Evaluation of cardiac arrhythmia in pediatric patients with Left Ventricular Assist Device (L-VAD).

OBJECTIVE: Pediatric heart failure is an important cause of morbidity and mortality in childhood. Left ventricular assist devices (L-VAD) are used for bridging to transplantation in patients with indications for heart transplantation. PATIENTS AND METHODS: The children included in the study were patients who underwent implantation of an L-VAD due to advanced heart failure at Ege University Faculty of Medicine Hospital between January 2009 and January 2023. RESULTS: Of the 33 patients who underwent L-VAD implantation, 16 (48.5%) were female and 17 (51.5%) were male. The median age at surgery was 13 years (IQR, 9.5-15). The median weight was 44 kg (IQR, 25.65-52), the median height was 158 cm (IQR, 134.5-168.5), and the median body surface area was 1.37 m2 (IQR, 0.95-1.51). All patients who underwent L-VAD implantation had an echocardiographic diagnosis of dilated cardiomyopathy. The patients underwent a median of 16 (IQR, 9-21) ECGs, and the median number of 24-hour Holter ECGs obtained was 3 (IQR, 2-5). Arrhythmias that occurred after L-VAD implantation were classified as atrial and ventricular. Ventricular arrhythmia included ventricular tachycardia (VT) lasting for more than 30 seconds (sustained VT), VT lasting for less than 30 seconds (nonsustained VT), and ventricular fibrillation. Atrial arrhythmias included atrial flutter, atrial fibrillation, supraventricular tachycardia, and atrial ectopic tachycardia. During the follow-up, atrial or ventricular arrhythmias were observed in 11 (33%) patients. The most common rhythm disturbances before L-VAD implantation were ventricular arrhythmias, while after the surgery, atrial arrhythmias were found to be the most frequent. A total of 5 patients underwent cardioversion (n=2) or defibrillation (n=3) due to arrhythmia. CONCLUSIONS: In patients undergoing L-VAD implantation, rhythm disorders that could normally lead to hemodynamic instability are frequently encountered. In these rhythm disorders, medical therapy should be attempted before resorting to cardioversion or defibrillation, and subsequently, more aggressive treatment methods should be considered.

Laparoscopic removal of heterotopic cesarean scar pregnancy.

OBJECTIVE: To present the laparoscopic management of heterotopic cesarean scar pregnancy and discuss other treatment options. DESIGN: Surgical video article. The Institutional Ethics Committee approved the video reproduction. SETTING: Tertiary referral to a university hospital PATIENT: A 29-year-old woman with spontaneous heterotopic cesarean scar pregnancy presented for vaginal spotting. Ultrasound revealed two gestational sacs at 7 weeks and 6 days of gestation with fetal cardiac activity. One sac was in a normal intrauterine (IU) location, and the other was in a previous cesarean section scar. INTERVENTIONS: Scar pregnancy was excised laparoscopically, preserving IU pregnancy. No additional measures were taken to reduce bleeding. The bladder was filled with 150 cc isotonic to determine its boundaries. The peritoneum was dissected away from the cervix. After removing the ectopic pregnancy material, the myometrial defect was excised. The uterine wall was closed in three layers using 2-0 V-Loc sutures. MAIN OUTCOME MEASURES: Ongoing IU pregnancy after laparoscopic removal of cesarean scar pregnancy and term delivery. RESULTS: The procedure was completed in 67 minutes. Total blood loss was <100 cc. The ongoing pregnancy follow-up was uneventful. Delivery was planned for the 37th-38th weeks. Although instructed to visit immediately after experiencing pain, the patient arrived after the 38th week and reported having pain for 2 days. During the cesarean section, a rupture was observed at the previous incision site, which was fortunately incomplete. A healthy male infant (weight, 3,210 g; Apgar score, 9/10) was delivered. CONCLUSIONS: The most common approach for heterotopic scar pregnancy is embryo reduction with potassium chloride injection. However, the mass persists in the scar area, resulting in complications associated with excessive bleeding during a cesarean section in approximately half of cases. Moreover, almost all published cases of embryo reduction resulted in premature births before week 36. Considering the present case, laparoscopic surgery may be appropriate for managing heterotopic cesarean scar pregnancy by preserving IU pregnancy.

What we learned from steroid therapy in the COVID-19 pandemic.

Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic named coronavirus disease 2019 (COVID-19) that has become the greatest worldwide public health threat. Although different treatment recommendations are offered for COVID-19 infection, steroid treatment remains important. Aim: We aimed to demonstrate the effect of pulse steroid therapy (PST) on inflammatory markers and patient outcomes in moderate/severe COVID-19 pneumonia. Materials and Methods: We retrospectively analyzed the patients 18 years and older hospitalized in our hospital's COVID-19 clinics between April 1, 2020, to June 30, 2020, and July 1, 2021, to November 30, 2021. Patients in the moderate/severe COVID-19 pneumonia category, according to the World Health Organization COVID-19 guidelines, were included in the study. The demographic characteristics of the patients, treatments, inflammatory markers, and patient outcomes (need for intensive care, length of hospital stay, high-flow nasal oxygen (HFNO) requirement, mechanical ventilation (MV), and mortality rates) were recorded and analyzed. Results: Patients who received PST had more advanced age (P < 0.01), more comorbidities (P < 0.001), and more HFNO need (P < 001) compared with the patients who did not receive PST. There was no statistically significant difference between clinical outcomes: the need for intensive care, length of hospital stay, need for MV, and mortality rates (P = 0.54, P = 0.3, P = 0.14, and P = 0.09, respectively). When we evaluated the unvaccinated patients, there was a statistically significant difference in the MV need and mortality rates between those who received PST and those who did not (P = 0.017, P = 0.014, respectively). Conclusion: It was observed that PST provided similar mortality, ICU, and MV requirements in patients with older age and comorbidities. Lower MV requirements and mortality were observed in the unvaccinated group receiving PST compared with the unvaccinated group not receiving steroids. PST is still promising in COVID-19 infection, and more studies are needed for standard doses and applications.

Are we aware of COVID-19-related acute kidney injury in intensive care units?

OBJECTIVE: Coronavirus disease-19 (COVID-19) primarily affects the respiratory system. In some cases, the heart, kidney, liver, circulatory system, and nervous system are also affected. COVID-19-related acute kidney injury (AKI) occurs in more than 20% of hospitalized patients and more than 50% of patients in the intensive care unit (ICU). In this study, we aimed to review the prevalence of COVID-19-related acute kidney injury, risk factors, hospital and ICU length of stay, the need for renal replacement therapy. We also examined the effect of AKI on mortality in patients in the ICU that we treated during a 1-year period. PATIENTS AND METHODS: The files of patients with COVID-19 (n=220) who were treated in our ICU between March 21st, 2020, and June 1st, 2021, were analyzed retrospectively. Demographic data of the patients, laboratory data, and treatments were examined. Patients were divided into two groups, group I patients without AKI and, group II patients with AKI. The patients with AKI were evaluated according to the theKidney Disease Improving Global Outcomes (KDIGO) classification and were graded. RESULTS: Of the 220 patients included in the study, 89 were female and 131 were male. The mean age of patients with AKI (70.92±11.28 years) was statistically significantly higher than among those without AKI (58.87±13.63 years) (p<0.001). In patients with AKI, ICU length of stay, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, initial lactate levels, need for mechanical ventilation, duration of mechanical ventilation, and secondary infection rates were found to be statistically significantly higher. Discharge rates from the ICU in patients without AKI were statistically higher (75.3% vs. 26.6%), and mortality rates were significantly higher in patients with AKI (67.8% vs. 14.3%). CONCLUSIONS: Various studies conducted have shown that patients with COVID-19 are at risk for AKI, and this is closely related to age, sex, and disease severity. The presence of AKI in patients with COVID-19 increases mortality, and this is more evident in patients hospitalized in the ICU. In our study, the prevalence of AKI was higher in older patients with high APACHE II scores and initial lactate levels. Comorbidities such as hypertension, chronic kidney disease, and coronary artery disease in patients with AKI were higher than in those without AKI.

The morphologic analysis of a not well-known anatomical structure's calcifications (Bochdalek's flower basket calcifications).

BACKGROUND: The aim of the study was to define the morphology of calcifications belonging to a not very well-known anatomical structure (calcification of foramen of Luschka/Bochdalek's flower basket calcification [Boc FBC]). MATERIALS AND METHODS: Two hundred sixty-four computed tomography (CT) scans obtained from healthy patients were included in the study (50.0038 ± 24.78309 [0-92 years old] [mean age ± standard deviation; range]). The morphology of the calcifications in the fourth ventricle (CFV) and Boc FBC was evaluated and compared with other common intracranial calcifications in each patient. RESULTS: Boc FBC was detected in 22.35% (59/264) of the patients. Out of 101 patients aged above 60 years, 59 presented Boc FBC (the rate increased to 55.45%), thus in our sample 94.91% of the detected Boc FBCs (56/59) were seen after 60 years of age. No Boc FBC was found under the age of 50. Statistically, there was a highly significant correlation between Boc FBC and pineal/habenular (p < 0.01) as well as choroid plexus calcifications (p < 0.01). The correlation between CFV and Boc FBC was significant (p < 0.05). It was found that 37.3% of Boc FBCs had a conical form. This form was not accompanied by any vascular calcifications, either basilar or vertebral. Therefore, seeing the conical form was valuable in the differential diagnosis. CONCLUSIONS: In our study, Boc FBCs were seen in advanced age and were not encountered under the age of 50. The conical form was seen in one-third of the cases, but it was a very beneficial finding for distinguishing Boc FBC from other calcifications if any. In the advanced age group, calcifications, especially choroid plexus calcifications and pineal/habenular calcifications, are highly associated with Boc FBC. In the presence of CFV, the probability of encountering Boc FBC is very high.

The evaluation of cerebral venous normal anatomy and variations by phase-contrast cranial magnetic resonance venography.

BACKGROUND: The aim of our study was to determine the ability of the phase-contrast-cranial magnetic resonance venography (PC-CMRV) technique to detect cranial anatomy, variations, thrombosis, to reveal the deficits of the technique and to discuss the reasons for these deficits on a physics basis. MATERIALS AND METHODS: Phase-contrast's detection rates of anatomic variations and physiological filling defects (FDs) were evaluated in 136 patients and compared with the time-of-flight technique magnetic resonance imaging (MRI) and cadaveric studies. RESULTS: The dominance correlation between the three evaluated sinuses (transverse sinus [TS], sigmoid sinus, jugular vein) which originated from different embryological buds was statistically significant and the right vessel chain was dominant. PC is inadequate to show some vessels like inferior sagittal sinus (anatomically, this vessel is approximately present in 100% of the cases, but it was only visualised in 41.2% of the patients in PC-MRI). Visualisation of major veins was sufficient. PC-MRI created physiological FDs in 27.2% (72.3% middle, 10.3% inner, 17% outer part) of the patients. The FDs were concentrated in the middle part and not observed in the dominant sinus. CONCLUSIONS: The defects of visualisation are present due to the PC's technique. It can be misdiagnosed as agenesis or thrombosis. PC creates a high incidence of physiologic FDs in TS. The results are not reliable, especially if FDs are in the middle part or non-dominant side.

Should we report Breslow density, a new concept in cutaneous melanoma?

INTRODUCTION: Breslow density is a newly defined biomarker, independent of Breslow thickness. We aimed to investigate the relationship of Breslow density with other clinicopathological prognostic factors and its effect on the overall survival and disease-free survival in patients with cutaneous melanomas. MATERIALS & METHODS: This was a single-centre retrospective study of patients (n = 19) diagnosed with cutaneous malignant melanomas in our hospital between 2011 and 2019 were included in the study. The exclusion criteria were in situ melanomas, punch or incisional biopsies and metastasis at the time of the diagnosis. Breslow density was determined by reevaluating slides obtained at the time of the initial diagnoses. The effect of Breslow density on survival was determined using univariate and multivariate Cox proportional risk analyses. RESULTS: In terms of the overall survival, mortality risk increased as Breslow density increased (p = 0.044). Breslow density was not significantly associated with the overall survival in the multivariate model (p = 0.078). In terms of disease-free survival, the risk of metastasis or recurrence increased 1.229- fold in accordance with an increase in Breslow thickness (CI: 1.057-1.428), whereas increased Breslow density increased the metastasis or recurrence risk 1.059-fold (CI: 1.008-1.112). In the multivariate model, only Breslow density was statistically significant (p = 0.046). CONCLUSIONS: As a semi-quantitative and subjective measurement, Breslow density is not a completely accurate representation of the invasive tumour load. However, the measurement is practical and low cost and requires no additional equipment. Therefore, Breslow density can be measured in every laboratory. Considering the value of Breslow density in predicting the prognosis in patients with cutaneous melanomas and strong inter-observer compliance observed in the present study, we believe that it would be useful to include this measurement in pathology reports.

Evaluation of nasolabial aesthetics by different groups in operated unilateral cleft lip and palate.

AIM: The aim of this study is to evaluate and to compare the perception of nasolabial aesthetic by experienced professionals, inexperienced professionals, cleft patients and laypersons in children with unilateral cleft lip and palate (UCLP) using the Asher-McDade Scoring System. MATERIALS AND METHODS: In this retrospective study, 75 patients who applied to Ege University, Faculty of Dentistry, Department of Orthodontics and whose primary surgery operations were completed in Ege University, Faculty of Medicine Department of Plastic and Reconstructive Surgery, were evaluated from the extra-oral and profile photographs. All photographs were arranged according to Asher-McDade Scoring System and evaluated by 4 different groups. 5 people were evaluated in each group consisting of experienced professionals, inexperienced professionals, cleft patients and the laypersons. Nasal form, nasal deviation, vermilion border and nasal profile were evaluated in 5 different categories according to Asher-McDade Scoring System. Statistical analyzes were performed using STATA 11 and MEDCALC software. G Power, Fleiss Kappa, Weighted Kappa and Friedman statistical analyzes were performed for determination of number of individuals, interobserver and intraobserver reliability and comparison of scoring between groups, respectively. RESULTS: In this study, the interobserver agreement was found to be between 0.75 and 0.80 that shows a high degree of reliability. In the comparision made between the groups; experienced professionals and inexperienced professionals; there was moderate agreement in nasal profile scoring (WK 0.2857) (-0.9673/0.6596). There was agreement between experienced professionals and cleft patients in mostly vermilion border (WK 0.5454) (-0.1643/1.0000). There was no agreement between vermilion border between inexperienced professionals and cleft patients (WK 0.9230) (-1.0000/-0.2878), and compliance with the nasal profile mostly (WK 0.5454) (-0.1643/1.0000). There was a similar insignificant agreement between experienced and inexperienced professionals, cleft patients among the laypersons, at all values (WK 0,0000) (-0.0000/0.0000). According to the scoring results of the photographs for experienced professionals; nasal form, nasal deviation, vermilion border and nasal profile were evaluated as bad and close the bad (4.00±0.00, 3.80±0.44, 3.80±0.44, 3.60±0.54); it was found fair and near the bad for inexperienced professionals (3.00±0.00, 3.00±0.00, 3.40±0.54 3.20±0.44) and close the bad for cleft patients (3.60±0.54, 3.80±0.44, 3.80±0.44, 3.40±0.54). But it was found to be acceptable and good for laypersons (2.00±0.00, 2.00±0.00, 2.40±0.54, 1.40±0.54). Laypersons showed statistically significant difference in the evaluation of nasal form, nasal deviation and nasal profile from the cleft patients (P<0.05), while they showed statistically significant difference in all the score from the experienced professionals (P<0.05, P<0.01). CONCLUSION: The aesthetic appearance of nasolabial region is one of the important tools to evaluate the success of the treatment in patients with CLP. The success of primary surgery has one of the most important effects for nasolabial aesthetics on patients with clefts. As a result of the study, the evaluation of cleft patients was found to be similar to that of experienced professionals and lower than that of inexperienced professionals and the laypersons. This result shows us that patients with CLP have higher awareness of self-perception, but these patients may have psychosocial problems ranging from low self-esteem to social isolation risk.

Cardiovascular and Neurologic Complications in Kidney Transplant Recipients: A Focused Appraisal of Symptoms.

BACKGROUND AND OBJECTIVE: After a kidney transplantation, all efforts are focused on graft function. However, cardiovascular and neurologic complications might lead to decreased quality of life and shortened life expectancy. Early recognition of related symptoms might be critical to successfully manage these complications. METHODS AND PATIENTS: We retrospectively reviewed the medical records of patients who had undergone kidney transplantation in a tertiary center between January 2014 and December 2017. Demographic data and past medical history were systematically gathered. Symptoms related to cardiac or neurologic disorders and final diagnoses were recorded. RESULTS: One hundred eighty-six patients were evaluated by a cardiologist or a neurologist in the early post-operative period or long-term follow-up. Chest pain (n = 17; 9.1%) and palpitations (n = 13; 7.0%) were the most prevalent symptoms. Coronary artery disease was diagnosed in 70.6% (n = 12) of the patients presenting with chest pain. All of the patients were treated successfully, with either antianginal drugs or percutaneous angioplasty. Atrial fibrillation was diagnosed in 53.9% (n = 7) of the patients presenting with palpitations. Headache was the most prevalent chronic neurologic symptom (n = 16; 8.6%). Transient ischemic attack occured in 7 patients (3.8%) and 5 (2.7%) patients experienced ischemic stroke. CONCLUSION: Kidney transplantation is associated with short- and long-term cardiac and neurologic complications. Our findings underscore the crucial role of questioning symptoms that might be related to severe disorders. Asymptomatic patients with high risk factors must also be under scope. Attending physicians should have a low threshold for referring these patients to cardiologists and neurologists.

Cardiac and Neurologic Complications in the Late Period After Liver Transplantation: A Retrospective Analysis of 4 Years.

BACKGROUND AND OBJECTIVE: The aim of our study was to assess the cardiac and neurologic complications after liver transplantation in the late period. METHOD AND PATIENTS: Medical records of 198 patients who had liver transplantation in the organ transplantation center of our university hospital between between February 2014 and October 2017 were reviewed retrospectively. Patients who were consulted by a physician from either the cardiology or neurology departments during their long-term follow-up after liver transplantation were included in the study. RESULTS: Thirty patients (9 female; 30.0%) were evaluated by a cardiologist (n = 23; 76.7%) or a neurologist (n = 19; 63.3%) during their long-term-follow-up. The mean age was 55.0 ± 13.3. Atherosclerotic risk factors such as hypertension (n = 10; 33.3%), diabetes mellitus (n = 17; 56.7%), hyperlipidemia (n = 7; 23.3%), and coronary artery disease (n = 7; 23.3%) were highly prevalent. Chest pain (n = 5; 16.7%) was the most encountered symptom. Of these patients, 2 (6.7%) underwent coronary bypass surgery, whereas 1 (3.3%) patient was treated medically. Palpitation was the second most frequent cardiac symptom (n = 3; 10.0%). Atrial fibrillation paroxysm occurred in 2 patients. Headache (n = 4; 13.3%) was the most prevalent neurologic symptom. Transient ischemic attack occurred in 1 patient (3.3%), whereas 2 patients (6.7%) experienced stroke (1 ischemic and the other hemorrhagic). Seizures occurred in 2 patients (6.7%). CONCLUSION: Long-term follow-up of liver transplant recipients might be challenging due to the diversity of symptoms and wide spectrum of cardiac and neurologic complications. A multidisciplinary approach involving cardiologists and neurologists would help to improve early preventive measures and medical treatment strategies.

Bacterial species and total bacterial load in the distal oesophagus in patients with and without clinical gastric reflux.

AIMS: The purpose of this study is to compare distal oesophagus of persons with and without gastric reflux in terms of bacterial load and presence of certain bacterial species. METHODS AND RESULTS: Two biopsy specimens were obtained from the distal oesophagus at 5 cm above the gastroesophageal junction of each of the 50 patients (20 with normal oesophagus and 30 with reflux oesophagitis) under endoscopic examination and used for histological examination and DNA isolation. We used a real-time PCR-based assay to quantify the bacterial load and the presence of certain bacterial species from one of the biopsy samples. The biopsy specimens taken from the patients with reflux oesophagitis were consistent with gastroesophageal reflux disease (GERD). The bacterial load did not significantly differ between the groups (P < 0·005). CONCLUSION: While there was no difference between the bacterial load in the two groups, variation was observed in bacterial species. Most of the bacteria identified in distal oesophagus of the patients with gastroesophageal reflux were Gram negative. SIGNIFICANCE AND IMPACT OF THE STUDY: The human oesophagus was considered sterile until quite recently. Molecular techniques displayed the presence of a diverse bacterial species in the oesophagus. Although it is known that dysbiosis in the oesophagus causes GERD, and that Barrett's oesophagus can trigger the development of oesophageal adenocarcinoma, its etiopathogenesis is not clear. A limited number of published studies support the importance of the present study.

Submandibular gland invasion and feasibility of gland-sparing neck dissection in oral cavity carcinoma.

OBJECTIVE: This study investigated the incidence and routes of submandibular gland involvement in oral cavity carcinoma to determine the feasibility of submandibular gland sparing neck dissection. METHODS: The records of 155 patients diagnosed with oral cavity squamous cell carcinoma, with a total of 183 neck specimens, including those involving level I, were reviewed retrospectively. RESULTS: Submandibular gland involvement, via direct invasion from the anatomical proximity of T4a tumours, was evident in two patients. The floor of mouth location, either primarily or as an extension of the primary tumour, was the only risk factor for submandibular gland involvement in oral cavity carcinoma (p = 0.042). Tumour location, clinical and pathological tumour (T) and nodal (N) stages, and radiological suspicion of mandible invasion, were not found to be statistically relevant (p > 0.05). CONCLUSION: The results suggest the feasibility of preserving the submandibular gland in early stage oral cavity carcinoma unless the tumour is located in, or extends to, the floor of mouth.

Effects of artificial tear treatment on corneal epithelial thickness and corneal topography findings in dry eye patients.

PURPOSE: To investigate the effects of artificial tear treatment on central corneal epithelial thickness, and central, mid-peripheral and peripheral corneal thicknesses in patients with dry eye disease (DED). MATERIAL-METHODS: Patients with DED underwent ocular examinations, including Schirmer-2 test, slit lamp examination for tear break-up time (BUT), corneal topography (CT) for measuring mean central, mid-peripheral and peripheral corneal thickness values and anterior segment optic coherence tomography (AS-OCT) for obtaining central corneal epithelial thickness. After artificial tear treatment (carboxymethylcellulose and sodium hyaluronate formulations) for one month, patients were examined again at a second visit and the results were compared. RESULTS: Sixty-one eyes of 33 female dry eye patients (mean age: 38.3±5.7 years) were enrolled. The mean follow-up time was 36.4±3.3 days. The mean tear BUT and Schirmer-1 tests revealed significant improvement after treatment (P=0.000, P=0.000, respectively). Central corneal epithelium and mean mid-peripheral corneal thicknesses measured significantly higher after treatment (P=0.001, P=0.02). Changes in central and peripheral corneal thicknesses were not statistically significant. CONCLUSION: Artificial tear treatment in dry eye patients seems to increase central corneal epithelial and mid-peripheral corneal thicknesses. Measurement of corneal epithelial thickness can be a useful tool for evaluation of treatment response in dry eye patients. Further long-term prospective studies are needed to investigate this item.

Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro-computed tomography analysis.

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid-based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro-computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study. One sinus side as a control group was grafted with only collagenated heterologous bone graft; the other region as a test group was grafted with hyaluronic matrix and collagenated heterologous bone graft. Bone biopsy samples were taken after 4 months during the dental implant surgery and analyzed using micro-computed tomography and histomorphometric parameters. According to the micro-computed tomography and histomorphometric results, a significantly higher percentage of new bone was observed in the test group when compared to the control group after 4 months of healing. This study confirmed the hypothesis that the addition of hyaluronic matrix to collagenated heterologous bone graft for sinus augmentation enhances bone formation compared to collagenated heterologous bone graft alone in the early healing period.

Hysterosalpingography prior to the gonadotropin stimulated intrauterine insemination improves clinical pregnancy rates in women with unexplained infertility.

PURPOSE OF INVESTIGATION: Gonadotropin stimulated intrauterine insemination (IUI) cycles performed following one month after hysterosalpingography (HSG) are associated with improvement in clinical pregnancy rates in unexplained infertile couples. MATERIALS AND METHODS: A retrospective cohort study was performed between 2008 and 2014. A total of 92 unexplained infertile couples undergoing their first cycle IUI stimulated by gonadotropins were included in the analysis. Participants were classified into two groups according to IUI cycles performed one month (Group A, n = 25 cycles) or longer than one month (Group B, n = 67 cycles) after the HSG procedure. RESULT: The overall clinical pregnancy rate was found as 25% (23 clinical pregnancies / 92 cycles). Clinical pregnancy rate was 44 % (11/25) for Group A and 17.9 % (12/67) for Group B. In Group A, there were significantly higher clinical pregnancy rates compared to Group B (OR: 3.6, 95% CI, 1.3-9.8; p = 0.012). CONCLUSIONS: It has been demonstrated that fertility improving effect of HSG was most prominent in the first six months after procedure. Likewise, in gonadotropin stimulated IUI cycles performed following one month after HSG, there seems to be an improvement in pregnancy rates in unexplained couples. In unexplained cases, it may be a reasonable approach to plan IUI cycles in the first month after HSG in clinical practice.

Hyperbaric oxygen therapy of olfactory dysfunction in diabetic neuropathy with type 2 diabetes mellitus and a new definition Diabetic Olfactopathy.

BACKGROUND: Hyperbaric Oxygen therapy is recommended as an adjuvant therapy for diabetic neuropathy. To investigate olfactory dysfunction and show the effectiveness of hyperbaric oxygen treatment in patients with type 2 diabetic neuropathy. MATERIAL AND METHODS: Patients diagnosed with Type 2 DM and diabetic neuropathy were included in the group 1. Patients of Group 1 were administered with a hyperbaric oxygen therapy for 30 sessions and patients who returned for a check up following 30 sessions were incorporated into the Group 2. Healthy volunteers with no medical problems were included in the study as a control group (Group 3). Connecticut Chemosensory Clinical Research (CCCRC) test and the subjective visual analog scale (VAS; 0-100) were utilized to evaluate the olfactory function. RESULTS: There was a statistically significant difference both between the control group and the patient group as well as before and after the HBO therapy in terms of total CCCRC scoring averages and VAS Scoring averages. CONCLUSION: When compared to normal individuals, type 2 diabetic neuropathy can cause an olfactory dysfunction, and a statistically significant improvement in olfaction can be obtained with HBO therapy. This is the first study demonstrating that the HBO therapy can play a role in treating olfactory dysfunctions suffered by the patients with diabetic olfactory neuropathies.

An assessment of the ship drag penalty arising from light calcareous tubeworm fouling.

A test coupon coated with light calcareous tubeworm fouling was scanned, scaled and reproduced for wind-tunnel testing to determine the equivalent sand grain roughness ks. It was found that this surface had a ks = 0.325 mm, substantially less than the previously reported values for light calcareous fouling. This result was used to predict the drag on a fouled full scale ship. To achieve this, a modified method for predicting the total drag of a spatially developing turbulent boundary layer (TBL), such as that on the hull of a ship, is presented. The method numerically integrates the skin friction over the length of the boundary layer, assuming an analytical form for the mean velocity profile of the TBL. The velocity profile contains the roughness (fouling) information, such that the prediction requires only an input of ks, the free-stream velocity (ship speed), the kinematic viscosity and the length of the boundary layer (the hull length). Using the equivalent sandgrain roughness height determined from experiments, a FFG-7 Oliver Perry class frigate is predicted to experience a 23% increase in total resistance at cruise, if its hull is coated in light calcareous tubeworm fouling. A similarly fouled very large crude carrier would experience a 34% increase in total resistance at cruise.

Indications and clinical outcomes of capsular tension ring implantation in phacoemulsification surgery at a tertiary teaching hospital: A review of 4316 cataract surgeries.

PURPOSE: To reveal the indications, clinical outcomes and complications of capsular tension ring (CTR) implantation in a series of consecutive phacoemulsification surgeries during a three-year interval. METHODS: A review of all patients undergoing cataract surgery with insertion of a CTR between 2010 and 2013 was conducted at our tertiary teaching ophthalmology department. The demographic details of patients, indications and clinical outcomes of CTR implantation were evaluated. RESULTS: Between 2010 and 2013, 4316 phacoemulsification surgeries were performed and of these surgeries CTR implantation was done in 41 eyes of 36 patients. The indications of CTR implantation were zonular dehiscence or weakness associated with mature cataract (29.2%), trauma (24.3%), pseudoexfoliation syndrome (19.5%), retinitis pigmentosa (14.6%), degenerative myopia (9.7%), and lens coloboma (2.4%). Posterior chamber intraocular lens (PCIOL) was implanted into the capsular bag in all eyes. Dislocation of PCIOL was not observed in any case. Transient IOP increased in 5 eyes (12%) and corneal edema in 14 eyes were noted. Posterior capsular opasification in 1 eye (2.4%), anterior capsule phimosis in 1 eye (2.4%) and cystoid macular edema in 1 eye (2.4%) were detected as late complications. CONCLUSION: The frequency of CTR implantation was 0.97% due to our study. In complicated cataract surgeries, CTR implantation seems to improve clinical outcomes.

Comparison of snakebite cases in children and adults.

OBJECTIVE: There are very few studies that compare the snakebite cases in children and adults. The present study aimed to compare the demographic characteristics, clinical presentations, laboratory findings, and developed complications in pediatric and adult patients due to snakebites. PATIENTS AND METHODS: This study included the patients admitted to the hospital and monitored due to snakebite between July 1999 and December 2012. The condition of each patient who had been bitten was admitted to the hospital was monitored from the time of admission to the end of their hospital stay. The fact that a snakebite occurred was recorded if the subjects saw the snake or if the appearance of the puncture sites was convincingly a snakebite. RESULTS: The present work included 290 patients, of whom 123 were children and 167 were adults. The most common location of the bites was the lower extremity with 78.9% (n=97) and 63.5% (n=106) in pediatric and adult patients, respectively. All of the pediatric patients received prophylactic treatment with antibiotics, whereas 62 (37.1%) adult patients received antimicrobial treatments due to the soft tissue infection. The most common complication developed was pulmonary edema in children at a rate of 33.3% (n=41) and compartment syndrome in adult patients at a rate of 3% (n=5). CONCLUSIONS: Patients admitted to the hospital due to snakebite should be monitored for at least 12 hours, even if there is no sign of clinical envenomation. Antivenom treatment should be administered to the patients requiring clinical staging. Patients should be kept under close monitoring to prevent the development of serious complications such as cellulitis, pulmonary edema, compartment syndrome, and disseminated intravascular coagulation.

Isokinetic Evaluation of Knee Extensor/Flexor Muscle Strength in Behcet's Patients.

BACKGROUND: Behçet's disease (BD) is an idiopathic, multisystemic, progressive disease. The purpose of this study is to compare the knee flexor and extensor isokinetic muscle strengths of Behcet's patients with that of healthy subjects. METHODS: Twenty-five (13 male and 12 female) patients with BD and 25 (15 male and 10 female) healthy individuals were included in the study. Velocities of 90°/sec, 120°/sec, and 150°/sec were used for the isokinetic muscle strength testing. Patients with active inflammatory knee arthritis were excluded. Peak torque (Nm) and peak torque adjusted to body weight (%) were taken into consideration for comparison between study groups. RESULTS: Compared to healthy controls, there was a statistically significant decrease in both the bilateral knee extensor and flexor muscle isokinetic peak torques(Nm) as well as the peak torques adjusted to body weight (%) at velocities of 90°/sec, 120°/sec and 150°/sec in patients with BD (p < 0.05). However, there was no significant difference in the agonist-antagonist ratio of the isokinetic peak torques of knee muscles between the two groups. CONCLUSION: In light of these findings, we have concluded that both knee flexor and extensor isokinetic muscle strengths are lower in BD. We therefore recommend careful monitoring of patients with BD in terms of muscle strength.