RED CELL DISTRIBUTION WIDTH AND ACUTE COMPLICATIONS OF DIABETES.

CONTEXT: Red cell distribution width (RDW) has been associated with type 2 diabetes (T2DM), however data in relation to diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar non-ketotic acidosis (HONK) remains unclear. OBJECTIVE: The aim of this study was to evaluate the association between RDW, MCV, and RDW/MVC values and acute complications in T2DM. PATIENTS AND METHODS: RDW was measured in 90 T2DM patients (30 DKA, 30 HONK and 30 T2DM without acute complications). Clinical variables were analyzed by One -Way ANOVA, Kruskal-Wallis and Pearson analysis with SPSS software. Diagnostic screening tests and ROC curve analysis determined the cut-off point of MCV,RDW and RDW/MCV values. RESULTS: DKA patients had higher levels of plasma glucose (524.20±201.43mg/dL, p<0.001), HbA1c (10.73±2.29%, p<0.001), osmotic pressure (310.32 mosm/L, p<0.001), RDW (14.61±1.75g/L, p<0.01), and the RDW/MCV ratio (0.17±0.04%, p<0.01), compared to HONK patients. RDW/MCV cut-off value was 0.15 with 90% sensitivity 50% specifity these values for only MCV were 76.67%-70%, for only RDW were 76.67%-63.33% respectively. The area under curve values for the ability to reflect DKA for RDW and the RDW/MCV ratio were 0.708 and 0.766, respectively (p<0.001). CONCLUSIONS: RDW and RDW/MCV ratio were found associated with DKA and valuable in predicting DKA. However these parameters were not valuable in predicting HONK.

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.

Mining wastewater management and its effects on groundwater and ecosystems.

Large-scale mining activities have a huge impact on the environment. Determination of the size of the effect and monitoring it is vital. In this study, risk assessment studies in mining areas and the effect of mining on groundwater and ecosystems were investigated. Best management practices and risk assessment steps were determined, especially in areas with huge amounts of mining wastewater. The pollution of groundwater and its reaching humans is a risk of major importance. Our study showed, using many cases with different parameters and countries, that the management of mining wastewater is vital. Environmental impact assessments and monitoring studies must be carried out before operation and at the closure of the mine. Policies must be in place and ready to apply. Factors of climate, geology, ecology and human health must be considered over a long period. Currently, only the developed countries are applying policies and paying attention to the risk. International assessments and health risk assessments should be carried out according to international standards.

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.

Real time ultrasound guided pediatric percutaneous renal biopsy: the traditional method versus angled tangential approach.

AIM: The aim of the present study was to compare the success and complication rates of pediatric renal biopsy procedures between the angled tangential approach and the traditional approach. METHODS: From 2004 to 2009 we prospectively enrolled pediatric patients who had undergone real time ultrasound guided renal biopsy with angled tangential approach. For comparison, we retrospectively reviewed pediatric patients who had undergone traditional renal biopsy between 2002 and 2004. Adequacy of renal tissue histopathological samples and the complication rates were compared between groups. RESULTS: One hundred twenty-eight patients underwent traditional renal biopsy (Group A) while 166 patients underwent biopsy performed with angled tangential approach (Group B).The rate of inadequate material was higher in Group A compared to Group B (6.3% vs. 0.6%, p = 0.006). In four cases (three in Group A and one in Group B) renal biopsies revealed normal renal tissue. While a major complication (hemoperitoneum requiring transfusion) occurred in one case in Group A, no major complications were seen in Group B. CONCLUSION: Compared with the traditional technique, the angled tangential approach resulted in a higher adequate material rate and lower complication rate.These findings indicate that angled tangential approach could be considered for pediatric percutaneous renal biopsies.

A new technique for endoscopic treatment of gastric phytobezoars: fragmentation using guidewire.

BACKGROUND AND STUDY AIMS: Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often occur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure. PATIENTS AND METHODS: Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endoscope. PBs were surrounded by a loop in the guidewire and destroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness. RESULTS: PB fragmentation time was 5-11 minutes. In five patients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients additionally treated with enzymatic degradation after the breaking procedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure. CONCLUSIONS: The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzymatic degradation, PBs can be managed quickly and effectively.

Granular cell tumor of the breast.

Granular cell tumor is a rare benign soft-tissue neoplasm, usually appearing in the tongue, the oral cavity and subcutaneous tissue. Examples of granular cell tumor of breast are encountered in 30-50-year-old women. Herein, we report ultrasonographic and mammographic imaging findings of a 59 years old woman presented with a painless palpable mass, which was diagnosed as granular cell tumor on histopathological analysis.

External validation of Cleveland Clinic Foundation colorectal cancer model in a University Clinic in terms of predicting operative mortality.

BACKGROUND: The aim of this study was to perform an external validation of Cleveland Clinic Foundation colorectal cancer model in a single center. METHODS: Relevant data of 771 patients who underwent surgery for colorectal cancer between January 1997 and November 2008 were retrospectively collected. The performance of the scoring system was evaluated by discrimination and calibration. Discrimination was evaluated by using the area under the receiver operator characteristics curve and calibration by using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Mean age was 60.8 (18-91). Forty-four percent of patients were female, and 56% were male. Overall mortality was 3.9%. Cleveland Clinic Foundation colorectal cancer model showed good discrimination but poor calibration. CONCLUSION: These data suggest that the Cleveland Clinic Foundation colorectal cancer model is a suitable model to be used in our center for patients with colorectal cancer but requires recalibration.

Drugs with blocking effects on the renin-angiotensin-aldosterone system do not improve endothelial dysfunction long-term in hypertensive patients.

In essential hypertension, endothelial dysfunction has been documented many times and correlates with prognosis. The influence of the renin-angiotensin-aldosterone system (RAAS) on endothelial dysfunction has also been studied. The present study investigated the duration of the effects of RAAS-blocking drugs on endothelial function in 44 consecutive, never-treated, outpatients with mild to moderate hypertension. Patients (11 per group) received an angiotensin receptor blocker (ARB; irbesartan 300 mg/day or valsartan 160 mg/day) or an angiotensin-converting enzyme inhibitor (ACEi; fosinopril 10 mg/day or quinapril 20 mg/day). If target blood pressure (< 140/90 mmHg) was not achieved, 12.5 mg/day hydrochlorothiazide was added. Endothelial function, assessed by measuring brachial artery diameter, did not change significantly after 6 weeks, 1 year or 3 years of treatment in any group. Across all groups, endothelium-dependent and -independent vasodilation increased significantly after 6 weeks but, after 1 year, decreased below baseline and was at a similar level after 3 years; groups did not differ significantly. Both ACEi and ARB had similar effects on endothelial function; improvement occurred at the start of treatment but was not maintained. Endothelial dysfunction may be a resistant or irreversible feature of hypertension, requiring high doses of antihypertensive drugs and above-average patient compliance.

Double outlet right ventricle and aortopulmonary window in a patient with Cornelia de Lange syndrome: a novel association.

We report a patient with Cornelia de Lange syndrome with congenital cardiac malformation; double outlet right ventricle and aortopulmonary window. This is the first report describing this combination of findings for Cornelia de Lange syndrome. Behalf of this report, the pathogenesis of congenital heart disease in Cornelia de Lange syndrome was also revisited.

Omani-type spondyloepiphyseal dysplasia with cardiac involvement caused by a missense mutation in CHST3.

We describe a family with progressive skeletal dysplasia and severe spinal involvement, short stature, premature arthrosis and joint contractures diagnosed as spondyloepiphyseal dysplasia Omani type. Mutation analysis in CHST3, the gene encoding for the chondroitin 6-O-sulfotransferase-1 (C6ST-1), revealed a homozygous missense mutation (T141M) in exon 3 in all three affected members of the family. Using recombinant C6ST-1, we showed that the identified missense mutation results in a reduction of C6ST-1 activity to 24-29% of the wild type protein. In addition to the previously noted skeletal features, affected members of this family also had cardiac involvement including mitral, tricuspid and/or aortic regurgitations and type E brachydactyly.

Supracoronary myotomy for myocardial bridges in the setting of hypertrophic cardiomyopathy: off-pump experience.

Myocardial bridges (MB) are rarely observed but well known pathology of the major epicardial coronary arteries which are embedded in the overlying myocardial tissue. It is most frequently found in young patients with hypertrophic cardiomyopathy (HCM). Myocardial bridges are associated with myocardial ischemia and infarction, cardiac arrhythmias and sudden death. The present case series report the outcomes of three symptomatic patients with hypertrophic cardiomyopathy who underwent myocardial muscle debridges. They were operated using beating heart technique without cardiopulmonary bypass. The authors conclude that off-pump supracoronary muscle myotomy is a feasible treatment modality in the young age group with non-obstructive hypertrophic cardiomyopathy.

Endothelial dysfunction in Turkish patients with non-alcoholic fatty liver disease.

BACKGROUND: The components of the metabolic syndrome are closely related with endothelial dysfunction, which is a pathophysiological issue of cardiovascular diseases. Non-alcoholic fatty liver disease (NAFLD) is considered as one of the components of the metabolic syndrome. The aim of this study was to evaluate the endothelial-dependent dilatation (EDD) and endothelial-independent dilatation (EID) of the brachial artery in NAFLD. METHODS: Fifteen non-alcoholic steatohepatitis (NASH), 17 patients with simple steatosis and 16 healthy subjects formed the study group. Non-alcoholic fatty liver disease group was composed of patients admitted to the gastroenterology outpatient clinic because of increased liver enzymes. Endothelial functions of the brachial artery were evaluated by vascular ultrasound. EDD was assessed by establishing reactive hyperaemia, and EID was determined by using sublingual nitrate. RESULTS: No statistical difference for the basal diameter of brachial artery was found between the groups (P = 0.49). The values for EDD and EID were significantly different across all three groups (P < 0.0001 and P < 0.0001, respectively). EDD and EID were significantly lower in NASH compared with simple steatosis (P = 0.01 and P < 0.01, respectively). However, there was no statistical significance for EDD and EID in simple steatosis groups compared with controls (P = 0.58 and P = 0.98, respectively). CONCLUSIONS: Our study showed that patients with NASH had significantly worse endothelial dysfunction compared with patients with simple steatosis and healthy subjects. The treatment strategies with ameliorative effects for endothelial dysfunction might be effective for delaying the development of cardiovascular complications in NAFLD.

Effect of Helicobacter pylori infection on deep vein thrombosis seen in patients with Behçet's disease.

OBJECTIVE: To investigate the role of homocysteine metabolism due to Helicobacter pylori infection on the development of deep vein thrombosis (DVT) in patients with Behcet's disease (BD). DESIGN: Prospective clinical study. SETTING: Teaching hospital. SUBJECT: Fifty-five patients with BD divided into groups, with DVT and without DVT, 19 healthy individuals and 18 patients with coronary artery disease (CAD) were enrolled into the study. INTERVENTIONS: Plasma homocysteine and Hp seropositivity were determined. RESULTS: There was significant Hp positivity in all groups (p > 0.05). Homocysteine levels were not significantly different for each group except patients with CAD (p > 0.05). CONCLUSION: There was no difference for frequency of Hp infection in all groups. We conclude that Hp does not influence DVT seen in BD via homocysteine metabolism, but the methinnin-loading test would be appropriate for enlighting patients whose fasting plasma homocysteine levels are found to be normal.

Echocardiographic study on the origin of the innocent flow murmurs.

To investigate the origin of the pulmonary systolic ejection innocent flow murmur (IFM), echocardiographic examinations were undertaken in 30 children with IFM and in a control group consisting of 28 healthy children without murmur. Compared to the controls, the diameters of the left ventricular outflow tract (LVOT) and aortic valve annulus and aortic valve area tended to be smaller, whereas stroke volume (SV) and cardiac output were slightly greater in children with IFM, but they were not statistically significant. Mean fractional shortening was significantly higher in children with IFM. Peak flow velocity of LVOT, right ventricular outflow tract, aorta, and pulmonary artery, mean velocity and velocity time integral of the aortic and pulmonary flow, and maximal acceleration of the aortic flow were all significantly higher in the IFM group compared to the controls. The variables of left-sided flow velocities in the same individuals with IFM were significantly higher compared to those derived from the right heart. The ratios of the SV to the LVOT diameter and to the aortic valve area were found to be significantly greater. It was concluded that IFM originates from higher blood flow velocities in the region of LVOT and aortic valve annulus, and that the increased flow velocity results from the larger SV passing through the relatively narrow LVOT and aortic valve in children with IFM.

Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe.

Anatomical variations in the venous system of liver are not a rarity. A prospective helical computerized tomography (CT) study was undertaken to determine the prevalence of surgically significant hepatic venous anatomic variations among 100 consecutive living liver donors. The studies evaluated the ramification pattern of hepatic veins, the presence of accessory hepatic veins, and of segment 5 or 8 veins (or both) draining into middle hepatic vein. These data obtained by CT influenced surgical planning. Sixty-four donors donated their right lobes and 24 donors, left lateral segments. Only one donor candidate was refused due to combined hepatic and portal venous variations accompanied by multiple bile ducts. Eleven donors were also refused due to reasons other than anatomical variations. Seventeen segment 5 and 17 segment 8 veins draining into middle hepatic vein were anastomosed to inferior vena cava in 23 (36%) of the right lobe liver transplantations. The middle hepatic vein was harvested in only one of the donors. Among the 100 cases, 47 had accessory right inferior hepatic veins, 13 of which were multiple. Twenty-two of the right lobe grafts required surgical anastomoses of these accessory hepatic veins (34%). An isolated hepatic vein anomaly or the presence of accessory hepatic veins are not contraindications to be a living liver donor candidate. However, preoperative knowledge of vascular variations alters surgical management. Helical CT is a valuable tool to delineate the hepatic venous anatomy for surgical planning in living liver donors.

Comparison of five detection methods for Helicobacter pylori.

OBJECTIVE: To evaluate which diagnostic test is preferable for the diagnosis of Helicobacter pylori in patients with gastroduodenal disease. STUDY DESIGN: H pylori infection was diagnosed prospectively in 101 patients. Diagnosis of H pylori was made by tests based on five different principles: (1) culture, (2) direct histologic demonstration, (3) imprint cytology, (4) brushing cytology, and (5) gram staining of H pylori. Efficacy of each test was compared. RESULTS: All the tests were reliable for diagnosing H pylori infection; 73.3% of patients showed concordance in at least two tests. All the tests were positive in > 50% of patients. Significant concordance between brushing and imprint cytology was also determined. These two tests have almost similar specificity when compared to other tests. CONCLUSION: When patients undergo upper endoscopy, we recommend taking biopsy specimens for culture and histology. H pylori can be assessed equally well with all the tests, but imprint and brushing cytology have the advantage of rapid response, specificity, much lower cost and reproducibility.

Iron status in breast-fed full-term infants.

The aim of this study was to evaluate the iron status of full-term babies breast-fed exclusively for four months and the importance of iron supplementation. One hundred sixteen term infants followed up since the newborn period by a well baby clinic were included in the study. Iron deficient and/or anemic infants were excluded from the study at four months. Some of the infants (51) were later given appropriate complementary food besides breast-feeding (Group A) and some (42) were given ferrous sulfate (1 mg/kg/d) (Group B). Blood count and serum iron and ferritin measurements were done at four and six months of age. At the 4th month, iron deficiency was found in 23 (19.8%) infants, 11 of which had iron deficiency anemia. At the 6th month, 23 (45%) infants in Group A were iron deficient and 11 (21.6%) of them had iron deficiency anemia. In Group B, three (7.1%) infants were iron deficient and one (2.4%) of them also had iron deficiency anemia (p < 0.0001). Significant iron deficiency and iron deficiency anemia have been found in four-month-old exclusively breast-fed full-term infants. It is observed that complementary food alone is insufficient; there is need for iron supplementation.