Clinical characteristics and short-term outcomes of adult patients with urolithiasis: first report from Somalia.

OBJECTIVE: This study aimed to investigate the data of adult patients admitted to the only tertiary care center in Somalia with the diagnosis of urolithiasis and to present the first report from this Sub-Saharan African country. PATIENTS AND METHODS: This study was designed as a retrospective single-center study conducted in Somalia Turkiye Training and Research Hospital. Adult patients who received the diagnosis of urolithiasis and who were admitted to the urology department constituted the target population. Reviewed data included demographic parameters, stone features, type of surgical procedure, intraoperative and early postoperative complications, and inpatient mortality. RESULTS: Overall, 3,680 patients were admitted during the study period. Among these, 620 (17%) patients were admitted due to urolithiasis. There was a significant male predominance with a male-to-female ratio of 3.4:1. Urinary bladder was the most common stone location (n=253, 40.8%), followed by the kidney (n=223, 35.9%). The mean stone diameter was 22.41 (5-64); most (39.4%) of the patients had a stone diameter between 20 and 30 mm, while 27.5% had stones with diameters between 10 and 20 mm. Minimally invasive procedures were the primary surgical modality in 52.6% (n=326) of our patients. However, 45.9% (n=285) of the patients underwent open surgery. CONCLUSIONS: The rate of adults with urolithiasis is relatively high in Somalia, as in many other African countries, with a significant male predominance. Although open surgery is rarely used for treating adult urolithiasis in industrialized countries, this approach is still commonly used in Somalia, similar to other parts of Africa.

Our kidneys and teeth may be closer than we think: relationship between dental calculi and renal stone burden grading in a patient series from Somalia.

OBJECTIVE: This study investigated the correlation between dental calculi grading and renal stone burden grading. PATIENTS AND METHODS: This study was designed as an observational single-center study and included consecutive patients with radiologically confirmed renal stones at our center between January 2022 and July 2022. These patients were referred to the dentistry clinic for a dental examination to assess dental calculi and oral hygiene. Investigated parameters included demographic characteristics, renal stone location and diameter, urine pH, and dental evaluation findings (teeth brushing habits, oral hygiene, and dental calculi). Renal stone burden grade and dental calculi grade were calculated, and Spearman's rank-order correlation analysis was used for correlation analyses. RESULTS: Overall, 204 patients were included. The mean patient age was 36.3±15.2. Approximately half of the patients (49.2%) had multiple stones. About 36% of the participants had high-grade dental calculi, while 29.4% had intermediate low-grade dental calculi. Oral hygiene was significantly associated with dental calculi grade (p<0.001). The dental calculi grade was positively and moderately correlated with the renal stone diameter (Spearman's rho=0.493, p<0.001). Among patients with a renal stone diameter greater than 20 mm, intermediate to high-grade dental calculi were found in 88.4%. This proportion was 49.1% for those with a renal stone diameter smaller than 20 mm. CONCLUSIONS: Dentists should consider the presence of undiagnosed kidney stones in patients with especially intermediate or high-grade dental calculi. Urologists should know that patients with large and multiple kidney stones may have dental calculi.

Pulmonary complications in heart transplant recipients.

BACKGROUND: Heart transplantation is an important therapeutic option for patients with end-stage disease, but is associated with major pulmonary complications. PATIENTS AND METHODS: We retrospectively reviewed the posttransplant follow-up of 34 orthotopic heart transplant recipients. RESULTS: Two of the 34 patients died of cardiac failure in the early postoperative period. Among the surviving patients, 10 (31.3%) developed pulmonary complications, all within the first 6 months: hospital-acquired bacterial pneumonia in five, fungal pneumonia in three, posttransplant lymphoproliferative disease in one, and community-acquired pneumonia in one patient. None of the patients developed transplantation-related malignancy. The overall mortality was 35.3%. Pneumonia-related mortality rate of 14.7% was due to early-onset nosocomial pneumonias, which were caused by bacterial and opportunistic microorganisms. Extrapulmonary causes of mortality were cardiac failure, meningitis, septicemia, and acute rejection. Cytomegalovirus antigenemia in the first month was associated with a poor prognosis. The frequency of pulmonary complications was higher among older patients and those who developed moderate rejection in the first month (P=.014 and P=.036, respectively). CONCLUSION: Pulmonary infections after heart transplantation occurred more frequently during the first 6 months posttransplantation, accounting for a significant portion of the posttransplantation mortality.

A 2 1/2-year-old girl with reflex sympathetic dystrophy syndrome (CRPS type I): case report.

An unusual case of a 2 1/2-year-old girl with reflex sympathetic dystrophy (RSD) of the left arm is described. She is the youngest RSD case ever presented in the literature. Upper extremity involvement is also rare in childhood RSD. She had both physical and psychological trauma in an earthquake preceding the disease. The association of RSD with a psychological disorder is stressed and awareness of the condition to the general paediatrician is recommended for early diagnosis and successful treatment.

Coexistence of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: a case report.

Diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis are two diseases which are listed in the differential diagnosis of each other. There have been limited numbers of case reports regarding the coexistence of both diseases in the literature. We describe a patient who demonstrated the features of diffuse idiopathic skeletal hyperostosis with coexisting features resembling ankylosing spondylitis in order to discuss the association of the two diseases.

Breast milk leptin: its relationship to maternal and infant adiposity.

BACKGROUND AND AIMS: Leptin, the product of the obese gene (ob), is synthesized by adipose tissue and contributes to the regulation of energy homeostasis and food intake. Recently, immunoreactive leptin was reported to be present in human milk. The objective was to determine if there was a relation between breast milk leptin concentrations and adiposity in exclusively breast-fed infants. METHODS: Fifty healthy, exclusively breast-fed infants beyond neonatal period, and their mothers were included into the study. Infants whose weight-for-length was above the 90th percentile were defined as obese (n=17), and non-obese if the weight for length between 20-90th percentile (n=33). Anthropometric measurements of infants and mothers were also made and breast milk samples were analyzed for leptin. RESULTS: There was no significant difference between breast milk leptin concentrations of obese and non-obese infants' mothers. Breast milk leptin concentrations were significantly correlated with mothers' body mass index when all subjects analyzed. There was no significant correlation between breast milk leptin concentrations and body mass index of infants. CONCLUSIONS: Leptin concentrations of human milk are not different in the mothers of obese and non-obese infants. These findings suggests that milk-borne leptin has no significant effect on adiposity during infancy.

Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints.

OBJECTIVE: The aim of this study was to investigate the association between pregnancy-related pelvic pain (PRPP) and sacroiliac joint (SIJ) laxity. METHODS: A cross-sectional analysis was performed in a group of 163 women, 73 with moderate or severe (PRPP+) and 90 with no or mild (PRPP-) PRPP at 36 weeks of pregnancy. SIJ laxity was measured by means of Doppler imaging of vibrations in threshold units (TU). Pain, clinical signs and disability were assessed with visual analog scale (VAS), posterior pelvic pain provocation (PPPP) test, active straight leg raise (ASLR) test, and Quebec back pain disability scale (QBPDS), respectively. RESULTS: Mean SIJ laxity in the PRPP+ group was not significantly different from the PRPP- group (3.0 versus 3.4 TU). The mean left-right difference, however, was significantly higher in the PRPP+ group (2.2 TU) than in the PRPP- group (0.9 TU). In the PRPP- group, only 4% had asymmetric laxity of the SIJs in contrast to 37% of the PRPP+ group. Between the PRPP+ subjects with asymmetric and symmetric laxity of the SIJs significant differences were found with respect to mean VAS for pain (7.9 versus 7.0), positive PPPP test (59% versus 35%), positive ASLR test (85 versus 41%) and mean QBPDS score (61 versus 50). CONCLUSIONS: Increased SIJ laxity is not associated with PRPP. In fact, pregnant women with moderate or severe pelvic pain have the same laxity in the SIJs as pregnant women with no or mild pain. However, a clear relation between asymmetric laxity of the SIJs and PRPP is found.

Vitamin D status and bone mineral density of veiled and unveiled Turkish women.

The aim of the study is to compare vitamin D status and bone mineral density (BMD) in veiled and unveiled healthy Turkish women of reproductive age. Thirty young to middle-aged volunteer veiled women and 30 age-matched control subjects with western clothing habits were enrolled in the study. The two groups had similar dietary habits, body mass index (BMI) distribution, and gestational history. Physical and laboratory examinations were performed to rule out any disease that could affect bone metabolism. Serum 25-hydroxyvitamin D (25-OHD) levels were measured, and BMD of the spine and hip were investigated by dual energy x-ray absorptiometry (DEXA). The mean age of dressing the veil was 15.7 +/- 6.13 years, and 66.7% of the veiled women claimed that they were not ever exposed to direct sunlight, as they were leading an indoor life. Compared with the control group, veiled women were less educated and physically less active (p < 0.001 and p < 0.05, respectively). 25-OHD levels were positively correlated with exposure to sunlight and negatively correlated with the duration of being veiled. None of the veiled women had vitamin D insufficiency, but their mean 25-OHD concentration (33.1 +/- 16 ng/ml) was significantly lower than that of controls (53.9 +/- 27.3 ng/ml) (p < or = 0.001), and serum alkaline phosphatase (ALP) levels were higher (p < 0.01). Differences in the absolute BMD values at the spine and hip were not statistically significant, but the mean Z value at the lumbar spine was significantly lower in the veiled subjects (p < 0.05). Veiled women have low 25-OHD status, and vitamin D supplementation should strictly be advised to these women for the prevention of osteomalacia and osteoporosis.

Antioxidant enzyme activities and total nitrite/nitrate levels in the collar model. Effect of nicardipine.

There is a large body of literature describing the causative role of oxidative stress mediated by increased levels of reactive oxygen species in the pathogenesis of cardiovascular disease such as atherosclerosis, hypertension, and restenosis after angioplasty. The positioning of a soft silicone collar around the rabbit carotid artery elicits intimal thickening. The findings from recent studies demonstrated that both intimal thickening and atherosclerosis lead to synthesis of inducible nitric oxide synthase, resulting in abundant amounts of nitric oxide. We investigated the effects of collaring and nicardipine treatment on the activities of antioxidant enzymes, superoxide dismutase and catalase, and total nitrite/nitrate levels, stable products of nitric oxide. Placing the collar increased the total nitrite/ nitrate levels and decreased superoxide dismutase activity in collared arteries. Treatment with nicardipine (20 mg/kg/day, s.c.) prevented enhanced nitric oxide degradation without affecting superoxide dismutase and catalase activities. Our results suggest that enhanced nitric oxide production and superoxide anion are generated in response to the collaring, resulting in oxidative stress within the segment in this model.

The electroneurophysiological findings in rheumatoid arthritis patients.

In rheumatoid arthritis (RA), vasculitis is a serious complication usually found in patients with long-standing erosive nodular seropositive disease. One clinical hallmark of this systemic arteritis is the appearance of neurological findings. However, it is often difficult to diagnose these slight or early neuropathies and the study of the peripheral neuromuscular system is often made difficult by symptoms resulting from pain in the joints and limitations of movement. It is nevertheless often possible by means of electroneuromyography to show objectively the existence and distribution of even subclinical neuropathies. In order to evaluate the neurophysiological functions of RA patients by means of the peripheral nerve conduction and somatosensorial evoked potential studies, 33 RA patients and 20 healthy controls were included in this study. Two (6%) patients were found to have carpal tunnel syndrome, while 6 (18%) patients had mononeuritis multiplex. Delayed N12, N13, N1 and P1 latencies were detected in 6 (18%) of 33 RA patients suggesting central nervous system involvement with intact peripheral nervous system. Our results confirm earlier observations that symptoms of neuropathy are fairly common in cases of RA without there being any clear correlation with any clinical variable. By means of electroneurophysiological studies, it is to evaluate the integrity of the peripheral nerve, the spine and the central pathways. Besides enabling to detect early subclinical involvement of the peripheral nervous system in RA, SEPs should also be used for the evaluation of subclinical myelopathy due to atlantoaxial subluxation or vasculitis. The inclusion of an electroneurophysiologic examination of the RA patients is recommended in routine diagnostic procedure.

Postacute predictors of functional and cognitive progress in traumatic brain injury: somatosensory evoked potentials.

OBJECTIVE: To investigate the prognostic value of electrophysiologic studies performed during the postacute phase after traumatic brain injury (TBI). DESIGN: A prospective comparative study in which 26 patients with TBI participated. Patients were grouped according to their admission short-latency somatosensory evoked potential (SEP) results. Nonparametric Kruskal-Wallis and Mann-Whitney U tests were applied to different SEP groups to determine the differences among them in specific functional and cognitive outcome measures. SETTING: An inpatient brain injury rehabilitation unit. PARTICIPANTS: Twenty-six patients with TBI who were admitted to the rehabilitation center at the postacute phase for a late inpatient rehabilitation program and 15 age-matched healthy subjects who served as a control group for the electrophysiologic comparison. MAIN OUTCOME MEASURES: Motricity Index, Barthel Index, Disability Rating Scale, Mini-Mental Status Exam, and Rancho Los Amigos Scale. RESULTS: Disability Rating Scale scores at discharge and rate of change of Barthel Index scores differed between median nerve SEP classification groups (p<.05 for both). Disability Rating Scale scores at admission (p<.05) and at discharge (p<.01), Barthel Index scores at discharge (p<.05), and rate of change of Barthel Index scores (p<.05) differed between tibial nerve SEP classification groups. There was a relation between Motricity Index side scores at discharge and the different body side SEP response groups (p<.0001). Cognitive results showed no relation to the SEP groups. CONCLUSIONS: Postacute SEP scores after a late admission to a rehabilitation center showed a relation to measures of functional and motor progress. Patients with better SEP responses were more likely to experience greater functional and motor improvement. Cognitive functions were not related to SEP results.

The electroneurophysiological evaluation of rheumatoid arthritis patients.

In Rheumatoid Arthritis (RA), one clinical hallmark of the vasculitis is the appearance of neurological findings. However, it is often difficult to diagnose these slight or early neuropathies and the study of the peripheral neuromuscular system is often made difficult by symptoms resulting from pain in the joints, and limitations of movement. It is nevertheless often possible, by means of electroneuromyography to show objectively the existence and distribution of even subclinical neuropathies. In order to evaluate the neurophysiological functions of RA patients by means of the peripheral nerve conduction and somatosensory evoked potential studies, 33 RA patients and 20 healthy controls were included in this study. Two (6%) patients were found to have carpal tunnel syndrome, while 6 (18%) patients had mononeuritis multiplex. Delayed N12, N13, N1 and P1 latencies were detected in 6 (18%) of 33 RA patients suggesting central nervous system involvement with intact peripheral nervous system. Our results confirm earlier observations that symptoms of neuropathy are fairly common in cases of RA without there being any clear correlation with any clinical variable. Therefore, the inclusion of an electroneurophysiologic examination of the RA patients is recommended in routine diagnostic procedure.

Effect of vitamin E on antioxidant enzymes and nitric oxide in ischemia-reperfused kidney injury.

The effects of Vitamin E administration on antioxidant enzyme activities and nitrite-nitrate levels of the reperfused rat kidney tissues were investigated by performing a 60 min ischemia followed by 24 and 72 hours of reperfusion. Vitamin E administration or the placebo (SF) was applied as 100 mg/kg BW. As expected, catalase (CAT) (p<0.05) and superoxide dismutase (SOD) (p<0.05) activities of ischemia/reperfused (I/R) kidney tissue were lower and malondialdehyde (MDA) levels were higher than control kidneys in both SF and vitamin E treated groups following 24 h reperfusion. During reperfusion of long term (72 h), vitamin E triggered a decrease in the MDA levels in the ischemic tissue, while it did not provoke a significant effect on SOD and catalase activities. Total nitrite levels of ischemic tissues in both of the groups were higher than matched control kidneys and this elevation was more clear in the vitamin E treated group. Our results showed that vitamin E has a protective effect on I/R injury, by a direct chain breaking effect on lipid peroxidation (LPO) and hence preventing the nitric oxide (NO) reservoir of ischemic tissue. Alfa-tocopherol may be a promising agent for the prevention of tissue injury caused by free oxygen radicals.

Delayed post-traumatic syringohydromyelia after an uncomplicated fracture of the spine: case report and literature review.

A patient who had had a traffic accident resulting with a compression fracture of the L1 vertebra but with no neurological deficits, developed urinary incontinence and weakness in his lower extremities 25 years after the spinal injury. An MRI scan of the spine revealed gliosis of the conus medullaris at the level of the compression fracture, with syringohydromyelia extending from T6 to conus medullaris. The patient underwent a rehabilitation program at the end of which he was able to ambulate independently.