Evaluation of the performance of simple laboratory parameters used in the diagnosis of acute appendicitis.

Background: Acute appendicitis (AA) is one of the most common emergency surgery. Aim: To evaluate the performance of laboratory parameters used in the diagnosis of AA. Subjects and Methods: There were two groups. In both groups, leukocyte (WBC), neutrophil, lymphocyte count, neutrophil/lymphocyte ratio (NLR), mean platelet volume (MPV), red cell distribution width (RDW), and platelet distribution width (PDW) values were examined in complete blood count (CBC). In addition, serum bilirubin (total bilirubin and direct bilirubin) values were examined. All laboratory parameters studied were compared to evaluate their diagnostic performance. Results: A total of 128 people were in the AA group and 122 people were in the healthy group (control). WBC count, neutrophil count, NLR, total bilirubin, direct bilirubin, and PDW values were significantly higher in the AA group than in the control group (P value <0.05). Lymphocyte counts and MPV values in the AA group were significantly lower than in the control group (P value <0.05). The sensitivity and selectivity of the WBC and neutrophil counts in AA were 95.13%, 89.34%, 94.53%, and 93.44%, respectively. The sensitivity and selectivity of the total bilirubin values were 59.38% and 73.77%, respectively. Area under the ROC curve (AUC) values within 95% confidence interval were over 0.900 for neutrophil count, WBC count, direct bilirubin, NLR, and PDW values. AUC values for total bilirubin, lymphocyte count, RDW, and MPV values were below 0.700. Conclusions: Diagnostic performances of the laboratory parameters were determined as follows: neutrophil count > WBC count > direct bilirubin = NLR = PDW > total bilirubin = lymphocyte count = RDW = MPV.

Correlations between objective and subjective tests of nasal patency in patients undergoing septoplasty.

OBJECTIVE: This study assessed correlations between pre- and post-operative objective and subjective nasal patency test results in patients undergoing septoplasty to treat nasal septum deviation. METHOD: Eighty nasal septum deviation patients who underwent septoplasty were prospectively enrolled. Nasal Obstruction Symptom Evaluation questionnaire scores, anterior rhinomanometry and acoustic rhinometry data were compared pre-operatively and three months after surgery. The left, right and total volume and left, right and total minimum cross-sectional area acoustic rhinometry values were compared. RESULTS: The left volume, total volume, left minimum cross-sectional area and total minimum cross-sectional area differed significantly between the two time-points (all p < 0.05). The total resistance, inspiratory total airflow, expiratory total resistance and expiratory total airflow rhinomanometric data did not differ between the two timepoints (all p > 0.05). CONCLUSION: This study suggested that subjective tests such as the Nasal Obstruction Symptom Evaluation questionnaire are optimal to identify complaints and assess post-operative satisfaction.

Evaluating the Efficacy of Chemical Disinfectants on Contaminated Dental Materials Contaminated by An Airborne Disease Tuberculosis Similar to COVID-19.

BACKGROUND: Tuberculosis (TB) is a communicable disease as well as an airborne disease. Mycobacterium tuberculosis (MTB) could survive on dental materials shipped to dental laboratories. AIMS: The aim of this study was to determine the number of bacilli held on the prosthetic material and the effect of chemical disinfection agents on various prosthetic materials that were shipped to dental laboratory of TB patient. MATERIALS AND METHODS: The study consisted of three study groups, and a control group. 10 mm x 2 mm disc-shaped (n = 18 for each group, n = 72 in total) nickel-chromium alloy (Ni-Cr), polymethylmethacrylate (PMMA), and dental ceramic (DC) samples were prepared. After exposure to MTB 24 hours in a 37°C incubator, six samples for each group (PMMA), Ni-Cr alloy and a control group DC samples) were exposed to three disinfectants; 10 minutes into 2% glutaraldehyde, 10 minutes into 5% sodium hypochlorite, and 1 minute into alcohol-based disinfectant after vortexed in distilled water. Colony forming units (CFU/ml) were calculated per milliliters. Two-way ANOVA statistical analysis method was used, and a P value less than 0.05 was considered as significant. RESULTS: The bacteria count for six Ni-Cr alloy disc-shaped specimens were recorded as 40, 10, 8, 6, 5, and 4 CFU/ml, respectively. Intensity of the colonies were found to be lower in other groups. 5 CFU/ml were detected on a single PMMA sample in the control group, and 40 CFU/ml were detected on one of the dental ceramic sample. No MTB uptake was observed on any sample in the 2% glutaraldehyde and 5% NaOCl disinfectant study groups. In alcohol-based disinfectant group, 1 CFU/ml was observed on Ni-Cr alloy sample. The effect of prosthetic materials used in this experimental study were not statistically significant on the CFU (p = 0.293). However, the disinfectants use was statistically significant on the number of colonies (p = 0.004). CONCLUSION: NaOCl and glutaraldehyde appeared to be more effective than alcohol-based disinfectant in removing MTB from Ni-Cr alloy, PMMA and dental ceramic surfaces.

Thiol-disulfide homeostasis and ischemia-modified albumin levels as indicators of oxidative stress in welders' lung disease.

Welders' lung disease refers to mixed exposure to different kinds of metals and chemicals from welding fumes, which affect all parts of the respiratory tract including airways and parenchyma together. This study aimed to investigate the oxidative status in patients with welders' lung (PWL) by means of thiol-disulfide homeostasis and ischemia-modified albumin (IMA) levels. The male welder workers diagnosed with welders' lung disease and healthy individuals were recruited in the study. Plasma levels of disulfide, disulfide/native thiol ratio, disulfide/total thiol ratio, IMA, and catalase (CAT) were determined. Pulmonary function test parameters of both groups were compared. The thiol-disulfide homeostasis parameters of PWL and control group were as follows: disulfide (20.5 ± 6.3 vs. 16.2 ± 3.9 µmol L-1, p < 0.001), disulfide/native thiol (4.36 (1.59) vs. 4.0 (1.64), p = 0.024), and disulfide/total thiol (4.01 (1.34) vs. 3.71 (1.41), p = 0.024). IMA levels in PWL were significantly higher than the control group (1.37 (0.27) mg dL-1 vs. 0.49 (0.61) mg dL-1, p < 0.001), whereas CAT activities were significantly higher in the control group (106.6 (54.5) kU L-1 vs. 78.3 (67.8) kU L-1, p = 0.003). The findings of the present study revealed that oxidative stress plays a key role in the pathogenesis of welders' lung disease. Plasma thiol-disulfide homeostasis and IMA levels might be indicators of oxidative stress in PWL.

Features of serial cranial ultrasound detected neuropathology in very preterm infants.

BACKGROUND: The purpose of this study was to identify the pattern and factors associated with changes in cranial ultrasound (CUS) -detected findings in infants born at or less than 28 weeks of gestation. METHODS: We compared readings of CUS performed at the end of the first week of life and at 4-5 weeks of age. Alteration of CUS findings was classified as: (i) unchanged, if no deviation was detected (Group 1); (ii) worsening, if there were new findings (Group 2); and (iii) improvement, if there was normalization or reduction in severity (Group 3). Descriptive statistics, multivariate controlled logistic regression, and kappa (k) statistics with 95% Confidence Interval (95% CI) were reported. RESULTS: Among 510 studied infants, 82.3% (95% CI 78.8-85.4) were in Group 1, 10.0% (95% CI 7.7-12.9) in Group 2, and 7.7% (95% CI 5.7-10.3) in Group 3. Overall agreement between the two scans was moderate (k 0.62; 95% CI 0.55-0.69). Worsening of CUS findings was associated with neonatal morbidities independently from gestational age and birth weight. The probability for worsening of CUS findings was higher in infants with an initial diagnosis of intraventricular hemorrhage (IVH) grade 2, than in those reported as no pathology/IVH grade 1 (Odds Ratio 5.79; 95% CI 2.42-13.91) or IVH grade 3-4 (Odds Ratio 3.81; 95% CI 1.10-13.21). CONCLUSIONS: In very preterm born infants, the initial CUS findings in combination with neonatal morbidities can help predict the brain lesions that are seen at the end of the first month of life and could be useful in their clinical management.

Human milk banking and milk kinship: perspectives of religious officers in a Muslim country.

OBJECTIVE: The present study aims to determine the knowledge, attitudes and views of the Muslim religious officers regarding infant feeding, breast milk, wet nursing, milk kinship and human milk banks (HMBs). STUDY DESIGN: A total of 401 religious officers were included in the study. Participants included 355 community service religious officers and 46 faculty religious officers. RESULTS: Two hundred fifty-four (63.3%) participants were in favor of administering donor human milk when breast milk is not available from the mothers. To the question 'What kind of human milk bank would you approve as far as the religious sensitivity is concerned?' a majority of the religious officers (71.3%) responded that they would only approve if the milk pool contained a restricted HMB where a limited number of recipients were allowed to use the mixtures in these milk pools. Only 7 (1.7%) participants advocated initiating Western-style HMBs in Turkey. CONCLUSION: Turkish religious officers have revealed that they would only approve the establishment of an alternative HMB by a maximum three donors where up to three recipients whose identities are known by one another are allowed to use donor milk from each milk pool.

Severity of periodontitis in patients with isolated coronary artery ectasia.

The concept that coronary artery ectasia (CAE) is an inflammatory-related disease has been increasingly recognized. Periodontitis induced low-grade chronic systemic inflammation has been shown to be associated with cardiovascular diseases. The aim of the present study was to evaluate the association between periodontitis and CAE.Thirty-two patients with isolated CAE, and 28 age, sex and smoking status-matched subjects with normal coronary arteries (NCA) underwent full dental examinations. Periodontal disease was evaluated using the following clinical parameters; number of remaining teeth, plaque index (PI), gingival index (GI), bleeding on probing (BOP), and pocket depth (PD).Cases and controls did not differ according to their baseline characteristics and prevalence of traditional cardiovascular risk factors. Patients with isolated CAE had higher periodontal indices when compared to subjects with NCA (PD: 3.6 ± 1.26 mm versus 2.3 ± 0.79 mm; GI: 2.29 ± 0.86 versus 1.43 ± 1.19; BOP (%): 52.18 ± 20.1 versus 27.8 ± 10.9, P < 0.001, P < 0.05 and P < 0.05, respectively). Moreover, in multivariate analysis higher values for PD were found to be significant predictors for the likelihood of having coronary ectasia.The results of the present study demonstrate for the first time that there is an association between periodontitis and isolated CAE.

Association of vitamin D deficiency with muscle strength and quality of life in postmenopausal women.

AIM: The aim of this study was to analyze the effect of vitamin D deficiency on muscle strength and quality of life in postmenopausal women. METHODS: Self-sufficient, community-dwelling, postmenopausal women over 55 years old attending the Physical Medicine and Rehabilitation outpatient clinic were included in the study. 25-Hydroxyvitamin D levels below 20 ng/ml were accepted as indicative of vitamin D deficiency. A computerized isokinetic dynamometer (Cybex 770 Norm, Lumex Inc., Ronkonkoma, NY, USA) was used for testing knee extensor muscle strength. RESULTS: Forty-nine postmenopausal women with median age 64.3 years (interquartile range 59.0-69.5 years) were included in the study. Vitamin D deficiency was detected in 49% of the participants. There was no relation between vitamin D deficiency and knee muscle strength in both right and left legs. Vitamin D deficiency was found not to be associated with any of the domains of SF-36. CONCLUSIONS: Vitamin D deficiency is not related to decreased muscle strength and lowered quality of life in postmenopausal women. Other factors rather than vitamin D deficiency should be investigated for illuminating the causalities of these two common clinical conditions.

Sexual problems of women with spinal cord injury in Turkey.

OBJECTIVES: Spinal cord injury (SCI) is a traumatic event that affects many facets of the injured people's lives. One aspect is sexual functioning. The purpose of this study is to identify the sexual problems of women with SCI and determine their level of knowledge about sexuality. METHODS: Twenty-six women with SCI for longer than 6 months were evaluated. Demographic information, sexual experiences were surveyed. Patients were also asked if and how they received sexual health consultation after SCI. Female Sexual Function Index (FSFI) and Beck Depression Inventory were evaluated. RESULTS: In this study, average age of the women with SCI was 32.96±8.23 years (22-50 years). Eight patients had regular sexual intercourse while one married woman did not have any sexual relationship after SCI. Twenty-four of the patients in the study received no information about pregnancy or sexual health after SCI. All women were willing to receive information about sexuality after SCI. These patients expected the doctors to start the conversation about sexuality rather than asking about it. FSFI survey revealed that all the patients had sexual dysfunction. CONCLUSION: Sexual rehabilitation should thus be fully addressed in all spinal units and rehabilitation centers, along with other aspects of rehabilitation.

Central retinal artery occlusion in a 13-year-old child as a presenting sign of hyperhomocysteinemia together with high lipoprotein(a) level.

BACKGROUND: We describe a child with central retinal artery occlusion and hyperhomocysteinemia. METHODS: A 13-year-old girl developed sudden vision loss and was hospitalized for diagnosis and treatment. RESULTS: Her physical examination was normal except for her ophthalmologic examination. Her serum homocysteine level and lipoprotein(a) were elevated to 45.27 µmol/L and 61 mg/dL 0-29 mg/dL, respectively. A homozygous mutation was identified for methylenetetrahydrofolate reductase at position C677T. CONCLUSION: This report documents central retinal artery occlusion associated with the risk factors of hyperhomocysteinemia caused by methylenetetrahydrofolate reductase C677 T mutation and high lipoprotein(a) level in a child. Retinal artery occlusion is rare in children. This patient emphasizes the need for a systemic evaluation for hyperhomocysteinemia and lipoprotein(a) levels in children with retinal vascular occlusion of uncertain etiology.

Demographic characteristics after traumatic and non-traumatic spinal cord injury: a retrospective comparison study.

STUDY DESIGN: Retrospective, 12-year case series. OBJECTIVE: To compare neurological and functional outcomes, and complications of patients with traumatic vs non-traumatic spinal cord injury (SCI) after in-patient rehabilitation. SETTING: In-patient rehabilitation unit of a tertiary research hospital. MATERIALS AND METHODS: The sample consisted of 165 newly injured patients with traumatic and non-traumatic spinal cord lesions whose medical records were retrospectively reviewed. Demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) subgroup scores, length of stay and medical complications in both groups were compared. RESULTS: In all, 38 patients (23%) were non-traumatic and 127 patients (77%) were traumatic in etiology. Compared with patients with traumatic SCI (mean age 37.81±13.65 years), patients with non-traumatic SCI (mean age 53.97±14.48 years) were significantly older (P<0.05). Incomplete SCI was significantly higher in the non-traumatic group when compared with the traumatic group (P<0.001). In the non-traumatic group, admission motor FIM scores were significantly higher (28.29±16.04) than scores from the traumatic group (36.60±21.65; P=0.029); however, there was no significant difference in discharge motor FIM scores between the two groups (P=0.140). ASIA impairment scale scores were significantly higher in non-traumatic group both at admission and discharge (P=0.000 and P=0.000, respectively). The length of hospital stay was significantly shorter in the non-traumatic group (P=0.002). CONCLUSION: According to the results of this study, although patients with non-traumatic SCI had shorter length of stay and higher ASIA scores, there was no significant difference in functional outcomes between traumatic and non-traumatic SCI patients.

Bilateral capitellum humeri fracture; a case report.

This is the report of a 33-year-old female patient who was admitted to the Emergency Department with bilateral capitellum humerus fracture after a fall from a height. The patient was surgically treated with open reduction and internal fixation for both elbows, with 3 Kirschner wires on the right elbow and one mini-fragment screw on the left. Surgical intervention was carried out in emergency conditions. Following an early physical rehabilitation programme at the end of the 1st week, the roentgenograms in the 9th week showed acceptable bone union. However, in the 2nd year of follow-up the patient had consistent pain and 35 degrees of flexion loss in her right elbow due to degenerative change. The literature reveals only two reports of such cases. Thus, this rare case of bilateral capitellum humerus showed that early mobilisation after anatomic reduction and stable fixation with a mini-screw provided the optimal outcome.

Internuclear and supranuclear disorders of eye movements: clinical features and causes.

Eye movements bring visual stimuli to the fovea and also maintain foveal fixation on a moving target and during head movements. These movements are performed by the ocular motor system that consists of ocular motor nerves and nuclei in the brainstem originating in the cerebral cortex, cerebellum, vestibular structures, and the extraocular muscles. The ocular motor system is divided according to anatomic location into infranuclear, nuclear, internuclear, and supranuclear components. It is important to distinguish supranuclear and internuclear from nuclear and infranuclear disturbances affecting cranial nerves III, IV, and VI, because the disturbances are of highly varied causes and present different clinical pictures. Internuclear ophthalmoplegia is due to a lesion of the medial longitudinal fasciculus, caused by multiple sclerosis in younger patients, particularly when the ophthalmoplegia is bilateral, and usually of vascular origin in the elderly. Eye movement abnormalities of supranuclear origin are characterized by gaze palsies, tonic gaze deviation, saccadic and smooth pursuit disorders, vergence abnormalities, nystagmus, and ocular oscillations. Supranuclear disorders result from lesions above the level of the ocular motor nerve nuclei. If oculocephalic maneuvers move the eyes appropriately, the lesion causing the gaze palsy is supranuclear. Supranuclear disorders account for almost 10% of all patients with disorders of eye movements.

Atypical MRI findings of synchronous cerebral metastasis. A case report and literature review.

Intracranial metastases represent 7% to 17% of all brain tumors. Metastases may appear before, after or synchronously with the primary tumor. Synchronous tumor presentation means that that metastasis is found within two months of primary tumor diagnosis. A 60-year-old man was seen 15 days after the acute onset of confusion and gait disturbance. Results of a neurologic examination revealed disorientation, dysarthria, and left-sided ataxia. Results of nonenhanced computed tomography scanning of the brain were unremarkable. Cerebral magnetic resonance imaging showed multiple miliary, round, small (maximum diameter, 1 cm) lesions located infra- and supratentorially. Gradient-echo magnetic resonance images of these lesions were compatible with hemorrhage and were more pronounced compared with other sequences. Hemorrhagic cerebral metastases were suspected, and the patient was examined for primary tumors. Chest computerized tomography revealed a tumor in the posterior, superior lobe of the right lung; a cervical lymph node biopsy suggested a metastatic carcinoma. Our case illustrates that magnetic resonance imaging findings of synchronous cerebral multiple metastases presenting with neurologic symptoms may be atypical while the results of cerebral computerized tomography are normal. Contrast-enhanced cerebral magnetic resonance imaging, especially gradient-echo magnetic resonance sequences, should always be considered for diagnosing hemorrhagic metastases in patients presenting neurologic findings with a known or unknown cancer.

High prevalence of neuropathy in patients with impaired 60-minute oral glucose tolerance test but normal fasting and 120-minute glucose levels.

AIM: The aim of this study was to define the prevalence of neuropathy in patients with impaired 60-min oral glucose tolerance test (OGTT) but normal fasting and 120-min glucose levels and to evaluate risk factors for polyneuropathy and glucose intolerance. METHODS: The hospital files of 320 patients (56.5+/-11.9 years, 73.1% female), who had both electrodiagnostic test for sensory symptoms (nerve conduction studies and needle electromyography) and OGTT in maximum 6 months apart, were studied in this retrospective design study. Serum glucose levels at fasting and 0-, 30-, 60-, 90- and 120-min of OGTT and some biochemical parameters were recorded. RESULTS: Fifteen percent of patients had diabetes mellitus (DM) and 10.9% and 5.6% had impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Twenty-one patients (6.6%) had only impaired 60-min blood glucose levels. Polyneuropathy was found in 44.4%, 28.5%, and 50.0% of patients with IGT, IFG and DM respectively. The prevalence of polyneuropathy was significantly higher in patients with impaired 60-min than OGTT normal subjects (52.4% vs 21.7% p=0.003). Fasting blood glucose, HDL, LDL and TSH levels, age, glucose intolerance low serum folic acid and significantly increased polyneuropathy risk. Age, weight, body mass index, high fasting, 30, 60-, 90-, 120-min serum glucose, insulin and HgA1c levels were risk factors for glucose intolerance. CONCLUSION: Since the prevalence of neuropathy in patients with impaired 60-min glucose levels is high, it would be valuable to look at 60-min glucose levels to detect abnormal glucose metabolism and the neuropathy earlier in the course.

Protection of the conjunctival flap from contact with mitomycin C during tunnel-trabeculectomy.

AIM: The mid-term appearance of the filtering bleb and surgical outcome following tunnel-trabeculectomy, in which protective measures were carried out to avoid contact between the mitomycin C (MMC) and the conjunctival flap, are presented. METHODS: In a retrospective study the records of 20 consecutive patients who had undergone tunnel-trabeculectomy >/=24 months earlier, using fornix-based conjunctival flap and MMC (0.4 mg/ml) application were evaluated. Inclusion criteria were patients in whom: (I) the MMC-socked sponge was applied without contact with the conjunctival flap; (II) during MMC washout, a second Weck cell sponge was held anterior to the conjunctival flap, to protect the flap from mitomycin contact during its back-flow. Excluded were five patients who either did not complete 24 months of follow-up (n=4) or underwent an intraocular surgery during that period (n=1). RESULTS: After 24-32 (26.9+/-2.2) months, the filtering bleb was completely vascularized and thick in 13/15 patients (86.7%), mostly vascularized with some para-limbal thick cysts in one and avascular and cystic in another. Mean intraocular pressure (IOP) dropped from a preoperative level of 25.3+/-7.0 mmHg with 3.5+/-0.9 hypotensive medications to 13.9+/-2.9 mmHg with 0.9+/-1.1 medications (P<0.0001, Wilcoxon test). Of the five excluded patients, the IOP ranged between 10 and 16 mmHg with 0-1 medications at the last examination, 1-15 months postoperatively. CONCLUSION: In this pilot study, an intraoperative protection of the conjunctival flap from mitomycin contact was mostly associated with a vascularized and thick filtering bleb after mid-term follow-up. Further controlled prospective studies are required to confirm these observations.

Bilateral drop-foot after orthotopic liver transplant.

Patients may demonstrate various neuromuscular abnormalities after liver transplantation. We report a patient who developed bilateral drop foot after orthotopic liver transplantation. He was diagnosed with critical illness polyneuropathy. During follow-up, his complaints gradually recovered and his electrodiagnostic findings improved.