An evaluation of matrix metalloproteinase-9 (Mmp-9) and tissue inhibitor metalloproteinase-1 (Timp-1) Serum levels and the Mmp-9/Timp-1 Ratio in Covid-19 patients.

Background: The progression of COVID-19 has different clinical presentations, which raises a number of immunological questions. Objectives: This study aimed to investigate MMP-9 and TIMP-1 levels in patients diagnosed with COVID-19 and whether the MMP-9/TIMP-1 ratio is associated with lung involvement in COVID-19. Methods: This study was conducted with 192 patients and 45 healthy controls. ELISA was used to measure the MMP-9 and TIMP-1. Results: The MMP-9 and TIMP-1 levels of the patients were found to be higher than those of the controls. MMP-9 and TIMP-1 were detected more in patients with lung involvement on chest CT scans than in those with no lung involvement on chest CT scans. A comparison of lung involvement levels revealed no difference was found between the groups. The MMP-9/TIMP-1 ratio was 5.8 in the group with lung involvement on chest CT scans and 6.1 in the group without lung involvement on chest CT scans. No difference was found between the two groups. A comparison with respect to lung involvement levels showed that the MMP-9/TIMP-1 ratio difference was found between the groups. Conclusion: Diagnostic and treatment methods targeting MMP-9 activity or neutrophil activation may be important in predicting lung involvement in COVID-19 and directing clinical outcomes.

Chest CT findings in RT-PCR positive asymptomatic COVID-19 patients.

PURPOSE: To investigate chest computed tomography (CT) findings in asymptomatic patients tested positive for coronavirus disease (COVID-19) by reverse transcription-polymerase chain reaction (RT-PCR). MATERIAL AND METHODS: The chest CT images of 64 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who were RT-PCR test-positive but asymptomatic were retrospectively evaluated for the appearance and distribution of abnormal parenchymal findings. RESULTS: Of the 64 patients (mean age 59.4 ± 12; range 23-85), 42 (65%) were female, and 22 (35%) were male, and 16 (25%) of the patients had no abnormal findings on chest CT. Of the remaining 48 patients, lung involvement was bilateral in 32 (67%). Right upper lobe in 26 (54%), right middle lobe in 20 (42%), right lower lobe in 38 (79%), left upper lobe in 27 (56%), and left lower lobe were affected in 34 (71%) patients. The mean number of opacities detected in patients was 7.5 ± 5.7. The opacities were located only peripherally/subpleural in 22 (46%), only centrally/peribronchovascular in 5 (10%), and mixed in 21 (44%) patients. The frequency of pure ground glass opacities (GGO) was 63% GGO with a crazy-paving pattern or consolidation was 33%. Pure consolidation was detected in only two (4%) patients. Parenchymal opacities were only round in 27 (56%), only geographic demarcated in 3 (6%), only patchy in 2 (4%), and mixed in 16 (33%) patients. CONCLUSION: Chest CT was normal in only one-quarter of the asymptomatic patients. CT findings in asymptomatic COVID-19 patients were often peripherally located, mostly round-shaped GGO.

An Exercise Prescription for COVID-19 Pandemic.

COVID-19 is an alarming public health concern worldwide. COVID-19 is highly contagious and has no approved treatment or vaccine yet. Therefore, the best strategy is prevention. Studies have shown that a healthy lifestyle, regular exercise, balanced eating, and quality sleep are the key elements for protection from this disease. We are going through a distressful period as a nation and as the human race in general. We need to manage this period in the best way possible in physiological and psychological terms. Physical activity is one of the major steps in managing this period in a healthy way. Individuals should be provided information about exercise so that they can perform correct physical activities within their means. This article presents an exercise prescription that can be followed in the days of the COVID-19 pandemic.

Is serum high-mobility group box 1 (HMGB-1) level correlated with liver fibrosis in chronic hepatitis B?

BACKGROUND: High-mobility group box 1 (HMGB1), identified as an alarmin molecule, was shown to have a role in virus-triggered liver injury. We aimed to evaluate the association between serum levels of HMGB1 and liver fibrosis. METHOD: This cross-sectional case-control study included 189 chronic hepatitis B (CHB) patients and 51 healthy controls. All patients underwent liver biopsy and modified Knodell scoring system used to determine the fibrosis level in CHB patients. Serum HMGB1 levels were determined with enzyme-linked immunosorbent assay (ELISA). RESULTS: Mean serum HMGB1 levels of patients (58.1 ±â€Š54.7) were found to be higher than those of the control group (7.1 ±â€Š4.3) (P = .001). HMGB1 levels of patients with advanced-stage fibrosis (stage 4 and 5) were detected to be higher than those of patients with early-stage fibrosis (stage 1-3). However, this difference was not statistically significant (P > .05). Albumin levels of fibrosis 3 and 4 patients were lower than fibrosis 1 and 2 patients. ALT, HBV DNA, and AFP levels of fibrosis 5 patients were significantly higher than fibrosis 1 and 2 patients, and their platelet and albumin levels are lower than fibrosis 1 and 2 patients (P < .001). In a logistic regression model, fibrosis levels were correlated with ALT values and inversely correlated with albumin levels. CONCLUSION: In this study, we demonstrated that serum HMGB1 levels increase in the early course of liver injury and this increase is not correlated with severity of the liver damage.

Serum Levels of Annexin A2 as a Candidate Biomarker for Hepatic Fibrosis in Patients With Chronic Hepatitis B.

BACKGROUND: Hepatologists have studied serologic markers of liver injury for decades. Annexins are a prominent group of such markers and annexin A2 (AnxA2) is one of the best characterized annexins. AnxA2 inhibits HBV polymerase among other functions. Its expression is up-regulated in regenerative hepatocytes. OBJECTIVES: To determine if serum AnxA2 level has a role in estimating liver damage in chronic HBV infection and investigate whether AnxA2 levels correlate with hepatic fibrosis. PATIENTS AND METHODS: This study included 173 patients with chronic hepatitis B (CHB) and 51 healthy controls. Liver fibrosis was graded histologically on liver biopsy samples. Blood samples were taken from patients during biopsy and serum AnxA2 levels were measured with ELISA. RESULTS: In a group of adult patients with CHB, AnxA2 values were far higher than those of the control group (P = 0.001). When we assessed AnxA2 levels based on fibrosis stages, serum AnxA2 levels of patients with early stage fibrosis (stages 1 - 3) were significantly higher than those of patients with advanced stage fibrosis (stages 4 - 5; P = 0.001). CONCLUSIONS: AnxA2 is a useful biomarker for early stage fibrosis in patients with CHB.

Retreatment of Chronic Hepatitis C Infection with Telaprevir: Preliminary Results in Turkey.

BACKGROUND: The use of pegylated interferon alpha and ribavirin (PegIFN/RBV) for the retreatment of chronic hepatitis C virus (HCV) infection without a sustained virological response (SVR) prior to PegIFN/RBV treatment has resulted in low success rates. AIMS: To investigate the efficacy and safety of telaprevir (TVR) in combination with PegIFN/RBV in patients infected with HCV genotypes 1 and 4 who were previously treated with PegIFN/RBV and failed to achieve SVR. STUDY DESIGN: Multi-center, retrospective, cross-sectional study. METHODS: The study included 111 patients: 80 prior relapsers, 25 prior null responders, and six prior partial responders to PegIFN/RBV treatment. The patients were given TVR/PegIFN/RBV for 12 weeks, followed by a 12-week PegIFN/RBV treatment; virological response results were assessed at weeks 4, 12, and 24. Treatment was discontinued in patients with HCV RNA >1000 IU/mL at week 4 or with negative RNA results at week 4 but >1000 IU/mL at week 12. Rapid virological response (RVR), early virological response (EVR), extended rapid virological response (eRVR), and virological response at 24th week of treatment were evaluated. The side effects of combination therapy and the rates of treatment discontinuation were investigated. RESULTS: The mean age of the patients was 56.02±9.96 years and 45.9% were male. Ninety-one percent of the patients were infected with viral genotype 1, 69.6% with the interleukin (IL) 28B genotype CT and 20.2% were cirrhotic. The RVR rate was 86.3% in prior relapsers, 56% in prior null responders, and 50% in prior partial responders (p=0.002). EVR rates in those groups were 91.3%, 56%, and 83.3%, respectively (p<0.001). eRVR rates were 83.8% in prior relapsers, 48% in prior null responders, and 50% in prior partial responders (<0.001). The virological response at the 24th week of treatment was found to be the highest in prior relapsers (88.8%); it was 56% in prior null responders and 66.7% in prior partial responders (p<0.001). Common side effects were fatigue, headache, anorexia, malaise, anemia, pruritus, dry skin, rash, dyspepsia, nausea, pyrexia, stomachache, and anorectal discomfort. All treatments were discontinued due to side effects in 9.9% of patients. CONCLUSION: High virological response rates were obtained with TVR/PegIFN/RBV treatment. Although side effects were frequently observed, the discontinuation rate of combination therapy was low.

Intracranial giant tuberculoma mimicking brain tumor: a case report.

Tuberculomas are small tumor-like lumps that can be seen, usually in large numbers, in central nervous system involvement of tuberculosis. Giant tuberculomas that are big enough to cause symptoms of compression are also encountered, though rarely. When they are really large, tuberculomas may result in increased intracranial compression, neurologic deficits, or epileptic attacks. Giant tuberculomas may be confused with brain tumors on cranial magnetic resonance imaging. Cranial magnetic resonance imaging and histopathology examinations are used for diagnosis. Although magnetic resonance imaging is useful for diagnosing tuberculoma, histopathology examination is the gold standard for a final diagnosis. This paper presents a case involving a 66-year-old patient who complained of headache, imbalance and dizziness, and underwent an operation in the neurosurgery clinic with a pre-diagnosis of brain tumor, and was then diagnosed with intracranial giant tuberculoma.

An alternative treatment approach in tetanus: Botulinum toxin.

Tetanus is a preventable infectious disease caused by tetanus toxin (tetanospasmin) produced by Clostridium tetani. Tetanus is still an important health problem in low- and middle-income countries (LMICs). Botulinum toxin administration is a treatment approach that has been used in recent years to reduce rigidity and spasms in tetanus patients. This case report focuses on its efficacy.

Primary hydatid disease of brachialis and biceps brachii muscles: a case report.

Primary hydatid cyst of the skeletal muscle is very rare and accounts for less than 1% of all cases. It is often asymptomatic and can pose diagnostic problems. Accurate diagnosis should be made using ultrasonography and magnetic resonance imaging. Proper treatment should be a wide surgical resection of the localized muscle with the aid of antihelmintic chemotherapy pre- and postoperatively. We report a case of primary hydatic cyst located simultaneously in both the biceps brachii and brachialis muscles, treated with wide resection surgery and pre- and postoperative anthelmintic chemotherapy.

The life-saving little tip: intraosseous gas.

A case is presented of an-aerobic osteomyelitis with intraosseous gas resulting in the extension of gas in soft tissue structures in a patient with diabetes mellitus. The finding of intraosseous gas and its extension into the pubic joint and the left anterior abdominal wall is depicted. Intraosseous gas is a rare but worrying finding for osteomyelitis in the absence of a penetrative wound, recent surgery, biopsy or fracture.

Neuro-Behçet's syndrome presenting with features mimicking acute tuberculous meningitis.

Behçet's disease is an inflammatory disease that can involve multiple systems. Here, we describe a case of neuro-Behçet's syndrome presenting with features mimicking acute tuberculous meningitis. Behçet's disease should be considered in the differential diagnosis of a meningeal syndrome unless a viral or bacterial agent is demonstrated.