Research for the factors effecting the headache experienced by the health-care personnel in COVID-19 pandemic: A monocentric survey study.

OBJECTIVES: The aim of this study is to determine the factors that may be related to the headache experienced by health-care professionals in the coronavirus disease 2019 (COVID-19) pandemic. METHODS: The target population of the study consisted of the health-care professionals working in the COVID-19 pandemic. The questionnaire form consisted of 40 questions. The demographic information of the participants, the presence of contact with the COVID-19 patient, they used which personal protective equipment (PPE) and how often, the effect of the pandemic process on the lifestyle, the presence of visual defects, the effect of the pandemic process on water consumption, the presence of old or de novo headaches, the factors that may affect this headache, and the factors that reduce the pain were questioned in the survey. RESULTS: A total of 177 health-care professionals participated in the study. About 93.8% of the participants use masks daily for more than 4 h. About 62.7% of the participants stated that their water consumption increased on the days when they used PPE. About 72.3% of the participants reported disruption in sleep patterns, 83.1% of them reported increase in their stress and anxiety. About 65.5% of the participants experienced headaches during the pandemic process. They reported that the most likely causes of headache were excessive sweating and difficulty in breathing due to the use of PPE. CONCLUSION: During the pandemic, a substantial portion of health-care professionals experiences headaches. Besides the physical difficulties caused by the use of PPE, the stress caused by the pandemic process should not be ignored.

Gastric Cancer Surgery During the Pandemic: What It Costs?

BACKGROUND: From the early days of 2020, the COVID-19 pandemic continues to change whole life all around the world. Oncological patients are the most affected populations since these days. Because of decreasing numbers in surgery and endoscopy, gastric cancer patients had difficulties in treatment and diagnoses. Therefore, the early and long-term results may be affected during the pandemic. In this study, we aimed to evaluate pandemia effects on gastric cancer surgery in a single center. PATIENTS-METHODS: Patients were categorized as the COVID group and the Pre-COVID group. Patients who received neoadjuvant chemotherapy were excluded from the study. In the COVID period, 50 patients underwent gastric cancer surgery, while 64 were operated on in the pre-COVID period. Patients' demographics and clinical and pathological outcomes were evaluated. RESULTS: There was no statistically significant difference in both periods among patient characteristics such as age, gender, and body mass index. Pre-operative laboratory results were similar between two groups. Although there was no difference in operation types, an increase was detected in Clavien-Dindo grade 3 and higher complications during the COVID period. During the pandemic, there was a significant difference in the pathological outcomes. Peritoneal cytology-positive patients were higher in the COVID group. More lymphovascular invasions were also detected in the COVID period. Finally, it resulted stage differences between two groups. CONCLUSION: Because of COVID-19's heavy burden on healthcare system, delays in the diagnosis and treatment of oncological patients may occur. Therefore, this may be affected pathological and survival outcomes of cancer patients. Finally, further investigations are needed.

Amorphous Solid Dispersions Containing Residual Crystallinity: Competition Between Dissolution and Matrix Crystallization.

Crystallinity in an amorphous solid dispersion (ASD) may negatively impact dissolution performance by causing lost solubility advantage and/or seeding crystal growth leading to desupersaturation. The goal of the study was to evaluate underlying dissolution and crystallization mechanisms resulting from residual crystallinity contained within bicalutamide (BCL)/polyvinylpyrrolidone vinyl acetate copolymer (PVPVA) ASDs produced by hot melt extrusion (HME). In-line Raman spectroscopy, polarized light microscopy, and scanning electron microscopy were used to characterize crystallization kinetics and mechanisms. The fully amorphous ASD (0% crystallinity) did not dissolve completely, and underwent crystallization to the metastable polymorph (form 2), initiating in the amorphous matrix at the interface of the amorphous solid with water. Under non-sink conditions, higher extents of supersaturation were achieved because dissolution initially proceeded unhindered prior to nucleation. ASDs containing residual crystallinity had markedly reduced supersaturation. Solid-mediated crystallization (matrix crystallization) consumed the amorphous solid, growing the stable polymorph (form 1). Under sink conditions, both the fully amorphous ASD and crystalline physical mixture achieve faster release than the ASDs containing residual crystallinity. In the latter systems, matrix crystallization leads to highly agglomerated crystals with high relative surface area. Solution-mediated crystallization was not a significant driver of concentration loss, due to slow crystal growth from solution in the presence of PVPVA. The high risk stemming from residual crystallinity in BCL/PVPVA ASDs stems from (1) fast matrix crystallization propagating from crystal seeds, and (2) growth of the stable crystal form. This study has implications for dissolution performance outcomes of ASDs containing residual crystallinity.

Targeting a hidden site on class A beta-lactamases.

Increasing resistance against available orthosteric beta-lactamase inhibitors necessitates the search for novel and powerful inhibitor molecules. In this respect, allosteric inhibitors serve as attractive alternatives. Here, we examine the structural basis of inhibition in a hidden, druggable pocket in TEM-1 beta-lactamase. Based on crystallographic evidence that 6-cyclohexyl-1-hexyl-ß-D-maltoside (CYMAL-6) binds to this site, first we determined the kinetic mechanism of inhibition by CYMAL-6. Activity measurements with CYMAL-6 showed that it competitively inhibits the wild type enzyme. Interestingly, it exhibits a steep dose-response curve with an IC50 of 100 µM. The IC50 value changes neither with different enzyme concentration nor with incubation of the enzyme with the inhibitor, showing that inhibition is not aggregation-based. The presence of the same concentrations of CYMAL-6 does not influence the activity of lactate dehydrogenase, further confirming the specificity of CYMAL-6 for TEM-1 beta-lactamase. Then, we identified compounds with high affinity to this allosteric site by virtual screening using Glide and Schrödinger Suite. Virtual screening performed with 500,000 drug like compounds from the ZINC database showed that top scoring compounds interact with the hydrophobic pocket that forms between H10 and H11 helices and with the catalytically important Arg244 residue through pi-cation interactions. Discovery of novel chemical scaffolds that target this allosteric site will pave the way for a new avenue in the design of new antimicrobials.

Effects of music on complications during hemodialysis for chronic renal failure patients.

The study was planned as a case-control study to examine the effects of music on some of the complications experienced by chronic renal failure (CRF) patients during hemodialysis. A total of 60 patients (30 intervention and 30 control) diagnosed with end-stage renal failure undergoing hemodialysis treatment participated in this study. The study was conducted in Manisa Merkez Efendi State Hospital Hemodialysis Unit and Manisa Özel Anemon Hemodialysis between April 2012 and July 2012. The intervention group listened 30 minutes in each session (12 total sessions) Turkish art music at the beginning of the third hour of their hemodialysis sessions. Patient Information Form and visual analog scale to assess pain, nausea, vomiting, and cramps during hemodialysis session were used. For the analysis of data, the number, percentage, chi-square test, and significance test of independent group differences between two averages were conducted. According to the findings of the study, the average of the intervention and control group ages, respectively, was 50.86 ± 11.3 and 55.13 ± 9.68. The primary duration of hemodialysis treatment for both intervention and control groups was "1 year and above" (70.0%). The intervention group's pain and nausea scores were lower than the control group for all 12 sessions. The difference between the intervention and the control group's pain scores was significant (P < 0.05). However, in pain scores from the first session to 12th session, continuous decreasing trend was not observed. According to the results, music can be used as an independent nursing practice for reduction of complications for CRF patients receiving hemodialysis treatment.

Investigation of biomarker in laryngeal carcinomas.

BACKGROUND: The aim of the study is to determine whether there is a role of podoplanin and glutathione S-transferases T1 (GST-T1) expression in laryngeal squamous cell carcinoma. METHODS: In this study, 33 patients were enrolled and gene expression analysis was performed by qRT-PCR. The podoplanin and GST-T1 expression patterns were analyzed to determine their correlation with clinicopathologic parameters of laryngeal cancer. RESULTS: Of all included patients, 20 had supraglottic, and 13 had glottic laryngeal cancer. Increased expression of podoplanin was found in seven (35%) supraglottic tumor tissues and seven (53.8%) glottic tumor tissues, but GST-T1 expression was not detected. CONCLUSION: Podoplanin expression did not show any prediction for tumor differentiation, regional metastasis, thyroid cartilage invasion, lymphatic vessel invasion, or tumor differentiation for laryngeal cancer, and also there were no significant differences in podoplanin expression between glottic and supraglottic regions, but extracapsullar extension is almost statistically significance (P = 0.05).

Investigation of a possible relationship between EPHX1 gene polymorphisms and colorectal cancer in Turkish society.

Metabolism of chemical carcinogens, including their activation and detoxification, plays a key role in carcinogenesis. Microsomal epoxide hydrolase (EPHX1) has an important role in the metabolism of polycyclic aromatic hydrocarbons and detoxification of procarcinogens. The aim of this study was to investigate the association between colorectal cancer (CRC) development and EPHX1 gene polymorphisms. We investigated the polymorphisms in exon 3 (T>C, Tyr113His) and exon 4 (A>G, His139Arg) of the EPHX1 gene in 68 CRC patients and 116 controls by polymerase chain reaction-restriction fragment length polymorphism. The frequencies of the Try113Try, Try113His, and His113His for EPHX1 exon 3 were 37.9%, 55.2%, and 6.9% in controls and 39.7%, 42.6%, and 17.6% in CRC patients, respectively. Frequencies of EPHX1 exon 4 genotypes were 62.1% His139His, 37.9% His139Arg, and 0% Arg139Arg in the control group and 76.5% His139His, 22.1% His139Arg, and 1.5% Arg139Arg in the patient group. Individuals carrying the EPHX1 exon 3 His113His genotype had a 2.5-fold increased risk (p=0.024), and those carrying the EPHX1 exon 4 His139Arg genotype had decreased risk of CRC compared with controls (p=0.019). Even though exon 3 Tyr113His and exon 4 His139Arg polymorphisms for EPHX1 gene appear to be important factors for CRC risk, further investigations with larger study groups are needed to fully elucidate the role of these polymorphisms in the development of CRC.

Association of serum lipoprotein-associated phospholipase A2 level with nonalcoholic fatty liver disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is one of the most common causes of chronic liver disease, worldwide. Lipoprotein-associated phospholipase A2 (Lp-PLA2) was recently characterized as a novel inflammatory biomarker that is correlated with several components constituting the metabolic syndrome. METHODS: In this study, we determined the serum levels of Lp-PLA2 in patients with definite nonalcoholic steatohepatitis (NASH, n=25), borderline NASH (n=22), simple fatty liver (n=10), and healthy controls without evidence of liver disease (n=38). The levels of Lp-PLA2 were measured by enzyme-linked immunosorbent assay and compared in the four study groups. Moreover, concentrations of Lp-PLA2 were assessed in relation to the general characteristics of the study participants and the results of liver biopsy. RESULTS: Concentrations of Lp-PLA2 were significantly higher in patients with definite NASH (161.8±0.9 µg/L, P<0.001), borderline NASH (135.4±47.7 µg/L, P=0.001), and simple fatty liver (132.4±46.2 µg/L, P=0.042) compared with healthy controls (86.2±40.7 µg/L). Furthermore, the serum Lp-PLA2 level was strongly associated to histological steatosis scores in patients with NAFLD (ß=0.32, t=2.50, P=0.016). CONCLUSION: Although subject to future confirmation, our data suggest that Lp-PLA2 levels are elevated in NAFLD.

Relationship of Podoplanin and Glutathione S-transferases T1 Expression with Laryngeal Cancer.

The aim of this study is to determine whether there is a role of podoplanin and glutathione S-transferases T1 (GST-T1) expression in laryngeal squamous cell carcinoma. The study was completed with 33 patients and gene expression analysis was performed by qRT-PCR. The podoplanin and GST-T1 expression patterns were analyzed to determine their correlation with clinicopathologic parameters of laryngeal cancer. Of all patients, 20 had supraglottic, and the remaining 13 had glottic laryngeal cancer. Increased expression of podoplanin was found in 14 tumor tissues, but GST-T1 expression was not detected. Podoplanin expression did not show any prediction for regional metastasis, thyroid cartilage invasion, lymphatic vessel invasion or tumor differentiation for laryngeal cancer, also there were no significant differences in podoplanin expression between glottic and supraglottic regions, but extracapsullar extension is almost statistically significant (p=0,05).

The association of urinary albumin excretion and metabolic complications in polycystic ovary syndrome.

OBJECTIVE: This study was planned to screen polycystic ovary syndrome (PCOS) women for albuminuria and to evaluate the association between urinary albumin excretion (UAE) and metabolic disturbances of PCOS. In addition, this is the first study in the literature evaluating the association between UAE and carotid intima-media thickness (CIMT) in PCOS cases. STUDY DESIGN: The study population consisted of 65 PCOS women. The study was prospectively designed and performed in a university hospital. The diagnosis of PCOS was made according to the Rotterdam criteria: exclusion criteria were hyperprolactinemia, thyroid dysfunction, adrenal dysfunction, diabetes mellitus, hypertension, and pregnancy. Blood samples were collected in the follicular phase of a menstrual cycle and serum samples were analyzed for fasting glucose, insulin, and hormone and lipid profiles. Twenty-four hour urine specimens were collected for the detection of UAE. CIMT was estimated by visual assessment of the distance between the lumen-intima and intima-adventitia interfaces. RESULTS: The mean age and BMI were 23 years and 23 kg/m(2), respectively. The median UAE was 7 mg/day (range: 0.3-154 mg/day). The median UAE as micrograms of albumin per milligram of creatinine (uACR) was 5.6 (0.28-159). Regarding the uACR cutoff value (>6.93 µg/mg), significantly higher levels of triglycerides, 17 OH-progesterone, insulin resistance (HOMA index > 2.1) and increased CIMT were present in these cases. Microalbuminuria (uACR > 25 µg/mg) was present in 6.2%. In the regression analyses serum HDL-C levels were found to be independent predictor for uACR > 2 µg/mg (OR: 0.85) and estradiol levels were the independent predicting factor for uACR > 6.93 µg/mg even after adjustments for age and BMI were performed (OR:1.02). CONCLUSIONS: UAE, expressed as uACR > 6.93 µg/mg, seems to be an associated sign of metabolic problems which might help in discriminating PCOS at risk of future CVD. Further studies are needed before routine use of albuminuria in PCOS cases for the detection of CVD risk.

The value of copper and zinc levels in hernia formation.

BACKGROUND: A defect in collagen metabolism is suspected to be one of the factors responsible for hernia formation. Lysyl oxidase is a copper-dependent enzyme in the process that provides for the structural integrity of collagen molecules, while zinc is essential for tissue maintenance. MATERIALS AND METHODS: In a prospective fashion, copper and zinc levels were measured in plasma and tissue specimens obtained from indirect (n=23), direct (n=20) and incisional hernia patients (n=19) and from healthy controls (laparoscopic cholecystectomy patients, n=15) by enzymatic colorimetric analysis. RESULTS: Groups were similar in age, comorbid diseases and body mass index. Whereas plasma levels of Cu and Zn in hernia and control patients were similar, and tissue levels were significantly lower in all hernia groups (especially the incisional hernia group) compared to controls (P<0·001). The incisional hernia group had significantly lower tissue copper levels than direct hernia patients and lower zinc levels than indirect hernia patients. CONCLUSIONS: Patients with all types of hernia, especially those with incisional hernias, have significantly lower tissue copper and zinc levels than control patients, despite having similar plasma levels. This finding might reflect excessive consumption or dysfunction of lysyl oxidase as playing a role in the aetiology of hernias.

[Investigation of the effect of constructions in hospital environment on the crucial units for immunocompromised patients and the development of opportunistic mold infections]. / Hastanede yapilan insaat calismalarinin immün sistemi baskilanmis hastalarin bulundugu cevre ve firsatçi küf enfeksiyonlari gelisimi uzerindeki etkisinin arastirilmasi.

This study was planned to determine the effect of building constructions in and around our hospital, on the development of opportunistic mold infections in immunocompromised patients hospitalized in bone marrow and kidney transplantation units and haematology and oncology units. Samples were collected from high risk units by an air sampler (Air Ideal) from indoors and outdoors of a total of 43 patient rooms. The most commonly isolated species from indoor air cultures of our hospital were Penicillium spp. (50.6%), Cladosporium spp. (20%), Chrysonilia spp. (11%) and Aspergillus (10.6%) species. When outdoor samples were considered, Penicillium spp. (38.8%) was still in the first line, followed by Cladosporium spp. (24.3%), Paecillomyces spp. (10.7%) and Aspergillus (8.7%) species. There was no statistically significant difference of total colony and spore numbers between the samples obtained from indoor and outdoor air (p > 0.05), indicating the close relation with the construction studies in and around the hospital. Clinical samples including bronchoalveoler lavage (BAL) fluid, sputum, endotracheal aspirate and sinus tissue were collected from the total of 43 patients staying at these air sampled rooms, and eight of them (18.6%) yielded positivity for the growth of molds. Of them four were identified as Penicillium chrysogenum (sputum isolates), two as Aspergillus fumigatus (sputum and BAL isolates), one as Aspergillus flavus (BAL isolate), and one as Valsa sordida (sinus tissue) which is considered as a plant pathogen. A total of 53 sera, BAL, and tissue supernatant samples were screened by ELISA for the presence of galactomannan antigen, and five of the eight patients whose cultures were positive were also found positive for galactomannan antigen. One patient has died due to invasive aspergillosis whose BAL specimen and indoor air sample were positive for A. fumigatus. In evaluation of indoor air samples before and after the change of HEPA filters, statistically significant decrease was detected in total colony and spore numbers between the samples taken before and after the filter changes (p < 0.005). This study has emphasized the importance of examination of mold flora of indoor air and clinical samples of high risk group patients intermittantly, in order to prevent opportunistic mold infections in crucial units especially during hospital constructions.

[The relationship between Candida albicans colonization indices and the presence of specific antibodies in non-neutropenic intensive care unit patients]. / Nötropenik olmayan yogun bakim hastalarinda Candida albicans kolonizasyon indeksi ve özgül antikor yaniti arasindaki iliskinin irdelenmesi.

Since nosocomial candidemiae is mainly evolved from the endogenous flora of the patients, the detection of colonization indices may guide for the risk of infection especially in intensive care unit (ICU) patients. The aims of this study were the detection of colonization rates of ICU patients with Candida spp., establishment of C. albicans colonization index (CI), and investigation of the relationship between the presence of C. albicans IgM and IgG antibodies and colonization indices. A total of 191 swab specimens collected from at least five different body sites of 37 patients, together with 29 serum samples were included to the study. The rate of patients colonized with Candida spp. was found 70.3% (26/37). C. albicans were isolated from 43 samples of 22 patients, whereas C. tropicalis, C. glabrata, C. krusei and C. parapsilosis were isolated from one each patient's single samples. In seven (27%) of 26 colonized patients, CI was found high (> 0.5), and all of them were found to be colonized with C. albicans. Five of the seven patients with CI > 0.5 were detected as IgM + IgG positive, and one was IgG positive, while one patient's serum could not be obtained. Nineteen patients yielded low CI (< 0.5), of which 15 were found to be colonized with C. albicans. Twelve serum samples could be obtained from these patients, and three were found positive for IgM + IgG, six were positive for IgG alone, whereas three were negative for anti-C. albicans. Seven serum samples could be collected from 11 non-colonized patients, and only two (18.2%) have yielded IgG positivity. A statistically significant difference was detected in IgM positivity (p<0.05), although there was no significance in IgG positivity (p > 0.05) between the patients with high and low colonization indices. In the follow-up of the patients, no candidemiae developed and this was thought to be due to the preventive measures which were taken especially in ICU patients with CI > 0.5. As a result, the follow-up of the ICU patients in terms of C. albicans CI and IgM would be effective for the prevention of serious Candida infections.

[The use of the nested real-time polymerase chain reaction in the diagnosis of Toxoplasma gondii infections.]. / Toxoplasma gondii infeksiyonu tanisinda iki turlu gerçek zamanli (real-time) polimeraz zincir reaksiyonu yönteminin kullanilmasi

This study was performed in order to investigate the presence of Toxoplasma gondii (T. gondii) DNA, in various clinical specimens, obtained from different clinics, using the real-time polymerase chain reaction. Investigation of a total of 80 specimens was carried out using B1 gene region specific primers and probes after the extraction of T. gondii DNA. T. gondii DNA was found in three out of 80 specimens. Out of the three specimens found to be positive for T. gondii DNA, two were amniotic fluid specimens obtained from the Obstetrics and Gynecology Department and one, a cerebrospinal fluid specimen obtained from the Neonatology Department. T. gondii DNA was not found in the blood of a CSF-positive case. DNA was not found in the specimens of the remaining 77 patients.