Abstract in English:

SUMMARY OBJECTIVE: The objective of this systematic review with meta-analysis was to evaluate the efficacy, safety, and short- and long-term tolerability of cannabidiol (CBD), as an adjunct treatment, in children and adults with Dravet syndrome (SD), Lennox-Gataut syndrome (LGS), or tuberous sclerosis complex (TSC), with inadequate control of seizures. METHODS: This systematic review was conducted through a search for scientific evidence in the Mediline/PubMed, Central Cochrane, and ClinicalTrials.gov databases until April 2022. Selected randomized clinical trials (RCTs) that presented the outcomes: reduction in the frequency of seizures and total seizures (all types), number of patients with a response greater than or equal to 50%, change in caregiver global impression of change (CGIC) (improvement ≥1 category on the initial scale), adverse events (AEs), and tolerability to treatment. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses. RESULTS: Notably, six RCTs were included, with a total of 1,034 patients with SD, LGS, and TSC, of which 3 were open-label extension RCTs. The meta-analysis of the studies showed that the use of CBD as compared with placebo, in patients with convulsive seizures refractory to the use of medications, reduces the frequency of seizures by 33%; increases the number of patients with a reduction ≥50% in the frequency of seizures by 20%; increases the number of patients with absence of seizures by 3%; improves the clinical impression evaluated by the caregiver or patient (S/CGIC) in 21%; increases total AEs by 12%; increases serious AE by 16%; increases the risk of treatment abandonment by 12%; and increases the number of patients with transaminase elevation (≥3 times the referral) by 15%. CONCLUSIONS: This systematic review, with meta-analysis, supports the use of CBD in the treatment of patients with seizures, originated in DS, LGS, and TSC, who are resistant to the common medications, presenting satisfactory benefits in reducing seizures and tolerable toxicity.

Abstract in English:

SUMMARY OBJECTIVE: This study aimed to assess the patterns of serum cytokines in chronic lymphocytic leukemia patients at baseline and post-chemotherapy and investigate their association with response to treatment and chronic lymphocytic leukemia prognosis. METHODS: Blood samples were taken from 32 subjects at their first medical visit after being diagnosed with chronic lymphocytic leukemia and 1 year after chemotherapy. Then, levels of cytokines and blood parameters in peripheral blood were measured. Correlation analysis was used to assess the indexes before and after chemotherapy as well as at different disease stages. RESULTS: Most of the patients (45.80%) had stages I and III before initiation of treatment and after treatment, respectively. There were significant differences between levels of interleukin (IL)-6 (p=0.006) and IL-10 (p=0.009) before and after treatment. Notably, the difference in IL-10 levels before and after treatment was significantly higher in the advanced stages compared to that in the non-advanced stages (p=0.007). IL-6 and IL-10 were also higher in the expired patients compared to the survived cases. CONCLUSIONS: Cytokines such as IL-6 and IL-10 may be considered predicting factors for chronic lymphocytic leukemia prognosis.

Abstract in English:

SUMMARY OBJECTIVE: This study aimed to evaluate the association between left ventricular ejection fraction recovery and the total oxidant status, total antioxidant capacity, and high-sensitivity C-reactive protein levels. METHODS: A total of 264 ST-elevation myocardial infarction patients were classified into two groups according to baseline and 6-month follow-up left ventricular systolic function: reduced and recovery systolic function. Predictors of the recovery of left ventricular ejection fraction were determined by multivariate regression analyses. RESULTS: Multivariable analysis indicated that oxidative status index, baseline left ventricular ejection fraction and peak creatine-kinase myocardial bundle level, and high-sensitivity C-reactive protein were independently associated with the decreased of left ventricular ejection fraction at 6-month follow-up. CONCLUSION: Oxidative stress and inflammation parameters were detrimental to the recovery of left ventricular ejection fraction in patients with ST-elevation myocardial infarction.

Abstract in English:

SUMMARY OBJECTIVE: This study aimed to characterize teleconsultations in neurology executed by Regula+Brasil project in Recife, a capital city in northeastern Brazil. METHODS: A descriptive study carried out by four private hospitals, in a partnership with the Ministry of Health in Brazil. Teleconsultation was performed preferably in the video modality. Conditions eligible for teleconsultation were headache, epilepsy, and cerebrovascular disorders. Period of analysis was May to September 2020. RESULTS: A total of 243 teleconsultations were analyzed, of which 76.95% was a first appointment. In 48.97% of cases, the teleconsultation represented the first opportunity for the patient to be consulted with the specialist. Among cases of first appointment, 20.16% were further referred to a face-to-face consultation and 21.81% could be redirected to primary health care. Headache disorders were the most predominant clinical conditions. CONCLUSIONS: The implementation and development of telemedicine by Regula+Brasil during the COVID-19 pandemic represented an opportunity to assess the value of having teleconsultations added along the line of care from primary care to a medical specialty, promoting the coordination of care across different levels of complexity of care in the health system and improving access to specialized care.

Abstract in English:

SUMMARY OBJECTIVE: The aim of this study was to examine the changes on the Purkinje cells in the cerebella of male rat pups born to pregnant dams that were exposed to an electromagnetic field in the prenatal period. METHODS: The first stage of the study involved 12 Sprague-Dawley rats, 6 male and 6 female, weighing between 180 and 250 g. The female rats in the experimental group were exposed to a 900-MHz electromagnetic field for 1 h at the same time every day, and no procedure was performed on the control group. Following pregnancy, six male pups from each group were divided into experimental and control groups without any procedure on the pups. After 2 months, they were sacrificed and their cerebella were removed. Histopathologically, following routine processing and fixation procedures, the cerebella were embedded in the tissue blocks. The sections taken from these blocks were stained with cresyl violet. The Purkinje cells in the cerebella were then counted on sections using the optical dissector method on an image analysis system. RESULTS: The estimation of number of the Purkinje cells in the groups revealed more cells in rats in the control group than in the experimental group. Histopathologically, Purkinje cells exhibited a normal morphological structure in the control group, while the cells in the experimental group showed damage. CONCLUSIONS: It might be asserted that the exposure of mothers to an electromagnetic field in the prenatal period may affect the development of Purkinje cells in the pup cerebella.

Abstract in English:

SUMMARY OBJECTIVE: Leprosy is a disabling infectious disease caused by Mycobacterium leprae. This study aimed to investigate the prevalence of leprosy among household contacts of leprosy patients. METHODS: This study is a serological survey in household contacts of leprosy patients who had been treated or were undergoing treatment in the city of Presidente Prudente, São Paulo, Brazil, from 2006–2016, using clinical examination and screening for anti- Phenolic glycolipid-I antibodies with Mycobacterium leprae-flow serology. RESULTS: A total of 263 index cases of leprosy were identified during the study period. Of these, 53 were approached, and among their household contacts, 108 were examined. The ML-flow test was positive in 2 (1.85%) individuals, but clinical examination revealed no signs or symptoms of leprosy in them. Therefore, they were considered to have a subclinical infection. Leprosy was not confirmed in any household contacts. In this study, a lower percentage of household contacts, when compared to that in the literature, had a positive Mycobacterium leprae-flow test result. CONCLUSION: The use of Mycobacterium leprae-flow should be encouraged during the follow-up of at-risk populations, such as the household contacts of leprosy patients.

Abstract in English:

SUMMARY OBJECTIVE: This study aimed to evaluate the correlation between Nonalcoholic fatty liver disease and cardiac abnormalities. METHODS: Patients with Nonalcoholic fatty liver disease who attended an outpatient clinic in Southern Brazil were prospectively evaluated. Patients should be older than 18 years and have steatosis. RESULTS: A total of 174 patients were evaluated. The mean age was 63±12 years, 65% were women, 71% white, 82.2% hypertensive, 52.3% diabetic, 56.3% obese, and 30% dyslipidemic. There was no association between Nonalcoholic fatty liver disease and cardiac abnormalities, even after adjusting for age, sex, and metabolic syndrome. CONCLUSIONS: The present study did not show a direct correlation between Nonalcoholic fatty liver disease and cardiac abnormalities, regardless of metabolic syndrome.

Abstract in English:

SUMMARY OBJECTIVE: The aim of this study was to investigate whether rosiglitazone-activated peroxisome proliferator-activated receptor gamma can inhibit the occurrence of benign biliary stricture and further elucidate the relevant molecular signaling mechanism. METHODS: The primary cultured rat biliary fibroblasts following experiments were performed using within the fifth generation cells, which were separated from the bile ducts of Sprague-Dawley rats. The primary cultured rat biliary fibroblasts were co-cultured with 10 ng/mL transforming growth factor-beta 1 for stimulating collagen formation. Competent cells were transfected with siRNA that specifically target Smad3 or connective tissue growth factor to inhibit the expression of the corresponding proteins. The cells were incubated with 10 μmol/L rosiglitazone to activate peroxisome proliferator-activated receptor gamma. The cells were incubated with 10 μmol/L GW9662 in the pretreatment session to inactivate peroxisome proliferator-activated receptor gamma. ELISA was used to determine the levels of connective tissue growth factor and type I collagen in the cell supernatant. Western blotting was used to detect the levels of intracellular p-Smad3/t-Smad3. RESULTS: Rosiglitazone-activated peroxisome proliferator-activated receptor gamma inhibited the secretion of type I collagen induced by transforming growth factor-beta 1. Peroxisome proliferator-activated receptor gamma inhibitor GW9662 could significantly reverse the rosiglitazone-triggered inhibition of transforming growth factor-beta 1-induced type I collagen secretion by suppressing peroxisome proliferator-activated receptor gamma activation (p<0.01). Furthermore, we also found that the activation of peroxisome proliferator-activated receptor gamma was accompanied by the inhibition of transforming growth factor-beta 1-induced Smad3 phosphorylation (p<0.01), increased connective tissue growth factor expression (p<0.01), and production of type I collagen (p<0.01), all of which effects elicited by rosiglitazone could be reversed by peroxisome proliferator-activated receptor gamma inhibitor GW9662. CONCLUSION: Peroxisome proliferator-activated receptor gamma activated by rosiglitazone inhibits the transforming growth factor-beta1 -induced phosphorylation of Smad3 and the increased connective tissue growth factor expression as well as inhibits the secretion of type I collagen in biliary fibroblasts.

Abstract in English:

SUMMARY OBJECTIVE: Malignant cutaneous melanoma is the most aggressive type of skin cancer, and its early detection and prompt initiation of treatment play an important role in reducing disease-associated morbidity and mortality. Many factors influence the diagnosis of melanoma, and its recognition is essential for the development of strategies for its early detection. This study was carried out to Identify the main variables related to the delay in diagnosis of Malignant Cutaneous Melanoma and correlate them with the time interval for making the definitive diagnosis. METHODS: Retrospective analysis of 103 patient records from January 2015 to December 2020 correlating social, economic, demographic, and cultural factors with the time elapsed between the onset of symptoms and the diagnosis of malignant cutaneous melanoma. RESULTS: The average time to seek medical services from the onset of symptoms was 29.54 months. The mean time for a referral from the primary to the referral service was 1.35 months, and the factors that contributed to a faster diagnosis were lesion Breslow (>1 mm), lesion growth, income range (≤1.5 minimum wages), lower phototypes (I and II), not having gone to the Basic Healthcare Units, profession (household), smoking, and type of housing. CONCLUSIONS: Our findings demonstrate that there is still a great delay in the recognition of signs and symptoms related to the diagnosis of malignant cutaneous melanoma in our country, influenced by several socioeconomic and demographic factors.

Abstract in English:

SUMMARY OBJECTIVE: The aim of this study was to compare the effects of general and spinal anesthesia on maternal and neonatal outcomes during cesarean section in pregnancies with macrosomia. METHODS: This retrospective cohort study included 1043 patients who delivered by cesarean section between May 2018 and December 2021 and had a baby born with a birth weight of 4000 g or greater. Maternal and neonatal outcomes were compared according to the type of anesthesia performed in the spinal anesthesia group (n=903; 86.6%) and general anesthesia group (n=140; 13.4%). The Apgar score was categorized into <7 and ≥7. RESULTS: Neonates with an Apgar score of <7 at the first minute (11.4 vs. 0.4%; p<0.001) and the fifth minute (2.9 vs. 0.3%; p=0.004) were significantly higher in the general anesthesia group. The preoperative and postoperative hematocrit difference was significantly lower in patients who received spinal anesthesia than those who received general anesthesia [2 (1.1–3.1) vs. 4.05 (2.8–5.35); p<0.001]. The number of patients transfused was higher in the general anesthesia group (9.3 vs. 2.7%; p<0.001). In the regression model, general anesthesia, birth weight, and emergency conditions were significant independent factors related to the preoperative and postoperative hematocrit decrease (p<0.001, p=0.005, and p=0.034, respectively). CONCLUSIONS: Apgar scores of <7 at the first and fifth minutes are higher in macrosomic neonates who received general anesthesia than in neonates who received spinal anesthesia. Performing cesarean section under general anesthesia in mothers of macrosomic neonates results in a greater decrease in hematocrit value and a greater need for blood transfusion than under spinal anesthesia.

Abstract in English:

SUMMARY OBJECTIVE: This study evaluates the self-practices with conventional and herbal drug use among ear, nose, and throat outpatients. METHODS: A cross-sectional survey-based study was carried out among all ear, nose, and throat outpatients on their first visit to the otorhinolaryngology department at a tertiary care hospital. The survey comprised a total of 14 questions with 4 different sections, including demographic characteristics, self-medication of conventional medicines, herbal medication usage, and perception regarding herbal medicines. RESULTS: Overall, 255 questionnaires were distributed among patients, of which 183 completed the questionnaire (response rate=71.7%). Respondents reported self-medication (44.8%) with conventional drugs before visiting a hospital. The most commonly used medicine was analgesics (31.7%) and antibiotics (21.9%). Nearly half of the patients (49.2%) used at least one herbal drug. The most commonly used herbal medications were Tilia cordata (78.8%), Zingiber officinale (62.2%), and Camellia sinensis (45.5%). According to the International Union for Conservation of Nature Red List, most of the medicinal herbs were considered as data deficient/least concern. About 36.6% of the participants perceived that herbal drugs are effective for ear, nose, and throat problems. Moreover, 22.9% of the patients did not know about herbal-drug interaction with other medications. CONCLUSIONS: This study observed a considerable prevalence of self-based practices with conventional and herbal medications. Strict national regulations on conventional and herbal medication access and long-term actions should be implemented to discourage inappropriate drug use.

Abstract in English:

SUMMARY OBJECTIVE: This study aimed to investigate the relationship between the presence of hip osteoarthritis and the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and neutrophil-monocyte ratio. METHODS: Participants with hip osteoarthritis and healthy controls aged 45–75 years were recruited in the study. The participants with hip osteoarthritis were divided into two groups: mild/moderate hip osteoarthritis and severe hip osteoarthritis. Complete blood parameters of the participants were recorded, and neutrophil-lymphocyte ratio, neutrophil-monocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were calculated. Pain severity was evaluated using a visual analog scale. RESULTS: A total of 76 participants with hip osteoarthritis and 59 healthy controls were included in the study. The mean age of the participants was 57.6±6.11 years. Mean neutrophil-lymphocyte ratio and neutrophil-monocyte ratio values were statistically significantly different between the hip osteoarthritis group and healthy control group (p<0.05). Platelet-lymphocyte ratio, monocyte-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein values were not significantly different between the groups. Also, there was no difference between all inflammatory parameters and hip osteoarthritis severity (p>0.05). CONCLUSIONS: Neutrophil-lymphocyte ratio and neutrophil-monocyte ratio values were higher in patients with hip osteoarthritis than in healthy controls. Mean platelet-lymphocyte ratio, monocyte-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein values did not change according to the presence of hip osteoarthritis. Not all hematological indices give valuable information regarding the severity of hip osteoarthritis.

Abstract in English:

SUMMARY OBJECTIVE: In the current literature, there are few studies investigating the relationship between premature coronary atherosclerosis and nonalcoholic fatty liver disease. We aimed to evaluate the relationship between nonalcoholic fatty liver disease and premature coronary atherosclerosis. METHODS: In this cross-sectional study, female patients aged <55 years and male patients aged <50 years were enrolled. Both male and female patients underwent coronary angiography and abdomen ultrasonography between 2014 and 2019. A stepwise binary logistic regression analysis was carried out to evaluate the independent variables related to premature coronary atherosclerosis and nonalcoholic fatty liver disease. A p-value<0.05 was considered statistically significant. RESULTS: nonalcoholic fatty liver disease was present in 44% of patients (n=377). Notably, 62% of the patients were female and the mean age was 44.5 (39–49) years. In a multivariate analysis, nonalcoholic fatty liver disease was shown to be an independent risk factor of premature coronary atherosclerosis (OR 1.438; 95%CI, 1.050–1.969; p=0.024). CONCLUSIONS: The presence of nonalcoholic fatty liver disease is an important independent risk factor for the development of premature coronary atherosclerosis.

Abstract in English:

SUMMARY OBJECTIVE: The aim of this study was to determine the effect of online breastfeeding counseling after cesarean section on breastfeeding success and anthropometric measurements of the baby in the first 6 months. METHODS: The study was conducted with single-blind randomized controlled experimental research design and performed with 151 primiparous women as intervention (n=76) and control (n=75) groups. The mothers were given training in the first 24 h postpartum by applying the “Data Collection Form,” “Breastfeeding and Infant Follow-up Form,” and “Breastfeeding Self-Efficacy Scale – Short Form,” who followed up at the first and sixth months, and further again for 6 months. RESULTS: Although there was no difference and homogeneity at the beginning of study among the participants in the intervention group compared with the control group, it was observed that the breastfeeding rates at the first and sixth months were higher and significant. When the anthropometric measurements of the participants in both the groups were compared, it was found that there was a significant difference between the measurements of height and weight at discharge, first, and sixth months. Breastfeeding self-efficacy scores in the intervention group were significantly higher at discharge, 4 weeks postpartum, and 6 months postpartum than those in the control group (p<0.05). CONCLUSIONS: Breastfeeding training and online counseling given to mothers who give birth by cesarean section during the early postpartum period increased breastfeeding rates and self-sufficiency, and the anthropometric measurements of babies were found to be higher at healthy limits.

Abstract in English:

SUMMARY OBJECTIVE: The main objectives of this investigation were to determine whether there were any relationships between corrected cardiac-electrophysiological balance value and National Institutes of Health Stroke Scale scores at admission and discharge in patients with acute ischemic stroke and to assess whether cardiac-electrophysiological balance value was an independent predictor of high National Institutes of Health Stroke Scale scores (National Institutes of Health Stroke Scale score ≥5). METHODS: In this retrospective and observational study, 231 consecutive adult patients with acute ischemic stroke were evaluated. The cardiac-electrophysiological balance value was obtained by dividing the corrected QT interval by the QRS duration measured from surface electrocardiography. An experienced neurologist used the National Institutes of Health Stroke Scale score to determine the severity of the stroke at the time of admission and before discharge from the neurology care unit. The participants in the study were categorized into two groups: those with minor acute ischemic stroke (National Institutes of Health Stroke Scale score=1–4) and those with moderate-to-severe acute ischemic stroke (National Institutes of Health Stroke Scale scores ≥5). RESULTS: Acute ischemic stroke patients with National Institutes of Health Stroke Scale score ≥5 had higher heart rate, QT, corrected QT interval, T-peak to T-end corrected QT interval, cardiac-electrophysiological balance, and cardiac-electrophysiological balance values compared with those with an National Institutes of Health Stroke Scale score of 1–4. The cardiac-electrophysiological balance value was shown to be independently related to National Institutes of Health Stroke Scale scores ≥5 (OR 1.102, 95%CI 1.036–1.172, p<0.001). There was a moderate correlation between cardiac-electrophysiological balance and National Institutes of Health Stroke Scale scores at admission (r=0.333, p<0.001) and discharge (r=0.329, p<0.001). CONCLUSIONS: The findings of this study demonstrated that the cardiac-electrophysiological balance value was related to National Institutes of Health Stroke Scale scores at admission and discharge. Furthermore, an elevated cardiac-electrophysiological balance value was found to be an independent predictor of National Institutes of Health Stroke Scale score ≥5.

Abstract in English:

SUMMARY OBJECTIVES: The transition from face-to-face to remote teaching is yet to be fully understood. In clinical training, traditional teaching must prevail because it is essential for the acquisition of skills and professionalism. However, the responses of each school to the pandemic and the decision on when to resume clerkship rotations were mixed. In this study, we aimed to analyze whether the time to resume clerkship rotations was associated with the performance of the students by using a multi-institutional Progress Test. METHODS: This is a cross-sectional study conducted at nine different Brazilian medical schools that administer the same annual Progress Test for all students. We included information from 1,470 clerkship medical students and analyzed the time of clinical training interruption as the independent variable and the student’s scores as the dependent variable. RESULTS: The comparisons of the students’ scores between the schools showed that there are differences; however, they cannot be attributed to the time the clerkship rotations were paused. The correlation between the schools’ average scores and the time to resume clerkship rotations was not significant for the fifth year (r= -0.298, p=0.436) and for the sixth year (r= -0.440, p=0.240). By using a cubic regression model, the time to resume clerkship rotations could explain 3.4% of the 5-year students’ scores (p<0.001) and 0.9% of the 6–year students, without statistical difference (p=0.085). CONCLUSIONS: The differences between the students’ scores cannot be attributed to the time when the schools paused the clerkship rotations.

Abstract in English:

SUMMARY OBJECTIVE: This study aimed to demonstrate the effectiveness of kinesio taping in nonspecific neck pain and to assess whether ultrasonographic parameters of the upper trapezius muscle can be used in the follow-up of kinesio taping treatment. METHODS: This was a single-blind, prospective, randomized controlled trial study involving 60 participants with nonspecific neck pain. The participants were randomly assigned into two groups. Kinesio taping group (n=29) received a 4-week neck exercise program, with kinesio taping applied twice a week for a total of four times, and the exercise group (n=28) received a 4-week neck exercise program. Participants were evaluated according to pain intensity (Visual Analog Scale), cervical range of motion, and disability (Neck Disability Index). Also, trigger point diameter and upper trapezius muscle thickness were evaluated with ultrasonography. Before and after the therapy, as well as the first month, all measures were taken by an investigator other than the practitioner of the treatment program. RESULTS: The results showed that the Visual Analog Scale and Neck Disability Index scores in the kinesio taping group were statistically significantly improved when compared to the exercise group (p<0.05). In addition, the thickness of the upper trapezius muscle and the diameter of the trapezius muscle trigger point were statistically significantly improved in the kinesio taping group compared to the exercise group (p<0.05). In the kinesio taping group, there was no statistical significance in cervical range of motion as compared to the exercise group. CONCLUSION: The combination of kinesio taping and exercise therapy was effective in reducing nonspecific neck pain and neck disability. Also, this study showed that ultrasonographic evaluation of the trapezius muscle could be used in the follow-up of kinesio taping therapy.

Abstract in English:

SUMMARY OBJECTIVE: This study aimed to describe sepsis progression in critical COVID-19 patients using the SOFA score and investigate its relationship with mortality. METHODS: Three researchers collected and analyzed retrospective clinical and laboratory data found in electronic health records from all patients admitted to a severe COVID-19 exclusive intensive care unit from March 2020 to October 2020. Mixed-effect logistic regression was used to evaluate SOFA (Sepsis-3) score variables as mortality prediction markers, while Kaplan-Meier survival curves were used to compare mortality between groups of patients. Cox proportional hazard models were used to further stratify mortality association between variants. RESULTS: A total of 73 patients were included. Temporal COVID-19-related sepsis progression analysis indicates difference in degrees and timing between different organ dysfunction over time. Sepsis-3 Cardiovascular Dysfunction characterized by severe hypotension added to the use of any vasopressor drugs was the only parameter associated with in-hospital death during the first 5 days of hospital admission (OR 2.19; 95%CI 1.14-4.20; p=0.01). CONCLUSION: Increased Sepsis-3 Cardiovascular Dysfunction score, characterized as hypotension associated with the use of vasopressor drugs in the first days of intensive care unit stay, is related to higher mortality in COVID-19 patients and may be a useful prognostic prediction tool.

Abstract in English:

SUMMARY OBJECTIVE: Acute appendicitis represents one of the most common causes of acute intra-abdominal emergencies worldwide. In this case-control study, we aimed to investigate associations of Rho-kinase gene expression and polymorphisms with acute appendicitis in a Turkish population. We also aimed to study the effects of gender on these parameters. METHODS: A total of 93 unrelated patients with acute appendicitis and 93 healthy controls in the Department of Emergency Medicine, Erciyes University, between June 2019 and June 2021 were included in this study. Genomic DNA was isolated from peripheral leukocytes, and the LightCycler 480 II real-time polymerase chain reaction was utilized to detect Rho-kinase1 gene rs35996865 and Rho-kinase2 gene rs2230774 (Thr431Asn) polymorphisms. Quantitative real-time polymerase chain reaction was applied to determine Rho-kinase1 and Rho-kinase2 gene expressions. RESULTS: There was a marked increase in Rho-kinase1, but not in Rho-kinase2, mRNA expression, and this increase was evident only in male patients (p=0.0008). No significant differences were found in allele and genotype frequencies for Rho-kinase1 gene rs35996865 and Rho-kinase2 gene rs2230774 polymorphisms between the patients with acute appendicitis and the control group. CONCLUSIONS: Our data imply that Rho-kinase1 (rs35996865) and Rho-kinase2 (rs2230774) gene variants are not risk factors for the development of acute appendicitis in the Turkish population. However, increased mRNA expression of the Rho-kinase1 gene in males indicated that Rho-kinase1 is involved in the pathogenesis of acute appendicitis in a gender-specific way.

Abstract in English:

SUMMARY OBJECTIVE: We investigated the relationship between thoracic diameters and chest compression-related thoracoabdominal injury in patients with non-traumatic out-of-hospital cardiac arrest who had a return of spontaneous circulation after cardiopulmonary resuscitation. METHODS: A total of 63 consecutive adult non-traumatic out-of-hospital cardiac arrest patients were enrolled in this prospective study. Computed tomography was performed on each patient and the anteroposterior diameter, skin-to-skin anteroposterior diameter, and transverse diameter of the chest were measured. Patients were divided into two groups based on the presence or absence of cardiopulmonary resuscitation-related thoracoabdominal injury. Age, sex, and duration of cardiopulmonary resuscitation, anteroposterior diameter, skin-to-skin anteroposterior diameter, and transverse diameter were compared between the groups. The primary outcome was the relationship between thoracic diameters and cardiopulmonary resuscitation-induced thoracoabdominal injuries. RESULTS: Thoracoabdominal injuries were detected in 46% (n=29) of the patients and consisted of rib fractures in 22 (34.9%) patients, pulmonary contusion in 7 (11.1%), and sternal fracture in 3 (4.8%) patients. There were no significant differences in cardiopulmonary resuscitation duration between patients with and without thoracoabdominal injuries (p=0.539). Similarly, there were no significant differences in anteroposterior diameter, skin-to-skin anteroposterior diameter, or transverse diameter between patient groups (p=0.978, p=0.730, and p=0.146, respectively) or between patients who died within the first 28 days and those who survived for longer than 28 days (p=0.488, p=0.878, and p=0.853, respectively). CONCLUSION: The iatrogenic thoracoabdominal injuries caused by cardiopulmonary resuscitation performed according to the cardiopulmonary resuscitation guidelines were independent of thoracic diameters. Therefore, the cardiac compression depth of 5–6 cm recommended by the current cardiopulmonary resuscitation guidelines is reliable for patients with different thoracic diameters.

Abstract in English:

SUMMARY OBJECTIVE: This study aimed to investigate the effect of mutations by comparing wild-type SARS-CoV-2 and Omicron regarding clinical features in patients with COVID-19. It also aimed to assess whether SARS-CoV-2 cycle threshold value could predict COVID-19 severity. METHODS: A total of 960 wild-type and 411 Omicron variant patients with positive results in SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction test from oropharyngeal and/or nasopharyngeal samples during their hospital admissions were included in this retrospective study. The reference symptoms of the patients were obtained from the hospital database. The correlation between chest computed tomography findings and the “cycle threshold” of patients with wild-type SARS-CoV-2 was assessed. RESULTS: Cough, fever, shortness of breath, loss of taste and smell, and diarrhea were found to be statistically significantly higher (p=0.001; 0.001; 0.001; 0.001; and 0.006; respectively) in the wild-type cohort, while in the Omicron cohort, sore throat and headache were found to be statistically significantly higher (p=0.001 and 0.003, respectively). An inverse relationship was found between chest computed tomography findings and viral load. CONCLUSION: This study revealed that the Omicron variant tended to infect predominantly the upper respiratory tract and showed decreased lung infectivity, and the disease progressed with a milder clinical course. Therefore, the study showed that the tropism of the virus was changed and the viral phenotype was affected. It was also found that SARS-CoV-2 viral load did not predict COVID-19 severity in patients with wild-type SARS-CoV-2.

Abstract in English:

SUMMARY OBJECTIVE: Mini-percutaneous nephrolithotomy is a recent advancement in the field of kidney stone treatment; however, its role has not been completely established. We aimed to compare the outcomes of initial Mini-percutaneous nephrolithotomy and flexible ureteroscopy. METHODS: A retrospective review of consecutive mini-percutaneous procedures was performed. Inclusion criteria were as follows: all percutaneous nephrolithotomy procedures performed with an access sheath up to 24Fr, kidney stone burdens up to 1550 mm3; and the presence of postoperative computed tomography (for control). The data collected for Mini-percutaneous nephrolithotomy procedures were paired 1:2 with patients treated with flexible ureteroscopy for stones between 100 and 1550 mm3, and with postoperative computed tomography for control. A 14Fr Mini-percutaneous nephrolithotomy set was used. The stone-free rate was defined as the absence of fragments on the control computed tomography, whereas success was limited to 2-mm residual fragments. Statistical analysis was performed using SPSS version 19. RESULTS: A total of 63 patients met the inclusion criteria (42 with flexible ureteroscopy and 21 with mini-percutaneous nephrolithotomy). Demographic data were comparable. The stone-free rate and success were similar between the groups (76.2 vs. 66.7%, p=0.42 and 90.5 vs. 85.7%, p=0.57). The complication rate was also similar (26.1 vs. 9.6%, p=0.188), but Mini-percutaneous nephrolithotomy had longer hospitalization and fluoroscopy time (p=0.001 in both). CONCLUSIONS: Our initial study of Mini-percutaneous nephrolithotomy showed that it is a promising procedure, with outcomes similar to flexible ureteroscopy, but with higher inpatient numbers and fluoroscopy times. A larger study population size and better equipment may improve the outcomes of mini-percutaneous nephrolithotomy.