Adrenocortical System Hormones in Non-Critically Ill COVID-19 Patients.

CONTEXT: The effects of COVID-19 on the adrenocortical system and its hormones are not well known. OBJECTIVES: We studied serum cortisol, serum adrenocorticotropic hormone (ACTH), and their ratio in hospitalized non-critically ill COVID-19 patients. DESIGN: A prospective case-control study. METHODS: The study participants were divided into 2 groups. Group 1 consisted of 74 COVID-19 patients. The second group consisted of 33 healthy persons. Early admission above hormones levels was determined and compared between the study groups. Besides that, COVID-19 patients were grouped according to their Glasgow Coma Score (GCS), CURB-65 score, and intensive care unit (ICU) requirement, and further sub-analyses were performed. RESULTS: There were no significant differences in the mean age or gender distribution in both groups. In the patients' group, the serum ACTH concentration was lower than in the healthy group (p<0.05). On the other hand, the serum cortisol levels and cortisol/ACTH ratio of the patients' group were significantly higher than of the healthy controls (p<0.05, all). Further analyses showed that, although serum cortisol and ACTH levels were not high, the cortisol/ACTH ratio was higher in COVID-19 patients with low GCS (<15) than patients with normal GCS (=15) (p<0.05). In COVID-19 in patients with different CURB-65 scores, the cortisol/ACTH ratio was significantly different (p<0.05), while serum cortisol and ACTH were not different in groups (p>0.05). Serum cortisol levels and cortisol/ACTH ratio were higher but ACTH level was lower in the ICU needed COVID-19 patients than in patients who do not need ICU (p<0.05). CONCLUSION: Our pilot study results showed that the cortisol/ACTH ratio would be more useful than serum cortisol and/or ACTH levels alone in evaluating the adrenocortical system of COVID-19 patients. Still, further detailed studies are needed to confirm these.

The relationship between the atherosclerotic cardiovascular disease risk score used in the prediction of cardiovascular disease risk and endocan.

OBJECTIVE: To date, there have been no studies investigating whether or not there is a correlation between the serum endocan level and the atherosclerotic cardiovascular disease (ASCVD) risk score that is frequently used in the determination of the risk of cardiovascular disease. If a single parameter such as endocan can provide reliable results which could be used in the prediction of the cardiovascular disease risk, the workload of the clinician would be lightened. The aim of this study was to investigate whether or not there is an association between the serum endocan level and the ASVCD risk score. MATERIALS AND METHODS: This prospective, cross-sectional study included individuals age 40-79 years with risk factors calculated using the ASVCD score and individuals without any of those risk factors. In accordance with ASCVD risk calculation, each participant was questioned with respect to age, gender, height, weight, and lifestyle habits such as smoking, diseases, and medications. Systolic blood pressure, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and serum endocan levels were measured and recorded. The serum endocan levels and ASCVD scores were compared. RESULTS: The study included 205 individuals, comprising 92 (44.9%) males and 113 (55.1%) females with a mean age of 50.7 ± 7.6 years. The 10-year atherosclerosis risk was determined as mean 6.32% ± 5.9% (range, 0.3%-27.3%). The mean serum endocan level was calculated as 1109.6 ± 1479.7 ng/mL. As the ASCVD risk score increased, no increase was detected in the serum endocan level. CONCLUSION: The results of the study suggested that the serum endocan level is not suitable for use in place of the ASCVD risk score as a predictor of cardiovascular disease risk.

Turkish Tombul hazelnut (Corylus avellana L.) protein concentrates: functional and rheological properties.

Turkish Tombul hazelnut consumed as natural or processed forms were evaluated to obtain protein concentrate. Defatted hazelnut flour protein (DHFP) and defatted hazelnut cake protein (DHCP) were produced from defatted hazelnut flour (DHF) and defatted hazelnut cake (DHC), respectively. The functional properties (protein solubility, emulsifying properties, foaming capacity, and colour), and dynamic rheological characteristics of protein concentrates were measured. The protein contents of samples varied in the range of 35-48 % (w/w, db) and 91-92 % (w/w, db) for DHF/DHC and DHFP/DHCP samples, respectively. The significant difference for water/fat absorption capacity, emulsion stability between DHF and DHC were determined. On the other hand, the solubility and emulsion activity of DHF and DHC were not significantly different (p > 0.05). Emulsion stability of DHFP (%46) was higher than that of DHCP (%35) but other functional properties were found similar. According to these results, the DHCP could be used as DHFP in food product formulations. The DHFP and DHCP samples showed different apparent viscosity at the same temperature and concentration, the elastic modulus (G' value) of DHPC was also found higher than that of DHFP samples.

Calf mortality in Turkish dairy farms: Economic impact, regional disparities, and farm-level drivers.

This study investigates the economic burden of calf mortality in Turkish dairy farms and its impact on the national economy. We gathered research data by directly surveying dairy farms in seven provinces, each representing a distinct region of Turkiye. By conducting these surveys, we captured data on various aspects of calf mortality, including losses among non-pregnant cows aged two and older, pregnant cows, and those experiencing complications during birth, as well as losses within the 0-6 month age bracket. These figures were then amalgamated to establish the overall calf loss rate. Using a fractional probit model, we examined the empirical relationship between total calf loss rates and the socio-demographic characteristics of farm operators and their establishments. Our findings revealed that approximately 82 % of farms experienced some degree of calf loss, with the calf loss rate among dairy cattle farming accounting for nearly 20 %. Notably, regional disparities emerged as a key observation, alongside the identification of certain socio-demographic farm characteristics that proved statistically significant. Specifically, factors such as the prevalence of local cattle breeds, the proportion of crossbred bulls, as well as the numbers of heifers and calves, stood out as influential. Further scrutiny, fortified by ANOVA tests and relationships between the number of cows and total calf loss rate, underscored pronounced geographical disparities in post-estimation calf loss rates. Meanwhile, correlation heatmaps illuminated noteworthy relationships between specific cattle traits and the extent of calf losses. These findings not only underscore the severity of the issue but also highlight the urgency of preventive measures. In light of these insights, we offer pertinent policy recommendations to stakeholders and policymakers aimed at mitigating this considerable economic burden effectively.

Radiation therapy for resistant sternal hydatid disease.

Hydatid disease is a zoonotic infectious disease for which there are known treatment procedures and effective antibiotics; however, there are resistant cases that do not respond to medication or surgery. We report a case diagnosed as hydatid disease of the chest wall and treated with radiation therapy (RT) after medical and surgical therapy had failed. In conclusion, RT represents an alternative treatment modality in resistant cases.

Bupivacaine combined with morphine for patient-controlled epidural analgesia after thoracotomy: high volume and low concentration vs. low volume and high concentration.

OBJECTIVE: In this prospective randomized controlled study, we aimed to evaluate the effects of the administration of equal doses of bupivacaine and morphine (BM) at high volume and low concentration (HV-LC) or low volume and high concentration (LV-HC) on the number of drugs consumed, pain scores and side effects. PATIENTS AND METHODS: We randomized 64 patients who underwent thoracotomy into two groups. Group 1 received a solution prepared with 0.12% bupivacaine and 0.05 mg/cc morphine, administered with a basal infusion rate of 4 cc/h, a 2-cc bolus dose, and a 30-minute lockout time. Group 2 received a solution prepared with 0.48% bupivacaine and 0.2 mg/cc morphine, administered with a basal infusion rate of 1 cc/h, a 0.5-cc bolus dose, and a 30-minute lockout time. We compared patient-controlled epidural analgesia (PCEA) usage doses, pain scores, sensory and motor block, hemodynamic effects, side effects, and patient satisfaction in the postoperative periods. RESULTS: An increase in drug consumption with PCEA was found in the first 24 hours postoperatively in Group 2 (p<0.05). Resting visual analog scale (VAS) scores were statistically significantly higher at hours 2, 28, 32, 36, 44 and coughing VAS scores were also higher at hours 2 and 20 in Group 2. Heart rates in Group 2 were lower than in Group 1 at hours 16, 24, 44 and 48 (p<0.05). The cephalic spread of the sensory block in Group 1 was more extensive (p<0.05). The groups demonstrated no significant differences regarding side effects and patient satisfaction (p>0.05). CONCLUSIONS: The HV-LC approach resulted in better analgesia, less drug consumption, and greater cephalic spread of sensory block than the LV-HC approach. Both applications were effective and safe in terms of analgesia and side effects.

Microscopic venous invasion is associated with disease free and cancer free survival in renal cell carcinoma.

AIM: The aim of this study was to investigate the significance of microscopic venous invasion (MVI) as a prognostic factor for patients with renal cell carcinoma (RCC). METHODS: The present study included 220 patients with non-metastatic RCC who underwent radical nephrectomy (RN). MVI was defined by the presence of a cancer cell in blood vessels based on microscopic examination of hematoxylin-eosin stained specimens. The impact of MVI on disease progression and survival after 37 (6-190) months of median follow-up and its correlation with known clinicopathological features were studied. Survival analyses using Kaplan-Meier and log-rank models for univariate comparisons and Cox proportional hazards model for multivariate analyses were performed. RESULTS: MVI was found in 68 patients (30.8%), and of these, 26 (38.2%) developed a tumor recurrence and 16 (23.5%) died of cancer progression, whereas only 18 (11.8%) of the remaining 152 patients without MVI presented with disease-recurrence and 8 (5.3%) died of cancer. In the multivariate analysis, MVI (P=0.014) Fuhrman's grade (P=0.028), and sarcomatoid differentiation (SD) (P=0.01) were the factors predicted a decreased disease-free survival (DFS). Meanwhile, MVI (P=0.04) and SD (P=0.029) were also found to be predictor of cancer specific survival (CSS) with necrosis (P=0.037) in multivariate analysis. CONCLUSION: The present study showed that MVI is associated with the vast majority of the adverse pathological features related with RCC. Furthermore, it was found to be an independent clinical prognostic factor for DFS and CSS.

Inflammatory pseudotumor following hematopoietic stem cell transplantation: a new case and review of the literature.

Inflammatory pseudotumor (IPT) is a rare tumor that occurs in various organs and tissues. The clinical picture varies from the more frequent benign lesions to the rare malignant tumors with distant metastases. IPT associated with hematopoietic stem cell transplantation (HSCT) is rarely reported. In this article, we review the reports of IPT after HSCT and describe the first case of bladder IPT. We also review the possible factors involved in the pathogenesis. IPT might be rare but it is a potentially serious complication of HSCT. It should be considered in patients with otherwise unexplained inflammatory symptoms or signs or with any mass lesion in the post-HSCT period. A knowledge of this entity and insistence on a definitive biopsy of mass lesions in the post-HSCT period can avoid unnecessary treatment such as radical surgery, chemotherapy or radiotherapy.

Peyronie's disease: a silent consequence of diabetes mellitus.

AIM: To investigate the clinical characteristics of patients with Peyronie's disease (PD) and diabetes mellitus (DM). METHODS: During an 8-year period, a total of 307 men seen at our outpatient clinic were diagnosed with PD. Clinical characteristics, penile deformities and the erectile status of patients with PD and DM together (n=102) were retrospectively analyzed and compared to patients with PD alone with no risk factors for systemic vascular diseases (n=97). RESULTS: The prevalence of PD among men with DM and sexual dysfunction was 10.7%. The mean age of diabetic patients with PD was (55.9+/-8.9) years; in the no risk factor group it was (48.5+/-9.0) years (P < 0.05). The median duration of DM was 5 years. The majority of diabetic patients with PD (56.0%) presented in the chronic phase (P < 0.05), and they were more likely to have a severe penile deformity (>60 degrees) than the no risk factor group (P < 0.05). In the diabetic group, the most common presenting symptom was penile curvature (81.4%), followed by a palpable nodule on the shaft of the penis (22.5%) and penile pain with erection (14.7%). A total of 19.6% of patients were not aware of their penile deformities in the diabetic group. Erectile function, provided by history and in response to intracavernosal injection and a stimulation test, was significantly diminished in patients with PD and DM (P < 0.05). CONCLUSION: DM probably exaggerates the fibrotic process in PD. Diabetic patients with PD have a higher risk of severe deformity and erectile dysfunction (ED). PD seems to be a silent consequence of DM and should be actively sought in diabetic men.

Non-Hodgkin lymphoma and Kaposi sarcoma in an eyelid of a patient with acquired immunodeficiency syndrome. Multiple viruses in pathogenesis.

A 36-year-old patient with acquired immunodeficiency syndrome sought care because of an upper eyelid lesion that dramatically increased in size. The histopathologic examination revealed a high-grade diffuse large cell non-Hodgkin lymphoma in continuity with a Kaposi sarcoma. In situ hybridization revealed Epstein-Barr virus in the large cell lymphoma and Kaposi sarcoma-associated herpesvirus in the Kaposi sarcoma lesion. This collision tumor is an unusual presentation of 2 malignant neoplasms in a patient with acquired immunodeficiency syndrome, with in situ hybridization evidence of Epstein-Barr virus and Kaposi sarcoma-associated herpesvirus in the lesion.

TGF-beta1 neutralizing antibodies decrease the fibrotic effects of ischemic priapism.

The objective of this study was to evaluate the possible role of transforming growth factor beta 1 (TGF-beta1) antibodies (ab) for the prevention of fibrotic effects of priapism in a rat model. In total, 30 adult Sprague-Dawley rats were divided into five groups. Priapism with 6 h (group 1), priapism with 6 h+ab (group 2), priapism with 24 h (group 3), priapism with 24 h+ab (group 4) and control (group 5). Priapism was induced with a vacuum erection device and a rubber band was placed at the base of the erect penis. At 1 h after the initiation of priapism, TGF-beta1 antibodies were given intracavernosaly. All rats underwent electrical stimulation of the cavernous nerve after 8 weeks. Intracavernous and systemic blood pressures were measured during the procedure. Rats in group 1 showed significantly higher (intracavernosal pressure (ICP) pressures to cavernous nerve stimulation and had higher ICP/BP ratios when compared to other groups. Similarly, histopathologic examination revealed less fibrosis in group 2, compared with the other groups. Consequently, TGF-beta1 antibodies antagonise the fibrotic effects of TGF-beta1, especially in cases with duration of priapism less than 6 h.

Bilateral multifocal choroidal carcinoid: long-term follow-up without treatment.

PURPOSE: To report a minimally symptomatic patient with bilateral carcinoid tumors metastatic to the choroid who was followed up for 42 months without any treatment. METHOD: Case report. RESULTS: A 54-year-old white man with a history of bronchial carcinoid tumor had bilateral multiple carcinoid tumors metastatic to the choroid. Follow-up for 42 months without treatment demonstrated no growth of the choroidal tumors, and corrected visual acuity remained RE, 20/20 and LE, 20/25. Systemic status also remained stable. CONCLUSIONS: Carcinoid tumors metastatic to the choroid may remain stationary for an extended period. Treatment may be deferred until tumor growth, exudative retinal detachment, or substantial impairment of vision develops.

Ocular findings in 55 patients with Down's syndrome.

Fifty-five patients with Down's syndrome were examined to evaluate the characteristics and frequency of ocular findings. Of these patients, 29 (52.7%) were hypermetropes, 7 (12.7%) were emmetropes, and 7 (12.7%) were myopes; astigmatism of more than 3.00 diopters was present in 7(12.7%) patients. Strabismus was observed in 12 (21.8%) patients. All but one of these 12 patients also had esotropia. Congenital nasolacrimal duct obstruction was present in 12 subjects (21.8%). Blepharitis was found in 19 (34.5%) cases. Nystagmus occurred in 7 (12.7%) patients. Brushfield spots were detected in only 20 (36.3%) of the patients and were more common in light-colored irides. Lens opacities were diagnosed in 11 (20%) patients, and two underwent successful cataract surgery. On fundus examination, an increased number of retinal vessels crossing the optic nerve head was detected in 21 (38.1%) cases. One of the patients had a retinal detachment. Significant but correctable ocular problems are present in patients with Down's syndrome and may interfere with the quality of life of the patient and with binocular vision. Surgical intervention may be needed for strabismus and for cataracts.

Orbital lymphangioma: an analysis of 26 patients.

AIM: To evaluate retrospective data on the clinical findings, histological features, radiological diagnosis, and management outcomes in orbital lymphangioma. METHODS: Data on 26 orbital lymphangioma patients managed over 16 years were re-evaluated. The computed tomograph and magnetic resonance scans and histological slides were reviewed. Parametric techniques were used to assess correlations among clinical, radiological, and histopathological factors. RESULTS: At presentation proptosis was present in 85%, ptosis in 73%, and restrictive eye movements in 46% of patients. The accuracy of the initial radiology interpretations was 77%. 24 cases required one or more surgeries. The mean follow up was 9.2 years (range 1-14 years). 58% of patients developed recurrences. In cases that recurred, motility restriction was significantly more frequent at initial examination than cases without recurrence (p < 0.05). After therapy, 75% of patients were satisfied with their visual function and cosmetic appearance. CONCLUSIONS: Conservative management of orbital lymphangioma with multiple partial resections may achieve satisfactory results.

Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases.

AIM: To evaluate the clinical features, treatment results, and recurrence rates in patients with either intraepithelial or invasive squamous cell carcinoma of the conjunctiva. METHODS: Retrospective analysis of 60 cases (22 conjunctival intraepithelial and 38 invasive squamous cell carcinomas) to determine patterns of clinical presentation, aetiological factors, and treatment results. The mean patient age was 64 years old. 70% of the patients were male. Patients were treated with a variety of therapies, depending on the degree of tumour involvement; most cases were treated with frozen section controlled excision and adjunctive cryotherapy. Modified eye wall resection or enucleation was done for intraocular invasion and exenteration was done for orbital involvement. RESULTS: Red eye (68%) and ocular irritation (57%) were the most common presenting symptoms. 44% of the patients had other eye findings consistent with extensive solar exposure. 20% of the patients had a history of malignant skin tumours. Visceral malignancies developed in 8%. Scleral involvement was present in 14 (37%), intraocular involvement in five (13%), and orbital invasion in four (11%) cases with invasive squamous cell carcinoma. After a mean follow up of 56 months (18-226 months) the rate of new or recurrent tumours was 4.5% for intraepithelial squamous carcinoma and 5.3% for invasive squamous cell carcinoma. No patient developed metastases or tumour related deaths. CONCLUSION: Excision with intraoperative control of the surgical margins and adjunctive cryotherapy results in good tumour control rates.

Chondrosarcoma diagnosed by fine needle aspiration cytology.

OBJECTIVE: To define and discuss the cytologic findings in 6 conventional chondrosarcomas (CS), 1 chondroblastic osteosarcoma, 1 extraskeletal myxoid CS and 20 chondroma cases. STUDY DESIGN: Study of fine needle aspiration cytology (FNAC) of cases air dried and May-Grünwald-Giemsa stained. RESULTS: Tumor cells were embedded in a pink, amorphous, chondroid matrix in conventional CS. They were larger than chondroma cells and had vacuoles and small, pink, chondroid substance-like granules. Chondroblastic osteosarcoma was diagnosed as high grade CS by FNAC, but extremely pleomorphic chondrocytes, osteoid matrix, osteoblastic cells, and clinical and radiologic findings should have produced the proper diagnosis. Extraskeletal myxoid CS had a pinkish, granular, myxoid background. The tumor cells had granulated, dark blue cytoplasm and oval-round, lobulated, slightly indented, hyperchromatic nuclei. CONCLUSION: FNAC is efficient for the diagnosis of CS and its variants as long as it is evaluated with radiologic and clinical findings by a pathologist familiar with bone pathology and cytology.

Primary pure choriocarcinoma of the ovary in reproductive ages: a case report.

Choriocarcinoma is an aggressive tumor with cyto- and syncytiotrophoblastic cells. It arises gestationally or nongestationally. Nongestational choriocarcinoma of the ovary can be pure or mixed with other germ cell tumors. Pure type is less frequent than mixed type and the diagnosis of nongestational choriocarcinoma of the ovary is very difficult in the reproductive period. A case of a 20-year-old woman with pure choriocarcinoma of the ovary is presented with a review of the literature and discussion of its origin.

Labeling of penicillamine di sulfide with technetium-99m.

Complex forming conditions of Penicillamine di sulfide with 99mTc have been specified. Labeling of penicillamine di sulfide with 99mTc by direct reduction with SnCl2 did not give favorable good results while the 99mTc complex of penicillamine can be easily obtained. Ligand exchange reaction with 99mTc-gluconate was attempted and a 95% labeling efficiency was obtained. Radiopharmaceutical potential of 99mTc-PADS (99mTc-Penicillamine di sulfide) has been investigated with a gamma camera in rabbits and the complex was found to be uptaken mostly by the liver and kidneys.

Determination of gamma radioactivity levels and associated dose rates of soil samples of the Akkuyu/Mersin using high-resolution gamma-ray spectrometry.

In this study several soil samples were collected from the Büyükeceli district where Turkey's first nuclear power plant will be built and radioactivity concentrations of (226)Ra, (232)Th, (40)K and (137)Cs were determined by gamma spectrometry using a high-purity germanium detector. The measured activity concentrations in soil samples ranged from 9.8 ± 0.7 to 258.6 ± 15.8, 11.7 ± 0.9 to 85.6 ± 5.0, 173.8 ± 2.1 to 1949.5 ± 14.7 and 0.4 ± 0.1 to 72.2 ± 2.2 Bq kg(-1) for (226)Ra, (232)Th, (40)K and (137)Cs, respectively. Findings are in good agreement with the published results of neighbouring areas. The absorbed gamma dose rate (D) in air and the annual effective dose of soil samples were calculated to be 80.2 nGy h(-1) and 98.3 mSv y(-1), respectively. The results show that the radiation hazard in the Büyükeceli district is insignificant. The data presented in this study would be very useful to determine the future effects of the nuclear power plant to the environment.

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.