Monocyte-to-high-density lipoprotein ratio: an independent predictor of reverse dipper pattern in hypertensive patients.

OBJECTIVE: In healthy individuals, blood pressure (BP) levels are expected to decrease by 10-20% during sleep hours, which is defined as the dipping pattern. On the other hand, the presence of a BP rise at night in hypertensive patients is defined as a reverse dipper hypertensive pattern (RDHT). RDHT has been associated with stroke and cardiovascular mortality. Similarly, the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has been associated with the prognosis of cardiovascular disease. We, therefore, aimed to assess the relationship between MHR and RDHT in patients with hypertension. PATIENTS AND METHODS: A total of 363 patients were enrolled in the study, all of whom had undergone 24-hour ambulatory BP monitoring. The patients were analyzed in three groups: RDHT (n: 92), dipper hypertensive (DHT) (n: 124), and normotensive controls (n: 147). Univariable and multivariable analyses were performed to identify factors that could be used to predict RDHT presence. RESULTS: The RDHT group was compared with the DHT and normotensive groups. A high MHR (p = 0.014, OR: 1.110, CIs: 1.021-1.206) and low daytime diastolic BP (p = 0.026, OR: 0.951, CIs: 0.910-0.994) were found to be independent factors that differentiated RDHT from DHT. Additionally, high MHR (p < 0.001, OR: 1.244, CIs: 1.140-1.357), body mass index (p = 0.005, OR: 1.143, CIs: 1.042-1.255), and C-reactive protein (p = 0.009, OR: 1.166, CIs: 1.039-1.308) were found to be independent factors that could differentiate patients with RDHT from controls. CONCLUSIONS: We demonstrated that MHR, a novel inflammatory marker, independently predicts RDHT. This easily applicable and inexpensive marker can be used to predict RDHT in patients with hypertension.

Insecticidal effects of extracts of Humulus lupulus (hops) L. cones and its principal component, xanthohumol.

Insecticidal effects of the dichloromethane, ethyl acetate, acetone, ethanol and methanol extracts of Humulus lupulus (hops) L. cones and its principal components, xanthohumol was investigated on five stored pests, Sitophilus granarius (L.), Sitophilus oryzae (L.), Acanthoscelides obtectus (Say.), Tribolium castaneum (Herbst) and Lasioderma serricorne (F.). The mortality of adults of the insects treated with 2, 5, 5, 10 and 20 mg mlÌ -1 concentrations of the extracts and xanthuhumol was counted after 24, 48, 72, 96 and 120 h. In order to determine the toxic effects of the substances tested against all tested insects, durations for 50% mortality of the adults, and LD50 values were also determined in the first 48 h by probit analysis. Our results also showed that xanthohumol was more toxic against the pests in comparison with the extracts applications. LD50 values for xanthohumol were found to be low dose as compared with the extracts. Xanthohumol was more toxic against S. granarius (L.) with 6.8 µg of LD50 value. Among the extracts, methanol extract was less effective than other extracts against all tested insects. The ethyl acetate extract of H. lupulus cones was the most effective extract against the tested pests. The quantitative amounts of xanthohumol in the extracts were determined using a high-performance liquid chromatography. The quantitative data indicated that amount of xanthohumol in the extracts increased with increase of polarity of the solvents used from methanol to dichloromethane. The methanol extract contained the high amount of xanthohumol with 5.74 g/100 g extract (0.46 g/100 g plant sample).

Evidence for neurotoxicity associated with amoxicillin in juvenile rats.

Amoxicillin (AMX) is one of the most commonly prescribed antibiotics for children, and childhood is the period to have the highest risk for toxicity cases including drug-induced adverse reactions. Some neurological adverse effects (anxiety, hyperactivity, confusion, convulsions, and behavioral changes) have been reported related to AMX treatment. In the present study, we aimed to determine the neurotoxic effects of AMX administration at clinically relevant doses in female juvenile rats. AMX was administered in single oral daily doses of 25 and 50 mg/kg for 14 days. According to our results, while AMX administration caused a significant increase in the immobility time of animals, swimming time of these animals significantly decreased. AMX administration significantly reduced the onset of pentylenetetrazole-induced convulsions. The serotonin levels of brain tissues in the AMX-administered groups were decreased significantly, which is thought to be related to depression. The glutamate levels in brain tissues increased significantly in AMX-administered groups, which is thought to be related to convulsion. Otherwise, superoxide dismutase and catalase activities were significantly decreased in brain tissues of AMX-administered groups. In conclusion, AMX administration triggered depression and shortened the time of the appearance of first seizure in juvenile rats. Also, altered brain neurotransmitter levels and increased oxidative stress observed in our study were thought to be the possible underlying mechanisms of AMX-induced neurotoxicity.

Effect of lidocaine spray in pain management during office-based endometrial sampling: A randomised placebo-controlled trial.

Office-based endometrial sampling is the most frequently performed gynaecological procedure. The procedure is usually associated with pain and discomfort. Several anaesthetic and analgesic techniques (e.g., non-steroidal anti-inflammatory drugs, paracervical block, misoprostol and topical anaesthetics) are used for pain management during endometrial sampling. There is no comprehensive study using lidocaine in spray form; we sought to investigate the analgesic efficacy of 10% lidocaine spray in patients undergoing office-based endometrial biopsy. We conducted a prospective, randomised (lidocaine spray (n = 60) and placebo (n = 60), respectively), double-blind study. The mean pain score during procedure was 3.51 ± 1.51 in the lidocaine spray group and 5.11 ± 1.66 in the placebo group. Lidocaine spray treatment significantly lowered the pain scores compared with placebo (p < 0.001). Lidocaine spray can be accepted as a non-invasive, easy to apply and more comfortable anaesthetic method for office-based endometrial sampling.

The association between anti-Müllerian hormone and IVF-ICSI outcome in poor responder patients performing long protocol.

PURPOSE OF INVESTIGATION: Ovarian reserve reflects the capacity of the ovaries for a successful pregnancy. Anti-Müllerian hormone (AMH) could be a useful marker to predict ovarian reserve and to adjust controlled ovarian stimulation. The aim of this study was to assess the relationship between AMH and intracytoplasmic sperm injection-in vitro fertilization (IVF-ICSI) outcome in poor responder women. MATERIALS AND METHODS: This study was conducted prospectively for a period of 12 months. Inclusion criteria were FSH value > 15 iu/l or antral follicle number < 4, on the 2nd day of cycle. All patients underwent GnRH agonist stimulation with long protocol. Serum AMH levels were measured in the treatment cycle just before the stimulation. After the treatment, patients who were pregnant formed the study group and patients who were not pregnant formed the control group. Serum AMH level was the main outcome measure. RESULTS: The study and control group consisted of 34 and 70 patients, respectively. No significant difference was found in duration of infertility, antral follicular count, basal E2 and FSH levels. The mean serum AMH level was significantly higher in study group (p = 0.005). The retrieved oocyte number, metaphase 2 oocyte number, and fertilization rate were also significantly higher in the study group. DISCUSSION: Evaluation of serum AMH seems to be a useful marker to predict IVF-ICSI outcome in poor responder patients.

Psychological effects of calisthenic exercises on neuroinflammatory and rheumatic diseases.

BACKGROUND: The aim of this study was to evaluate the effects of calisthenic exercises on psychological status in patients with ankylosing spondylitis (AS) and multiple sclerosis (MS). METHODS: This study comprised 40 patients diagnosed with AS randomized into two exercise groups (group 1 = hospital-based, group 2 = home-based) and 40 patients diagnosed with MS randomized into two exercise groups (group 1 = hospital-based, group 2 = home-based). RESULTS: The exercise programme was completed by 73 participants (hospital-based = 34, home-based = 39). Mean age was 33.75 ± 5.77 years. After the 8-week exercise programme in the AS group, the home-based exercise group showed significant improvements in erythrocyte sedimentation rates (ESR). The hospital-based exercise group showed significant improvements in terms of the Bath AS Metrology Index (BASMI) and Hospital Anxiety and Depression Scale-Anxiety (HADS-A) scores. After the 8-week exercise programme in the MS group, the home-based and hospital-based exercise groups showed significant improvements in terms of the 10-m walking test, Berg Balance Scale (BBS), HADS-A, and MS international Quality of Life (MusiQoL) scores. There was a significant improvement in the hospital-based and a significant deterioration in the home-based MS patients according to HADS-Depression (HADS-D) score. CONCLUSION: The positive effects of exercises on neurologic and rheumatic chronic inflammatory processes associated with disability should not be underestimated.

Effects of testicular histopathology on sperm retrieval rates and ICSI results in non-obstructive azoospermia.

Non-obstructive azoospermia (NOA) is characterised by absence of sperm in the ejaculate. Significant relationship between the pattern of the testis histopathology of NOA and successful sperm retrieval rate is well known. In this study, we assess efficacy of testicular histopathology on sperm retrieval rates and intracytoplasmic sperm injection results after microdissection testicular sperm extraction in cases of non-obstructive azoospermia. It is a retrospective analysis of 111 NOA patients who have histopathological confirmation. According to histopathological findings, the patients were divided into three groups: Sertoli-cell-only syndrome (SCOS), maturation arrest (MA) and hypospermatogenesis. Sperm retrieval rate was significantly higher in hypospermatogenesis group compared with that in SCOS and MA groups. In terms of fertilisation and clinical pregnancy rates, there was no significant difference between the groups. As a result, compared with MA and SCOS, hypospermatogenesis has higher sperm retrieval rates. Our study revealed that once successful sperm retrieval is achieved, fertilisation and clinical pregnancy rates are similar in NOA patients.

Urinary leukotriene E4 and prostaglandin F2a concentrations in children with migraine: a randomized study.

OBJECTIVES: Pro-inflammatory mediators are thought to play both peripheral and central roles in migraine pathophysiology. Prostaglandins and leukotrienes, known as the eicosanoids, are degradation products of arachidonic acid and constitute signalization components of inflammatory pathways. This study was designed to assess concentrations of leukotriene E4 (LT-E4) and prostaglandin F2a (PG-F2a) in children with migraine. MATERIALS AND METHODS: This study involved patients aged ≤18 years who presented to the Ondokuz Mayis University Children's Hospital with migrainous headache between January and October 2011. Urinary LT-E4 and PG-F2a concentrations were measured in patients during a headache episode and at a headache-free time and in a control group. RESULTS: The patient group consisted of 38 girls and 26 boys aged 5-18 years diagnosed with migraine and having at least 6 months of headache, whereas the control group consisted of 21 girls and 29 boys. Mean ± standard deviation (SD) urinary LT-E4 concentrations were significantly higher in patients during a migraine episode than in controls (1466.8±1052.5 pg/ml vs 811.6±460.0 pg/ml, P<0.001). In patients with migraine, both urinary LT-E4 (P<0.001) and PG-F2a (P=0.021) levels were significantly higher during headache than during non-headache periods. CONCLUSION: Urinary LT-E4 and PG-F2a were both significantly higher in children with migraine during headache than during non-headache periods. The elevation in the levels of these inflammatory mediators was compatible with the hypothesis relating neuroinflammation in trigeminal vascular blood vessels with migraine pathophysiology. Leukotriene antagonists may be effective in the prophylaxis of migraine attacks.

Evaluation of the effectiveness of home based or hospital based calisthenic exercises in patients with multiple sclerosis.

OBJECTIVES: The aim of this study is to evaluate the effects of calisthenic exercises on balance, walking speed, fatigue, quality of life, and psychological status in patients with Multiple Sclerosis (MS). PATIENTS AND METHODS: Forty patients diagnosed with MS were randomized into two exercise groups (group 1 = hospital-based, group 2 = home-based). Outcome measures including the MS International Quality of Life Scale, 10-meter walking test, Berg Balance Scale, Fatigue Severity Scale and the Hospital Anxiety Depression Inventory were assessed at the baseline and at 12-weeks. RESULTS: Thirty-six participants completed the exercise programme (hospital based = 16, home based = 20). The mean age was 32.83 ± 3.64 years. The mean duration of disease was 6.97 ± 3.15 years. Hospital-based and home-based exercise groups had significant improvements in the balance, 10-meter walking test, anxiety, and the quality of life after the 12-week exercise programme. There was a significant improvement in the hospital-based patients in terms of the depression scores. No significant improvement was observed in terms of fatigue in any of the groups. When both groups were compared, the improvement in the balance and depression scores of the hospital-based patients was significantly higher than the home-based patients. CONCLUSIONS: Calisthenic exercises can be easily performed both at home and in hospital setting. In patients with MS, calisthenic exercises performed at home or at the hospital may improve the balance, quality of life, and the functional and psychological status, while no significant effect has been observed on fatigue.

Does dehydroepiandrosterone supplementation really affect IVF-ICSI outcome in women with poor ovarian reserve?

OBJECTIVES: It is difficult to choose the correct fertility treatment in women with poor ovarian reserve. Although various methods have been used, the management of controlled ovarian hyperstimulation is not easy in poor responders. The aim of this study was to evaluate the efficacy of dehydroepiandrosterone (DHEA) on in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) outcome of poor responders. STUDY DESIGN: This was a randomized, prospective controlled trial. Women with serum antimullerian hormone<1 ng/ml or serum follicle-stimulating hormone>15 IU/l and antral follicle count <4 on day 2 of the menstrual cycle were considered to have poor ovarian reserve. All women were treated with a microdose induction protocol. Women in the study group received IVF-ICSI and DHEA 75 mg daily for 12 weeks. Women in the control group received IVF-ICSI without DHEA supplementation. RESULTS: In total, 208 women with diminished ovarian reserve was enrolled in the study, 104 in the study group and 104 in the control group. The number of oocytes retrieved and the fertilization rate were slightly higher in the study group, but the pregnancy rate was higher in the control group. The differences were not significant. CONCLUSIONS: The results failed to show that DHEA supplementation enhances IVF-ICSI outcome in women with poor ovarian reserve.

Single-incision laparoscopic cholecystectomy: a new retraction technique.

BACKGROUND: Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot's triangle. SURGICAL TECHNIQUE: Twelve patients underwent laparo-endoscopic single site laparoscopic cholecystectomy using this retraction technique. An intra-umbilical skin incision was made by pulling out the umbilicus. A SILS port was placed through an open approach. We inserted a 10-mm 30 degrees camera through the SILS port without using any trocar. One suture was knotted in the middle of the gallbladder. Gallbladder retraction was achieved by the use of an EndoClose needle that was inserted into abdominal cavity at the subcostal border. The floppy knot was held by the notched end of the EndoClose needle. This device provided retraction of the gallbladder in every direction. CONCLUSIONS: Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.

Clinical and radiological characteristics of tumefactive demyelinating lesions: follow-up study.

BACKGROUND: Demyelinating lesions over 20 mm in size, referred to as tumefactive demyelinating lesions, can be misdiagnosed as being either a tumor or an abscess. Although some radiological characteristics can help make a differential diagnosis easier, a cerebral biopsy may still be necessary. OBJECTIVE: Our objective was to assess the clinical characteristics of tumefactive lesions, with or without a diagnosis of multiple sclerosis (MS), and present follow-up data for 54 patients with tumefactive lesions. METHODS: Demographic, clinical, radiological and laboratory data were gathered and treatment responses were evaluated in a total of 54 patients from five medical centers. RESULT: Twenty-nine patients were diagnosed with tumefactive lesions at the onset, whereas 25 patients were diagnosed with tumefactive lesions after a diagnosis of MS. Median follow-up was 38.12 months. At final examination, 19 of the patients with a tumefactive lesion diagnosis at the onset eventually developed relapsing-remitting MS, while 10 remained with the condition as a clinically isolated syndrome. The tumefactive lesions studied were mostly focal, with closed-ring enhancement. We found that oligoclonal band positivity was less frequent in the patients with tumefactive onset. CONCLUSION: Although our demographic data were similar to formerly collected Turkish MS data, we found that the distribution of the patients' clinical course differed if there was an absence of primary progressive MS and that there was a lower frequency of secondary progressive MS cases in our group of patients. We believe that less frequent oligoclonal band positivity and the difference we witnessed in the clinical course of disease in our study groups suggest that there is a need for further studies to compare all the biological and immunological differences between MS and tumefactive lesion cases, in order to reveal whether there are different pathogenetic mechanisms involved.

The effects of levothyroxine substitution on body composition and body mass after total thyroidectomy for benign nodular goiter.

OBJECTIVE: Many patients who have undergone total thyroidectomy complain about weight gain and changes in body composition. This prospective study was designed to evaluate the effect of thyroxine replacement on body mass index (BMI) and body composition following total thyroidectomy for benign multinodular goiter. METHODS: Thirty-three consecutive patients were enrolled. The patients of those histopathological examination revealed carcinoma (n=5) and who did not present for the 6th month follow-up visit (n=6) were excluded. Thyroxine (T4, 100 µg, dose range 50-200 µg) was started in all patients immediately after the surgery and adjusted according to plasma TSH and FT4-FT3 levels in the postoperative 3rd week and postoperative 3rd and 6th months respectively to achieve optimal TSH within normal reference range (0.5- 4.2 mU/L). Changes in weight, BMI and anthropometric measurements were performed preoperatively and in the postoperative 3rd and 6th months. RESULTS: The study completed with 22 patients (17 female and 5 male, mean: 45.8 years; range: 26-64 years). Fourteen patients maintained euthyroid status and eight had subclinical hypothyroidism. There were no significant differences between the subclinical hypothyroid and euthyroid patients in BMI and the other anthropometric values (p>0.05). In the comparisons for age, there were significant changes with regarding weight and BMI. Increases in weight were noted as 2.2±2.7 kg in age over 45 (n= 14, mean: 52.7 years, range: 46-64 years), while 0.1±1.3 kg in age under 45 years (mean; 33.8, range: 26-43 years) and BMI as 0.8±1.0 in age over 45 years compared to 0.04±0.5 in age under 45 years, respectively (p=0.025 and p=0.029, respectively). No significant differences were noted in other anthropometric parameters at the end of 6th month compared to the baseline value except the triceps skin fold (p=0.027). CONCLUSION: Levothyroxine replacement had no effect on their body composition; however, age was found to be an important factor for weight gain and change in BMI during the midterm follow-up period.

Reliability of a functional test battery evaluating functionality, proprioception, and strength in recreational athletes with functional ankle instability.

AIM: In contrast to the single evaluation methods used in the past, the combination of multiple tests allows one to obtain a global assessment of the ankle joint. The aim of this study was to determine the reliability of the different tests in a functional test battery. METHODS: Twenty-four male recreational athletes with unilateral functional ankle instability (FAI) were recruited for this study. One component of the test battery included five different functional ability tests. These tests included a single limb hopping course, single-legged and triple-legged hop for distance, and six and cross six meter hop for time. The ankle joint position sense and one leg standing test were used for evaluation of proprioception and sensorimotor control. The isokinetic strengths of the ankle invertor and evertor muscles were evaluated at a velocity of 120 degrees /s. The reliability of the test battery was assessed by calculating the intraclass correlation coefficient (ICC). Each subject was tested two times, with an interval of 3-5 days between the test sessions. RESULTS: The ICCs for ankle functional and proprioceptive ability showed high reliability (ICCs ranging from 0.94 to 0.98). Additionally, isokinetic ankle joint inversion and eversion strength measurements represented good to high reliability (ICCs between 0.82 and 0.98). CONCLUSION: The functional test battery investigated in this study proved to be a reliable tool for the assessment of athletes with functional ankle instability. Therefore, clinicians may obtain reliable information from the functional test battery during the assessment of ankle joint performance in patients with functional ankle instability.

Shoulder terminal range eccentric antagonist/concentric agonist strength ratios in overhead athletes.

OBJECTIVE: The agonist-antagonist strength relationship for shoulder external rotation and internal rotation was formerly described by the relatively more functional ratios of eccentric external rotator to concentric internal rotator moments, and eccentric internal rotator to concentric external rotator moments for the entire range of motion. The aim of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist rotator cuff strength in overhead athletes. METHOD: The dominant and non-dominant shoulders of 40 asymptomatic military overhead athletes were tested through a range of 20 degrees of external rotation to 90 degrees of internal rotation using the Cybex NORM isokinetic dynamometer at a speed of 90 degrees /s. Differences between the dominant and non-dominant shoulders were assessed using the paired samples t-test. RESULTS: The terminal range ratios during external rotation (20 degrees of internal rotation - 10 degrees of external rotation) were found to be 2.09 and 1.58 for the dominant and non-dominant shoulders, respectively, whereas the terminal range ratios during internal rotation (60-90 degrees of internal rotation) were 1.03 and 1.19 for the dominant and non-dominant shoulders, respectively. These ratio differences between the dominant and non-dominant shoulders were significant (P<0.01 for external and internal rotation). CONCLUSION: The muscle torque ratios of eccentric antagonist/concentric agonist are different between dominant and non-dominant shoulders of skilled overhead athletes at terminal ranges. This functional assessment of strength testing that reflects dynamic shoulder joint stability during the throwing activity at these specific ranges may provide valuable information either during preventive exercise programs or in the evaluation of the injured shoulder of the overhead athlete. We recommended functional exercises that improve eccentric external rotation strength on the dominant shoulder during the rehabilitation and prevention programs in overhead athletes.

Modern and traditional practices of Turkish infertile couples.

OBJECTIVE: This investigation was carried out to determine modern and traditional practices of infertile couples in Kayseri, Turkey. METHODS: Two hundred and fifty-two infertile couples were selected from the study area. Modern and traditional practices of the infertile women and their husbands were investigated through a questionnaire. The effects of some factors on the utilization of traditional methods were analysed through the logistic regression method. RESULTS: It was found out that 92.5% of the infertile women and 71.8% of their husbands had consulted a physician for infertility and 92.1% of the women and 32.6% of their husbands had applied for medical or surgical intervention. However, only 11.1% of the couples had attempted in vitro fertilization. In contrast, 61.5% of the infertile couples admitted to carrying out traditional practices. All traditional practices were more prevalent among the women than the men. CONCLUSION: It was concluded that traditional practices were more prevalent in the rural areas and among the older couples.

Sequential avulsion of the anterior inferior iliac spine in an adolescent long jumper.

We present here an unusual case of a sequential avulsion fracture of the anterior inferior iliac spine (AIIS), occurring first in the right and then the left AIIS, during long jump attempts. The case of a 17 year old boy with pain around his right groin, which first occurred during a long jump attempt, is presented. Radiographic examination revealed an avulsion fracture of the right AIIS. After conservative treatment, full athletic activity was allowed 2 months after the injury. However, 4 months later the patient returned with a similar pain in the opposite side of his groin. Radiographs revealed another fracture of the left AIIS. The boy underwent the same treatment protocol; he was examined with isokinetic dynamometry. No complication or re-injury occurred during the 2 year follow up period. In the present study, we introduce the first case of a sequential bilateral AIIS avulsion fracture caused by a long jump.