Dysregulation of kidney proteases in the pathogenesis of hypertension following unilateral nephrectomy in juvenile mice.

BACKGROUND: Unliteral nephrectomy (UNX) results in the reduction of kidney mass. The remaining kidney undergoes compensatory renal growth via hypertrophy of the glomeruli and renal tubules to maintain a normal glomerular filtration rate (GFR). These compensatory mechanisms result in increased capillary pressure and glomerular hyperfiltration to increase single nephron GFR. Over time, hyperfiltration may lead to kidney scarring and the development of hypertension. OBJECTIVES: The first objective of this study was to test the hypothesis that a 50% reduction in functioning nephrons in juvenile mice leads to increased blood pressure over a 24-hour phase. The second objective was to test the hypothesis that UNX leads to changes in the expression and activity of kidney proteases in juvenile mice. METHODS: Eight male C57B6 juvenile wild-type mice were subject to UNX and an equal number of mice were subject to sham (SH) surgery. Metabolic cage studies were performed for 5 weeks to collect urine produced during the inactive and active phases. Blood pressure was measured using the tail cuff method twice weekly and tail blood was collected on different days during the inactive or active phase of each animal. The mice were euthanized at the age of 9 weeks. Western blotting and immunohistochemistry were performed to investigate changes in renal protein expression of various cathepsins and renal kallikrein 1 (KLK1) between the two groups. Protease activity assays were performed using kidney lysates and urine samples from each group. RESULTS: Compared to the SH group, UNX mice showed a persistent increase in blood pressure at week 3 which progressed toward the end of the study at week 5 of age. Cathepsin B, D, and S expression and activity were up-regulated in kidney cortex lysates from UNX mice compared to the SH control group. KLK1 protein expression was down-regulated and urinary nitric oxide excretion was decreased in UNX mice compared to the SH control group. CONCLUSION: UNX results in the development of persistent and progressive hypertension. Down-regulation of KLK1 and up-regulation of various cathepsins may contribute to the development of hypertension via multiple mechanisms including a decrease in nitric oxide (NO) production.

Intradermal Sterile Water Injection: Safe and Effective Alternative for Relief of Acute Renal Colic in the Emergency Department.

BACKGROUND: The optimal pain relief method for acute renal colic in the emergency department remains controversial. OBJECTIVE: We compared the safety and efficacy of intradermal sterile water injection (ISWI) to treatment with intramuscular (IM) diclofenac, intravenous (IV) opioids, and IV paracetamol in patients with acute renal colic. METHODS: This randomized, single-blind study included 320 patients with renal colic to one of four treatment groups. The first group received ISWI at four different points around the most painful flank area. Patients in the DI, PARA, and TRAM groups received 75 mg IM diclofenac, 1 g IV paracetamol, and 100 mg IV tramadol, respectively. Pain intensity was measured using a visual analog scale (VAS) before treatment and 15, 30, and 60 min after treatment. RESULTS: VAS scores 15 and 30 min after treatment were significantly lower in group ISWI than in groups DI, PARA, and TRAM. However, there were no significant differences in the decrease in the pain score at baseline and at 60 min after treatment. In addition, fewer patients required rescue analgesia in group ISWI than in group TRAM. However, no significant differences were observed between group ISWI and group DI or PARA in terms of the need for rescue analgesia. Finally, there were significantly fewer adverse events in group ISWI than in groups DI and TRAM. CONCLUSIONS: ISWI had similar efficacy, faster pain relief, and lower need for rescue analgesia compared with diclofenac, paracetamol, and tramadol for the management of acute renal colic. In addition, ISWI was well-tolerated and had no adverse effects.

Ethnoveterinary uses of forage plants for domesticated ruminants in Malakand agency, Pakistan.

Plant ethnoveterinary uses are evident in various studies around the world, but the ethnoveterinary practices of forage species are not widely reported. Traditional knowledge is rapidly disappearing because of urbanization and commercial activities. The purpose of this study was to document plant species used by the local communities in Malakand Agency, Pakistan for foraging and ethnoveterinary purposes. Twenty different localities in the study area were surveyed for documentation of forage species and related traditional ethnoveterinary knowledge used for livestock. Semistructured questionnaires and field walks were used to conduct 67 interviews with local farmers and herdsmen. A total of 91 forage species from 26 families were documented, as well as their ethnoveterinary applications. Poaceae and Fabaceae were dominant families with 45% and 15% of species respectively. Among the forage species documented, 62 were highly palatable, 26 were moderately palatable and 12 were less palatable. The region's major veterinary diseases are flu, ringworms, inflammations, low milk production, constipation, bloat, mastitis, pneumonia and wounds. The 62 forage species were reported for the first time for various veterinary uses. This study revealed that local communities commonly use a diverse range of forage species in conjunction with indigenous knowledge of ethnoveterinary uses. These forage species have the potential to overcome the recent fodder shortage. Such studies will be beneficial to the commercial production of such forage species.

Comparison of Hand-Wrist Findings of Rheumatoid Arthritis Patients According to the Use of Synthetic and Biological Disease-Modifying Antirheumatic Drugs (DMARDs): A Clinical, Radiographic, and Ultrasonographic Study.

OBJECTIVE: The aim of this study is to evaluate the hand-wrist findings in patients with rheumatoid arthritis (RA) using synthetic and a combination of synthetic and biological disease-modifying antirheumatic drugs (DMARDs) in terms of ultrasonographic, clinical, and radiographic data. METHODS: The study is designed as a cross-sectional study, and 31 RA patients followed up in the rheumatology outpatient clinic were enrolled. Nineteen patients were using only synthetic DMARDs, and 12 patients were using a combination of synthetic and biological DMARDs. The clinical data of each patient were recorded simultaneously. Disease Activity Score-28 (DAS-28) was used for the assessment of disease activation, and the Health Assessment Questionnaire (HAQ) score was used for the evaluation of general health status. Bilateral proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints, and the radiocarpal, ulnocarpal, and midcarpal joints of the patients were examined by ultrasonography (US). The Sharp-van der Heijde modified score was used to determine the radiographic damage. RESULTS: There was no significant difference between the two groups in terms of demographic data, clinical findings, ESR, and CRP. When the groups were compared in terms of right and left PIP, MCP, and radiocarpal, ulnocarpal, and midcarpal synovitis grade total scores, no significant difference was found between the two groups. Radiographic total joint space scores were significantly lower in the group receiving only synthetic DMARD treatment (p=0.047) and 25-OH vitamin D levels were significantly higher (p=0.008). CONCLUSION: This study revealed that there was no significant difference between groups except radiographic total joint space scores.

Augmentation of Cathepsin Isoforms in Diabetic db/db Mouse Kidneys Is Associated with an Increase in Renal MARCKS Expression and Proteolysis.

The expression of the myristoylated alanine-rich C-kinase substrate (MARCKS) family of proteins in the kidneys plays an important role in the regulation of the renal epithelial sodium channel (ENaC) and hence overall blood pressure regulation. The function of MARCKS is regulated by post-translational modifications including myristoylation, phosphorylation, and proteolysis. Proteases known to cleave both ENaC and MARCKS have been shown to contribute to the development of high blood pressure, or hypertension. Here, we investigated protein expression and proteolysis of MARCKS, protein expression of multiple protein kinase C (PKC) isoforms, and protein expression and activity of several different proteases in the kidneys of diabetic db/db mice compared to wild-type littermate mice. In addition, MARCKS protein expression was assessed in cultured mouse cortical collecting duct (mpkCCD) cells treated with normal glucose and high glucose concentrations. Western blot and densitometric analysis showed less abundance of the unprocessed form of MARCKS and increased expression of a proteolytically cleaved form of MARCKS in the kidneys of diabetic db/db mice compared to wild-type mice. The protein expression levels of PKC delta and PKC epsilon were increased, while cathepsin B, cathepsin S, and cathepsin D were augmented in diabetic db/db kidneys compared to those of wild-type mice. An increase in the cleaved form of MARCKS was observed in mpkCCD cells cultured in high glucose compared to normal glucose concentrations. Taken together, these results suggest that high glucose may contribute to an increase in the proteolysis of renal MARCKS, while the upregulation of the cathepsin proteolytic pathway positively correlates with increased proteolysis of MARCKS in diabetic kidneys, where PKC expression is augmented.

Computer-Based Intelligent Solutions for the Diagnosis of Gastroesophageal Reflux Disease Phenotypes and Chicago Classification 3.0.

Gastroesophageal reflux disease (GERD) is a multidisciplinary disease; therefore, when treating GERD, a large amount of data needs to be monitored and managed.The aim of our study was to develop a novel automation and decision support system for GERD, primarily to automatically determine GERD and its Chicago Classification 3.0 (CC 3.0) phenotypes. However, phenotyping is prone to errors and is not a strategy widely known by physicians, yet it is very important in patient treatment. In our study, the GERD phenotype algorithm was tested on a dataset with 2052 patients and the CC 3.0 algorithm was tested on a dataset with 133 patients. Based on these two algorithms, a system was developed with an artificial intelligence model for distinguishing four phenotypes per patient. When a physician makes a wrong phenotyping decision, the system warns them and provides the correct phenotype. An accuracy of 100% was obtained for both GERD phenotyping and CC 3.0 in these tests. Finally, since the transition to using this developed system in 2017, the annual number of cured patients, around 400 before, has increased to 800. Automatic phenotyping provides convenience in patient care, diagnosis, and treatment management. Thus, the developed system can substantially improve the performance of physicians.

Tempol treatment normalizes membrane expression of epithelial transport proteins in the kidney of salt-loaded hypertensive diabetic db/db mice.

OBJECTIVE: Hypertension exacerbates the progression and severity of diabetic kidney disease. In this study, we addressed the hypothesis that tempol acts at multiple segments of the nephron to normalize the abundance of sodium coupled epithelial transport proteins in the luminal plasma membrane to mitigate high blood pressure in salt-loaded hypertensive diabetic db/db mice. METHODS: Soluble and membrane fractions from freshly homogenized kidney cortex tissue samples were resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and probed for specific proteins by Western blotting. Western blotting for specific urinary extracellular vesicle (uEV) markers and nanoparticle tracking analysis was performed to characterize each uEV preparation from each group. A one-way ANOVA was performed to determine statistical significance between three groups (hypertensive diabetic db/db mice treated with vehicle, hypertensive diabetic db/db mice treated with tempol, and wild-type mice). RESULTS: Tempol treatment reduced systolic blood pressure in hypertensive diabetic db/db mice compared to db/db mice that received vehicle. We observed attenuated membrane protein expression of the sodium hydrogen exchanger 3 (NHE3), sodium potassium chloride co-transporter (NKCC2), sodium chloride cotransporter (NCC), and epithelial sodium channel (ENaC) in the kidney of salt-loaded hypertensive diabetic db/db mice infused with tempol by osmotic minipump for 5 days compared to hypertensive diabetic db/db mice infused with vehicle. Also, the infusion of tempol in hypertensive diabetic db/db mice reduced the augmented protein expression of protein kinase c (PKC) epsilon observed in the vehicle treated hypertensive diabetic db/db kidney when compared to the healthy wild-type kidney. The amount of uEV and their size profiles were comparable between the three groups. CONCLUSIONS: This study demonstrates that tempol down-regulates epithelial transport mechanisms in each segment of the nephron and normalizes salt-induced high blood pressure in diabetic animals presumably in a PKC dependent manner.

Impacts of Demographic and Clinical Characteristics on Disease Severity and Mortality in Patients with Confirmed COVID-19.

BACKGROUND: We investigated potential predictive factors for mortality and disease severity from demographic and clinical data, comorbidities, and laboratory findings in patients with confirmed COVID-19 who were consecutively admitted to our tertiary hospital. METHODS: In this retrospective, single-center, observational study, we enrolled consecutive 540 adult patients who had COVID-19 confirmed by a molecular method. Patients were categorized into three groups based on disease severity. Patients' demographic and clinical characteristics, mortality rates, and mortality-associated factors were analyzed. RESULTS: The overall mortality rate was 4.3% (23/540). Disease severity was mild in 40.9% (n = 221), severe in 53.7% (n = 290), and critical in 5.4% (n = 29) of the patients. There were significant differences among groups in terms of median white blood cell (WBC), hemoglobin, neutrophil, lymphocyte, and thrombocyte counts, as well as C-reactive protein (CRP), procalcitonin, lactate dehydrogenase (LDH), creatinine, albumin, D-dimer, ferritin, troponin, and fibrinogen levels. Furthermore, there were significant differences between surviving and non-surviving patient groups in terms of median WBC, hemoglobin, neutrophil, and lymphocyte counts, as well as CRP, procalcitonin, LDH, creatinine, albumin, D-dimer, and ferritin levels. CRP level (odds ratio [OR]: 1.020, 95% confidence interval [CI]: 1.009-1.032; p < 0.001), and CURB-65 score (OR: 4.004, 95% CI: 1,288-12,447; p = 0.017) were independently associated with disease severity and mortality. CONCLUSION: On admission, WBC, neutrophil, lymphocyte, and platelet counts can be used to predict disease severity in patients with COVID-19. CRP, ferritin, LDH, creatinine, troponin, D-dimer, fibrinogen, and albumin levels can also be used to predict disease severity in these patients. Finally, elevated CRP level and high CURB-65 score were predictors of disease severity and mortality.

Evaluation of toxicity potential of cobalt in wheat irrigated with wastewater: health risk implications for public.

The use of wastewater in irrigation weakens the beneficial properties of the soil and leads to a threat to food safety standards. The present research was designed to explore the cobalt toxicity associated with the ingestion of wastewater irrigated wheat. Wheat plants of five different varieties were collected from 7 different sites of Punjab, Pakistan, which were irrigated with three different sources of water. The sampling was done in two cropping years. The cobalt values in water, soil and wheat samples (root, shoot, grain) ranged from 0.46 to 1.24 mg/l, 0.15 to 1.20, 0.29 to 1.30, 0.08 to 0.76 and 0.12 to 0.57 mg/kg, respectively. All the water samples showed high cobalt concentration than the maximum permissible value. However, all the soil and wheat plant samples were found within the maximum allowable range. The high cobalt concentration in irrigating water showed that the continuous usage of such type of water may lead to cobalt toxicity in living organisms with the passage of time and may results in severe health risks.

Traditional practices of the ethnoveterinary plants in the Kaghan Valley, Western Himalayas-Pakistan / Prácticas tradicionales etnoveterinarias de las plantas en el valle de Kaghan, Himalaya occidental Pakistán

Introduction: Indigenous people in a far-flung mountainous area without basic facilities, mainly rely on medicinal plants to cope with various veterinary health problems. Objective: The present study was carried out to explore the traditional knowledge of ethnoveterinary practices in Kaghan Valley, district Mansehra, Western Himalayas-Pakistan. Method: Ethnoveterinary data were collected between February to October 2014 from nine villages of the Kaghan Valley by involving 80 local people include traditional healers using a semi-structured interview. Results: A sum of 41 plant taxa of ethnoveterinary medicinal plants was documented for treating livestock ailments. Out of which, herbaceous plants were recorded with high percentage (27 species, 65.8 %). Most of the species were used to treat gastrointestinal diseases (12 taxa), followed by health improvement (7 taxa). The widely used part of plants for livestock aliments was the whole plant (9 species) followed by leaves (7 species), and preparation were paste (18 species) followed by powder with 10 species. The highest used values were recorded for Arisaema costatum (0.82), Primula denticulata (0.76), and high relative frequency citations for Berberis lyceum and Dryopteris ramosa with 0.37 each. Among the plant species Skimmia laureola, Thymus linearis and Phytolacca latbenia were among the taxa with cent fidelity level. Conclusion: The flora used in traditional remedies of the valley was found mostly endemic due to excessive utilization. Thus, further chemical investigation, better utilization and conservation of indigenous use of the reported species should be considered for future work.

Introducción: Los pueblos indígenas de zonas montañosas lejanas sin facilidades básicas dependen principalmente de las plantas medicinales para afrontar problemas de salud de tipo veterinario. Objetivo: Explorar el conocimiento tradicional en las prácticas etnoveterinarias en el valle de Kaghan, distrito de Mansehra, Himalaya occidental-Pakistán. Métodos: Se recopilaron datos etnoveterinarios mediante una entrevista semiestructurada entre febrero y octubre de 2014 en nueve aldeas del valle de Kaghan, con la participación de 80 habitantes locales, incluidos curanderos tradicionales. Resultados: Se documentó un total de 41 taxones de plantas medicinales etnoveterinarias para el tratamiento de enfermedades del ganado. Se registró un alto porcentaje de plantas herbáceas (27 especies, 65.8 %). La mayoría de las especies utilizadas han sido para tratar enfermedades gastrointestinales (12 taxones), y mejora de la salud (7 taxones). Para el tratamiento de enfermedades del ganado, lo más usual fue utilizar la planta entera (9 especies), seguida de las hojas (7 especies), con preparación en pasta (18 especies) y en polvo (10 especies). Las especies registradas con más uso fueron: Arisaema costatum (0.82), Primula denticulata (0.76) y Berberis lyceum y Dryopteris ramosa con la misma alta frecuencia relativa (0.37 cada una). Las especies Skimmia laureola, Thymus linearis y Phytolacca latbenia se reportaron entre los taxones con mayor nivel de fidelidad porcentual. Conclusión: La flora utilizada en los remedios tradicionales del valle de Kaghan fue mayoritariamente endémica. Se propone para trabajos futuros mayor investigación química, y mayor utilización y conservación en las especies de plantas reportadas por los indígenas.

Correction of High-Grade Pseudogynecomastia After Massive Weight Loss: Modified Inferior Dermoglandular Pedicled Transverse Scar Reduction.

INTRODUCTION: Whereas body-contouring surgery after massive weight loss in women receives much attention, little attention has been devoted to accentuating the male physique. Male patients after massive weight loss often suffer from redundant skin and soft tissue in the anterior and lateral chest region, causing various deformities of pseudogynecomastia. The authors present their approach to high-grade pseudogynecomastia correction with preservation of the NAC on an inferior dermoglandular pedicle with transverse scar only closure and without any meaningful liposuction. MATERIALS AND METHODS: A description of comprehensive pseudogynecomastia correction with the aforementioned technique followed by review of 58 consecutive patients operated on in our clinic from January 2017 to June 2018. Epidemiological data such as age, weight, height, body mass index (BMI), weight loss, and the medical history of each patient were collected. All patients were photo-documented preoperatively and postoperatively in a standard manner. During the operation, weight of resected tissue and operative time were noted. RESULTS: Fifty-eight patients were operated on in a single stage. In our series, one patient had unilateral partial necrosis on nipple-areola complex, and two patients had minimal to moderate amounts of hematoma which were followed up without intervention. We did not encounter any infection-related complications or skin redundancy in our patients. Out of 58 patients, 55 of all the patients were highly satisfied with the aesthetic results. Three patients were mildly satisfied with the results, but they stress that moderate scar widening was the reason for the displeasure, not the definition of the chest which was deemed as satisfactory like the rest. CONCLUSION: Our technique obviates the need for skin resection in a second operation, allows immediate skin recontouring, and provides a viable nipple-areola complex at the desired location. The patient does not have to suffer prolonged stress while awaiting skin retraction and is protected from a second dose of anesthesia and hospitalization. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Health risk assessment through determining bioaccumulation of iron in forages grown in soil irrigated with city effluent.

The irrigation with sewage water can be useful if it has no negative effects on food crop yield, soil pollution, and health of humans. However, it includes various types of contaminants like heavy metals that pollute the soil and crops. In this regard, the aim of this study was to evaluate the possible health risks of heavy metals in forages. Forages both of summer and winter were grown with different water treatments (sewage water and tap water) in Department of Botany, University of Sargodha. The concentration of iron (Fe) in water, soil, and plant samples was determined. The Fe values in tap and sewage water were observed as 0.090 and 0.115 mg/L, respectively. The highest mean concentration of Fe was 9.608 mg/kg in the soil where Trifolium alexandrinum is grown, and the lowest mean concentration was 0.154 mg/kg which occurred in the soil where Trifolium resupinatum is grown in winter. The maximum mean concentration of Fe in the root samples of plants was observed as 2.483 mg/kg in Pennisetum typhoideum, and the minimum mean concentration occurred as 0.390 mg/kg in Zea mays grown in summer. The maximum bioconcentration factor value of Fe was observed for T. resupinatum (5.259) grown in winter. The maximum pollution load index value of Fe was observed for T. alexandrinum (0.1688). The maximum value of daily intake of metals was observed as 0.0731 in Medicago sativa, and the maximum health risk index value was determined as 0.1091 in P. typhoideum.

Metal accumulation in Raphanus sativus and Brassica rapa: an assessment of potential health risk for inhabitants in Punjab, Pakistan.

Pakistan is an agricultural country and due to the shortage of clean water, most of the irrigated area (32,500 ha) of Pakistan was supplied with wastewater (0.876 × 109 m3/year). Concentrations of heavy metals in radish (Raphanus sativus) and turnip (Brassica rapa) taken from vegetable fields in Sargodha, Pakistan, were measured. Untreated wastewater was used persistently for a long time to irrigate these vegetable fields. A control site was selected that had a history of fresh groundwater irrigation. Mean metal concentrations were found for irrigation water, soil, and vegetables. In irrigation water, concentrations of Mo and Pb at three sites and Se at sites II and III were higher than the recommended limits. In vegetables, concentrations of Mo and Pb were above the maximum permissible limits. High bioconcentration factor was observed for Zn (12.61 in R. sativus and 11.72 in B. rapa) at site I and high pollution load index was found for Pb (3.89 in R. sativus and 3.87 in B. rapa) at site II. The differences in metal concentrations found in samples depended upon different soil nature and assimilation capacities of vegetables at different sites which in turn depended upon different environmental cues. The entrance of metal and metalloids to human body may happen through different pathways; however, the food chain is the chief route through which metals are transferred from vegetables to individuals. Health risk index observed for metals, (Mo, As, Ni, Cu, and Pb) higher than 1 indicated high risk through consumption of these vegetables at three sites.

An ethnobotanical study in Midyat (Turkey), a city on the silk road where cultures meet.

BACKGROUND: Studies of ethnobotanical usages in south-eastern Turkey are rare. To widen this field of knowledge, we conducted an ethnobotanical study in Midyat (Mardin Province), Turkey. METHODS: The field study was completed during three years (2007-2010). Our aim was to document the ethnobotanical uses of local plants and to make an ethnobotanical inventory of uncommon plants using qualitative interviews. RESULTS: During field studies, 368 voucher specimens were collected in the investigated area. Ninety-two traditionally used plant species were reported from Midyat and surrounding vicinities in Turkey. Among the 92 taxa (129 usages), 35% were used for medical purposes, 22% for food, 13% for animal fodder, 7% as ornamental plants and dyes, 6% as brooms, 4% for latex and as fragrance, 4% for herbal tea, molasses and wine preparation, 3% for agricultural purposes, and 6% for other purposes. Comparative assessment showed that Teucrium polium (0.51), Matricaria aurea (0.26), Alcea setosa (0.21), and Malva neglecta (0.21) have the highest recorded UVs, and the following taxa had UVs between 0.10-0.20: Anthemis cotula (0.12), Allium cepa (0.13), Alcea striata subsp. striata (0.14), Crupina crupinastrum (0.12), Papaver rhoeas (0.13), Salvia multicaulis (0.14), Thymbra spicata (0.11), and Vicia pannonica subsp. striata (0.15). We reported the ethnobotanical usages of 21 taxa for the first time, in addition to indicating usages previously recorded in the literature. We also recorded four endemic plant usages in the area: Alkanna trichophila var. mardinensis, Centaurea kurdica, Centaurea stapfiana, and Sideritis libanotica subsp. linearis. They have variable leaf and flower morphology that are used traditionally. They are present as well-developed populations and thus their conservation status is not compromised. Additionally, Thymbra sintenisii is a recorded species that is classified as a rare and extensively used species in the region. CONCLUSIONS: These results contribute to the fundamental knowledge of ethnobotanical usages in Midyat. To date, ethnobotanical studies have not been carried out in this region. This investigation uncovered usages of endemic medicinal plant species and traditional knowledge of Midyat communities living in a mixed culture. The people of Midyat, Batman, and Sirnak are Turkish citizens from various ethnic backgrounds, such as Kurdish, Arabic, and Syriac. We compared our data with results from other studies conducted in Turkey, particularly in south-eastern and eastern regions, as well as with studies from bordering countries, Iraq, Jordan, Syria, and Iran. Nonetheless, more work needs to be conducted to extend the present knowledge for locals to contribute to and evaluate economic potential in the region.

The relationships between metabolic syndrome, erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia.

OBJECTIVE: To determine the relationship between erectile dysfunction and metabolic syndrome (MetS) in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). MATERIAL AND METHODS: Seventy-eight patients who were admitted to our outpatient clinic because of BPH-related LUTS over 40 years of age were included in the study. Patients with LUTS and erectile dysfunction (ED) were evaluated by International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) forms. The National Cholesterol Education Program Adult Treatment Panel III criteria was used for the diagnosis of MetS. LUTS were classified as mild, moderate, and severe according to IPSS and ED was classified as mild- moderate, moderate, and severe according to the IIEF-5. For the evaluation of data, descriptive statistical methods (mean, standard deviation, median, frequency, ratio, minimum, and maximum) and also for the comparison of the variables with non-normal distribution in 3 or more than 3 groups Student's t test, Mann-Whitney U, ANOVA, chi-square, Fisher Exact tests, and Pearson correlation analysis were used. P<0.05 was accepted as the level of statistical significance. RESULTS: Mean age of the patients included in the study was 61.83±9.15. In 34.6% of the patients with MetS, 70.5% of the patients with ED and 37.2% of the patients with severe LUTS were determined. There were no significant differences between the mean age of patients with and without metabolic syndrome (p>0.05). There was a positive correlation with age and severity of LUTS but this relationship was not found to be statistically significant (p>0.05). Mean age of the patients with ED was significantly higher than those without (p<0.001). A statistically significant relationship was not observed between the mean IPSS scores and the severity of LUTS with Mets. However, we observed a weakly positive correlation between triglyceride levels and IPSS. Mean IIEF-5 scores of the patients with MetS were significantly lower than those of the patients without MetS. Severity of ED in the patients with MetS was significantly higher than patients without MetS. The percentage of ED in patients with severe LUTS was found to be statistically higher than other patients with mild, and moderate LUTS. In addition, we found a low degree of negative correlation between IPSS and IIEF-5 scores. CONCLUSION: In patients with LUTS as a consequence of BPH, when severity of symptoms increases, frequency of MetS increases proportionally and severe ED is observed much more frequently.

An ethnobotanical perspective on traditional fermented plant foods and beverages in Eastern Europe.

ETHNOPHARMACOLOGICAL RELEVANCE: Fermented food and beverages represent an important part of the worldwide foodscape, medicinal food domain and domestic strategies of health care, yet relevant traditional knowledge in Europe is poorly documented. METHODS: Review of primary ethnographic literature, archival sources and a few ad-hoc ethnobotanical field studies in seven selected Eastern European countries (Albania, Belarus, Bulgaria, Estonia, Hungary, Kosovo, and Poland) were conducted. RESULTS: Current or recently abandoned uses of 116 botanical taxa, belonging to 37 families in fermented food or medicinal food products were recorded. These findings demonstrate a rich bio-cultural diversity of use, and also a clear prevalence of the use of fruits of the tannin- and phenolic-rich Rosaceae species in alcoholic, lactic- and acetic acid fermented preparations. In the considered countries, fermentation still plays (or has played until recent years) a crucial role in folk cuisines and this heritage requires urgent and in-depth evaluation. DISCUSSION: Future studies should be aimed at further documenting and also bio-evaluating the ingredients and processes involved in the preparation of homemade fermented products, as this can be used to support local, community-based development efforts to foster food security, food sovereignty, and small-scale local food-based economies.

Of the importance of a leaf: the ethnobotany of sarma in Turkey and the Balkans.

BACKGROUND: Sarma - cooked leaves rolled around a filling made from rice and/or minced meat, possibly vegetables and seasoning plants - represents one of the most widespread feasting dishes of the Middle Eastern and South-Eastern European cuisines. Although cabbage and grape vine sarma is well-known worldwide, the use of alternative plant leaves remains largely unexplored. The aim of this research was to document all of the botanical taxa whose leaves are used for preparing sarma in the folk cuisines of Turkey and the Balkans. METHODS: Field studies were conducted during broader ethnobotanical surveys, as well as during ad-hoc investigations between the years 2011 and 2014 that included diverse rural communities in Croatia, Bosnia and Herzegovina, Serbia, Kosovo, Albania, Macedonia, Bulgaria, Romania, and Turkey. Primary ethnobotanical and folkloric literatures in each country were also considered. RESULTS: Eighty-seven botanical taxa, mainly wild, belonging to 50 genera and 27 families, were found to represent the bio-cultural heritage of sarma in Turkey and the Balkans. The greatest plant biodiversity in sarma was found in Turkey and, to less extent, in Bulgaria and Romania. The most commonly used leaves for preparing sarma were those of cabbage (both fresh and lacto-fermented), grape vine, beet, dock, sorrel, horseradish, lime tree, bean, and spinach. In a few cases, the leaves of endemic species (Centaurea haradjianii, Rumex gracilescens, and R. olympicus in Turkey) were recorded. Other uncommon sarma preparations were based on lightly toxic taxa, such as potato leaves in NE Albania, leaves of Arum, Convolvulus, and Smilax species in Turkey, of Phytolacca americana in Macedonia, and of Tussilago farfara in diverse countries. Moreover, the use of leaves of the introduced species Reynoutria japonica in Romania, Colocasia esculenta in Turkey, and Phytolacca americana in Macedonia shows the dynamic nature of folk cuisines. CONCLUSION: The rich ethnobotanical diversity of sarma confirms the urgent need to record folk culinary plant knowledge. The results presented here can be implemented into initiatives aimed at re-evaluating folk cuisines and niche food markets based on local neglected ingredients, and possibly also to foster trajectories of the avant-garde cuisines inspired by ethnobotanical knowledge.

Heavy metal accumulation in the bark and leaves of Juglans regia planted in Artvin City, Turkey.

The aim of this study was to determine the level of heavy metals such as copper, iron, manganese, zinc, lead, nickel, cadmium and chromium concentrated in Juglans regia bark and leaf samples from different localities in Artvin, Turkey. Analysis of the heavy metals Cu, Fe, Mn, Zn, Pb, Ni, Cd and Cr in samples was carried out by inductively coupled plasma optical emission spectroscopy (ICP-OES; Perkin Elmer, Optima 8000 DV). Statistical significance was determined by analysis of variance (ANOVA). The comparisons were performed in order to determine whether there were any differences between J. regia bark and leaf samples in terms of average heavy metal accumulation levels. As a result of this study, the following mean concentrations were determined for J. regia bark samples: the contents of Cu, Fe, Mn, Zn, Pb, Ni, Cd and Cr (µg g-1, dry weight) ranged from 72.46 to 88.14, 14.40 to 628.0, 0.896 to 67.71, 7.000 to 28.52, 0.040 to 0.905, 1.031 to 2.744, 0.011 to 0.158 and 1.192 to 3.134, respectively. On the other hand, for J. regia leaf samples, the contents of Cu, Fe, Mn, Zn, Pb, Ni, Cd and Cr (µg g-1, dry weight) ranged from 0.339 to 13.80, 12.72 to 698.2, 1.001 to 204.6, 7.362 to 56.03, 0.158 to 0.665, 0.130 to 2.744, 0.041 to 0.114 and 0.508 to 2.767, respectively. In the statistical analysis, heavy metal accumulation values of J. regia bark and leaf samples for Cu, Ni and Cr were significantly different (P < 0.05).

A distinctive presentation of diplopodia: a Y-metatarsal combining the extra foot and the extra digit of the main foot.

Diplopodia is a rare congenital anomaly and has been described as extra digits, metatarsals, and tarsal bones that form an extra foot or foot-like structure. Various skeletal deformities and anomalies involving other organ systems can accompany diplopodia. Treatment consists of surgery, splinting, and physical therapy, planned according to each patient's specific condition. We present a patient who had diplopodia with distinctive anatomic features (with postaxial polydactyly and without any anomaly of the tibia or fibula) compared with the previously reported cases, and concomitant anomalies, including left renal agenesis and anal atresia.

Foreign body penetrations of hand and wrist: a retrospective study.

BACKGROUND: Despite significant practical knowledge and experience on foreign body penetration injuries to the hand and/or wrist, deficient management and complications can still be encountered, and ignorance of its causative and eventual social aspects unfortunately is a substantial fact. This study aims to cover the clinical and social properties and the management of these kinds of injuries. METHODS: A retrospective analysis of 86 patients requiring evaluation and treatment in a Hand Surgery Division of a university hospital was performed. RESULTS: The median age was 32 (min: 4, max: 63). Industrial workers constituted the largest occupational group (n=22, 25.6%). Twenty-three (26.7%) of the cases were elective admissions. Thirteen (15.1%) patients had various comorbidities, and five (5.8%) had psychiatric diagnoses at the time of the injury. The index finger was the most frequent site of injury (n=29, 33.7%). General anesthesia was not necessary for the management of 94.2% of the cases. In 26 (30%) of the patients, neural, tendinous or osseous damage was observed. Twenty-four (30%) patients were included in a postoperative hand physiotherapy program. CONCLUSION: The practically well-known general features of the issue and those aspects that may still be overlooked currently are reevaluated herein, in light of our observational data.