In vivo Gonadoprotective Effects of Myricetin on Cisplatin- Induced Testicular Damage via Suppression of TLR4/NF-kB Inflammation Pathway and Heat-Shock Response / Efectos Gonadoprotectores in vivo de la Miricetina sobre el Daño Testicular Inducido por Cisplatino Mediante la Supresión de la Vía de Inflamación TLR4/NF-kB y la Respuesta al Choque Térmico

SUMMARY: The aim of this study is to reveal the gonadoprotective effects of myricetin (MYC), which has many biological properties, on cisplatin (CP)-induced testicular damage in rats. For this purpose, 40 male Wistar albino rats were divided into 4 groups as Control (group given no treatment), MYC (group given 5 mg/kg/i.p myricetin for 7 days), CP (group given 7 mg/kg/i.p cisplatin at 7th day) and MYC + CP (group given 5 mg/kg/i.p myricetin for 7 days before 7 mg/kg/i.p cisplatin injection). After administrations, testicular tissues of animals were extracted and processed according to tissue processing protocol. Hematoxylin & Eosin staining were performed to evaluate the histopathological changes and Johnsen'sTesticular Biopsy Score (JTBS) was applied and mean seminiferous tubule diameters (MSTD) were measured to compare experimental groups in terms of histopathological changes. Moreover, TLR4, NF-kB, HSP70 and HSP90 expression levels were detected by immunohistochemical staining and the density of immunoreactivity were measured to determine the difference in the expression levels of these factors among groups. Additionally, testicular apoptosis was detected via TUNEL assay. JTBS and MSTD data were significantly lower in CP group compared to other groups and MYC administrations significantly protects testicular tissue against CP-induced damage. Moreover, TLR4, NF-kB, HSP70 and HSP90 expressions and apoptotic cells significantly increased in the CP group (p<0.05). However, MYC administrations exerted a strong gonadoprotective effect on testicular tissue in terms of these parameters in MYC+CP group (p<0.05). According to our results, we suggested that MYC can be considered as a protective agent against cisplatin-induced testicular damage.

El objetivo de este estudio es revelar los efectos gonadoprotectores de la miricetina (MYC), que tiene muchas propiedades biológicas, sobre el daño testicular inducido por cisplatino (CP) en ratas. Para este propósito, se dividieron 40 ratas albinas Wistar macho en 4 grupos: Control (grupo que no recibió tratamiento), MYC (grupo que recibió 5 mg/kg/i.p de miricetina durante 7 días), CP (grupo que recibió 7 mg/kg/i.p de cisplatino al séptimo día) y MYC + CP (grupo que recibió 5 mg/ kg/i.p de miricetina durante 7 días antes de la inyección de 7 mg/ kg/i.p de cisplatino). Después de las administraciones, se extrajeron y procesaron tejidos testiculares de animales según el protocolo de procesamiento de tejidos. Se realizó tinción con hematoxilina y eosina para evaluar los cambios histopatológicos y se aplicó la puntuación de biopsia testicular de Johnsen (JTBS) y se midieron los diámetros medios de los túbulos seminíferos (MSTD) para comparar los grupos experimentales en términos de cambios histopatológicos. Además, los niveles de expresión de TLR4, NF-kB, HSP70 y HSP90 se detectaron mediante tinción inmunohistoquímica y se midió la densidad de inmunorreactividad para determinar la diferencia en los niveles de expresión de estos factores entre los grupos. Además, se detectó apoptosis testicular mediante el ensayo TUNEL. Los datos de JTBS y MSTD fueron significativamente más bajos en el grupo CP en comparación con otros grupos y las administraciones de MYC protegen significativamente el tejido testicular contra el daño inducido por CP. Además, las expresiones de TLR4, NF-kB, HSP70 y HSP90 y las células apoptóticas aumentaron significativamente en el grupo CP (p<0,05). Sin embargo, las administraciones de MYC ejercieron un fuerte efecto gonadoprotector sobre el tejido testicular en términos de estos parámetros en el grupo MYC+CP (p<0,05). Según nuestros resultados, sugerimos que MYC puede considerarse como un agente protector contra el daño testicular inducido por cisplatino.

Prognostic value of Gustave Roussy immune score in operable pancreatic adenocarcinoma

Background: The Gustave Roussy immune score (GRIm score) is a laboratory index developed to predict survival in nonsmall cell lung cancer patients undergoing immunotherapy and has shown that the pretreatment value is an independent prognostic factor for survival. In this study, we aimed to determine prognostic significance of GRIm score for pancreatic adenocarcinoma that have not been determined in the literature for pancreatic cancer before. The reason for choosing this scoring is to show that the immune scoring system works as a prognostic marker in pancreatic cancer known as immune?desert tumor via immune properties of microenvironment. Methods: Medical records of patients with histologically confirmed pancreatic ductal adenocarcinoma, who were treated and followed up between December 2007 and July 2019 at our clinic, were reviewed retrospectively. GRIm scores of each patient were calculated at the time of diagnosis. Survival analysis were performed according to risk groups. Results: A total of 138 patients were included in the study. While 111 (80.4%) patients were in the low?risk group; 27 (19.6%) were in high?risk group according to GRIm score. Median OS was 36.9 months (95% Confidence interval (CI): 25.42�.56) in lower GRIm scores, and it was 11.1 months (95% CI: 6.83�.44) in higher GRIm scores (P = 0.002). One?two?three?year OS rates were 85% versus 47%, 64% versus 39%, 53% versus 27% for low versus high GRIm scores, respectively. The multivariate analysis revealed that high GRIm score was an independent poor prognostic factor. Conclusion: GRIm can be used as a noninvasive, easily applicable, practical prognostic factor in pancreatic cancer patients

Triglyceride-glucose index levels in patients with Klinefelter syndrome and its relationship with endothelial dysfunction and insulin resistance: a cross-sectional observational study

ABSTRACT Objectives: This study aimed to investigate the triglyceride-glucose (TyG) index, which is a simple surrogate marker of insulin resistance that is associated with various cardiometabolic diseases, in patients with Klinefelter syndrome (KS). Subjects and methods: A total of 30 patients with KS (mean age: 21.53 ± 1.66 years) and 32 healthy controls (mean age: 22.07 ± 1.01 years) were included in the study.The clinical and laboratory parameters,TyG index, asymmetric dimethylarginine (ADMA) level, homeostatic model assessment of insulin resistance (HOMA-IR) score, and high-sensitivity C-reactive protein level were measured in patients with KS and healthy subjects. Results: Patients with KS had higher HOMA-IR score (p = 0.043), ADMA levels (p < 0.001), and TyG index (p = 0.031) and lower high-density lipoprotein cholesterol levels (p < 0.001) than healthy subjects. TyG index was positively correlated with plasma ADMA (r = 0.48, p < 0.001) and HOMA-IR (r = 0.36, p = 0.011). Multivariate analyses showed that total testosterone level (β = −0.44, p = 0.001) and TyG index (β = 0.29, p = 0.045) were independent determinants of plasma ADMA levels. Conclusion: Patients with KS had higher TyG indices than healthy subjects. Moreover, TyG index was independently associated with endothelial dysfunction in patients. TyG index may be a practical and useful measure to show the increased endothelial dysfunction in patients with KS.

Effects of early unilateral mandibular first molar extraction on condylar and ramal asymmetry / Efectos de la extracción temprana del primer molar mandibular unilateral sobre la asimetría condilar y ramal

SUMMARY: Craniofacial symmetry is an important factor in creating a harmonious facial appearance. Genetic and external factors may cause the formation of mandibular asymmetry. The aim of this study was to evaluate vertical mandibular asymmetries in adolescents who had unilateral mandibular first permanent molar (FPM) teeth extracted at an early age. The study group consisted of 60 subjects (30 females, 30 males with a mean age of 16.18±1.04 years) who had their mandibular permanent first molar tooth extracted before the age of 12, and the control group consisted of 60 healthy subjects (30 females, 30 males with a mean age of 16.23±0.92 years). Condylar asymmetry index (CAI), ramal asymmetry index (RAI), and condylar-ramal asymmetry index (CRAI) were calculated using panoramic radiographs of the subjects. Independent samples t-test was used to evaluate the differences between groups. CAI, RAI, and CRAI values were similar between male and female subjects in both control and study groups, and no statistically significant difference was found (p>0.05). No statistically significant difference was observed between the group who had their mandibular first permanent molar teeth extracted at an early age and the control group (p>0.05). CAI values were relatively higher in both groups, but there was no significant difference between the CAI, RAI, and CRAI values between the groups.

La simetría craneofacial es un factor importante para crear una apariencia facial armoniosa. Factores genéticos y externos pueden causar la formación de asimetría mandibular. El objetivo de este estudio fue evaluar las asimetrías mandibulares verticales en adolescentes a quienes se les extrajo el primer molar permanente (FPM) mandibular unilateral a una edad temprana. El grupo de estudio consistió en 60 sujetos (30 mujeres, 30 hombres con una edad media de 16,18±1,04 años) a quienes se les extrajo el primer molar mandibular permanente antes de los 12 años, y el grupo control consistió en 60 sujetos sanos (30 mujeres, 30 hombres con una edad media de 16,23±0,92 años). El índice de asimetría condilar (CAI), el índice de asimetría ramal (RAI) y el índice de asimetría condilar-ramal (CRAI) se calcularon utilizando radiografías panorámicas de los sujetos. Se utilizó la prueba t de muestras independientes para evaluar las diferencias entre los grupos. Los valores de CAI, RAI y CRAI fueron similares entre los hombres y las mujeres tanto en el grupo control como en el de estudio, y no se encontraron diferencias estadísticamente significativas (p>0.05). No se observaron diferencias estadísticamente significativas entre el grupo al que se le extrajo el primer molar permanente mandibular a una edad temprana y el grupo control (p>0,05). Los valores de CAI fueron relativamente más altos en ambos grupos, pero no hubo diferencias significativas entre los valores de CAI, RAI y CRAI entre los grupos.

Results of Use of Ringer Solution and Preservation Solution as Kidney Washing Solution in Living Donor Renal Transplantation / Resultados del uso de la solución Ringer y la solución de conservación como solución de lavado de riñón en el trasplante renal de donante vivo

ABSTRACT Background and Aims: Preservation solutions used as kidney washing solutions in transplantation are necessary for the longer preservation of the kidney. The study aims to compare different kidney-washing solutions used in living renal transplantation. Methods and Results: Forty-nine patients who underwent renal transplantation from live donors were included in the retrospective study. The Ringer's solution flushed the renal graft in 37 patients (Group 1), and the preservation solution was in 12 patients (Group 2). Group 1, and Group 2 patients were included in the study. There were 22 (59.5%) males in Group 1 and 9 (75%) males in Group 2. Twenty-seven (73%) patients using Ringer's and 7 (58.3%) patients on preservation solution had comorbidities. There was no significant difference between Group 1 and Group 2 in warm ischemia time, cold ischemia time, and HLA mismatch levels (p> 0.05). The preoperative creatinine value was significantly higher in the preservation solution group (p = 0.003). There was no significant difference between the two groups in values of creatinine levels on the postoperative (p> 0.05). Conclusion: In living renal transplantation, an inexpensive Ringer's solution, may be used instead of the expensive preservation solution to wash the graft.

RESUMEN Antecedentes y Objetivos: Las soluciones de conservación utilizadas como soluciones de lavado de riñón en trasplantes son necesarias para una conservación más prolongada del riñón. El estudio tiene como objetivo comparar diferentes soluciones de lavado de riñón utilizadas en el trasplante renal vivo. Métodos y Resultados: Cuarenta y nueve pacientes sometidos a trasplante renal de donante vivo incluidos en el estudio retrospectivo. La solución de Ringer se utilizó para lavar el injerto renal en 37 pacientes (Grupo1) y la solución de conservación se utilizó en 12 pacientes (Grupo2). Se incluyeron en el estudio pacientes del Grupo 1 y del Grupo 2. Había 22 (59,5%) hombres en el Grupo 1 y 9 (75%) hombres en el Grupo 2. Veintisiete (73%) pacientes que usaban Ringer y 7 (58,3%) pacientes que usaban solución de conservación tenían comorbilidades. No hubo diferencias significativas entre el Grupo 1 y el Grupo 2 con respecto a la isquemia caliente, los tiempos de isquemia fría y los niveles de desajuste (p> 0,05). El valor de creatinina preoperatorio fue significativamente mayor en la solución de conservación (p = 0,003). No hubo diferencia significativa entre los dos grupos en términos de niveles de creatinina en el postoperatorio (p> 0.05). Conclusión: En el trasplante renal vivo, se puede utilizar una solución económica de Ringer en lugar de la costosa solución de conservación para lavar el injerto.

High-impact chronic pain: evaluation of risk factors and predictors

Background@#The concept of high-impact chronic pain (HICP) has been proposed for patients with chronic pain who have significant limitations in work, social life, and personal care. Recognition of HICP and being able to distinguish patients with HICP from other chronic pain patients who do not have life interference allows the necessary measures to be taken in order to restore the physical and emotional functioning of the affected persons. The aim was to reveal the risk factors and predictors associated with HICP. @*Methods@#Patients with chronic pain without life interference (grade 1 and 2) and patients with HICP were compared. Significant data were evaluated with regression analysis to reveal the associated risk factors. Receiving operating characteristic (ROC) analysis was used to evaluate predictors and present cutoff scores. @*Results@#One thousand and six patients completed the study. From pain related cognitive processes, fear of pain (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87–0.98; P = 0.007) and helplessness (OR, 1.06; 95% CI, 1.01–1.12; P = 0.018) were found to be risk factors associated with HICP. Predictors of HICP were evaluated by ROC analysis. The highest discrimination value was found for pain intensity (cut-off score > 6.5; 83.8% sensitive; 68.7% specific; area under the curve = 0.823; P < 0.001). @*Conclusions@#This is the first study in our geography to evaluate HICP with measurement tools that evaluate all dimensions of pain. Moreover, it is the first study in the literature to evaluate predictors and cut-off scores using ROC analysis for HICP.

Identification of royal jelly as a potential new drug to protect the ovarian reserve and uterus against cyclophosphamide in rats / 대한생식의학회지

Objective@#The aim of this study was to investigate the effect of royal jelly (RJ), a powerful natural antioxidant, on cyclophosphamide-induced ovarian damage. @*Methods@#Thirty-two Wistar albino rats were divided into four groups. Oral treatment was administered to all rats for 16 days after a single intraperitoneal injection. The control group received intraperitoneal and oral saline; the RJ group received intraperitoneal saline and 100 mg/kg/day oral RJ; the cyclophosphamide group received intraperitoneal 100 mg/kg cyclophosphamide and oral saline; and the treatment group received intraperitoneal 100 mg/kg cyclophosphamide and 100 mg/kg/day oral RJ. The groups were compared in terms of ovarian reserve tests and histopathological changes in the ovary and uterus. @*Results@#All follicle counts were higher in the treatment group than in the cyclophosphamide group. The increase in the number of preantral follicles (p=0.001) and the decrease in the number of atretic follicles (p=0.004) were statistically significant. RJ treatment significantly improved follicular degeneration and cortical fibrosis in the ovary and epithelial and gland degeneration in the uterus due to cyclophosphamide toxicity. @*Conclusion@#According to these results, RJ reduces cyclophosphamide-related ovarian and endometrial damage in rats. For this reason, it should be further investigated to determine its effects on reproductive function.

Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine / 中西医结合学报

Kaiy (medieval cautery) is an ancient method of heat therapy in traditional Persian medicine (TPM). Some of its important applications have been neglected during the medical revolution. Meanwhile, different treatment modalities that incorporate heat, including moxibustion, have progressed in traditional Chinese medicine. In this study, we reviewed the main TPM textbooks that were written specifically in the field of kaiy. We considered the traditional teachings in the context of contemporary information, gathered from the scientific literature about moxibustion and modern cauterization. Some surgical therapeutic indications of kaiy (e.g., debridement and coagulative procedures) have been advanced by the innovation of electro-cauterization. However, those therapeutic applications that were based on the TPM humoral theory for relieving body coldness or myofascial pains-which are similar to moxibustion usages-have not received the same attention. Apart from the broad similarities of kaiy and moxibustion as thermal therapies with similar indications, there is a striking correspondence between kaiy point mapping and acupoints. Therefore, further research on different kaiy aspects is recommended. Please cite this article as: Jaladat AM, Alizadeh Vaghasloo M, Atarzadeh F, Ayati MH, Kazemi AH, Akin E, Hashempur MH. Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine. J Integr Med. 2023; 21(4):354-360.

Age-related outcomes in patients with cardiogenic shock stratified by etiology / 老年心脏病学杂志（英文版）

BACKGROUND@#As a result of improved and novel treatment strategies, the spectrum of patients with cardiovascular disease is consistently changing. Overall, those patients are typically older and characterized by increased burden with comorbidities. Limited data on the prognostic impact of age in cardiogenic shock (CS) is available. Therefore, this study investigates the prognostic impact of age in patients with CS.@*METHODS@#From 2019 to 2021, consecutive patients with CS of any cause were included. The prognostic value of age (i.e., 60-80 years and > 80 years) was investigated for 30-day all-cause mortality. Spearman's correlations, Kaplan-Meier analyses, as well as multivariable Cox proportional regression analyses were performed for statistics. Subsequent risk assessment was performed based on the presence or absence of CS related to acute myocardial infarction (AMI).@*RESULTS@#223 CS patients were included with a median age of 77 years (interquartile range: 69-82 years). No significant difference in 30-day all-cause mortality was observed for both age-groups (54.6% vs. 63.4%, log-rank P = 0.169; HR = 1.273, 95% CI: 0.886-1.831, P = 0.192). In contrast, when analyzing subgroups stratified by CS-etiology, AMI-related CS patients of the group > 80 years showed an increased risk of 30-day all-cause mortality (78.1% vs. 60.0%, log-rank P = 0.032; HR = 1.635, 95% CI: 1.000-2.673, P = 0.050), which was still evident after multivariable adjustment (HR = 2.072, 95% CI: 1.174-3.656, P = 0.012).@*CONCLUSIONS@#Age was not associated with 30-day all-cause mortality in patients with CS of mixed etiology. However, increasing age was shown to be a significant predictor of increased mortality-risk in the subgroup of patients presenting with AMI-CS.

Serum and urinary angiotensinogen levels as prognostic indicators in acute kidney injury: a prospective study

SUMMARY OBJECTIVE: The delayed increase in serum creatinine levels poses challenges in the timely diagnosis of acute kidney injury. This study aimed to investigate the relationship between serum angiotensinogen and urinary angiotensinogen levels and the prognosis of renal function in patients diagnosed with acute kidney injury. METHODS: A total of 79 newly diagnosed acute kidney injury patients aged 18 years and older were enrolled. Serum angiotensinogen and urinary angiotensinogen levels were measured at the onset of the disease, as well as on the 15th and 30th days of follow-up. After 3 months, renal function was evaluated by measuring serum creatinine levels. RESULTS: Among the acute kidney injury patients, those in Kidney Disease: Improving Global Outcomes stage 3 exhibited significantly higher urinary angiotensinogen/urine creatinine levels compared with stages 1 and 2 patients at the time of diagnosis (p<0.05). Furthermore, a positive correlation was observed between the urinary angiotensinogen/urine creatinine level at the time of diagnosis and the serum creatinine level at the third month (r=0.408, p=0.048). CONCLUSION: The findings suggest that urinary angiotensinogen levels can serve as an indicator of the severity of acute kidney injury. Monitoring urinary angiotensinogen levels could potentially contribute to the prognosis assessment and management of acute kidney injury patients.

Comparison of four different nutritional risk screening tools in hospitalized children / Comparação de quatro ferramentas diferentes de triagem de risco nutricional em crianças hospitalizadas

ABSTRACT Objective: Early detection of malnutrition risk in hospitalized children can improve health outcomes and quality of life; however, the number of studies where the pediatric screening tool is appropriate for Turkish children is limited. Therefore, this article aims to determine the prevalence of malnutrition risk in pediatric patients evaluated with Screening Tool for Risk on Nutritional Status and Growth, Screening Tool for the Assessment of Malnutrition in Pediatrics, Pediatric Yorkhill Malnutrition Score, and Simple Pediatric Nutrition Screening Tool with original and adjusted cutoffs and to evaluate which pediatric screening tool is appropriate for Turkish children. Methods: In this cross-sectional study, four published nutritional risk screening tools (Screening Tool for Risk on Nutritional Status and Growth, Screening Tool for the Assessment of Malnutrition in Pediatrics, Pediatric Yorkhill Malnutrition Score, Pediatric Nutrition Screening Tool) were applied to pediatric inpatients (n=604) aged 1 month to 17 years, admitted to a pediatric ward for at least 24 hours. Results: Pediatric Nutrition Screening Tool with adjusted cutoffs had the greatest recognition rate (94.2%) of acute malnutrition. Having a high nutritional risk by Pediatric Yorkhill Malnutrition Score was associated with an increased risk of acute (OR: 6.57 for Screening Tool for Risk on Nutritional Status and Growth, 5.84 for Screening Tool for the Assessment of Malnutrition in Pediatrics, and 20.35 for Pediatric Yorkhill Malnutrition Score) and chronic malnutrition (OR: 1.27 for Screening Tool for Risk on Nutritional Status and Growth, 3.28 for Screening Tool for the Assessment of Malnutrition in Pediatrics, and 1.72 for Pediatric Yorkhill Malnutrition Score). Classifying the at-risk category by the Pediatric Nutrition Screening Tool was related to raised odds of malnutrition (OR: 2.64 for original and 5.24 for adjusted cutoffs). This positive association was also observed for acute (OR: 4.07 for original cutoffs, and 28.01 for adjusted cutoffs) and chronic malnutrition (OR: 1.14 for original cutoffs, and 1.67 for adjusted cutoffs). Conclusion: Pediatric Nutrition Screening Tool with adjusted cutoffs and Pediatric Yorkhill Malnutrition Score have higher diagnostic accuracy than other screening tools in assessing the nutritional status of hospitalized Turkish children and detecting children, particularly with acute malnutrition.

RESUMO Objetivo: A detecção precoce do risco de desnutrição em crianças hospitalizadas pode melhorar a saúde e a qualidade de vida, porém o número de estudos em que a ferramenta de triagem pediátrica é apropriada para crianças turcas é limitado. O objetivo deste estudo foi determinar a prevalência do risco de desnutrição em pacientes pediátricos avaliados com Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria, Escore de Malnutrição Pediátrica de Yorkhill e Ferramenta de Triagem de Nutrição Pediátrica Simples com pontos de corte originais e ajustados para avaliar qual ferramenta de triagem pediátrica é apropriada para crianças turcas. Métodos: Neste estudo transversal, quatro ferramentas de triagem de risco nutricional publicadas (Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria, Escore de Malnutrição Pediátrica de Yorkhill, Ferramenta de Triagem de Nutrição Pediátrica) foram aplicadas a pacientes pediátricos (n=604) com idades entre 1 mês e 17 anos, internados em uma enfermaria pediátrica por pelo menos 24 horas. Resultados: A Ferramenta de Triagem de Nutrição Pediátrica com pontos de corte ajustados obteve a maior taxa de reconhecimento de desnutrição aguda (94,2%), enquanto a Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria teve a maior taxa na identificação da desnutrição crônica (67,4%). Essas associações positivas foram mais notáveis para desnutrição aguda (OR: 6,57 para Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, 5,84 para Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria e 20,35 para Escore de Malnutrição Pediátrica de Yorkhill) do que para desnutrição crônica (OR: 1,27 para Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, 3,28 para Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria e 1,72 para Escore de Malnutrição Pediátrica de Yorkhill). A classificação da categoria de risco pela Ferramenta de Triagem de Nutrição Pediátrica foi relacionada a maiores chances de desnutrição (OR: 2,64 para pontos de corte originais e 5,24 para pontos de corte ajustados). Essa associação positiva também foi observada para desnutrição aguda (OR: 4,07 para pontos de corte originais e 28,01 para pontos de corte ajustados) e crônica (OR: 1,14 para pontos de corte originais e 1,67 para pontos de corte ajustados). Conclusão: A Ferramenta de Triagem de Nutrição Pediátrica com pontos de corte ajustados e Escore de Malnutrição Pediátrica de Yorkhill têm maior precisão diagnóstica do que outras ferramentas de triagem na avaliação do estado nutricional de crianças turcas hospitalizadas e na detecção da desnutrição aguda em particular.

A guideline for femoral nerve block with the age-related formulas obtained from the distances between the femoral nerve and surface anatomical landmarks in fetal cadavers / Una guía para el bloqueo del nervio femoral con fórmulas relacionadas con la edad obtenidas a partir de las distancias entre el nervio femoral y los puntos de referencia anatómicos superficiales en cadáveres fetales

SUMMARY: The femoral nerve (FN) is used for nerve block in many surgeries and provides effective postoperative analgesics in the pediatric population. However, although there are sufficient anatomical maps and signs for femoral nerve blockades in adults, there is not enough information for the pediatric group. Therefore, in our study, we tried to determine an effective area for safe block blocking with the help of bone structures in order to perform effective blockade in younger age groups. The study was conducted on 60 lower limbs. The exit point of the FN was identified. The measurements were examined in two regards, namely the level of the FN and the relationship of the FN with the surrounding structures. For the right and left sides, all the parameters showed increases with age. A significant relationship was found between all the parameters of the fetal cadavers (p<0.01). It was determined that there was a strong correlation between all parameters related to FN and surrounding bone structures (p<0.01). Sex was not found to be significantly related to the other parameters (p<0.05 Among all the fetal cadavers, high-level division was observed in six limbs (10 %), mid-level division in 33 limbs (55 %), and lower-level division in 21 limbs (35 %). Gestational age-based regression equations from my study showed that the site of the blockage could be effectively performed with the aid of palpable bone structures from the outside without the need for technical assistance.

RESUMEN: El nervio femoral (NF) se utiliza para el bloqueo nervioso en muchas cirugías y proporciona analgesia posoperatoria eficaz en la población pediátrica. Sin embargo, aunque existen suficientes mapas anatómicos y signos de bloqueo del NF en los individuos adultos, no hay suficiente información para el grupo pediátrico. Se intentó determinar una área exacta para el bloqueo del NF junto con estructuras óseas para realizar un bloqueo efectivo. El estudio se realizó en 60 miembros inferiores. Se identificó el punto de salida del NF. Las mediciones se realizaron en dos puntos, nivel del NF y la relación de éste con las estructuras circundantes. Para los lados derecho e izquierdo, todos los parámetros mostraron incrementos con la edad. Se encontró una relación significativa entre todos los parámetros de los cadáveres fetales (p<0,01). Se determinó que existía una fuerte correlación entre todos los parámetros relacionados con el NF y las estructuras óseas circundantes (p <0,01). No se encontró que el sexo se relacionara significativamente con los otros parámetros (p<0,05 Entre todos los cadáveres fetales se observó un alto nivel de división en seis miembros (10 %), una división de nivel medio en 33 miembros (55 %) y división de nivel inferior en 21 miembros (35 %). Las ecuaciones de regresión basadas en la edad gestacional del estudio mostraron que el sitio de bloqueo se podría realizar eficazmente con la ayuda de estructuras óseas palpables desde el exterior sin necesidad de asistencia técnica.

Fechamento transcateter de fístula de artéria coronária com dispositivo Amplatzer Piccolo™ / Transcatheter closure of coronary artery fistula with Amplatzer Piccolo™ device

As fístulas das artérias coronárias são anomalias congênitas raras e caracterizam uma comunicação anormal entre as artérias coronárias e as câmaras cardíacas ou grandes vasos. Muitos dispositivos que incluem vários coils, plugues vasculares, oclusores e stents recobertos têm sido usados no fechamento transcateter de fístulas de artérias coronárias. Neste relato, realizamos com sucesso o fechamento de uma fístula de artéria coronária, entre a artéria descendente anterior e o ápice do ventrículo direito, usando o dispositivo Amplatzer PiccoloTM, anteriormente chamado de tamanho adicional do AmplatzerTM Duct Occluder. Em nossa opinião, o dispositivo Amplatzer PiccoloTM é adequado para oclusão transcateter de fístula da artéria coronária, podendo ser usado no lugar de plugues vasculares.

Coronary artery fistulas are rare congenital anomalies and characterize an abnormal communication between coronary arteries and cardiac chambers or major arteries. Many devices, including various coils, vascular plugs, occluders, and cover stent, have been used in transcatheter closure of coronary artery fistulas. In this report we successfully closed coronary artery fistula, between left anterior descending artery and right ventricle apex, by using Amplatzer PiccoloTM device, formerly called as AmplatzerTM Duct Occluder additional size. In our opinion, Amplatzer PiccoloTM device is suitable for transcatheter occlusion of coronary artery fistula and can be used instead of vascular plugs.

Human bocavirus infection in children hospitalized with lower respiratory tract infections: Does viral load affect disease course?

Objective: To examine the effects of human bocavirus type 1 (HBoV1) on the course of lower respiratory tract infections in cases of monoinfection and coinfection, and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections. Methods: Children under six years of age, who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study. Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction (PCR). Results: Fifty-four (16.4%) children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study. There were 28 (51.9%) males and 26 (48.1%) females with a median age 23.4 months [interquartile range (IQR): 13.2, 30.0 months] (min-max:1 month-68 months). HBoV1 was detected as a monoinfecton in 26 (48.1%) children, and as a coinfection with other respiratory agents in 28 children (51.9%). In multiple regression analysis, coinfection (P=0.032) was associated with the length of hospitalization (P<0.001; R 2 =0.166). There was a negative correlation (r= 0.281, P=0.040) between cough and cycle threshold. Fever was found to be positively correlated with C-reactive protein (r=0.568, P<0.001) and procalcitonin (r=0.472; P=0.001). Conclusions: Although we found a higher HBoV1 viral load in children with more cough symptoms in our study, it had no effect on the severity of the disease, such as length of hospital stay and need for intensive care. Coinfection was found to affect the length of hospitalization.

One Genetic Defect and Two Related Entities in Monozygotic Twins: Otosclerosis and Superior Semicircular Canal Near Dehiscence Syndrome

The purpose of this study was to evaluate the clinical and genetic findings of 53-year-old monozygotic twins who had bilateral otosclerosis and right-sided superior semicircular canal near dehiscence (SSCND). Monozygotic twins at the age of 53 presented with conductive hearing loss and normal tympanic membranes. Detailed audiovestibular testing and computed tomography scan revealed that both patients had concurrent otosclerosis and SSCND. Conservative management (hearing aids) was the treatment for these patients. Exome sequencing (ES) for the twins and their affected mother identified a heterozygous missense variant in the EYA4 (c.1744G>A; p.Glu582Lys) gene. This is the first case report to present these separate entities identified in monozygotic twins with a heterozygous missense variant in the EYA4 gene. Our ES data may imply a possible causal relationship or association between variants in the EYA4 gene and concurrent otosclerosis and SSCND.

Factors affecting family medicine programmes in Sub-Saharan Africa: a narrative review of recent literature

Objectives: This study sought to assess the level of anti-glycaemic medication-taking and its predictors among adults living with diabetes receiving treatment at Cape Coast Teaching Hospital (CCTH). Design: This was a cross-sectional study carried out among adults living with diabetes and receiving care at CCTH. Data on socio-demographic characteristics and anti-glycaemic medication-taking were gathered using a structured questionnaire. A scale consisting of 4 domains (filling prescribed medication; taking medications appropriately ac-cording to the instructions of healthcare professionals; practising behavioural modifications, and showing up for fol-low-up appointments) and eight items was used to measure the level of anti-glycaemic medication-taking. Descriptive statistics, chi-square test (and Fisher's exact test where appropriate), bivariate and multivariate logistic regression models were used in analysing the data. Setting: The study was carried out in the diabetes clinic in Cape Coast Teaching Hospital. Participants: The total enumerative sampling technique was used to select 250 adults living with diabetes and receiv-ing care at CCTH.Main outcome measures: Anti-glycaemic medication-taking Results: Out of 250 participants studied, 42% had high anti-glycaemic medication-taking. Predictors of anti-glycae-mic medication-taking included; forgetfulness (aOR=0.02, 95% CI: 0.00-0.64, p<0.001), patient's involvement in treatment plan (aOR=0.12, 95% CI: 0.02-0.64, p=0.014) and having good knowledge about one's medication (aOR=2.34, 95% CI: 1.10-4.98, p=0.028). Conclusion: Less than half of the sample population (42%) had high anti-glycaemic medication-taking, with forget-fulness, involvement in the treatment plan and good knowledge about anti-glycaemic medications, predicting medi-cation-taking

Replacement of maxillary lateral incisors with digitally manufactured single tooth retained all-ceramic pontics: a clinical report / Reabilitação da região de incisivo lateral superior ausente por pôntico modelo cantiléver em cerâmica pura fabricado digitalmente: relato de caso clínico

Several treatment options for replacement of anterior missing teeth exist, varying from no-prep (no preparation) adhesive restorations to implants. Patients' biological, psychological, economic conditions or age have an effect on the treatment choice. It is important to perform the most conservative and beneficial treatment option considering the patient based factors. The aim of this case report was to demonstrate a single session, minimally invasive, cantilevered 2-unit all-ceramic restorations replacing anterior missing teeth combined with the advantages of CAD/CAM technology and materials. (AU)

Existem várias opções de tratamento para reabilitação de dentes anteriores ausentes, variando de restaurações adesivas sem preparo (sem preparação) até implantes. As condições biológicas, psicológicas, econômicas ou a idade dos pacientes têm um efeito na escolha do tratamento. É importante realizar a opção de tratamento mais conservadora e benéfica, considerando os fatores baseados no paciente. O objetivo deste relato de caso foi demonstrar em sessão única, minimamente invasiva, um cantiléver de restaurações de cerâmica pura de 2 unidades, reabilitando a região de dentes anteriores ausentes combinadas com as vantagens da tecnologia CAD/CAM.(AU)

Internal acoustic opening: different osseous landmarks and their clinical implications / Poro acústico interno: diferentes hitos óseos y sus implicaciones clínicas

SUMMARY: Internal acoustic opening is a space that opens to facies posterior of the petrous piece of temporal bone that goes inside facial nerve, vestibulocochlear nerve, intermedial nevre and labyrinthine artery. The purpose of this study is the assessment of internal acoustic opening from a morphometric perspective, determination of the shape of the hole and determination of the distance to some important anatomic formations. This study is conducted on 166 temporal bones with unknown sex formation which are part of the skull collection in NEU and KTO Karatay University, Anatomy Department. In this study, the vertical and diameter of internal acoustic meatus, its distance to the bottom and top sides of posterior surface of the petrous part, its distance to groove for superior sagittal sinus and its distance to apex were measured. Moreover, in this study internal acoustic opening spaces are categorized into six groups as round, oval, U-shaped, fissure, irregular and V shape. Digital caliper was used for internal acoustic meatus measurements. While the vertical horizontal diameters and distance to groove for superior sagittal sinus of internal acoustic opening on the right side are 4.12 mm, 6.83 mm and 19.64mm respectively, they are 4.56 mm, 7.10 mm and 21.06 mm on the left side respectively. We have observed in this study, 37.3 % of the internal acoustic opening as round, 34.3 % as oval, 6.6 % as U-shaped, 6.6 % as fissure, 12.7 % as irregular and 2.4 % as V-shaped. We believe that these measurements can provide guidance and help in surgical procedures.

RESUMEN: El poro acústico interno es un espacio que se abre en la cara posterior de la parte petrosa del hueso temporal, donde entran los nervios facial, intermedio y vestibulococlear, además de la arteria laberíntica. El propósito de este estudio fue la evaluación del poro acústico interno desde una perspectiva morfométrica, determinación de la forma del foramen y de la distancia a algunas formaciones anatómicas importantes. Este estudio se realizó en 166 huesos temporales de individuos de sexo desconocido que forman parte de la colección de cráneos del Departamento de Anatomía en NEU y KTO, Universidad de Karatay, Se midió la altura vertical y el diámetro del poro acústico interno, su distancia a los lados inferior y superior de la superficie posterior de la parte petrosa, su distancia al surco del seno sagital superior y su distancia al vértice. Además, el poro acústico interno se clasificó en seis grupos: redondos, ovalados, en forma de U, de fisura, irregulares y en forma de V. Se utilizó un calibrador digital para las mediciones del meato acústico interno. Mientras que los diámetros horizontales, verticales y la distancia al surco para el seno sagital superior del poro acústico interno en el lado derecho fue de 4,12 mm, 6,83 mm y 19,64 mm respectivamente, en el lado izquiedo fue de 4,56 mm, 7,10 mm y 21,06 mm, respectivamente. Hemos observado que en el 37,3 % de los casos el poro acústico interno era redondo, el 34,3 % ovalado, el 6,6 % en forma de U, el 6,6 % de fisura, el 12,7 % irregular y el 2,4 % en forma de V. Estas medidas pueden servir de guía y ayuda en los procedimientos quirúrgicos.

Intra and Extra-granular Disintegrant Properties of Modified Underutilised Red Lima Bean Starch in Paracetamol Tablet Formulation

Abstract Red lima bean (Phaseolus lunatus Linn) Family Fabaceae, has been modified by succinylation and annealing, and used as intra- and extra-granular disintegrants at concentrations of 5 and 10 %w/w in paracetamol tablet formulation in comparison with corn starch BP. The starches were characterised using FT-IR spectroscopy, SEM, proximate analysis, physicochemical and functional properties. FT-IR spectrometry revealed characteristic peaks at 1575.53 and 1713.99 cm-1 for the succinylated starch while the annealed showed no significant difference from the native starch. Modifications did not alter the ovoid shape of the native starch but reduced the particle size. Succinylation improved water absorption capacity, solubility and swelling of lima bean starch but annealing reduced the parameters. Tablets with disintegrants of lima bean starches generally had higher crushing strengths and lower friability than tablets with corn starch. Modifications reduced the disintegration time of the tablets when the starches were incorporated intra-granularly, which suggested particle-particle bond interruption and destruction of hydrogen bonds as mechanism of disintegration. Tablets containing 10 %w/w succinylated red lima bean starch incorporated intra-granularly had the highest disintegration efficiency ratio, DER, indicating a great balance between mechanical and disintegration properties. Modified red lima bean starches incorporated intra-granularly into paracetamol tablets led to faster disintegration and could efficiently substitute corn starch as disintegrant.

The gelling properties of Dillenia indica mucilage in benzyl benzoate emulgel formulations

Abstract The objective of the study was to evaluate the gelling properties of Dillenia indica mucilage in benzyl benzoate emulgel formulation. Mucilage was extracted from the fruits of Dillenia indica using established methods and characterized by rheology and swelling. Emulsion (F1) was prepared using the continental emulsification method. Gelling agents (2 %w /v) were prepared by dispersing in distilled water with constant stirring at a moderate speed using a magnetic stirrer. F1 was added to the gel (0-75 %w /w) to obtain emulgel formulations and evaluated using viscosity, globule size, pH, release profiles and kinetic modeling. Data were expressed as mean ± SD, and similarity factor (f2) was used to compare all formulations. Formulation viscosity was significantly higher with carbopol than with Dillenia; globule sizes increased with concentration of gelling agents, and pH reduced as the concentration of Dillenia increased. All formulations showed controlled release properties with t80 ranging between 114 and 660 min. The release was governed by Korsmeyer-Peppas model. Formulation F5 prepared with 50 % Dillenia showed highest similarity to F4 prepared with 75 %w /w carbopol. Dillenia indica demonstrated acceptable gelling properties comparable with that of carbopol and could be improved for use in emulgel formulations.