Can lactate be valuable in early diagnosis and prognosis of neonatal sepsis?

Background: Sepsis monitoring tissue perfusion is crucial for detecting circulatory failure early, implementing the right treatments, and assessing response. Insufficient oxygenation leads to a rise in lactate level and has been shown to be useful in predicting mortality and morbidity in newborns. There have not been many studies on how lactate measurement affects neonatal sepsis diagnosis and prognosis. Aim: The aim of our study was to determine the impact of lactate on early diagnosis and prognosis in neonatal sepsis. Materials and Methods: Eighty-seven newborns diagnosed with neonatal sepsis at a neonatal intensive care unit between January 2010 and July 2021 were included in the study. Venous blood gas, lactate, and C-reactive protein (CRP) levels and complete blood count on the first, second, and third day of hospitalization were noted. Lactate values were correlated with other variables to determine the impact of hyperlactatemia on morbidity and to determine factors affecting the length of stay. IBM SPSS Statistics version 22.0 for Windows was used to analyze the data (SPSS Inc., Chicago, IL, United States). Results: A strong negative correlation between lactate and oxygenation and perfusion indicators (HCO3, BE, PaO2) during the therapeutic process was observed. With treatment, the initial measured lactate value decreased, and a significant increase in CRP and oxygen saturation was observed, which was interpreted as the observation of an early lactate response to infection before a CRP response. The initial lactate level, as well as the change in lactate levels, was not, however, significantly correlated with the length of stay. Conclusion: Lactate can be used in the early diagnosis of neonatal sepsis and for determining prognosis.

The relationship between intracoronary thrombus burden and atherogenic index in patients with ST-elevation myocardial infarction.

OBJECTIVE: Increased coronary thrombus load is a strong predictor of adverse cardiovascular (CV) outcomes. Identifying predictors of intracoronary thrombus burden may contribute to the management of ST-segment elevation myocardial infarction (STEMI). We aimed at evaluating the relationship between the atherogenic index (ATI) and coronary thrombus burden in patients presenting with STEMI. PATIENTS AND METHODS: 139 patients who presented with STEMI and underwent primary percutaneous coronary intervention were included in this study. Angiographic thrombus burden was classified as previously defined in the myocardial infarction (TIMI) study group. RESULTS: The patients were divided into two groups as those with high and low thrombus load. Independent predictors of high thrombus burden were ATI (OR: 4.23, 95% CI: 2.38-7.5; p<0.001), serum creatinine level (OR: 17.4, 95% CI: 3.03-101.4; p=0.001) and non-LAD involvement (OR: 0.363, 95% CI: 0.14-0.92; p=0.034). The association of ATI with thrombus load was independent from HDL and TGL levels. CONCLUSIONS: The atherogenic index can be used as a reliable marker for increased coronary thrombus burden, which is associated with adverse CV outcomes.

Aortic valve sclerosis is a high predictive marker of systemic endothelial dysfunction in hypertensive patients.

BACKGROUND: Aortic valve sclerosis (AVS) is closely related to hypertension and is an important predictor of coronary artery disease as well as cardiovascular morbidity and mortality. However, the mechanisms causing AVS have not yet been clarified. Therefore, we planned to investigate the influence of atherosclerosis-related risk factors including C-reactive protein (CRP), epicardial adipose tissue (EAT), carotid intima-media thickness (CIMT), pulse wave velocity (PWV), left ventricular hypertrophy, and the conventional risk parameters as well as endothelial dysfunction in untreated hypertensive patients. METHODS AND RESULTS: Our study was cross-sectional and observational, and included 107 consecutive untreated hypertensive patients. All patients underwent vascular evaluation by CIMT, PWV, flow-mediated dilation (FMD%), as well as echocardiographic examinations. Age (OR = 1.180, p < 0.001), male sex (OR = 3.056, p = 0.019), waist circumference (OR = 1.082, p = 0.004), EAT (OR = 1.419, p = 0.001), smoking status (OR = 3.161, p = 0.014), FMD% (OR = 0.649, p < 0.001), mean CIMT (OR = 2.481, P < 0.001), and carotid plaque (OR = 4.692, P = 0.001) were associated with AVS in univariate analyses. Multivariate analyses revealed only age (OR = 1.144, P = 0.006) and FMD% (OR = 0.691, 0.001) as independent predictors of AVS. The presence of AVS had a high positive predictive value (100 %) but a low negative predictive value (51 %) for endothelial dysfunction (FMD < 12 %) in hypertensive patients. CONCLUSION: Our study supports the theory that systemic endothelial dysfunction has an initial and independent effect on AVS pathogenesis. Moreover, we demonstrated that the presence of AVS in patients with hypertension predicts endothelial dysfunction, with a high positive predictive value. Thus, AVS in hypertensive patients may urge clinicians toward aggressive risk factor modification and intensive treatment.

Primary hydatid cyst in an unexpected localization.

Echinococcal disease remains a problem within some endemic areas. It usually involves the liver and lungs, but any other organ can potentially be involved. Soft tissue hydatid disease without liver and lung involvement was reported in 2.3 % of patients. This paper presents a case of 35-year-old male patient who was referred to our department with a 9x9x6cm hydatid cyst at psoas muscle. The rarity of the musculoskeletal disease renders the decision making on the favorable treatment quite difficult. Conservative treatment, complete excision and simple drainage have all been suggested as adequate. We advocate total en bloc excision whenever possible (Fig. 2, Ref. 4).

Effects of Saccharomyces cerevisiae extract on haematological parameters, immune function and the antioxidant defence system in breeder hens fed aflatoxin contaminated diets.

The study was conducted to investigate the efficacy of Saccharomyces cerevisiae extract (SC) on haematological parameters, immune function, and the antioxidant defence system in breeder hens fed a diet contaminated with low level aflatoxin (AF). Forty-eight Ross 308 breeder hens were fed on diets containing AF (0 or 100 µg/kg) and SC (0 or 1 g/kg) in a 2 × 2 factorial arrangement. Red blood cell (RBC), white blood cell (WBC), and platelet counts, differential leucocyte counts, blood CD3+, CD4+, CD8+ and CD5+ T cell ratios, phagocytic activity and oxidative burst of heterophils, plasma and liver catalase activity, and malondialdehyde (MDA) and ascorbic acid concentrations were measured. 3. Plasma and liver MDA concentrations increased (P < 0·05), liver catalase activity decreased (P < 0·05) and total WBC count tended to decrease (P = 0·082) in hens fed the contaminated diet. WBC count, monocyte percentage, phagocytic activity and oxidative burst of heterophils increased (P < 0·05), and plasma MDA concentration tended to decrease (P = 0.088) in SC extract supplemented hens. There was a significant interaction between AF and SC on heterophil, lymphocyte, CD5+ cell percentages, and plasma catalase activity. Blood heterophil percentage decreased but lymphocyte percentage increased in hens fed on the AF contaminated diet without SC supplementation. SC supplementation counteracted the negative effect of AF on heterophils and lymphocytes. The CD5+ cell percentage decreased in unsupplemented hens fed the AF contaminated diet and this negative effect was minimised in SC supplemented hens. Plasma catalase activity increased in SC supplemented hens fed the uncontaminated diet whereas the effect of SC decreased in hens fed the AF contaminated diet. 4. The SC reduced some of the some adverse effects of AF, and improved functions of the non-specific immune system. Therefore, the SC extract which has been used for improving productive performance in birds and mammals may also be useful for modulating some of the effects of a low level, chronic dosage of AF.

Complications of misuse of Bacillus Calmette-Guerin.

Intravesical BCG is a good treatment choice for vesical carcinomas. Nevertheless, it can also become a mortal toxin when applied in a wrong way. The application routes of the prescribed drug should be rigorously described to patients and detailed instructions regarding the ways of application such as intravesical application should be given to the persons taking this medicine (Ref. 9).

The effects of Saccharomyces cerevisiae extract on the weight of some organs, liver, and pancreatic digestive enzyme activity in breeder hens fed diets contaminated with aflatoxins.

The effects of the Saccharomyces cerevisiae extract on some organ, liver, and pancreatic digestive enzymes in breeder hens fed on aflatoxin (AF)-contaminated feed were investigated. Forty-eight 58-wk-old Ross 308 breeder hens were used. The hens were fed diets containing 0 or 100 µg of AF/kg and 0 or 1 g of S. cerevisiae/kg in a 2×2 factorial arrangement of treatments. Although serum alkaline phosphatase levels were significantly higher, serum alkaline aminotransferase (P=0.068) and gamma-glutamyltransferase (P=0.067) levels tended to increase (P<0.05) in hens fed the AF-contaminated diet than those of hens fed the uncontaminated diet. Both AF and S. cerevisiae extract increased (P<0.001) pancreatic amylase activity, but the effect was not additive, resulting in an AF×S. cerevisiae extract interaction (P<0.001). α-Amylase activity in duodenum was lower (P<0.001) in hens fed the AF-contaminated diet. Duodenum α-amylase activity was higher (P=0.024), but jejunum α-amylase activity was lower in S. cerevisiae extract-supplemented hens than that of nonsupplemented hens. There was a significant interaction between AF and S. cerevisiae extract on pancreatic and duodenal lipase activity. Pancreatic lipase activity decreased in hens fed the AF-contaminated diet. However, S. cerevisiae supplementation extract minimized this effect of AF on pancreatic lipase activity. Duodenal lipase activity was decreased in hens fed the AF-contaminated diet without S. cerevisiae extract supplementation. However, there were not any significant differences between hens fed the AF-contaminated diet and hens fed the uncontaminated diet after S. cerevisiae extract supplementation. Pancreatic trypsin activity was higher (P=0.044) in hens fed the AF-contaminated diet than that of hens fed the uncontaminated diet. There was a significant interaction between AF and S. cerevisiae extract on pancreatic chymotrypsin activity. It was increased in hens fed the AF-contaminated diet without S. cerevisiae extract supplementation. However, S. cerevisiae extract supplementation counteracted this negative effect of AF on pancreatic chymotrypsin activity. The treatments did not result in any change in duodenal chymotrypsin activity, but S. cerevisiae supplementation decreased (P<0.05) jejunal chymotrypsin activity. In conclusion, our results showed that addition of 1 g/kg of S. cerevisiae extract reduces the toxic effects of AF on pancreatic lipase and chymotrypsin activity. Therefore, it may be useful to supplement feedstuff with S. cerevisiae extract to reduce the effects of AF in laying breeder hens.

Does percutaneous thyroid laser ablation induce mixed papillary and medullary thyroid carcinoma?

Mixed medullary-papillary carcinomas are very rare and still not listed in the WHO classification (1988). The rarity of the co-existence of medullary and papillary carcinoma suggests that these cases represent mere coincidence. Some studies have shown that radiation exposure has induced neoplasia in the two cell types in rats. But we still have limited information about the carcinogenetic effect of laser ablation on the thyroid gland. This report describes the first case of thyroid carcinoma that demonstrated both medullary carcinoma and papillary components in the thyroid, which might occur due to percutaneous thyroid laser ablation.

Endometriosis of the groin hernia sac: report of a case and review of the literature.

Endometriosis is characterized by the presence of histological normal endometrial tissue outside the uterine cavity. It occurs in up to 15% of menstruating women and often goes undetected. Some cases of soft-tissue involvement have been reported, particularly in the skin and subjacent tissues of surgical scars. However, we came cross a 42-year-old female patient with millimetric focal lesions in a groin hernia sac. A case report and a review of the literature are presented. Although definitive diagnosis still requires biopsy, the patient's cyclic symptoms and history of previous uterine surgery should suggest the correct diagnosis.

Retroperitoneal cystic lymphangioma.

An interesting and rare differential diagnosis for a retroperitoneal cystic mass is cystic lymphangioma. A case of a patient presenting with a multicystic mass in the retroperitoneum that was identified as a cystic lymphangioma is reported. These tumours are commonly confused with other cystic masses in the retroperitoneum.

Primary hydatid disease of the soft tissue.

Human hydatid disease is caused by the larval form of the tapeworm genus Echinococcus. The ova hatch in the small intestine, penetrate the intestinal wall, pass through the portal vein into the liver, lungs, and other tissues, and develop into a hydatid cyst. Hydatid disease is endemic in many parts of the world; in the Mediterranean Countries, the Middle and Far East and South America. Soft tissue hydatid disease without the liver and the lung involvement occurs in 2.3% of patients reported from endemic areas. Hydatid disease should be considered in the differential diagnosis of all cystic masses in all anatomic locations especially in endemic areas.

Migration of an ingested needle to the mesentery, causing intestinal necrosis.

A case of an intra-abdominal sharp foreign body with migration to the mesentery vessels, causing intestinal necrosis in a 20-year-old patient is presented. Emergency surgery with 75 cm small bowel resection was performed.

Heredity and familial tendency of acute appendicitis.

BACKGROUND: Although inflammatory disease of the vermiform appendix has been recognized as such for more than 100 years, its etiology remains a subject of controversy. The notion that appendicitis is familial, is not only important for understanding the etiology of the condition but might contribute substantially to the diagnosis and thus provide an indication for early surgical intervention. METHODS: An extensive Medline search, textbooks, scientific reports and scientific journals are the data sources. CONCLUSIONS: In the light of past studies, we can suggest that almost half of the variability in risk of acute appendicitis is due to genetic factors. A positive family history increases the relative risk of being acute appendicitis nearly 3 times.

Occult malignancy in patients with venous thromboembolism: risk indicators and a diagnostic screening strategy.

BACKGROUND: The study was designed to analyse the risk indicators for a possible underlying malignancy and to evaluate whether extensive cancer screening is necessary in all patients with venous thromboembolism or not. METHODS: In total, 126 patients with idiopathic deep venous thrombosis, and 121 patients with secondary deep venous thrombosis of lower extremity and without a known malignancy were studied. A diagnostic screening workup including a clinical history, physical examination, complete blood count, blood sedimentation rate, basic biochemistry panel including hepatic and renal function tests, prostate-specific antigen, a chest X-ray and an abdominopelvic ultrasonography was performed for all patients. RESULTS: Suspicious findings suggesting an underlying cancer, previous history of venous thromboembolism, bilateral venous thrombosis and associated thrombosis in unusual sites were significantly more common in patients with idiopathic venous thrombosis. A malignancy was detected in 10 of the 126 patients (7.9%) without a known risk factor for deep venous thrombosis. During the follow-up period, a diagnosis of malignancy was established in two patients in the same group. CONCLUSION: The risk of an underlying malignancy in patients with idiopathic venous thromboembolism is significantly higher. A moderate screening strategy has the capacity to identify the majority of the malignancies in such patients. We advocate simple laboratory tests, a chest X-ray and an abdominopelvic ultrasonography in order to search for an occult malignancy. A more extensive screening strategy may be considered for patients with suspicious findings for cancer, recurrent or bilateral venous thromboembolism and associated thrombosis in unusual sites.

Effects of Taxol plus radiation on the apoptotic and mitotic indices of mouse intestinal crypt cells.

PURPOSE: In this study we investigated the effect of Taxol, radiation, or Taxol plus radiation on highly proliferative normal tissue--the intestinal crypt cells of Swiss albino mice. MATERIALS AND METHODS: Swiss-albino mice, 3-4 months old, were used in this study. Taxol was administered by bolus intravenously through the tail vein. Radiation was given using a linear accelerator. There were four treatment categories, which comprised a total of 34 groups. Each group consisted of five animals. The first category was a control category which comprised one group (n = 5). The second treatment category was Taxol alone which comprised three groups (n = 15). The third treatment category was radiation alone which comprised three groups (n = 15). The fourth treatment category was Taxol plus radiation which comprised 27 groups (n = 135). Mice were killed 24 h after Taxol or radiation or combined administration using ether anesthesia. Using a light microscope, apoptotic and mitotic indices were counted on jejunal crypt cells of mice that were stained with hematoxylin-eosin. Differences between groups were statistically evaluated with Student's t-test. RESULTS: Taxol caused a dose-dependent increase in apoptosis (P = 0.045) and decreased the mitotic index (P = 0.006) at high doses. Similarly, radiation caused a dose-dependent increase in apoptosis (P = 0.046) and decreased the mitotic index (P = 0.299) at higher radiation doses. Compared to radiation alone, Taxol caused a significant induction of apoptosis (P = 0.010). In combination, no significant radiosensitizing effect of Taxol was observed (enhancement ratio < 1), when compared to radiation alone. However, an increase in apoptosis was observed after 24 h of Taxol exposure when compared to 12 or 48 h of Taxol exposure (P = 0.0001 and P = 0.0001). CONCLUSION: These findings suggest that Taxol did not cause a radiosensitizing effect in intestinal crypt cells. However, a 24-hour pretreatment of Taxol exposure followed by radiation caused significant induction of apoptosis and reduction of the mitotic index when compared to other Taxol timing sequences. Thus, the lack of a radiosensitizing effect of Taxol in these proliferative cells may be due to enhanced mitotic death rather than apoptotic death.

The relationship between genetic susceptibility to head and neck cancer with the expression of common fragile sites.

BACKGROUND: Numerous studies have recently been conducted to investigate genetic mechanisms in cancer causes and pathogenesis. Some of these studies have shown that there were certain specific chromosomal defects in normal cells of cancer patients and in their first-degree relatives. It was suggested that these individuals were susceptible to cancer development when compared with people without these defects. Materials and Methods Chromosomal anomalies, such as gaps, breaks, and acentric fragments, and fragile site expression rates were determined in peripheral blood lymphocyte cultures in 14 head and neck cancer patients, 17 first-degree relatives of these patients, and 20 healthy individuals as a control group in this study. RPMI 1640 medium, composed of aphidicolin, 5-bromodeoxyuridine, and caffeine were used for the induction of fragile sites. RESULTS: In cytogenetic and statistical evaluation, it was observed that both chromosomal aberration rates and fragile site expression frequencies in head and neck cancer patients and in their first-degree relatives were significantly greater than the control group (p <.05). It was found that fragile site expression was site specific in head and neck cancer patients and in their first-degree relatives. These specific sites were determined to be 1p21-22, 1q21, 1q25, 2q21, 2q31-33, 3p14, 16q22-23, 18q21, and 22q12 sites. CONCLUSIONS: These findings support studies showing that the fragile sites might be unstable factors in human genomes and their expression could be affected by some genetic factors, such as tumor suppressor genes and mismatch repair genes, and by some environmental factors, such as benzo (a) pyrene, dimethylnitrosamine, and dimethylsulfate. In conclusion, fragile sites may be playing an important role in the genetic tendency to head and neck cancer. Overexpression of these sites in normal lymphocytes may be used as a reliable marker to determine the genetic susceptibility in head and neck cancer patients and in their first-degree relatives.

In vivo dominant lethal effect of pyrimethamine in male mouse germ cells.

Pyrimethamine is used for treatment of malaria and toxoplasmosis. The embryotoxicity and clastogenicity of pyrimethamine is known and our aim was to investigate its dominant lethal effect in vivo. For this purpose, we used three groups of Swiss-albino male mice and a control group. We injected males with doses of 16, 32 or 64 mg/kg pyrimethamine and housed them with 10 females/male for each mating interval. Females were sacrificed and their uteri were evaluated for dominant lethality. As a result of this study we found that pyrimethamine induced dominant lethal mutations in the third, fourth and sixth weeks at the 64 mg/kg dose level, without the effect being dose-dependent. We conclude that pyrimethamine is a suspected germ cell mutagen.