein products (AOPP) in patients with nonalcoholic fatty liver disease.

BACKGROUND: Oxidative stress is increased and anti-oxidant defense mechanisms are impaired in patients with hepatosteatosis. The aim of the present study was to evaluate the serum levels of several oxidant and anti-oxidant markers in patients with nonalcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS: Thirty-four patients with NAFLD, and 19 healthy controls were included. In this study, we measured serum nitrate and advanced oxidation protein product (AOPP) as the oxidizing products and nitrite as the anti-oxidizing marker. Nitrate and nitrite levels were measured using a calorimetric method, and levels of serum AOPP were measured by a spectrophotometric method using a commercial ELISA kit. RESULTS: Serum nitrate and AOPP levels were significantly higher in the NAFLD group compared to the control group. Serum nitrite and N-N levels were similar between the two groups. Serum nitrate and N-N levels were found to be significantly higher in patients with elevated ALT levels compared to patients with normal ALT levels. Serum nitrite and AOPP levels were comparable between these groups. Mean platelet volume (MPV) was significantly lower in the NAFLD group compared to the control group. CONCLUSIONS: Serum levels of oxidizing agents including nitrate and AOPP increase in patients with NAFLD. In contrast, serum nitrite, an antioxidant agent, does not adequately increase to compensate for the oxidizing effects in these patients.

Differences in nephrotoxicity risk and renal effects among anti-viral therapies against hepatitis B.

BACKGROUND: Results are conflicting with respect to the renal effects of anti-viral agents used for hepatitis B virus infection. AIM: To compare short and long-term renal effects in real-life settings and to determine risk factors for renal impairment during treatment. METHODS: 2221 treatment-naïve patients were enrolled. Among these, 895 (302 lamivudine, 27 telbivudine, 282 entecavir, 273 tenofovir and 11 adefovir initiated patients) had 'repeated measures' of creatinine (baseline, 1st, 6th, 12th and 24th month of treatment). Telbivudine and adefovir groups were excluded from further analysis because of the low number of patients. We calculated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula at each time point. Hypophosphataemia was also recorded. Risk factors for renal impairment were analysed. RESULTS: Tenofovir caused a decline in GFR at each time point when compared to baseline levels. However, lamivudine and entecavir did not change GFR. GFR-shifting from ≥90 to 60-89 mL/min/1.73 m(2) was comparable among groups. The proportion of patients whose baseline creatinine increased more than 25% was comparable among all anti-virals. GFR showed a decline in patients who switched from entecavir to tenofovir. One patient with compensated cirrhosis needed to change from tenofovir because of renal safety. Seven and three patients developed transient hypophosphataemia in the tenofovir and lamivudine groups, respectively. CONCLUSIONS: Although tenofovir caused a decline in GFR, differences between the anti-viral agents do not appear to be so impressive. In patients with and without renal risk factors at baseline, there is no impact of anti-virals, including tenofovir.

Candesartan mediates microcirculation in acute necrotizing pancreatitis.

AIM: In the present study we aimed to determine the effect of an AT-II antagonist candesartan on pancreatic microcirculation in an experimental model of acute necrotizing pancreatitis. MATERIALS AND METHODS: There were five study groups with 10 animals in each. Pancreatitis was induced by intravenous infusion of cerulein and coadministration of glycodeoxycholate into biliopancreatic canal. Candesartan is given at 6th and 18th hour to the 24th and 48th hour groups, respectively. At 24th and 48th hours; following anaesthesia laparotomy was performed and laser Doppler flowmetry was performed in the pancreatic tissue of the animals. Following scarification blood samples were obtained for amylase, myeloperoxidase, IL-6 and tumour necrosis factor alpha. Tissue samples from the pancreas were obtained for histopathological analysis, endothelial cell apoptosis (TUNEL assay) and matrix metalloproteinase-9 immunohistochemistry. RESULTS: Pancreatic microcirculation was higher in the candesartan treated groups (p < 0.05). Myeloperoxidase, IL-6 and tumour necrosis factor alpha was found to be lower in the candesartan treated groups (p < 0.05). The pancreatic edema and inflammation were found to be reduced in the candesartan treated groups (p < 0.05). Endothelial apoptosis was found to be reduced by cadesartan treatment but it did not reach statistical significance (p > 0.05). Tissue matrix metalloproteinase -9 levels were found to be reduced with candesartan treatment (p < 0.05). CONCLUSION: Treatment with candesartan in the early phases of acute necrotizing pancreatitis effective on microcirculation of pancreatic tissue (Tab. 3, Fig. 6, Ref. 28).

A rarely seen case among retroperitoneal mass lesions: paraganglioma.

Pheochromocytomas are rarely seen cathecolamine-secreting neuroendocrine tumors. Diagnosis, treatment, and prognosis of this rarely seen condition have been discussed. In this study, a retroperitoneal paraganglioma with a diameter of 27 mm was detected in a 29-years old nephrectomized male patient. In our case, in reevaluations performed after definitive establishment of the diagnosis, any abnormal radiological signs suggesting a metastatic lesion were not detected. During the postoperative period the patient was referred to the clinics of endocrinology, and oncology for medical follow-up. In the differential diagnosis of retroperitoneal mass lesions, pheochromocytoma/paraganglioma should not be forgotten. Besides, for malignant tumors chemoradiotherapy, and for benign functional tumors medical treatment should be applied.

Effect of benign testicular mass on fertility: an epidermoid cyst case.

The article discusses the problem of epidermoid cysts - extremely rare but the most common benign intratesticular tumors. The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men, are benign tumors. The case of a young man who had incidentally diagnosed, during his infertility evaluation, a right testicular mass which was pathologically reported as epidermoid cyst after partial orchiectomy is presented. It was suggested that benign testicular cysts may effect the normal parenchyma of testis even if the normal histopathology. Thus, the excision of these benign lesions especially in infertile population is recommended.

A rare entity of benign bladder neoplasm: female lipoma.

Although benign bladder neoplasms constitute less than 5% of all bladder neoplasms, they should be taken into consideration because they can be symptomatic, and have the risk of confusing with other malignant neoplasms. Herein, we reported a 59-year-old female patient consulted to our outpatient clinic with the incidents of hematuria. During cystoscopic examination, a yellow-coloured mass lesion with smooth contours on the right posterolateral wall of the bladder was observed. Histopathological examination of the specimen demonstrated mature adipose tissue contained within submucosal layer without bladder wall invasion. Bladder lipomas are rarely seen pure benign masses which almost all reported ones were men. We think that female cases should also be taken into consideration for differential diagnosis presenting with hematuria.

Endometrial echotexture parameters in Turkish Saanen Goats (Akkeci) during oestrus and early pregnancy.

This experiment was conducted to evaluate endometrial echotexture in oestrus and early pregnancy and its association with ovarian hormones and foetal count in goats. Akkeci goats (Saanen×Kilis crossbreed, n=40) were randomly divided into two groups. Ten does (NAT) were mated on natural oestrus and 30 does (SYN) were subjected to synchronisation-prior to mating. The uterus was scanned on the days of sponge insertion (d -14), sponge removal (d -2) and mating (d 0) as well as 17 (d 17) and 30 (d 30) days after mating. Mean gray level (MGL), homogeneity (HOM) and contrast (CON) values were calculated. Blood samples were collected on days ultrasonography was performed. Data were analyzed by Chi-square, ANOVA, regression tests. HOM value reached the highest level on the mating day and then continuously decreased (P<0.0001). Overall, HOM values were greater for SYN does than for NAT does after mating. CON values were virtually stable during the experimental period. MGL value fluctuated during the breeding period (P<0.03) at a similar fashion in NAT and SYN does. Foetal count was not correlated with plasma hormones and echotexture parameters. Plasma progesterone concentration was correlated with echotexture parameters (r=-0.28 for HOM; r=0.29 for CON; r=0.25 for MGL; P<0.05 for all) during post-mating. In conclusion, echotexture parameters changed during the breeding period, in association with plasma progesterone concentration. Future studies should test if the echotextural changes during embryonic fixation days can be used as a marker for early detection of pregnancy in does.

Polymorphic variants of MnSOD Val16Ala, CAT-262 C < T and GPx1 Pro198Leu genotypes and the risk of laryngeal cancer in a smoking population.

OBJECTIVE: To investigate the relationship between development of laryngeal cancer and the presence of polymorphisms of the MnSOD Val16Ala, CAT-262 C < T and GPx1 Pro198Leu genes in a smoking population. PATIENTS AND METHODS: Single nucleotide polymorphisms were determined in DNA from the peripheral blood erythrocytes of 48 heavy smokers (25 patients with laryngeal cancer and 23 cancer-free controls), using polymerase chain reaction. RESULTS: There were no significant differences in age, smoking duration or smoking intensity, comparing the two groups. The homozygous AA genotype of MnSOD Val16Ala was significantly more prevalent in the cancer group than the control group (92 vs 13 per cent, respectively), while the heterozygous AV genotype of MnSOD Val16Ala was more prevalent in the control group than the cancer group (87 vs 8 per cent, respectively) (p < 0.001). There were no significant differences between the cancer and control groups regarding GPx1 Pro198Leu or CAT-262 C < T polymorphisms. CONCLUSION: Polymorphism of the MnSOD Val16Ala gene may contribute to susceptibility to laryngeal cancer among smokers.