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Melanogaster broomeanus Berk. is a type of truffle common in pine, oak, and hazelnut forests and which naturally spreads in the Black Sea, Mediterranean, South-West Anatolia in Turkey, is consumed as food and traded. Chemical investigation of M. broomenaus led to isolate of ten known compounds namely, brassicasterol (1), ergosterol (2), ergosterol peroxide (3), 5α, 6α-epoxy ergosta-7,22-diene-3ß-ol (4), trametenolic acid (5), maleic acid (6), fumaric acid (7), mannitol (8), kojibiose (9) and trehalose (10). Assessments of the antioxidant, anticholinesterase, anti-urease, and cytotoxic properties of extracts and isolated compounds were carried out. Compound 5 showed the highest cytotoxic activity against H-1299 with IC50: 23.78±0.98 µg/mL, while compound 2 demonstrated most potent cytotoxicity against MCF-7 with IC50: 30.91±0.15 µg/ml. Also, compound 5 showed the highest antioxidant activity in all methods, particularly in DPPH and ABTS assays with IC50 values of 90.24±0.87, 75.41±0.10 µg/mL, respectively. Similarly, compound 5 exhibited highest activity with 38.84±1.22% and 44.58±0.96% inhibitions against AChE and BChE, respectively, while compound 7 were found to be most potent inhibitory against urease with value of 55.20±0.45% at 100 µg/mL concentration. These findings suggest that M. broomenaus, like numerous other edible mushrooms, is a steroid-rich truffle and a potential source of steroids.
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Objectives: This study aimed to evaluate the applicability of the new 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria in Turkish adult patients previously diagnosed with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Patients and methods: One hundred sixty-four patients (96 males, 68 females; mean age: 49.6±14.4 years; range, 18 to 87 years) diagnosed with AAV by experienced rheumatologists between July 2016 and May 2022 were included in this retrospective cross-sectional study and reclassified based on the 1990 ACR criteria, the European Medicines Agency (EMEA) algorithm, and the 2022 ACR/EULAR criteria. For external validation, 83 patients (48 males, 35 females; mean age: 47.3±17.5 years; range, 19 to 81 years) diagnosed with immunoglobulin (Ig)A vasculitis were included. Results: One hundred twenty-six (76.8%) patients had granulomatosis with polyangiitis (GPA), 13 (7.9%) patients had eosinophilic granulomatosis with polyangiitis (EGPA), and 25 (15.2%) patients had microscopic polyangiitis (MPA). According to the criteria, the number of unclassified patients was nine (5.5%) for both the 2022 ACR/EULAR AAV classification criteria and the EMEA algorithm. The new criteria had an almost perfect agreement with the clinician's diagnosis (Cohen's kappa coefficient [κ]=0.858 for GPA, κ=0.820 for EGPA, and κ=0.847 for MPA). The kappa statistics for agreement of 2022 ACR/EULAR classification criteria with the EMEA algorithm were found 0.794 for GPA, 0.820 for EGPA, and 0.700 for MPA. None of the 83 patients diagnosed with IgA vasculitis could be classified as GPA, EGPA, or MPA using the new ACR/EULAR AAV classification criteria. Conclusion: The 2022 ACR/EULAR classification criteria for AAV showed substantial or perfect agreement with the clinical diagnosis and the EMEA algorithm.
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Clinical data on the use of tumour necrosis factor inhibitors (TNFi) in late-onset ankylosing spondylitis (LoAS) are limited. The present study aimed to evaluate efficacy, safety, and treatment adherence associated with the initial use of TNFi therapy in biologic naive patients diagnosed with LoAS. Patients whose age of onset was ≥ 45 years and < 45 years were classified as having LoAS and YoAS, respectively, based on the age of symptom onset. There were 2573 patients with YoAS and 281 LoAS. Baseline disease activity measures were similar between the groups. No significant differences were seen between the two groups in response to treatment and in remaining on the first TNFi at 6, 12 and 24 months. In the LoAS group, the analysis showed that TNFi discontinuation was linked to VAS pain score (HR 1.04; 95% CI 1.01-1.06). Patient groups had similar rates of adverse events (YoAS: 8.7% vs. LoAS: 11.7%). In both biologic naive LoAS and YoAS patients, the study showed that the initial TNFi therapy was equally effective and safe.
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Sistema de Registros , Espondilite Anquilosante , Humanos , Espondilite Anquilosante/tratamento farmacológico , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Inibidores do Fator de Necrose Tumoral/efeitos adversos , Idade de Início , Antirreumáticos/uso terapêutico , Antirreumáticos/efeitos adversos , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
OBJECTIVE: The present study aims to determine the frequency of vascular calcification in Takayasu arteritis (TA) and the risk factors for it and to evaluate its relation with atherosclerotic predictors such as metabolic syndrome (MS), left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT). METHODS: A cross-sectional study was conducted in patients with TA; MS was defined according to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria. The study included 49 TA patients (22 with MS, 27 without MS) and 31 healthy controls (HCs). Non-contrast computed tomography measured calcification in coronary arteries, aorta, and branches. RESULTS: Forty-seven patients (95.9%) were female and mean age was 33.45 ± 8.53 years. Total calcification score (mean ± SD; 5223.9 ± 18041.1 AU vs. 35.87 ± 72.70 AU (p = 0.05)), CIMT, and LVMI were found to be significantly higher in TA patients than HCs (p < 0.05). While there was no significant difference between the total calcification score of MS (+) TA patients and MS (-) TA patients, in both patient groups, the total calcification score was found to be significantly higher than HCs. MS (+) and MS (-) groups were found to have significantly higher CIMT and LVMI values than the control group, in addition, MS (+) patients were found to have significantly higher LVMI and CIMT values than MS (-) group (p < 0.05). CONCLUSION: Vascular calcification, CIMT, and LVMI are elevated in all TA patients, with greater impact in the presence of MS.
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OBJECTIVE: To analyze antiphospholipid antibody (aPL)-positive patients using the 2023 American College of Rheumatology/The European Alliance of Associations for Rheumatology (ACR/EULAR) antiphospholipid syndrome (APS) classification criteria and compare the revised Sapporo criteria and the 2023 ACR/EULAR criteria and evaluate whether the 2023 ACR/EULAR criteria provide added value over the revised Sapporo criteria. METHODS: In this descriptive study, 94 aPL-positive patients (with or without APS diagnosis) were identified from two hospital-based registries (Gazi and Hacettepe University). Patients were classified into four groups to compare both criteria sets. These four groups are as follows: (1) patients classified with only the revised Sapporo criteria; (2) patients classified with only the 2023 ACR/EULAR APS criteria; (3) patients classified with both two criteria sets; and (4) patients classified with neither two criteria set. RESULTS: Of the 94 patients, 11 were classified with only the revised Sapporo criteria; one with only the 2023 ACR/EULAR APS criteria; 52 with both criteria sets; and 30 with neither set of criteria. For these 94 patients, the operating characteristics of the 2023 ACR/EULAR APS criteria, using the revised Sapporo criteria as the gold standard, the 2023 ACR/EULAR APS entry criteria demonstrated 100% sensitivity, and the 2023 ACR/EULAR APS classification criteria demonstrated 98% specificity and 82.5% sensitivity. CONCLUSION: The study emphasizes the importance of recognizing differences in clinical manifestations, such as early pregnancy loss without severe preeclampsia (PEC) and/or severe placental insufficiency (PI) and calls for a nuanced discussion on anticardiolipin (aCL) and anti-beta 2-glycoprotein-I (anti-ß2GPI) immunoglobulin G (IgG) cutoff values.
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Anticorpos Antifosfolipídeos , Síndrome Antifosfolipídica , Valor Preditivo dos Testes , Sistema de Registros , Humanos , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/imunologia , Síndrome Antifosfolipídica/sangue , Feminino , Masculino , Adulto , Gravidez , Pessoa de Meia-Idade , Anticorpos Antifosfolipídeos/sangue , Biomarcadores/sangue , Reprodutibilidade dos Testes , Turquia , Adulto Jovem , Reumatologia/normasRESUMO
Background/aim: The objective of this study is to evaluate the clinical presentations and adverse outcomes of Coronavirus Disease 2019 (COVID-19) in patients with systemic sclerosis (SSc) and assess the impact of SSc features on the clinical course of COVID-19. Materials and methods: In this multicenter, retrospective study, SSc patients with COVID-19 were included. Clinical features of SSc, along with detailed COVID-19 data, were extracted from medical records and patient interviews. Results: The study included 112 patients (mean age 51.4 ± 12.8 years; 90.2% female). SSc-associated interstitial lung disease (ILD) was evident in 57.1% of the patients. The findings revealed hospitalization in 25.5%, respiratory support in 16.3%, intensive care unit admission in 3.6%, and a mortality rate of 2.7% among SSc patients with COVID-19. Risk factors for respiratory failure, identified through univariate analysis, included ILD (OR: 7.49, 95% CI: 1.63-34.46), ≥1 comorbidity (OR: 4.55, 95% CI: 1.39-14.88), a higher physician global assessment score at the last outpatient visit (OR 2.73, 95% CI: 1.22-6.10), and the use of mycophenolate at the time of infection (OR: 5.16, 95 %CI: 1.79-14.99). Notably, ≥1 comorbidity emerged as the sole significant predictor of the need for respiratory support in COVID-19 (OR: 5.78, 95% CI: 1.14-29.23). In the early post-COVID-19 period, 17% of patients reported the progression of the Raynaud phenomenon, and 10.6% developed new digital ulcers. Furthermore, progression or new onset of dyspnea and cough were detected in 28.3% and 11.4% of patients, respectively. Conclusion: This study suggests a potential association between adverse outcomes of COVID-19 and SSc-related ILD, severe disease activity, and the use of mycophenolate. Additionally, it highlights that having comorbidities is an independent risk factor for the need for respiratory support in COVID-19 cases.
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COVID-19 , SARS-CoV-2 , Escleroderma Sistêmico , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto , Fatores de Risco , Doenças Pulmonares Intersticiais/epidemiologia , Hospitalização/estatística & dados numéricos , Comorbidade , Idoso , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Progressão da DoençaRESUMO
OBJECTIVE: This study aimed to evaluate the prevalence of sarcopenia and its clinical significance in Turkish women with SLE, exploring the association between muscle mass, muscle strength and SLE disease activity. METHODS: A cross-sectional study was conducted at Gazi University Hospital's Department of Rheumatology from January to December 2020. It involved 82 patients with SLE, diagnosed according to the 2019 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria, and 69 healthy controls. Sarcopenia was assessed using hand grip dynamometry (hand grip strength (HGS)) and bioelectrical impedance analysis for muscle mass, with sarcopenia defined according to the 2018 European Working Group on Sarcopenia in Older People criteria and specific cut-offs for the Turkish population. The main outcomes measured were the presence of sarcopenia and probable sarcopenia, HGS values, skeletal muscle mass index and SLE Disease Activity Index 2000 (SLEDAI-2K). RESULTS: Among the patients with SLE, 51.2% met the criteria for probable sarcopenia and 12.9% were diagnosed with sarcopenia. The mean HGS was significantly lower in the SLE group (21.7±4.9 kg) compared with controls, indicating reduced muscle strength. The prevalence of anti-double-stranded DNA (anti-dsDNA) antibodies was 82.9%. Multivariate regression analysis identified height and levels of anti-dsDNA antibodies as independent predictors for developing probable sarcopenia. No significant association was found between clinical parameters, including SLEDAI-2K scores, and sarcopenia status. CONCLUSIONS: Sarcopenia is prevalent among Turkish women with SLE, with a significant proportion showing reduced muscle strength. The study found no direct association between sarcopenia and SLE disease activity or clinical parameters. These findings underscore the importance of including muscle strength assessments in the routine clinical evaluation of patients with SLE to potentially improve management and quality of life.
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Força da Mão , Lúpus Eritematoso Sistêmico , Força Muscular , Sarcopenia , Humanos , Sarcopenia/epidemiologia , Sarcopenia/fisiopatologia , Sarcopenia/diagnóstico , Feminino , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Estudos Transversais , Turquia/epidemiologia , Adulto , Pessoa de Meia-Idade , Prevalência , Estudos de Casos e Controles , Anticorpos Antinucleares/sangue , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Índice de Gravidade de DoençaRESUMO
Inteins are proteins that excise themselves out of host proteins and ligate the flanking polypeptides in an auto-catalytic process called protein splicing. In nature, inteins are either contiguous or split. In the case of split inteins, the two fragments must first form a complex for the splicing to occur. Contiguous inteins have previously been artificially split in two fragments because split inteins allow for distinct applications than contiguous ones. Even naturally split inteins have been split at unnatural split sites to obtain fragments with reduced affinity for one another, which are useful to create conditional inteins or to study protein-protein interactions. So far, split sites in inteins have been heuristically identified. We developed Int&in, a web server freely available for academic research (https://intein.biologie.uni-freiburg.de) that runs a machine learning model using logistic regression to predict active and inactive split sites in inteins with high accuracy. The model was trained on a dataset of 126 split sites generated using the gp41-1, Npu DnaE and CL inteins and validated using 97 split sites extracted from the literature. Despite the limited data size, the model, which uses various protein structural features, as well as sequence conservation information, achieves an accuracy of 0.79 and 0.78 for the training and testing sets, respectively. We envision Int&in will facilitate the engineering of novel split inteins for applications in synthetic and cell biology.
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Inteínas , Internet , Aprendizado de Máquina , Processamento de Proteína , Software , Domínio CatalíticoRESUMO
Herein, nineteen buckwheat honey samples collected from 19 stations of different ecological zones of Kazakhstan were analysed for their pollen density, physicochemical properties, chemical composition, antioxidant, anticholinesterase, tyrosinase inhibitory, and urease inhibitory activities with chemometric approaches. Twelve phenolic compounds and fumaric acid were identified using HPLC-DAD, and mainly fumaric, p-hydroxybenzoic, p-coumaric, trans-2-hydroxy cinnamic acids, and chrysin were detected in all samples. The honey samples collected from the Northern zone exhibited best antioxidant activity in lipid peroxidation inhibitory (IC50:8.65 ± 0.50 mg/mL), DPPH⢠(IC50:17.07 ± 1.49 mg/mL), ABTSâ¢+ (IC50:8.90 ± 0.65 mg/mL), CUPRAC (A0.50:7.51 ± 0.30 mg/mL) and metal chelating assay (IC50:10.39 ± 0.71 mg/mL). In contrast, South-eastern zone samples indicated better acetylcholinesterase (55.57 ± 0.83%), butyrylcholinesterase (49.59 ± 1.09%), tyrosinase (44.40 ± 1.21%), and moderate urease (24.57 ± 0.33%) inhibitory activities at 20 mg/mL. The chemometric classification of nineteen buckwheat honey was performed using PCA and HCA techniques. Both were supported by correlation analysis. Thirteen compounds contributed significantly to the clustering of buckwheat honey based on geographical origin.
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Antioxidantes , Fagopyrum , Mel , Mel/análise , Mel/classificação , Fagopyrum/química , Fagopyrum/classificação , Antioxidantes/química , Antioxidantes/análise , Cazaquistão , Monofenol Mono-Oxigenase/antagonistas & inibidores , Quimiometria , Fenóis/análise , Fenóis/química , Inibidores Enzimáticos/química , Inibidores Enzimáticos/farmacologia , Inibidores Enzimáticos/análiseRESUMO
OBJECTIVES: To evaluate the use of calcineurin inhibitors (CNIs), specifically tacrolimus, in unplanned pregnancies with active lupus disease among patients with systemic lupus erythematosus (SLE). MATERIALS AND METHODS: The study includes data from pregnancies in women diagnosed with SLE at Gazi University Hospital in Ankara, Türkiye, between January 2010 and July 2022. The study categorized pregnancies into planned and unplanned groups based on lupus nephritis presence, emphasizing the need for inactive lupus disease for at least 6 months before attempting conception in planned pregnancies. The outcomes of pregnancies involving CNIs, particularly tacrolimus, were assessed. RESULTS: In our cohort comprising 632 SLE patients, 39 individuals reported 42 pregnancies. Among the 42 pregnancies, 14 have a history of lupus nephritis. We observed that 8 of 14 patients with a history of lupus nephritis had unplanned pregnancies. Three patients used cyclosporine and 2 used tacrolimus during their pregnancy; their pregnancies were completely healthy, and no lupus flare was observed during their pregnancies. The pregnancy of 2 patients who used azathioprine and 1 last patient who used no immunosuppressive treatment ended in abortion. CONCLUSION: This study reveals that tacrolimus can be effectively used in unplanned pregnancies with active lupus disease, providing favorable maternal and fetal outcomes. The findings emphasize the importance of considering CNIs, particularly tacrolimus, in the management of SLE pregnancies, even in cases of unplanned pregnancies with a history of lupus nephritis.
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Inibidores de Calcineurina , Imunossupressores , Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Gravidez não Planejada , Tacrolimo , Humanos , Feminino , Gravidez , Inibidores de Calcineurina/uso terapêutico , Estudos Retrospectivos , Adulto , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/diagnóstico , Tacrolimo/uso terapêutico , Imunossupressores/uso terapêutico , Nefrite Lúpica/tratamento farmacológico , Adulto Jovem , Complicações na Gravidez/tratamento farmacológico , Ciclosporina/uso terapêutico , Resultado da Gravidez , Turquia/epidemiologiaRESUMO
INTRODUCTION: To evaluate the quality of laparoscopic radical nephrectomy videos and determine the extent to which they are informative and educational for healthcare professionals. PATIENTS AND METHODS: We used the YouTube® search engine to search for the term 'laparoscopic radical nephrectomy' with time filters of 4-20 min (Group 1) and >20 min (Group 2) and then sorted the results uploaded chronologically before January 2023. One hundred videos were analysed for each group. The reliability of the videos was assessed using the Journal of American Medical Association (JAMA) Benchmark Criteria and DISCERN questionnaire scores (DISCERN). Educational quality was assessed using the Global Quality Score (GQS) and a 20-item objective scoring system (OSS) for laparoscopic nephrectomy. The popularity of the videos was evaluated using the video power index (VPI). RESULTS: The mean video duration was 8.9 ± 4.3 min in Group 1 and 52.02 ± 31.09 min in Group 2 (P < 0.001). The mean JAMA (2.49 ± 0.61) and OSS scores (60 ± 12.3) were higher in Group 2 than in Group 1, while no significant difference was observed in the mean GQS (2.53 ± 0.7, 2.39 ± 0.88, respectively) between the groups (P < 0.001, P = 0.039, P = 0.131, respectively). CONCLUSION: While the standardisation of surgical videos published on YouTube® and the establishment of auditing mechanisms do not seem plausible, high total OSS, periprocedural OSS, and VPI scores, and high OSS, JAMAS, GQS and DISCERN scores in long videos indicate that such videos offer a greater contribution to education.
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PURPOSE: To evaluate the effectiveness of preoperative ultrasound (US) measurements in predicting pediatric vesicoureteral reflux (VUR) treatment outcomes. METHODS: This prospective study enrolled 35 patients (53 renal units) aged 1-16 years who underwent subureteric injection therapy for primary VUR between July 2020 and June 2022. Preoperative ultrasound examinations measured the bladder wall thickness at the ureteral orifice, ureteral submucosal tunnel length, distal ureteral diameter, patient demographics, VUR grade, presenting complaints, bladder-bowel dysfunction, and renal scarring, and the impact of these variables on treatment success was analyzed. RESULTS: Among the patients, 91.4% were female, with a mean age of 6.83 ± 3.84 years. A comparison between the treatment success and failure groups revealed no significant differences in the age, sex, VUR grade, laterality, bilaterality, presenting complaints, bladder-bowel dysfunction, bladder wall thickness, or distal ureteral diameter (p > 0.05). However, renal scarring occurred in 16 (38.1%) patients in the treatment success group and 10 (90.9%) in the treatment failure group (p = 0.002). The treatment failure group had shorter detrusor-to-ureteral orifice distances and smaller detrusor-ureteral orifice distance-to-distal ureteral diameter (D/U) ratios than that of the success group (p = 0.004 and p = 0.006, respectively). Patients with a detrusor-to-ureteral orifice distance < 7.4 mm had an 81.82% likelihood of treatment failure. CONCLUSION: Ultrasound measurements of the detrusor-to-ureteral orifice distance and D/U ratio proved reliable in predicting the success of endoscopic subureteric injection therapy for VUR.
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Objectives: This study sought to examine the chemical profile, antioxidant, antimicrobial, antibiofilm, and anti-quorum sensing potential of two propolis ethanolic extracts (PEEs) collected from northeast Algeria. Materials and Methods: To achieve the main objectives of this study, multiple in vitro tests were employed. The phenolic and flavonoid contents were analyzed, and the chemical composition of both PEE was determined by high-performance liquid chromatography. The antioxidant properties of the propolis extracts were investigated using six complementary tests. The inhibitory effects of propolis extracts were evaluated against multidrug-resistant (MDR) clinical isolates using agar well diffusion and microdilution methods, whereas their antibiofilm and quorum-sensing disruption effects were determined by spectrophotometric microplate methods. Results: The results demonstrated that phenolic and flavonoid contents were higher in propolis from the Guelma (PEEG) region (PEEG; 188.50 ± 0.33 µg GAE/mg E, 144.23 ± 1.03 µg QE/mg E), respectively. Interestingly, different components were identified, and cynarin was the major compound detected. The PEEG sample exhibited potential antioxidant effects in scavenging ABTSâ¢+ radicals with minimal inhibitory concentration values equal to 10.46 ± 1.40 µg/mL. Furthermore, the highest antibacterial activity was recorded by PEEG against Gram-positive Staphylococcus aureus MDR1. Similarly, PEEG effectively inhibited the biofilm formation of S. aureus MDR1 and the degradation of biofilm was up to 60%. In addition, quorum sensing disruption revealed that both extracts have a moderate capacity for violacein inhibition by the Chromobacterium violaceum ATCC 12472 strain in a concentration-dependent manner. Conclusion: These findings indicate that propolis can be regarded as a natural therapeutic agent for health problems associated with MDR bacteria and oxidative stress.
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Acanthocephaliasis is a zoonotic parasitic infection of vertebrates. The phylum Acanthocephala contains nearly 1500 acanthocephalan species. The Archiacanthocephala class is observed in terrestrial habitats and usually has a large, spineless trunk. Acanthocephalans are parasitic worms that use insects as intermediate hosts in their two-host life cycles. Insects, millipedes, and crustaceans in terrestrial areas serve as intermediate hosts and birds and mammals as definitive hosts. Acanthocephalans collected from the red fox (Vulpes vulpes) found dead on the road to Sarikamis-Kars in 1995 and stored in formaldehyde were kept in Ondokuz Mays University Faculty of Veterinary Medicine, Veterinary Parasitology Laboratory Museum until 2023 after our parasitological study found an infected red fox with Pachysentis sp. This study provides the anatomy of the acanthocephalans and the laboratory practice necessary for a good and reliable diagnosis. This study reports a new species, Pachysentis sp., of acanthocephalan (thorny-headed worm) found in red foxes for Türkiye. On the basis of relevant articles, we have created a key to Acanthocephala species occurring in mammals.
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Acantocéfalos , Artrópodes , Humanos , Animais , Raposas , Turquia , ZoonosesRESUMO
BACKGROUND: In critically ill patients, especially those with septic shock, fluid management can be a challenging aspect of clinical care. One of the primary steps in treating patients with hemodynamic instability is optimizing intravascular volume. The Passive Leg Raising (PLR) maneuver is a reliable test for assessing fluid responsiveness, as demonstrated by numerous studies and meta-analyses. However, its use requires the measurement of cardiac output, which is often complex and may necessitate clinician experience and specialized equipment. End-Tidal Carbon Dioxide (ETCO2) measurement is relatively easy and is generally stable under steady metabolic conditions. It depends on the body's CO2 production, diffusion of CO2 from the lungs into the bloodstream, and cardiac output. If the other two parameters (metabolic conditions and minute ventilation) are constant, ETCO2 can provide information about cardiac output. The aim of the present study is to investigate the sensitivity of ETCO2 measurement in demonstrating fluid responsiveness. METHODS: All patients diagnosed with septic shock and meeting the inclusion criteria were subjected to a passive leg raising test, and cardiac outputs were measured by echocardiography. An increase in cardiac output of 15% or more was considered indicative of the fluid responder group, while patients with an increase below 15% or no increase were classified as the non-responder group. Patients' intensive care unit admission diagnoses, initial laboratory parameters, tidal volume, minute volume before and after the PLR maneuver, mean and systolic blood pressure, heart rate, Pulse Pressure Variation (PPV) values, and ETCO2 values were recorded. RESULTS: Before and after the ETCO2 test, there was no statistically significant difference between the two groups. However, the change in ETCO2 (ΔETCO2) was significantly higher in the responder group. In the non-responder group, ΔETCO2 was 2.57% (0.81), whereas it was 5.71% (2.83) in the responder group (p<0.001). Receiver Operating Characteristic (ROC) analysis was performed for ΔETCO2, baseline Stroke Volume Variation (SVV), ΔSVV, baseline Heart Rate (HR), ΔHR, baseline PPV, and ΔPPV to predict fluid responsiveness. ΔETCO2 predicted fluid responsiveness with a sensitivity of 85% and a specificity of 86% when it was 4% or higher. When ΔETCO2 was 5% or higher, it predicted fluid responsiveness with a specificity of 99.3% and a sensitivity of 75.5%, with an Area Under the Curve (AUC) of 0.89 (95% confidence interval, 0.828-0.961). CONCLUSION: This study demonstrates that in septic patients, ETCO2 during the PLR test can indicate fluid responsiveness with high sensitivity and specificity and can be used as an alternative to cardiac output measurement.
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Choque Séptico , Humanos , Choque Séptico/diagnóstico , Choque Séptico/terapia , Dióxido de Carbono/metabolismo , Volume Sistólico/fisiologia , Hemodinâmica , Respiração Artificial , Débito Cardíaco/fisiologia , Hidratação/métodosRESUMO
INTRODUCTION: Ingrown nail is a condition caused by the perforation of the periungual soft tissues on nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized. OBJECTIVES: The main objective of this study aimed to determine whether foot deformities played significant roles in ingrown nail development with objective radiological parameters. METHODS: The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as controls without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal angle (THA), and talometatarsal angle (TMA) related to pes planus. RESULTS: No significant difference was found in terms of hallux valgus radiological measurements of HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when compared to controls. THA was statistically significantly higher in the control group (P = 0.025). There was a moderate strength positive relationship between ingrown nail stage and measured TMA for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between ingrown nail stage and other angles. CONCLUSIONS: Therefore, we do not recommend foot anatomy correction in the prevention and treatment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot deformity that can accompany patients with severely ingrown nails.
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PURPOSE: We aimed to determine the tongue edema that may develop due to the pressure exerted by the endotracheal intubation (ETI) tube on the tongue during the follow-up period of mechanical ventilation in patients intubated in the intensive care unit (ICU) by submental ultrasonography (USG). Also, we aimed to investigate the effect of tongue edema on the oxygen saturation values (SpO2) measured two h after extubation. METHODS: One hundred patients aged 18-65 years, who were followed up with mechanical ventilation in the ICU from the 0th day of intubation, were included. Patients (n = 57) who were followed up on mechanical ventilation for four days or longer after ETI were included in the study group. Those who were followed up on mechanical ventilation for three days or less after endotracheal intubation and were extubated during this period were included in the control group (n = 43). The tongue cross-sectional areas (TSAs) of patients in both groups were measured twice with submental USG. The first measurement (TSA1) was performed on the 0th day of ETI in all patients in both groups. The second measurement (TSA2) was performed on the 4th day of ETI in the study group and just before extubation in the control group. The difference between TSA2 and TSA1 was defined as tongue edema. Also, the effect of tongue edema on the oxygen saturation levels measured at the 2nd h after extubation of the patients in the control group was investigated. RESULTS: The tongue edema was more prevalent in the study group (p < 0.01). A significant negative correlation was found between the SpO2 levels two hours after extubation and the increase in the mean TSA values indicating tongue edema (p < 0.01). The oxygen saturations of the patients with tongue edema were 4% lower than those without tongue edema. CONCLUSIONS: Tongue edema may develop due to the long-term application of pressure of the ETI tube on the tongue and may impair oxygenation after extubation. GOV IDENTIFIER: NCT05249738.
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Edema , Unidades de Terapia Intensiva , Intubação Intratraqueal , Respiração Artificial , Língua , Ultrassonografia , Humanos , Intubação Intratraqueal/efeitos adversos , Pessoa de Meia-Idade , Masculino , Estudos Prospectivos , Adulto , Feminino , Língua/diagnóstico por imagem , Ultrassonografia/métodos , Edema/diagnóstico por imagem , Edema/etiologia , Idoso , Respiração Artificial/efeitos adversos , Saturação de Oxigênio , Adulto Jovem , Adolescente , Doenças da Língua/etiologia , Doenças da Língua/diagnóstico por imagem , Oxigênio/sangue , Extubação/efeitos adversosRESUMO
INTRODUCTION AND OBJECTIVES: Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. METHODS: Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. RESULTS: The stone location was the upper pole in 28 (7.6 %) patients, the middle pole in 44 (12 %), the pelvis in 98 (26.6 %), the lower pole in 139 (37.8 %), and multiple locations in 59 (16 %) patients. A stoneless state was achieved in 277 (75.3 %) units, while 91 units (24.7 %) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p = 0.012) and stone location (OR, 3.142; p = 0.018). DISCUSSION: RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100 % success rate reported in various studies. A full stoneless state was achieved in 277 (75.3 %) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6 %. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. CONCLUSION: RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.
Assuntos
Cálculos Renais , Centros de Atenção Terciária , Humanos , Cálculos Renais/cirurgia , Masculino , Feminino , Criança , Estudos Retrospectivos , Pré-Escolar , Resultado do Tratamento , Adolescente , Lactente , Ureteroscopia/métodos , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
OBJECTIVE: Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease. Colchicine is the primary treatment for FMF, although some patients do not respond well or are unable to tolerate it. For these patients, the addition of interleukin-1 (IL-1) antagonists is the preferred option. However, the impact of colchicine treatment alongside the use of IL-1 antagonists remains unclear. METHODS: We recruited adult FMF patients who satisfied the Eurofever and Pediatric Rheumatology International Trials Organization classification criteria and were receiving IL-1 antagonist treatment from our FMF cohort. All the patients exhibited colchicine intolerance or resistance. As per the FMF cohort protocol, the patients were longitudinally followed up, including assessments of their C-reactive protein, erythrocyte sedimentation rate, autoinflammatory disease activity index (AIDAI), and autoinflammatory damage index (ADDI). RESULTS: Among the 125 patients (68 female and 57 male), 96 received a combination of IL-1 antagonists and the maximum tolerated dose of colchicine, whereas 29 were treated exclusively with IL-1 antagonists due to colchicine intolerance. The patients' inflammatory markers, AIDAI activity, and ADDI damage scores did not differ significantly between the two groups during the follow-up period. Notably, the drug retention rates were significantly higher in the patients treated solely with IL-1 antagonists. CONCLUSION: While the typical approach is to maintain colchicine treatment alongside the use of IL-1 antagonists, for patients who cannot tolerate effective colchicine doses, IL-1 antagonists alone may effectively control FMF disease activity.
Assuntos
Febre Familiar do Mediterrâneo , Adulto , Criança , Feminino , Humanos , Masculino , Anticorpos Monoclonais Humanizados/uso terapêutico , Sedimentação Sanguínea , Colchicina , Febre Familiar do Mediterrâneo/induzido quimicamente , Febre Familiar do Mediterrâneo/tratamento farmacológico , Interleucina-1/uso terapêuticoRESUMO
OBJECTIVES: The aim of this study was to evaluate the impact of obesity on the treatment response to secukinumab and drug survival rate in patients with ankylosing spondylitis (AS). METHODS: We performed an observational cohort study that included AS patients based on the biological drug database in Turkey (TURKBIO) Registry between 2018 and 2021. The patients were divided into three groups: normal [body mass index (BMI) < 25 kg/m2], overweight (BMI: 25-30 kg/m2), and obese (BMI ≥ 30 kg/m2). Disease activity was evaluated at baseline, 3, 6, and 12 months. Drug retention rates at 12 months were also investigated. RESULTS: There were 166 AS patients using secukinumab (56.6% male, mean age: 44.9 ± 11.6 years). The median follow-up time was 17.2 (3-33.2) months. Forty-eight (28.9%) patients were obese. The mean age was higher in the obese group than in others (P = .003). There was no statistically significant difference in Bath Ankylosing Spondylitis Disease Activity Index 50, Assessment of SpondyloArthritis international Society 20 (ASAS20), ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, and ASDAS clinically important improvement responses between the three groups at 3, 6, and 12 months, although they were numerically lower in obese patients. Drug retention rates at 12 months were similar in all groups (P > .05). CONCLUSIONS: This study suggested that obesity did not affect secukinumab treatment response and drug retention in AS patients.