Contrast­induced acute kidney injury in COVID-19 patients.

METHODS: Forty-two COVID-19 patients who underwent emergency PCI due to the diagnosis of acute coronary syndrome were included in the study. Mean age was 63±14.76 and males accounted for 81 % (34/42). Contrast-induced acute kidney injury (CI-AKI) was defined as absolute increase in serum creatinine level by 0.3 mg/dL above baseline within 48 hours of contrast exposure. Patients were divided into two groups according to CI-AKI development following coronary angiography. RESULTS: CI-AKI developed in 33.3 % (14/42) of the patients. Pre-procedure e-GFR (p=0.028), serum albumin levels (p=0.021), and ejection fraction (p=0.039) were lower in the CI-AKI group. Whereas the platelet/lymphocyte ratio was significantly lower in the non-CI-AKI group (p=0.010). CONCLUSIONS: Our study results demonstrated that patients suffering from COVID-19 had a high risk of CI-AKI development following coronary angiography (Tab. 1, Ref. 36).

Characteristic features of thermoluminescence in neodymium-doped gallium sulfide.

The thermoluminescence (TL) of neodymium-doped gallium sulfide (GaS:Nd) single crystals was measured from 10 K to room temperature with various heating rates between 0.2 and 1.0 K/sec. Two peaks centered at 70.9 K and 116.0 K were observed when using a heating rate of 0.8 K/sec. Initial rise and curve fitting methods were used to obtain information on trap activation energies. Activation energies of 94 and 216 meV were found for two analyzable peaks. The heating rate dependencies of TL intensities revealed that one of the observed peaks showed normal behavior according to the one trap-one recombination model, whereas the other model showed anomalous heating rate behavior. TL experiments were also carried out at different illumination temperatures from 10 to 32 K; maximum peak temperature remained almost the same at various illumination temperatures. This behavior indicated that the revealed trapping centers are single, discrete levels. The TL glow curves of undoped GaS crystals were also investigated and the effect of Nd doping on the TL characteristics of crystals is discussed in the manuscript.

Cytopathology of pericardial effusions : Experience from a tertiary center of cardiology.

BACKGROUND: Pericardial effusion (PE) is a common clinical condition that can develop as a result of systemic or cardiac diseases. Here, we report the results of cytology for patients who underwent pericardiocentesis for PE. METHODS: The study comprised 283 patients who underwent primary percutaneous pericardiocentesis between 2007 and 2016. The mean age of the patients was 60.0 ± 16.6 years; 162 (57.2%) were male and 121 (42.8%) were female. The presence of reactive mesothelial cells, acute and chronic inflammatory cells, and/or blood without evidence of malignant cells was considered as benign. The presence of malignant cells with/without reactive mesothelial cells, inflammatory cells, and/or blood was considered as malignant. RESULTS: The vast majority of PE specimens (219 cases; 77.4%) were classified as benign. Only 20 cases (7.1%) were classified as atypical, and malignant cells were present in the PE specimens of 44 cases (15.5%). The most common diagnosis was benign PE. The most commonly encountered malignancy was lung cancer. The rate of malignancy was 1.9% in the serous group and 24% in the hemorrhagic group, which was statistically significant. CONCLUSION: Benign PE was the most frequent cytological diagnosis in our study. Chronic nonspecific pericarditis was the most frequent type of pericarditis in the benign PE group, while lung adenocarcinoma was the most frequent malignancy in the malignant PE group. The rate of malignancy was significantly higher in the hemorrhagic group than in the serous group.

Comparison of infracondylar versus subsartorial approach to saphenous nerve block: A randomized controlled study.

BACKGROUND AND OBJECTIVES: Only a few different approaches are currently utilized for saphenous nerve block. Our study aimed to compare two different ultrasound (US)-guided saphenous nerve blocks and designed this study to test the hypothesis that the medial infracondylar approach has more success rate than the subsartorial approach applied in saphenous nerve blockage. METHODS: The study included 76 patients (18-65 years old) with the American Society of Anesthesiologists physical status of I-III, who were scheduled for below-knee surgery by the orthopedics clinic. The patients who underwent US-guided saphenous nerve blockade were randomly divided into two groups: Group S (subsartorial approach) and Group M (medial infracondylar approach). For all patients who had a block procedure, the pinprick test was performed using a blunt needle on the saphenous nerve dermatome. Success rate, time of block performance (TBP), onset time of block (OTB), and duration of sensory blockade (DSB) were recorded using a patient follow-up form. RESULTS: The US-guided saphenous nerve block success rate was similar (88% vs. 91%) or both techniques. The DSB values were 415.2 ± 65.3 min (95% confidence interval [CI]: 286.3-539.8) for Group S and 369.7 ± 52.2 min (95% CI: 265.6-467.8) for Group M (P = 0.04), and no significant differences in the TBP and OTB were observed between the groups. CONCLUSION: Both of the different anatomical approaches have equally high success rates. Although the DSB was found to be significantly longer in the subsartorial approach, this is clinically unimportant, and the medial infracondylar approach is still a viable alternative technique during saphenous nerve blockage.

Comparison of the effectiveness of medicinal leech and TENS therapy in the treatment of primary osteoarthritis of the knee : A randomized controlled trial.

OBJECTIVES: The aim of this study was to evaluate the effects of leech therapy in the treatment of knee osteoarthritis in terms of duration of effectiveness and symptom relief and to compare these results with transcutaneous electrical nerve stimulation (TENS) therapy. MATERIAL AND METHODS: This study was designed as a prospective, single center, randomized, single-blind and parallel group study. A total of 90 patients were included in the study, 46 in the leech group and 44 in the TENS group. Primary outcome measures were changes of the pain scores in visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) on the measurements day 0, 21 and 180. Secondary outcome measures were the changes in the sub-groups of the WOMAC scores. Five leeches were applied to the affected knee, once every week for 3 weeks. RESULTS: The VAS pain score showed a similar decrease in both groups in the evaluation on day 21 (p < 0.001). The course of the change of the VAS pain score in both groups was similar in the comparisons between groups. Long-term benefits of the TENS therapy group were slightly more than the leech therapy group. All the sub-scores of WOMAC in both therapy groups showed a similar decrease (p = 0.819). Throughout the study this decrease was statistically significant in both groups (p < 0.001). CONCLUSION: Leech therapy relieves symptoms in patients with osteoarthritis of the knee and is as effective as TENS therapy in the management of osteoarthritis of the knee. This treatment has the potential of being an additional or alternative therapy for the non-surgical management of osteoarthritis of the knee.

The expression of miR-181a-5p and miR-371b-5p in chondrosarcoma.

OBJECTIVE: Chondrosarcomas are malignant tumors of chondrocytes that affect bones and joints, and it represents the third most common type of primary bone tumors. Chondrosarcoma is difficult to treat because it is relatively resistant to both chemotherapy and radiation. Thus, surgery remains the best available treatment. It is important to find new diagnostic markers and improve treatment options. BACKGROUND: miRNAs are small non-coding transcripts (19-25 nucleotides) that regulate gene expression via targeting complementary sequences within messenger RNAs (mRNAs). miRNAs have been shown to be involved in regulation of many biochemical pathways. Dysregulated expression of many miRNAs has also been associated with multiple human diseases, such as cancer. PATIENTS AND METHODS: 18 surgical chondrosarcoma specimens were obtained from patients. RNA extractions were performed from decalcified paraffin embedded tissues. The aim of this study was to investigate the expression levels of miR-181a and miR-371b in patients with chondrosarcoma by using RT-PCR and to evaluate the relationship between these miRNAs and chondrosarcoma. RESULTS: miR-181a was found to be upregulated in chondrosarcoma specimens whereas no significant alteration was found for miR-371b expression. CONCLUSIONS: It has been proposed that miRNA expression studies might be used as diagnostic, prognostic marker in cancer. miRNA expression data produced in our study may contribute future chondrosarcoma diagnosis and therapy.

Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres.

Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. In total 56 patients met the inclusion criteria. The number of patients without additional injury was 22 out of which according to the Robert's criteria, 15 children (68%) had an excellent, four (18%) a good, one (5%) a fair, and two (9%) a poor outcome. From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes.

Analysis of the effects of heparin and enoxaparin on degloving injuries.

BACKGROUND: Heparin and low molecular weight heparin are the most frequently used antithromboembolic drugs in fractures. OBJECTIVES: We aimed to compare the effects of heparin and enoxaparin, which are used as standard treatment, on viability in degloving injuries. METHODS: Thirty rats were used in the study. Three groups were composed including 10 rats in each group. Degloving injuries were formed in the tails of the rats. Enoxaparin was injected subcutaneously to the rats in group 1. Standard heparin was injected subcutaneously to the rats in group 2. Serum physiologic solution was injected subcutaneously to the rats in group 3. The experiment was ended on day 15. The tails of the rats were evaluated clinically and histopathologically. RESULTS: There was a statistically significant difference in the clinical results (p < 0.05). There was a statistically significant difference in the histopathological results (p < 0.05). CONCLUSIONS: We encountered positive effects of both heparin and enoxaparin on the treatment of degloving injuries in this experimental study. However, the findings of this study should be supported and improved by new experimental and especially clinical studies (Fig. 3, Ref. 18).

The insertion/deletion polymorphism in the ACE gene and chronic obstructive pulmonary disease.

An insertion/deletion (I/D) polymorphism was identified in intron 16 of the gene encoding the human angiotensin I-converting enzyme (ACE), a candidate gene for chronic obstructive pulmonary disease (COPD). We investigated the relationship between this polymorphism in the ACE gene and the risk of developing COPD. Sixty-six COPD in-patients and 40 non-smoking control individuals were recruited for this study. The distribution of ACE genotypes in these individuals was studied. The frequencies of ACE genotypes were found to be 47.0% for DD, 30.3% for ID, and 22.7% for II in the COPD group and 32.5% for DD, 47.5% for ID, and 20.0% for II in the control group. The allele frequencies were found to be 0.62% for the D allele and 0.38% for the I allele in the COPD group and 0.56% for the D allele and 0.44% for the I allele in the control group. A significant difference was found between I and D allele frequencies (P < 0.05) of the study and control groups. Our results suggest that this ACE polymorphism may be associated with the development of COPD.

What are the predictors of scapula fractures in high-impact blunt trauma patients and why do we miss them in the emergency department?

AIM: To find out the predictors of scapula fractures in high-impact blunt trauma patients and the predictors of missing them in the emergency department (ED). METHODS: This is a retrospective descriptive review of patients treated at a single hospital over a 3.5-year period. The study included 1,039 high-impact blunt trauma patients of any age. The patients were divided into two groups: patients with scapula fractures (the patient group) and others (the control group). The patient group was re-assessed into two subgroups: patients with and without missed scapula fractures. Logistic regression analysis was used to assess the predictors of a scapular fracture in the ED. RESULTS: The incidence of scapula fractures was 4%. The Injury Severity Scores (ISS) of the scapula fracture group were significantly higher than those of the control group (P < 0.0001). Patients with scapula fractures were significantly older (P < 0.001). Patients with scapular body fractures stayed for significantly longer in the intensive care unit (ICU) (P = 0.039) and their mean Abbreviated Injury Scale (AIS)face score was higher (P = 0.04) compared to scapular fractures without body parts. Scapula fractures were missed in 35.7% of patients. All bilateral scapula fractures were missed. Computerized tomography showing shoulder region or scapula was obtained in 26.7% of missed injuries. CONCLUSION: After matching for ISS, the mortality of patients with scapula fracture was significantly higher than the control group. We observed that fractures in the glenoid and scapular neck occurred higher than in the body region. We found that the seniority of the ED doctor, consultation ratio for orthopedics in ED, and the existence of brain contusion were important parameters for missing scapula fractures in ED.

Safety and efficacy of FOLFIRI-bevacizumab for metastatic colorectal carcinoma as second line treatment.

PURPOSE: To evaluate the efficacy and the safety of FOLFIRI-bevacizumab (B) in the 2nd line therapy of metastatic colorectal carcinoma (MCRC). METHODS: Between March 2006 and July 2009 35 patients with MCRC were treated with 2nd line therapy FOLFIRI- B (irinotecan 180 mg/m(2) D1, folinic acid 200 mg/m(2) D1, 5-fluorouracil/5 FU 400 mg/m(2) bolus D1, followed by 5 FU 2600 mg/m(2) 46-h continuous infusion, and bevacizumab 5 mg/kg D1, every 2 weeks) Their data were collected and analysed. RESULTS: The patient median age was 54 years (range 36-75). One patient (2.8%) had received oxaliplatin-based adjuvant chemotherapy and 33 patients (94.3%) were exposed to oxaliplatin during first line chemotherapy for MCRC. The median follow up period was 12.2 months (range 1.5-37.9). Complete remission (CR) was achieved in 5.7% of the patients and the sum of CR and partial remission (PR) was 11.4%. Disease control (CR+PR+stable disease/SD) was registered in 74.3% of the patients. During follow up, progression (PD) was seen in 32 (91.4%) patients and 23 (65.7%) patients had died. The median progression free survival (PFS) was 7.4 months (95%CI 5.5-9.3) and the median overall survival (OS) 13 months (95%CI 8.8-17.2). Grade 3-4 toxicity requiring delay of chemotherapy was observed in 12 (34.3%) patients with 10 patients (28.6%) having neutropenia and 2 (5.7%) diarrhea. CONCLUSION: FOLFIRI-B may be an efficient and safe choice in the 2nd line treatment of patients with MCRC previously treated with oxaliplatin.

Gastric adenocarcinoma under the age of 40; more metastatic, less differentiated.

PURPOSE: Gastric carcinoma is relatively rare under the age of 40 years, and the mean age at presentation is 65 years. Histologically, adenocarcinoma prevails. Previous studies state that gastric adenocarcinoma under 40 is more aggressive. The present retrospective study was undertaken to clarify the clinicopathological characteristics of gastric adenocarcinoma in patients under 40 and to compare their clinical features with the patients over 40 years of age. METHODS: All of the patients with histologically diagnosed gastric adenocarcinoma who had applied to our department from March 2001 to September 2009 were retrospectively evaluated. Patients were stratified according to their age at diagnosis (≤ 40 years; group 1, and > 40 years; group 2). Their clinical, laboratory, and pathological characteristics were analyzed. RESULTS: 251 patients were studied. Sixty-eight percent of those under 40 and 46% over 40 had poorly differentiated histology (p= 0.036). Fifteen (60%) patients under 40 and 73 (32.3%) over 40 had metastatic diseases (p=0.007). CONCLUSION: Younger patients with gastric adenocarcinoma have less differentiated, more advanced and metastatic disease. Patients' complaints, tumor localization, metastatic sites and smoking did not differ significantly between the groups. Controversy for survival parameters still exists.

First-line therapy for metastatic colorectal carcinoma: modified FOLFOX4 or FOLFIRI-bevacizumab.

PURPOSE: The aim of this study was to compare the efficacy and toxicity of modified (m) FOLFOX4 (folinic acid, 5-fluorouracil [5-FU], and oxaliplatin) vs. FOLFIRI-B (folinic acid, 5-FU, irinotecan, and bevacizumab) as first-line treatment of metastatic colorectal carcinoma (MCRC). METHODS: The medical records of 89 MCRC patients treated with either mFOLFOX4 (group 1) or FOLFIRI-B (group 2) as first-line chemotherapy were evaluated retrospectively. RESULTS: Complete (CR) plus partial response (PR) were seen in 18 (36.7%) vs. 13 (32.5%) patients in the mFOLFOX4 vs. FOLFIRI-B, respectively (p=0.67). Median progression-free survival (PFS) was 9 months (95% CI 7.2- 9.5) vs. 10 months (95% CI 7.6-12.3) in group 1 vs. group 2, respectively (p=0.30). Median overall survival (OS) was 22 months (95% CI 17.6-26.3) and 19 months (95% CI 13-24.9) in group 1 and 2, respectively (p=0.32). There was no statistically significant difference in grade 3-4 hematological toxicity between the groups, but grade 3-4 grade weakness, diarrhea, nausea and vomiting was observed more frequently in the FOLFIRI-B patients (p=0.03, p=0.01, p=0.05, respectively). CONCLUSION: Our data suggest that mFOLFOX4 and FOLFIRI-B are equally effective as first-line chemotherapy in MCRC patients. This may partially be explained by the fact that almost 50% of those receiving FOLFOX in the first-line received FOLFIRI-B in the second-gline, an observation suggesting that bevacizumab in the second line may be as effective as in the first line.

Ultimate azo dye degradation in anaerobic/aerobic sequential processes.

The treatability of Remazol Black-5 was studied in an anaerobic/aerobic sequential process. Laboratory scale UASB/CSTR reactors were used and operated at different organic loadings and HRTs to investigate the COD, color removal, and methane gas production efficiencies. The effect of both sludge age and HRT on the color and COD removal efficiencies were also investigated. The reactive dye used in this study contains the groups N=N, -SO3, S=O and is in use in some of the textile industries in Turkey. The studies were carried out in continuous mode and the effluent of the UASB reactor was used as feed in the CSTR reactor. COD removal efficiencies decreased from 56 to 27% with increases in COD loadings from 5 kg COD/m3.day and 25 kg COD/m3.day in the anaerobic UASB reactor. The color removals were 92 and 87%, respectively, for the aforementioned organic loadings. The methane percentages were found to be 50 and 76% at organic loading rates of 2.49 kg COD/m3.day and 14.8 kg COD/m3.day, respectively. 28, 42, and 90% COD removal efficiencies were obtained at sludge retention times of 1.7, 5.7 and 11 days in the aerobic CSTR reactor. Optimum sludge age was 11 days in aerobic reactor and 67 and 28% COD removal efficiencies were obtained at F/M ratios of 0.05-0.17 and 0.30-1.4 kg COD/kg MLSS.day. 90-95% color and 40-60% COD removal efficiencies were obtained depending on the applied organic loadings in the UASB reactor. The remaining COD was removed with a treatment efficiency of 85-90% in the aerobic CSTR reactor.