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Background and aim: The aim of this study is to evaluate whether the long-term (≥4 weeks) use of proton pump inhibitors (PPIs) is a risk factor for intubation requirement and mortality in patients hospitalized for COVID-19. Materials and methods: In this multicentric retrospective study, a total of 382 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalized for treatment were enrolled. The patients were divided into two groups according to the periods during which they used PPIs: the first group included patients who were not on PPI treatment, and the second group included those who have used PPIs for more than 4 weeks. Results: The study participants were grouped according to their PPI usage history over the last 6 months. In total, 291 patients did not use any type of PPI over the last 6 months, and 91 patients used PPIs for more than 4 weeks. Older age (HR: 1.047, 95% CI: 1.026–1.068), current smoking (HR: 2.590, 95% CI: 1.334–5.025), and PPI therapy for more than 4 weeks (HR: 1.83, 95% CI: 1.06–2.41) were found to be independent risk factors for mortality. Conclusion: The results obtained in this study show that using PPIs for more than 4 weeks is associated with negative outcomes for patients with COVID-19. Patients receiving PPI therapy should be evaluated more carefully if they are hospitalized for COVID-19 treatment.

SMARCB1 (INI1) deficient carcinoma (SDC) is a newly-described, aggressive, high-grade malignancy of the adult population. Rarely, these tumors demonstrate yolk sac differentiation. Treatment protocols are not defined due to the rarity of this entity. A 55 year-old-male presented with a tumor originating in the maxillary sinus. He was treated with neoadjuvant therapy followed by radical surgery and adjuvant treatment. We review the literature and discuss the course of disease and treatments of sinonasal SDC with yolk sac tumor differentiation. To our knowledge, this is the sixth reported case of sinonasal SDC with yolk sac tumor differentiation. This is the first publication describing the clinical course and efficacy of therapeutic interventions.

Adhesion after a tendon injury is one of the major problems following upper extremity surgery. In the present study, we evaluated a new material that is clinically usable as an adhesion barrier. Twenty-four male Wistar albino rats were used in the study. These rats (48 legs) were divided into three groups: sham, control, and experimental. No surgical intervention was performed in the sham group. After making a full-thickness cut through the right Achilles tendon, the tendon was repaired using the modified Kessler technique in the control group, while bovine collagen matrix was wrapped around the surgically repaired tendon using the modified Kessler technique in the experimental group. Two months after surgery, the operated and non-operated tendons were resected and analyzed through biomechanical, macroscopic, and histopathological examinations. The results of the biomechanical testing did not differ significantly between the control and experimental groups. Macroscopic examination of the adhesions revealed less adhesions in the experimental group but this difference was not statistically significant. Moreover, the results of the histopathological examination, which was performed based on five criteria, did not differ significantly between the two groups. Our study's results indicate that a bovine collagen matrix can be used to prevent tendon adhesion; however, larger studies are needed to verify these findings.

Pathogenesis of Behçet disease (BD) has not yet been clearly revealed and there is no ideal test for the estimation of disease activation at present. This study aimed to assess the efficiencies of IgG/IgM and IgA/C3 ratios in determining activation of BD.This retrospective cohort study consisted of 140 patients with BD. Patients were divided into two groups: (1) active BD (Significantly higher levels of erythrocyte sedimentation rate, C-reactive protein, IgA, G, C4, IgA/C3, IgG/IgM ratios (IgA/C3 and IgG/IgM ratios may be used as additional parameters for the assessment of BD status.

Background Behcet disease (BD) is an immune-mediated vasculitis-like syndrome characterized by recurrent aphthous lesions and various systemic manifestations. Inflammatory markers may be useful to assess disease severity. The Systemic Immune-Inflammation Index (SII) (neutrophils × platelets/lymphocytes) has been widely used in oncology since 2014, with promising results. Aim To assess the efficiency of the SII in determining activity of BD. Methods This retrospective cohort study was conducted on patients with BD who were admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between 1 January 2010 and 31 December 2019. Patients were divided into two groups based on their disease status upon admission: (i) active BD (n = 103), and (ii) inactive BD (n = 63). Clinical characteristics, demographic features, type of medications, full blood count parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin and SII were compared between the groups. Furthermore, receiver operating characteristic curve analysis was performed to assess the performance of the SII in determining disease severity upon admission to hospital. Results Higher numbers of white blood cells, platelets and neutrophils, greater red cell distribution width, higher levels of ESR, CRP and ferritin, and higher SII were observed in the active disease group (P Conclusion The SII may be used as an additional indicator for the assessment of BD status and physicians should be cautious in patients with SII levels of > 552 × 103 /mm3 ) at the initial evaluation of the patients.

Background. Diabetes mellitus (DM) is a multisystemic, chronic disease that affects many organs. Coronary artery disease (CAD) is the leading cause of death in patients with DM. The electrocardiogram’s new ventricular repolarization parameters can predict mortality and morbidity. The ventricular repolarization indices were examined in diabetic patients with a CAD diagnosis in this study. Methods. The study group consisted of 84 DM patients (51 males; mean age 58.8 ± 6.6) with noncritical CAD. The control group consisted of 84 DM patients (47 males; mean age 58.7 ± 8.8) with a normal coronary artery. The intervals of QT, QRS, JT, and Tp-e were all measured. Tp-e/QT, Tp-e/QTc, Tp-e/JT, and Tp-e/JTc ratios were determined with QTc, QTd, QTdc, and JTc intervals. Results. Heart rate (74.4 ± 13.1 vs. 70.0 ± 13.6 bpm, p : 0.036), QT (381.0 ± 30.3 vs. 368.6 ± 29.1 ms, p : 0.008), QTc (407.5 (359–450) vs. 389 (339–430) ms, p < 0.001 ), QTd (25.1 ± 6.2 vs. 21.9 ± 9.9 ms, p : 0.013), QTdc (26.7 ± 6.1 vs. 23.1 ± 10.8 ms, p : 0.010), Tp-e (95.7 ± 12.2 vs. 73.6 ± 9.8 ms, p < 0.001 ), JT (293.8 ± 22.0 vs. 283.5 ± 30.9 ms, p : 0.014), and JTc (313.6 ± 12.3 vs. 302.4 ± 33.7 ms, p = 0.005 ) intervals, and Tp-e/QT (0.25 ± 0.03 vs. 0.20 ± 0.03 ms, p < 0.001 ), Tp-e/QTc [0.23 (0.19–2.33) vs. 0.19 (0.14–0.25) ms, p = 0.007 ], Tp-e/JT (0.33 ± 0.04 vs. 0.26 ± 0.04 ms, p < 0.001 ), and Tp-e/JTc (0.30 ± 0.03 vs. 0.24 ± 0.03 ms, p < 0.001 ) ratios were all found to be significantly higher in diabetic patients with noncritical CAD. Conclusion. In this study, ventricular repolarization markers on the surface ECG were found to be elevated in diabetic CAD patients. These variables may be related to fatal arrhythmic events. To be sure, large-scale, randomized controlled trials are required.

We aimed to compare the efficacy and the safety of the FOLFOX and the FLOT regimens in metastatic gastric cancer (mGC) as first-line treatment. It was a retrospective multicenter observational study. The comparisons between groups were conducted in terms of progression-free survival (PFS), overall survival (OS), objective response rate (ORR) and hematologic adverse events. Seventy-nine patients, diagnosed with mGC between March 2012 and December 2019, treated with FOLFOX (n = 43) or FLOT (n = 36) regimens as first-line treatment were included in the study. The mPFS was 10.9 months [95% confidence interval (CI), 5.8-16.1] in the FLOT arm and 7.1 months (95% CI, 5.1-9.1) in the FOLFOX arm (P < 0.001). The ORR was 63.9% in the FLOT arm and 30.2% in the FOLFOX arm (P = 0.003). The mOS was 13.3 months (95% CI, 11.3-15.4) in the FLOT arm and 10.9 months (95% CI, 8.2-13.5) in the FOLFOX arm (P = 0.103). The hematologic adverse events in all grades were 88.4% (n = 38) in the FOLFOX arm compared with 80.6% (n = 29) in the FLOT arm (P = 0.335). The FLOT regimen might be a preferred option in mGC with an improved PFS and ORR compared with the FOLFOX regimen.

Introduction Extravasation injuries are one of the most feared complications of intravenous drug administration. The most common drugs associated with extravasation injury include chemotherapy agents and contrast media. Natural course of vesicant extravasation is discomfort, pain, swelling, inflammation, and ultimately skin ulceration. While diligence is the principle approach in prevention, immediate bed-side measures are as important in controlling the extent of tissue damage. Various options, either medical or interventional are next steps in treatment of the condition including antidotes, volume dilution, flushing, suction, hyperbaric oxygen therapy, and surgery. Materials and methods 12 male Wistar albino rats were divided into two groups; one group received fat injections following subdermal doxorubicin infiltration in their right thighs, while other group received saline injection following subdermal doxorubicin infiltration in their right thighs for dilution. Left thighs of both groups were left untreated following subdermal doxorubicin infiltration. Total area of necrosis, as well as resultant epidermal thicknesses were assessed. Histological analyses were conducted using modified Verhofstad scoring system for comparison. Results Mean necrotic area was significantly smaller in the fat injection group compared to other groups. Median Verhofstad score was lesser in the fat injection group as well. Median epidermal thickness, on the other hand, was greater in the fat injection group. Conclusion Injection of fat grafts following vesicant extravasation might be beneficial in preventing the progression of tissue damage, if employed early.

Introductions Results with convalescent plasma therapy in coronavirus disease 2019 (COVID-19) have been contradictory. Timing seems to be an important factor for COVID-19 convalescent plasma(CCP) to be effective. Aim of this study is to compare disease outcomes in hospitalized COVID-19 patients who were treated with CCP within first three or seven days of symptoms to patients with symptoms longer than seven days. Material and methods A multicenter retrospective study was conducted to evaluate disease outcomes in hospitalized COVID-19 patients who received CCP in addition to standard of care (SOC) approach. Patients were subgrouped according to time of CCP administration; within three days of symptoms, seven days of symptoms and after seven days of symptoms. A control group was formed from age, gender and comorbidity matched hospitalized patients who received SOC treatments without CCP. Length of hospital stay, rates of anti-inflammatory treatment initiation, intensive care unit (ICU) admission and mortality was set as outcome measures. Results A total of 223 patients were enrolled in this study, 113 patients received CCP (38 within three days, 63 within seven days, 50 after seven days of symptom onset). Rate of anti-inflammatory treatment initiation was significantly lower (38.1 % vs 62.7 %, p = 0.002, relative risk, 0.60,73; 95 % confidence interval [CI], 0.42 to 0.85) and length of hospital stay was significantly shorter (median(IQR) 8(4) days vs 9.5(5.25) days, p = 0.0025) in patients who received CCP within seven days of symptom onset when compared to SOC group. Conclusion CCP therapy may provide better outcomes when applied within seven days of symptoms.

Irreversible pulpitis is an acute, brief, and painful condition. Oxytocin, cortisol, and secretory immunoglobulin A (sIgA) are released by the body in response to pain and emotional stress. The aim of this study was to investigate the expression of salivary cortisol, sIgA, and oxytocin among patients with irreversible pulpitis. This was an ethically approved case-control study comparing 90 cases of irreversible pulpitis and 40 healthy individuals. Five study groups were established: nonpregnant female pulpitis, pregnant female pulpitis, male pulpitis, healthy (nonpregnant) female control, and healthy male control. Pregnant women in the first trimester were enrolled in the study. Participants received both clinical and radiographic examinations, completed a simple questionnaire related to food intake, habits, and anxiety, and their pain levels were recorded on a visual analog scale in which 0 represented no pain and 10 represented the worst possible pain. Unstimulated saliva samples were collected to measure oxytocin, sIgA, and cortisol levels. Dental pulp specimens were obtained and stained with hematoxylin and eosin to evaluate the agreement between clinical and histologic pulpal diagnoses. The statistical analysis included analysis of variance and Tukey tests. The majority of patients (37%) recorded a score of 8 (severe pain) on the visual analog scale, while a score of 10 (worst possible pain) was recorded only by pregnant women (3%). There was no statistically significant difference among healthy subjects for all salivary samples. Oxytocin levels increased significantly in nonpregnant (P0.5) and pregnant (P0.001) women with pulpitis. Cortisol (P0.01) and sIgA (P0.001) levels were significantly elevated only in pregnant women with pulpitis. The results of the present study indicate that acute dental pain during pregnancy can be considered as a pregnancy risk factor because of the resulting elevated oxytocin and cortisol levels.

Background: The use of perforator propeller flaps in lower limb reconstruction has increased recently. Many pharmacological agents are used to increase flap viability. Botulinum toxin has been used in various types of flaps in the literature. However, there is no study regarding the use of botulinum toxin in the lower limb propeller flaps. This study investigates the effect of botulinum toxin administration on flap survival for lower limb propeller flap in rats. Materials and methods: The study included 20 male Wistar albino rats, divided into two groups with a flap rotation of 90 degrees in group 1 and 180 degrees in group 2. in both groups, botulinum toxin was administered to the right thigh and a physiological saline solution was applied to the left thigh. Five days later, flaps were elevated over the posterior aspect of the right and left thighs and inset after 90 degrees and 180 degrees rotation was performed. Histopathological, immunohistochemical, and necrosis area analyses were performed. Results: Necrosis area, edema, polymorphonuclear leukocyte infiltration, and necrosis were found to be higher on the left side of the groups, whereas epidermal thickness, collagen density, vascularization, and hair root density were found to be higher on the right side of the groups. No significant difference was found between the right posterior thighs in either group on any parameter other than vascularization. Histopathologically and immunochemically statistically significant differences were found between the two groups. Conclusions: The present study found that botulinum toxin increases flap viability in lower limb perforator-based propeller flaps. (C) 2020 Elsevier Inc. All rights reserved.

OBJECTIVES: Peripheral nerve injuries are common in Europe; however, the treatment techniques may lead to disabilities. This study aimed to evaluate the effect of tacrolimus use on the capacity of the epineural sheath graft to improve its regeneration quality in rat sciatic nerves as a treatment option for nerve injuries. MATERIALS AND METHODS: In the experimental process, 30 male Sprague Dawley were used as recipients and 10 Wistar rats were used as donors. Under anesthesia, all rats were operated on to resect the sciatic nerve. The nerve tissue of Wistar rats was used as allograft. In the autograft group, the resected nerve was reversed and sutured, resulting in an epineural sheath graft. For the allograft groups, rats were randomly divided into 2 groups as the tacrolimus-treated group and the nontreated group after allograft transplant. Tacrolimus was administered intramuscularly at 0.1 mg/kg daily for 12 weeks. After the treatment period, rats were killed and evaluated histomorphologically with light and electron microscopy. RESULTS: Histological examination showed no remarkable differences between different regions of the sciatic nerves (distal, middle, and proximal). The axonal density was decreased in the allograft groups compared with the autograft group (P < .001). Results showed that the number of mast cells was increased in the allograft group without tacrolimus treatment (P < .05). Similarly, there was a mild increase in mast cell count in the tacrolimus-treated allograft group. CONCLUSIONS: Our results showed that tacrolimus use in rats with implanted epineural nerve sheath supported recovery in terms of morphological and physiological regeneration of the nerve.

BackgroundThis study aims to investigate the prognostic value of the ratio of hemoglobin-RDW (HRR) at diagnosis, in terms of overall survival (OS) and progression-free survival in patients with advanced non-small cell lung cancer (NSCLC).MethodsPatients with metastatic NCCLC who attended two separate medical oncology clinics between April 2013 and December 2017 were retrospectively screened. HRR was calculated as Hgb (g/dL) divided by the RDW (%). Patients were assigned to either the low HRR group or high HRR group.ResultsA total of 153 patients were included in the study. The cuff-value for HRR was taken as 0.88. Among the low and high HRR groups, Glasgow prognostic scores (GPS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and weight loss were statistically significantly different (p

Purpose The study was aimed to evaluate the effect of uric acid (UA) on the 30-day mortality of patients admitted to the tertiary referral hospital with a complaint of febrile neutropenia (FEN). The secondary aim was to evaluate the use of combining serum UA levels with the Multinational Association for Supportive Care in Cancer (MASCC) risk score. Methods A retrospective study in which the MASCC score and serum UA levels were used to evaluate the mortality risk within 30 days among patients with FEN. Results A total of 118 FEN episodes were included in the study and 17 (14%) of these patients died. While this rate is 23% in the high-risk group according to the MASCC score, it is 7% in the low-risk group (p = 0.011). In multivariate analysis of the parameters that significantly affect the 30-day FEN mortality, MASCC risk score (OR, 4.28; CI 95% 1.19-15.39,p = 0.013) and having a level of serum UA > 7 mg/dL (OR, 4.46; CI 95% 1.19-15.38,p = 0.032) was significantly increased the risk of in 30-day mortality of FEN. The rate of 30-day mortality of FEN was 0% in patients with a low MASCC risk score and UA level compared with 50% in the high MASCC risk score and high UA level group, and the difference was statistically significant (p < 0.001). Conclusion Increased level of UA at the time of FEN diagnosis was independently associated with an increased rate of 30-day mortality of FEN. The combination of the MASCC risk score and serum UA level might thoroughly predict the 30-day mortality of FEN.

© 2021 Elsevier Inc.Brigatinib is a novel potent tyrosine kinase inhibitor as third-generation therapy for anaplastic lymphoma kinase (ALK) rearrangement positive non-small cell lung cancer (NSCLC). Clinical trials show that brigatinib is potent choice of treatment for the first line and further lines of treatment of ALK rearranged NSCLC with highly potent anti-tumor effect on brain metastasis. The adverse effects of brigatinib are tolerable and managable. However, there is limited data about effects on immune system. The most possible serious adverse effect of brigatinib on immune system might be brigatinib associated grade 3-4 lymphopenia. Here we report a brigatinib-induced tuberculosis reactivation patient who is using third-line brigatinib for metastatic NSCLC and have partial response.

Objective: To compare alveolar ridge splitting (ARS) and autogenous onlay bone grafting (AOBG) in atrophic jaw bones. Methods : Forty patients were included in this retrospective, parallel-group study conducted at the Istanbul Medipol University School of Dentistry, Istanbul, Turkey, between 2012-2015. The initial bone thickness was measured by cone beam computed tomography (CBCT). Patients were allocated into ARS (n=17) and AOGB (n=23) groups on the basis of ridge thickness and shape. Follow-up CBCT measurements to assess horizontal bone were repeated 4 to 6 months post augmentation. The diameters of the implants were recorded. Implant bone resorption was measured at one year post implant placement on panoramic radiography. Surgical complications and implant survival were evaluated. Results : The final bone width in the AOBG group was significantly higher than that in the ARS group ( p =0.029). Forty-four implants were inserted in the AOGB group, whereas 33 implants were inserted in the ARS group. There was no significant difference regarding implant diameter ( p =0.920). Implant survival rate was 93.9% in the ARS group and 93.1% in the AOGB group. Peri-implant bone resorption at one year was higher in the AOBG group than in the ARS group ( p =0.032). There were minor surgical complications, including bad split and wound dehiscence. Conclusion : The incidence of peri-implant bone resorption for the AOGB technique was higher than that for the ARS technique, but their implant survival rates were similar. Saudi Med J 2017; Vol. 38 (12): 1207-1212 doi: 10.15537/smj.2017.12.21462 How to cite this article: Gurler G, Delilbasi C, Garip H, Tufekcioglu S. Comparison of alveolar ridge splitting and autogenous onlay bone grafting to enable implant placement in patients with atrophic jaw bones. Saudi Med J . 2017 Dec;38(12):1207-1212. doi: 10.15537/smj.2017.12.21462.

Study objective Our aim was to determine the efficiency of ultrasound (US) scanning in patients with wrist trauma admitted to the emergency department and to compare US diagnostic usage with other radiological imaging methods. Methods Patients who presented to the emergency department with wrist injury and who met the inclusion criteria and exclusion criteria were eligible. For all patients, US evaluation of the whole wrist was performed by an emergency physician before other radiological imaging methods (radiographies, computed tomography (CT) and magnetic resonance (MR) imaging). All of the patients included in the study underwent US, radiography, CT, and MR. Results During the study, 122 patients were admitted with a wrist injury. After filtering for the exclusion criteria, 80 patients were included in the study. The sensitivity of US scanning in detecting fractures was 95.31% (95% confidence interval [CI]: 87.1–98.39), the specificity was 93.75% (95% CI: 71.67–98.89), and the positive predictive value was 98.39% (95% CI: 91.72–99.85), and the negative predictive value was 83.33% (95% CI: 72.98–90.41). The sensitivity of US scanning in detecting tendon and ligamentous structural injury was 66.67% (95% CI: 41.71–84.82), the specificity was 100% (95% CI: 94.42–100), the positive predictive value was 100% (95% CI: 94.29–99.89), and the negative predictive was 92.86% (95% CI: 84.25–97.14). Conclusion US scanning is an effective method that can be applied in the emergency department to adult patients to diagnose distal forearm and carpal bones fractures. In soft tissue injuries, US and MR examinations produce similar results.

BACKGROUND The fibula flap is a workhorse flap for bony reconstruction of oro-mandibular area and can be modified to include soft tissue for reconstruction of composite defects. However, the design of a reliable skin paddle that can be used for composite tissue reconstruction remains a challenge. The authors described the applicability of perforator concept for a more reliable free osteomusculocutaneous fibula flap. METHODS Between 2013 and 2015, 29 patients underwent free fibula osteocutaneous flap reconstruction. Twenty-two patients have been operated due to squamous cell carcinoma and 7 patients due to gunshot injuries. RESULTS The mean harvesting time was 60 ± 15 minutes. The range of width of the skin paddle was 3 to 12 cm and length was 6 to 23 cm. The range of length of bone was 5 to 18 cm. One patient had revision due to venous occlusion. All flaps have survived. CONCLUSION The authors advocate approaching all components of flap individually using the perforator concept and dissection. Good exposure is mandatory for a reliable dissection. In our opinion, the posterior approach is more useful as it reveals all vascular relationships between the bone, muscle, skin paddle, and peronel vessels.

The aim of this study was to test the suitability of the interspecific hemizona assay (HZA) to predict the fertilizing capacity of bovine sperm after modifying the length of the equilibration period before freezing and thawing. Ejaculates from 10 proven fertile bulls were split after dilution, equilibrated at 4 °C for either 24 h (control sperm = CS) or 6, 48, 72 or 96 h (test sperm = TS) and cryopreserved. Hemizona (HZ) pairs from in vitro matured pig oocytes were used for the heterologous HZA: After thawing and swim-up (1 h) CS and TS were co-incubated with matching HZ (125,000 S/HZ in 25 μL Fert-TALP) for 4 h. Spermatological analyses (progressive motile sperm (PMS), plasma membrane- and acrosome-intact sperm (PMAI), sperm showing a high degree of DNA fragmentation (%DFI)) were performed after 0 and 3 h of incubation after thawing. After an equilibration time of 48 h and 72 h values for PMAI0h were higher (P

Whooping cough is a vaccine-preventable infectious diseases caused by Bordetella pertussis/parapertussis. Despite of routine immunization programs in the world, pertussis still remains endemic. Recently unvaccinated or partially immunized infants have infected with this pathogen and also increase of incidence was observed in adolescents and adults. The source of pertussis in newborns are attributed to household, especially due to the family members. Theaim of this study was to determine B.pertussis IgG antibody positivity by ELISA method in adults. Eighty-four of the total study population (39.6%) were anti-pertussis IgG positive, 128 (60.4%) were negative. The samples included in the study (n= 212) were divided into three groups according to ages: 19-35 years (Group 1, n= 61), 36-50 years (Group 2, n= 58), 51-65 years (Group 3, n= 93). Anti-pertussis IgG antibody positivity was 26.2% (n= 22) in Group 1, 26.2% (n= 22) in Group 2 and 47.6% (n= 40) in Group 3. According to the anti-pertussis IgG positivity results, no significant difference was observed between genders. The results were obtained as absorbance values by ELISA test, then transformed into semi-quantitative values as NovaTec Test Unit (NTU). NTU positive values were between 11.01-39.4. Ninety four percent of NTU values were in the range of 11.01 to 28.01 and 6% were between 28.01 to 39.4. It was observed that seropositivity rates peaked at ages of 27, 55 and 65. The highest NTU values were observed in the age of 32 in females and in the age of 24 in males. Relatively, low seropositivity values (NT= 15-20) were observed in both females and males to the age of 45 in Group 2. However a slight increase was observed in females after the age of 45. An increase (NTU ≥ 20) was determined in the age of 49 in males. The seropositivity rates were generally low (NT ≤ 20) in females in Group 3, but the highest values (NTU ≥ 30) were observed in 55 and 65 years of age in males in this group. The highest seropositivity (NTI ≥ 30) were in 55 and 65 years of age (NTI ≥ 30) in males and 27 years of age (NTU ≥ 30) in females while in 36-50 age range, it was relatively low (NTI ≤ 20). Routine pertussis vaccination program is not yet implemented for adults in our country. However, the causes more clearly demonstrate the need for adult pertussis vaccination since adults may be incompletely vaccinated or not vaccinated in the childhood, current vaccinations are not available in the childhood of adults, adults become more susceptible to infections as the age increases, life expectancy increases and the likelihood of encountering infections, and childhood vaccination antibodies diminish over time. According to the results of this study, a single dose of pertussis vaccine is recommended to implement for adults in our country.

Background: Clinical vaccine failure is the occurence of the specific vaccine-preventable disease in an appropriately and fully vaccinated person after enough time has elapsed for protection against the antigens of the vaccine to develop. Fully immunized cases with pneumoccal vaccine may sometimes develop a complicated pneumonia with empyema caused by a vaccine serotype. Case Report: A 2 year-old male patient was admitted with the complaints of fever. On the basis of findings and laboratory results, the patient was diagnosed as having empyema. He was successfully treated with parenteral antibiotics and chest tube drainage. The pleural fluid culture and hemoculture of the patient yielded penicillin-susceptible pneumococci and the isolate was identified as serotype 9V. The patient had been vaccinated with a 13-valent pneumococcal conjugate vaccine according to the Turkish national immunization schedule at 2, 4, 6 and 12 months of age. His medical history and basic immunological profile were inconsistent with a primary immunodeficiency. Conclusion: The failure of the PCV13 vaccine may results in a complicated pneumonia with empyema. It is important to investigate serotypes of pneumococci in these cases to determine other possible vaccine failures due to PCV13 and to study the underlying mechanisms.

Lower respiratory infections are commonly due to viruses and are the third largest cause of death. Respiratory tract viruses have a tendency to target the specific regions in the lung and can harm the host via direct effect of the virus and the host's inflammatory response. In this study, relationships between morphologic changes in the lung and the viral agent type isolated in the lung by the polymerase chain reaction technique were investigated. This study was performed retrospectively at 113 autopsy cases in the Council of Forensic Medicine in Istanbul. Slides from the lung tissues diagnosed as interstitial pneumonia and detected viral agent in polymerase chain reaction were evaluated and reviewed under light microscope by 2 pathologists simultaneously according to predetermined bronchiolar, alveolar, and interstitial findings. Alveolar findings were detected in 108 cases (95.6%), whereas interstitial and bronchiolar findings were detected in 91 (80.5%) and 38 (33.6%) cases, respectively. Intra-alveolar edema was the most common alveolar finding. Some findings such as multinucleated syncytial cells and smudge cells can aid the search for etiologic agent. Interstitial inflammation was the most common histopathologic finding in the lung in viral infections and the most prominent clue to viral infections in the lung histopathologically without discrimination of viral agent type.

The aim of this report was to compare corneal topographic measurements and anterior high order corneal aberrations in eyes with keratoconus and normal eyes by using Scheimpflug-Placido topography.Eighty cases diagnosed with mild (group 1), moderate (group 2), and advanced (group 3) stage keratoconus (KC) according to Amsler-Krumeich Classification and 81 healthy (control group) cases were retrospectively examined. The mean keratometric measurements (as both diopters (Kavg) and mm values (mmavg)), central corneal thickness values (CCT), high order aberration (HOA), total wavefront aberration (TWA), coma, trefoil, and spherical aberration measurements were performed using Sirius topography equipment. The topographic values were compared between the groups.There were 25 cases in group 1 KC (15.5%), 34 cases in group 2 KC (21.1%), 21 cases in group 3 KC (13.1%), and 81 cases (50.3%) in the control group. In terms of mean age and gender distributions, there was no statistically significant difference between the groups (p0.05). However, there was significant difference between the groups in terms of Kavg, CCT, HOA, TWA, coma, trefoil, and spherical aberration values (p0.01). Mean HOA, TWA, coma, trefoil, and spherical aberration values were observed to increase with the severity of KC disease.Anterior high order corneal aberrations were significantly increased in eyes with moderate and advanced keratoconus. Anterior high order corneal aberration measurements are a useful tool to guide the physician in diagnosis and classification of keratoconus.

To analyze the data of patients who underwent vitreoretinal surgery due to intraocular foreign body (IOFB) injuries that occurred in the Syrian civil war.Seventy-eight eyes of 78 patients who underwent vitreoretinal surgery due to IOFB injuries that occurred during the Syrian civil war were analyzed.Forty-four eyes (56.4%) had traumatic cataract, 44 (56.4%) had retinal tears, 42 (53.8%) had vitreous hemorrhage, 18 (23%) had retinal detachment, 12 (15.3%) had endophthalmitis, and eight eyes had hyphema (10.2%). IOFBs consisted of metal in 62 eyes (79.4%), stone in eight eyes (10.2%), organic material in four eyes (5.1%), and glass in four eyes (5.1%). Approximately 86% of the eyes had initial VAs of 4/200 or worse. However, VAs improved in 64 eyes (82%) after the surgeries.Despite delays in treatment and the severity of injuries, 82% (64/78) of the eyes had an improvement in VA after the surgeries.

Stage III non-small cell lung cancer (NSCLC) is a highly heterogeneous subtype of lung cancer. There are still no widely accepted prognostic parameters for stage III NSCLC. In this study, we evaluated the prognostic value of the standardized uptake value (SUV) max ratio of primary tumor to lymph node (T/N SUV max) and its correlation with various hematological parameters. Patient data were reviewed from the hospital database retrospectively. The T/N SUV max ratio was calculated by dividing the SUV max of the primary tumor by the maximal SUV max of the lymph node. The cut-off value for T/N SUV max ratio was determined by receiver operating characteristic analysis. Survival analysis was performed by Kaplan–Meier method with the Long-rank test. P value 1.96 were defined as low risk patients. The median event (recurrence or progression) free survival was 24.3 months (95% confidence interval: 12.0–36.6) for low risk patients, and 9.2 months (95% confidence interval: 6.1–12.4) for high risk patients (P = .0015). There was an inverse correlation between T/N SUV max and hemoglobin concentration and mean corpuscular volume (rho: −0.349, P = .011; rho: −0.312, P = .025, respectively). Low risk patients had a more favorable prognosis compared to high risk patients. We demonstrated that T/N SUV max can be of prognostic value in stage III NSCLC. T/N SUV max correlated only with hemoglobin and mean corpuscular volume.

Background Fragility can have a negative effect on health systems and people’s health, and poses considerable challenges for actors implementing health programmes. However, how such programmes, in turn, affect the overall fragility of a context is rarely considered. The Swiss Red Cross has been active in South Sudan and Haiti since 2008 and 2011, respectively, and commissioned a scoping study to shed new light on this issue within the frame of a learning process launched in 2015. Methods The study consisted of a document review, qualitative field research undertaken between June and August 2015 in South Sudan and Haiti, and two data triangulation/validation workshops. Semi-structured key informant interviews and focus group discussions included 49 purposively sampled participants who helped build a deeper understanding of what constitutes and drives fragility in the respective countries. Moreover, interviews and focus group discussions served to grasp positive and negative effects that the Swiss Red Cross’s activities may have had on the overall state of fragility in the given contexts. Results Qualitative data from the two case studies suggest that the community-based health programmes implemented in South Sudan and Haiti may have influenced certain drivers of fragility. While impacts cannot be measured or quantified in the absence of a baseline (the projects were not originally designed to mitigate overall fragility), the study nevertheless reveals entry points for designing programmes that are responsive to the overall fragility context and contain more specific elements for navigating a more sustainable pathway out of fragility. There are, however, multiple challenges, especially considering the complexity of fragile and conflict-affected contexts where a multitude of local and international actors with different goals and strategies interfere in a rapidly changing setting. Conclusions Health programmes may not only reach their health objectives but might potentially also contribute towards mitigating overall fragility. However, considerable hurdles remain for aid agencies, especially where scope for action is limited for a single actor and where engagement with state structures is difficult. Thus, cooperation and exchange with other aid and development actors across the spectrum has to be strengthened to increase the coherence of aid policies and interventions of actors both within and across the different aid communities.

Acrylamide (ACR) is a hazardous substance associated with the accumulation of excessive reactive oxygen species and causes oxidative stress. Presence of ACR in foods leads to public health concerns due to its known neurotoxic, genotoxic, and carcinogenic effects. The present study investigated the ameliorative effects of boron (B) against ACR exposed rats. Forty Wistar albino male rats, fed with low-boron diet, were randomly and equally allocated into 5 groups. The control group was orally treated with physiological saline as placebo, the second group was orally given 15 mg/kg ACR. The other groups were orally treated with 15 mg/kg ACR and B at the levels of 5, 10, and 20 mg/kg/day for 60 days, respectively. ACR-treatment significantly increased malondialdehyde levels whereas decreased glutathione levels in rat tissues. Also, ACR-treatment increased the activities of superoxide dismutase and catalase in erythrocytes and tissues. Meanwhile, mRNA expression levels of NF kappa B, IFN-gamma, IL-1 beta, and TNF-alpha in liver and brain of rats were increased under ACR treatment. Additionally, ACR caused a significant decrease in the level of high-density lipoprotein, with increase in the levels of low-density lipoprotein, triglyceride, cholesterol, glucose, urea nitrogen, and creatinine. Lastly, B alleviated histopathological alterations induced by ACR in rat tissues.

The objective of this study was to analyze the characteristics and surgical results of pediatric rhegmatogenous retinal detachment (RRD). The medical records of 30 eyes of 29 patients younger than 18 years of age who underwent vitreoretinal surgery due to RRD were analyzed. The gender, age, laterality, duration of presenting symptom, etiology, ocular and systemic co-morbidities, type of breaks, lens status, presence of proliferative vitreoretinopathy (PVR) and its grade, initial and final best-corrected visual acuities (BCVAs), surgical management, number of operations, duration of follow-up, functional and anatomical success, and complications were noted. As the most common predisposing factors were trauma (trauma group) and myopia (myopia group), the data of these patients were further analyzed. The mean age was 12.6 ± 3.0 years. There were 23 male (79.3 %) and 6 female (20.6 %) subjects. The most common etiologic factors were high myopia (40 %) and trauma (36.6 %). Functional success rate was 70 % (n = 21) after the primary surgeries and was 80 % (n = 24) after the secondary surgeries. There were no significant differences between the trauma and myopia groups regarding the presence of total retinal detachment, macula-off status, and the rate of PVR worse than grade C. Although the preoperative mean BCVA and the initial and final retinal reattachment rates of the groups were statistically similar, trauma group had significantly higher postoperative mean BCVA compared to myopia group (p = 0.013). Myopia and trauma were the most common etiologic factors for RRD in children. The visual outcomes of trauma-associated RRD were better than those of myopia-associated RRD.

Malaria is a lethal protozoan infection which is generally diagnosed antemortem and rarely diagnosed postmortem in a few cases. A fifty five year old, Turkish citizen male has been referred for autopsy. It has been found that he has gone abroad to work a month ago, however, quitted malaria prophylaxis before the intended end and brought into the emergency department in an unconscious state.Following quinine and clindamycin treatment with the initial diagnosis of cerebral malaria, the case was reported to have died due to his general condition got worsened at the end of the third day of therapy.Histopathological evaluation of postmortem tissues was revealed haphazardly arranged minor bleedings and central vascular necrotic foci in the cerebrum, cerebelum and brain stem; light brown pigment containing cells around vasculature; and pigment containing cells in the spleen and bone marrow. Cerebral malaria has a rapid course and is rare but one of the lethal complications of infections with Plasmodium. Although domestic malaria cases has been decreasing in our country, it should be kept in mind that the malaria infection can be seen in persons travelling abroad to high endemic malarial regions and an appropriate antimalarial prophylaxis should be recommended to those overseas travellers.

Infection after open fractures is a common complication. Treatment options for infections developed after intramedullary nailing surgery remain a topic of controversy. We therefore used a rat fracture model to evaluate the effects of infection on osseous union when the implant was maintained.In a rat model, (1) does infection alter callus strength; (2) does infection alter the radiographic appearance of callus; and (3) does infection alter the histological properties of callus?An open femoral fracture was created and fixed with an intramedullary Kirschner wire in 72 adult male Sprague-Dawley rats, which were divided into two study groups. In the infection group, the fracture site was contaminated with Staphylococcus aureus (36 animals), whereas in the control group, there was no bacterial contamination (36 animals). No antibiotics were used either for prophylaxis or for treatment. We performed biomechanical (maximum torque causing failure and stiffness), radiographic (Lane and Sandhu scoring for callus formation), and histologic (scoring for callus maturity) assessments at 3 and 6 weeks. The number of bacteria colonies on the femur, wire, and soft tissue inside knee were compared to validate that we successfully created an infection model. The number of bacteria colonies in the soft tissue inside the knee was higher in the infection group after 6 weeks than after the third week, demonstrating the presence of locally aggressive infection.Infection decreased callus strength at 6 weeks. Torque to failure (299.07 ± 65.53 Nmm versus 107.20 ± 88.81, mean difference with 95% confidence interval, 192 [43-340]; p = 0.007) and stiffness at 6 weeks (11.28 ± 2.67 Nmm versus 2.03 ± 1.68, mean difference with 95% confidence interval, 9 [3-16]; p = 0.004) both were greater in the control group than in the group with infection. Radiographic analysis at 6 weeks demonstrated the fracture line was less distinct (Lane and Sandhu score of 2-3) in the infection group and complete union was observed (Lane and Sandhu score of 3-4) in the control group (p = 0.001). Semiquantitative histology scores were not different between the noninfected controls and the rats with infection (score 10 versus 9).Retaining an implant in the presence of an underlying infection without antibiotic treatment leads to weaker callus and impedes callus maturation compared with noninfected controls in a rat model. Future studies might evaluate whether antibiotic treatment would modify this result.This model sets the stage for further investigations that might study the influence of different interventions on fracture healing in implant-associated osteomyelitis. Future observational studies might also evaluate the histological properties of callus in patients with osteomyelitis.

Background We aimed to investigate the potentially pathogenic bacteria of upper respiratory tract infections (URTIs) and their susceptibilities to different antibiotics. Methods Two-hundred adenoid and tonsil specimens from 100 patients who had undergone adenotonsillectomy were obtained and analyzed bacteriologically. Identification of the pathogens was made by conventional or commercial identification systems and antibiotic susceptibility tests were carried out by disk diffusion method. Results A total of 274 pathogens were recovered from 81% specimens of 73% of the patients. Haemophilus influenzae (31.8%) was the most prevalent pathogen, followed by Staphylococcus aureus (17.2%), Group A beta hemolytic Streptococci, GABHS (12.0%), Moraxella catarrhalis (7.7%), Streptococcus pneumoniae (7.3%), and nine other bacterial species (24.0%). Penicillins (penicillin, ampicillin) had 100% activity against GABHS followed by 96.5% in H. influenzae, 45% in S. pneumoniae, and 0% in S. aureus strains. The efficacy of beta-lactamase inhibitor antibiotics (ampicillin/sulbactam, amoxycillin/clavulanic acid) were similar to those of penicillins but had superior activity (89.4%) against S. aureus strains. Cefotaxime had high activity (100%) against GABHS and H. influenzae followed by S. aureus (89.4%). Cotrimoxazole was also active in S. aureus (97.8%) and H. influenzae (83.9%) but revealed intermediate activity (45%) in S. penumoniae and was not efficient (0%) in GABHS. Macrolids (erythromycin, clindamycin) were very efficient (100%) in GABHS followed by S. aureus (95.7%) and had intermediate activity (50%) in S. pneumoniae. Levofloxacin, telithromycin, and vancomycin had 100% activity against S. pneumoniae strains. Conclusions Our finding have shown that H. influenzae was the most prevalent pathogen followed by S. aureus, GABHS, M. catarrhalis, and S. pneumoniae and that there was no unique antibiotic to combat all prevalent pathogens, but penicillins could be the choice in GABHS and H. influenzae; beta-lactamase inhibitors and cefotaxime for GABHS, H. influenzae, and S. aureus; macrolids in GABHS and S. aureus; cotrimoxazole in H. influenzae and S. aureus; and levofloxacin and telithromycin in the treatment of S. penumoniae related URTIs.

Death resulting from burns is an important social problem and a frequent accident. However, because approximately 10% of cases are estimated to result from a fire that was deliberately started, all fire-related deaths should be treated as suspicious, and the cause of a fire should be investigated. For the bodies recovered from the scene of a fire, the manner of death could also be suicide or homicide. The objective of this study was to contribute to the clarification of controversial data present in the literature on the manner of death determination of fire-related deaths, through evaluation of autopsy findings of bodies recovered from fires. We reviewed 20,135 autopsies performed in a 5-year period, in Istanbul, as the whole autopsy data of the city and found 133 fire-related deaths. The death scene investigation reports and other judicial documents, autopsy findings, and toxicological analysis results were evaluated to determine the parameters of age, sex, level of the burn, vital signs [red flare; soot in the lower respiratory tract, esophagus, and/or stomach; and screening of carboxyhemoglobin (COHb) levels in the blood], toxicological substances, presence of accelerants, cause of death, and manner of death. The manner of death was determined to be an accident in 98 (73.7%) and homicide in 12 (9%) cases, whereas there was no suicide. In addition, it could not be determined in 23 (17.2%) cases. In accidental deaths, the most frequent cause of death was COHb poisoning with statistically significant blood COHb levels greater than 10%. Further, the presence of soot in the lower respiratory tract, esophagus, and/or stomach and the existence of at least 1 or 2 vital signs together were found to be valid deterministic criteria with statistical significance in terms of identifying the manner of death.

Background Febrile neutropenia (FN) is a life-threatening condition that requires urgent management in the emergency department (ED). Recent progress in the treatment of neutropenic fever has underscored the importance of risk stratification. In this study, we aimed to determine independent factors for prediction of poor outcomes in patients with FN. Material/Methods We retrospectively evaluated 200 chemotherapy-induced febrile neutropenic patients who visited the ED. Upon arrival at the ED, clinical data, including sex, age, vital signs, underlying systemic diseases, laboratory test results, estimated GFR, blood cultures, CRP, radiologic examinations, and Multinational Association of Supportive Care in Cancer (MASCC) score of all febrile neutropenic patients were obtained. Outcomes were categorized as “poor” if serious complications during hospitalization, including death, occurred. Results The platelet count 24/min (OR 8.75, 95% CI 2.18–35.13), and MASCC score 50 mg/dl (OR 3.80, 95% CI 1.68–8.61), hypoproteinemia (OR 7.81, 95% CI 3.43–17.78), eGFR ≤90 ML/min/1.73 m2 (OR 3.06, 95% CI 1.13–8.26), and MASCC score

Purpose: Genetic factors are shown to have a role in the development of primary open-angle glaucoma (POAG). The aim of this study was to determine the effects of genetic polymorphisms of Rho-kinase (ROCK) genes on the risk of POAG in a Turkish population. Methods: Genomic DNA was extracted from leukocytes of the peripheral blood, and 8 single nucleotide polymorphisms in the ROCK1 and ROCK2 genes were analysed in 179 patients with POAG and in 182 healthy controls of similar age by using BioMark HD dynamic array system. Results: Neither genotype distributions nor the allele frequencies for the ROCK1 (rs35996865) and ROCK2 [rs2290156, rs965665, rs10178332, rs2230774 (Thr431Asn), rs2230774 (Thr431Ser), rs6755196, and rs726843] gene polymorphisms showed a significant difference between the groups. There were also no marked associations between the haplotype frequencies and POAG. Conclusions: This is the first study to examine the involvement of ROCK1 and ROCK2 gene variations in the risk of POAG development. This study demonstrated that the polymorphisms studied are not associated with the increased risk of development of POAG in the Turkish population.

Flow injection cold vapor atomic absorption spectrometry (FI-CVAAS) was used for determination of cadmium in high salt matrices such as dialysis concentrates and textile leach solutions. The parameters such as acidity, concentration of reducing agent, reaction coil length, and carrier gas flow rate were investigated to obtain the best sensitivity. No significant background signal was observed even at high salt concentrations. Under the optimized conditions the limit of detection value (3sb m-1, where sb is the standard deviation of the blank signals and m is the slope of the calibration graph) was found to be 0.05 ng mL-1 for an injection volume of 250 m L and the precision in terms of relative standard deviation was 3.2% using 11 consecutive measurements of 0.5 ng mL-1 standard. The standard addition method was used for quantitation. The accuracy of the method was tested using ETAAS as a comparison method and a certified reference material (Waste Water EU-L-1). In both cases, the results were in good agreement at 95% confidence level. The concentrations of cadmium in textile product leach solutions were found to be below the limit value assigned by Oeko-Tex standards.

In emergency medicine practice, radiological investigations relying on ionising radiation are increasingly used to diagnose a wide range of diseases and injuries. The aim of this study was to investigate the knowledge of radiation exposure doses and risks among interns, resident doctors, and radiographers.A questionnaire, consisting of 14 questions in multiple choice format, was distributed to 300 participants (100 interns, 100 radiographers, 100 resident doctors) working in the emergency department. The participants were asked to estimate the radiation dose that patients received during the different radiological procedures. The questionnaire was designed to determine the participants' knowledge about radiation-related hazards.None of the radiation doses delivered by the imaging modalities was 100% correctly estimated. A total of 41.4% of all participants and 46.3% of resident doctors underestimated the radiation doses. The frequency of answers underestimating doses was found to be significantly higher (p0.001). Resident doctors, with a 39.4% correct answer rate, were found to be significantly less knowledgeable when compared with the interns and radiographers (p = 0.003). Emergency resident doctors had a statistically significantly higher rate of correct answers for the lowest and highest radiation sources for a foetus when compared with other groups (p = 0.001, p = 0.008).Our study showed that the resident doctors', interns', and radiographers' knowledge of radiation exposure from radiological investigations and the associated risks was poor. This result could imply that we are not aware of the radiation risks, and we are inattentive in informing our patients about the radiation exposure related to the different imaging modalities.

WOS: 000329923600019 PubMed ID: 24168901 Objectives:The purpose of this study was to compare the intraoperative and postoperative effects of Piezosurgery and conventional rotative instruments in direct sinus lifting procedure.Patients and Methods:Twenty-three patients requiring direct sinus lifting were enrolled. The osteotomy and sinus membrane elevation were performed either with Piezosurgery tips or rotative diamond burs and manual membrane elevators. Time elapsed between bony window opening and completion of membrane elevation (duration), incidence of membrane perforation, visibility of the operation site, postoperative pain, swelling, sleeping, eating, phonetics, daily routine, and missed work as well as patient's expectation before and experience after the operation were evaluated.Results:There was no significant difference between Piezosurgery and conventional groups regarding incidence of membrane perforation, duration, and operation site visibility as well as patient's expectation before and experience after the operation (P > 0.05). However, there were significantly more pain and swelling in the conventional group compared with the Piezosurgery group (P 0.05).Conclusion:Sinus lifting procedure performed with Piezosurgery causes less pain and swelling postoperatively compared with conventional technique. Patients' daily life activities and experience about the operation are not affected from the surgical technique.

Objectives Available data on biological variation of HbA 1c revealed marked heterogeneity. We therefore investigated and estimated the components of biological variation for HbA 1c in a group of healthy individuals by applying a recommended and strictly designed study protocol using two different assay methods. Design and methods Each month, samples were derived on the same day, for three months. Four EDTA whole blood samples were collected from each individual (20 women, 9 men; 20–45 years of age) and stored at − 80 °C until analysis. HbA 1c values were measured by both high performance liquid chromatography (HPLC) (Shimadzu, Prominence, Japan) and boronate affinity chromatography methods (Trinity Biotech, Premier Hb9210, Ireland). All samples were assayed in duplicate in a single batch for each assay method. Estimations were calculated according to the formulas described by Fraser and Harris. Results The within subject (CV I )–between subject (CV G ) biological variations were 1.17% and 5.58%, respectively for HPLC. The calculated CV I and CV G were 2.15% and 4.03%, respectively for boronate affinity chromatography. Reference change value (RCV) for HPLC and boronate affinity chromatography was 5.4% and 10.4% respectively and individuality index of HbA 1c was 0.35 and 0.93 respectively. Conclusions This study for the first time described the components of biological variation for HbA 1c in healthy individuals by two different assay methods. Obtained findings showed that the difference between CV A values of the methods might considerably affect RCV. These data regarding biological variation of HbA 1c could be useful for a better evaluation of HbA 1c test results in clinical interpretation.

The aim of the present study was to examine the effects of feeding alpha-linolenic (ALA) acid on fatty acid composition and quality of bovine sperm and on antioxidative capacity of seminal plasma. Nine bulls (ALA bulls) were fed with 800 g rumen-resistant linseed oil with a content of 50% linolenic acid and eight bulls with 400 g palmitic acid (PA bulls). Sperm quality was evaluated for plasma membrane and acrosome intact sperm (PMAI), the amount of membrane lipid peroxidation (LPO), and the percentage of sperm with a high DNA fragmentation index (DFI). Fatty acid content of sperm was determined using gas chromatography. Total antioxidant capacity, glutathione peroxidase, and superoxide dismutase activity were determined in seminal plasma. Feeding ALA increased (P < 0.05) the docosahexaenoic acid (DHA) content in bulls whereas in PA bulls did not change. PMAI increased after cryopreservation in ALA bulls as well as in PA bulls during the experiment period (P < 0.005). LPO of sperm directly after thawing did not change during the study period in ALA group, but decreased in PA group (P < 0.006). After 3h of incubation LPO increased in the ALA group (P < 0.02), while LPO did not differ between phases within groups. In conclusion, feeding of neither saturated nor polyunsaturated fatty acids affect the antioxidant levels in seminal plasma. Both saturated as well as polyunsaturated fatty acids had positive effects on quality of cryopreserved bovine sperm, although the content of docosahexaenoic acid in sperm membranes increased only in ALA bulls.

The aim of the present study was to investigate inter- and intra-individual variability of total antioxidant capacity (TAC) in seminal plasma of bulls. In addition, relationships between TAC and glutathione peroxidase (GPx), superoxide dismutase activities (SOD), and parameters of sperm quality, respectively, were examined. Eight consecutive ejaculates were collected from nine Holstein-Friesian bulls. The percentage of plasma membrane and acrosome intact (PMAI) sperm was measured by using the FITC-PNA/PI assay, the amount of membrane lipid peroxidation (LPO) without and with stimulation(s) of LPO was quantified by using the BODIPY assay before cryopreservation and immediately (0 h) as well as 3h after thawing. The percentage of sperm with a greater DNA fragmentation index was measured by the sperm chromatin structure assay. The amount of TAC differed (P0.0001) between bulls but not (P0.05) between ejaculates within bulls. The amounts of TAC were not related (P0.05) to amounts of SOD and GPx, but were negatively associated with LPO 0 h (r = -0.85; P ≤ 0.01). The amounts of SOD showed positive relationships with LPO 0 h (r = 0.71; P ≤ 0.05) and LPO 3h (r = 0.80; P ≤ 0.05). In conclusion, total antioxidant activity varied among bulls, but not between ejaculates within bulls. While the amounts of antioxidative enzyme GPx was not related to sperm quality and SOD was positively related with lipid peroxidation after thawing of sperm, whereas total antioxidative capacity was negatively correlated with lipid peroxidation of cryopreserved sperm.

Aim: The aim of the present study was to compare the neurosensory complications related to implants inserted closer than 2 mm to the inferior alveolar canal (IAC) with those inserted further than 2 mm.Materials and Methods: A total of 474 implants in 314 patients placed posterior to mental foramen area were evaluated retrospectively on panoramic radiographs. Patients were divided into two groups regarding implant proximity to the IAC (Group 1, distance ≤2 mm, Group 2, distance >2 mm). Postoperative neurosensory complications (pain and paresthesia) were recorded. Chi-square test was used for statistical comparison and P ≤ 0.05 was considered significant.Results: One hundred and fifty-three implants (32.2%) were inserted closer than 2 mm to the IAC whereas 321 implants (67.8%) were inserted further than 2 mm. Three implants which had a distance of 0 mm to the IAC (0.63%) caused paresthesia after surgery. Implant distance to IAC did not show a significant difference regarding pain and paresthesia (P = 0.06 and P = 0.08, respectively).Conclusion: When 2 mm is considered as a safety distance, the distance of the implants to the IAC did not yield any statistical difference regarding postoperative neurosensory complications.Keywords: Dental implants, inferior alveolar nerve injury, neurosensory complication

Purpose To compare the choroidal thicknesses in long-term smokers with those of nonsmoking healthy individuals using spectral domain optical coherence tomography. Participants Forty-six individuals who had been smoking at least for 20 years, but otherwise without systemic problems, participated in this prospective pilot study. The control group comprised 42 nonsmoking individuals. Methods The ages, refractions, and axial length measurements of the cases were recorded. Central macular thickness and choroidal thickness at the fovea and at 500 μm intervals from the foveal center in both temporal and nasal directions were measured using spectral domain optical coherence tomography. Results Although the smoking period of the smokers was mean 32.4 ± 9 years (range: 20-60), the mean pack-years of cigarettes was 35.1 ± 23.8 (range: 10-120). No significant difference was observed regarding refraction value and axial length between smokers and nonsmokers group. In addition, no significant difference was observed for central macular thickness and choroidal thickness values at 500, 1,000, 1,500, and 2,000 μm nasal and temporal part of the fovea, between 2 groups. Conclusion Macular and choroidal thicknesses in long-term smokers were observed to be similar to those of healthy individuals.

Purpose: To evaluate the thicknesses of the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCL), and choroid layer using spectral domain optical coherence tomography (SD-OCT) for investigating the effects of vascular changes on the eye and optic nerve in patients who have migraine with aura. Methods: Forty-five patients who had migraine with aura (migraine group) and 45 healthy individuals (control group) were enrolled in the study. Age, gender, duration after migraine diagnosis, intraocular pressure, and axial length measurements were recorded in each case. RNFL, GCL, and choroid layer thicknesses were measured using SD-OCT in all participants. Results: The mean age was 36.1 ± 6.7 (20-45) years in the migraine group and 35.7 ± 8.6 (19-45) years in the control group. There was no significant difference in the RNFL thicknesses of the temporal and nasal quadrants (p >0.05). The RNFL thicknesses of the superior and inferior quadrants were significantly lower in the migraine group compared with those in the control group (p =0.001, p 0.05). Subfoveal, temporal, and nasal choroidal thickness measurements at 500 µm, 1000 µm, and 1500 µm were significantly lower in the migraine group than in the control group (p =0.001; p 0,05). A espessura da RNFL nos quadrantes superiores e inferiores foram significativamente menores no grupo de enxaqueca em comparação ao grupo controle (p=0,001; p0,05). Espessuras subfoveais, temporais e nasais da coroide (CT) a 500 µm, 1000 µm e 1500 µm foram significativamente menores no grupo de enxaqueca em relação ao grupo controle (p=0,001; p

To investigate the incidence and clinical characteristics of Behçet disease in children.The authors retrospectively reviewed the charts of 3382 patients with Behçet disease from October 1986 to December 2005 at Ankara University Medical School Behçet Unit and/or Atmaca private clinic.110 children were diagnosed with Behçet disease. The 110 children represented 3.3% of the total number of Behçet patients that were reviewed. 62.7% were girls and 37.3% were boys. The mean age at initial manifestation was 11.63 ± 3.46 years and at diagnosis was 14.15 ± 2.13 years. Ocular involvement was found in 30.9% of the children. Of these, 61.8% were bilateral and 38.2% were unilateral. Anterior uveitis was found in 18 eyes (32.8%), posterior uveitis in 24 eyes (43.6%), and panuveitis in 13 eyes (23.6%).Behçet disease should be considered in the differential diagnosis of childhood uveitis, particularly in endemic areas. The collaboration of pediatricians, rheumatologists, dermatologists, ophthalmologists, and other specialists when necessary is required in the diagnosis and management of children with Behçet disease.

WOS: 000388736900040, PubMed: 27454468, This is an observational epidemiological study to describe causes of bacterial meningitis among persons between 1 month and 18 y of age who are hospitalized with suspected bacterial meningitis in 7 Turkish regions. covering 32% of the entire population of Turkey. We present here the results from 2013 and 2014. A clinical case with meningitis was defined according to followings: any sign of meningitis including fever, vomiting, headache, and meningeal irritation in children above one year of age and fever without any documented source, impaired consciousness, prostration and seizures in those < 1 y of age. Single tube multiplex PCR assay was performed for the simultaneous identification of bacterial agents. The specific gene targets were ctrA, bex, and ply for N. meningitidis, Hib, and S. pneumoniae, respectively. PCR positive samples were recorded as laboratory-confirmed acute bacterial meningitis. A total of 665 children were hospitalized for suspected acute meningitis. The annual incidences of acute laboratory-confirmed bacterial meningitis were 0.3 cases / 100,000 population in 2013 and 0.9 cases/100,000 in 2014. Of the 94 diagnosed cases of bacterial meningitis by PCR, 85 (90.4%) were meningococcal and 9 (9.6%) were pneumococcal. Hib was not detected in any of the patients. Among meningococcal meningitis, cases of serogroup Y, A, B and W-135 were 2.4% (n = 2), 3.5% (n = 3), 32.9% (n = 28), and 42.4% (n = 36). No serogroup C was detected among meningococcal cases. Successful vaccination policies for protection from bacterial meningitis are dependent on accurate determination of the etiology of bacterial meningitis. Additionally, the epidemiology of meningococcal disease is dynamic and close monitoring of serogroup distribution is comprehensively needed to assess the benefit of adding meningococcal vaccines to the routine immunization program., GlaxoSmithKline Biologicals SAGlaxoSmithKline, Funding for this study was provided by GlaxoSmithKline Biologicals SA. GlaxoSmithKline Biologicals SA was provided the opportunity to review a preliminary version of this manuscript for factual accuracy but the authors are solely responsible for final content and interpretation. The authors received no financial support or other form of compensation related to the development of the manuscript.

Purpose. To compare the 6-week and 6-month outcome in 60 patients who received a single-dose injection of platelet-rich plasma (PRP) or steroid for subacromial impingement syndrome (SIS). Methods. 22 men and 38 women (mean age, 49.7 years) opted to receive a single-dose injection of PRP (n=30) or steroid (n=30) for SIS that had not responded to conservative treatment for >3 months. The PRP or a mixture of 1 ml 40 mg methylprednisolone and 8 ml prilocaine was administered via a dorsolateral approach through the interval just beneath the dorsal acromial edge. Both groups were instructed to perform standard rotator cuff stretching and strengthening exercises for 6 weeks. The use of non-steroid anti-inflammatory drugs was prohibited. Patients were evaluated before and 6 weeks and 6 months after treatment using the Constant score, visual analogue scale (VAS) for pain, and range of motion (ROM) of the shoulder. Results. No local or systemic complication occurred. Improvement in the Constant score and VAS for pain at week 6 and month 6 was significantly better following steroid than PRP injection. The difference in the Constant score was greater than the mean clinically important difference of 10.4. Nonetheless, the 2 groups were comparable for improvement in ROM of the shoulder. Conclusion. Steroid injection was more effective than PRP injection for treatment of SIS in terms of the Constant score and VAS for pain at 6 weeks and 6 months.

Coskun, Sina/0000-0003-2965-3112 WOS: 000378646700005 PubMed: 27513392 Background/aim: Small vehicles known locally as pat-pats, which are used in agricultural work, are forbidden in traffic. The inherent instability of the vehicle may result in accidents, both on farmland and in traffic. The aim of this study was to evaluate orthopaedic injuries related to pat-pats. Materials and methods: Patients hospitalised for pat-pat accidents in two central hospitals in Samsun between December 2006 and October 2013 were scanned using ICD codes. A total of 46 patients with orthopaedic injuries (43 male, 3 female) with a mean age of 36 +/- 13.3 years were evaluated. Results: The most injured age group was between 10 and 49 years (n = 40, 87%), and accidents occurred most in summer (n = 30, 65%). Open fractures were determined in 42 (91%) patients. Amputation was necessary in 4 (8%) patients. The hospitalisation period was a mean of 17.1 +/- 14 days. A statistically significant relationship was determined between open fracture type and the hospitalisation period (P < 0.001). Conclusion: As most of the orthopaedic injuries related to home-made agricultural machines are open fractures, it is important to guard against these types of injuries. The regulations that these machines are not used in traffic should be enforced and safer practices should be applied for use in agriculture.

WOS: 000371745700019, PubMed ID: 26325175, Successful vaccination policies for protection from invasive pneumococcal diseases (IPD) dependent on determination of the exact serotype distribution in each country. We aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey and emphasize the change in the serotypes before and after vaccination with 7-valent pneumococcal conjugate vaccine (PCV-7) was included and PCV-13 was newly changed in Turkish National Immunization Program. Streptococcus pneumoniae strains were isolated at 22 different hospitals of Turkey, which provide healthcare services to approximately 65% of the Turkish population. Of the 335 diagnosed cases with S. pneumoniae over the whole period of 2008-2014, the most common vaccine serotypes were 19F (15.8%), 6B (5.9%), 14 (5.9%), and 3 (5.9%). During the first 5y of age, which is the target population for vaccination, the potential serotype coverage ranged from 57.5 % to 36.8%, from 65.0% to 44.7%, and from 77.4% to 60.5% for PCV-7, PCV-10, and PCV-13 in 2008-2014, respectively. The ratio of non-vaccine serotypes was 27.2% in 2008-2010 whereas was 37.6% in 2011-2014 (p=0.045). S. penumoniae serotypes was less non-susceptible to penicillin as compared to our previous results (33.7vs 16.5 %, p=0.001). The reduction of those serotype coverage in years may be attributed to increasing vaccinated children in Turkey and the increasing non-vaccine serotype may be explained by serotype replacement. Our ongoing IPD surveillance is a significant source of information for the decision-making processes on pneumococcal vaccination., PfizerPfizer, This study was supported by Pfizer.

Full-thickness defects of the nose result in severe esthetic and functional problems. Regardless of the etiology of such defects, the complexity of the reconstruction process of full-thickness defects of this region is not correlated with the size of the defect. Local flaps are frequently used for reconstruction but often yielding facial scarring and bulky alae. Composite helical grafts are used for relatively small defects but defects of more than 2.0 cm in diameter require vascularized tissue transfer. Composite free flap from the root of the auricular helix has been used to reconstruct an anatomically diverse set of defects of the distal third of the nose, with satisfactory success in our series of 6 patients.

WOS: 000367254100002 PubMed ID: 26574849 Purpose: To investigate whether the presence of bony septum, thickness of sinus membrane (schneiderian membrane), and residual alveolar bone height affects membrane perforation and the duration of sinus augmentation. Materials and Methods: Preoperative cone beam computed tomography (CBCT) images obtained from patients undergoing lateral sinus augmentation were evaluated for the presence of bony septum, thickness of sinus membrane, and residual alveolar bone height. During the operation, membrane perforation and duration of surgery were noted. The Student t test was used to compare descriptive statistics (mean, standard error) and quantitative variables between groups. The Fisher exact. chi(2) test was used to compare the qualitative data, and Pearson correlation test was used to evaluate the correlation between data. P < .05 was considered significant. Results: Data from 57 patients were evaluated. Membrane perforation occurred in 14 patients included in the study and in 8 patients with sinus septum. A significant relationship was found between the presence of septum and membrane perforation during sinus augmentation (P = .014). However, the relationship among other CBCT and intraoperative findings was not significant. Conclusion: Presence of septum in the maxillary sinus increases the risk of membrane perforation, but does not extend the duration of the sinus augmentation.