The role of chest X-ray in coronavirus disease 2019 (COVID-19) infection: findings and correlation with clinical outcome.

OBJECTIVE: It is possible to diagnose coronavirus disease 2019 (COVID-19) faster and more accurately with chest X-ray (CXR) and chest computed tomography (CT) than with reverse transcriptase PCR (RT-PCR) tests. The aim of this study was to verify the possibility of reducing the use of CT in diagnosis and follow-up of COVID-19 infection by using CXR. PATIENTS AND METHODS: A total of 326 COVID-19 patients who were hospitalized in Ankara City Hospital were included in this retrospective study. RESULTS: A total of 326 patients were RT-PCR positive for COVID-19 infection; 178 were male (54.6%) and 148 were female (45.4%), with a median age of 45. Considering the results, the baseline CXR sensitivity in our experience was approximately 72%. The CXRs of 113 patients with abnormal CT were divided into 2 groups, the CXR normal and abnormal groups, and were then compared. In the 1st group with abnormal CXR, the mean age, the number of patients over 65 years old, and the comorbidity rate were higher. Additionally, it was determined that the number of patients requiring respiratory support and intensive care unit (ICU) admission in this 1st group was higher than in the 2nd group (with normal CXR). Most of the patients who died (91%, 10/11) were in Group 1. In the group with normal CXR, no patients in the critically ill category needed invasive or non-invasive mechanical ventilators. CONCLUSIONS: CXR can help in detecting clinically moderate and severe cases of COVID-19. CXR can assist clinicians in patient management and treatment planning regarding the clinical course, respiratory support, ICU need, and mortality and can help them prepare for potential negative outcomes.

Comparison of culture and real-time polymerase chain reaction methods for detection of Mycoplasma hominis in amniotic fluids samples.

BACKGROUND: Mycoplasma hominis is often present in the amniotic cavity with microbial invasion associated with spontaneous preterm labor. Conventional culture method is the gold standard for detection of Mycoplasmas, but real-time polymerase chain reaction (real-time PCR) has revolutionized the diagnosis of M. hominis. OBJECTIVE: The purpose of this study is the comparison of the culture methodology with real-time PCR for the detection of M. hominis in amniotic fluid samples. METHODS: Amniotic fluid samples were collected from 65 pregnant women (age range: 25-45 years) previously followed at an infertility clinic. They were collected by transabdominal genetic amniocentesis during 16-21 weeks of gestation. Amniotic fluids were inoculated in SP4 broth for 48-72 h, and after becoming alkaline, culture suspension was spread on A7 agar plate for 1 week till the typical colonies seen in "fried-egg" morphology under stereomicroscope. DNA was extracted using a QIAGEN Mini DNA kit. The real-time-PCR was performed using Rotor-Gene Q Real-time PCR instrument. A melting-curve analysis was also performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured by real-time PCR by taking culture as gold standard. RESULTS: Sixty-five women in 16-21 weeks of gestation, with a mean age of 33 ± 5.06 years, were enrolled into this study. M. hominis detected by culture and real-time PCR assay was 72% (47/65) and 69% (45/65), respectively. 66% (43/65) specimens were positive by both methods. Real-time PCR sensitivity was 91.5%, specificity 88.9%, PPV 95.6%, and NPV 80%. CONCLUSION: Rapid detection of Mycoplasmas causing maternal complications such as neonatal infections and preterm labor in pregnancy by real-time PCR may be important and necessary. The high sensitivity and shorter time requirement of real-time PCR support its further development for diagnosis of Mycoplasma infections.

Automated computer-aided diagnosis of splenic lesions due to abdominal trauma.

BACKGROUND: Computer-aided detection in the setting of trauma presents unique challenges due to variations in shape and attenuation of the injured organs based on the timing and severity of the injury.  We developed and validated an automated computer-aided diagnosis algorithm to detect splenic lesions such as laceration, contusion, subcapsular hematoma, perisplenic hematoma, and active extravasation using computed tomography (CT) images in patients sustaining blunt or penetrating abdominal trauma. METHODS: We categorized the splenic pathologies into three groups: contusion/laceration, hematoma, and active extravasation. We first analyzed the spleen and perisplenic region by estimating the mean value and standard deviation of the spleen. We determined adaptive threshold values based on the histogram of the area and detected the lesions after morphological operations and volumetric comparisons. RESULTS: The overall performance of the three computer-aided diagnosis (CAD) algorithms is an accuracy of 0.80, sensitivity of 0.95, specificity of 0.67, and a diagnostic odds ratio (DOR) of 40 with a 95 % confidence interval (CI): 14 to 117. The CAD of perisplenic hematoma had the highest diagnosis rates with an accuracy of 0.90, a sensitivity of 0.95,  specificity of 0.80, and DOR of 76 with a 95 % CI:  13 to 442. CONCLUSIONS: We developed a new algorithm to detect post-traumatic splenic lesions automatically and with high accuracy. Our method could potentially lead to the automated diagnosis of all traumatic abdominal pathologies. HIPPOKRATIA 2018, 22(2): 80-85.

Synthesis and anti-inflammatory activities of novel 5-(3,4-dichlorophenyl)-3-[(4-substitutedpiperazin-1-yl)methyl]-1,3,4-oxadiaxole-2(3H)-thiones.

To synthesize a new series of 5-(3,4-dichlorophenyl)-3-[(4-substitutedpiperazin-1-yl)methyl]-1,3,4-oxadiaxole-2-thiones for their anti-inflammatory activity.The title compounds synthesized by Mannich reaction of prepared 5-(3,4-dichloro-phenyl)-1,3,4-oxadiazole-2-thione and appropriate substituted piperazine derivatives. The structures of the compounds were confirmed by IR, NMR and elemental analyses. The newly synthesized compounds were evaluated for their anti-inflammatory and ulcerogenic activities.Most of the compounds were found to have significant anti-inflammatory profile in carrageenan footpad edema test. The compounds showed anti-inflammatory activity ranging from 30.6% to 57.8% inhibition.The compounds 5b, 5f, 5i, 5p and 5r showed most prominent anti-inflammatory activity with low gastric ulceration incidence than the reference drug indomethacine. These compounds could serve as lead molecules for further modifications.

Effects of melatonin on testis histology, oxidative stress and spermatogenesis after experimental testis ischemia-reperfusion in rats.

BACKGROUND: Testicular torsion due to oxidative stress results in infertility and testicular damage which can be preventable an important health problem worldwide. AIM: The purpose of the present study was to investigate the changes of malondialdehyde (MDA), total antioxidant status (TAS), total oxidant status (TOS) levels; histopathological alterations; morphology, concentration and motilities of the sperm in post ischemic reperfused (I/R) testis tissue. MATERIALS AND METHODS: Forty adult male Wistar rats were carried out and were randomized to five groups; (1) Control group, (2) Ipsilateral left testis ischemia, (3) Melatonin plus ipsilateral left testis ischemia, (4) Contralateral right testis ischemia, 5. Melatonin plus contralateral right testis ischemia. After 1 h ischemia and 24 h perfusion; MDA, TAS and TOS levels were measured, histopathological alterations were determined using by Johnsen's score (JS) and sperm morphology, concentration, motility were examined. RESULTS: MDA, TAS and TOS levels of the testis tissue did not change in all groups (p > 0.05 for all). JS was decreased in I/R group and melatonin treatment reversed histopathological changes and increased JS both in ipsilateral and contralateral testis. Abnormal sperm rate significantly increased in I/R group and melatonin administration changed abnormal sperm rate to normal. CONCLUSIONS: As a result, the present study demonstrated that testicular damage occurs following I/R without an increase of MDA, TAS and TOS levels. Our results also suggested that melatonin is a potent antioxidant agent in preventing testicular I/R injury, as shown by increased JS and changed abnormal sperm rate.

Synthesis and cytotoxic activity of novel 3-methyl-1-[(4-substitutedpiperazin-1-yl)methyl]-1H-indole derivatives.

A series of novel 3-methyl-1-[(4-substitutedpiperazin-1-yl)methyl]-1H-indoles (3a-l) were synthesized and their cytotoxicities were analyzed against 3 different human cell lines, including liver (HUH7), breast (MCF7) and colon (HCT116). The Mannich reaction of 3-methylindole (1) with 4-substitutedpiperazines (2) and formaldehyde resulted to the 3-methyl-1-[(4-substitutedpiperazin-1-yl)methyl]-1H-indoles (3a-l) in 38-69% yields. The investigation of anticancer screening revealed that the tested compounds showed comparable activity to the reference drug 5-fluorouracil and compounds 3g, 3h, 3i and 3k, had lower 50% inhibition (IC50) concentration than reference drug. Moreover, the cytotoxic effect of the most potent compound 3h on HUH7 and MCF7 cells through apoptosis was visualized by Hoechst staining and compared with paclitaxel, which is a mitotic inhibitor acting on microtubules. The morphological features of apoptosis were observed as condensed and fragmented nuclei that are similar to paclitaxel.

Effect of melatonin and n-acetylcysteine on hepatic injury in rat induced by methanol intoxication: a comparative study.

BACKGROUND: Methanol intoxication leads liver injury; in contrast melatonin and n-acetyl cysteine (NAC) are known to have protective effects on liver. AIM: We aimed to investigate the ultrastructural effects of melatonin and NAC on livers of methanol intoxicated rats and compare potential protective effects of melatonin and NAC on their liver ultrastructure. MATERIALS AND METHODS: Fifty-six adult male Wistar rats were carried out and were randomized to eight groups that have seven rats each: Control groups (C 6h, C 24h), treated with intragastric (i.g.) 1.0 ml saline; Methanol groups (M 6h, M 24h), treated with a dose of 3 g/kg i.g. methanol; Melatonin plus methanol groups (MEL+M 6h, MEL+M 24h), treated with dose of 10 mg/kg i.p melatonin immediately, following with a dose of 3 g/kg i.g. methanol; NAC plus methanol groups (NAC+M 6h, NAC+M 24h), treated with dose of 150 mg/kg, following with a dose of 3 g/kg i.g. methanol. 24 h group rats were given the same dose of melatonin and NAC 12 h after intoxication. Electron microscopy was used to evaluate histological changes in liver tissue at both 6th and 24th hour. RESULTS: Histopathological damage was found to be higher in methanol-induced intoxicated rats compared with the controls. Extensive tubules of smooth endoplasmic reticulum, increased mitochondria, increased primary lysosomes and some marked openings of bile canaliculus were distinguished. Melatonin administration prevents liver injury especially in early hours and although not as effective as melatonin, NAC also prevents liver injury. CONCLUSIONS: Melatonin is much more efficient than NAC, as well as significantly greater hepatoprotective effect against the liver injury secondary to the methanol intoxication.

Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnoea syndrome.

PURPOSE: To determine the retinal nerve fibre layer (RNFL) thickness in patients with obstructive sleep apnoea syndrome (OSAS) in order to investigate the possibility of detecting early signs of glaucoma in this population. METHODS: A total of 66 consecutive patients admitted for polysomnographic evaluation of suspected OSAS. Patients underwent an overnight sleep study in an effort to diagnose and determine the severity of OSAS. Patients who had the disease were classified as having mild and severe OSAS, while patients who did not have the disease were classified as controls. All patients received physical, neurological, and ophthalmological evaluation including visual acuity, slit-lamp examination, Goldmann applanation tonometry, gonioscopy with a three mirror contact lens, and fundus examination. After these examinations, patients with glaucoma and patients who had ophthalmological and/or systemic disease known to affect RNFL thickness were excluded from the study. The RNFL thickness was assessed with a scanning laser polarimeter (Nerve Fiber Analyzer GDx, Laser Diagnostic Technologies Inc., San Diego, CA, USA). RESULTS: A total of 34 patients with obstructive sleep apnoea (19 mild, 15 severe) and 20 age-matched controls were included in the study. The thickness of RNFL was reduced in patients with OSAS compared to controls. The decrease in RNFL was found to be correlated with the severity of sleep apnoea (r=0.78, P=0.01). CONCLUSIONS: The sleep apnoea syndrome is correlated with a proportional decrease in the RNFL. Decreased ocular perfusion related to hypoxia and vasospasm associated with OSAS may cause RNFL thinning, which may precede clinically detectable glaucoma.

Synthesis and evaluation of anticonvulsant activities of some new arylhexahydropyrimidine-2,4-diones.

In this study, some new 3-alkyl-6-arylhexahydropyrimidine-2,4-dione derivatives were synthesized as anticonvulsant agents. 6-Arylhexahydropyrimidine-2,4-diones which were used as starting materials in the synthesis of the compounds were prepared in acidic media by the cyclization of potassium cyanate and the appropriate ureido acids that were gained by the reaction of beta-aminoacids, malonic acid and ammonium acetate. The structures of the synthesized compounds were confirmed by UV, IR, 1H-NMR and elementary analysis. Their anticonvulsant activities were determined by maximal electroshock (MES), subcutaneous metrazol (scMet) and rotorod toxicity tests for neurological deficits. According to the activity studies, 3-arylalkyl-6-(p-chlorophenyl) derivatives were found to be protective against scMet, whereas 6-phenyl derivatives were not. 6-Phenyl-3-(2-morpholinoethyl)hexahydropyrimidine-2,4-dione was the only compound determined to be active against MES at 300 mg/kg dose at half an hour.

Pars plana lensectomy with double-capsule-supported intraocular lens implantation in children.

An alternative technique to manage pediatric cataracts comprises a pars plana lensectomy and anterior vitrectomy with anterior and posterior capsulotomies and posterior chamber heparin-surface-modified intraocular lens (IOL) implantation in the ciliary sulcus through a scleral tunnel. The surgical results in 7 eyes of 6 consecutive patients between 3.5 and 12.0 years old with developmental or traumatic cataract who had surgery using this technique were evaluated prospectively. Follow-up ranged from 12 to 19 months. All 7 eyes maintained a clear pupillary axis and a well-centered IOL from immediately after surgery to the last follow-up. Final best corrected visual acuity was 20/40 or better in 71% of cases.

Acute corneal decompensation after silicone oil removal.

PURPOSE: To assess acute corneal decompensation after silicone oil removal in some aphakic eyes with clear corneas whose anterior chambers were completely filled with silicone oil for a considerable period of time. METHODS: Eight eyes of 8 patients who underwent vitrectomy and intraocular silicone oil injection were studied. All the eyes were aphakic and anterior chambers were completely filled with silicone oil. In all eyes, corneas were clear and no corneal finding indicating keratopathy was detected by slit-lamp microscopy before silicone oil removal. The mean silicone oil removal time was 4 months (range 2-7 months). A specular microscope was used for the evaluation of corneal endothelial changes and corneal pachometry was performed to observe corneal changes before and after the silicone oil removal in 5 eyes besides slit-lamp microscopy. The follow up period after silicone oil removal was 2-12 months (mean 6 months). RESULTS: In all eyes severe corneal stromal edema and clouding was detected in the first day following silicone oil removal. Increased corneal thickness was seen in all eyes. Decreased (at or below critical levels) corneal cell density was detected by specular microscopy before and after silicone oil removal. No significant improvement was observed during the follow up period. CONCLUSION: Eyes whose anterior chambers completely filled with silicone oil could be evaluated as clear corneas by slit lamp microscopy despite severe endothelial damage. We recommend that eyes with silicone oil in the anterior chambers should be monitored by a combination of slit-lamp microscopic examination and specular microscopy to determine the relative corneal endothelial tolerance to the silicone oil and endothelial damage. Early removal of the silicone oil can be considered when the retinal adhesion allows.

Facial palsy and Lyme borreliosis: long-term follow-up of children with antibiotically untreated "idiopathic" facial palsy.

We report on the follow-up of 28 patients, who were admitted to our hospitals between 1968 and 1984, and who, at that time, were diagnosed as having idiopathic facial palsy. These children were neither tested for Lyme borreliosis (LB) nor did they receive antibiotic treatment. In those days LB was an unfamiliar infection. Today we can assume that approximately 30%-50% of the patients we studied represent actual cases of neuroborreliosis. We, therefore, considered them an appropriate model in studying the spontaneous course of LB in children. the analysis of the questionnaire designed for our study as well as the supplementary clinical and serological reexaminations in some cases provided no evidence that neuroborreliosis led to relevant health disorders in any of the children (follow-up 10 to 26 years, mean 17). The results of our retrospective study led us to conclude that tick-borne facial palsy is relatively benign in children and that neuroborreliosis is insignificantly related to late complications.

Non-Hodgkin's lymphomas in Turkey.

Between 1982 and 1986, 185 adult patients with non-Hodgkin's lymphoma (NHL) were studied at Cukurova University Hospital (CUH), Adana, Turkey. This constituted 13% of all malignant neoplasms diagnosed in the oncology clinic. The mean age for men was 45.5 years and 41 years for women. Fifty-four percent of the cases were nodal lymphoma and the remaining 46% were extranodal lymphoma. Sixty-six percent of the extranodal lymphoma cases were gastrointestinal lymphoma. The stomach was the most common localization (43%), followed by intestinal involvement (30%) and abdominal mass (27%). The mean age of the patients with gastric lymphoma was 49 years, and 36 years for patients with abdominal mass. The following conclusions were reached: (1) the relative frequency rate of NHL in South Turkey is higher than Turkey averages, but similar to other Middle East countries; (2) extranodal lymphomas account for more than 40% of all lymphomas; (3) gastric lymphoma is more prevalent than intestinal lymphoma in our region; and (4) compared with western gastric lymphomas, our patients were 10 years younger and had a higher incidence of small lymphocytic and immunoblastic lymphoma.