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An atypical acute exacerbation of COPD due to Aspergillus fumigatus
No full textPubMed: 31986874A 64-year-old male with a history of stabile chronic obstructive pulmonary disease (COPD) presented with increasing dyspnea and sputum for the last two months. Complete blood count showed WBC 14x103/ml, Hgb: 14.2 g/dL and eosinophilia. Blood biochemistry was normal. Chest x-ray showed hyperlucency while thorax computed tomography (CT) revealed obstructive lung disease and bronchiectasis. Pulmonary function tests demonstrated severe obstructive lung disease and a negative bronchoreversibility with a moderately reduced diffusing capacity/alveolar volume (DLCO/VA). ABG gases revealed significant hypoxemia. Sputum culture was negative. Total IgE was 1140 ng/ml. Aspergillus RAST, precipitins and aspergillus-galactomannan antigen were positive. CF genetic screening tests gave negative results. Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction that occurs due to bronchial aspergillus colonization. It is most common in patients with asthma and cystic fibrosis. We present a COPD case with an acute exacerbation due to Aspergillus fumigatus that lead to an aberrant clinical profile unresponsive to conventional treatment. Clinicians should consider Aspergillus fumigatus as an etiologic agent in an atypical and severe COPD exacerbation. © Copyright the Author(s), 2020 Licensee PAGEPress, Ital
Anatomical landmarks for cochlear implantatıon in ossifıed cochleas
No full textPubMed: 32440899Purpose: in this study, we aimed to introduce the facial nerve as a new anatomical landmark which can be used in ossified cochleas during cochlear implantation. We also set out to define a safe line to preserve the internal auditory canal (IAC) while drilling the basal turn of the cochlea. Methods: Thirty patients who had temporal computed tomography (CT) were studied. the distances from the facial nerve and the round window to the IAC, carotid artery, and jugular bulb were measured in the reformatted CT images. We have created a line in the direction of the stapedial tendon from the round window to the IAC and called it ROWIAC (Round window–IAC) line. We have investigated whether this line intersects the IAC and measured the distances from this line to the IAC. Results: Fifty-four temporal CT scans were included to the study. the mean distances from the facial nerve to the IAC, carotid artery, and jugular bulb were 8.8 ± 0.9, 15.0 ± 2.0, and 12.2 ± 2.9 mm, respectively. the mean distances from the round window to these structures were 3.8 ± 0.7, 9.4 ± 2.2, and 8.3 ± 2.9 mm, respectively. ROWIAC line did not intersect the IAC in any of the patients. the mean distance between this line and the IAC was 0.8 ± 0.4 mm. Conclusion: We propose that facial nerve and ROWIAC line can be used as potential landmarks during cochlear implantation in ossified cochleas to protect the adjacent neurovascular structures. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.The authors would like to thank Ms. Cigdem Altunok, Department of Bioistatistics, Yeditepe University School of Medicine, for her support with the statistical analyses
Hafif Kognitif Bozukluğu Olan Parkinson Olgularının Serumlarında Nöroinflamasyon Mediyatörlerinin Azalması
No full textIntroduction: Cognitive impairment is common in Parkinson’s disease (PD) and PD patients with mild cognitive impairment (PD-MCI) are at increased risk of developing Parkinson’s disease dementia (PDD). Reliable biomarkers are required for objective identification of cognitive decline in PD. In this pilot study, serum levels of well-known mediators of neuroinflammation were measured in PD patients with or without MCI to find out the involvement of neuroinflammation and microglial activation in PD-MCI. Methods: 36 PD-MCI, 25 PD patients with normal cognition (PD-NC) and 19 healthy controls were recruited. Serum levels of NLR family pyrin domain containing 1 (NLRP1), NLRP3, caspase-1, NF-kB, IL-1b and IL-18 were measured by ELISA and a panel of neuropsychological tests was administered. Results: PD-MCI patients showed significantly reduced levels of NFkB, IL-1b and IL-18, whereas NLRP1, NLRP3 and caspase-1 levels were comparable among PD-NC and PD-MCI patients. IL-18 levels were positively correlated with Addenbrooke’s Cognitive Examination-Revised and Symbol Digit Modalities Test scores. Conclusion: Levels of several microglial activation mediators are reduced in PD-MCI patients inferring a protective role to certain inflammation factors against cognitive decline in PDAmaç: Parkinson hastalığında kognitif bozukluk oldukça sık görülmektedir ve Parkinson hastalığı - hafif kognitif bozukluğu (PH-HKB) Parkinson hastalığı demansı (PHD) için yüksek bir risk faktörüdür. Parkinson hastalığında gözlenen bu kognitif gerilemenin objektif olarak belirlenebilmesi için güvenilir biyobelirteçlere ihtiyaç vardır. Bu pilot çalışmada, nöroinflamasyon ve mikroglial aktivasyonun PH-HKB’deki rolünü araştırmak amacıyla PH-HKB ve PH-kognitif normal (PH-KN) hastalarda iyi bilinen nöroinflamasyon mediyatörlerinin serum seviyeleri ölçülmüştür. Yöntem: Parkinson hastalığı tanısı almış 36 PH-HKB, 25 PH-KN ve 19 sağlıklı kontrol çalışmaya dahil edilmiştir. NLR family pyrin domain containing 1 (NLRP1), NLRP3, caspase-1, NF-kB, IL-1b ve IL-18’in serumdaki seviyeleri ELISA yöntemi ile ölçülmüştür. Kognitif değerlendirme için tüm katılımcılara nöropsikolojik testler uygulanmıştır. Bulgular: PH-HKB hastalarında NF-kB, IL-1b ve IL-18 seviyelerinin anlamlı derecede azaldığı gözlenirken, NLRP3 ve caspase-1 seviyeleri açısından PH-KN ve PH-HKB grupları arasında anlamlı bir fark bulunmamıştır. Ayrıca IL-18’in Addenbrooke kognitif değerlendirme bataryası (ACE-R) skorları ile pozitif bir korelasyon gösterdiği gözlenmiştir. Sonuç: PH-HKB hastalarında mikroglial aktivasyon mediyatör seviyelerinin azalmış olması, bazı inflamasyon faktörlerinin PH’deki kognitif bozulmaya karşı koruyucu bir role sahip olduklarını göstermektedir
Can allergy patch tests with food additives help to diagnose the cause in childhood chronic spontaneous urticaria?
No full textWOS: 000551559000015PubMed: 32792880Introduction: Chronic spontaneous urticaria (CSU) is characterized by the onset of symptoms which are not induced by specific triggers, but are rather spontaneous. A considerable number of patients report that foods or food additives might be responsible for their chronic urticaria. Aim: To determine the prevalence of sensitization to food additives in children with CSU using atopy patch tests (ATP). Material and methods: Atopy patch tests for 23 different food additives were applied to 120 children with CSU and 61 healthy controls. Results: Seventeen (14.1%) children with CSU were sensitized with food additives. None of the control group had positive APT. Azorubine and Cochineal red were the food additives detected with the highest sensitization rates (5.8% (n = 7) and 6.7% (n = 8), respectively). Conclusions: There can be an association between food additives and CSU. APT tests may be a helpful tool in the assessment and management of CSU so that easier to follow diets and effective treatments can be offered to families
Splenic Artery Transposition for Arterial Reconstruction in Living Donor Liver Transplantation
No full textPurpose: in living donor liver transplantation, poor compatibility of the recipient hepatic artery remains a technical challenge. Here, we analyzed our 14 years of experience with extra-anatomic hepatic artery reconstruction. Methods: Between July 2004 and December 2018, there were 1063 liver transplantations at our center. All patients with an extra-anatomic hepatic artery reconstruction were identified. the gastroduodenal artery and the transposed splenic artery were the primary options for extra-anatomic arterial reconstruction. Patient characteristics, operative data, and post-transplant outcome were reviewed retrospectively. Results: There were 22 patients with extra-anatomic hepatic artery reconstruction, 6 with gastroduodenal artery, and 16 with splenic artery. There were 2 major complications: 1 patient underwent early reoperation due to bleeding from the splenic artery trunk and another had an iatrogenic injury to the transposed splenic artery during conversion hepaticojejunostomy. Both were treated successfully with surgery. One patient died perioperatively due to sepsis. the 1- and 3-year graft survival rates of these 16 patients were 93.7% and 87.5%. Conclusion: If the hepatic arteries are not suitable for anastomosis, then we consider the gastroduodenal artery and the splenic artery to be the conduits of choice for extra-anatomic arterial reconstruction. the transposed splenic artery is very consistent, easily accessible, and offers adequate length and diameter for successful arterial anastomosis. © 2020 Elsevier Inc
Klinicke prakticne smjernice za perioperacijsku i poslijeoperacijsku skrb o arterijsko-venskim fistulama i umetcima za hemodijalizu u odraslih Sa?etak Europske najbolje bubre?ne prakse
No full text2-s2.0-85103634028[No abstract available
Plasenta perkreatalı hastaların perinatal sonuçları
No full textAim: Placental invasion anomalies are rare, but it causes serious fetomaternal morbidity and mortality. In our study, we aimed to evaluate the fetomaternal results of cases with Abnormal Invasive Placenta ( Placenta Percreata).Methods: Patients who underwent a peripartum hysterectomy or whose placenta was left in uterin cavity due to placenta percreata in our hospital were retrospectively analyzed. Data of 20 patients were noted.Results: The mean age of the patients was ± SD (min-max) 33 ± 5,704 (25-46) and 60% (n = 12) of the patients had additional diseases. Fifty five percent of patients (n=11) were operated in emergency conditions and 45% (n= 9) in elective conditions. Surgical complications were 65% (n = 13) bladder injuries, 30% (n = 6) disseminated intravascular coagulation (DIC), 20% (n = 4) infection, 15% (n = 3) relapartomy and 5% (n = 1) was pulmonary embolism. Mortality increased three times (OR; 3.003 (95% CI, 0.372-24.390) in patients with a comorbidity, while 4.7 times (OR; 4.784) in emergency operations. Operations under elective conditions and previously ultrasonographic diagnosis (Odd ratio values ; 0,219 (95% CI, 0,021-2,447) and 0,615 (95% CI, 0,043-8,695), recpectively) decreased maternal mortality.Conclusion: Prenatal diagnosis and performing elective surgeries in percreata cases are important to reduce maternal mortality. Although there are various surgical complications, we think that DIC development is important in mortality and massive transfusion does not decrease the mortality.Amaç: Plasenta invazyon anomalileri nadir görülmesine rağmen ciddi fetometarnal morbidite ve mortaliteye sebep olmaktadır. Çalışmamızda plasenta invazyon anomalisi olan olguların perinatal sonuçlarını değerlendirmeyi amaçladık. Yöntemler: Hastanemizde 2012-2014 tarihleri arasında peripartum histerektomi yapılan ve intraoperatif plasentası uterin kavitede bırakılan hastalar retrospektif olarak incelendi. 20 hastanın verileri not edildi. Bulgular: Hastaların yaş ortalamaları ± SD (min-max) 33 ± 5,704. (25-46) saptandı. Hastaların % 60’ında (n=12) ek hastalıklar da vardı. Hastaların % 55’i (n=11) acil şartlarda ve % 45’i (n=9) elektif şartlarda opere edildi. Perkreta operasyonlarında oluşan cerrahi komplikasyonlar sıklığına göre sırasıyla % 65(n=13) mesane yaralanması, % 30 (n=6) dissemine intravaskülar kuagulasion (DIC), % 20 (n=4) enfeksiyöz komplikasyonlar ve % 5 (n=1) pulmoner emboli şeklindeydi. Maternal mortalite riskinin ek hastalığı olan hastalarda 3 kat (OR; 3,003 (95%CI, 0,372-24,390) ve acil şartlarda ameliyat olan hastalarda 4,7 kat (OR;4,784 (95%CI, 0,408-47,619) artığı saptandı. Hastaların elektif şartlarda ameliyat olması ve önceden ultrasonografik olarak tanı almış olmalarının da (OR; 0,219 (95%CI, 0,021-2,447), OR; 0,615 (95%CI, 0,043-8,695) maternal mortalite riskini azalttığı saptandı. Korelasyon analizinde maternal mortalite ile maternal yaş (0,473, p=0,035) ve masive kan transfüzyonunun (0,562, p=0,010) pozitif korelasyon, postoperatif hemoglobin değeri ile de negatif kolerasyon gösterdiği saptanmıştır (-0,723, p= 0,010). Sonuç: Plasenta perkreatalı hastalarda, prenatal tanı konulmuş olması ve hastaların elektif şartlarda opere edilmesi maternal mortalite riskinin azaltılması açısından önem arz etmektedir. Çeşitli cerrahi komplikasyonlar olmasına rağmen DIC tablosu mortalite açısından önemlidir ve bu tabloda masif transfüzyon da mortaliteyi azaltmamaktadır
Erişkin Bireylerde Bağlanma Biçimleri ile Psikososyodemografik Değişkenlerin Aleksitimi Düzeyleri Üzerindeki Etkileri
No full textAmaç: Bu araştırmada; erişkin bireylerde bağlanma biçimleri (kaygılı ve kaçınmacı bağlanma boyutları) ile psikososyodemografik değişkenlerin aleksitimi düzeyi üzerindeki etkileri araştırılmıştır. Gereç ve Yöntemler: Araştırmaya, Türkiye’nin çeşitli bölgelerinde yaşayan ve çalışmaya gönüllü olarak katılan 192 (%69,6)’si kadın, 84 (%30,4)’ü erkek toplam 276 birey katılmıştır. Araştırmada, psikososyodemogra- fik özelliklerin belirlenebilmesi için araştırmacı tarafından oluşturulan, “Demografik Bilgi Formu”, aleksitimi düzeylerini ölçmek amacıyla “Toronto Aleksitimi Ölçeği (TAÖ-20)”, bağlanma biçimlerini belirle- mek amacıyla da “Yakın İlişkilerde Yaşantılar Envanteri II (YİYE-II)” kullanılmıştır. Bulgular: Erişkin bireylerde kaygılı ve kaçınmacı bağ- lanma biçiminin aleksitimi toplam puanını ve duygularını tanıma zor- luğu alt boyutunu yordadığı görülmektedir (p<0,01). Bununla birlikte kaçınmacı bağlanma biçiminin, duygularını ifade etme zorluğu alt bo- yutunu yordadığı da gözlenmiştir (p<0,01). Öte yandan aleksitimi top- lam puanı ile dışa-vuruk düşünce puanının cinsiyetler açısından arasında orta düzeyde, düşük güçte anlamlı bir ilişki bulunmaktadır (p<0,01). Analiz sonuçları, TAÖ-T, TAÖ-DTZ, TAÖ-DİEZ ve TAÖ- DVD puanlarının, bireylerin eğitim seviyesine göre farklılaştığını gös- termiştir. Son olarak TAÖ-DVD haricinde TAÖ-T, TAÖ-DTZ ve TAÖ-DİEZ puanlarının, bireylerin romantik ilişki durumlarına göre farklılaştığını göstermiştir (p<,05). Sonuç: Erişkin bireylerde, kaygılı ve kaçınmacı bağlanma biçimi olanlar aleksitimik özellikler göster- mektedir. Kaçınmacı bağlanma biçimi olanlarda, duygularını ifade etme zorluğu saptanmıştır. Aleksitiminin dışa-vuruk düşünce özelliği erkek- lerde kadınlardan fazla bulunmuştur. Eğitim seviyesi arttıkça, aleksiti- mik özellikler taşıma olasılığı azalmaktadır. Romantik ilişkisi olmayan bireylerde, aleksitimik özellikler daha fazla görülmektedir
Akne Klinik
No full textAkne klinik belirtileri polimorfik özellikte olup lezyonlar, primer ve sekonder olmak üzere iki grupta incelenebilir. Primer akne lezyonları, açık ve kapalı komedonlar, papül, püstül ve nodüllerdir. Sekonder lezyonlar ise çoğu kez primer lezyonlardan gelişen apse, kist, post-enflamatuvar hiperpigmentasyon, ekskoriasyon izleri ve skarlardan oluşur. Hastalığın aktivitesini primer lezyonların şiddeti belirler
Therapeutic Effects of Liraglutide, Oxytocin and Granulocyte Colony-Stimulating Factor in Doxorubicin-Induced Cardiomyopathy Model: An Experimental Animal Study
No full textDoxorubicin-induced (DXR) cardiomyopathy is a serious health issue in oncology patients. Effective treatment of this clinical situation still remains to be discovered. In this experimental animal study, we aimed to define therapeutic effects of liraglutide, oxytocin and granulocyte colony-stimulating factor in DXR-induced cardiomyopathy model. 40 male Sprague–Dawley rats were included to study. 32 rats were given doxorubicin (DXR) for cardiomyopathy model. DXR was administered intraperitonally (i.p.) at every other day of 2.5 mg/kg/day at six times. Eight rats were taken as normal group and no treatment was performed. 32 rats given doxorubicin were divided into 4 groups. Group 1 rats were assigned to a placebo group and was given with a 0.9% NaCl saline solution at a dose of 1 ml/kg/day i.p. (DXR + saline), Group 2 rats were given with 1.8 mg/kg/day of Liraglutide i.p. (DXR + LIR), Group 3 rats were given with 160 ?g/kg/day oxytocin i.p. (DXR + OX), Group 4 rats were given with 100 ?g/kg/day filgrastim i.p. (DXR + G-CSF). All medications were given for 15 days. On day 16, under anesthesia, ECG was recorded from derivation I. After that, blood samples were taken by tail vein puncture for biochemical analysis. Finally, the animals were euthanized and the heart removed and prepared for immunohistochemical examination. All three treatments were shown to ameliorate the toxic effect of doxorubicin in cardiac tissue with the best results in DXR + OX group. DXR + OX group had the most preserved tissue integrity examined by light microscopy, least immune expression level of CASPASE-3 (5.3 ± 0.9) (p < 0.001) the highest ECG QRS wave voltage amplitude (0.21 ± 0.008 mV) (p < 0.00001) least plasma MDA (115.3 ± 19.8 nm) (p < 0.001), TNF-alpha (26.6 ± 3.05 pg/ml) (p < 0.001), pentraxin-3 (2.7 ± 0.9 ng/ml) (p < 0.001), Troponin T (1.4 ± 0.08 pg/ml) (p < 0.001), pro-BNP (11.1 ± 3.6 pg/ml) (p < 0.001) levels among all three treatment groups. Consistent with previous literature, we found that OX treatment decreased oxidative, apoptotic and inflammatory activity in DXR-induced cardiomyopathy rat model as well as provided better tissue integrity and better results in clinically relevant measures of ECG assessment, plasma Troponin T and pro-BNP levels. LIR and G-CSF treatment caused similar results with less powerful effects. Our findings suggest that with the best results in OX treatment group, all three agents including LIR and G-CSF attenuates DXR-induced cardiomyopathy in this rat model. © 2019, Springer Science+Business Media, LLC, part of Springer Nature