Spiral capsulorhexis technique with anterior chamber maintainer under continuous fluid pressure in intumescent cataracts and its clinical outcomes.

PURPOSE: To evaluate the efficacy of technique combining an anterior chamber maintainer (ACM) and spiral capsulorhexis under continuous fluid pressure in intumescent cataracts. METHODS: One hundred thirty-one eyes of 128 patients who underwent phacoemulsification and IOL implantation for intumescent white cataracts without a red reflex were included in the study. Group 1 consisted of 67 eyes of 65 patients who underwent spiral capsulorhexis with an ACM under continuous fluid pressure. Group 2 consisted of 64 eyes of 63 patients who underwent capsulorhexis after injection of viscoelastic material into the anterior chamber. Both groups were compared in terms of endothelial cell loss, intraoperative and postoperative complications. RESULTS: Progression to the periphery in the capsule not resulting in a radial tear was observed in 3 eyes in Group 1 and 11 eyes in Group 2 (P=0.019). While the type of radial tear known as the Argentinian flag sign was not observed in Group 1, it was observed in 8 eyes in Group 2 (P=0.003). Postoperative intraocular lens (IOL) decentration did not develop in any eye in group 1, but in 3 eyes in group 2 (P=0.11). CONCLUSION: The combination technique of an anterior chamber maintainer and spiral capsulorhexis provides a controlled and safe capsulorhexis and reduces intraoperative and postoperative complications in intumescent cataracts.

ICD detected patient activity is associated with arrhythmic events in heart failure patients.

BACKGROUND: Although implantable cardioverter-defibrillator (ICD) reduces mortality in heart failure patients with reduced left ventricle function, arrhythmic episodes are related with increased mortality. Aim: The aim of this study was to investigate whether low patient activity predicts arrhythmic events in the heart failure patients with primary prevention ICD. METHODS: We examined 206 heart Failure (HF) patients (mean age: 61.3 ± 10.9 years, 77.7% male) with primary prevention implanted ICD who referred to our outpatient clinic for pacemaker control. After pacemaker (PM) controls, the overall study group was categorized into three distinct subgroups: Activity less than 2 h, activity 2-4 h, and activity 4-8 h in a day. RESULTS: Activity less than 2 h had a substantially higher level of arrhythmic episodes in comparison to other groups (P < 0.05). In addition, appropriate shock or ATP (antitachycardia pacing) was detected higher in patients whose activity was less than 2 h in a day than other groups (P < 0.001). CONCLUSIONS: Detected low patient activity in ICD control may be a predictor of arrhythmic episodes and appropriate therapies. Increasing physical activity may potentially protect these patients from unwanted events.

Effect of Interviews Done by Intensive Care Physicians on Organ Donation.

In this study, we examined the correspondence between intensive care unit physicians and the relatives of potential brain-dead donors regarding the decision to donate or the reasons for refusing organ donation. A total of 12 consecutive cases of potential brain-dead patients treated in intensive care units of Marmara University Pendik Education and Research Hospital in 2013 were evaluated. For each of the cases, the Potential Donor Questionnaire, and Family Notification, Brain Death Criteria Fulfilment and Organ Donation Conversation Questionnaires were used to collect the required data. Statistically, descriptive analyses were performed. We concluded that honestly, regularly, and sufficiently informed relatives of the potential brain-dead donor more readily donate organs, with a positive contribution from the intensive care physician.

Comparison of HbA1c analysers: Agilent 1100 HPLC using kits produced by Gordion Diagnostic (Turkey) with Premier Hb9210 using kits produced by Trinity Biotech (USA) in different patient groups.

BACKGROUND: The aim of this study was to compare the performance of Agilent 1100 HPLC analyser using HbA1c kits manufactured by Gordion Diagnostic (Turkey) with that of Premier Hb9210 using the original kits for the measurement of HbA1c in different patient groups. METHODS: Subjects were divided into four groups: Group 1 included 140 diabetic and non-diabetic subjects with normal urea and haemoglobin levels; Group 2 included 84 diabetic and non-diabetic subjects with high urea levels; Group 3 included 44 diabetic and non-diabetic subjects with iron deficiency anaemia; and Group 4 included 52 diabetic and non-diabetic subjects with high haemoglobin levels. EP Evaluator Release 8 program was used to evaluate the resultant data. RESULTS: According to the comparison results of the two methods in all groups, there was an excellent correlation between the two methods (R>0.98). Moderate-low correlation was found between increased urea concentration and the difference of the two methods (R= -0.374, p = 0.0005). The difference between the methods was found to be increased with increased urea concentrations. This difference, although statistically significant, was within the permitted limits. The observed correlation between the difference of the two methods and the low and high haemoglobin concentrations was statistically non-significant (R = 0.149, p = 0.3343; R = 0.263, p = 0.0594). CONCLUSIONS: We found that Agilent 1100 HbA1c analyser and Gordions' HbA1c kit comply with the clinical requirements and are suitable for HbA1c analysis at high levels of urea and Hb and low levels of Hb in diabetic and non-diabetic patients.

Donor Contraindications to Living Kidney Donation: A Single-Center Experience.

OBJECTIVE: Kidney transplantation is the treatment of choice in end-stage renal disease. In Turkey, the inadequate cadaveric donor supply has resulted in transplantation from living kidney donors (LKD) in 80% of transplant operations. LKD candidates undergo a thorough general medical evaluation and are approved to donate their kidneys only if no contraindication is found. In our study we aimed to investigate the reasons and rate of denial for living kidney donation in our center. METHODS: We included all LKD candidates who applied to our center between June 2012 to June 2014. Demographic data, rate of rejection, and the reasons for denial to organ donation were analyzed retrospectively. RESULTS: Of the 97 LKD candidates included in the study, 60 (62%) were unable to donate their kidneys. Among the reasons for denial were hypertension with target organ damage in 30% (n = 18), immunologic reasons in 23% (n = 14), impaired renal function in 20% (n = 12) cardiovascular reasons 13.3% (n = 8), diabetes mellitus in 10% (n = 6), malignity in 10% (n = 6), obesity (body mass index > 35 kg/m(2)) in 5% (n = 3), and miscellaneous in 18.3% (n = 11). There were >1 reasons in 13 candidates. CONCLUSIONS: The problems detected in donor candidates offer a possibility for early detection of disorders and increased awareness.

An epidemiological study to evaluate the use of vitamin K antagonists and new oral anticoagulants among non-valvular atrial fibrillation patients in Turkey- AFTER-2 study design.

OBJECTIVES: Atrial fibrillation (AF) is one of the most common causes of preventable ischemic stroke and is related to increased cardiovascular morbidity and mortality. There is a lack of data in Turkey on the use of new oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modality. In this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients. STUDY DESIGN: Four thousand one hundred consecutive adult patients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding and hospitalization). RESULTS: First results are expected in June 2015. Data about major cardiovascular end-points will be available in January 2016. CONCLUSION: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 study. In addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).

The combination of agomelatine and ritanserin exerts a synergistic interaction in passive avoidance task.

Agomelatine is a potent agonist at melatonergic 1 and 2 (MT1 and MT2) receptors and an antagonist at serotonin-2C (5HT-2C) receptors. It was suggested that psychotropic effects of agomelatine is associated with its melatonergic and serotonergic effects. In this study, we aimed to evaluate the effects of agomelatine alone or in combination with ritanserin (5HT-2A/2C antagonist) on memory and learning. Male Balb-C mice (25-30 g) were used, and all drugs and saline were administrated by intraperitoneal (i.p.) route 30 min prior to evaluating retention time. Whilst agomelatine was administered at the doses of 1, 10 and 30 mg/kg, ritanserin was administered at the doses of 0.1, 1 and 10 mg/kg. To evaluate memory function, passive avoidance test was used. On the first day, acquisition time and on the second day (after 24h), retention time of mice were recorded. To evaluate the synergistic activity, only the least doses of agomelatine and ritanserine were used, that is, 1 and 0.1 mg/kg, respectively. Scopolamine (1 mg/kg) was used as a reference drug, so it was combined with drug groups. Our results show that 5HT-2A/2C receptor antagonist ritanserin (1 and 4 mg/kg, i.p.) and agomelatine (10 and 30 mg/kg, i.p.) improve memory deficit induced by scopolamine, whilst a synergistic interaction is observed between ritanserin and agomelatine (0.1 mg/kg and 1 mg/kg, i.p., respectively) when they were administered at their ineffective doses. According to our findings, we concluded that agomelatine improves memory deficit and thus improves the effect of agomelatine arises from its 5HT-2C receptor antagonist activity.

Genomic damage in patients with type-2 diabetes mellitus.

DNA damage seems to play a role in the pathogenesis of type-2 diabetes mellitus (DM2) and its complications. Several in vitro assays have been used to measure the DNA damage. In the present study, we aimed to investigate the frequency of sister chromatid exchange (SCE) and micronuclei (MN) in DM2 patients compared with healthy controls. SCE and MN tests were carried out with the blood-cell cultures from 50 DM2 patients and 30 healthy, age- and sex-matched control subjects. The mean age of the DM2 patients was 58.12 +/- 13.39 years, with a mean duration of the diabetes of 5.40 +/- 4.32 years. The mean level of HbAlc of the DM2 patients was 8.93 +/- 2.56. Patients with DM2 showed a higher frequency of SCE compared with controls (7.11 +/- 1.14 and 4.96 +/- 0.92, p < 0.001). Furthermore, the SCE frequency was positively correlated with the plasma HbA1c level (p < 0.05), but there was no significant correlation between the duration of diabetes and SCE. On the other hand, our result showed a MN frequency significant increase in DM2 patients (3.45 +/- 1.01 per 1000 cells) relative to that of the control group (1.79 +/- 0.67 per 1000 cells) (p < 0.001), but there was no significant correlation between the duration of diabetes, HbA1c and MN. In conclusion, these results suggest that DM2 is a condition with genomic instability characterized by an increased level of SCE and MN. Hyperglycemia-induced oxidative stress may be the underlying factor of the increased SCE and MN frequency.

Hyperbaric oxygen treatment and N-acetylcysteine ameliorate acetaminophen-induced liver injury in a rat model.

An overdose of acetaminophen (APAP) produces centrilobular hepatocellular necrosis. We aimed to investigate the hepatoprotective effects of N-acetylcysteine (NAC) only and hyperbaric oxygen (O(2)) treatment (HBOT) combined with NAC, and their anti-inflammatory properties in liver tissue. In the current study, a total of 32 male Sprague Dawley rats were divided into 4 groups: sham, APAP, NAC, and NAC + HBOT. In the APAP, NAC, and NAC + HBOT groups, liver injury was induced by oral administration of 1 g/kg APAP. The NAC group received 100 mg/kg NAC per day. NAC + HBOT group received intraperitoneal injection of 100 mg/kg/day NAC and were given HBOT at 2.8 ATA pressure with 100% O(2) inhalation for 90 min every 12 h for 5 days. Rats in the sham group received distilled water only by gastric tube. All animals were killed on day 6 after APAP or distilled water administration. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities, hepatic neopterin, tumor necrosis factor-α (TNF-α), and interleukin 6 (IL-6) levels were measured. There was a significant increase in serum AST and ALT activities in the APAP group compared with the sham group (in both p = 0.001). NAC and NAC + HBOT groups had significant decreases in hepatic neopterin, TNF-α, and IL-6 levels compared with the APAP group. APAP administration caused extensive hepatic necrosis. NAC and NAC + HBO treatments significantly reduced APAP-induced liver injury. Our results showed that the liver damage in APAP toxicity was attenuated by NAC and NAC + HBO treatments. NAC + HBOT exhibit hepatoprotective activity against APAP-induced liver injury in rats.

Tear film osmolarity in patients with diabetes mellitus.

PURPOSE: To compare tear film osmolarity (TFO) between patients with diabetes mellitus (DM) and normal healthy individuals. METHODS: In this prospective case-controlled study, the TFO in 46 normal subjects (control group) and 55 patients with DM (study group) was evaluated. TFO in milliosmole (mOsm) was measured by using an auto-osmometer. The serum levels of glycosylated hemoglobin (HbA1c) and blood glucose in all participants were also measured. Mean outcome measures were TFO and its relationship with HbA1c level and duration of DM. RESULTS: Mean TFO was 320.40 ± 21.80 mOsm/l in the study group and 308.22 ± 18.16 mOsm/l in the control group (p < 0.001). The TFO values were significantly associated with duration of DM (r = 0.476, p < 0.001), but no significant correlation was found with HbA1c level (r = 0.225, p = 0.114). CONCLUSIONS: The study shows a significantly higher TFO in patients with DM than in the healthy controls. TFO also correlates with the duration of DM.

Ring chromosome 18 in a child with febrile seizures.

Ring chromosomes are uncommon cytogenetic findings but have meanwhile been reported for nearly all human chromosomes. Among the rare observations of ring chromosomes in man, the diagnosis of ring chromosome 18 represents a prominent group. We here describe on the cytogenetic analysis results obtained for a 9 years old male patient of non-consanguineous parents. He had growth and developmental delay, mental and motor retardation, microcephaly, microphtalmia, triangle face, small dysplastic ears, strabismus, epicanthal folds on the left, short stature, cryptorchidism, spasticity, pes equinovarus, pes planus, hypothroidism, stereotypic movements and febrile seizures. Also he had hypomyelinization and multiple hyperintense focuses within the white matter on the MRI. The generalized epileptiform abnormality originated from bilateral Centroparietal region. The metabolic investigations including blood and urine amino acids and lysosomal screening tests were normal. The chromosome analysis identified [46,XY,r(18)/46,XY] in 35% of cells a ring 18 and in 65% of cells normal karyotype in peripheral blood cells examined by standard G-bands by Trypsin using Giemsa (GTG) analysis. The dysmorphic features of the presented patient are discussed to the identification of the genotype-phenotype correlation related to his karyotype.

HLA alleles and haplotypes in the east Black Sea Turkish population.

HLA class I and class II alleles were studied for the first time in 234 unrelated individuals inhabiting the East Black Sea region in Turkey. This region is on the historic silk road and close to Georgia. HLA class I (A* and B*) and class II DRB1* typing was done by the PCR-SSP method. A total of 17 HLA-A* alleles, 34 HLA-B* alleles, and 15 HLA-DRB1* alleles were detected. HLA-A*-B*, A*-DRB1*, and B*-DRB1* two-loci linkage disequilibrium data show that two specific combinations (A2-B35, A2-DRB1*11, and B35-DRB1*13) had the highest frequency (more than three or four times) compared with the other two-loci combinations, possibly reflecting an ancient founder effect. A*24 B*18 DRB1*13 and A*32 B*27 DRB1*11 were the most common haplotypes in the east Black sea Turkish population. HLA-B* showed the highest heterozygosity (94%) among the samples. The observed diversity in the HLA-A* and HLA-DRB1* loci was quite similar, ranging from 79% to 84%. We suggest that the east Black Sea Turkish population is characterized by the features of the Turkish anthropological type with some influence of other groups, such as Caucasians, Asians, and Mediterraneans.

The in-vitro effects of medroxyprogesterone acetate on acidic pH induced apoptosis of periferal blood mononuclear cells.

Medroxyprogesterone acetate (MPA) which has a steroid structure, is widely used in oncology practice in the treatment of the cachexia of cancer and to reduce hematologic toxicity in patients receiving chemotherapy. However, the mechanisms of MPA on these effects are unclear. In this study, we investigated the effects of two different doses of MPA (10(-5) and 10(-6) M/L) on acidic pH induced apoptosis of periferal blood mononuclear cells (PBMC) derived from 10 healthy volunteers. Compared with the control group, we found that MPA at the dose of 10(-5) M/L had a negative effect on apoptosis (32.88 +/- 4.61 and 20.7 +/- 1.53% respectively, p < 0.05), a positive effect on cell count of PBMC (1395 +/- 151 x 10(3) and 1100 +/- 139 x 10(3) respectively, p < 0.05) and no effects on cell viability and its proliferation. More comprehensive trials are needed to clarify this effect of MPA.

Philadelphia negative, Bcr-Abl positive chronic myeloid leukemia associated with pure red cell aplasia.

Pure red cell aplasia (PRCA) is a rare disorder which is associated with thymoma, viral infections and autoimmune diseases. A few cases of PRCA during the clinical course of CML have been reported and these usually terminate in blastic crisis and death, suggesting a poor prognosis. However, only one case of Philedelphia chromosome negative, Bcr-Abl positive CML associated with PRCA has been reported. Here, we present a second case report of a Philedelphia negative, Bcr-Abl positive CML associated with PRCA who was unresponsive to all the chemotherapeutic regimens. We conclude that the present case supports the idea that the development of PRCA in the course of CML may be a bad prognostic sign.

The effects of impaired trace element status on polymorphonuclear leukocyte activation in the development of vascular complications in type 2 diabetes mellitus.

Impaired trace element metabolism may be involved in some of the metabolic dysfunctions, and contribute to the development of vascular complications in diabetic patients. In order to investigate the relationships among diabetes mellitus, trace element status, leukocyte activation and vascular complications, 55 type 2 diabetic patients (34 with vascular complications and 21 without vascular complications) and 50 non-diabetic control subjects were studied. The mean leukocyte count (p<0.001), polymorphonuclear elastase (p<0.001), erythrocyte malondialdehyde (p<0.001), and glycated haemoglobin (p<0.001) levels, and copper/ zinc ratio (p<0.001) were found to be higher in diabetic patients than in the control group, but serum zinc levels (p<0.001) and erythrocyte superoxide dismutase activities (p<0.001) were lower, and serum copper levels showed no differences. In patients with vascular complications, the mean leukocyte count (p<0.05), zinc (p<0.05), polymorphonuclear elastase (p<0.05), erythrocyte malondialdehyde (p<0.001) and glycated haemoglobin (p<0.05) levels, and copper/zinc ratio (p<0.001) were significantly different from those patients without complications. Closer correlations between the copper/zinc ratio and polymorphonuclear elastase (r=0.82, p<0.01), erythrocyte malondialdehyde (r=0.46, p<0.05) or erythrocyte superoxide dismutase (r= -0.85, p<0.01) were found in patients with vascular complications compared to those without, and all of those showed significant relationships with poor glycaemic metabolic control. We conclude that zinc deficiency may provoke polymorphonuclear leukocyte activation, and contributes to the development of vascular complications in type 2 diabetic patients. Furthermore, copper/zinc ratio and polymorphonuclear elastase may be used as important markers to evaluate the presence of vascular complications.

Factor V Leiden and its relation to left ventricular thrombus in acute myocardial infarction.

OBJECTIVE: The genetic defect of coagulation factor V, known as factor V Leiden, produces a resistance to degradation by activated protein C (APC) and increases the risk of venous thrombosis. However, the role of factor V Leiden in the formation of left ventricular (LV) thrombus has not been studied. We investigated whether factor V Leiden is a risk factor for LV thrombus in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: We have analyzed clinical, echocardiographic and biochemical data in 135 consecutive patients (aged 58 +/- 13 years; 31 women) with first anterior AMI. Two-dimensional echocardiographic examination was performed on days 1, 3, 7, 15 and 30; LV thrombus was detected in 33 (24.4%) of 135 patients with AMI. The study also included 95 control subjects. Healthy age and sex-matched subjects without a personal or family history of ischaemic heart disease, stroke or thromboembolic disease served as a control group. Blood samples from the patients and controls were analyzed for the factor V Leiden mutation by DNA analysis, using the polymerase chain reaction. In addition, concentrations of fibrinogen, von Willebrand factor (vWF), tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and D-dimer were measured in 135 patients. There was no significant difference in the prevalence of factor V Leiden between patients and control subjects. The prevalence of the factor V mutation was 9% (3/33) in patients with thrombus, and 7.7% (8/103) in patients without thrombus. The prevalence of factor V Leiden was 7.3% (7/95) in control subjects. No significant differences in plasma fibrinogen (480 +/- 195 vs. 444 +/- 179 mg/dl, p = 0.6), D-dimer (471 +/- 256 vs. 497 +/- 293 ng/dl, p = 0.7), vWF (112 +/- 18 vs. 103 +/- 15%, p=0.5), PAI-1 (26.7+/- 9.8 vs. 28.1 +/- 10.2 ng/dl, p = 0.6), and t-PA (19.8 +/- 8.7 vs. 17.2 +/- 9.1 ng/dl, p = 0.7), levels are found in patients with LV thrombus when compared with those without LV thrombus. Multivariate analyses showed that peak creatine kinase level (p = 0.002) and LV wall motion score index (p = 0.003) were independent predictors of LV thrombus formation. CONCLUSION: Factor V Leiden mutation is not a risk factor for LV thrombus formation in patients with AMI.

[Effects of factor V Leiden mutations on prognosis in patients with acute myocardial infarction]. / Akut miyokard infarktüslü hastalarda faktör V Leiden mutasyonunun prognoz üzerine etkisi.

OBJECTIVE: Factor V Leiden mutation, the genetic defect underlying resistance to activated protein C, is the most common risk factor for venous thrombosis. Factor V Leiden mutation and its relation to post-myocardial infarction (MI) complications including angina pectoris, heart failure, reinfarction and cardiac mortality has not been investigated. We aimed to investigate this relation. METHODS: The prevalence of factor V Leiden mutation was investigated in 122 patients with first acute myocardial infarction (aged 56 +/- 11, 82 men/40 women). These patients were divided into two groups according to whether the patients had factor V Leiden mutation (Group I) or not (Group II). Post MI complications were evaluated during 18 months. Blood samples from the patients were analyzed for factor V Leiden mutation by DNA analysis, using the polymerase chain reaction (PCR). RESULTS: Factor V Leiden was detected in 11 (9%) patients (aged; 54 +/- 10, 5 women/men) and was not detected in 111(90%) patients (aged; 56 +/- 11; 35 women/76 men) of the 122 patients. There were no significant differences between Group I and Group II in terms of post MI complications, including reinfarction (27% vs. 29%; p > 0.05, respectively), angina pectoris (45% vs. 38%; p > 0.05, respectively), heart failure (27% vs. 23%; p > 0.05, respectively) and cardiac mortality (18% vs. 14%; p > 0.05, respectively). CONCLUSION: Post MI complications, including reinfarction, heart failure, angina pectoris and cardiac mortality were not increased in patients with factor V Leiden.