Lactate and base deficit combination score for predicting blood transfusion need in blunt multi-trauma patients.

BACKGROUND: Lactate and base deficit (BD) values are parameters evaluated as indicators of tissue perfusion and have been used as markers of severity of injury and mortality. OBJECTIVES: The aim of the study was to determine the relationship between combined score (CS) and blood transfusion need within 24 h and comparison of the variables between transfusion and non-transfusion group, correlation lactate with BD and with physiological, laboratory parameters, and determining the major risk factors of patients for the need for blood transfusion. METHODS: The study included a total of 359 patients (245 males, median age: 40, min-max: 18-95) with blunt multi-trauma. De-mographics data, laboratory parameters (hemoglobin [Hb], hematocrit [Htc], lactate, BD, pH), physiologic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], respiratory rate [RR]), shock index (SI), and revised trauma score (RTS) were recorded. Logistic regression method was used to create the CS formula using lactate and BD values. According to this formula, the probability value of 0.092447509 was calculated for the need for blood transfusion within 24 h. If CS was higher than the probability value, the need for blood transfusion within 24 h was considered. Furthermore, univariate analysis was used to determine major risk for blood transfusion need in 24 h, and the receiver operating characteristic curves were performed to compare CS, lactate, BD, SI and RTS. RESULTS: The comparison between transfusion and non-transfusion group there was significance between SBP, DBP, HR, RR, SpO2, Glasgow coma scale, Hb, Htc, lactate, BD, pH, SI and RTS (for each p<0.05). Lactate value has a positive correlation with SI, HR and has a negative correlation with BD, RTS, SBP, and DBP. BD values has a positive correlation with RTS, SBP, DBP, Hb, and Htc and has a negative correlation with SI, HR, and RR. The main risks for blood transfusion need were SI, lactate, BD, SBP, and SpO2%. CS was 0.09 in 100 (27.85%) patients and 41 with high CS had blood transfusion within 24 h (p<0.001; OR21.803, sensitivity 83.7%, specificity 81%,positive predictive value 41%, and negative predictive value 96.9%). A ROC curve showed that CS (AUC: 86.) was more significant than SI and RTS for the need for blood transfusion. CONCLUSION: CS is effective for predicting blood necessity in 24 h for blunt multi-trauma patients.

Computed Tomographic Findings of Injuries After Mechanical and Manual Resuscitation: A Retrospective Study.

Introduction Cardiopulmonary resuscitation (CPR)-related injuries are complications of chest compressions during CPR. This study aimed to investigate the differences and complications between mechanical and manual CPR techniques by using computed tomography (CT). Methods Patients in whom return of spontaneous circulation was achieved after CPR and thorax CT imaging were performed for diagnostic purposes were included in the study. Results A total of 178 non-traumatic cardiac arrest patients were successfully resuscitated and had CT scans in the emergency department. The complications of CPR are sternum fracture, rib fracture, pleural effusion/hemothorax, and pneumothorax. There were no statistically significant differences in terms of age, first complaint, cardiac arrest rhythm, CPR duration, and complications between mechanical and manual CPR. The number of exitus in the emergency department was similar (p=0.638). The discharge from hospital rate was higher in the mechanical CPR group but there was no statistically significant difference (p=0.196). The duration of CPR was associated with the number of rib fractures and lung contusion, but it did not affect other CPR-related chest injuries. Conclusion There was no significant difference observed in terms of increased complications in patients who received mechanical compression as compared with those who received manual compression. According to our results, mechanical compression does not cause serious complications, and the discharge from hospital rate was higher than for manual CPR; therefore, its use should be encouraged.

The Flatness Index of Inferior Vena Cava can be an Accurate Predictor for Hypovolemia in Multi-Trauma Patients.

INTRODUCTION: Shock is the leading cause of death in multi-trauma patients and must be detected at an early stage to improve prognosis. Many parameters are used to predict clinical condition and outcome in trauma. Computed tomography (CT) signs of hypovolemic shock in trauma patients are not clear yet, requiring further research. The flatness index of inferior vena cava (IVC) is a helpful method for this purpose. METHODS: This is a prospective, cross-sectional study which included adult multi-trauma patients (>18 years) who were admitted to the emergency department (ED) and underwent a thoraco-abdominal CT from 2017 through 2018. The main objective of this study was to investigate whether the flatness index of IVC can be used to determine the hypovolemic shock at an early stage in multi-trauma patients, and to establish its relations with shock parameters. The patients' demographic features, trauma mechanisms, vitals, laboratory values, shock parameters, and clinical outcome within 24 hours of admission were recorded. RESULTS: Total of 327 (229 males with an average age of 40.9 [SD = 7.93]) patients were included in the study. There was no significant difference in the flatness index of IVC within genders (P = .134) and trauma mechanisms (P = .701); however, the flatness index of IVC was significantly higher in hypotensive (systolic blood pressure [SBP] ≤90 mmHg and/or diastolic blood pressure [DBP] ≤60 mmHg; P = .015 and P = .019), tachycardic (P = .049), and hypoxic (SpO2 ≤%94; P <.001) patients. The flatness index of IVC was also higher in patients with lactate ≥ 2mmol/l (P = .043) and patients with Class III hemorrhage (P = .003). A positive correlation was determined between lactate level and the flatness index of IVC; a negative correlation was found between Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) with the flatness index of IVC (for each of them, P <.05). CONCLUSION: The flatness index of IVC may be a useful method to determine the hypovolemic shock at an early stage in multi-trauma patients.

Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital

Objective: Immunocompromised patients are at a greater risk of developing intestinal parasite infections. In this study, we examined the presence of Enterocytozoon bieneusi, Encaphalitozoon intestinalis and other intestinal protozoa in stool samples of immunosuppressed patients. Methods: A total of 100 stool samples were obtained from patients receiving chemotherapy because of solid organ tumour with haematological malignancies and those receiving immunosuppressive treatment because of rheumatic diseases, organ transplant patients and patients receiving treatment for HIV-related infections. Stool samples were examined by using the native-lugol method in which the stool concentration, modified Kinyoun acid-fast and trichrome staining methods and parasite presence were analysed. The stool samples were also examined for the presence of Enterocytozoon bieneusi and Encephalitozoon intestinalis using an indirect fluorescent antibody method. Results: Intestinal parasites were detected in 12% of all patients. The distribution of intestinal parasites in patients were 7% Blastocystis spp., 2% Blastocystis spp. + Dientamoeba fragilis, 1% Blastocystis spp. + Entamoeba coli, 1% Blastocystis spp. + Giardia intestinalis and 1% G. intestinalis. Microsporidia spp. were detected in 4% of all patients by the IFAT method and in 8% of all patients by calcoflour staining method. Conclusion: In our study, the most prevalent parasite detected in the immunosuppressed patients was Blastocystis spp. The pathogenesis of Blastocystis spp. remains to be controversial, and their role in immunocompromised patients continues to remain unknown. Although these rates detected in our study are similar to the prevalence in the normal population, it is important to study these microorganisms in immunocompromised patients in terms of the associated decreasing morbidity and mortality rates.

Comparison of Endotracheal Intubation Skills With Video Laryngoscopy and Direct Laryngoscopy in Providing Airway Patency in a Moving Ambulance.

BACKGROUND: Early and successful management of the airway in the prehospital and hospital settings is critical in life-threatening situations. OBJECTIVE: We aimed to perform endotracheal intubation (ETI) by direct laryngoscopy (DL) and video laryngoscopy (VL) on airway manikins on a moving track and to compare the properties of intubation attempts. METHODS: Overall, 79 participants with no previous VL experience were given 4 h of ETI training with DL and VL using a standard airway manikin. ETI skill was tested inside a moving ambulance. The number of attempts until successful ETI, ETI attempt times, time needed to see the vocal cords, and the degree of convenience of both ETI methods were recorded. RESULTS: Overall, 22 of 79 individuals were men; mean age was 30.3 ± 4.5 years. No difference was found in the comparison of the two methods (p = 0.708). Time needed to see the vocal cords for those who were successful in their first attempt were between 1 and 8 s in both methods. In the VL method, time needed to see the vocal cords (p = 0.001) and the intubation time (p < 0.001) in the first attempt were shorter than in the DL method. The VL method was easier (p < 0.001). The success rate was 97.5% in DL and 93.7% in VL. CONCLUSIONS: The VL method is rapid and easier to see the vocal cords and perform successful ETI. Therefore, it might be preferred in out-of-hospital ETI applications.

The association of viral load and disease severity in children with COVID-19.

It is still not fully understood how to predict the future prognosis of patients at the diagnosis coronavirus disease 2019 (COVID-19) due to the wide clinical range of the disease. We aimed to evaluate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load could predict the clinical course of pediatric patients. This study was conducted retrospectively with medical records of pediatric patients who were tested for SARS-CoV2 between April 12 and October 25, 2020 in the University of Health Sciences, Ankara Educating and Training Hospital and Hacettepe University Faculty of Medicine. We evaluated 518 pediatric patients diagnosed with COVID-19 and classified according to severity as asymptomatic (16.2%), mild (59.6%), moderate (20.2%), and critical/severe (3.9%) cases. We analyzed patients in four groups in terms of ages: <4, 5-9, 10-14, and 15-17 years. There was no statistically significant difference in terms of ∆Ct value among age groups, different gender and the existence of underlying diseases in each disease course. The ∆Ct values were relatively lower in the first 2 days of symptoms than after days in all groups. Our study has indicated that children with COVID-19 have similar amount of viral load in all disease courses irrespective of the age and underlying disease. It should be taken into account that, regardless of the severity of the disease, pediatric patients may have a role in the transmission chain.

Detection of enteric parasites and molecular characterization of Giardia duodenalis and Blastocystis sp. in patients admitted to hospital in Ankara, Turkey.

This epidemiological study assesses the occurrence of enteric parasites in 4303 patients attended at two public hospitals in Ankara (Turkey) during 2018-2019. Microscopy was used as a screening test. Giardia duodenalis was also identified using a commercial ELISA for the detection of parasite-specific coproantigens. Giardia-positive samples by microscopy/ELISA were confirmed by real-time PCR and characterized using a multilocus genotyping scheme. Blastocystis sp. was genotyped in a sample subset. Blastocystis sp. (11.1%, 95% CI 11.4‒14.8%) and G. duodenalis (1.56%, 95% CI 1.22‒1.96) were the most prevalent pathogens found. Cryptosporidium spp., Entamoeba histolytica and intestinal helminths were only sporadically (<0.5%) found. For G. duodenalis, sequence (n = 30) analyses revealed the presence of sub-assemblages AII (23.3%), discordant AII/AIII (23.3%) and mixed AII + AIII (6.7%) within assemblage A, and BIII (10.0%), BIV (3.3%) and discordant BIII/BIV (23.3%) within assemblage B. Two additional sequences (6.7%) were assigned to the latter assemblage but sub-assemblage information was unknown. No associations between G. duodenalis assemblages/sub-assemblages and sociodemographic and clinical variables could be demonstrated. For Blastocystis sp., sequence (n = 6) analyses identified subtypes ST1, ST2 and ST3 at equal proportions. This is the first molecular characterization of G. duodenalis based on MLG conducted in Turkey to date.

Comparison of manual and mechanical chest compression techniques using cerebral oximetry in witnessed cardiac arrests at the emergency department: A prospective, randomized clinical study.

AIM: We aimed to compare regional cerebral oxygen saturation (rSO2) levels during cardiopulmonary resuscitation (CPR), performed either manually or using a mechanical chest compression device (MCCD), in witnessed cardiac arrest cases in the emergency department (ED), and to evaluate the effects of both the CPR methods and perfusion levels on patient survival and neurological outcomes. METHODS: This single-center, randomized study recruited patients aged ≥18 years who had witnessed a cardiopulmonary arrest in the ED. According to the relevant guidelines, CPR was performed either manually or using an MCCD. Simultaneously, rSO2 levels were continually measured with near-infrared spectroscopy. RESULTS: Seventy-five cases were randomly distributed between the MCCD (n = 40) and manual CPR (n = 35) groups. No significant difference in mean rSO2 levels was found between the MCCD and manual CPR groups (46.35 ± 14.04 and 46.60 ± 12.09, respectively; p = 0.541). However, a significant difference in rSO2 levels was found between patients without return of spontaneous circulation (ROSC) and those with ROSC (40.35 ± 10.05 and 50.50 ± 13.44, respectively; p < 0.001). In predicting ROSC, rSO2 levels ≥24% provided 100% sensitivity (95% confidence interval [CI] 92-100), and rSO2 levels ≥64% provided 100% specificity (95% CI 88-100). The area under the curve for ROSC prediction using rSO2 levels during CPR was 0.74 (95% CI 0.62-0.83). CONCLUSION: A relationship between ROSC and high rSO2 levels in witnessed cardiac arrests exists. Monitoring rSO2 levels during CPR would be useful in CPR management and ROSC prediction. During CPR, MCCD or manual chest compression has no distinct effect on oxygen delivery to the brain. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03238287.

SARS-CoV-2 neutralizing antibody development strategies.

In December 2019 a novel coronavirus was detected in Wuhan City of Hubei Province-China. Owing to a high rate of transmission from human to human, the new virus called SARS-CoV-2 differed from others by its unexpectedly rapid spread. The World Health Organization (WHO) described the most recent coronavirus epidemic as a global pandemic in March 2020. The virus spread triggered a health crisis (the COVID-19 disease) within three months, with socioeconomic implications. No approved targeted-therapies are available for COVID-19, yet. However, it is foreseen that antibody-based treatments may provide an immediate cure for patients. Current neutralizing antibody development studies primarily target the S protein among the structural elements of SARS-CoV-2, which mediates the cell entry of the virus through the angiotensin converting enzyme 2 (ACE2) receptor of host cells. This review aims to provide some of the neutralizing antibody development strategies for SARS-CoV-2 and in vitro and in vivo neutralization assays.

Plasma Procalcitonin Is Useful for Predicting the Severity of Acute Cholecystitis.

BACKGROUND: Acute cholecystitis is a common complication of cholelithiasis. Delayed diagnosis may constitute morbidity and mortality; therefore, early diagnosis and determining the severity of acute cholecystitis are crucial. OBJECTIVES: This study aimed to determine the validity of blood procalcitonin (PCT) levels in assessing the severity of acute cholecystitis. METHODS: The Emergency Department (ED) patients diagnosed as acute cholecystitis were included in the study. Patients were allocated into three severity grades according to the Tokyo Guidelines 2013. PCT level was measured after the clinical and radiological diagnosis of acute cholecystitis in the ED. RESULTS: Ninety-five patients diagnosed with acute cholecystitis, among them 48 of were male. Forty patients (42.1%) were allocated to grade 1, 19 (20%) to grade 2, and 36 (37.9%) to grade 3. The median values of PCT were 0.104 ng/ml, 0.353 ng/ml, and 1.466 ng/ml for grade 1, 2, and 3 patients, respectively (p < 0.001). CONCLUSION: Blood procalcitonin levels can be used to determine the severity of acute cholecystitis effectively.

Perfusion Index Measurement in Predicting Hypovolemic Shock in Trauma Patients.

BACKGROUND: Perfusion index (PI) derived from pulse oximeter shows the ratio of the pulsatile blood flow to the nonpulsatile blood flow or static blood in peripheral tissue. OBJECTIVES: The aim of this study was to investigate the relationship between PI and blood transfusion necessity in 24 h and stage of hemorrhagic shock, as well as the utility of PI according to laboratory and clinical parameters, and determining the major risk of hemorrhage. METHODS: PI was measured with a pulse oximeter in 338 patients (235 males, average age 41.8 ± 17.94 years). Laboratory parameters (hemoglobin, hematocrit, lactate, base deficits, pH) and clinical parameters (pulse rate, respiratory rate, SpO2, systolic blood pressure [SBP] and diastolic blood pressure [DBP]), shock index (SI) and revised trauma score (RTS) were recorded. Univariate analysis was used to determine major risk for bleeding, and the receiver operating characteristic curves were performed to compare parameters. RESULTS: PI was < 1 in 39 (11.5%) patients. Positive correlation between PI and hemoglobin (p < 0.001; r: 0.320), hematocrit (p < 0.001; r: 0.294), base deficit (p < 0.001; r: 0.315), pH (p < 0.05; r: 0.235), SBP (p < 0.001; r: 0.146), DBP (p < 0.001; r: 0.259), SpO2 (p < 0.001; r: 0.197), RTS (p < 0.001; r: 0.344), and negative correlation with lactate (p < 0.05; r: -0.117), pulse (p < 0.001; r: -0.326), respiratory rate (p < 0.001; r: -0.231), and SI (p < 0.001; r: -0.257) were detected. A difference was detected between class 1 and 2, and class 1 and 3 (both p < 0.05) in hemorrhagic shock. Thirty-one with PI < 1 had blood transfusion within 24 h (p < 0.001; odds ratio 111.98, sensitivity 75.6%, specificity 97.3, positive predictive value 79.5%, negative predictive value 96.7%). The main risk factors of the need for blood transfusions were PI, pulse rate, and SpO2. PI was more significant than lactate, base deficit, RTS, and SI measurements. CONCLUSION: PI might be beneficial in the detection and exclusion of critical patients and blood transfusion needs in the emergency department. PI can be used with vital signs and shock parameters in the early diagnosis of hemorrhage.

Factors Affecting Mortality in Patients Admitted to the Hospital by Emergency Physicians despite Disagreement with Other Specialties.

BACKGROUND: Emergency physicians (EPs) face critical admission decisions, and their judgments are questioned in some developing systems. This study aims to define the factors affecting mortality in patients admitted to the hospital by EPs against in-service departments' decision and evaluate EPs' admission diagnosis with final discharge diagnosis. METHODS: This is a retrospective analysis of prospectively collected data of ten consecutive years (2008-2017) of an emergency department of a university medical center. Adult patients (≥18 years-old) who were admitted to the hospital by EPs against in-service departments' decision were enrolled in the study. Significant factors affecting mortality were defined by the backward logistic regression model. RESULTS: 369 consecutive patients were studied, and 195 (52.8%) were males. The mean (SD) age was 65.5 (17.3) years. The logistic regression model showed that significant factors affecting mortality were intubation (p < 0.0001), low systolic blood pressure (p = 0.006), increased age (p = 0.013), and having a comorbidity (p = 0.024). There was no significant difference between EPs' primary admission diagnosis and patient's final primary diagnosis at the time of disposition from the admitted departments (McNemar-Bowker test, p = 0.45). 96% of the primary admission diagnoses of EPs were correct. CONCLUSIONS: Intubation, low systolic blood pressure on presentation, increased age, and having a comorbidity increased the mortality. EPs admission diagnoses were highly correlated with the final diagnosis. EPs make difficult admission decisions with high accuracy, if needed.

Bradyarrhythmia due to mirtazapine overdose: A case of serious adverse event in a suicidal patient.

There are a limited number of studies on postoverdose clinical findings of mirtazapine in the literature. Our case presented an unlikely junctional rhythm, which we have not seen in the previous studies, in a patient who had bradycardia and hypotension following mirtazapine intake. A 37-year old male was admitted to the emergency department (ED) after his suicide attempt with 300 mg PO of mirtazapine tablets. He took the drug 2 h prior to his ED visit. He did not have any complaints after the mirtazapine intake. His complete physical examination and electrocardiography (ECG) revealed no pathological findings. He was observed in the ED. The results were in the normal range in his blood test and he has 0 mg/dl of blood ethanol. He experienced dizziness after 5 h and 30 min. The blood pressure was 60/30 mmHg. The heart rate was 34 beats/min. The simultaneous ECG showed junctional bradycardia. 0.5 mg atropine IV was given two times at intervals. Norepinephrine infusion was initiated after normal saline therapy. Forty-five minutes later, he did not have any clinically significant complaint. There are no pathological findings in his follow-up ECG and physical examination. He was discharged of his own accord 10 h after his ED admission. His initial mirtazapine level was 145 ng/ml when he came to the ED. Mirtazapine was known to have a safe cardiac profile both for regular dose and overdose. However, physicians should consider that it might induce a life-threatening bradyarrhythmia.

Evaluation of the Tp-e interval and Tp-e/QTc ratio in patients with benign paroxysmal positional vertigo in the emergency department compared with the normal population.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is a common diagnosis for dizziness patients admitting to emergency department and for initial diagnosis, cardiac causes of dizziness should be excluded at admittance. Electrocardiography (ECG) is a simple method to detect cardiac arrhythmias for these patients. Tp-e interval and Tp-e/QTc ratio are transmural repolarization parameters and shown to be strongly related to ventricular arrhythmias. With this study, we aim to investigate ventricular repolarization parameters like Tp-e interval and Tp-e/QTc ratio which can be easily evaluated by ECG in BPPV patients. MATERIALS AND METHODS: A total of 84 newly diagnosed BPPV patients and 59 age-sex matched control group without dizziness symptoms compatible with inclusion criteria were included for the study. Patients with previous vertigo, coronary artery disease, renal disease, heart failure, severe valvular disease, arrhythmia history, electrolyte disturbances and patients under 18 years of age were excluded. RESULTS: Mean age of the study population was 44.4 ±â€¯12.1 years, 36.4% were male. There was no significant difference among groups in terms of age, sex, diabetes mellitus, hypertension and hypothyroidism history. When ECG results were evaluated QRS interval, QT interval, Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were statistically higher in BPPV patients compared to control group (p = 0.000, p = 0.047, p = 0.000, p = 0.000 and p = 0.001, respectively). DISCUSSION: As a result of our study, Tp-e and Tp-e/QTc ratio were significantly higher in BPPV patients compared to the control group. These findings suggest that ventricular arrhythmia risk may be higher in BPPV patients. Further evaluation of these patients in terms of ventricular arrhythmia would be beneficial.

[A Rare Complication of Acute Diarrhae Caused by Cryptosporidium: Possible Hepatobiliary System Involvement in a Child without Immunodeficiency]. / Akut Cryptosporidium Ishalinin Nadir Bir Komplikasyonu: Immün Yetmezlik Bulunmayan Çocuk Olguda Olasi Hepatobiliyer Tutulum.

Cryptosporidium spp. is one of the leading causes of parasitic diarrhea. It is the most common parasite in humans all over the world with Giardia. Cryptosporidium is an important cause of chronic diarrhea in Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) patients. Patients with normal immune system may have an asymptomatic course or clinical presentation such as acute watery diarrhea without blood and persistent diarrhea. The severity and duration of the disease may be a reflection of the immune deficiency. Children under two years of age and children with malnutrition may have a risk of prolonged Cryptosporidium spp. infection, even if immunodeficiency work-up is normal, as they may have defects in the natural immune system and lymphocyte functions. Cryptosporidium spp. oocysts contaminate water sources, swimming pools, vegetables and fruits because oocysts are partially resistant to chlorination. So it may be problem for public health. Pets, livestock and humans can be carriers of Cryptosporidium spp. Factors such as developmental level of the countries, immune system, nutritional status, living in crowded environments, contact with contaminated water, close contact with animals, working at a hospital and hot and humid climate affect the incidence of Cryptosporidiosis. Cryptosporidium spp. may cause asymptomatic infection, mild diarrheal disease or severe diarrhea with high volume, which may be accompanied by nausea, vomiting, abdominal pain and fever, following a 1-7 day incubation period. Diarrhea may be acute or chronic, transient, intermittent, or continuous; loss of fluid can be up to 25 L/day in severe diarrhea. Cryptosporidium spp. are mainly located in intestines, but non-intestinal (bile ducts, pancreas, stomach, respiratory system, kidney) involvement may occur in immunocompromised patients. Hepatobiliary system involvement occurs in 10-30% of patients with AIDS; stone-free cholecystitis can lead to sclerosing cholangitis and pancreatitis. Hepatobiliary involvement is not expected in patients without immunodeficiency. In this article, we present a case of Cryptosporodiosis with hepatobiliary system involvement who were admitted to the pediatric emergency clinic with the complaints of severe diarrhea and Cryptosporidium spp. oocysts were detected in parasitological examination of the stool specimen. Immunodeficiency was not considered with her resume and laboratuary examinations. We would like to emphasize that Cryptosporodium spp. may be the cause of severe acute diarrhea in non-immunocompromised patients and may also involve hepatobiliary system involvement.

The investigation of Strongyloides stercoralis seroprevalence in immunosupressed patients in Turkey

Background/aim: In immunosuppressed patients, strongyloidiasis can be lifethreatening because of hyperinfection or dissemination. Therefore, diagnosis of S. stercoralis is important in immunosuppressed patients with chronic strongyloidiasis. In this study, our objective was to investigate the presence of S. stercoralis antibodies by an ELISA method in immunosuppressed patients. Materials and methods: A total of 100 immunosuppressed patients' sera were included in the study. Forty-two of the patients were receiving immunosuppressive therapies for cancer or being treated for hematopoietic malignancies, 38 of the patients were receiving immunosuppressive drugs for rheumatic diseases, 14 were receiving immunosuppressive therapies for liver transplantation. Two of the patients were being treated for HIV infection and 4 were being treated for hypogammaglobulinemia. As control group, 50 individuals without a known disease were included in the study. The presence of IgG antibodies against S. stercoralis was investigated with a commercial ELISA kit. Results: S. stercoralis antibody test was positive in 4 of 100 (4%) sera from immunosuppressed patients. All control patients were negative for S. stercoralis. Conclusions: Strongyloidiasis can be a lifelong chronic infection if not treated. In patients who are going to receive immunosuppressive therapy, it should be tested before treatment, as it can become a disseminated and life-threatening infectious disease.

Evaluation of intestinal parasites in patients with chronic spontaneous urticaria in a territory hospital in Turkey.

INTRODUCTION: Chronic spontaneous urticaria (CSU) which develops without a known stimulation is defined as the occurrence of spontaneous wheals, angioedema or both for longer than six weeks. Infections, autoimmunity, food intolerance and internal parasitic infections are supposed to be underlying causes of CSU. The aim of this study was to evaluate the intestinal parasites in children and adult patients diagnosed as CSU, to determine the frequency of parasites in chronic urticaria, and to compare these patients with healthy demographic control groups. METHODOLOGY: Seventy six children and 38 adult patients with CSU were examined in terms of parasitic infections. The patients whom parasites were detected received anti-parasitic therapy and the improvements in CSU symptoms were evaluated. Stool samples were examined with direct microscopic examination (native-lugol), stool concentration and trichrome staining methods. RESULTS: In pediatric patient group, 18.4% (n = 14) of the stool samples were positive for Blastocystis sp., 2.6% (n = 2), Dientamoeba fragilis and 1.3% (n = 1), Giardia duodenalis. In adult patient group, Blastocystis sp. was detected in 18.4% (n = 7) of the stool samples. Anti-parasitic therapy yielded substantial improvement in urticaria symptoms in 57.1% of pediatric and 60.0% of adult patients. CONCLUSIONS: Blastocystis sp. and D. fragilis may play a role in chronic urticaria which seriously disrupts the patient's quality of life. Parasitic infections should not be neglected in patients with cutaneous manifestations.

Investigation of the effect of combined use of alloplastic-based tricalcium phosphate bone graft and antihemorrhagic plant extract (ABS) on bone regeneration in surgically induced bone defects in nondiabetic rats: an experimental animal study

Background/aim: In this experimental study, we aimed to evaluate the late period effects of the combination of Ankaferd Blood Stopper (ABS), which has bone wound healing effects, and ß-tricalcium phosphate (TCP) on the regeneration of bone tissue through histopathological, immunohistochemical, and radiological (dual energy X-ray absorptiometry - DEXA) methods in nondiabetic rats. Materials and methods: Sixty-four Wistar albino male rats were used. In the calvaria of the rats, a bone defect 7.0 mm in diameter was created. These rats were divided into 4 different groups. Group 1 was the control group without any treatment, a 0.125 mL Β-TCP graft was applied to Group 2, a 0.125 mL ABS was applied to Group 3, and a 0.125 mL (ß-TCP + ABS) mixture was applied to group 4. Half of the rats were sacrificed on day 28 and the other half on day 56. Histopathological, immunohistochemical, and DEXA analyses of the specimens were performed after the experiment. Results: As a result of the histopathological analysis, osteoblastic activity and new bone formation were found to be significantly higher in Group 2, Group 3, and Group 4 than the control group on day 28 (P < 0.05). However, inflammatory cell infiltration and vascular dilatation and hemorrhage decreased significantly compared to the control group (P < 0.05). The histopathological analysis in rats on day 56 showed that osteoblastic activity in Group 2 and Group 4 was significantly higher than in the control group, but there was a statistically significant decrease in inflammatory cell infiltration and vascular dilatation and hemorrhage compared to the control group (P < 0.05). New bone formation in Group 2, Group 3, and Group 4 was significantly higher than in the control group. Western blotting findings revealed that the osteonectin and osteopontin expression on day 28 was increased significantly in Group 2 and Group 4. DEXA analyses revealed that BMC values in Group 2 and Group 4 on day 28 were significantly higher than in the control group (P < 0.05). There was no significant difference in bone mineral density values on the 28th and 56th days (P > 0.05). Conclusion: The use of both ß-TCP + ABS and only ABS had positive effects on wound healing and bone formation in nondiabetic rats.

Refractory Giardiasis in an Immunosuppressed Patient in Turkey.

Giardiasis is an infection of the small intestine caused by the protozoan parasite Giardia duodenalis. In immunocompetent patients the infection is usually self-limited and no treatment may be needed. Immunodeficiency, however, is a predisposing factor for the development of severe Giardia infection. In this report, a case of recurrent giardiasis refractory to nitroimidazoles and nitazoxanides presented. A 28-year-old male patient with hypogammaglobulinemia admitted to our hospital because of chronic diarrhoea. Microscopic examination of stool revealed a high number of Giardia trophozoites and cysts. Treatment with higher doses and a longer course of metronidazole, trimethoprim-sulfamethoxazole, ornidazole and albendazole failed. Administration of nitazoxanide, which has been reported to be effective against Giardia duodenalis refractory to nitroimidazoles, was commenced, but his symptoms persisted and stool samples demonstrated Giardia trophozoites and cysts again.

Clinical Evaluation of Complications in Implant-Supported Dentures: A 4-Year Retrospective Study.

BACKGROUND Implants that can be used in the prosthetic rehabilitation of full and partial edentulous patients are now frequently used due to advances in dentistry. Despite advanced methods of applications, failures and complications can still be seen. The aim of our study was to evaluate clinical prosthetic values and complications that occurred during 4-year follow-up in implant-supported restorations. MATERIAL AND METHODS This retrospective study included 40 patients who received oral rehabilitation with an implant-supported prosthesis. A total of 162 implants were placed: 99 in the maxilla and 63 in the mandible. The prosthetic and surgical data were recorded. Data including prosthetic complications and implant loss were recorded and statistically analyzed using Cox proportional hazard regression analysis. RESULTS In total, 159 implants (98.14%) survived, 3 implants (1.86%) failed, and 100% of the protheses were successful. There were 62 dental implants used as abutments for removable dentures and 97 for fixed dentures. The most frequent prosthetic complications after placement of an implant-supported prosthesis were loss of retention, mucositis, abutment screw loosening, and fracture. Patient satisfaction after prosthesis use was also evaluated, showing that satisfaction was systematically increased. CONCLUSIONS To minimize the frequency of complications, protocols must be established from diagnosis to the completion of treatment and follow-up of implant-supported prostheses, especially in terms of adequate technical steps and careful radiographic evaluation of the components.