Bronchiectasis After Solid-Organ Transplant: A Retrospective Single Center Study.

OBJECTIVES: Bronchiectasis is characterized by abnormal, persistent, and irreversible enlargement of the bronchi. Many etiological factors have been described, but there are limited data on the development of bronchiectasis after organ transplantation. Our study is the first to study evaluate the frequency of bronchiectasis in heart and liver transplants as well as kidney transplants. Our aim is to analyze the frequency of bronchiectasis development after solid-organ transplant and the characteristics of the cases and to evaluate potential relationships. MATERIALS AND METHODS: We retrospectively analyzed data of patients who underwent solid-organ transplant at the Baskent University Faculty of Medicine Hospital through the hospital electronic information system. Demographic, clinical, and laboratory data and thoracic computed tomography scans were evaluated. RESULTS: The study included 468 patients (151 females/317 males). Kidney transplant was performed in 61.5% (n = 207), heart transplant in 20.3% (n = 95), and liver transplant in 18.2% (n = 85) of patients. Development of bronchiectasis was detected in only 13 patients (2.7%). We determined a 13.64-fold risk of developing bronchiectasis in patients with chronic obstructive pulmonary disease and 10.08-fold risk in patients with pneumonia by multivariate regression analyzes, in which all possible risk factors for the development of bronchiectasis after transplant were evaluated. CONCLUSIONS: The pathophysiology of transplantassociated bronchiectasis has not yet been clarified. Underlying diseases, recurrent pulmonary infections, and potential effects from immunosuppressive drugs may contribute to the pathogenesis of bronchiectasis. Further prospective studies are needed to include long-term health outcomes in transplant patients with and without bronchiectasis.

Experience with the Ketogenic Diet in a Boy with CLCN4 Related Neurodevelopmental Disorder.

Raynaud-Claes syndrome is rare condition characterized with intellectual disability and is caused by X-linked pathogenic variants in CLCN4 gene. Hemizygous missense variant NM_001830.4: c.1597G>A (p.V533M) was detected in a 6-year-old male followed up with intellectual disability, dysmorphism, and epileptic encephalopathy. The mother and one sister of the patient were also carrying the same variant. The clinical picture of the patient was significantly more severe, and the patient exhibited nonconvulsive status. Tonic status was observed with benzodiazepine treatment and the patient was successfully treated with a ketogenic diet. Many types of seizures can be seen in Raynaud-Claes syndrome, some of which can be life-threatening. CLCN4 variants can be investigated in patients who exhibit an increase in tonic seizures with benzodiazepine treatment. However, ketogenic dietary therapy as first-line treatment can be lifesaving in resistant epilepsy cases caused by the CLCN4 gene.

Association of biochemical and clinical parameters with parathyroid adenoma weight. Turkish-Bulgarian endocrine and breast surgery study group, hyperparathyroidism registry study.

BACKGROUND: Primary hyperparathyroidism (pHPT) caused by a single benign parathyroid adenoma is a common endocrine disorder that is affected by regional differences. Living in different geographical regions reveals differences in the laboratory results and pathological findings, but studies on this subject are not sufficient. The article focuses on biochemical and pathological effects of geographical differences in parathyroid adenoma. In addition, the present study seeks to elaborate on treatment methods and effectiveness of screening in geographical area of Bulgaria and Turkey. METHOD: In this prospective study, 159 patients were included from 16 centres. Demographic characteristics, symptoms, biochemical markers and pathologic characteristics were analysed and compared between 8 different regions. RESULTS: Patients from Turkish Black Sea had the highest median serum calcium (Ca) level, whereas patients from Eastern Turkey had the lowest median serum phosphorus (P) level. On the other hand, there was no significant difference between Ca, parathormone (PTH) and P levels according to regions. Patients from Eastern Turkey had the highest adenoma weight, while patients from Bulgaria had the lowest adenoma weight. The weight of adenoma showed statistically significant differences between regions (p < 0.001). There was a correlation between adenoma weight and serum PTH level (p = 0.05) and Ca level (p = 0.035). CONCLUSION: This study has provided a deeper insight into the effect of the regional differences upon clinicopathological changing and biochemical values of pHTP patients with adenoma. Awareness of regional differences will assist in biochemical screening and treatment of this patient group.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study.

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

Eosinophil cationic protein: A new diagnostic biomarker in coronary slow flow phenomenon.

AIM: This study has investigated the role of eosinophil cationic protein (ECP), released by eosinophils, in the coronary slow flow phenomenon. METHODS: This study included sixty patients with coronary slow flow (CSF) and sixty patients with normal coronary flow. The coronary flow rate was evaluated with TIMI frame count (TFC). ECP level, blood count and biochemical parameters were assessed. RESULTS: The ECP levels (18.9±7.5 vs 13.1±6.4 ng/ml, p<0.001) and eosinophil counts (0.25±0.14 vs 0.18±0.09 10³/mm³, p=0.001) were higher in the CSF group. Multivariable regression analysis showed that ECP level and eosinophil counts were independent predictors the presence of CSF (p=0.003 and p=0.006). There was a weak but important correlation among the ECP level, eosinophil count and mean TFC (p=0.001, p=0.003, respectively). The ROC analysis showed a cut off value of 14.05 ng/ml for ECP level to diagnose CSF with 73.3 % sensitivity and 66.7 % specificity, and area under the ROC curve was 0.745 (95% CI: 0.657-0.833, p<0.001). CONCLUSION: ECP levels were increased in CSF patients and this increasing correlated with coronary artery flow rates. The ECP level was independent predictor for the presence of SCF and it may be use as suitable diagnostic biomarker for CSF (Tab. 3, Fig. 3, Ref. 30).

The force required to fracture endodontically roots restored with various materials as intra-orifice barriers.

OBJECTIVE: To evaluate the effect of various materials as intra-orifice barriers on the force required fracture roots. MATERIALS AND METHODS: One hundred-thirty five mandibular premolars were decoronated and prepared up to size #40. The root canals were filled and randomly divided into two control and seven experimental groups (n = 15), as follows: Positive control group (the intra-orifice barrier cavity was not prepared), negative control group (the intra-orifice barrier cavity was prepared, but not filled), filling using glass ionomer cement, nano-hybrid composite resin, short fiber-reinforced composite, bulk-fill flowable composite, MTA Angelus, Micro Mega MTA or Biodentine. A fracture strength test was performed, and the data were analyzed using one-way ANOVA and Tukey's post hoc tests. RESULTS: Nano-hybrid composite, short fiber-reinforced composite, bulk-fill flow able composite, and glass ionomer cement increased the force required fracture the roots compared to the positive and negative control groups (P < 0.05). While MTA groups did not increase the force required fracture the roots compared to the control groups, Biodentine increased significantly. CONCLUSIONS: Within the limitations of the present study, the use of nano-hybrid composite, short fiber-reinforced composite, bulk-fill flowable composite, and glass ionomer cement as an intra-orifice barrier may be useful in reinforcing roots. MTA placement (MTA Angelus or Micro Mega MTA) did not significantly increase the fracture resistance of endodontically treated roots compared to the control groups, however Biodentine did.

Influence of blood contamination during multimode adhesive application on the microtensile bond strength to dentin.

OBJECTIVES: The present study evaluated the effects of blood contamination performed at different steps of bonding on the microtensile bond strength (µTBS) of multimode adhesives to dentin when using the self-etch approach. MATERIALS AND METHODS: Seventy-five molars were randomly assigned to three adhesive groups comprising 25 specimens each: two multimode adhesives [Single Bond Universal (SBU) and All-Bond Universal (ABU)] and a conventional one-step self-etch adhesive [Clearfil S3 Bond Plus (CSBP)]. Each group was subdivided as follows: (1) uncontaminated (control): bonding application/light curing as a positive control; (2) contamination-1 (cont-1): bonding application/light curing/blood contamination/dry as a negative control; (3) contamination-2 (cont-2): bonding application/light curing/blood contamination/rinse/dry; (4) contamination-3 (cont-3): bonding application/blood contamination/dry/bonding re-application/light curing; and (5) contamination-4 (cont-4): bonding application/blood contamination/rinse/dry/bonding re-application/light curing. Dentin specimens were prepared for µTBS testing after the composite resin application. Data were analyzed with two-way ANOVA and post-hoc tests (α = 0.05). RESULTS: µTBS values were similar in cont-3 groups, and ABU/cont-4 and corresponding control groups, but were significantly lower in the other groups than in their control groups (P < 0.05). Cont-1 groups showed the lowest µTBS values (P < 0.05). CONCLUSIONS: Neither decontamination method prevented the decrease in µTBS when contamination occurred after light curing. Drying the blood contaminants and reapplying the adhesive may regain the dentin adhesion when contamination occurs before light curing. Alternatively, rinsing and drying contaminants followed by adhesive re-application may be effective depending on adhesive type.

Effectiveness of laser-assisted irrigation and passive ultrasonic irrigation techniques on smear layer removal in middle and apical thirds.

The purpose of this study was to investigate the evaluation of laser-assisted irrigation (LAI) on the removal of the smear layer as compared to passive ultrasonic irrigation (PUI). Forty-eight single-rooted, upper-central incisor teeth were selected and prepared with ProTaper rotary instruments up to size #40 (F4) at the working lengths. Specimens were divided into four groups, as follows: (a) PUI with 5 mL of 2.5% NaOCl for 60 s; (b) PUI with 2.5 mL of 17% EDTA and 2.5 mL of 2.5% NaOCl each for 30 s; (c) LAI with 5 mL of 2.5% NaOCl for 60 s; and (d) LAI with 2.5 mL of 17% EDTA and 2.5 mL of 2.5% NaOCl each for 30 s. In the PUI groups, the ultrasonically activated file was inserted 1 mm short of the working length, but in the LAI groups, the fiber tip was applied into the pulp chamber. LAI in the pulp chamber with the combination of 17% EDTA and 2.5% NaOCl removed more of the smear layer than the other groups (p < 0.018). LAI in the pulp chamber with the combination of 2.5% NaOCl and 17% EDTA better removed the smear layer than LAI applied similarly but without EDTA or PUI with the same NaOCl and EDTA combinations using an ultrasonically activated file inserted 1 mm short of the working length.

An in vitro comparison of irrigation using photon-initiated photoacoustic streaming, ultrasonic, sonic and needle techniques in removing calcium hydroxide.

AIM: To evaluate the effect of various techniques including photon-initiated photoacoustic streaming (PIPS), ultrasonic, sonic and needle irrigation on the removal of calcium hydroxide [Ca(OH)2 ] from artificial grooves created in root canals. METHODS: The root canals of 48 extracted single-rooted teeth with straight canals were prepared using ProTaper rotary instruments up to size 40. After the specimens had been split longitudinally, a standardized groove was prepared in the apical part of one segment that was filled with Ca(OH)2 powder mixed with distilled water. Each tooth was reassembled and the apices closed with wax. The specimens were irrigated for 60 s with one of the following techniques: needle irrigation using 17% EDTA, PIPS with 17% EDTA, ultrasonic irrigation using 17% EDTA and sonic irrigation (EndoActivator) using 17% EDTA. The root segments were then disassembled, and the amount of remaining Ca(OH)2 evaluated under a stereomicroscope at 25× magnification. A pixel count of Ca(OH)2 remaining on the artificially created grooves was recorded as a percentage of the overall groove surface. The data were evaluated statistically using one-way analysis of variance and the least significant difference post hoc tests at 95% confidence level (P = 0.05). RESULTS: Photon-initiated photoacoustic streaming was superior in removing Ca(OH)2 as compared to needle irrigation (P < 0.001), sonic irrigation (P < 0.001) and ultrasonic irrigation (P = 0.046). CONCLUSION: Photon-initiated photoacoustic streaming provided complete removal of Ca(OH)2 from artificial grooves in straight root canals. Ultrasonic irrigation enhanced the Ca(OH)2 removal capacity of irrigating solution but did not provide complete removal from artificial grooves.

The relationship between acute coronary syndrome and stress hyperglycemia.

BACKGROUND AND OBJECTIVE: Hyperglycemia on admission is associated with increased mortality and morbidity in acute coronary syndrome (ACS) irrespective of presence of diabetes mellitus. To the best of our knowledge, no evidence on the relationship between stress hyperglycemia (SH) and the extent of coronary artery disease is found in the literature. Our objective in this study is to assess the relationship of SH with the prognosis of acute coronary syndrome, extent of coronary artery disease (CAD), development of arrhythmia, and major adverse cardiac events. METHOD: 89 patients who were hospitalized in the coronary intensive care unit with diagnosis of ACS between January 2010 and June 2010 were enrolled in the study. The patients were separated into 2 groups as having stress hypergly-cemia or not, according to their blood glucose levels on admission. TIMI and GRACE risk scores were obtained and GENSINI scoring was performed to assess CAD extent for all the patients. Major adverse cardiac events (MACE) (death, MI, re-revascularization, stroke) were recorded for all patients while in the hospital and at 1st and 6th months. RESULTS: In our study, MACE, GENSINI scores at 6 months and development of in-hospital arrhythmia rates were statistically significantly higher and left ventricular ejection fractions were statistically significantly lower in the group with SH. The association of TIMI, GRACE, GENSINI, New York Heart Association (NYHA) and Killip classifications with blood glucose, fasting blood glucose and HbA1c on admission was confirmed. CONCLUSION: Prognostic course happens to be worse and CAD is more extensive in patients with SH. In addition, blood glucose values may have to be estimated lower compared to the samples in the literature, in order to diagnose SH.

Effect of photon-initiated photoacoustic streaming on removal of apically placed dentinal debris.

AIM: To compare the efficacy of photon-induced photoacoustic streaming (PIPS) technique with conventional, sonic and ultrasonic irrigation on the removal of apically placed dentinal debris from an artificial groove created in a root canal. METHODOLOGY: Root canal preparation was performed up to size 40 on 48 extracted single-rooted teeth using ProTaper rotary instruments. The specimens were then split longitudinally, and a standardized groove was prepared in the apical part of each segment. Each groove was filled with dentinal debris mixed with 5% NaOCl. Each tooth was reassembled and irrigated as follows: (i) conventional irrigation with 1% NaOCl, (ii) sonic, (iii) ultrasonic irrigation, and (iv) PIPS. The root segments were disassembled, and the amount of remaining dentinal debris was evaluated under a stereomicroscope at 20× magnification, using a four-grade scoring system. The data were evaluated statistically using Kruskal-Wallis and Mann-Whitney U-tests with a 95% confidence level (P = 0.05). RESULTS: Photon-induced photoacoustic streaming removed significantly more dentinal debris than conventional irrigation (P < 0.001), sonic irrigation (P < 0.001) or ultrasonic irrigation (P = 0.005). There was no significant difference between sonic and ultrasonic irrigation (P = 0.377). CONCLUSIONS: Photon-induced photoacoustic streaming was more effective than conventional, sonic and ultrasonic irrigation in the removal of apically placed dentinal debris.

Circumcision during the phallic period: does it affect the psychosexual functions in adulthood?

The aim of this study was to elucidate whether circumcision during the phallic period (3-to 6-year old) has a negative impact on psychosexual functions in adulthood. Over a 6-month period, healthy and sexually active men between 30 and 40 years without any comorbidities were involved. Participants were evaluated with detailed history, physical examination, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT) and Beck Depression Inventory. Cases were divided into two groups according to the age at circumcision (group-1: phallic period, group-2: nonphallic period). Student's t-test and Kruskall-Wallis were used for statistical analysis. Of the 321 participants, a total of 302 men were eligible for the study (group-1: n = 135, group-2: n = 167). No statistical difference was found between the mean total IIEF scores (group-1: 25.1 ± 4.8, group-2: 25.4 ± 4.6, P > 0.05). The subdomains of IIEF; erectile function, orgasm, sexual desire, intercourse satisfaction, overall satisfaction were also found to be comparable. Additionally, the PEDT scores were similar between the two groups (group-1: 8.2 ± 4.8, group-2: 8.7 ± 5.4, P > 0.05). Finally, Beck depression scores were also found to be comparable between the groups (group-1: 10.8 ± 10.4, group-2: 9.8 ± 8.9, P > 0.05). Our results suggest that circumcision during the phallic period does not negatively affect the psychosexual functions in adulthood.

Transfemoral balloon expandable aortic valve implantation in a patient with myelodysplastic syndrome.

In this case presentation, the transcatheter aortic valve implantation (TAVI) intervention successfully performed on a 76-year-old male patient with severe degenerative aortic stenosis and diagnosed with myelodysplastic syndrome (MDS) is discussed. This case presentation represents the first case on the treatment of severe aortic stenosis on a patient with myelodysplastic syndrome through the use of the TAVI method and may form an alternative to surgery in patients with severe aortic stenosis who have a known haematological disease. For a successful procedure, the patient must be evaluated in cooperation with the haematology clinic and all necessary precautions regarding bleeding and infection complications of the patient must be taken prior to the procedure.

An unusual cause of hoarseness: hydatid cyst of the thyroid.

Hydatid cyst is a parasitic infestation that is distributed world-wide. It may be found in nearly any part of the body, most often in the liver and the lungs, but occasionally in other structures such as the thyroid gland. Thyroid gland is very rarely involved by this parasitic infection even in Turkey where the echinococcal disease is endemic. In this article we report a very rarely encountered case of thyroid cyst revealed by hoarseness, and underwent subtotal thyroidectomy and diagnosed as primary hydatid cyst disease by histological studies.

Correlation between the resistive index values of renal and orbital arteries.

BACKGROUND: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage. AIMS: The purpose of this study is to evaluate the association between RI values of orbital and intrarenal arteries by means of Doppler ultrasonography (US). METHODS: We evaluated 103 diabetic patients. As a control group, 30 subjects were examined. The patients were divided into two groups. Group 1 consisted of patients with urinary albumin excretion (UAE) <300 mg/day and estimated glomerular filtration rate (eGFR) levels >90 ml/min (n = 50); Group 2 had a UAE >300 mg/day and/or eGFR levels between 89 and 60 ml/min (n = 53). The association between RI values obtained with Doppler US of the ophthalmic artery, central retinal artery, posterior ciliary artery and intrarenal arteries were calculated. RESULTS: Both orbital and intrarenal arterial RI values in Group 1 and Group 2 were higher than the control group (p = 0.001); furthermore, values were higher in Group 2 than in Group 1 (p = 0.0004/0.029/0.036, p = 0.016, respectively). A positive correlation was found between orbital and intrarenal arterial RI values in Group 2 (r = 0.475, 0.285, 0.363, p < 0.01, respectively). CONCLUSION: Both orbital and renal arterial RI values were shown to be higher than the control group. Further, a trend towards higher RI values was observed with renal disease. RI may be useful as one of the markers for early diagnosis and follow-up of diabetic nephropathy and retinopathy.

Early outcomes of carotid artery stenting.

BACKGROUND AND AIM: Ischemic cerebrovascular events are the most common reason for patients to be bedridden and the third most common reason for death. Many studies in recent years have demonstrated that carotid artery stenting (CAS) may be an alternative to carotid endarterectomy (CEA). In this study, we aimed to report early outcomes of patients who were treated with CAS in our clinic and discuss practicability, advantages and safety of CAS. METHODS AND FINDINGS: Eighty patients who underwent CAS between December 2009 and May 2011 were eligible. The mean age was 65 years (range, 49 - 89 years). Of the study group, 73.75% were males and 26.25% were female. The percentage of asymptomatic patients was 11.7%, and the remaining patients were symptomatic. A distal embolic protection device (Angioguard®) was used in 22% of the patients whereas, in the other patients (78%), a proximal blockage system (Mo.MA®) was used. Self-expandable hybrid stents were implanted in all patients and post-dilatation was performed after implantation. None of the patients suffered from stroke, myocardial infarction or death due to CAS during their hospital stay. The mean follow-up period was 10 months (range 2 - 18 months) after discharge. None of the patients had died or had a stroke, a transient ischemic attack (TIA), or a myocardial infarction during the follow-up period. Re-stenosis was not observed in the follow-up carotid Doppler ultrasonography; flow rates were within normal limits. CONCLUSION: No major complication was observed during the early follow-up period in patients who underwent CAS in our clinic. Only 2 (2.5%) patients showed transient numbness and weakness and these did not lead to morbidity. In the management guide of extracranial carotid and vertebral artery diseases, CAS, in the light of recent studies, is recommended as an alternative to CEA in recommendations for revascularization. One of the important issues emphasized in this guide is the experience of centers. Very low complication rates after CAS suggested that, with suitable patient selection and an experienced team, similar results may be obtained.

Aortic elastic properties are impaired in patients with Graves' ophtalmopathy.

BACKGROUND: Aortic elastic properties have been shown to be an important predictor of cardiovascular morbidity and mortality. Hyperthyroidism was shown to be an important cause of impaired aortic elastic properties both due to the direct effect of the thyroid hormones on the aorta and also due to modulating effects of thyroid hormones on the vascular renin angiotensin system. However, there is no study investigating the aortic elastic properties in Graves's patients who were euthyroid. The goal of the present study was to investigate the aortic elastic properties of patients with Graves' Ophtalmopathy (GO) who had been euthyroid for at least 3 months. PATIENTS AND METHODS: A cross-sectional study was performed on 47 GO patients and 27 controls. Aortic-diastolic and aortic-systolic diameters, aortic strain, aortic distensibility, and aortic stiffness indices were calculated from the diameter of the thoracic aorta as measured by transthoracic echocardiography. RESULTS: The aortic stiffness index was markedly increased (31 ± 26 vs. 17 ± 8.9; p = 0.015) and aortic strain was markedly reduced (20.3 ± 10 % vs. 25.9 ± 12 %; p = 0.046) in the GO group relative to the control group. Aortic distensibility was statistically significantly decreased in the GO group as compared to the control group (9.5 ± 5.7 10(-3)/kPa vs. 13.5 ± 7.1 10(-3)/kPa; p = 0.022). Weak correlations were detected between GO severity and aortic distensibility (r = -0.333, p = 0.011) as well as the aortic stiffness index (r = 0.266, p = 0.044). CONCLUSIONS: Aortic elastic properties were impaired in patients with GO. Therefore, patients with GO, especially those with severe manifestations of the condition, should be followed closely with regard to the occurrence of future cardiovascular events.

Rare mechanical complication of myocardial infarction: isolated right ventricle free wall rupture.

Rupture of the left ventricular free wall is a dramatic complication of acute myocardial infarction (MI) and occurs in about ten percent of patients with fatal acute MI. However, there are limited reports about right ventricular free wall rupture due to MI. In this case report, a patient with isolated right ventricular rupture following MI that was visualised with real-time transthoracic echocardiography is discussed for the first time in the literature.