Investigation of Heme Oxygenase 2 Enzyme Protein Expression in Keratoconus and Normal Human Corneal Epithelium: An Immunohistochemical Study.

PURPOSE: To compare heme oxygenase 2 (HO-2) enzyme levels detected by immunohistochemical staining methods in the cornea epithelium obtained from keratoconus patients and normal subjects. MATERIALS AND METHODS: The keratoconus group included 69 eyes of 69 patients with keratoconus scheduled for cross-linking surgery. The control group included 52 eyes of 52 patients with refractive error scheduled for photorefractive keratectomy surgery. After a detailed ophthalmologic examination, corneal topographic maps of each patient were generated, and then the patients underwent surgery. The corneal epithelium was collected mechanically during the surgery, fixed with formalin, embedded in paraffin blocks, and sectioned by microtomes. HO-2 antibodies were applied to the samples for immunohistochemical evaluation. The intensity of the staining was identified as negative, weak, moderate or strong. The keratoconus group was classified as early (average keratometry (AvrK) ≤ 47 D), moderate (AvrK 47-55 D) and advanced keratoconus (AvrK ≥ 55 D). Finally, intergroup and intragroup comparison analyses were made statistically. RESULTS: In the keratoconus group, 20 (29%) (14 weak and 6 moderate staining) of the 69 corneal epithelial specimens were identified with HO-2 expression. In the control group, 40 (76.9%) (16 moderate and 24 strong staining) of the 52 corneal epithelial specimens were identified with HO-2 expression. HO-2 expression in the corneal epithelial specimens was significantly less in the keratoconus group than in the control group (p < 0.001). There was no substantial difference among the keratoconus subgroups in terms of staining with the HO-2 antibody (p = 0.797). CONCLUSIONS: The HO-2 enzyme staining using immunohistochemical methods was at lower amounts in the keratoconic corneal epithelial cells as compared with normal corneal epithelial cells. The HO-2 enzyme may play a role in the etiopathogenesis of keratoconus.

Protective effects of thymoquinone and melatonin on intestinal ischemia-reperfusion injury.

BACKGROUND/AIM: In the present study, we aimed to compare the potential protective effects of thymoquinone and melatonin by using equivalent dose, on oxidative stress-induced ischemia-reperfusion (IR) injury in the intestinal tissue of rats. MATERIALS AND METHODS: The study was performed using 32 male Wistar-Albino rats (weighing 180-200 g) randomly divided into four groups: Group I, sham group; Group II, IR group; Group III, IR with melatonin group; and Group IV, IR with thymoquinone group. After laparotomy, ischemia and reperfusion were performed for 60 and 120 min, respectively, on all the groups. Intestinal tissue sections were stained using routine histological methods and examined under the light microscope. In addition, the sections were immunohistochemically stained using the TUNEL method for determination of apoptosis. Superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-Px) activity, and malondialdehyde (MDA) levels in the intestinal tissue were also measured. RESULTS: The IR group had significantly elevated tissue SOD activity, GSH-Px activity, and MDA levels compared with the sham group. Administration of thymoquinone and melatonin efficiently reduced these increases. Statistically significant number of apoptotic cells was observed in the intestinal tissue of IR group rats compared with the sham group. Treatment with thymoquinone and melatonin markedly reduced the number of apoptotic cells. CONCLUSION: The effects of melatonin and thymoquinone on IR-induced oxidative stress in rat intestines were similar. Our findings suggest that melatonin and thymoquinone protect against IR-induced injury to intestinal tissues.

Initial experience with delivery of palliative care toterminal cancer patients.

BACKGROUND/AIM: We investigated the symptoms and needs of terminal cancer patients in a region where formal palliative care is limited. Here we present the demographic features and symptoms of end-stage cancer patients living in a city in northern Turkey. MATERIALS AND METHODS: The study was conducted at Gaziosmanpasa University (Tokat, Turkey), in 2011 and 2012. End-stage cancer patients admitted or referred by various departments to our outpatient pain unit were included. Demographic data, treatment histories, primary tumor sites, patient complaints, and symptom intensities measured using the Edmonton Symptom Assessment System Scale were prospectively entered into a database. RESULTS: A total of 107 patients (36 female and 71 male) were included. Gastrointestinal cancer was the most common form of cancer (43%), followed by genitourinary (25.3%) and lung cancer (15%). The most common symptom was fatigue (98.1%). The other symptoms (in decreasing order) were pain (92.5%), insomnia (92.5%), loss of appetite (76.6%), constipation (71%), dyspnea (63.6%), nausea (60.7%), cough (57.9%), and vomiting (48.6%). Eighty-six percent of the patients (n = 92) had metastases. Most lived in the city (59.8%) and 84 (78.5%) lived with their spouses. CONCLUSION: Patients were referred at the late stages of disease with pain as the principal presenting symptom. Family members were the principal caregivers.

[Comparing efficiencies of diclofenac sodium and paracetamol in patients with primary dysmenorrhea pain by using Visual Analog Scale]. / Primer dismenore agrili hastalarda diklofenak sodyum ve parasetamol tedavi etkinliklerinin Vizüel Analog Skala kullanilarak karsilastirilmasi

OBJECTIVES: The aim of this study was to compare the efficiency of diclofenac sodium to paracetamol using a visual analog scale in the patients presenting to the emergency room with primary dysmenorrhea. METHODS: Group I (n=40) patients were diagnosed with primary dysmenorrhea and treated with paracetamol (1 gr intravenous) and Group II (n=40) patients were diagnosed with primary dysmenorrhea and treated with diclofenac sodium (75 mg intramuscular). In both groups, patients were 19-30 years old. In all groups, the intensity of the pain was ranked from 0 (no pain) to 10 (intolerable) using VAS. The VAS scores were compared between treatment groups. RESULTS: Between two groups, there was no statistically significant difference in age, mean arterial pressure and pulse values. The initial VAS values of the first group were higher than that of 2nd group. Following treatment, in the 10th and 30th minutes, the VAS values were lower in Group I than Group II (p=0.00). The VAS values of each group were significantly different from each other on the 10th and 30th minutes. VAS values at the 10th and 30th minutes were lower compared to the initial values and the values in the 30th minute were lower relative to the 10th minute (p=0.00) in both treatment groups. CONCLUSION: We can suggest that paracetamol is more efficient than diclofenac sodium in the treatment of primary dysmenorrhea.

[Investigation of Coxiella burnetii and Brucella seropositivities in patients presenting with acute fever]. / Akut ates yakinmasiyla basvuran hastalarda Coxiella burnetii ve Brucella seropozitifliginin arastirilmasi

Tokat province and Kelkit Valley located in the Black Sea region of Turkey are endemic areas for brucellosis and Crimean-Congo hemorrhagic fever. Since the risk factors are similar, the probability of Coxiella burnetii seroposititivity is assumed to be also high in this area. The aim of this study was to investigate Q fever and brucellosis seropositivity in patients with acute fever. A total of 53 patients (37 male, 16 female; age range: 18-65 years, mean age: 47.13 ± 16.40 years) who were admitted to the emergency room and infection diseases outpatient clinics of Gaziosmanpasa University hospital with acute fever between June 2011-June 2012 were included in the study. Symptoms, physical examination findings and laboratory test results of the patients were recorded. In addition, their place of residence, relationship with rural area, and history of contacts with animals were questioned. The presence of C.burnetii phase II lgM and lgG antibodies were investigated by indirect immunofluorescent antibody assay, and Brucella spp. antibodies by Rose Bengal and standard tube agglutination methods in the serum samples of patients. C.burnetii seropositivity was determined in 19 (36%) of the patients, and 2 (4%) of them were diagnosed as acute Q fever with the positivity of both lgG and lgM antibodies. Among the seropositive and seronegative patients, there was no statistically significant differences in terms of age, gender, animal contact, occupation, place of residence and relationship with rural-life (p> 0.05). Acute fever was attributed to pneumonia in 10 patients and of them five were found positive for phase II lgG antibodies. There was no significant difference between C.burnetii seropositive and seronegative patients in terms of the presence of pneumonia (p= 0.30). In two patients diagnosed as acute Q fever no signs of pneumoniae were detected in the chest X-rays; one of these cases was resided in the city and the other in the rural area while both had contact with animals. The most frequently detected symptoms in patients with acute Q fever were malaise, fatigue, chills, cough, sputum, dyspnea, nausea, abdominal pain and diarrhea. Brucella seropositivity was detected in 6 (11%) patients and four of them were diagnosed as acute brucellosis. Four of the Brucella seropositive patients were also found positive for C.burnetii. Sixteen (84%) of C.burnetii seropositive patients were male and 3 (16%) were female. Eleven of them were living in the village and eight in the city, however six out of eight urban patients had a history of relation with rural-life, resulting a total of 17 (89%) rural-contacts. In addition, 79% (15/19) of seropositive cases had the history of animal contact most commonly with cattle and sheep (11/15; 73%). When the laboratory findings were compared, serum ferritin levels were found to be significantly higher in patients with acute Q fever then those seronegative patients (874 ng/ml mean value vs. 150 ng/mL mean value; p= 0.04), however there was no significant difference between the other laboratory parameters (p> 0.05). Our data indicated that Q fever seropositivity was quite high in Tokat region and the reason may be attributed to entwined life between rural and urban areas. In conclusion in the patients presenting with acute fever, brucellosis and Q fever should be considered in differential diagnosis, since both infections are endemic in that area of Turkey.

The apoptotic effect of a high dose of toluene on liver tissue during the acute phase: an experimental study.

The aim of this study is to investigate the acute toxic effects of high-dose toluene and its mechanisms on the liver tissue of toluene-treated rats. In this study, 16 adult male Wistar albino rats (200-220 g) were divided into two equal groups. Group I was used as a control group, while group II was exposed to high dose of toluene, 5200 mg/kg (6 ml/kg per gavage). After the 3-hour experimental period, blood samples and liver tissues were taken from the euthanized animals. Serum aspartate and alanine aminotransferase levels were assayed. Liver tissues were fixed in 10% neutral formalin, then embedded in paraffin and sectioned (5 µm thickness). Sections were stained with hematoxylin and eosin for histopathological examination. A terminal transferase dUTP nick end labeling assay was also done for the determination of apoptosis in liver tissues. For the determination of Bax and caspase-3 immunoreactivity, the sections were stained using avidin-biotin-peroxidase immunohistochemical method. The level of plasma transaminase was found to be increased in toluene administered rats. Additionally, slight degeneration of hepatocyte and mononuclear cell infiltration was observed in the liver tissue sections and a high (+++) immunoreactivity for Bax and caspase-3 protein was observed in the toluene group. This study showed that the high dose of toluene triggers apoptosis in the liver of rats via the mitochondrial pathway in acute period.

Acute cardiotoxic effects of high dose toluene: an experimental study.

OBJECTIVE: This study aimed to investigate the acute cardiotoxic effects of high dose toluene and its damage mechanisms on heart tissue in the acute period. METHODS: Twenty adult male Wistar Albino rats (200-220 g) were used in this controlled experimental animal study. Animals were divided into two equal groups: a control group (Group 1) and a high dose (6 mL/kg/gavage) toluene-administered group (Group 2). Arterial blood pressure (BP) and heart rate (HR) values were measured at 30th, 60th and 90th minutes after toluene was administered. At the end of the experimental period, blood samples and heart tissues were taken from the rats. Serum troponin T levels were assayed. Heart tissue sections were stained using routine histological methods and examined under a light microscope. In addition, the sections were immunohistochemically stained using the avidin-biotin-peroxidase method to determine caspase-3 immunoreactivity and TUNEL to detect apoptosis. To compare the apoptotic index, the Mann-Whitney U test was used. For comparisons between the two groups, the independent t- test was used. In addition, time-based changes of intra-group parameters were evaluated using paired t tests. RESULTS: BP and HR values were low in toluene-treated rats compared to the control group. Troponin T levels were increased in toluene-administered animals as compared with controls [Toluene group: 0.140 (0.010-2.000) ng/mL vs control group: 0.010 (0.010-0.010) ng/mL, p=0.01]. Histopathologic examination of heart tissue sections showed congestion and edema in toluene administrated rats. Higher TUNEL positivity and (+++) immunoreactivity for caspase-3 protein were observed in the toluene group compared to the control group. CONCLUSION: The present study demonstrated that high doses of toluene cause apoptosis and may lead to impairment of cardiac function in the acute period.

Investigating the effect of aromatherapy in patients with renal colic.

AIM: The aim of the present study was to investigate the usefulness of rose essential oil as a supplementary and adjunctive therapy for the relief of renal colic, specifically because rose essential oil is soothing and can act as a muscle relaxant. MATERIALS: Eighty patients who were diagnosed with renal colic in the emergency room were included in the study, with ages ranging from 19 to 64 years. Half of the patients (n=40) were treated with conventional therapy (diclofenac sodium, 75 mg intramuscularly) plus placebo (physiological serum, 0.9% NaCl), while the other half (n=40) were given aromatherapy (rose essential oil) in addition to conventional therapy. In each patient, the severity of pain was evaluated using the Visual Analog Scale (VAS) (0 [no pain] to 10 [very severe pain]). FINDINGS: The VAS values prior to the start of therapy, and 10 and 30 minutes after therapy were 8.18 ± 1.36, 5.60 ± 2.02, and 3.75 ± 2.08 for the conventional therapy plus placebo group, while for the conventional therapy plus aromatherapy group, the VAS values were 8.63 ± 1.03, 4.25 ± 1.72, and 1.08 ± 1.07, respectively. There was no statistically significant difference between the starting VAS values of the two groups, but the VAS values 10 or 30 minutes after the initiation of therapy were statistically lower in the group that received conventional therapy plus aromatherapy. CONCLUSION: This study demonstrated that rose essential oil therapy in addition to conventional therapy effectively reduces renal colic pain.

Detailed evaluation of patients admitted to emergency department with a tick bite complaint.

BACKGROUND AND OBJECTIVE. A tick bite has been an emergency of increased importance in recent years since it can cause a progressive, fatal disease such as Crimean-Congo hemorrhagic fever (CCHF). This issue should be considered by physicians working not only in endemic areas but also in the entire world, taking into account immigration, overseas trips, etc. In our study, we aimed to increase the awareness of the issue by evaluating the emergency department admissions of tick bite complaints in an endemic area. MATERIAL AND METHODS. In total, 251 patients who had been admitted to the emergency department with a complaint of a tick bite within 10 months were included into the study. The data were obtained by collecting main complaints, demographic characteristics, cell counts on admission, and biochemical tests as well as CCHF findings in the RT-PCR test. The patients were divided into 2 groups according to the results of real-time polymerase chain reaction (PCR+ and PCR-). RESULTS. All the patients complained of tick bites. As for the additional complaints, 46% of the overall study population had fatigue and 36% experienced fever. Fever was the most common complaint in the PCR+ group (39%). The platelet and white blood cell counts were significantly lower and the AST level was significantly higher in the PCR+ group than the PCR- group (P<0.01). CONCLUSIONS. In CCHF, where an early diagnosis is very important in reducing mortality, and the symptoms such as a tick bite, fever, and fatigue should be taken seriously by emergency medicine physicians. Leukopenia and thrombocytopenia and higher levels of enzymes in the liver function tests should be taken into account.

Pain levels associated with renal colic and primary dysmenorrhea: a prospective controlled study with objective and subjective outcomes.

OBJECTIVES: To evaluate the degree of pain associated with renal colic and primary dysmenorrhea using objective and subjective measurements. METHODS: In total, 60 subjects participated in this study. There were 20 subjects in the renal colic group (average age 24.45 ± 2.35 years), 20 subjects in the primary dysmenorrhea group (average age 23.75 ± 1.86 years), and 20 subjects in the control group (average age 24.20 ± 2.57 years). The serum chromogranin A (CgA) values were determined by an enzyme-linked immunosorbent assay and the mean pain score was assessed by means of a Visual Analog Scale (VAS) for each individual. RESULTS: The serum CgA level was 19.83 ± 19.61 ng/ml for the renal colic group, 13.45 ± 8.52 ng/ml for the primary dysmenorrhea group and 12.45 ± 7.76 ng/ml for the control group. The mean VAS score for pain was 7.95 ± 1.54 for the renal colic group and 7.05 ± 1.50 for the primary dysmenorrhea group. CONCLUSIONS: Primary dysmenorrheic pain is as intense as renal colic pain. Emergency room physicians should display the same degree of care and attention for the treatment of patients with primary dysmenorrhea as they do for patients with renal colic, and rapidly initiate an effective treatment for these patients.

The effect of N-acetyl cysteine on serum glutathione, TNF-alpha and tissue malondialdehyde levels in the treatment of sepsis.

BACKGROUND: The aim of this study was to investigate the effects of Nacetyl cysteine (NAC) on the levels of reactive oxygen species in sepsis. METHODS: In this study, 30 Sprague-Dawley female rats weighing 180- 200 g were used. Rats were randomized into three groups, each containing 10 rats, as follows: Group I: Sham, Group II: Sepsis and Group III: Sepsis+NAC. Group I underwent only laparotomy. In Groups II and III, sepsis was induced by cecal ligation and perforation (CLP) technique. NAC (20 mg/kg/ day) was administered orally to Group III at 0, 8 and 16 hours. At the 24th hour, tissue and blood samples were taken for erythrocyte glutathione (GSH) and serum tumor necrosis factor (TNF)-? levels, histopathological determination, and lung, liver and kidney tissue malondialdehyde (MDA) analyses. RESULTS: Group III was significantly different from the other groups with respect to erythrocyte glutathione, serum TNF-? and kidney MDA levels (p<0.05). There was no significant difference between the groups regarding liver MDA levels and histopathological parameters for lung, liver and kidney (p>0.05). CONCLUSION: NAC treatment had beneficial effects on erythrocyte GSH, serum TNF-?, lung function, and kidney MDA levels in sepsis-induced rats. However, this beneficial effect was not confirmed as histopathological improvement. Further research is needed to prove the effect of NAC in sepsis treatment.

The effectiveness of various doses of octreotide for sulfonylurea-induced hypoglycemia after overdose.

This study was conducted to investigate the effectiveness of various doses of octreotide in reducing hypoglycemic attacks and the need for dextrose in patients with refractory and recurrent hypoglycemia related to sulfonylurea toxicity. This study was carried out at the Center of Experimental Research of Selcuk University Meram School of Medicine in Konya, Turkey. A total of 40 New Zealand rabbits of both sexes, weighing between 2500 and 3000 g, were used in this experiment. Rabbits were randomly divided into 4 groups, each of which consisted of 10 animals. All animals were given oral gliclazide 100 mg. For the treatment of hypoglycemic attacks in group I, only 15 mL of 50% dextrose (7.5 g) was given intravenously; in groups II, III, and IV, octreotide was given in doses of 25 ug, 50 ug, and 100 ug, respectively. Octreotide was given to groups II, III, and IV at the 8th hour (when hypoglycemic attacks were induced), along with an intravenous infusion of an additional 15 mL of 50% dextrose (7.5 g) for each hypoglycemic attack that occurred. After the toxic dose was given, the rabbits were given the amount of dextrose used before and after octreotide administration, and the numbers of hypoglycemic attacks were recorded. The values of blood glucose for all animals were read every hour on the hour from the beginning of the study, and the study ended at the 24th hour, when hypoglycemic attacks stopped. A significant difference was observed between groups I, II, and IV in numbers of hypoglycemic attacks that occurred and dextrose doses given between 9 and 24 h (P=.001). The findings of this study suggest that a single dose of octreotide 100 ug may be used to reduce the number of refractory and recurrent hypoglycemic attacks that occur because of sulfonylurea overdose; large prospective studies are needed to validate these findings.