Diagnostic Contribution of Additional Sequences to the Evaluation of Cord Lesions in Patients with Cervical Spinal Multiple Sclerosis in Turkey: A Retrospective Study.

BACKGROUND: Multiple Sclerosis (MS) is the most common cause of non-traumatic disability in young adults. Spinal cord involvement is observed in 55-75% of patients with MS. AIM: To identify the strengths and shortcomings of sagittal phase-sensitive inversion recovery (PSIR), sagittal proton density/T2-weighted (PD/T2W), and axial turbo inversion recovery magnitude (TIRM) sequences in the detection of cervical MS plaques by comparing with routine sequences (axial and sagittal T2W, sagittal T1W, sagittal TIRM, fat-suppressed contrast T1W) and therefore determine their diagnostic contributions. MATERIALS AND METHODS: A total of 48 patients in whom additional magnetic resonance imaging (MRI) sequences were obtained for the diagnosis of cervical MS were retrospectively identified and included in the study. A total of 111 MS plaques were analyzed in terms of visibility, number, size, border sharpness, and intensity ratio based on the routine and additional MRI sequences. The evaluation of the images was independently undertaken by two radiologists. RESULTS: The highest visibility was provided by sagittal PSIR, sagittal TIRM, and axial TIRM sequences (P < 0.05 for all additional sequences). Seven lesions in PD/T2W and four lesions in axial T2W sequences were unable to be detected. Lesions seen in sagittal and axial TIRM sequences were larger than the others. The sharpest borders were determined in the axial TIRM sequence, and the most diffuse borders in the PD/T2W sequence. In intensity ratio, the sagittal PSIR sequence revealed the most significant contrast difference. CONCLUSION: The sagittal PSIR sequence may improve the detection of cervical MS plaques due to the improved visibility and intensity ratios. The axial TIRM sequence may be more useful than routine axial T2W in the evaluation of visibility, border sharpness, and size measurement of MS plaques.

Investigation of the effects of swimming exercises in rats given acrylamide.

BACKGROUND: Acrylamide is a toxic substance used in industrial and laboratory processes. Acrylamide exposure has a toxic effect on many systems. Protective mechanisms should be developed against the effects caused by acrylamide. OBJECTIVE: In our study, we investigated whether exercise has a protective effect against the changes that acrylamide will cause in pancreas. METHODS: 32 adult Sprague-Dawley male rats were used. Control group was given only saline. Exercise group was applied swimming exercise for 1hour daily for 4 weeks. Acrylamide group was given 50mg/kg acrylamide by gavage for 4 weeks. Acrylamide+exercise group was applied 50mg/kg acrylamide for 4 weeks and swimming exercise for 1hour daily. After the experiment, fasting blood glucose and oral glucose tolerance test measurements were performed. Then, blood and pancreas samples were taken. RESULTS: Acrylamide exposure caused an increase in fasting blood glucose and oral glucose tolerance, a decrease in insulin levels and oxidative stress in acrylamide group. In exercise group, these values were similar to control group and no significant change was observed in acrylamide+exercise group. While there was an increase in the number of alpha cells in acrylamide group compared to the other groups, here was a decrease in the number of beta cells compared to control group. CONCLUSION: We can say that acrylamide causes changes in the islets of Langerhans by affecting alpha and beta cell numbers. The protective effect of exercise on beta and alpha cell mass was not statistically significant in the acrylamide+exercise group. When the results were examined, the decrease in oxidative stress and the higher number of beta and alpha cells in the acrylamide+exercise group compared to the acrylamide group suggested that 4 weeks of swimming exercise may have an effect on acrylamide exposure.

Increased risk of death associated with the use of proton-pump inhibitors in patients with dementia and controls - a pharmacoepidemiological claims data analysis.

BACKGROUND AND PURPOSE: The use of proton-pump inhibitors (PPIs) was reported to be associated with increased mortality risk and has been proposed as a potential risk factor for neurodegenerative diseases. We aimed to assess the impact of PPI use on survival in patients with dementia as compared with controls. METHODS: This register-based control-matched cohort study included 28 428 patients with dementia ascertained by the prescription of antidementia drugs and two control individuals matched by sex, age and area of residence for each patient with dementia during the study period from 1 January 2005 to 30 June 2016. Cumulative defined daily doses (DDDs) of PPIs were extracted from the health insurance prescription registries. A multivariate Cox regression model for non-proportional hazards was used to analyse mortality risk in dependence of PPI exposure, which was limited to 1 year preceding the date of cohort entry (index date) in order to avoid immortal time bias. RESULTS: The PPI exposure of 100 DDDs in the year before the index date was associated with an increased mortality risk in patients with dementia (adjusted hazard ratio, 1.07; 95% confidence intervals, 1.03-1.12), but also in controls (adjusted hazard ratio, 1.47; 95% confidence intervals, 1.31-1.64). The mortality risk in relation to PPI use was significantly lower in patients with dementia as compared with controls (P < 0.0001) and highest in the first 2 years after the index date in both cohorts. CONCLUSIONS: Our findings promote more stringent pharmacovigilance strategies to avoid PPI use in cases lacking a clear indication for therapy or where potential risks outweigh the benefits.

Genotype-guided diagnostic reassessment after exome sequencing in neuromuscular disorders: experiences with a two-step approach.

BACKGROUND AND PURPOSE: Next-generation sequencing has greatly improved the diagnostic success rates for genetic neuromuscular disorders (NMDs). Nevertheless, most patients still remain undiagnosed, and there is a need to maximize the diagnostic yield. METHODS: A retrospective study was conducted on 72 patients with NMDs who underwent exome sequencing (ES), partly followed by genotype-guided diagnostic reassessment and secondary investigations. The diagnostic yields that would have been achieved by appropriately chosen narrow and comprehensive gene panels were also analysed. RESULTS: The initial diagnostic yield of ES was 30.6% (n = 22/72 patients). In an additional 15.3% of patients (n = 11/72) ES results were of unknown clinical significance. After genotype-guided diagnostic reassessment and complementary investigations, the yield was increased to 37.5% (n = 27/72). Compared to ES, targeted gene panels (<25 kilobases) reached a diagnostic yield of 22.2% (n = 16/72), whereas comprehensive gene panels achieved 34.7% (n = 25/72). CONCLUSION: Exome sequencing allows the detection of pathogenic variants missed by (narrowly) targeted gene panel approaches. Diagnostic reassessment after genetic testing further enhances the diagnostic outcomes for NMDs.

The c.65-2A>G splice site mutation is associated with a mild phenotype in Danon disease due to the transcription of normal LAMP2 mRNA.

Danon disease (DD) is a rare X-linked multisystem disorder caused by mutations of the LAMP2 gene and characterized by intellectual disability, skeletal myopathy and cardiomyopathy. The survival time is severely reduced. Contrasting with the usual disease course, we report on a family with an exceptionally mild phenotype of DD despite having two potentially damaging LAMP2 mutations. Using RNA-Seq analysis, we showed that a c.65-2A>G splice site mutation results in the tissue-specific production of four different transcripts including the full-length mRNA in muscle tissue but not in leukocytes. We confirmed our results by immunohistochemistry and immunoblotting, showing the detection of LAMP2 protein only in muscle. The second mutation (c.586A>T, p.T196S) has been reported before to have an uncertain clinical significance. In our patients, however, neither of the two mutations seem to have a high enough functional impact to cause a severe phenotype. Overall, our study reveals that alternative splicing is a potential mechanism in DD with underlying splice site mutations of the LAMP2 gene in order to rescue the full-length mRNA. Moreover, our report of a mild phenotype complements the DD spectrum, which is of great importance for a rare disease suspected to be underdiagnosed.

Pediatric Awake Craniotomy for Brain Lesions.

Awake craniotomy is a special method to prevent motor deficits during the resection of lesions that are located in, or close to, functional areas. Although it is more commonly performed in adult patients, reports of pediatric cases undergoing awake craniotomy are limited in the literature. In our clinic, where we frequently use awake craniotomy in adult patients, we performed this method in 2 selected pediatric cases for lesion surgery. At an early age, these 2 cases diagnosed with epilepsy presented cerebral lesions, but since the lesions enclosed functional areas, surgical resection was not regarded as a treatment option at this time. In these 2 pediatric cases, we successfully completed lesion surgery with awake craniotomy. The method and the techniques employed during surgery are presented concomitant with other reports in the literature.

Electroconvulsive therapy during pregnancy as a possible cause of Möbius syndrome: additional clinical observation.

Möbius syndrome is a rare congenital disease with a prevalence of between 0.0002 and 0.002% of births. Minimum diagnostic criteria for this disease include congenital unilateral or bilateral facial and abducens nerve paresis. Occasionally, the cranial nerves V and VIII are affected. If cranial VIII is affected, the person experiences hearing loss. Other findings in these patients that are not part of the diagnostic criteria include the involvement of other cranial nerves, malformations of orofacial structures, reductive limb anomalies, and defects of the chest wall. We herein report a newborn case with Möbius syndrome.

The effect of early prednisolone treatment on the generalization rate in ocular myasthenia gravis.

BACKGROUND AND PURPOSE: Several small retrospective studies have observed that patients with a purely ocular manifestation of myasthenia gravis (MG) are significantly less likely to convert to a generalized disease when treated early on with corticosteroids. However, given the limited number of reported patients in the literature these findings still remain controversial. METHODS: In order to increase the number of published cases, we performed a retrospective analysis on 44 patients with newly diagnosed ocular MG who were subsequently either treated with corticosteroids or received no immunosuppressive therapy at all. The generalization rate was assessed at the end of a 2-year follow-up period. RESULTS: Whereas none of 17 treated patients generalized, 11 of 27 (41%) untreated patients developed generalized symptoms. The difference between the groups was significant (P=0.003). CONCLUSIONS: Our results agree well with previous studies on this issue. Taken together, published data indicate risk ratios for generalization of below 0.32 under corticosteroid treatment in comparison to untreated patients.

New approach to morphometric analysis of Huschke's foramen.

BACKGROUND: The aim of the study is to analyse the demographic and anatomical details of the Huschke's foramen (HF) which have not been previously studied and to present a new clinical perspective. MATERIALS AND METHODS: Multidetector computed tomography (MDCT) images of 495 patients were retrospectively evaluated. Presence of a HF, its' size, relations to side, age and gender were noted for every patient. Size of the foramen was measured in the axial plane, as well as on the reconstructed coronal and sagittal planes. RESULTS: Of the 495 patients 99 (20%) had HF. There was no significant difference between females and males according to the presence of the HF and the side of the HF. When the dimension of the left- and the right-sided HFs were compared, there were no significant differences on none of the axes for the patients with unilateral or bilateral HF. There was no significant linear correlation between age and the dimension in the axial axis, the dimension in the sagittal axis and the dimension in the coronal axis CONCLUSIONS: The present work presenting morphologic and statistical variables of HF provides data for further studies which will indicate risk factors of herniation through HF. By the aid of MDCT, which is sensitive method for detection of the HF because of its thin sections, high spatial resolution, and multiplanar capabilities, lesions which were previously diagnosed as dehiscence were found to be defects.

Response to doxycycline and oxytetracycline treatments in cats infected with Mycoplasma spp. and analysis of haemato-clinical findings and risk factors.

This study was planned to determine the efficacy of doxycycline and oxytetracycline in the treatment of feline Mycoplasma spp. infections and to analyze risk factors as well as clinical and haematological findings. Cats accepted to the clinic with complaints such as weakness, loss of appetite and fever were routinely examined. Clinical history of animal was demanded from the owner. An interview and a short questionnaire were conducted to owner to evaluate the risk factors associated with possible Mycoplasma status of animal. During the interview, the age, sex, breed, housing, flea infestation, worm control, external parasite control, other accompanying infections and vaccination status of cats were asked and the data recorded. Peripheral blood smears were stained with the DIFF-QUICK. Fifty positive cats were included in the study, 16 of which were treated with doxycycline (orally, 5 mg/kg twice a day) while other 34 with oxytetracycline (intramuscular injection, 10 mg/kg once a day). It was determined that all (100%) cats with Mycoplasma spp. infection had a flea infestation. Majority of cats (94%) did not receive the regular antiparasitic application and only 6 (12%) of them had complete vaccinations. Mycoplasma spp. infection was associated with younger age and outdoor access. Among the feline breed, striped cat (74%) was more prone to infection. The most common clinical signs encountered in cats were weakness (94%) and anorexia (84%). Haematological parameters revealed thrombocytopenia (86%), and anaemia (40%) in infected cats. At the end of the treatment, recovery rates for doxycycline and oxytetracycline groups were 87.5% and 67.6%, respectively. General status of these cats indicated significant improvement on the 4th day of treatment, and clinical symptoms are restored on the th day. Mycoplasmosis is an important infection for cats having anaemia, thrombocytopenia and leukocytosis. Flea infestations are risk factor for contamination of the disease. Based on our results, we recommend doxycycline treatment (5 mg/kg) for up to 21 days for elimination of Mycoplasma spp. in the blood of infected cats.

Necrotizing fasciitis of eyelid secondary to parotitis.

PURPOSE: Evaluation of a patient with necrotizing fasciitis of the eyelid spreading from parotid gland. METHODS: Interventional case report. The patient admitted with rapidly progressive swelling, redness, and pain of four eyelids, and whole face. Pathogenic microorganism was searched, laboratory tests were evaluated. Intensive medical treatment and necrotic wound debridement was performed. RESULTS: The patient had been receiving oral cephalosporin at the time she was referred to our hospital, but her infection had spread rapidly under this treatment. In addition to her eyelid necrosis, septic shock developed within 24 hours. No pathogenic microorganism was detected in cultures. The patient responded to intravenous sulbactam ampicillin, surgical debridement of necrotic wound and supportive medical care. Moderate ptosis was the only complication observed in this patient. Reconstructive surgery was not needed. CONCLUSIONS: With prompt antibiotic treatment and surgical debridement, cosmetic and functional success may be obtained in necrotizing fasciitis cases rarely seen with parotid gland origin.

Volatile solvent abuse caused glomerulopathy and tubulopathy in street children.

Substance misuse among street children is a significant problem in developing countries. Volatile substances are the most abused agents. According to case reports, chronic renal diseases are common among substance-abusing street children. In this study, we examined the renal findings of 42 volatile substance-abusing street children and compared them with results from 49 healthy children (control). The street children's weight, height, and blood pressure were lower than the controls' (P < 0.05). However, their blood alkaline phosphatase and creatinine phosphokinase levels were higher (P < 0.05), and total blood protein, creatinine, and phosphorus levels were lower than the controls' (P < 0.05). Furthermore, the street children's glomerular filtration rates were within normal limits (P < 0.05), their urinary N-acetyl-beta-glucosaminidase (NAG), beta(2)-microglobulin, microalbumin, protein, calcium, phosphorus, sodium, potassium, and chloride excretions were higher, and tubular phosphate reabsorption were lower than the controls' (P < 0.05). Volatile substances have been charged with causing distal tubular disease, but increased urinary protein, NAG, beta(2)-microglobulin, microalbumin, and electrolyte excretions also result from glomerular, proximal, and distal tubular influences. We believe that increased volatile substance products in the renal parenchyma are responsible for glomerular and tubular damage. Volatile substance-abusing street children should be examined for glomerular and proximal tubular function and distal tubular acidosis.

Temperature dependence of the current-voltage characteristics of Sn/PANI/p-Si/Al heterojunctions.

Sn/PANI/p-Si/Al heterojunctions were fabricated by electropolymerization of aniline on chemically cleaned p-Si substrates. Current-voltage characteristics of Sn/PANI/p-Si/Al heterojunctions measured in the temperature range 140-280 K are presented and analyzed. Although these devices were clearly rectifying, their I-V characteristics were non-ideal, which can be judged from the nonlinearity in the semi-logarithmic plots. The high values of the ideality factor n depending on the sample temperature may be ascribed to a decrease of the exponentially increasing rate in current due to space-charge injection into the PANI thin film at higher forward bias voltages. Careful analysis of the forward bias I-V characteristics on a log-log scale indicates that the space-charge-limited current (SCLC) conduction controlled by an exponential trap distribution above the valence band edge dominates the current transport in the PANI/p-Si diodes at high voltages. Furthermore, the PANI was characterized by using Fourier transform infrared (FTIR) and ultraviolet-visible (UV-vis) spectra.

Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula.

PURPOSE: To evaluate the added value of diffusion-weighted (DWI) magnetic resonance imaging (MRI) by comparison with T2-weighted images alone in the diagnosis of perianal fistula. MATERIAL AND METHODS: MRI examinations of 123 patients (97 men, 26 women; mean age, 41.9 years) with suspected perianal fistula were retrospectively evaluated by two radiologists. Fat-suppressed T2-weighted fast spin echo images, DWI (b values, 0 and 1000s/mm2) and fat-suppressed gadolinium chelate-enhanced T1-weighted images were evaluated for each patient by using a four-point scale. Confidence scores and sensitivities were calculated for T2-weighted images alone, the combination of DWI and T2-weighted images and the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images. The combination of gadolinium chelate-enhanced and T2-weighted images was used as reference standard. RESULTS: Perianal fistulas were present in 92/123 patients (74.8%). An almost perfect interobserver agreement was found for T2-weighted images (kappa=0.868), the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images (kappa=0.96) and the combination of DWI and T2-weighted images (kappa=0.90). The confidence scores for the diagnosis of perianal fistula for the combination of gadolinium chelate-enhanced T1-weighted images and T2-weighted images were greater than those of T2-weighted images alone for observer 1 (P<0.001) and observer 2 (P=0.009). The confidence scores of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for observer 1 (P<0.001) and observer 2 (P=0.032). Sensitivity and specificity of the combination of DWI and T2-weighted images were greater than those of T2-weighted images alone for both observers. CONCLUSION: DWI has a significant added value compared to T2-weighted imaging alone in the diagnosis of perianal fistula.

Evaluation of temephos and chlorpyrifos-methyl against Culex pipiens (Diptera: Culicidae) larvae in septic tanks in Antalya, Turkey.

The larvicidal activity of chlorpyrifos-methyl and temephos was evaluated against Culex pipiens L. (Diptera: Culicidae) in septic tanks in Antalya, Turkey. Chlorpyrifos-methyl (Pyrifos MT 25 emulsifiable concentrate [EC] ) was evaluated at application rates of 0.04, 0.08, and 0.12 mg active ingredient (AI)/liter, and temephos (Temeguard 50 EC) was evaluated at 0.02, 0.04, and 0.06 mg (AI)/liter during a 21-d study. Generally, overall larval reduction in septic tanks from single- and multifamily dwellings treated with either larvicide was significantly greater than pretreatment levels and control tanks for the duration of the study. At 14 d posttreatment, duration of control was greatest in multifamily tanks treated with chlorpyrifos-methyl at the highest application rate with similar levels of control through 21 d for single-family dwellings (range 97-100%). Septic tanks from both types of family dwellings treated at the highest application rate of temephos resulted in >90% reduction through day 21 (range 91-100%). Laboratory bioassays of septic tank water treated at field application rates, without daily dilution, revealed that complete larval mortality was achieved for 21 d at each application rate and formulation. It is thought that daily addition of water and organic matter to the septic tanks in the single and multifamily dwellings influenced the duration of effectiveness of the larvicides.

Iodine deficiency and goiter prevalence in Turkey after mandatory iodization.

OBJECTIVE: The determination of (a) iodine deficiency, and (b) the relation between the iodized salt consumption in the Isparta province of Turkey. METHODS: Five hundred students between 6-11 yr of age were evaluated. With a questionnaire, the subjects were asked whether they were using iodine-containing salt or not. After their body weight and height were measured, thyroid glands were examined with palpation, thyroid volumes were determined with ultrasonography (USG), and urinary iodine concentration was analyzed. RESULTS: The median urinary iodine concentration (UIC) of children was 7.00 microg/dl. This value reveals that Isparta is a region with mild iodine deficiency. The total goiter prevalence was 30.4% with palpation and 26% with USG. The goiter prevalence by ultrasonography was 14.2% for the urban and 36.2% for the rural areas. This difference was statistically significant (p<0.05). The rate of total iodized salt consumption was 68%, which was not a satisfactory level. The consumption of iodized salt in the urban areas was significantly higher than that in rural areas (74 vs 62%, p<0.05). The median UIC value was 10.00 microg/dl in urban areas compared to 5.00 microg/dl in rural areas. CONCLUSIONS: Our results indicate that although Isparta is a region with mild iodine deficiency, goiter prevalence remains a serious problem.

Efficacy of diflubenzuron, a chitin synthesis inhibitor, against Culex pipiens larvae in septic tank water.

The mosquito Culex pipiens L. is an important pest in urban and suburban areas in many parts of the world. Septic tanks are the most important habitats supporting the production of this species in the city of Antalya, southwestern Turkey. Diflubenzuron, in a 25% wettable powder (Du-dim 25 WP), and a 4% granular formulation (Du-dim 4 G) was evaluated against late 2nd to early 3rd instars of Cx. pipiens in single-family septic tanks. Both formulations were tested at 0.01, 0.02, and 0.03 mg (AI)/liter. The results indicated that both formulations applied at the rate of 0.02 and 0.03 mg (AI)/liter achieved 100% adult inhibition, at intervals of 7, 14, 21, and 28 days after treatment. Septic tanks treated with 0.01 mg (AI)/liter WP formulation resulted in complete (100%) adult inhibition through 14 days, whereas the G formulation gave the same effect through 21 days posttreatment at this rate.

Early laparoscopic cholecystectomy with continuous pressurized irrigation and dissection in acute cholecystitis.

Background. The aim of this study was to evaluate the preliminary results of a new dissection technique in acute cholecystitis. Material and Method. One hundred and forty-nine consecutive patients with acute cholecystitis were operated on with continuous pressurized irrigation and dissection technique. The diagnosis of acute cholecystitis was based on clinical, laboratory, and radiological evidences. Age, gender, time from symptom onset to hospital admission, operative risk according to the American Society of Anesthesiologists (ASA) score, white blood cell count, C-reactive protein test levels, positive findings of radiologic evaluation of the patients, operation time, perioperative complications, mortality, and conversion to open surgery were prospectively recorded. Results. Of the 149 patients, 87 (58,4%) were female and 62 (41,6%) were male. The mean age was 46.3 ± 6.7 years. The median time from symptom onset to hospital admission 3.2 days (range, 1-6). There were no major complications such as bile leak, common bile duct injury or bleeding. Subhepatic liquid collection occurred in 3 of the patients which was managed by percutaneous drainage. Conversion to open surgery was required in four (2,69%) patients. There was no mortality in the study group. Conclusion. Laparoscopic cholecystectomy with continuous pressurized irrigation and dissection technique in acute cholecystitis seems to be an effective and reliable procedure with low complication and conversion rates.

Experience with teicoplanin in the treatment of neonatal staphylococcal sepsis.

We aimed to evaluate retrospectively the clinical and bacteriological efficacy and potential side-effects of teicoplanin treatment in neonates with proven staphylococcal infection. There were 37 episodes of staphylococcal septicaemia in neonates with a mean gestational age of 34.2 +/- 2.3 weeks; 26 were caused by coagulase-negative staphylococcal (CoNS) sepsis and 11 by Staphylococcus aureus sepsis. All episodes were treated with teicoplanin (intravenous loading dose 16 mg/kg followed by a maintenance dose of 8 mg/kg daily). The methicillin resistance and antibiotic susceptibilities of both micro-organisms were evaluated. Bacterial eradication was achieved in 89.1% of cases and mortality was 16.2%. The mean duration of treatment of the survivors was 11.6 +/- 2.3 days. There were no drug-related adverse events and the biochemical and haematological tests showed no clinically significant changes in relation to teicoplanin therapy. Our results suggest that teicoplanin is highly effective in neonatal staphylococcal sepsis.

Larvicidal activity of a botanical natural product, AkseBio2, against Culex pipiens.

A botanical natural product, AkseBio2, was evaluated for its larvicidal effect against Culex pipiens under laboratory conditions. The product exhibited strong larvicidal activity and caused >90% mortalities in both the young (first-second) and the older (third-fourth) larval stages of the species at 24 h at the doses of 25 and 50 ppm. However, it was determined that the young larval stages were more susceptible to the product in comparison with the older larval stages. The results suggest that the product is promising as a larvicide against C. pipiens and could be useful in the search of new larvicidal natural compounds.