The diagnostic role of preoperative blood tests in complicated appendicitis: A feasible approach to surgical decision.

Background: An accurate diagnosis and timely surgical intervention have significant importance in noncomplicated appendicitis (NCA) and complicated appendicitis (CA). Therefore, any factor that helps in the prediction of CA also contributes to suitable treatment options. Aim: This retrospective study aimed to identify any relationship between acute appendicitis (AA) and preoperative blood test levels and whether these parameters can differentiate between NCA and CA patients. Patients and Methods: A database of 201 appendectomies and 100 control healthy patients was analyzed between 2019 and 2022. Patients were divided into three groups: NCA without peritonitis or phlegmonous appendicitis as group 1; CA with perforated, necrotizing appendicitis with peritonitis as group 2; and the healthy control group (CG) as group 3. White blood cell (WBC), platelet distribution width (PDW), mean platelet volume (MPV), red cell distribution width (RDW), creatine kinase (CK), and bilirubin levels were collected from the patients and compared statistically between the groups. Results: Age, WBC, and PDW levels were set as predictive in the differential diagnosis of CA as a result of receiver operating characteristic (ROC) analysis. The multivariate analysis demonstrated that age (OR: 1.023; 95% CI: 1.000-1.045; P = 0.04), male sex (OR: 3.718; 95% CI: 1.501-9.213; P = 0.005), WBC levels (OR: 1.000; 95% CI: 1.000-1.000; P = 0.002), and PDW levels (OR: 2.129; 95% CI: 1.301-3.484; P = 0.003) were independently associated with CA. Conclusion: Age, higher WBC count, and PDW levels are valuable in differentiating the diagnosis of CA from NCA, and this could be a feasible approach for surgical decisions.

Postoperative pancreatic fistula after pancreaticoduodenectomy: if you lack knowledge of what to search for, you will be unable to locate what you desire.

OBJECTIVE: Postoperative pancreatic fistula (POPF) is the most common and critical complication of pancreatoduodenectomy (PD). In this study, we aimed to define preoperative, perioperative, and postoperative conditions that may cause POPF and examine the predictive value of drain fluid amylase (DFA) values in showing the clinical severity of POPF. PATIENTS AND METHODS: Between December 2018 and December 2019, 49 patients who underwent PD for malignant reasons by a single team were retrospectively analyzed. Patients with benign indications, vascular reconstruction, preoperative biliary drainage catheterization, resectable liver metastases, POPF that occurred after reoperation, and patients undergoing neoadjuvant oncological treatment were excluded from the study. The patients were divided into two groups developing (FP) and non-developing (FN) POPF. RESULTS: There was no difference between the groups in terms of gender (p=0.781), age (p=0.219), American Society of Anesthesiologists (ASA) score (p=0.338), and comorbidity status (p=0.219). The mean body mass index (BMI) kg/m2 values of the patients in the FN and FP groups were 25.2±4.0 kg/m2 and 27.4±2.6 kg/m2, respectively (p=0.042). An increased BMI increases the risk of POPF. Preoperative prognostic nutritional index (PNI) score (p=0.588), preoperative total bilirubin level (p=0.707), pancreatic duct diameter (p=0.334), pancreatic texture (p=0.334), operation time (p=0.659) do not pose a risk for POPF. Increased perioperative bleeding amounted to a risk for POPF (123.8±46.7 ml, 244.7±66.3 ml in FN and FP groups, respectively, p=0.024). Drain fluid amylase (DFA) values (p<0.001, p=0.043, p=0.019, respectively) were found to be high in patients with POPF on postoperative days 1, 4, and 7. CONCLUSIONS: Increased BMI and excess perioperative blood loss increase the risk of POPF. DFA level is an easily applicable method that provides early diagnosis for POPF.

Evaluation of SARS-CoV-2 RT-PCR test results from a pandemic hospital according to demographic data.

OBJECTIVES: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to coronavirus disease 2019 (COVID-19) in China at the end of 2019 has resulted in a global pandemic. On 11 March 2020, the first case of COVID-19 was reported in Turkey. The aim of this study was to evaluate SARS-CoV-2 Real-Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test results from the Medical Microbiology Laboratory of a pandemic hospital according to demographic data. STUDY DESIGN: Retrospective cohort study. METHODS: SARS-CoV-2 RT-PCR test results of 413,013 samples from 194,062 patients were retrospectively analysed. Tests were carried out between 27 March and 31 December 2020 using two commercial kits. The patient's age and gender were recorded, in addition to the percentage of positive test results per month (i.e. monthly positivity). Pearson's Chi-squared test was used to analyse statistical significance. RESULTS: Overall SARS-CoV-2 positivity in the pandemic hospital was 19.9%. Female gender and younger age (0-18 years) had a statistically significant higher positivity (P < 0.05). There was a statistically significant higher positivity in August and September. CONCLUSIONS: Higher positivity among the younger population and females may be the leading cause of low COVID-19 mortality rates in Turkey as these population groups are less likely to die from the disease. Governments should disaggregate COVID-19 data by age and gender, and vaccine studies focussing on younger populations should be accelerated because this population group represents an important source of infection.

Effect of propolis on erythrocyte rheology in experimental mercury intoxication in rats.

In the present study, changes in erythrocyte rheology in association with mercury toxicity and the role of propolis were analyzed in rats. Forty male Wistar Albino rats that were 4-5 months old were used in the study. The control group was administered normal saline intraperitoneal (ip) injections; the mercury chloride group was administered HgCl2 (4 mg/kg, ip); the propolis group was administered propolis (200 mg/kg, by gavage); and the HgCl2+ propolis group was administered HgCl2 (4 mg/kg, ip) + propolis (200 mg/kg, by gavage) for 3 days. The following parameters were analyzed: hematological parameters, plasma potassium (K) levels, methemoglobin, 2,3-DPG, erythrocyte deformability, and hemolysis as a percentage. The results revealed that leukocyte count significantly increased, and a significant decline occurred in the platelet count (p < 0.01). Serum K(+), MetHb, 2, 3-DPG, and hemolysis percentage significantly increased in the rats exposed to mercury (p < 0.01). However, the values of rats administered only with propolis were close to the values of the control group and the changes were avoided by the administration of propolis as protection in the rats exposed to mercury chloride.

Toscana virus (TOSV) exposure is confirmed in blood donors from Central, North and South/Southeast Anatolia, Turkey.

Toscana virus (TOSV), a sandfly fever virus serotype of medical and public health importance, is a major pathogen involved in aseptic meningtis occurring in Mediterranean countries and poses a threat to the residents as well as travellers. Limited data on TOSV activity are present from Turkey despite being located in the endemic zone. We aimed to identify TOSV exposure in 1115 healthy blood donors at the Hacettepe University Hospital Blood Bank in Ankara, Turkey, using commercial indirect fluorescence assays (IFAs) and virus neutralization test (VNT) for antibody detection and specificity confirmation. A total of 199 samples (17.8%) were positive for anti-TOSV that include IgG reactivity in 10.4%, IgM reactivity in 8.2% and IgM + IgG reactivity in 0.7% of the sera. Anti-TOSV specificity could be confirmed via VNT in 56% of the IgG- and 43.6% of the IgM-positive sera, making up a total of 58 samples (5.2%). Risk factors associated with TOSV IgG reactivity were male gender, residing in rural areas, frequent sighting of mosquitoes/sandflies and working outdoors. TOSV-specific antibody prevalence increased significantly with age. Evidence of exposure to other sandfly fever viruses was noted. These data reveal that mild or asymptomatic infections with TOSV are frequent in central and northern Anatolia. TOSV exposure has also been identified in residents of 9 provinces in southern/southeastern Anatolia for the first time.

Sandfly fever virus activity in central/northern Anatolia, Turkey: first report of Toscana virus infections.

Sandfly fever viruses (SFVs) cause febrile diseases as well as aseptic meningitis/encephalitis and include serotypes sandfly fever Sicilian virus (SFSV), sandfly fever Naples virus (SFNV) and Toscana virus (TOSV). Infections are endemic in the Mediterranean basin and data on SFV activity in Turkey are limited. In this study, sera from 1533 blood donors from the Ankara, Konya, Eskisehir and Zonguldak provinces of Turkey were evaluated for SFV exposure by indirect immunofluorescence test (IIFT) and confirmed by virus neutralization test (VNT). One hundred and two patients with central nervous system (CNS) infections of unknown aetiology were also tested via IIFT and real-time reverse-transcription PCR for SFV/TOSV. Rate of overall IgG reactivity in IIFT was 32.9% (505/1533) among blood donors. TOSV exposure was confirmed by VNT in all study regions. Exposure to the recently-identified serotype sandfly fever Turkish virus, as evaluated by VNT, was revealed in Konya and Ankara. SFNV exposure was identified in Konya and SFSV was observed to be present in all regions except Zonguldak. TOSV RNA was detected in 15.7% (16/102) and was accompanied by TOSV IgM in 25% (4/16) of the patients. Partial L and S sequences suggested that TOSV circulating in Turkey can be grouped into TOSV genotype A strains. Exposure to TOSV and other SFV serotypes was revealed in blood donors and CNS infections by TOSV were identified for the first time in Turkey. Infections are observed to be endemic in central Anatolia and should be considered as aetiologic agents in cases/outbreaks of fever and meningoencephalitis.

Confirmed exposure to tick-borne encephalitis virus and probable human cases of tick-borne encephalitis in Central/Northern Anatolia, Turkey.

Tick-borne encephalitis virus (TBEV) is the aetiological agent of tick-borne encephalitis (TBE), a potentially fatal central nervous system infection of humans. TBE is endemic in many areas of Europe and Asia; however, very scarce data on TBEV activity are available from Turkey. We aimed to identify TBEV exposure in healthy blood donors and the impact of TBEV in central nervous system infections in Central/Northern Anatolia. Two-thousand four hundred and fifty four sera, collected from blood donors at Ankara, Konya, Eskisehir and Zonguldak branches of the Turkish Red Crescent Middle Anatolia Regional Blood Center, were analysed for TBEV serosurveillance. Paired serum and cerebrospinal fluid samples from 108 patients with the diagnosis of aseptic meningitis/encephalitis of unknown aetiology were also evaluated to identify TBE and neuroborreliosis cases. Commercial enzyme-linked immunosorbent assays and indirect immunofluorescence tests were employed for antibody detection. Forty-seven donor samples (1.9%) were reactive for TBEV IgG. In 25 persons with IgG reactivity (53.1%), risk factors for tick-borne infections were revealed. One sample from Zonguldak province (1/198; 0.5%) in the Black Sea region of Turkey was confirmed to possess neutralizing antibodies via plaque reduction neutralization test. TBEV IgM was detected in 9.2% (8/108) of the patients. IgM was accompanied by IgG reactivity in two persons where, in one, recent history of a tick bite was also identified. Intrathecal antibody production for TBEV could not be demonstrated. No evidence for Borrelia infections could be found. Confirmed exposure to TBEV and/or an antigenically similar tick-borne flavivirus is documented for the first time in blood donors in Zonguldak in Northern Anatolia. Probable cases of TBE have also been identified from Central Anatolia. The epidemiology of TBEV activity in Turkey needs to be assessed and benefits of vaccination for general population, risk groups or travellers must be considered.

Melatonin and nitric oxide.

Melatonin is a product of the amino acid tryptophan in the pineal gland. Once synthesized, the specific mechanisms governing the release of melatonin from the pineal gland and its functions are largely unknown. Besides its regulatory role in circadian rhythms in mammals, because of its widespread subcellular distribution, melatonin contributes to the reduction of oxidative damage in both the lipid and the aqueous environments of the cell. This postulate is widely supported by the experimental observations showing that melatonin protects lipids in membranes, proteins in the cytosol, and DNA in the nucleus and mitochondria from free radical damage. Melatonin thus reduces the severity of disease conditions where free radicals are implicated. The direct free radical scavenging effects of melatonin are receptor independent. It has recently been shown that it has an ability to scavenge free radicals, including hydroxyl radicals, hydrogen peroxide, peroxyl radicals, singlet oxygen and nitric oxide (NO) and peroxynitrite anion. An excessive amount of NO, a free radical which is generated by the inducible form of NO synthase, is known to cause cytotoxic changes in cells. Hence, NO synthase is considered a pro-oxidative enzyme, and any factor that reduces its activity would be considered an antioxidant. Recent studies have shown that melatonin inhibits the activity of NO synthase, beside its NO and peroxynitrite scavenging activity. Thus, inhibition of NO production may be another means whereby melatonin reduces oxidative damage under conditions, such as ischemia-reperfusion, sepsis, etc, where NO seems to be important in terms of the resulting damage.

Effects of membrane adhesion barriers on wound healing reaction after glaucoma filtration surgery: a comparative study with Interceed and Seprafilm.

PURPOSE: To evaluate and compare the effectiveness of two adhesion barriers, Interceed and Seprafilm, on wound heal ing reaction after glaucoma filtration surgery. MATERIALS AND METHODS: Full-thickness filtration surgery was carried out on three groups, each containing four rabbits. Interceed and Seprafilm prepared in 3 x 4 mm dimensions was put on and around scleral opening in Groups 1 and 2, respectively. All groups received tobramycin and dexamethasone drops tid for 14 days. Intraocular pressure (IOP), anterior chamber depth, and bleb appearance were checked on the first, third, seventh, and 14th days. The rabbits were killed on the 14th day and the trabeculectomy area with overlying conjunctiva was excised. The samples were fixed wi th 10% formalin, buried in paraffin, and stained with hematoxylin and eosin. The surgical site and surrounding subconjunctival area were evaluated histopathologically for cell counts (fibroblast, lymphocyte, eosinophil, and macrophage), presence of edema and foreign body reaction, and potency of the fistula tract. RESULTS: Mean IOP at the first and third day examinations was significantly different between groups, but there was no statistically significant difference among the groups with respect to IOP, anterior chamber depth, or bleb appearance at the seventh and 14th days. The groups were similar with respect to number of fibroblasts, eosinophils, and neutrophils. Number of macrophages was significantly increased in Groups 1 and 2 and number of vessels was significantly decreased in Group 1. CONCLUSIONS: Neither of these two adhesion-preventing substances seems to suppress wound healing reaction after glaucoma filtration surgery. However, a diminished wound healing reaction was expected wi th a decreased number of vessels, such as in Group 1. Increased number of macrophages in both groups may result in a decreased level of some inflammatory mediators.

Evaluation of the neurosensory deficiencies of oral and maxillofacial region following surgery.

Maxillofacial neurosensory deficiencies may be caused by various surgical procedures such as tooth extraction, osteotomies, preprosthetic procedures, excision of tumors or cysts, surgery of the TMJ and surgical treatment of fractures and cleft lip/palate. These deficiencies may be intolerable for the patient, mainly because of the elective nature of the procedures such as osteotomies. In this study, a retrospective evaluation of incidence of neurosensory deficiencies (NSD) in 227 patients who underwent different kinds of surgeries in the maxillofacial region is presented. Clinical neurosensory testing such as two-point discrimination, static light touch, brush directional stroke, pin-prick, thermal discrimination and dental vitality tests were used for evaluation. All the patients were grouped according to the surgical procedures and all of them were evaluated at least one year post operation. It was concluded that osteotomies, especially sagittal split ramus osteotomies, have the highest incidence of postoperative NSD.

The importance of visual erotic stimulation in the differential diagnosis of erectile impotence.

In this study we aimed to determine the importance of visual erotic stimulation (VES) alone, and in combination with intracavernosal papaverine injection (ICPE) in the differential diagnosis of erectile impotence. Sixty-four patients with erection problems were investigated between June 1992 and January 1994. VES could be the first investigative method in the differential diagnosis of erectile impotence. This will help us in some groups of patients with psychogenic impotence to avoid the application and complications of ICPE. In patients with insufficient erections with VES alone, ICPE must be combined with VES in order to detect the causes of psychogenic erectile impotence more correctly.

Zinc-induced alterations in contractile properties of rat diaphragm muscle in vitro.

The effect of zinc ions on the isometric contraction of rat diaphragm muscles in the presence and in the absence of external calcium was studied. Using a transducer, the isometric force was measured as a function of supramaximal electrical stimulation, either directly or indirectly applied to the muscle. The following parameters were measured: peak twitch tension, PT, twitch contraction time, CT, relaxation half-time, RT-1/2, and peak rates of tension increase and decrease, +dP/dt and -dP/dt. The following zinc-induced alterations were observed: an increase of the PT; a decrease of the RT-1/2; an increase in the +dP/dt and -dP/dt. The CT was not changed significantly. Our results suggest that zinc ions have a positive inotropic effect on isolated diaphragm muscle. The increase in PT may be explained by a zinc-activated Ca2+ uptake by sarcoplasmic reticulum. This was followed by an increase in the rate of rise of tension development, which was secondary to increased -dP/dt. The mechanism(s) by which extracellular Ca2+ contributes to this action of zinc is not known.

Keratinization of palatal mucosa beneath metal-based removable partial and acrylic-based complete dentures compared with normal palatal mucosa: a clinical, cytological and histological study.

Normal human palatal epithelium is an orthokeratinizing tissue with a well-developed stratum corneum. Several cytological and histological studies showed that when the palate covered by a denture fully or partially, keratinization of the mucosa changes. The results of some studies suggested that keratinization changes from orthokeratosis to parakeratosis, and there is a reduction in the thickness of stratum corneum. Whereas the results of some other studies showed increased orthokeratinization. This study was planned to determine changes in keratinization of palatal mucosa in denture wearers compared with normal palatal mucosa. Keratinization of palatal mucosa was examined by mainly exfoliative cytology in three groups. Group-1 consisted of 51 patients wearing metal-based removable partial denture; group-2 consisted of 50 patients wearing acrylic-based complete denture and group-3 including 57 healthy volunteers who have not been wearing denture served as the controls. In each group, the results of exfoliative cytology were supported by histological examinations. Statistical results showed that either acrylic-based complete or cobalt-chromium-based removable partial dentures seem to reduce the quantity and/or quality of the keratin layer. The mean values of keratinization and the thickness of stratum corneum were significantly lower in the complete denture group than in the partial denture group. Furthermore the reliability of exfoliative cytology was confirmed by the guidance of histological examination.

The influence of dietary iron on zinc in rat.

The purpose of this study was to clarify the influence of iron on zinc status. The animals were divided into four groups, consisting of five rats in each group. The control group was fed on basal diet with adequate levels of zinc and iron, whereas the experimental group was fed diets containing different levels of iron ad libitum for 15 d. Low levels of iron (LFe) significantly increased the zinc absorption percentage but there was a decrease in high (HFe) and very high iron (VHFe) level groups (p < 0.001). The retention percentage changes were found to be parallel to the changes in the absorption percentage curve. It was found that zinc (per total dry tissue) and Zn-65 (per total tissue) increased in the rats fed the LFe, whereas in general they decreased in the rats fed the HFe and VHFe diets. Significant changes were found in the duodenum and liver. Zn-65 (per g wet tissue) significantly increased in the brain and liver in the LFe group, but there was a decrease in the duodenum, ileum, kidney, liver, and brain in the HFe and VHFe groups. Changes in the level of zinc (per g dried tissue) were found to be parallel to the changes in Zn-65 in all the groups. The dietary proportions of iron appear to influence zinc metabolism at the intestinal and cellular transport levels over a given period of time.

Effects of honey containing grayanotoxin I on frog gastrocnemius muscle.

The presence of grayanotoxins (GTX-I, GTX-II and GTX-III) in honey samples from the Mediterranean Sea and Black Sea regions of Turkey and the effect of honey containing GTX-I on the threshold stimulus voltage of frog gastrocnemius muscle were studied. We used 2 groups of gastrocnemius muscles isolated from curarized or noncurarized frogs. The threshold voltage was measured by external perfusion with a polygraphic system. Isolated muscle preparations were perfused separately with Clark-frog-Ringer's solution containing honey solutions from the Mediterranean Sea region (normal) or with honey solutions from the Black Sea region (GTX-I-containing, poisonous). There was no significant difference between the normal and poisonous honey groups data with the curarized preparations. But in the noncurarized preparations, the honey containing GTX-I significantly decreased the threshold voltage in comparison with normal honey. These findings suggest the effect of GTX-I on frog neuromuscular junctions is due to an increase in membrane permeability to sodium ions.

Comparative effects of calcium deficiency and supplements on the intestinal absorption of zinc in rats.

The purpose of this study was to clarify the influence of calcium on zinc status. The animals were divided into four groups consisting of five rats in each group. The control group was fed on basal diet with adequate levels of zinc and calcium while the experimental group was fed diets containing different levels of calcium ad libitum for 15 d. Low calcium did not significantly affect the zinc absorption percentage but there was a decrease in high and very high calcium groups. The retention percentage changes were found parallel to the changes in the absorption percentage curve. When the zinc distribution was expressed as per g of dry tissue, duodenum, brain, and liver zinc content increased in the low calcium group but a decrease in duodenum, ileum, and liver in the high and very high calcium groups was observed. Also the 65Zn amount in some tissues and blood increased substantially in the low calcium group, decreased in the high and very high calcium groups. These results suggest that calcium affects zinc status in rats.

Immunoglobulin-G and creatinine levels in rabbits in altitude adaptation.

The changes of immunoglobulin-G and creatinine levels in mid-altitude were investigated in rabbits. The animals living at sea level were exposed to 2240 m altitude for 22 days period. When compared with sea level values; immunoglobulin-G levels were significantly low. Serum creatinine level decreased significantly in the 2nd day, then reached the sea level amount on the 12th day. On the 22nd day a significant increase was observed. It was concluded that the decrease in immunoglobulin-G values may be due to the depression of protein synthesis. The increase in plasma creatinine level would be explained by the decrease in urine.

Changes in serum protein lipid and electrolyte levels in rabbits at mid-altitude.

1. The effects of mid-altitude on the profiles of total serum lipid, cholesterol, fibrinogen, albumin, Ca2+, Cl-, Na+ and K+ were investigated in rabbits for 22 days. From 30 rabbits living at sea level 15 were exposed to 1170 m and 15 to 2240 m altitude. 2. When compared with sea level values; total protein, albumin and K+ significantly decreased up to 5th day (P less than 0.01), then they gradually increased. 3. Total lipid, cholesterol, Ca2+, Cl- and Na+ levels elevated in 2nd day (P less than 0.01) then they gradually decreased to their sea-level values. 4. It was concluded that the adaptation mechanisms begin at mid-altitudes.

[A new and effective therapeutic method for the treatment of leishmaniasis]. / Leismaniasis tedavisinde yeni ve etkili bir yöntem.

Life for millions of people is at stake in the development of new techniques for homing drugs on to specific targets in the body. The use of artificial phospholipid vesicles known as liposomes is one of the most promising of the new approaches. Recent studies show that encapsulating drugs in liposomes, can make them more than 700 times more effective than unencapsulated (free) drugs.