Evaluation of treatment processes in childhood fifth metacarpal bone (Boxer) fractures with QuickDASH scoring system.

OBJECTIVE: Metacarpal fractures are one of the most common orthopedic injuries seen in emergency departments. Despite this, only a few data have been published about the epidemiology of metacarpal fractures. Simple radiographs are the standard imaging modality used to diagnose boxer fractures and determine the degree of angulation. Fractures and angulations should be identified by anteroposterior and lateral radiographs. The aim of this study was to follow the healing after closed reduction of fifth metacarpal neck fractures in a pediatric population using the QuickDASH score to determine whether it results in clinically significant improvement. SUBJECTS AND METHODS: Between 2020 and 2022, our clinical record database for all metacarpal fractures treated at our institution was searched retrospectively every month. Children aged 18 years and younger with fifth metacarpal neck fractures treated with closed reduction and immobilization in our tertiary care emergency clinic were retrospectively reviewed. RESULTS: 52 pediatric patients were included in the study. The mean age at the time of injury was 14.04 years (SD=2.10, range=10-18 years). 92.30% (n=48) of the patients were male, and 7.70% (n=4) were female. CONCLUSIONS: Accurate diagnosis and appropriate treatment are crucial in the management of childhood fifth metacarpal fractures to ensure proper healing, prevent long-term complications, and facilitate optimal functional recovery.

Accurate diagnosis of COVID-19 from lung CT images using transfer learning.

OBJECTIVE: In this study, it is aimed to classify data by feature extraction from tomographic images for the diagnosis of COVID-19 using image processing and transfer learning. MATERIALS AND METHODS: In the proposed study, CT images are made better detectable by artificial intelligence through preliminary processes such as masking and segmentation. Then, the number of data was increased by applying data augmentation. The size of the dataset contains a large number of images in numerical terms. Therefore, the results of the models are more reliable. The dataset is split into 70% training and 30% testing. In this way, different features of the applied models were found, and positive effects were achieved on the result. Transfer Learning was used to reduce training times and further increase the success rate. To find the best method, many different pre-trained Transfer Learning models have been tried and compared with many different studies. RESULTS: A total of 8,354 images were used in the research. Of these, 2,695 consist of COVID-19 patients and the remaining healthy chest tomography images. All of these images were given to the models through masking and segmentation processes. As a result of the experimental evaluation, the best model was determined to be ResNet-50 and the highest results were found (accuracy 95.7%, precision 94.7%, recall 99.2%, specificity 88.3%, F1 score 96.9%, ROC-AUC score 97%). CONCLUSIONS: The presence of a COVID-19 lesion in the images was identified with high accuracy and recall rate using the transfer learning model we developed using thorax CT images. This outcome demonstrates that the strategy will speed up the diagnosis of COVID-19.

Comparison of Shetty ankle test and Ottawa ankle rules in ankle injuries.

OBJECTIVE: Foot and ankle injuries are the most common extremity trauma and have an important place among the admissions to the emergency service. Ankle injuries are the most frequent form of orthopedic emergencies. Currently, Ottawa ankle rules (ORL) is the most popular test used worldwide for the ankle injuries. Shetty test is an important test used to evaluate the clinical status of patients admitted for the ankle trauma. PATIENTS AND METHODS: This study was initiated in the emergency service between May 1, 2018, and May 1, 2019, after the approval of the Ethics Committee. The patients were classified according to gender, age, and admission, Ottawa test results, Shetty test results, and radiography status. RESULTS: Shetty test can be used to differentiate between the foot sprains and fractures as a simple and inexpensive method. Despite its effectiveness, Ottawa ankle rules is not widely used due to the detailed implementation of the Ottawa ankle rules and the components of the test. The ease of applicability of the Shetty test in primary care makes the test stand out. In our study, although the sensitivity of Shetty and Ottawa tests resulted in close percentages (82.86% - 85.71%), the specificity of Ottawa test was found to be higher. CONCLUSIONS: Detecting a fracture in emergency services is more valuable than excluding a fracture. Even though Shetty test is simple to use, we recommend Ottawa test for the foot and ankle sprains due to the legal problem that could be caused by Shetty test.

The Symptoms in Persons At Risk of Rheumatoid Arthritis (SPARRA) questionnaire: predicting clinical arthritis development.

OBJECTIVE: There is a need to better define symptom characteristics associated with arthritis development in individuals at risk of rheumatoid arthritis (RA). We investigated whether reported symptoms in at-risk individuals could predict arthritis development and whether predictive symptoms differed between seropositive and seronegative at-risk individuals. METHOD: At-risk individuals from four cohorts (Netherlands, UK, Sweden, and Switzerland) completed the Symptoms in Persons At Risk of Rheumatoid Arthritis (SPARRA) questionnaire. Participants had either (i) anti-citrullinated protein antibodies and/or rheumatoid factor, or (ii) relevant symptoms with or without RA antibodies. Follow up was ≥ 24 months or until clinical arthritis development. Stepwise forward selection created SPARRA prediction models for the combined group and for a seropositive subgroup. RESULTS: Of 214 participants, the mean age was 50 years, 67% were female, and 27% (n = 58) developed clinical arthritis after a median time of 7 months. Four symptoms predicted arthritis development: self-reported joint swelling, joint pain moving from side to side (combined group only), feeling pins and needles in the joints, and often feeling fatigued (predicting non-arthritis). CONCLUSION: Specific symptoms can provide useful information to estimate a person's RA risk. Differences in predictive symptoms between seropositive and seronegative at-risk individuals need to be further investigated. Future research is needed to determine whether changes in symptoms over time improve prediction and to determine the value of SPARRA in optimizing the selection of individuals who need to consult a rheumatologist.

Magnetic resonance imaging (MRI) findings after knee, foot, and ankle traumas.

OBJECTIVE: The aim of this study is to investigate the demographic and clinical characteristics of knee and ankle traumas that could not be detected in the first post-traumatic evaluation and diagnosed within 15 days after the follow-up examination and to discuss the results we obtained with current data. PATIENTS AND METHODS: Patients admitted to the emergency department trauma department between January 1, 2017, and December 31, 2018, were retrospectively analyzed. Applications due to traffic accidents and all traumas except knee and ankle trauma were excluded from the study. Medical records were used to reveal the demographic characteristics of the cases, clinical findings, mechanisms of injury, additional injuries, and interventions in the emergency room. RESULTS: The mean age of 2,039 patients included in the study due to knee, foot, and ankle trauma was 35.69±12.01, and the median value was 36 (age range 11-71). The patients were divided into 2 groups knee trauma and ankle trauma and statistical evaluations were made. Of the patients evaluated for knee trauma (n=1,157), 463 (40%) were female and 694 (60%) were male. Of the patients evaluated for ankle trauma (n=882), 397 (45%) were female and 485 (55%) were male. CONCLUSIONS: It is evident that knee, foot, and ankle traumas after simple falls and sports injuries are frequently encountered by emergency physicians. It is known that post-traumatic ligament injury, bone contusion, intraarticular fluid/hematoma formation, and fractures that cannot be detected by radiographs can be overlooked in emergency departments where patient density is high.

Effects of thymoquinone on spinal cord injury in rats.

PURPOSE: Spinal cord injury (SCI) is a condition that causes disturbances in normal sensory, motor, and autonomic functions. During SCI, damages occur such as, contusion, compression, distraction. The aim of this study was to investigate effects of the antioxidative thymoquinone on neuron and glia cells in SCI biochemically, immunohistochemically and ultrastructurally. METHODS: Male Sprague-Dawley rats were divided into Control, SCI and SCI + Thymoquinone groups. After T10- T11 laminectomy was performed, a metal weight of 15 grams was left down the spinal tube for spinal damage. Immediately after the trauma, the muscles and skin incision were sutured. Thymoquinone was given to the rats by gavage as 30mg/kg/21days. Tissues fixed in 10% formaldehyde, embedded in paraffin wax and immunstained with Caspase-9 and phosphorylated signal transducer and activator of transcription 3 (pSTAT-3) antibodies. Remaining were stored at -80oC for biochemistry. Frozen spinal cord tissues were placed in a phosphate buffer solution and homogenized, centrifuged then used to measure malondialdehyde (MDA) levels, glutathione peroxidase (GSH) and Myeloperoxidase (MPO). RESULTS: In the SCI group, MDA, MPO, neuronal degeneration, vascular dilatation, inflammation, apoptotic appearance in the nucleus, loss of membrane and cristae in mitochondria, and dilatation in the endoplasmic reticulum were observed due to degeneration in the neuron structure. In the electron microscopic examination of the trauma + thymoquinone group, the membranes of the nuclei of the glial cells were thick and euchromatin, and mitochondria were shortened in length. In the SCI group, pyknosis and apoptotic changes were observed in neuronal structures and nuclei of glia cells in the substantia grisea and substantia alba region, along with positive Caspase-9 activity. An increase in Caspase-9 activity was observed in endothelial cells in blood vessels. In the SCI + thymoquinone group, Caspase-9 expression was positive in some of the cells in the ependymal canal while the cuboidal cells showed a negative Caspase-9 reaction in the majority. A few degenerated neurons in the substantia grisea region showed a positive reaction with Caspase-9. In SCI group, pSTAT-3 expression was positive in degenerated ependymal cells, neuronal structures, and glia cells. pSTAT-3 expression was positive in the endothelium and surrounding aggregated cells of the enlarged blood vessels. In the SCI+ thymoquinone group, pSTAT-3 expression was negative in most of the bipolar and multipolar neuron structures and glial cells in ependymal cells, enlarged blood vessel endothelial cells. CONCLUSIONS: It has been thought that thymoquinone application in spinal cord injuries may be an antioxidant that can be recommended as an alternative treatment in suppressing the apoptosis of neural cells by significantly reducing the inflammation process.

Characteristics and outcome of varicella-zoster virus central nervous system infections in adults.

We conducted an observational retrospective study of all adults hospitalized for documented varicella-zoster virus (VZV) meningitis or encephalitis during years 2000-2015 in one referral centre. Thirty-six patients (21 males, 15 females) were included, with meningitis (n = 21), or meningoencephalitis (n = 15). Median age was 51 years [interquartile range, 35-76], and 6 patients (17%) were immunocompromised. Aciclovir was started in 32 patients (89%), with a median dose of 11 mg/kg/8 h [10-15]. No patient died, but 12 (33%) had neurological sequelae at discharge. Age was the only variable associated with adverse outcome (OR 1.98 [1.17-3.35] per 10-year increment, P = 0.011).

Idiopathic pulmonary fibrosis: Significance of the usual interstitial pneumonia (UIP) CT-scan patterns defined in new international guidelines.

INTRODUCTION: The new 2018 international guidelines for diagnosing usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) by CT scan split the old pattern possible UIP (2011 IPF guidelines) into two new patterns: probable UIP and indeterminate for UIP. However, the proportions and prognoses of these new CT-scan patterns are not clear. METHODS: We used a monocentric retrospective cohort of 322 patients suspected of having IPF (University Hospital of Rennes; Competence Center for Rare Lung Diseases; 1 January 2012-31 December 2017). All patients initially diagnosed by CT scan as possible UIP were included. The chest CT-scans were then reclassified according to the new 2018 international guidelines by 3 observers. These data were then subjected to survival analysis with multivariate Cox regression using a composite endpoint of death, lung transplantation, a decline of≥10% in forced vital capacity (FVC), or hospitalization. RESULTS: Of the 89 possible UIP patients included, 74 (83%) were reclassified as probable UIP and 15 (17%) as indeterminate for UIP. Probable UIP patients were more likely to meet the composite endpoint (56/74 [75.7%] vs. 5/15 [33%] patients; HR [IC 95%] =3.12 [1.24; 7.83], P=0.015). Multivariate analysis indicated that the probable UIP pattern was associated with significantly increased risk of reaching the composite endpoint (HR [95% CI]=2.85[1.00; 8.10], P=0.049). CONCLUSION: The majority of possible UIP diagnoses corresponded to probable UIP, which was associated with a significantly worse prognosis than indeterminate for UIP. This distinction between these two CT patterns emphasizes the relevance of the new international guidelines for the diagnosis of IPF.

Neuroblastoma between 1990 and 2014 in the Netherlands: Increased incidence and improved survival of high-risk neuroblastoma.

PURPOSE: Long-term trends in neuroblastoma incidence and survival in unscreened populations are unknown. We explored trends in incidence, stage at diagnosis, treatment and survival of neuroblastoma in the Netherlands from 1990 to 2014. METHODS: The Netherlands Cancer Registry provided data on all patients aged <18 years diagnosed with a neuroblastoma. Trends in incidence and stage were evaluated by calculating the average annual percentage change (AAPC). Univariate and multivariable survival analyses were performed for stage 4 disease to test whether changes in treatment are associated with survival. RESULTS: Of the 593 newly diagnosed neuroblastoma cases, 45% was <18 months of age at diagnosis and 52% had stage 4 disease. The age-standardized incidence rate for stage 4 disease increased at all ages from 3.2 to 5.3 per million children per year (AAPC + 2.9%, p < .01). This increase was solely for patients ≥18 months old (3.0-5.4; AAPC +3.3%, p = .01). Five-year OS of all patients increased from 44 ± 5% to 61 ± 4% from 1990 to 2014 (p < .01) and from 19 ± 6% to 44 ± 6% (p < .01) for patients with stage 4 disease. Multivariable analysis revealed that high-dose chemotherapy followed by autologous stem cell rescue and anti-GD2-based immunotherapy were associated with this survival increase (HR 0.46, p < .01 and HR 0.37, p < .01, respectively). CONCLUSION: Incidence of stage 4 neuroblastoma increased exclusively in patients aged ≥18 months since 1990, whereas the incidence of other stages remained stable. The 5-year OS of stage 4 patients improved, mostly due to the introduction of high-dose chemotherapy followed by stem cell rescue and immunotherapy.

Medial olivocochlear suppression in musicians versus non-musicians.

The medial olivocochlear efferent (MOCE) branch synapses with outer hair cells (OHCs), and the efferent pathway can be activated via a contralateral acoustic stimulus (CAS). The activation of MOCE can change OHC motile responses and convert signals that are capable of controlling the sensitivity of the peripheral hearing system in a frequency-specific manner. The aim of this study was to examine the MOCE system activity in professional musicians using transient evoked otoacoustic emission test and CAS. Musician group showed stronger suppression in all frequency bands in the presence of CAS.

Acute effect of primary percutaneous coronary intervention on left ventricular dyssynchrony in ST-segment elevation myocardial infarction.

OBJECTIVE: The aim of this study was to prospectively evaluate the effect of percutaneous coronary intervention in the acute period on left ventricular dyssynchrony in ST-segment elevation myocardial infarction patients by using Tissue Synchronization Imaging. METHODS: Forty-four ST-segment elevation myocardial infarction (MI) patients (29 male, 15 female), who were admitted within the first 12 hours of chest pain symptoms, were enrolled in the study. According to the localization of MI, the patients were divided into groups as anterior MI (n=26) and inferior MI (n=18). All echocardiography measurements were taken just before percutaneous coronary intervention (PCI) and following PCI at a mean of 3-6 days. They were assessed according to the time to reach the peak systolic velocity, which was calculated by the tissue synchronization imaging method from four pairs of non-apical alternate segments. The difference between the duration to reach the peak systolic velocity in alternate segments was regarded as left ventricle dyssynchrony and the results were compared. RESULTS: In the anterior MI group, basal anterior (p<0.01), mid-anterior segment (p<0.01) and basal septal segment (p<0.01); in the inferior MI group, the basal septal segment (p=0.02), mid-septal segment (p=0.02), and basal and mid-inferior segment (p<0.01) values were significantly lower in the post-PCI measurements when compared to the measurements taken prior to PCI. In both groups, the intraventricular dyssynchrony indices of the basal anterior-basal inferior (p<0.01), mid-anterior-mid-inferior (p<0.01) segments were found to be significantly lower in the post-PCI period when compared to the pre-PCI period. CONCLUSION: It was found that percutaneous coronary intervention in patients with ST-elevation significantly decreases the degree of LV dyssynchrony in the acute period.

Two cases of very late bare-metal stent thrombosis and literature review.

BACKGROUND: Bare metal stents (BMS) are commonly used in the treatment of coronary artery disease. Very late stent thrombosis (VLST) is a quite rare clinical entity. However, it is a serious complication that often results myocardial infarction or death. Since the stent endothelialization is considered to be completed within 4 weeks after the intervention, VLST is not common with BMS. PATIENTS AND METHODS: The pathogenesis of the VLST is poorly defined. Herein, we report two cases of VLST in which one a 62 year old male patient devoloped VLST of a BMS implanted in the right coronary artery (RCA) and presented inferior myocardial infarction and other a 48 year old male patient devoloped very late thrombosis of a BMS implanted in the RCA and presented inferior myocardial infarction, respectively. CONCLUSIONS: On the basis of these two cases and our review of the current literature we suggest that what can be done to prevent this rare but offending complication. Moreover, in the light of new imaging modalities such as optical coherence tomography (OCT), the pathophysiology of stent thrombosis will be clearly defined and preventive measures will be taken before it occurs.

New methods for using computer-aided detection information for the detection of lung nodules on chest radiographs.

OBJECTIVE: To investigate two new methods of using computer-aided detection (CAD) system information for the detection of lung nodules on chest radiographs. We evaluated an interactive CAD application and an independent combination of radiologists and CAD scores. METHODS: 300 posteroanterior and lateral digital chest radiographs were selected, including 111 with a solitary pulmonary nodule (average diameter, 16 mm). Both nodule and control cases were verified by CT. Six radiologists and six residents reviewed the chest radiographs without CAD and with CAD (ClearRead +Detect™ 5.2; Riverain Technologies, Miamisburg, OH) in two reading sessions. The CAD system was used in an interactive manner; CAD marks, accompanied by a score of suspicion, remained hidden unless the location was queried by the radiologist. Jackknife alternative free response receiver operating characteristics multireader multicase analysis was used to measure detection performance. Area under the curve (AUC) and partial AUC (pAUC) between a specificity of 80% and 100% served as the measure for detection performance. We also evaluated the results of a weighted combination of CAD scores and reader scores, at the location of reader findings. RESULTS: AUC for the observers without CAD was 0.824. No significant improvement was seen with interactive use of CAD (AUC = 0.834; p = 0.15). Independent combination significantly improved detection performance (AUC = 0.834; p = 0.006). pAUCs without and with interactive CAD were similar (0.128), but improved with independent combination (0.137). CONCLUSION: Interactive CAD did not improve reader performance for the detection of lung nodules on chest radiographs. Independent combination of reader and CAD scores improved the detection performance of lung nodules. ADVANCES IN KNOWLEDGE: (1) Interactive use of currently available CAD software did not improve the radiologists' detection performance of lung nodules on chest radiographs. (2) Independently combining the interpretations of the radiologist and the CAD system improved detection of lung nodules on chest radiographs.

A critical analysis of low molecular weight heparin use during pregnancy in a tertiary referral centre.

The aim of this study was to analyse low molecular weight heparin (LMWH) use during pregnancy in terms of patient evaluation, treatment indication and social and financial costs. This was a retrospective analysis of patients using LMWH in their pregnancies. A total of 147 women were included in the study. The most common indications were thrombophilia (55/147, 37.4%); recurrent pregnancy loss (RPL); (47/147, 32.0%) and previous single pregnancy loss (18/147, 12.2%). In the RPL group, 53.1% of patients were not evaluated with standard tests; 31.9% of women were incompletely evaluated and 15% were properly evaluated. Out of 104 women screened for thrombophilia, 32 (32/104, 30.8%) were tested during pregnancy. Despite published guidelines and increasing scientific evidence against their use in some indications, LMWHs are prescribed widely during pregnancy for a variety of indications. Public and healthcare providers' education to change this attitude should be implemented.

Predictors of reintervention after coronary artery bypass grafting.

AIM: Percutaneous and surgical reintervention after coronary artery bypass grafting (CABG) is frequent. The purpose of this study was to determine the predictors of reintervention in patients with symptoms of recurrent ischemia after coronary artery bypass graft surgery (CABG). PATIENTS AND METHODS: The data of 20000 patients who had coronary angiography (CAG) from 2003 to 2010 in our centre were retrospectively analysed. 485 of these patients with CABG who had CAG were included in this study. Demographic characteristics, the presence of coronary artery disease (CAD), risk factors for CAD, electrocardiographic (ECG) changes, troponin and CKMB levels, and left ventricular function were evaluated in terms of time elapsed after CABG. RESULTS: Reintervention was performed significantly more frequent in patients with acute coronary syndrome, diabetes mellitus (DM), hypertension (HT), family history of CAD, ECG changes, positive troponin level, elevated CKMB, ejection fraction (EF) > 50% and in smoker patients (p < 0.05). Multivariate backward logistic regression analysis revealed that DM, smoking, family history of CAD, HT, ECG changes and patients with EF > 50% were found the independent predictors of reintervention. CONCLUSIONS: Reintervention after CABG is especially higher in patients with risk factors for atherosclerosis and those who have ECG changes and normal EF. Knowledge of these risk factors is useful in the determination of CAG requirement and modification of risk factors for  atherosclerosis may play an important role in reducing reintervention.

Bacillus Calmette-Guérin is a preventive factor in mortality of childhood tuberculous meningitis.

OBJECTIVES: Studies have been done that have focused on the efficacy of bacillus Calmette-Guérin (BCG) vaccination in the prevention of cases of childhood tuberculous meningitis (TBM). However the efficacy of the vaccination in the prevention of mortality has not been sufficiently evaluated. This study aimed to determine the main features of TBM cases in childhood and to evaluate the factors related to mortality, proving the protective effect of BCG vaccination in childhood TBM. METHODS: In a retrospective approach, all consecutive cases of TBM in children that occurred between 1997 and 2005, at Dicle University Hospital, were studied. The following data were evaluated: demographic aspects, admission symptoms, radiology and laboratory findings, BCG vaccination status, tuberculin skin test (TST) positivity, and mortality rates. RESULTS: In total, 172 cases of childhood TBM were evaluated (mean age 53.3±55.7 months; 109 boys (63.4%)). The majority of these cases (70.4%) had typical TBM symptoms on admission. BCG vaccination data were available for 152 (88.4%) cases and 29 of them (19.1%) were positive. The TST was performed for 143 patients (83.1%) and 28 (19.6%) were found positive. Hydrocephalus was identified in 118 patients (68.6%) on computed tomography examination. A shunt was placed in 79 cases (45.9%). In total, 24 patients (14.0%) died in the hospital. TST negativity was a significant factor for mortality (p=0.012). BCG positivity was found to be a preventive factor from mortality (p=0.05). CONCLUSIONS: BCG vaccination is effective in the prevention of TBM-associated mortality in childhood. TST negativity may be a sign of a poor prognosis in TBM cases.

Infraannular dislocation and its successful management: A rare complication following TAVI.

Transcatheter aortic valve implantation has been increasingly used in symptomatic patients with severe aortic stenosis who are inoperable or at high risk. However it remains associated with the potential for serious complications. We report a case in which an Edwards Sapien (Edwards, Irvine, CA, USA) valve prosthesis dislocated to the left ventricular outflow tract with hemodynamic collapse 6 h following implantation. .