Comparison of High-Resolution Computed Tomography and Real-Time Reverse Transcriptase Polymerase Chain Reaction in Diagnosis of COVID-19 Pneumonia in Intensive Care Unit Population.

Introduction The efficacy of high-resolution computed tomography (HRCT) chest in common respiratory infections is well-established; however, its use in the diagnosis of COVID-19 pneumonia is less popular. The previous studies have failed to establish the efficacy of HRCT in the diagnosis of COVID-19 pneumonia. Objective The current study aimed to assess the efficacy of HRCT as compared to a polymerase chain reaction (PCR) in diagnosing COVID-19 pneumonia in patients in our setting. Methodology A prospective observational study was conducted at the Department of Chest Medicine, Shifa International Hospital from April 2020 to December 2020. A total of 250 patients were admitted to medical intensive care units. Findings of HRCT and PCR were documented. The accuracy of HRCT compared with PCR was assessed. Data were analyzed using SPSS version 24 (IBM Corp., Armonk, NY). Results COVID-19 infection was more prevalent in male patients (62.8% vs 37.2%). The mean age was 60 years (interquartile range, IQR, 49-72). Sensitivity and specificity of HRCT segregated into typical, indeterminate, and atypical HRCT were (94.8%, 56.8%), (92.7%, 47.2%), and (91.7%, 76.8%), respectively. The positive predictive value for typical HRCT was 84.3% (p≤0.001). Conclusion We concluded that typical HRCT findings have diagnostic utility in the diagnosis of COVID pneumonia. Similarly, a negative HRCT chest reliably excludes the possibility of COVID pneumonia. HRCT chest is a reliable alternative to RT-PCR.

Parapharyngeal space tumours: the efficiency of a transcervical approach without mandibulotomy through review of 44 cases.

The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and to investigate associated postoperative sequelae and complications. The study investigated and analysed the retrospective charts of 44 patients who underwent surgery for benign parapharyngeal space tumours over a 10-year period. The diagnosis was reached in all patients with clinical and radiologic findings; preoperative fine-needle aspiration biopsy was not performed in any case. The preferred means of accessing the parapharyngeal space in all patients was a transcervical route. In 5 of these patients, transparotid extension was performed due to the position of the tumour. Tumours were classified radiologically as poststyloid in 27 cases and prestyloid in 17 cases. The final histopathologic diagnosis was vagal paraganglioma in 16 cases, pleomorphic adenoma in 13 cases, schwannoma in 10 cases and comparatively rarer tumours in the remaining 5 cases. In three patients, cranial nerve paralysis was observed during preoperative evaluation. Permanent cranial nerve paralysis occurred in 19 cases (43.2%) in the postoperative period, the majority of which were neurogenic tumours such as vagal paraganglioma (n = 16) and schwannoma (n = 2), and one case of non-neurogenic parapharyngeal tumour. The median duration of follow-up was 61 ± 33 months. There was no local recurrence in any patient during the follow-up period. A transcervical approach should be the first choice for excision of parapharyngeal space tumours, except for recurrent or malignant tumours, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck and optimal aesthetic outcomes due to preservation of mandibular continuity with minimal morbidity and hospitalisation time.

Factors affecting visual outcomes in patients with diabetic macular edema treated with ranibizumab.

PURPOSE: To identify factors associated with visual outcomes in patients with diabetic macular edema (DME) treated with ranibizumab (RBZ) in the Ranibizumab for Edema of the mAcula in Diabetes-Protocol 2 (READ-2) Study. PATIENTS AND METHODS: Optical coherence tomography scans, fundus photographs, and fluorescein angiograms (FAs) were graded and along with baseline characteristics were correlated with month (M) 24 visual outcome of best-corrected visual acuity (BCVA) ≤20/100 (poor outcome) vs >20/100 (better outcome). RESULTS: Of 101 patients with a M20 visit or beyond, 27 (27%) had BCVA ≤20/100. Comparison of patients with or without poor outcome showed mean baseline BCVA of 16.8 letters (20/125) in the former compared with 30.4 letters (20/63; P<0.001). Mean change in BCVA between baseline and M24 was -2.6 letters in the poor outcome group compared with +9.8 letters (P<0.001). Foveal thickness (FTH) at M24 was 374.1 µm in the poor outcome group compared with 268.8 µm (P<0.01), a difference driven by 14 patients with mean FTH of 450.3 µm. Foveal atrophy occurred in 65% (11/17) in the poor outcome group compared with 17%(12/71, P=0.001). Persistent edema was noted in 52% (14/27) of patients with poor outcome. Laser scars near foveal center were significantly more common in patients with poor outcome who did not have edema vs those who did (78% (7/9) vs 23% (3/13) P=0.03). CONCLUSION: Poor baseline BCVA (≤20/125) in DME patients predicts poor visual outcome (≤20/100) after 2 years of treatment with RBZ and/or focal/grid laser, often due to foveal atrophy and/or persistent edema.

Oral squamous cell carcinoma and serum paraoxonase 1.

BACKGROUND: Serum paraoxonase 1 is involved in mechanisms that protect cells from oxidative stress damage. This study aimed to investigate the correlation between serum paraoxonase 1 activity and polymorphisms in patients with oral squamous cell carcinoma. METHODS AND MATERIALS: Fifty-seven patients with oral squamous cell carcinoma and 59 matched healthy controls participated in the study. Serum paraoxonase 1 activity and polymorphisms in blood samples were compared with results for polymerase chain reaction and restriction fragment length polymorphism tests. RESULTS: Mean serum paraoxonase 1 activity levels were lower in patients than controls (mean ± standard deviation, 21.9 ± 5 units/l and 120.4 ± 2 units/l, respectively) (p = 0.001). The serum paraoxonase 1 192 glutamine polymorphism was more common in patients than controls. CONCLUSION: Patients with oral squamous cell carcinoma had significantly lower serum paraoxonase 1 activity levels and a greater prevalence of the serum paraoxonase 1 192 glutamine allele, compared with controls. Serum paraoxonase 1 may play a role in the aetiology of oral squamous cell carcinoma.

Closed-cell stents present with higher velocities on duplex ultrasound compared with open-cell stents after carotid intervention: short- and mid-term results.

BACKGROUND: The purpose of this study was to evaluate the effect of carotid cell design on duplex ultrasound velocity readings in the immediate postoperative period and over time. METHODS: A prospective database encompassing all patients treated with carotid artery stents between 2003 and 2008 was established and analyzed for stent type (closed-cell vs. open-cell), indications, and comorbidities. Patients were followed up clinically and with duplex ultrasound immediately after surgery, and every 6 months thereafter. Peak systolic velocities (PSV), end diastolic velocities (EDV), and internal carotid artery (ICA) to common carotid artery (CCA) ratios of PSV were recorded. RESULTS: A total of 214 interventions with 157 (73.3%) open-cell and 57 (26.7%) closed-cell types of carotid stents were performed in 205 patients. Two groups were similar regarding demographics, comorbidities, lesions characteristics, and stent length and diameter. The only difference was a significantly higher mean age (74.4 ± 10.1 vs. 70.9 ± 9.7 years; p = 0.027) and a history of myocardial infarction (34.5% vs. 15.6%; p = 0.004) in the closed-cell group versus open-cell group. Immediately after surgery PSV (115.9 ± 66.1 vs. 93.1 ± 38.7 cm/s; p = 0.003) and ICA/CCA ratio (2.08 ± 1.66 vs. 1.45 ± 0.52; p = 0.001) were significantly higher in closed-cell compared with open-cell group. This difference persisted during the follow-up period of 20.2 +/- 16.4 months; PSV (147.2 ± 108.8 vs. 110.0 ± 51.9; p = 0.003) and ICA/CCA ratio (2.61 ± 2.31 vs. 1.76 ± 0.81; p = 0.001). Patients with diabetes and calcified lesions had higher PSV and ICA/CCA ratio immediately after surgery (p > 0.05 and p < 0.05 for those with diabetes and calcified lesions, respectively) and over time. The number of readings showing significant restenosis (PSV >300 cm/s) over time were significantly higher in closed-cell 5 (8.7%) versus open-cell 1 (0.06%). EDV was not statistically different in the two groups (p > 0.05). CONCLUSION: Our study suggests that duplex criteria to screen for poststent restenosis may require modification according to stent-type. However, long-term effect of stent design on restenosis is still to be established.

Radiochemical synthesis of etomoxir.

Sodium 2-{6-(4-chlorophenoxy)hexyl}oxirane-2-carboxylate (Etomoxir) inhibits transport of fatty acids via the carnitine shuttle into mitochondria of muscle cells and prevents long chain fatty acids from providing energy through ß-oxidation especially for muscle contraction. The objective of this synthesis is to develop a method for radioiodination of Etomoxir in order to explore its potential in diagnostic metabolic studies and molecular imaging. Thus, a method is described for the radiochemical synthesis and purification of ethyl 2-{6-(4-[(131)I]iodophenoxy)hexyl}oxirane-2-carboxylate (3) and 2-{6-(4-[(131)I]iodo-phenoxy)hexyl}oxirane-2-carboxylic acid (4). For the synthesis of these new agents, ethyl 2-{6-(4-bromophenoxy)hexyl}oxirane-2-carboxylate (1) and 2-{6-(4-bromophenoxy)hexyl}oxirane-2-carboxylic acid (2) were refluxed with [(131)I]NaI in the presence of anhydrous acetone at a temperature of 80°C and 90°C for a period of 3-4 hours, respectively. The method of radiolabeling, based on the nucleophilic exchange reaction, resulted in a radiochemical yield of 43% and 67% for compounds 3 and 4, respectively. This paper reports on the labeling of etomoxir with radioiodine as (124)I labeled etomoxir may be of great importance in molecular imaging.

Lesion types and device characteristics that predict distal embolization during percutaneous lower extremity interventions.

OBJECTIVE: Distal embolization (DE) during percutaneous lower extremity revascularization (LER) may cause severe clinical sequelae. To better define DE, we investigated which lesion types and treatment modalities increase the risk for embolization. METHODS: A prospective registry of LER from 2004 to 2009 was reviewed. All cases with runoff evaluated before and after intervention were included. Angiograms and operative reports were reviewed for evidence of DE. Interventions included percutaneous transluminal angioplasty (PTA), with or without stent placement, and atherectomy with four different devices. Chi-square analysis and Fisher's exact test were used to assess significance. Patency rates were calculated using Kaplan-Meier analysis and compared using log-rank analysis. RESULTS: There were 2137 lesions treated in 1029 patients. The embolization rate was 1.6% (34 events). Jetstream (Pathway, Kirkland, Wash) and DiamondBack 360 (Cardiovascular Systems Inc, St Paul Minn) devices had a combined embolization rate of 22% (8 of 36), 4 of 18 (22%) in each group, which was significantly higher than with PTA alone (5 of 570, 0.9%), PTA and stent (5 of 740, 0.7%), SilverHawk (ev3, Plymouth, Minn) atherectomy (14 of 736, 1.9%), and laser atherectomy (2 of 55, 3.6%; P < .001). There was a significantly higher rate of embolization for in-stent restenosis (6 of 188, 3.2%) and chronic total occlusions (15 of 615, 2.4%) compared with stenotic lesions (13 of 1334, 0.9%; P = .01). The embolization rate was significantly higher in Transatlantic Inter-Society Consensus (TASC) II C and D lesions compared with TASC A and B lesions (P = .018). DE rates were not affected by preoperative runoff status (P = .152). Patency was restored at the completion of the procedure in 32 of 34 cases of DE. The 24-month primary patency, assisted primary patency, and secondary patency in the DE group was 54.0% ± 11.9%, 70.0% ± 10.3%, and 73.2% ± 10.3%, respectively, and was 44.4% ± 1.7%, 61.5% ± 1.7%, and 68.2% ± 1.6%, respectively, when embolization did not occur (P > .05). Limb salvage was 72.6% ± 3.1% in lesions in which no DE occurred vs 83.3% ± 15.2% in lesions in which DE occurred (P = .699). CONCLUSIONS: DE is a rare event that occurs more often with the Jetstream and DiamondBack 360 devices. In-stent and complex native lesions are at higher risk for DE. DE is typically reversible with endovascular techniques and has no effect on patency rates and limb salvage.

Head and neck reconstruction with dorsoradial forearm free flap: a preliminary clinical study.

UNLABELLED: Head and neck reconstruction with dorsoradial forearm free flap: a preliminary clinical study. PROBLEMS/OBJECTIVES: The most common criticism of the radial forearm free flap (RFFF) is donor site morbidity. Delayed or defected integration of split thickness skin graft (STSG) is the most commonly encountered complication. Defective healing or excessively thin skin coverage of important forearm structures, such as the median nerve and ulnar artery-nerve bundle, places these structures at increased risk of injury. The current study aims to modify the RFFF to utilize a dorsoradial skin island in order to protect the volar tissue aspect of these structures. METHODOLOGY: Seven patients were included in the study between 2005 and 2008. All patients had oncologic resections in the oral cavity necessitating free tissue transfer. The main variation from the standard RFFF technique is that the medial incision was placed 1 cm lateral to the palmaris longus tendon. The dissection was extended laterally and dorsally, depending on the necessary flap size. The donor side defect was covered with a thigh STSG. RESULTS: None of the patients had partial or complete flap necrosis. This surgical modification provided tissue coverage along the course of the median nerve and ulnar neurovascular bundle. CONCLUSIONS: Dorsoradial forearm free flap is a feasible technique that allows preservation of tissue coverage on the volar surface of the forearm.

Effectiveness of brachytherapy in the treatment of lip cancer: a retrospective study at the istanbul university oncology institute.

Stage T1 through T3 lip cancers can be treated primarily by brachytherapy (BRTX), with or without external radiotherapy (ERT), with adequate safety margins and good results. In this study, the outcomes of BRTX were reviewed for patients treated at the Brachytherapy Department of the Istanbul University Oncology Institute (IUOE). The medical records of 41 patients registered at IUOE with a diagnosis of lip cancer between 1988 and 2003 were reviewed. The median follow-up time was 88 months (24-160 mo). Among these patients, 21 patients with a primary tumor, 14 with tumors arising postoperatively, and 6 with postoperative recurrence of tumor were treated using BRTX. A total of 33 patients (80%) received BRTX alone and 8 (20%) received BRTX and ERT. The 10-year local control rate was 100%, 93%, and 67% for patients treated with BRTX alone, BRTX and surgery, and those treated for postoperative recurrence, respectively (P<.02). For patients treated with BRTX only and BRTX plus surgery, specific disease-free survival was 95% and 94%, respectively, and overall survival was 93% and 100%, respectively; these differences were not statistically significant. One patient with a postoperative recurrence who had been treated with BRTX died as a result of lip cancer. No patients developed any ulcerations, intra-oral complications, or mandibular necrosis. In the BRTX only group, 83% had excellent or good cosmetic results. In the surgery group, 62% had a contour deformity. In lip cancer management, BRTX results were comparable for local control, survival, and minimal late effects in normal tissue. This is in accordance with current reports in the medical literature. Satisfactory results were observed in patients with stage T1 and T2 lesions who had been treated with BRTX only and in patients with stage T3 lesions who had been treated with BRTX plus ERT, without a need for additional treatment modalities.

Frequencies of gap- and tight-junction mutations in Turkish families with autosomal-recessive non-syndromic hearing loss.

Mutations in genes encoding gap- and tight-junction proteins have been shown to cause distinct forms of hearing loss. We have now determined the GJB2[connexin 26 (Cx26)] mutation spectrum in 60 index patients from mostly large Turkish families with autosomal-recessive inherited non-syndromic sensorineural hearing loss (NSSHL). GJB2 mutations were found in 31.7% of the families, and the GJB2-35delG mutation accounted for 73.6% of all GJB2 mutations. The carrier frequency of GJB2-35delG in the normal Turkish population was found to be 1.17% (five in 429). In addition to the described W24X, 233delC, 120delE and R127H mutations, we also identified a novel mutation, Q80R, in the GJB2 gene. Interestingly, the Q80R allele was inherited on the same haplotype as V27I and E114G polymorphisms. As little is known about the mutation frequencies of most other recently identified gap- and tight-junction genes as a cause for hearing loss, we further screened our patients for mutations in GJB3 (Cx31), GJA1 (Cx43), DeltaGJB6-D13S1830 (Cx30) and the gene encoding the tight-junction protein, claudin 14 (CLDN14). Several novel polymorphisms, but no disease-associated mutations, were identified in the CLND14 and GJA1 genes, and we were unable to detect the DeltaGJB6-D13S1830 deletion. A novel putative mutation, P223T, was found in the GJB3 gene in heterozygous form in a family with two affected children. Our data shows that the frequency of GJB2 mutations in Turkish patients with autosomal-recessive NSSHL and the carrier rate of the GJB2-35delG mutation in the Turkish population, is much lower than described for other Mediterranean countries. Furthermore, mutations in other gap- and tight-junction proteins are not a frequent cause of hearing loss in Turkey.

The novel R75Q mutation in the GJB2 gene causes autosomal dominant hearing loss and palmoplantar keratoderma in a Turkish family.

Dominant mutations in the GJB2 gene encoding connexin 26 (Cx26) can cause non-syndromic hearing impairment alone or in association with palmoplantar keratoderma (PPK). We have identified the novel G224A (R75Q) mutation in the GJB2 gene in a four-generation family from Turkey with autosomal dominant inherited hearing impairment and PPK. The age of onset and progression of hearing loss were found to be variable among affected family members, but all of them had more severe impairment at higher hearing frequencies. Interestingly, the novel R75Q mutation affects the same amino acid residue as described recently in a small family (R75W) with profound prelingual hearing loss and PPK. However, the R75W mutation was also observed in a control individual without PPK and unknown hearing status. Therefore, the nature of the R75W mutation remains ambiguous. Our molecular findings provide further evidence for the importance of the conserved R75 in Cx26 for the physiological function of the inner ear and the epidermal cells of the skin.

Serum and tissue c-erb B2, bcl-2, and mutant p53 oncoprotein levels in nasopharyngeal cancer.

To date there are no prognostic factors that can account for the biology and disease behavior in nasopharyngeal cancer. Therefore, identification of new factors that can help in predicting the behavior of the disease and characterizing the subgroup with more aggressive tumors more likely to benefitfrom chemotherapy is important. In this study, c-erb B2, bcl-2, and mutant p53 protein levels were investigated in sera and tumor tissue of patients with nasopharyngeal cancer. Serum c-erb B2 levels were significantly higher in the patients than in the healthy subjects. No meaningful difference was observed between the serum and tissue levels of the mutant p53 protein. Tissue bcl-2 concentrations were considerably high. Our results suggest that serum c-erb B2 levels may aid in identifying a subgroup of patients with a poorer response rate to first-line treatment.