Stent plus balloon-assisted coiling with low-profile braided stents in the treatment of complex wide-necked intracranial bifurcation aneurysms.

INTRODUCTION: Wide-necked bifurcation aneurysms pose significant challenges for endovascular treatment. A recent innovation, the stent plus balloon-assisted coiling technique, combines a stent and a balloon to address these aneurysms effectively. PURPOSE: To evaluate the safety and efficacy of the stent plus balloon-assisted coiling for the treatment of wide-necked bifurcation aneurysms. METHODS: We conducted a retrospective review of our endovascular database to identify patients who were treated with this technique and had a satisfactory angiographic follow-up of at least 24 months. Technical success, initial clinical and angiographic outcomes, procedural complications, and follow-up results were analyzed. Angiographic and clinical outcomes were assessed using Modified Raymond-Roy Classification and Modified Rankin Scale, respectively. RESULTS: Our study included 37 aneurysms in 36 patients (26 females) with a mean age of 56.6 years. Mean aneurysm and neck sizes were 7.3 ± 3.5 mm and 3.7 ± 1.0 mm, respectively. Technical success reached 97.2%, with an immediate occlusion rate of 65.7%. At a mean follow-up of 36.5 ± 9.7 months, final angiographic follow-up showed a 91.9% complete occlusion rate. Three aneurysms did not achieve complete occlusion; however, none required retreatment. Complications developed in 32.4% of the procedures. Mortality and morbidity rates were 5.4% and 2.7%, respectively. A good clinical outcome was observed in 91.9% of patients. CONCLUSION: Our results showed that stent plus balloon-assisted coiling technique allows good angiographic outcomes for wide-necked bifurcation aneurysms. However, overall complication rate is high. Subgroup analysis indicated promising safety and efficacy for MCA bifurcation aneurysms, suggesting this technique could be a valuable option for select aneurysms.

Evaluation of common carotid artery wall stiffness by shear wave elastography in smokers and non-smokers.

INTRODUCTION: Smoking is one of the most important preventable causes of cardiovascular diseases. Vascular disease caused by smoking is associated with vascular endothelial damage, platelet aggregation, and adhesion. In our study, we examined the effect of chronic smoking on vessel wall stiffness in smokers and control group by measuring carotid artery wall stiffness by shear wave ultrasonography. METHODS: Sixty-two smokers of similar ages and genders, and 67 people who never smoked in the last ten years were included as the control group in this cross-sectional study. Arterial wall stiffness over the common carotid arteries of all participants was measured by shear wave elastography (SWE). In addition, each patient's blood pressure, fasting blood glucose, body mass index (BMI), HDL and LDL cholesterol measurements were recorded. RESULTS: Arterial wall stiffness values in smokers were found to be statistically significantly higher than in non-smokers. The mean of SWE measurements of the smokers was 47.3 ± 6.2 kPa, and that of the control group was 42.9 ± 4 kPa. The mean values of HDL and LDL of the smokers were 46.9 ± 5.6 mg/dL and 147.3 ± 9.3 mg/dL, respectively, and those of the control group were 50.3 ± 5.1 mg/dL and 136.9 ± 5.9 mg/dL. The LDL cholesterol values were statistically significantly higher in smokers compared to the control group, and HDL cholesterol values were statistically significantly lower in smokers. CONCLUSIONS: In our study, the arterial wall stiffness values measured by the SWE technique were higher in smokers than non-smokers.

Magnetic resonance imaging/ultrasound fusion-guided sacroiliac joint corticosteroid injection in patients with axial spondyloarthritis.

Local glucocorticoid injections are used in the treatment of isolated sacroiliitis in patients with spondyloarthritis. Sacroiliac joint injections can be performed intraarticularly or periarticularly. Since the accuracy of blind injections is low, fluoroscopy, magnetic resonance imaging, computed tomography, or ultrasonography guidance are used to increase the accuracy of sacroiliac joint injections. Currently, imaging fusion software is successfully used in sacroiliac joint interventions with three-dimensional anatomic information added to ultrasonography. Herein, we present two cases of sacroiliac joint corticosteroid injections under ultrasonography-magnetic resonance imaging fusion guidance.

Ultrasound-Guided Suprascapular Nerve Block at Suprascapular Notch-Do We Really Target Suprascapular Notch or Not? Where Is Our Real Target?

Ultrasound (US)-guided suprascapular nerve block (SSNB) is a widely used procedure and while describing the US-guided SSNB in the suprascapular notch, the suprascapular fossa is often visualized and injection is performed in that location. Although it can be done in both location, to inject the right area, the terminology should be settled and the visualization of these areas which are unclear and confusing in the literature should be clarified. In this sense, we showed the course of the nerve on a cadaver and briefly describe a protocol to correctly visualize the suprascapular notch with US.

Wound healing activity of Salvia huberi ethanolic extract in streptozocin-induced diabetic rats.

Objective: The aim of this study was to examine the in vivo wound healing potential of Salvia huberi Hedge (endemic to Turkey) on excision and incision wound models in diabetic rats. Method: Male Wistar albino rats, 3-4 months old and weighing 180-240g were used. The animals were randomly divided into five groups including Control, Vehicle and Fito reference, and two different concentrations (0.5% and 1% weight/weight (w/w)) of ethanol extract of Salvia huberi were investigated in both wound models on streptozocin-induced diabetic rats using macroscopic, biomechanical, biochemical, histopathological, genotoxic and gene expression methods over both seven and 14 days. Fito cream (Tripharma Drug Industry and Trade Inc., Turkey) was used as the reference drug. Results: A total of 60 rats were used in this study. Salvia huberi ointments at 0.5% and 1% (w/w) concentrations and Fito cream showed 99.3%, 99.4% and 99.1% contraction for excision wounds, and 99.9%, 97.0% and 99% contraction for incision wounds, respectively. In Salvia huberi ointments and Fito cream groups, re-epithelialisation increased dramatically by both day 7 and day 14 (p<0.05). By day 14, low hydroxyproline and malondialdehyde (MDA) levels, and high glutathione (GSH) levels were observed in the Salvia huberi ointment groups. After two application periods, damaged cell percent and genetic damage index values and micronucleus frequency of Salvia huberi ointment treatment groups were lower than Control and Vehicle groups (p<0.001). A growth factor expression reached a high level by day 7 in the Control group; in Salvia huberi-treated groups it was decreased. Conclusion: The study showed that application of Salvia huberi ointments ameliorated the healing process in diabetic rats with excisional and incisional wounds and may serve as a potent healing agent.

Evaluation of the Coronal Malposition of the Volar Locking Plate in the Treatment of Distal Radius Fractures.

BACKGROUND AND OBJECTIVES: Literature does not show any studies regarding plate placement problems in the coronal plane of patients with volar plating due to distal radius fracture diagnosis. We aimed to investigate the functional and laboratory results of the coronal malposition of the volar locking plate in patients with distal radius fracture treated with internal fixation. METHODS: In this retrospective study, we included patients who had volar plate fixation, were aged between 18 and 80, had no pathological fracture, had a minimum of six months of follow-up, and had the same rehabilitation protocol. We consider the angle subtended on the coronal axis between the distal radius long axis and the distal radius locking plate as coronal malposition. We named the coronal malposition angle the "AYE Angle." Patients with an AYE angle of over 1 degree were evaluated under group 1. Patients with an AYE angle of 0-1 degrees were evaluated under group 2. Radiological parameters were taken from AP-Lateral X-ray views. Superficial University System of Georgia (USG) examinations were applied to detect tendon problems. The DASH and QUICK-DASH scoring systems were used for clinical evaluation. Grip strength was measured with a dynamometer in all patients. All results were compared between the two groups. RESULTS: Thirteen patients were female and 27 patients were male. Nineteen patients who had coronal malposition were added to group 1, while 21 patients who had no coronal malposition were added to group 2. Fifteen patients had normal USG results in group 2, while 18 patients had edema around the flexor pollicis longus (FPL) tendon as a result of USG in group 1. Statistically, a significant difference was detected between the two groups in terms of the amount of tenosynovitis around FPL (p=0.01). A statistically significant relationship was found between USG grading and malposition grading. The study revealed that a higher rate of USG grade 2 was found in patients with malposition grade 2 (90.9%), while a higher rate of USG grade 1 (50%) was observed in patients with malposition grade 1 (p=0.01). A statistically significant difference was not found between Soong grading and USG in terms of the level of tenosynovitis around the FPL tendon. The amount of tenosynovitis detected around the FPL tendon was 62.5% for Soong and grade 0 level, 60.7% for grade 1 level, and 50% for grade 2 level. There was no statistically significant difference between the two groups in the DASH and QUICK-DASH scoring systems (p=0.96). There was no statistically significant difference between the two groups in the grip strength (p=0.52). CONCLUSION: Coronal plate position in the treatment of the distal radius fracture is important to avoid potential flexor tendon problems. The volar plate position should be adjusted properly both in the coronal and sagittal axes.

Added value of coronal-T1W sequence to the lumbar MR imaging protocol for low back pain. / Valor de la secuencia coronal-T1W agregada al protocolo de imágenes de resonancia magnética en casos de dolor lumbar

INTRODUCTION: Magnetic resonance imaging (MRI) is the most appropriate imaging method to investigate low back pain. As low back pain is very common, a large number of MRI scans are performed. OBJECTIVE: To evaluate the extraspinal findings and clinical effect of the T1-weighted spin echo (T1W SE) coronal sequence added to the lumbar MRI protocol for low back pain. MATERIALS AND METHODS: In 2015, we added a T1-weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images for low back pain performed with this protocol. The extraspinal MRI findings obtained from them were then grouped as associated with low back pain (Category 1) and not associated with low back pain (Category 2). We also evaluated whether the recorded incidental extraspinal findings could be detected on conventional sagittal and axial images. RESULTS: Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1) and 56 (37%), Category 2. Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images. CONCLUSION: Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment.

Introducción. La resonancia magnética (RM) es el método de imágenes diagnósticas más apropiado para investigar el dolor lumbar. Dado que este es muy común, son muchas las resonancias magnéticas de este tipo que se hacen. Objetivo. Analizar los hallazgos extraespinales que se pueden detectar al agregar la secuencia coronal T1W al protocolo de imágenes de RM para el dolor lumbar y evaluar su efecto clínico. Materiales y métodos. En el 2015 se agregó una secuencia coronal ponderada en T1W al protocolo de resonancia magnética lumbar de rutina de nuestro hospital. Se evaluaron retrospectivamente 969 imágenes solicitadas en casos de dolor lumbar y realizadas con este protocolo. Los hallazgos obtenidos a partir de dichas imágenes se agruparon luego como asociados con el dolor lumbar (categoría 1) y no asociados con el dolor lumbar (categoría 2). Se evaluó, asimismo, si los hallazgos extraespinales registrados podían detectarse en imágenes axiales y sagitales convencionales. Resultados. Noventa y seis (63 %) de los hallazgos extraespinales se asociaron con lumbalgia (categoría 1) y 56 (37 %) correspondieron a la categoría 2. El 78 % de los hallazgos extraespinales se detectaron solo en imágenes coronales-T1W y no en las convencionales. Conclusión. La secuencia coronal-T1W agregada al protocolo de rutina de la resonancia magnética lumbar puede ayudar a detectar afectaciones extraespinales y guiar el tratamiento clínico.

Effects of COVID-19 lockdown strategies on emergency medical services.

INTRODUCTION: The aim of this study is to evaluate the change in the number of EMS cases by comparing the lockdown period, the non-lockdown period, and the pre-pandemic period. METHODS: In our study, 3 periods of EMS cases were compared to evaluate the effect of lockdown. The first period (Period A) included in the study was the lockdown period (01-12-2020 and 31-01-2021. The second period (period B) is the period between 01 and 10-2020 and 30-11-2020, where there was no lockdown despite the pandemic. The third period (period C) in the study is the period between 01 and 12-2019 and 31-01-2020 before the pandemic. RESULTS: A total of 120,989 cases in 3 periods were included in the study. It was determined that the highest number of patients were in period C (42,703, 35.3%), while the least was in period A (39,054, 32.2%). On the other hand, it was found that the number of calls was highest in period A (246,200, 35.1%), while the least was in period C (212,267, 30.2%). Response times were longer in the pandemic period than in the pre-pandemic period. Mean talk time were longer during the pandemic period. The most frequent diagnosis in period A (21.6%) and B (42.2%) was COVID-19. The second most frequent disease group in these two periods was cardiovascular diseases. CONCLUSION: While the number of EMS cases decreased during the pandemic period, it decreased even more during the lockdown period. However, the number of calls increased significantly during the lockdown period, and the response times and talk times increased accordingly.

Added value of coronal-T1 W sequence to the lumbar MR imaging protocol for low back pain / Valor de la secuencia coronal-TIW agregada al protocolo de imágenes de resonancia magnética en casos de dolor lumbar

Introduction: Magnetic resonance imaging (MRI) is the most appropriate imaging method to investigate low back pain. As low back pain is very common, a large number of MRI scans are performed. Objective: To evaluate the extraspinal findings and clinical effect of the T1-weighted spin echo (T1 W SE) coronal sequence added to the lumbar MRI protocol for low back pain. Materials and methods: In 2015, we added a T1-weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images for low back pain performed with this protocol. The extraspinal MRI findings obtained from them were then grouped as associated with low back pain (Category 1) and not associated with low back pain (Category 2). We also evaluated whether the recorded incidental extraspinal findings could be detected on conventional sagittal and axial images. Results: Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1) and 56 (37%), Category 2. Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images. Conclusion: Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment.

Introducción. La resonancia magnética (RM) es el método de imágenes diagnósticas más apropiado para investigar el dolor lumbar. Dado que este es muy común, son muchas las resonancias magnéticas de este tipo que se hacen. Objetivo. Analizar los hallazgos extra espinales que se pueden detectar al agregar la secuencia coronal T1 W al protocolo de imágenes de RM para el dolor lumbar y evaluar su efecto clínico. Materiales y métodos. En el 2015 se agregó una secuencia coronal ponderada en T1W al protocolo de resonancia magnética lumbar de rutina de nuestro hospital. Se evaluaron retrospectivamente 969 imágenes solicitadas en casos de dolor lumbar y realizadas con este protocolo. Los hallazgos obtenidos a partir de dichas imágenes se agruparon luego como asociados con el dolor lumbar (categoría 1) y no asociados con el dolor lumbar (categoría 2). Se evaluó, asimismo, si los hallazgos extra espinales registrados podían detectarse en imágenes axiales y sagitales convencionales. Resultados. Noventa y seis (63 %) de los hallazgos extra espinales se asociaron con lumbalgia (categoría 1) y 56 (37 %) correspondieron a la categoría 2. El 78 % de los hallazgos extra espinales se detectaron solo en imágenes coronales-T1W y no en las convencionales. Conclusión. La secuencia coronal-T1 W agregada al protocolo de rutina de la resonancia magnética lumbar puede ayudar a detectar afectaciones extra espinales y guiar el tratamiento clínico.

Antiproliferative and cytotoxic activity of Geraniaceae plant extracts against five tumor cell lines.

AIM: To determine the antiproliferative and cytotoxic activities of Geranium and Erodium species against human cancer and noncancer cell lines, respectively. METHODS: Twenty-one species of Geranium and Erodium were extracted and screened against cancerous and noncancerous human cell lines. RESULTS: In a dose-response manner, G. glaberrimum, G. asphodeloides, E. brandianum and E. leucanthum were able, with variable potency, to inhibit cellular proliferation. Except for E. brandianum, all extracts induced cellular autophagy in tumor cells with similar levels to that of rapamycin; but, only E. brandianum induced cellular apoptosis, likely through Bcl2 and BAX protein expressions. DISCUSSION: This is the first study to report the potential antiproliferative effects of ethanol extracts of several Geraniaceae species.

Comparison of metropolitan cities for mortality rates attributed to ambient air pollution using the AirQ model.

In the present study, the air pollution dynamics of the metropolitan cities of Balikesir, Bursa, Istanbul, Kocaeli, Sakarya and Tekirdag in the Marmara Region, which is the geographical region with the highest urban and industrial activity in Turkey, were examined for the time period between 2016 and 2019. Annual changes in the cities in terms of air pollution, which was examined with a focus on the PM2.5 parameter as indicated by United Nations (UN) Sustainable Development Goals (SDGs); differences in the cities by years; and the seasonal changes in air pollution in the cities were investigated. Additionally, mortality rates attributed to air pollution were calculated with the AirQ + software based on integrated exposure-response function recommended by the World Health Organization (WHO) and the UN using city-scale statistics of fatal disease cases that can be attributed to air pollution. It was determined that all cities in the Marmara Region study area exceeded the limit PM2.5 values specified by the European Union (EU) in the years 2016, 2017 and 2018 while only Kocaeli and Tekirdag were below the limit values in 2019. The limit values specified by the WHO were exceeded in all cities in each year. A total of 46,920 premature deaths attributed to the exceedance of WHO limit values were calculated for the years 2016, 2017, 2018 and 2019 with 11,895, 13,853, 11,748 and 9,429, respectively. Determining national limit values for the PM2.5 parameter, which is among the most important factors of air pollution, and monitoring it in a sustainable manner using a sufficient number of well-equipped stations is of great importance. This way, national, regional and urban action plans regarding the impact of air pollution on human health, as indicated by UN SDGs, can be prepared.

Pulmonary fibrotic-like changes on follow-up chest CT exam in patients recovering from COVID-19 pneumonia.

INTRODUCTION: To date, there is limited data on the long-term changes in the lungs of patients recovering from coronavirus (COVID-19) pneumonia. In order to evaluate pulmonary sequelae, it was planned to investigate fibrotic changes observed as sequelae in lung tissue in 3-6-month control thorax computerized tomography (CT) scans of moderate-to-severe COVID-19 pneumonia survivors. MATERIALS AND METHODS: A total of 84 patients (mean age: 67.3 years ±15) with moderate-to-severe pneumonia on chest tomography at the time of diagnosis were included in the study, of which 51 (61%) were males and 33 (39%) were females. Initial and follow-up CT scans averaged 8.3 days ± 2.2 and 112.1 days ± 14.6 after symptom onset, respectively. Participants were recorded in two groups as those with and without fibrotic-like changes such as traction bronchiectasis, fibrotic - parenchymal bands, honeycomb appearance according to 3-6 months follow-up CT scans. Differences between the groups were evaluated with a two-sampled t-test. Logistic regression analyzes were performed to determine independent predictive factors of fibrotic-like sequelae changes. RESULT: On follow-up CTs, fibrotic-like changes were observed in 29 (35%) of the 84 participants (Group 1), while the remaining 55 (65%) showed complete radiological recovery (Group 2). With logistic regression analysis, hospital stay of 22 days or longer (OR: 4.9; 95% CI: 20, 32; p< 0.05) and a CT score of 15 or more at diagnosis (OR: 2.2; 95% CI: 13.5, 18; p< 0.05) were found to be an independent predictor for sequelae fibrotic changes in lung tissue. CONCLUSIONS: More than one-third of patients who survived COVID-19 pneumonia had fibrotic-like sequelae changes in the lung parenchyma. These changes were found to be associated with the presence of severe pneumonia at the time of diagnosis and longer hospital stay.

Fast three-dimensional time-of-flight magnetic resonance angiography: Should it be used in routine neuroimaging for headaches?

OBJECTIVES: We aimed to evaluate the diagnostic efficacy of fast three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) in the detection of cerebral aneurysms. METHODS: We screened 1589 patients over a 3-year period, who underwent a magnetic resonance imaging for headache. Fast 3D TOF MRA images taken in addition to routine neuroimaging sequences, which were examined by two independent observers to assess cerebral aneurysms. RESULTS: Sixty-nine aneurysms were detected in 63 patients. The locations of the aneurysms were as follows: Middle cerebral artery, 27.5% (n = 19); internal carotid artery, 53.6% (n = 37); anterior cerebral artery, 5.8% (n = 4); posterior cerebral artery, 5.8% (n = 4); anterior communicating artery, 5.8% (n = 4); and ophthalmic artery, 1.4% (n = 1). Thirty-five (50.7%) were 7 mm or less, 23 (33.3%) were 8-10 mm, and 11 (15.9%) were 11 mm or larger. About 88% of pathological cases (n = 61) were saccular and 12 (n = 8) were fusiform type aneurysms. The interobserver compliance was high (K = 0.83) for detecting the aneurysms. CONCLUSION: Considering the mortality and morbidity of subarachnoid hemorrhages, 3D TOF MRA is a successful, non-invasive method for detecting cerebral aneurysms. Results of the present study have shown that adding 3D TOF MRA to the routine brain imaging protocol is a beneficial tool for diagnosis.

The role of pleural fluid thiol/disulphide homoeostasis in the differentiation between transudative and exudative pleural effusions.

OBJECTIVE: In the present study, we aimed to differentiate between transudative and exudative pleural effusions using thiol sulphide homoeostasis, an oxidative stress marker. DESIGN: This was a prospective study. SETTING: Emergency Department of Ankara City Hospital, between 1 January 2020 and 15 May 2020. SUBJECTS: Patients who were diagnosed with pleural effusion and underwent thoracentesis to make a differentiation between transudative and exudative pleural effusions. The patients were divided into two groups as those who have transudative pleural effusion and those who have exudative pleural effusion. These two groups were assessed with respect to demographic features and oxidative stress parameters. MAIN OUTCOME MEASURES: Oxidative stress parameters (The native thiol (NT), total thiol (TT), and disulphide (D) levels and their ratios to one another were calculated (index 1: D/NT, index 2:D/TT, index 3: NT/TT). RESULTS: This study enrolled a total of 50 patients with pleural effusion. Twenty patients (40%) were men, and 30 patients (60%) were women. In the transudative pleural effusion group, 14 patients (56%) had decompensated heart failure, 9 patients (36%) had hepatic cirrhosis, and 2 patients (8%) had hypoalbuminemia. In the exudative pleural effusion group, 17 patients (68%) had malignancy, 7 patients (28%) had parapneumonic effusion, and 1 patient (4%) had pulmonary embolism. TT (P < .001) and NT (P = .001) values were significantly lower in the transudative pleural effusion group compared with the exudative pleural effusion group whereas there was no significant difference between the two groups with respect to D (P = .489), index 1 (P = .07), index 2 (P = .064), and index 3 (P = .063) values. CONCLUSION: We believe that a differentiation can be made between transudative and exudative pleural fluids by using thiol sulphide homoeostasis, an oxidative stress marker.

Biochemical, Histopathologic, and Genotoxic Effects of Ethanol Extract of Salvia hypargeia (Fisch. & Mey.) on Incisional and Excisional Wounded Diabetic Rats.

Purpose: Nonhealing wounds are a serious problem of diabetic patients. Salvia species are traditionally used for the treatment of wounds. The aim of the study was to investigate the effects of ointment prepared with ethanol extract obtained from the aerial parts of Salvia hypargeia, an endemic plant from Turkey, on diabetic rat incisional and excisional skin wounds. Materials and Methods: Male Wistar albino rats (n: 60) were divided into five groups. Diabetes was induced and two concentrations (0.5% and 1%) of the extract were used for ointments and applied on wounds for 7 and 14 days. Fito cream was chosen as a reference drug. Results: In excisional wounds, healing ratios of 0.5% (63.4% and 99.3%) and 1% (65.5% and 99.9%) S. hypargeia groups were higher compared to control (35.9% and 75.1%), and in incisional wounds, healing ratios of 0.5% (78.1% and 98.5%) and 1% (84.4% and 99.4%) S. hypargeia groups were higher compared to control (30.5% and 72.9%) (p < .01). Hydroxyproline (0.31 ± 0.3 and 0.34 ± 0.2) levels were lower and GSH (10.7 ± 3.1 and 7.6 ± 0.9) levels were higher in 0.5% and 1% S. hypargeia groups on the 14th day (p < .01). Histopathological results revealed re-epithelialization and formation of granulation tissue in all S. hypargeia groups. Genotoxicologic results indicated, GDI, DCP values, and MN frequency of 0.5% and 1% S. hypargeia groups did not reach to significant levels both on the 7 and 14 days. Conclusions: S. hypargeia may have a potential for therapeutic use in treatment and management of diabetic wounds with a successful topical application.

Role of lung ultrasonography in the diagnosis of COVID-19 patients admitted to the emergency department.

Introduction: In this study, the use of lung ultrasonography (LUS) to diagnosis lung findings was evaluated in patients with suspected COVID-19 who were admitted to the emergency department (ED). Methods: This observational clinical study was conducted in the ED of the Ankara City Hospital during the period April 1-30, 2020. Patients who were admitted to the ED were triaged as COVID-19 infected and who agreed to undergo LUS/LCT (lung computed tomography) were included in the study. Results: Included in the study were 40 patients who had been prediagnosed with COVID-19. Pneumonia was detected with LCT in 32 (80%) patients, while the LUS examination identified pneumonia in 23 patients. The most common finding in LCT was ground-glass opacity (n = 29, 90.6%). Of the 23 patients with pneumonia findings in LUS, 15 (65.2%) had direct consolidation. Among the 32 patients who were found to have pneumonia as a result of LCT, 20 (62.5%) had signs of pneumonia on LUS examination, and 12 had no signs of pneumonia. In addition, 3 patients showed no signs of pneumonia with LCT, but they were misdiagnosed with pneumonia by LUS. The sensitivity of LUS in the diagnosis of pneumonia in the COVID-19 patients was 62.5%, while its specificity was 62.5%. In addition, its positive predictive value was 87.0%, and its negative predictive value was 29.4%. Conclusion: LUS may also be used in the diagnosis of pneumonia in COVID-19 patients because it is a valuable and accessible bedside diagnostic tool.

Comparison of Two Different Methods of Fine Needle Aspiration Biopsy and Histopathology for Thyroid Nodules.

OBJECTIVE:  Two different methods for fine needle aspiration biopsy (FNAB) of thyroid nodules (multi-pass conventional smear, MPCS; single-pass liquid-based cytology, SPLBC) were evaluated regarding the magnitude of nondiagnostic/unsatisfactory sampling ratio, and basic demographic and ultrasonographic (USG) factors to predict such outcome. METHODS:  One thousand FNAB patients were retrospectively assessed. Of them, 517 nodules were evaluated with the conventional smear method, and the rest were evaluated with liquid-based cytology method using the Bethesda System for Reporting Thyroid Cytopathology. FNAB technique had certain procedural differences for both pathological methods. For conventional smear, a modified "needle-only" technique with three independent passes was performed, whereas a single pass was used for liquid-based cytology. The reduction of nondiagnostic/unsatisfactory results constituted the basis of this study. Pathological results, therefore, were subgrouped under "nondiagnostic/unsatisfactory" (Category I), "benign" (Category II), and "atypia/neoplasia/malignancy" (Category III-VI). RESULTS:  Both FNAB groups were not statistically different or only slightly different regarding size (P = 0.196), echogenicity (P = 0.014), and the presence of echogenic foci (P = 0.11), therefore considered to have equal USG properties. In MPCS method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 24%. Other cytological results were as follows: Category II (67.1%), Category III-VI (8.8%). In SPLBC method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 14.5%. Other cytological results were as follows: Category II (77.6%), Category III-VI (7.8%). A significant difference was found between two sampling methods regarding pathological results (Independent samples t-test, P < 0.0001). The demographic and USG factors, considered in this study, did not offer a successful prediction of nondiagnostic/unsatisfactory outcomes. CONCLUSION:  SPLBC has significantly lower (14.5% vs 24%) nondiagnostic rate than MPCS, and higher 77.6% vs 67.1%) Category II rate than MPCS. This may point to the possibility that MPCS method undercategorizes many benign (i.e., Category II) nodules under nondiagnostic/unsatisfactory category. The success of the former is due to the elimination of confounding material during the process. Single pass, also, increases patient comfort and compliance, and has additional advantages for the interventionalist, as it obviates the need to smear aspirates. This dramatically decreases the actual duration of the biopsy procedure and is free of interventionalist expertise for smearing.

Pulmonary Embolism and Giant Cavitary Lesion Developing After COVID-19 Pneumonia.

Introduction: The clinical manifestations of the worldwide pandemic, which began in mainland China in December 2019, were very similar to viral pneumonia and defined as Coronavirus disease 2019 (COVID-19). Complications such as acute respiratory distress syndrome (ARDS), acute cardiac tissue damage, secondary infections, isolated coagulopathy and pulmonary embolism have been reported with COVID-19 disease. Clinical Findings: A 79-year-old woman admitted to the emergency room (ER) had complaints of fever and cough. The patient was admitted to the ER with the suspicion of COVID-19. Samples were collected with a nasopharyngeal swab and confirmed as COVID-19. In addition, a chest CT examination was performed. In the first evaluation after admittance, the D-dimer value was measured as 450 µg/L. In the follow-up of the patient, on the 18th day, increased respiratory distress and high D-dimer level (7893 µg/L) were detected in the laboratory findings. Outcomes: A chest CT scan had ground-glass opacities compatible with COVID-19 pneumonia. A giant cavitary lesion was detected following the development of pulmonary embolism after COVID-19 disease. Conclusions: In rare cases of COVID-19 cavitation development may occur after pulmonary infarction. In addition, it should be remembered that emphysema, giant bulla and pneumothorax may develop in COVID-19 pneumonia cases undergoing HFNC oxygen therapy. We present a case of a giant cavitary lesion that developed following a COVID-19-related pulmonary embolism.

Rosmarinic and carnosic acid contents and correlated antioxidant and antidiabetic activities of 14 Salvia species from Anatolia.

Herbal medicine has been used worldwide as an alternative treatment. Salvia genus is one of the most remarked herbs which is traditionally used in the treatment of many diseases. Therefore, it is a crucial issue to reveal the chemical and biological profiles of different Salvia species. Rosmarinic and carnosic acid are the most well-known bioactive components generally accepted as the main antioxidant compounds in Salvia. This study firstly aims the determination of rosmarinic and carnosic acid contents of 14 Anatolian Salvia species by a simple and rapid capillary electrophoresis method. Moreover, the antioxidant activities and total phenolic contents of the Salvia samples were investigated. α-Glucosidase enzyme inhibitory effects of the samples were tested concerning their antidiabetic activities. The rosmarinic acid contents in the samples were well-correlated with the bioactivities.