Estimating motor unit numbers from a CMAP scan: Repeatability study on three muscles at 15 centres.

OBJECTIVE: To assess the repeatability and suitability for multicentre studies of MScanFit motor unit number estimation (MUNE), which involves modelling compound muscle action potential (CMAP) scans. METHODS: Fifteen groups in 9 countries recorded CMAP scans twice, 1-2 weeks apart in healthy subjects from abductor pollicis brevis (APB), abductor digiti minimi (ADM) and tibialis anterior (TA) muscles. The original MScanFit program (MScanFit-1) was compared with a revised version (MScanFit-2), designed to accommodate different muscles and recording conditions by setting the minimal motor unit size as a function of maximum CMAP. RESULTS: Complete sets of 6 recordings were obtained from 148 subjects. CMAP amplitudes differed significantly between centres for all muscles, and the same was true for MScanFit-1 MUNE. With MScanFit-2, MUNE differed less between centres but remained significantly different for APB. Coefficients of variation between repeats were 18.0% for ADM, 16.8% for APB, and 12.1% for TA. CONCLUSIONS: It is recommended for multicentre studies to use MScanFit-2 for analysis. TA provided the least variable MUNE values between subjects and the most repeatable within subjects. SIGNIFICANCE: MScanFit was primarily devised to model the discontinuities in CMAP scans in patients and is less suitable for healthy subjects with smooth scans.

Potential Preventive Strategies for Amyotrophic Lateral Sclerosis.

It may seem useless to propose preventive measures for a disease without established pathogenesis and successful therapy, such as amyotrophic lateral sclerosis (ALS). However, we will show that ALS shares essential molecular mechanisms with aging and that established anti-aging strategies, such as healthy diet or individually adjusted exercise, may be successfully applied to ameliorate the condition of ALS patients. These strategies might be applied for prevention if persons at ALS risk could be identified early enough. Recent research advances indicate that this may happen soon.

Salmonella Spp. and Shigella Spp. detection via multiplex real-time PCR and discrimination via MALDI-TOF MS in different animal raw milk samples.

AIMS: The aim of this study was to provide epidemiological data about the presence of Salmonella spp. and Shigella spp. in raw milk samples collected from different animals. METHODS: A total of 231 raw milk samples from 48 cows, 65 goats, 65 sheep, and 53 donkeys were studied. The ISO 6579:2002 and ISO 21567:2004 methods, antimicrobial susceptibility tests, and serotyping were performed. Species and subspecies discriminations were made via matrix-assisted laser desorption/ionization-time of flight mass spectrometry. After DNA isolation from all samples, Salmonella spp. and Shigella spp. were detected using real-time polymerase chain reaction (PCR) kits. RESULTS: Five samples (2.16%) showed positivity out of 231 raw milk samples for Salmonella spp., and 2 (0.87%) samples were detected to be positive by multiplex real-time PCR design. CONCLUSION: We found that raw milk samples were not free of Salmonella spp. and Shigella spp. and need to be tested routinely to avoid public health problems. Rapid and reliable real-time PCR method can be developed and used for this purposes instead of slow bacterial culture processes.

Reduced Akkermansia muciniphila and Faecalibacterium prausnitzii levels in the gut microbiota of children with allergic asthma.

INTRODUCTION AND OBJECTIVES: The amounts of Akkermansia muciniphila and Faecalibacterium prausnitzii in gut microbiota are reduced in patients with allergic diseases compared to healthy controls. We aimed to quantify levels of A. muciniphila and F. prausnitzii amounts using real-time quantitative PCR (qPCR) in the gut microbiota of children with allergic asthma and in healthy controls. MATERIALS AND METHODS: In total, 92 children between the ages of three and eight who were diagnosed with asthma and 88 healthy children were included in the study and bacterial DNA was isolated from the stool samples using the stool DNA isolation Kit. qPCR assays were studied with the microbial DNA qPCR Kit for A. muciniphila and microbial DNA qPCR Kit for F. prausnitzii. RESULTS: Both bacterial species showed a reduction in the patient group compared to healthy controls. A. muciniphila and F. prausnitzii were found to be 5.45±0.004, 6.74±0.01 and 5.71±0.002, 7.28±0.009 in the stool samples of the asthma and healthy control groups, respectively. CONCLUSIONS: F. prausnitzii and A. muciniphila may have induced anti-inflammatory cytokine IL-10 and prevented the secretion of pro-inflammatory cytokines like IL-12. These findings suggest that A. muciniphila and F. prausnitzii may suppress inflammation through its secreted metabolites.

The effect of gender on acute kidney injury developing in the intensive care unit.

BACKGROUND: There are distinct differences specific to gender in the susceptibility, prevalence, and progression of kidney injuries. We aimed to investigate whether there is a correlation between acute kidney injury (AKI) developing in patients monitored in the intensive care unit (ICU) with regards to gender. METHODS: The current study retrospectively screened the electronic records of patients monitored in the adult ICU between 2015 and 2018. The patients' age, gender, duration of their stay in the ICU, mortality rate, and need for hemodialysis were recorded and analyzed. The diagnosis of AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. Patients with AKIN stage 2 and stage 3 were accepted as having an AKI. Patients were separated into two groups: those who developed an AKI and those who did not. The patients were classified into age groups: those aged 18-65 years and those older than 65 years. The demographic data and gender distribution of the groups were then compared. RESULTS: Of the patients who developed AKI, the mean age (p =0.0001), the number of days they stayed at the ICU (p =0.006), the mortality rate (p =0.0001), and the need for hemodialysis were significantly higher than the non-AKI group. There was no statistically significant difference between the groups with regards to gender distribution (p =0.612). Acute kidney injury was found to be statistically significantly higher in both the male and female groups over 65 years when compared to the group aged 18-65-years (male p =0.004, female p =0.002, respectively). CONCLUSIONS: When surveying the complete patient sample, AKI in the ICU was more prevalent in adult males under 65 than their female counterparts. However, there were more incidences of AKI in women over 65 than in men over 65 years. This may be due to structural changes and comorbidities in the kidney due to advanced age, as well as a decrease in estrogen levels. HIPPOKRATIA 2019, 23(3): 126-130.

Research on Toxocara canis antibodies obtained from patients with eosinophilia.

BACKGROUND: Eosinophils may suggest the presence of a great variety of anomalies whereupon allergies, malignancies, certain tissue disorders, idiopathic hypereosynophilic syndrome and parasitic infections (with the exception of protozoons) can be cited as a few. Although the clinical manifestations may differ, the eosinophils level is quite an important data in cases related to the helminth infections. Similarly, in parasitic infections related to larva migrans (visceral, cutaneous, ocular), the eosinophils level is again a primary indicator and its evident cause is the roundworm Toxocara spp. AIM: The aim of this study was to evaluate the significance characteristics of Toxocara spp. in patients with eosonophilia. MATERIALS AND METHODS: In our study, serums were collected from 93 patients of various age groups with eosonophilia (10% and above) while visiting Istanbul University Medical Faculty due to various complaints. RESULTS: Serum samples were treated with Toxocara IgG ready ELISA kit and Toxocara western blot IgG ready kit. Based on the ELISA method; out of 93 patients, 30 patients (32.3%) were positive. Western blot technique; 45 (48.4%) were positive with anti-toxocara IgG antibodies. CONCLUSION: Results point out to western blot technique being more sensitive and superior on a scale of (P < 0.0001) when compared with the ELISA method.

Does the STOP-Bang, an obstructive sleep apnea screening tool, predict difficult intubation?

OBJECTIVE: A close relationship between obstructive sleep apnea (OSA) and difficult intubation has been suggested. We hypothesized that the STOP-Bang questionnaire, a screening tool for obstructive sleep apnea (OSA), can predict difficult intubation. PATIENTS AND METHODS: In this prospective cohort study, 200 adult surgical patients undergoing surgery under general anesthesia were studied to evaluate the usefulness of the STOP-Bang questionnaire for predicting difficult intubation. STOP-Bang questionnaire results, Mallampati score and tonsil size, as well as demographic data, were recorded preoperatively. Cormack & Lehane grading and difficulty of intubation (Cormack & Lehane grade III or IV, need of an intubation aid, or need of three or more intubation attempts) were also evaluated. RESULTS: Eighty-three out of 200 patients had a high risk of OSA based on the STOP-Bang questionnaire. The occurrence of difficult intubation was higher in the patients at a high risk of OSA (i.e., a STOP-Bang score of ≥ 3) than in the patients at a low risk (13.3% vs. 2.6%) (p = 0.004). Higher age, greater weight, higher body mass index, greater neck circumference, male gender, presence of comorbidities, lower preoperative SpO2, longer extubation times, higher Mallampati score, higher Cormack & Lehane grading, tonsil size and difficult intubation were significantly correlated with a high risk of OSA (p < 0.001). Fourteen out of 200 patients had difficulty in intubation. A STOP-Bang score of ≥ 3 was seen more frequently in the difficult intubation patients (78.6% vs. 38.7%) (p = 0.009). Greater weight, greater neck circumference, greater Mallampati score, a STOP-Bang score ≥ 3 and male gender were significantly correlated with difficult intubation (p < 0.05). CONCLUSIONS: A STOP-Bang score of ≥ 3 was a predictor for difficult intubation.

A rare case of urinary schistosomiasis in Turkey.

Schistosomiasis is a chronic, parasitic disease and is endemic in some countries, primarily in Africa, Latin America and Asia. In some regions, Schistosoma haematobium is one of the principal causes of haematuria. In Turkey, due to the increasing amount of travel to and from endemic regions, the number of cases is also rising. We report a case of a 22-year-old Nigerian male who was admitted to our hospital with haematuria. Direct microbiological examination revealed S. haematobium eggs in his urine specimen. Schistosomiasis was diagnosed by pathology testing. Schistosomiasis has not been seen frequently in Turkey, and we therefore discuss the epidemiology, treatment options and clinical importance of S. haematobium.

Removal of the toxic effects of chlormadinon acetate on the development of Drosophila melanogaster via the use of nordihydroguaiaretic acid.

In this study, the effects of chlormadinon acetate (CMA) and CMA + nordihydroguaiaretic acid (NDGA) on various developmental stages of Drosophila melanogaster were investigated. Different concentrations of CMA (1.0; 3.0; 5.0 and 10.0 µM/100 mL medium) and CMA + NDGA as the concentrations of CMA (1.0 + 1.0; 3.0 + 3.0; 5.0 + 5.0 and 10.0 + 10.0 µM/100 mL medium) were carried out during the developmental periods of the flies. When F(1) progeny of control and application groups were compared, CMA was found to extend the process of metamorphosis and decrease the total offspring numbers. However, these negative effects were inhibited by NDGA treatment at different concentrations. These results suggest that NDGA could effectively inhibit CMA-induced abnormalities in developmental stages of D. melanogaster. It was found that the difference between the groups was significantly important (p < 0.05).

MR imaging findings in brachial plexopathy with thoracic outlet syndrome.

The BPL is a part of the peripheral nervous system. Many disease processes affect the BPL. In this article, on the basis of 60 patients, we reviewed MR imaging findings of subjects with brachial plexopathy. Different varieties of BPL lesions are discussed.

Preventive role of folic acid on the developmental toxicity of phenol in Drosophila melanogaster.

Phenol (PN), obtained from coal tar, is used commonly in medical treatments, industrial areas, petroleum refineries, production of glue, fiber, and nylon. PN is used in the production of benzene and it is emitted in the atmosphere by motor vehicles. Folic acid (FA) is an essential nutrient among the B complex group of vitamins. The main aim of this study was to investigate the effects of PN and PN + FA on various developmental stages of Drosophila melanogaster. Different concentrations of PN and PN + FA were administered during the developmental periods of the fly (egg, larva and pupa). When F1 progeny of control and experimental groups were compared, PN was found to extend the process of metamorphosis and decrease the total offspring numbers. However, these negative effects were inhibited by FA treatment at different concentrations (0.25-2.50 mg/kg). These results suggest that FA could effectively inhibit PN-induced abnormalities in developmental stages of Drosophila melanogaster.

An experimental analysis of stresses in simulated flared root canals subjected to various post-core applications.

Cervical root fracture is a major clinical problem in flared root canals treated with different post and core applications. This in vitro study evaluated the stress transfer of different post and core systems to the cervical part of the artificially created flared root canals, by using strain gauges. The post-core systems investigated were: (a) cast post-core system without resin reinforcement, (b) cast post-core system with resin reinforcement, (c) pre-fabricated post and resin core with resin reinforcement. The post-core systems which were cemented on simulated roots were subjected to a load applied at an angle of 45 degrees to the long axis of the simulated roots. The strain gauges which were cemented to the cervical part of simulated roots were connected to the data acquisition module to measure and record the changes in strain data. Specimens restored with resin reinforcement either with cast post-core or pre-fabricated post and resin core transferred the stress to the cervical part of the artificial roots at a rate lower than conventional cast post-core system (P = 0.001; anova and Tukey's post hoc test). It was concluded that the resin reinforcement of root canals before post-core applications reduces the stresses at the cervical part of the root surfaces.

The relationship between HRCT and pulmonary function in Behcet's disease.

The purpose of this study was to compare the pulmonary functions in female Behcet's patients with or without pathological pulmonary lesions using high resolution computerized tomography (HRCT). Twenty-nine female patients aged 19-54 yrs and 20 healthy females aged 19-50 yrs (control group) were accepted into the study. HRCT images were taken and according to HRCT patients were divided into HRCT (+) and HRCT (-) groups (18 patients in each). Pulmonary function tests (PFT) through a spirometer were performed and FVC, FEV(1), FEF(25-75%), PEF, VC, RV, FRC, DLCO and DLCO/VA were determined. No statistically significant difference was observed when the PFT values were compared between HRCT (+) and HRCT (-) patients for the obtained results and the percentage of the expected values. When the PFT values were compared for both HRCT (+) and HRCT (-) patients with the control group separately there was no statistical difference between the best values. A statistically low DLCO/VA value was observed between the percentage of the expected values. It is concluded that though there is a pulmonary restriction in Behcet's disease, this restriction has no relation to pulmonary functions. It would be useful to perform pulmonary function tests in the patients with Behcet's disease both with or without any pathological findings in HRCT for obtaining information about pulmonary functions. We suggest that even when the results of the pulmonary function tests are normal, considering some pathological changes in HRCT, HRCT investigations may be useful for following up the disease.

Multiple plasma cell granuloma of the central nervous system: a unique case with brain and spinal cord involvement. Case report and review of literature.

STUDY DESIGN: Single subject (male, 34 years-of-age) case report. OBJECTIVES: To describe a unique case of plasma cell granuloma (PCG) with simultaneous brain and spinal cord involvement. SETTING: Private hospital, capital city, Turkey. METHODS: The patient presented with headache and paraplega. T2 weighted MR images showed multiple hyperintense cerebral, cerebellar, brainstem and spinal cord lesions that enhanced homogeneously with contrast medium. The patient was operated on, and the two intramedullary spinal cord lesions at T11 and T12 were totally excised. RESULTS: After 3 months of an intense physiotherapy programme the patient was able to walk with help. CONCLUSION: We report for the first time, the occurrence of multiple, simultaneous brain and intramedullary spinal cord plasma cell granulomas.

Fatal hydrothorax due to misplacement of a nasoenteric feeding tube.

Blind nasoenteric intubation was attempted in a patient with chronic parkinsonism. The tube was inadvertently misplaced and penetrated the left pleural cavity. The next day, the patient developed cardiopulmonary arrest during dietary supplement infusion. This complication ultimately led to the patient's death. We have reviewed the known complications of nasoenteric tube placement and conclude that difficult insertion in patients at risk from tube misplacement should be followed by chest radiography to confirm the correct placement of the tube before nutritional support is started.

Correlation between lead exposure indicators and sister chromatid exchange (SCE) frequencies in lymphocytes from inorganic lead exposed workers.

Inorganic lead exposure was studied in 31 volunteers employed in storage battery plant. The genotoxicity of lead was measured in terms of sister chromatid exchange (SCE). Erythrocyte delta-aminolevulinic acid dehydrogenase (ALAD) activity, urinary delta-aminolevulinic acid (U-ALA), and blood lead levels (PbBs) were also determined to evaluate some possible relations between these lead exposure indicators and the observed SCE frequencies. Blood lead concentration of 36.31 microg/dl was determined as an average level in the workers. Consequently decreased ALAD activity in erythrocytes and increased U-ALA excretion was observed in statistically higher PbBs when compared with the control group. A statistically significant correlation was observed between the PbBs and SCE frequencies (p < 0.05). Moreover, the correlation between U-ALA excretion and SCE frequencies (p < 0.01) was relatively higher than the correlation between PbBs and SCE frequencies. These results might indicate a possible mechanism of ALA mediation in the genotoxic effects of lead.

Salmonella encephalopathy with seizure and frontal intermittent rhythmic delta activity.

A 54-year-old woman was admitted to our clinic with frequent convulsions. Subsequently she developed a toxic look, rigidity, confusion and severe encephalopathy. Salmonella typhii was isolated from the blood cultures and she was diagnosed with Salmonella encephalopathy. The prominent electrophysiological finding was the frontal intermittent rhythmic delta activity (FIRDA) in electroencephalograph (EEG). After treatment EEG revealed normal activity. The presence of FIRDA is not a specific finding but this kind of EEG change has not been reported before. Diffuse encephalopathy due to endotoxins might be the reason. We propose that S. typhii encephalopathy was the cause of FIRDA which is a sign of diffuse encephalopathy.

Changes in the expression and distribution of fibronectin, laminin and tenascin by cultured fibroblasts from skin lesions of patients with tuberous sclerosis.

Fibronectin, laminin and tenascin play an important part in the assembly of the extracellular matrix and the interaction of cells with it. In this study, changes in their expression and distribution associated with tuberous sclerosis are reported. Fibroblasts from three different tuberous sclerosis skin lesions (forehead plaque, neck fibroma and ungual fibroma) secreted more fibronectin and tenascin into their culture medium than did normal skin fibroblasts. Immunohistochemistry and flow cytometry showed that cells from an ungual fibroma which secreted most of each of these glycoproteins also retained more of them, associated mainly with the cell surface and a perinuclear area. Laminin was also produced by all fibroblasts but only in those from the neck fibroma was more both secreted and retained. The proportions of fibronectin/laminin/tenascin secreted by the skin lesion fibroblasts were markedly different from normal. The results suggest that the characteristic tissue hardening of skin lesions in tuberous sclerosis may result, at least in part, from differences in the expression and distribution of these critical components of the extracellular matrix and its consequent abnormal assembly.