Evaluation and follow-up of antibody formation after CoronaVac vaccine.

OBJECTIVE: The aim of this study was to monitor the time-dependent change by evaluating the antibody levels at the 4th, 7th, 10th, 13th, and 16th weeks after the second dose of the CoronaVac vaccine. METHODS: The study group (n=65) were between 21 and 60 years old and received two doses of the CoronaVac vaccine. Blood samples were collected after 4th, 7th, 10th, 13th, and 16th weeks of the second dose of the vaccine administration. There was a coronavirus disease 2019 recovered group (n=29) who were SARS-CoV-2 real-time PCR test result positive before the vaccination period, and no coronavirus disease 2019 history group (n=36). Age, BMI, gender, smoking, comorbidity, coronavirus disease 2019 contact history, and working in the coronavirus disease 2019 service history of the individuals were recorded. RESULTS: No statistically significant difference was found in the descriptive findings of the individuals according to coronavirus disease 2019 recovered group and no coronavirus disease 2019 history group. It was observed that antibody levels in the coronavirus disease 2019 recovered group were found to be higher for each period of serum collection compared to the no coronavirus disease 2019 history group, which were statistically significant. The distribution curves of the antibody levels according to the timing of blood collection in coronavirus disease 2019 recovered group, no coronavirus disease 2019 history group, and total subjects were extrapolated, and it was observed that the estimated time for the antibodies to reach the threshold value of the test was 214, 145, and 166 days after vaccination. CONCLUSION: It is important to make booster doses, as the CoronaVac vaccine will lose its effect after the fifth month due to the decrease in Ab levels. In addition, since the antibody levels decrease later in those who have a history of coronavirus disease 2019 infection and are vaccinated, individuals who have no previous history of coronavirus disease 2019 should be given priority for vaccination.

Possible Role of Endocannabinoids in Olfactory and Taste Dysfunctions in COVID-19 Patients and Volumetric Changes in the Brain.

Introduction: COVID-19 infection develops neurologic symptoms such as smell and taste loss. We aimed to determine the volumetric changes in the brain and correlation of possible related biochemical parameters and endocannabinoid levels after COVID-19 recovery. Methods: Brain magnetic resonance images of recovered COVID-19 patients and healthy volunteers, whose olfactory and gustatory scores were obtained through a questionnaire, were taken, and the volumes of the brain regions associated with taste and smell were measured by automatic and semiautomatic methods. Endocannabinoids (EC), which are critical in the olfactory system, and vitamin B12, zinc, iron, ferritin, thyroid-stimulating hormone (TSH), and thyroxine (T4) levels, which are reported to have possible roles in olfactory disorders, were measured in peripheral blood. Results: Taste and smell disorder scores and EC levels were found to be higher in recovered COVID-19 patients compared to controls. EC levels were negatively correlated with bilateral entorhinal cortex (ENT) volumes in the COVID-19 group. Subgenual anterior cingulate cortex volumes showed correlations with gustatory complaints and ferritin in recovered COVID-19 patients. Conclusions: The critical finding of our study is the high EC levels and negative correlation between EC levels and left ENT volumes in recovered COVID-19 patients. Implications: It is possible that ECs are potential neuromodulators in many conditions leading to olfactory disorders, including COVID-19.

Evaluation and follow-up of antibody formation after CoronaVac vaccine

SUMMARY OBJECTIVE: The aim of this study was to monitor the time-dependent change by evaluating the antibody levels at the 4th, 7th, 10th, 13th, and 16th weeks after the second dose of the CoronaVac vaccine. METHODS: The study group (n=65) were between 21 and 60 years old and received two doses of the CoronaVac vaccine. Blood samples were collected after 4th, 7th, 10th, 13th, and 16th weeks of the second dose of the vaccine administration. There was a coronavirus disease 2019 recovered group (n=29) who were SARS-CoV-2 real-time PCR test result positive before the vaccination period, and no coronavirus disease 2019 history group (n=36). Age, BMI, gender, smoking, comorbidity, coronavirus disease 2019 contact history, and working in the coronavirus disease 2019 service history of the individuals were recorded. RESULTS: No statistically significant difference was found in the descriptive findings of the individuals according to coronavirus disease 2019 recovered group and no coronavirus disease 2019 history group. It was observed that antibody levels in the coronavirus disease 2019 recovered group were found to be higher for each period of serum collection compared to the no coronavirus disease 2019 history group, which were statistically significant. The distribution curves of the antibody levels according to the timing of blood collection in coronavirus disease 2019 recovered group, no coronavirus disease 2019 history group, and total subjects were extrapolated, and it was observed that the estimated time for the antibodies to reach the threshold value of the test was 214, 145, and 166 days after vaccination. CONCLUSION: It is important to make booster doses, as the CoronaVac vaccine will lose its effect after the fifth month due to the decrease in Ab levels. In addition, since the antibody levels decrease later in those who have a history of coronavirus disease 2019 infection and are vaccinated, individuals who have no previous history of coronavirus disease 2019 should be given priority for vaccination.

Cystic schwannoma of the axillary region: imaging findings of a rare disease. Case report.

Schwannomas are well capsulated, benign, and slowly growing tumors which originate from Schwann cells of peripheral nerve sheath. The incidence of schwannomanas in the axillary region is not common. This rarity causes misdiagnosis at the radiological evaluation. In this case we present the imaging and histopathological findings of a cystic schwannoma located in the axillary fossa of a 47-year-old female patient mimicking complex cyst, lymphadenopathy or hydatid cyst in radiological evaluation. Although lymphadenopathy, lymphatic malformation, lipoma, cyst, hidradenitis suppurativa or dermatofibroma are the most frequent lesions to be considered, peripheral nerve sheath should also be kept in mind in the differential diagnosis of axillary masses.

The effect of relaparotomy timing on wound healing in an animal model.

BACKGROUND: The effect of the timing of the second laparotomy on wound healing is not clear. In an experimental study in rats, we aimed to investigate the effect of timing on wound healing after reoperations on the same surgical site. MATERIAL AND METHODS: Forty-eight rats were divided into four groups. The control group (GC) didn't have another laparotomy whereas the relaparotomies on the same surgical site were performed either on the 3rd, 15th or the 30th postoperative days in the three study groups (G3, G15, G30 respectively). The midline tension pressure, collagen types I, III and, histological analysis were performed from the specimens in order to assess the wound healing and strength. RESULTS: The tensile strength was the highest in GC and decreased gradually in G3, G15 and G30, the difference between the groups did not reach statistical significance. Higher collagen levels, increased fibrosis, and large defects were observed in relaparotomy groups than CG. The musculoaponeurotic gap was shortest in GC when compared to other three relaparotomy groups (P < 0.001) and, it was the longest in G30 (P = 0.004 between G3 and G30). CONCLUSIONS: Although non-statistically significant the gradual decrease in the tensile strength and the statistically significant increase in the musculoaponeurotic gap with time point out the importance of the timing of relaparotomy in the healing process. Early relaparotomies do not disrupt the healing process as much as relaparotomy performed later.

Percutaneous ilioinguinal-iliohypogastric nerve block or step-by-step local infiltration anesthesia for inguinal hernia repair: what cadaveric dissection says?

PURPOSE: The repair of groin hernias with local anesthesia has gained popularity. Two main methods have been described for local anesthesia. This study was aimed at comparing percutaneous truncular ilioinguinal-iliohypogastric block and step-by-step infiltration technique by using cadaver dissections. METHODS: The study was performed on an adult male cadaver by using blue dye injection. A percutaneous nerve block simulation was done on right side and the dye was given in between the internal oblique and transversus muscles. On the left side, a skin incision was deepened and the dye was injected under the external oblique aponeurosis. Following the injections, stained areas were investigated superficially and within the deeper tissues with dissection. RESULTS: There was a complete superficial staining covering the iliohypogastric and ilioinguinal nerves in the inguinal floor at both sides. On the right side, intraabdominal observation showed a wide and intense peritoneal staining, while almost no staining was seen on the left side. Preperitoneal dissection displayed a massive staining including testicular vascular pedicule and vas deferens on the right side. The dye solution also infiltrated the area of the femoral nerve prominently. On the contrary, a very limited staining was seen on the left. CONCLUSION: It may not always be easy to keep the percutaneous block within optimum anatomical limits without causing adverse events. A step-by-step infiltration technique under direct surgical vision seems to be safer than percutaneous inguinal block for patients undergoing inguinal hernia repair.

Fibrin sealant effects on the ilioinguinal nerve.

BACKGROUND: Chronic pain after mesh repair for inguinal hernia may be related to the trauma to the regional nerves by direct compression with sutures, staples, or tacks during mesh fixation. Fibrin sealant (FS) has been recommended to eliminate this risk. In this experimental study, the effects of FS on the ilioinguinal nerve when a mesh was applied was searched. MATERIALS AND METHODS: Fifteen New Zealand rabbits were used in three groups. In Group 1, a 2×1 cm, standard monofilament, pure polypropylene mesh was laid over ilioinguinal nerve. In Group 2, 0.5 ml FS was applied on the nerve without using an onlay mesh. In Group 3, a 2×1 cm mesh was laid onlay and secured with 0.5 ml FS with no fixating suture. Three months after surgery bilateral nerve samples were taken from the contiguous nerve segment for microscopic study. RESULTS: Group 1 showed prominent findings with regard to all parameters. There were significant differences between Group 1 and Group 2 in respect of fibrosis, lymphocyte, and edema scores, and foreignbody reaction. The values of Group 3, where the mesh was secured by the application of FS with no suture, were roughly placed in between Group 1 and Group 2. Prominent fibrosis and increased collagen proliferation in peripheral area of mesh was seen in Group 1 subjects, whereas a mild fibroblastic activity among mesh fibers in Group 3 subjects. CONCLUSIONS: FS has no negative effect on ilioinguinal nerve. FS application may protect the nerve from the harmful effects of polypropylene mesh in inguinal hernia repair.

Recurrent Incisional Hernia due to Pseudomyxoma Peritonei.

Pseudomyxoma peritonei is a rare but challenging neoplastic disease which is characterized with intraperitoneal mucinous-gelatinous fluid accumulation. It rarely presents as a mass mimicking abdominal wall hernias A recurrent incisional hernia due to pseudomyxoma peritonei is presented here. A 60-year-old female patient had been operated on for a left mucinous ovarian cyst 20 cm in diameter in 1998. Mucinous material had disseminated into interloop spaces through the right subdiaphragmatic region. Total abdominal hysterectomy + bilateral salpingooophorectomy and peritoneal toilet had been performed. She was rehospitalized for abdominal distention and a 4 cm defect over the incision and underwent a hernia repair using polypropylene mesh in 2001. Abdominal distention recurred to give a rise to an incisional hernia in 2006. She was reoperated for decompression and repair, but nothing could be done because of sticky adhesions and the incision were simply closed. The patient was referred to our department for operation. A prosthetic hernia repair with 30 × 30 cm polypropylene mesh was performed. The patient was discharged on the postoperative 5th day following an uneventful recovery. However, she died of disseminated disease after 18 months.

The faith of ilioinguinal nerve after preserving, cutting, or ligating it: an experimental study of mesh placement on inguinal floor.

BACKGROUND: Postherniorrhaphy chronic pain may be related to the trauma to the regional nerves or prosthetic mesh. This study was aimed to search the objective findings of prosthetic mesh placement on the ilioinguinal nerve in three different nerve treatment patterns with two different mesh types. MATERIALS AND METHODS: Thirty New Zealand rabbits were used. Bilateral ilioinguinal nerves were identified. A 2×1 cm standard polypropylene mesh was laid on the nerve on right side, whereas a same sized lightweight polypropylene was applied on the left after three different nerve treatments were carried out. The nerve was completely preserved in the first group [G1], cut by scissors without a further process in the second [G2], and proximal cut end was ligated with 5/0 polyglactin. Three months after the surgery, bilateral nerve samples were taken from the contiguous nerve segment for light microscopy and electron microscopy. RESULTS: Nerve protection could not prevent microscopic changes entirely. Prosthetic mesh itself seemed to cause histopathologic changes. Overall incidence of histopathologic changes in light microscopy, without taking the nerve treatment pattern into account, was somewhat lower at standard mesh side than that of lightweight mesh side. However this difference did not reach the level of significance (P=0.39). When three groups were evaluated in respect to overall nerve damage without paying attention to mesh type, the highest damage rate was observed in G3 (cut and ligate). When each group was compared separately within itself for histopathologic changes, no differences were observed between heavy and light mesh sides in any group. When the microscopic changes were compared in respect to the different nerve treatment patterns on heavyweight mesh side, the rates were 12.5%, 12.5%, and 33.3%, respectively. On lightweight mesh side, all three groups exhibited similar microscopic finding rates, 37.5%, 25.0%, and 33.3%, respectively. Protection of the nerve resulted in virtually zero neuroma formation after two types of mesh use. Surgical trauma to the nerve was observed to have an obvious potential for neuroma formation. Mesh type did not affect the overall neuroma rate within the whole subject pool; both groups displayed same 40% overall neuroma development rate. The neuroma incidence was in 43.8% G2 and 72.2% in G3, however the difference did not attain level of significance (P=0.09). The highest rate was observed when a lightweight mesh was used after dividing and ligating the nerve. CONCLUSIONS: Light mesh could not provide a protection in subjects whose nerves were injured during surgery. Ligation of the cut end of the nerve also could not be helpful. Nerve protection still seems to be the best way for a nerve-related complaint-free postoperative period. The merit of nerve end implantation into the muscle should also be reconsidered.

A questionnaire study on the surgeons' preferences for inguinal hernia repair after a decade.

During the 20th century, hernia repair trend changed several times. A very interesting competition has been going on between the opponents of Lichtenstein and laparoscopic repairs. We recently questioned the same issue by the same method to see if laparoscopic hernia repair found more opponents and preference rate in surgeons and physicians in Ankara, Turkey. In general 88.9% of the respondents preferred open repair, while only 11.1% chose laparoscopy. The majority of the participants who preferred an open repair stated that it was a better known technique to choice. Almost half considered local anaesthesia an advantage. Laparoscopic repair was mainly preferred for its advantages of less pain and early return to work. When three consecutive surveys among the same population in Ankara in 1997, 2001 and 2007 were compared the laparoscopic repair preference rates did not show a statistical difference (9.1%, 16.1% and 11.1% respectively).

Paravertebral block in inguinal hernia surgeries: two segments or 4 segments?

BACKGROUND AND OBJECTIVES: In this study, we compare paravertebral block (PVB) of the T10 and L1 segments and multiple-segment PVB for anesthesia and analgesia in inguinal hernia surgeries. METHODS: Anatomic study was performed on 3 cadavers. A 15-mL methylene blue solution was injected at the T10 level and then an additional 5-mL dye injection at L1 level. Fifty patients were included in the study. Patients in group 1 (n = 25) underwent PVB of 2 segments at the T10 and L1 vertebrae levels on the same side as the hernia, whereas patients in group 2 (n = 25) underwent PVB through 4 segments at T10, T11, T12, and L1 on the same side as the hernia. Perioperative propofol/remifentanil consumption, surgery start time, time to perform the block, duration of sensory block, postoperative visual analog scale scores, and complications were evaluated. RESULTS: Any passage down to the T12 level was not observed after injection at the T10 level and also only after additional 5-mL dye injection at the L1 level; the genitofemoral, ilioinguinal, iliohypogastric, and lateral femoral cutaneous nerves were stained with dye in cadavers. The times for block application were 5 mins (SD, 1 min) in group 1 and 16 mins (SD, 4 mins) in group 2 (P < 0.001). The surgery start time was 25 mins (SD, 3 mins) in group 1 and 27 mins (SD, 6 mins) in group 2 (P = 0.234). In both groups, propofol and remifentanil were used in similar quantities during the perioperative period. Use of paracetamol tablets was similar in both groups (P > 0.05). Whereas none of the patients in group 1 displayed motor block or contralateral spread, 2 patients in group 2 displayed contralateral spread, and motor block was observed in 1 patient. Twenty-three patients (92%) in group 1 and 24 patients (96%) in group 2 were satisfied with the method (P > 0.05). CONCLUSION: Two-segment PVB can be an alternative to 4-segment PVB in inguinal hernia surgeries. Decreasing the number of injections required in this technique may further increase patient comfort and decrease complications.