Cortical thickening in remitters compared to non-remitters with major depressive disorder following 8-week antidepressant treatment.

OBJECTIVE: Little is known about the relationship between antidepressant treatment outcomes and underlying neurobiological mechanisms in patients with major depressive disorder (MDD). In this prospective study, we aimed to investigate how cortical thickness and subcortical volumes differed between remitter and non-remitter patients with MDD. METHODS: Fifty-eight patients with MDD with a score of at least 17 on the 17-item Hamilton Depression Rating Scale and free of medication for at least 2 months and 41 healthy controls underwent structural magnetic resonance imaging. At the baseline, patients with MDD started on either selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, or vortioxetine. After 8-week antidepressant treatment, patients with MDD were scanned using the same MRI protocol. Structural images were analyzed using the FreeSurfer software package (version 6.0). RESULTS: Longitudinal analyses showed remitter patients with MDD had significantly greater right cerebral cortex thickening in six significant clusters, including superior temporal cortex, precuneus, rostral middle frontal cortex, pars opercularis (although the cluster extends into the insula), inferior parietal cortex, and supramarginal cortex than in non-remitter patients with MDD. CONCLUSION: Our results suggest that distinct antidepressant treatment-related structural alterations in brain regions implicated in cognition, emotion regulation, and rumination might be associated with treatment outcome.

Immunohistochemical evaluation of natural cases of encephalitic listeriosis in sheep.

Listeriosis is an important public health problem in the world. It can cause abortion, encephalitis, septicemia, conjunctivitis and mastitis in ruminants. The development of central nervous system lesions is not fully understood in encephalitic listeriosis. We performed a retrospective analysis of 15 sheep with encephalitic listeriosis. Hyperemia and opacification of the meninges were common necropsy findings. Lesions generally were localized in the caudal part of the brain including the pons, medulla oblongata, thalamus and cerebellum. Microabscesses usually were found in the caudal brain and cerebellum, while perivascular infiltrates were found most often in other parts of the brain. Evidence of Listeria monocytogenes was detected immunohistochemically in the medulla oblongata, pons, thalamus and cerebellum. Prominent reactions for glial fibrillary acidic protein (GFAP), S100 protein, N-methyl-D-aspartate receptor-1 (NMDAR1) and inducible co-stimulatory protein (ICOS) were detected in the caudal brain, which indicates that these proteins may play roles in the pathogenesis of encephalitic listeriosis.

Immunohistochemical evaluation of bcl-2, ER-alpha, caspase -3, -8, -9, PCNA and Ki-67 expressions in canine mammary carcinomas.

We investigated the expression of bcl-2, estrogen receptor alpha (ER-alpha), caspase-3, -8, -9, proliferating cell nuclear antigen (PCNA) and Ki-67 in canine mammary carcinomas. We used 65 paraffin embedded and re-diagnosed archival canine mammary tumor samples to which we applied the routine streptavidin-biotin-peroxidase technique. Seventeen cases were re-diagnosed as tubulopapillary carcinoma, 31 were re-diagnosed as complex carcinoma and 17 were re-diagnosed as carcinosarcoma. Differences of expression of bcl-2 and PCNA were statistically significant according to tumor type. Differences in expression of ER-alpha, caspase-3, -8, -9 and Ki-67 were not statistically significant. Differences of expression of bcl-2 and PCNA were statistically significant compared to ER-alpha, caspase-3, -8, -9 and Ki-67 in carcinosarcomas. We report the prognostic significance of bcl-2 and PCNA expression in canine mammary carcinosarcomas.

Surgical outcomes of a civil war in a neighbouring country.

OBJECTIVES: The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. METHODS: 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. RESULTS: The median age of the patients was 30.05 (18-66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). CONCLUSIONS: In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.

Anaesthetic Management of Anaphylactic Shock Caused by Nonruptured Hydatid Cyst of the Liver.

Hepatic hydatid cyst (HC) caused by Echinococcus granulosus is still endemic in many parts of the world, and it is a common health problem, especially in developing countries. The rupture of the HC can cause anaphylactic shock or even death during surgical treatment. We present a case report regarding anaphylactic reaction due to surgery to the liver for HC which has an aberrant venous drainage incidentally detected during surgical operation in a 50-year old female patient. She was successfully treated with adrenaline, antihistamines, steroids, colloid or crystalloid fluids. After the surgery, she was transferred from the intensive care unit to the surgical ward on the first postoperative day. The possibility of anaphylaxis should be kept in mind; despite all the precautionary measures, nonrupture of the hydatic cyst and absence of spillage of the cyst to the circulation or into the surrounding tissues, anaphylaxis can still occur. Therefore, close monitoring for early diagnosis and appropriate management of anaphylaxis are essential to stabilize the patient and produce the best outcome.

Evaluation of incidental thyroid cancer in patients with thyroidectomy / Evaluación incidental del cáncer de tiroides en pacientes con tiroidectomía

OBJECTIVE: The present study aimed to emphasize the necessity and significance of thyroidectomy by determining the prevalence of incidental thyroid cancer in the cases that underwent surgical intervention for the treatment of benign thyroid disease. SUBJECTS AND METHOD: Thyroidectomy was performed in 443 cases including those with benign multinodular goitre (BMNG) or toxic adenoma or toxic multinodular goitre. Diagnosis was made based on routine physical examination, laboratory analyses, imaging methods and postoperative histopathological findings of the cases. RESULTS: The mean age of the cases was 45.5 (19-68) years and 72.5% (n = 321) were female. The most common clinical diagnosis prior to the surgery was BMNG (n = 428, 96.6%). While BMNG was determined to be the most common histopathological diagnosis after thyroidectomy at a rate of 81.7% (n = 362), the rate of thyroid cancer was found to be 14% (n = 81). The prevalence ofpapillary cancer was 84% (n = 56), whereas it was 4% (n = 4), 1% (n = 1) and 0.0% (n = 0) for medullary, follicular and anaplastic cancers, respectively. Papillary cancer was also the most common type of thyroid cancer between genders. As compared to gender, there was no statistically significant difference in terms of distribution of age among general, benign and malignant types of thyroid cancer (p > 0.05). CONCLUSION: It is appropriate to prefer thyroidectomy for the treatment of benign thyroid diseases due to the high prevalence ofincidental thyroid cancer after thyroidectomy in such cases.

OBJETIVO: El presente estudio tiene por objeto destacar la necesidad e importancia de la tiroidectomía mediante la determinación de la prevalencia del cáncer de tiroides incidental en los casos sometidos a intervención quirúrgica para el tratamiento de enfermedades tiroideas benignas. SUJETOS Y MÉTODO: Se practicó la tiroidectomía en 443 casos incluyendo aquellos con bocio multinodular benigno (BMNG) o adenoma tóxico o bocio multinodular tóxico. El diagnóstico se realizó a partir de un examen físico de rutina, análisis de laboratorio, métodos de imaginología, y resultados histopatológicos postoperatorios de los casos. RESULTADOS: La edad promedio de los casos fue 45.5 años (19-68) y 73% (n = 321) eran mujeres. El diagnóstico clínico más común antes de la cirugía fue BMNG (n = 428, 96,6%). Si bien se determinó que BMNG era el diagnóstico histopatológico más frecuente después de la tiroidectomía con una tasa de 81.7% (n = 362), se halló que la tasa de cáncer de tiroides era 14% (n = 81). La prevalencia de cáncer papilar fue de 84% (n = 56), mientras que para el cáncer medular, folicular y anaplásico, fue de 4% (n = 4), 1% (n = 1) y 0.0% (n = 0) respectivamente. El cáncer papilar también fue el tipo más común de cáncer de tiroides entre los géneros. En comparación con el género, no hubo ninguna diferencia estadísticamente significativa en cuanto a la distribución por edad entre los tipos generales, benignos y malignos de cáncer de tiroides (p > 0.05). CONCLUSIÓN: Es apropiado preferir la tiroidectomía para el tratamiento de las enfermedades tiroideas benignas debido a la alta prevalencia de cáncer tiroideo incidental después de la tiroidectomía en tales casos.

The effect of diosmin on pancreatic injury induced by hepatic ischemia reperfusion in rats.

PURPOSE: This experimental study aimed at comparing the cyanoacrylate abdomen closure to the effectiveness of triclosan coated polidioxanone abdomen closure. METHODS: The abdomen layers were closed with 3/0 polidioxanone suture in the first group. In the second group, the layers were closed with triclosan coated polidioxanone suture in a single layer. The abdomen layers of rats in the third group were attached with cyanoacrylates without sutures. The rats were sacrificed on the 14th day and the adhesive level was recorded. The incision resistance strength was measured. The tissue was examined blindly in the terms of inflammatory cell infiltration, capillary proliferation, fibrosis and micro-abscess by the pathologist. RESULTS: No significant difference was determined between the 1st and 2nd groups in the terms of inflammatory cell infiltration, capillary proliferation, collagen deposition, fibroblast activity, adhesive and tissue distension strength. The fibrosis and adhesive rate of the 3rd group was significantly higher than the 1st and 2nd groups statistically. The tissue distension strength was lower than in the other groups and the differences between the groups were found to be significant (p < 0.05). No significant difference was determined between the groups in the term of micro-abscess. CONCLUSIONS: Antibacterial suture is not superior to the conventional suture. It is concluded that cyanoacrylate is not an appropriate molecule for abdomen closure (Tab. 1, Fig. 3, Ref. 17).

Evaluation of incidental thyroid cancer in patients with thyroidectomy.

OBJECTIVES: Variations such as communications between median nerve and musculocutaneous nerve or in their abnormal branching pattern constitute a major concern in clinical and surgical field. Knowledge of these variations not only provides the clinician with a proper interpretation of the case, but also minimizes the complication in surgical approaches in this region. METHOD: We examined 50 isolated upper limbs to investigate the possible incidences of various types of communications between these two neighbouring peripheral nerves. RESULT: Twenty-eight per cent of limbs were found to have communication between these two nerves. When categorized according to Venieratos and Anagnostopoulou's classification method, 11 out of 14 cases (79%) showed type I communications, two out of 14 (14%) showed type II and the remaining one (7%) showed type III communication pattern. CONCLUSION: Prior knowledge of communications between these two neighbouring nerves, both in terms of their incidences and pattern of communications, may be of considerable significance to neurologists and orthopaedicians in dealing with nerve entrapment syndromes in the upper limb of patients.

Effects of diosmine-hesperidine on experimental colonic anastomosis.

AIM: Our goal was to determine the effects of a diosmine-hesperidine combination on wound healing in a rat model of colonic anastomosis. MATERIALS AND METHODS: In this study, 20 Wistar Albino female rats were randomized into four experimental groups containing five rats in each group. A segment of 1 cm of colon was excised 4 cm proximally to the peritoneal reflection in all rats without carrying out any mechanical or antibacterial bowel preparation. Colonic anastomosis was performed with interrupted, inverting sutures of 6/0 polypropylene. Beginning from the first postoperative day, the rats in Groups II and IV received 100 mg/kg per day of diosmine-hesperidine via orogastic route by 4F fine feeding catheter. RESULTS: A significant difference was detected between groups in terms of their hydroxyproline levels (p<0.05); the hydroxyproline level of Group I was significantly lower than that of the other groups while no significant difference was noted between Groups II and III. CONCLUSION: The administration of diosmine-hesperidine increased the amount of collagen and bursting pressures at the anastomotic site and thus had favorable influences on the healing of colonic anastomosis (Tab. 1, Fig. 3, Ref. 33).

Pathomorphological, immunohistochemical and bacteriological findings in budgerigars (Melopsittacus undulatus) naturally infected with S. Gallinarum.

The present study describes the pathological and bacteriological findings and diagnosis by immunoperoxidase and immunofluorescence methods in budgerigars (Melopsittacus undulatus) naturally infected with Salmonella gallinarum obtained from three commercial budgerigar rearing farms. The course of the disease in young budgerigars was peracute or acute, whereas in adult budgerigars the disease was acute or chronic. Clinically, yellow-white diarrhoea was observed in the young budgerigars with the acute form. In the adult budgerigars with the acute and chronic forms, a decrease in feed and water consumption with loss in body condition together with greenish-yellow diarrhoea was generally noted. Peritonitis and pericarditis were the most common findings in young budgerigars at necropsy, while in adult budgerigars scattered grey-white necrotic foci were found in the livers. Histopathologically, the lesions in young budgerigars were characterized with fibrinonecrotic peritonitis and/or pericarditis and necrotic hepatitis. In adult budgerigars with acute infection, hepatic necrosis with focal heterophil infiltration was present; whilst lesions in the chronic cases were granulomatous in nature with the infiltration of macrophages, lymphocytes and histiocytes. For the detection of S. Gallinarum in formalin-fixed, paraffin-embedded tissues, the avidin-biotin peroxidase complex and immunofluorescence methods were used. Both methods showed bacteria to be localized in the liver, kidney, peritoneum, heart, spleen and intestines of both young and adult budgerigars. The results of the present study indicate that the avidin-biotin peroxidase complex method was more sensitive than the immunofluorescence method in the detection of the bacteria.

Neuropathologic study of border disease virus in naturally infected fetal and neonatal small ruminants and its association with apoptosis.

The present study describes the pathologic changes and cellular apoptosis in the central nervous system (CNS) of fetal and neonatal small ruminants infected with border disease virus (BDV), as demonstrated by immunohistochemistry and in situ hybridization. Abortions of ewes and goats were observed, as were births of lambs and kids with poor survival rates and nervous signs. Lesions included cerebellar hypoplasia, porencephaly, hydranencephaly, and nonsuppurative meningoencephalomyelitis with hypomyelinogenesis. Viral antigens and RNA were present in neuropil, glial, and neuronal cells, especially in periventricular areas, cerebellum, and brainstem. TUNEL positivity and labeling of anti-bax and anti-caspases 3, 8, and 9 were detected in BDV-infected CNSs, especially in glial and neuronal cells. The double immunostaining and TUNEL assay revealed that in BDV-infected animals, not only were BDV-infected glial and neuronal cells undergoing apoptosis, but so were uninfected cells in close vicinity of BDV-infected cells. The expression of activated caspases 3, 8, 9; bax; and TUNEL in glial and neuronal cells of the infected fetal and neonatal kids were significantly (P < .05) higher than those of the infected fetal and neonatal lambs. Yet, the expression of bcl-2 in the CNSs of the infected fetal and neonatal lambs was higher (P < .05) in neuronal and glial cells than in those of the infected fetal and neonatal kids. The results suggest that cell death in the BDV-infected CNS is induced by intrinsic and extrinsic cascades of apoptotic pathways.

Inappropriate antimicrobial use in Turkish pediatric hospitals: a multicenter point prevalence survey.

OBJECTIVES: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. METHODS: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). RESULTS: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p<0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p=0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p=0.008). CONCLUSIONS: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials.

Differences in hepatitis A seroprevalence among geographical regions in Turkey: a need for regional vaccination recommendations.

Hepatitis A is a worldwide vaccine-preventable infection. Recommendation of vaccination depends on the endemicity of the disease. The World Health Organization recommends universal hepatitis A vaccination in intermediate areas; however, there is no need of mass vaccination in high and low endemicity regions. Therefore, most of the countries are using a vaccination policy according to the endemicity characteristic representing the whole of the country. The endemicity of this infection varies due to sanitary and hygiene conditions and socioeconomic differences among the countries and in various regions of the same country. A sample of 1173 persons between the age of 0 and 91 years from nine randomly selected medical centres from five different geographical centres of Turkey were tested for the level of anti-hepatitis A virus (anti-HAV) immunoglobulin-G antibodies using an enzyme-linked immunosorbent assay. The overall prevalence of anti-HAV antibodies was 64.4% (1142/1173). While the rate of sero-positivity was over 80% in the 5-9 age group and more than 90% after 14 years of age in south-eastern and eastern regions, it was lower than 50% at the age of 5-9 years in central and western regions and remains under 80% in those areas. We conclude that the differences observed in HAV sero-positivity among various geographical regions in Turkey support a universal HAV immunization policy for children currently living in regions of intermediate endemicity.

Visceral leishmaniosis and parapoxvirus infection in a Mediterranean monk seal (Monachus monachus).

A Mediterranean monk seal was shown by immunohistochemical and polymerase chain reaction techniques to be dually infected with a Leishmania sp. and parapoxvirus. The pathological findings included a deep ulcer on the side of the head, ulcers on the gingival and inner aspect of the lower lip, enlarged lymph nodes and tonsils, and respiratory lesions (pulmonary consolidation, oedema, haemorrhages and emphysema; tracheal and bronchial congestion, exudates and haemorrhage). Amastigotes were demonstrated in macrophages in the lymph nodes and spleen, and intracytoplasmic inclusion bodies were observed in the tracheal and oral mucosa.

Effect of povidone-iodine liposome hydrogel on colonic anastomosis.

BACKGROUND: To evaluate the effect of povidone-iodine liposome hydrogel on colonic anastomosis. METHODS: 70 Wistar-Albino male rats were randomly divided into seven groups. The left colon was transected and end-to-end anastomosis was performed. PVP-I liposome hydrogel was applied around the anastomoses in groups 2 and 5. Colonic bursting pressures and tissue hydroxyproline contents were measured on postoperative days 3 and 7. RESULTS: PVP-I application did not cause any difference in the bursting pressures on postoperative day 3, but anastomotic strength was significantly increased by the use of PVP-I on postoperative day 7. The use of PVP-I liposome hydrogel had no effect on the level of perianastomotic hydroxyproline on postoperative day 3 but had positive effects on postoperativeday 7. CONCLUSIONS: We concluded that the beneficial effects of PVP-I liposome hydrogel might be due to the combination of broad-spectrum antimicrobial activity of PVP-I with the drug delivery properties and moisturizing molecular film effects of the liposome hydrogel.

The Rett syndrome. A case report.

A rare case of a 40 month old girl has been diagnosed clinically to be that of the Rett syndrome, i.e. demonstrating regression in the development, repetitive handwringing movements and inability to speak. There were no specific laboratory findings.