Prevalence of thyroid disorders and the correlation of thyroid profile with liver enzymes, serum activin-A and follistatin during the treatment of patients with chronic hepatitis C genotype 1 and 4
Ahmed Mohammed Ashshi, Adel Galal El-Shemi, Adnan AlZanbagi, Bassem Refaat
J Clin Exp Invest 2014;5(3):343-353.
https://doi.org/10.5799/ahinjs.01.2014.03.0418
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Objectives Chronic hepatitis C (CHC) and peg-interferon-α (Peg-INF-α) modulate serum activins and follistatin and are associated with thyroid disorders (TD).The aim of this study was to determine the frequency of CHC induced TD and to investigate the correlation of liver damage, serum activin-A and follistatin with the thyroid function parameters and thyroid autoantibodies.
Methods: The study was cross-sectional and sera were obtained from 132 patients with CHC who were divided into 3 groups: 56 patients with no treatment, 30 after 24 weeks of Peg-INF-α and 46 at the end of 48 weeks Peg-INF-α. Thyroid stimulating hormone (TSH), free thyroxin (FT4), thyroid antibodies (Tabs), serum activin-A and follistatin levels were measured using ELISA.
Results: Thyroid disorders were detected in 15% (n=20), more frequent in females (70%) and the majority were autoimmune thyroiditis (80%). TSH receptor antibodies (TSHR-Abs) were significantly prevalent compared to the other antibodies (p<0.05) and significantly increased in the 24 weeks group (p<0.05). TSH and FT4 correlated significantly with liver enzymes (p<0.05). There was no significant difference in activin-A and follistatin values between thyroid disorder and euthyroids. However, significant correlations were found between TSHR-Abs concentration with follistatin, activin-A and activin/follistatin ratio (p<0.05).
Conclusion: Thyroid disorders induced by CHC and/or Peg-INF-α were common in our patients, more prevalent in females and the majority are autoimmune. Additionally, activin-A and/or follistatin could be involved in the induction/aggravation of TSHR-Abs. Further studies are needed to confirm our findings and to explore the mechanisms by which CHC induces thyroid disorders.
Keywords: Chronic hepatitis C, thyroid disorder, activin-A, follistatin, Saudi Arabia
The roles of urine interleukin-13, CD80, CD28, matrix metalloproteinase-2 and granzyme B in the pathogenesis of childhood minimal change nephrotic syndrome
Cengiz Zeybek, Duygu Övünç Hacıhamdioğlu, Süleyman Tolga Yavuz, Aysel Pekel, Cihangir Akgün, Burcu Bulum, Kaan Gülleroğlu, Aslı Kantar, Aslı Kavaz, Uğur Muşabak, Fatoş Yalçınkaya, Esra Baskın, Faysal Gök
J Clin Exp Invest 2014;5(3):354-361.
https://doi.org/10.5799/ahinjs.01.2014.03.0419
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Objective: Minimal change disease (MCD) is the most common cause of nephrotic syndrome in childhood but its pathogenesis remains poorly understood. A T-cell-derived factor or factors were initially alleged as contributing to the disease pathogenesis. However, podocyte CD80 expression is now a commonly discussed theory. The aim of this study was to investigate the pathogenesis of MCD by determining urine interleukin-13, CD80, CD28, matrix metalloproteinase-2 (MMP-2), and granzyme B levels.
Methods: Thirty patients and thirty healthy children were evaluated in this study. Six patients had biopsy proven MCD. The remaining patients were considered to have MCD because of their age at time of diagnosis; response to steroid treatment, absence of gross hematuria, hypocomplementemia or renal failure; and normal blood pressures in the active stage. The nephrotic-phase urine interleukin-13, CD80, CD28, MMP-2, and granzyme B levels of all patients were compared with the remission-stage urine levels of the same patients and control subjects. The urine samples were collected immediately before the application of immunosuppressive drugs or other treatment modalities.
Results: Significantly higher interleukin-13, CD80, CD28, and MMP-2 levels were observed in the relapse period compared with both the remission period and control subjects. There was a significant positive correlation between the active-stage urine interleukin-13 and CD80 levels (r=0.619, p<0.001).
Conclusion: Interleukin-13, CD80, CD28, and MMP-2 seem to have roles in the pathogenesis of MCD and using inhibitors of these molecules in treatment of steroid and immunosuppressive-resistant MCD cases can be thought.
Keywords: Minimal change disease, Interleukin-13, B7 proteins, MMP-2, granzyme B
Evaluation of the analytical performance of Roche immunoturbidimetric immunoglobulin assays and comparing to Dade Behring immunonephelometer
Cevdet Züngün, Fatma Meriç Yılmaz, Bağdagül Çakır
J Clin Exp Invest 2014;5(3):362-367.
https://doi.org/10.5799/ahinjs.01.2014.03.0420
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Objective: The aim of this study is to evaluate the analytical performance of the Roche immunoturbidimetric immunoglubulin assays, and also compare the results obtained by Roche immunoturbidimetric method to Dade Behring II Nephelometer.
Methods: Low and high concentration patient samples and internal quality control materials were used to evaluate precision, limit of detection (LoD) linearity, and sample carry over of Roche immunoturbidimetric analyzer. External quality control results were used to evaluate accuracy. For method comparison, 451 patients serum were analyzed using Roche Hitachi Modular P System with an immunoturbidimetric method and Dade Behring BNII immunonephelometer with an immunonephelometric method.
Results: In precision study on Roche immunoturbidimetric immunoglobulin assays, imprecision values were 1.37%, 3.88% and 5.34% for IgG, A and M, respectively. Correlation coefficents between Roche immunoturbidimetric analysis and Dade Behring BN II immunonephelometer were 0.967, 0.979 and 0.939 for IgG, IgA and IgM respectively.
Conclusion: In immunoturbidimetric Roche Ig analyses precision for IgG was allowable according to the the desirable quality specifications. However, both IgA and IgM had higher imprecisions than the desirable total precision. Immunoturbidimetric Roche Ig analyses were found linear in the reference values but unreliable results were observed in the presence of excess antigen. The same samples performed on Roche analyzers needed to be diluted suggesting Dade Behring had wider linearity range than Roche immunoturbidimetric analyzer in the presence of excess antigen
Keywords: Ig G, Ig A, Ig M, immunoturbidimetry, immunonephelometry
Anatomy-Based navigation for ventriculostomy: Nasion-coronal suture distance measurement
Mevci Ozdemir, Ayhan Comert, Kevser Ozdemir, Gokmen Kahilogullari, Melih Bozkurt, Agahan Unlu, Hasan Caglar Ugur
J Clin Exp Invest 2014;5(3):368-370.
https://doi.org/10.5799/ahinjs.01.2014.03.0421
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Objective: In this study we aimed to determine a landmark that can be measured through the skin with nasal mid-point (bregma) to coronal suture, and additionally an average value was calculated. We report, to our knowledge, the distance between the nasion-coronal sutures is reported for the first time in Turkish population.
Methods: The study included 30 craniums and 30 frontal bones. Each skull from midline nasal suture to coronal suture curved up at the distance was measured with tape measure.
Results: Mean values were determined. Nasal suture between coronal suture distance average 12,2 cm (min10,3 cm, up to 13,5 cm) were detected.
Conclusion: Nasal suture is an easily palpable area through the skin. A small incision is carried down through skin to bone at the spot 12 cm back from the nasion 3 cm lateral to the midline for ventricular drainage operation. This data provide practical information for neurosurgeon and is available everywhere.
Keywords: Coronal suture, external ventricular drainage, hydrocephalus, subarachnoid hemorrhage, shunt infection
Comparison of two different methods for the determination of erythrocyte sedimentation rate
Gülfer Öztürk, Şeyda Özdemir, Aynur Altuntaş, Sümeyya Akyol, Erdem Bulut, Gönül Erden, İsmail Temel
J Clin Exp Invest 2014;5(3):371-375.
https://doi.org/10.5799/ahinjs.01.2014.03.0422
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Objective: Erythrocyte Sedimentation Rate (ESR) can be used for the follow-up of number of diseases. In recent years, closed automated systems that measure ESR directly from a capped EDTA and citrate blood sample tube have been developed. In this study, we aimed to compare and evaluate the consistence of assay results of iSed Alcor Auto-instrument and Berkhun SDM60 Auto-instrument.
Methods: K2EDTA and citrated blood samples were taken from 149 randomly selected outpatients. The ESR of blood samples in tubes containing K2EDTA was determined by iSed Alcor Auto-instrument whereas Berkhun SDM60 Auto-instrument was used to determine the ESR of blood samples in tubes containing citrate.
Results: The mean ± SD ESR was 24.48 ± 23.10 mm/hr (95% CI for the mean was 20.54–28.02 mm/hr) for iSed Alcor Auto-instrument and 23.94 ± 17.24 mm/hr (95% CI for the mean was 21.15–26.73 mm/hr) for the Berkhun Auto-instrument. We found the mean difference between two methods as 0.336 mm/hr (95% CI for the mean was −2.06 to 1.39 mm/hr; P = 0.701). The obtained correlation coefficient was 0.90 (P = 0.0001). There was no evidence of systemic bias, equal to 0.3 mm/hr (limits of agreement, –20.6 to 21.2 mm/hr).
Conclusion: iSed Alcor Auto-instrument and Berkhun SDM60 Auto-instrument might be used as alternative systems each other. However, it should be monitored carefully in especially high ESR (>50 mm/hr) results and the results should be checked according to the Westergren method.
Keywords: Erythrocyte sedimentation rate, EDTA tube, citrate tube, Bland–Altman analyses
Evaluation of serum cortisol and dehydroepiandrosterone sulphate levels in parkinson patients with and without postural instability
Murat Gültekin, Recep Baydemir, Sevda İsmailoğulları, Fatih Tanrıverdi, Meral Mirza
J Clin Exp Invest 2014;5(3):376-380.
https://doi.org/10.5799/ahinjs.01.2014.03.0423
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Objective: Parkinson’s disease (PD) is the second most common neurodegenerative disease. During PD many disorders occur in the neuroendocrine mechanism along with autonomic dysfunction. The aim of this study was to evaluate the values of cortisol and dehydroepiandrosterone sulphate (DHEAS) in idiopathic PD patients with postural instability (PI) in the medium and advanced stages of the disease.
Methods: Three groups were included in this study; patients with PI, patients without PI and control subjects. Each of the groups consisted of 30 patients. The fasting serum cortisol and DHEAS values of patients were obtained.
Results: Serum cortisol levels were significantly higher in patients with PI in the advanced stage of PD, whereas DHEAS levels were significantly higher in patients without PI in the early stage.
Conclusion: This situation was evaluated as the reflection of neuroendocrine response that occurred secondary to the progressive advancing neurodegeneration seen in PD patients. The data obtained may contribute to a better understanding of the pathophysiology of PD that in intermediate and advanced stages. In addition, our findings may help in establishing new treatment options for PD patients in the future.
Keywords: Parkinson’s disease, postural instability, cortisol, dehydroepiandrosterone sulphate
The diagnostic value of mean platelet volume in males with premature atherosclerotic coronary artery disease having stable angina pectoris
Özgül Malçok Gürel, Fatma Nurcan Özdoğan Başar, Hikmet Selçuk Gedik, Kemal Korkmaz, Evvah Karakılıç, Özcan Özeke, Kumral Çağlı, Ali Şaşmaz
J Clin Exp Invest 2014;5(3):381-385.
https://doi.org/10.5799/ahinjs.01.2014.03.0424
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Objective: In this study, we aimed to investigate whether platelet count and mean platelet volume (MPV) could be new biomarkers addition to classical risk factors in premature coronary artery disease (CAD).
Methods: Totally 124 male patients (mean age: 45.8±13.0 year; range of age: 27-78 year), with stable angina pectoris, were included. Clinical and laboratory findings (whole blood cell count, glucose, creatinine, lipid profile) were recorded. Automatic blood counter was used for hematological parameters. Conventional coronary angiography was performed. Patients having acute coronary syndrome within the last six months, with severe valvular, structural or congenital heart disease, thyroid and hepatic dysfunction or signs of any infection were excluded.
Results: The study population were separated into three groups by coronary angiography: 51 with stable CAD aged ≤40 years (premature CAD), 38 with stable CAD older than 40 (mature CAD) and 35 with the normal coronary arteries (NCA). No significant difference was found in MPV values between premature CAD and mature CAD and also between premature CAD and NCA (p>0.05). A significant negative correlation was found between MPV and platelet count in premature CAD (r=-0.419, p=0.002). Both in premature CAD and mature CAD groups, higher MPV values was found in critical CAD subgroup than noncritical CAD subgroup, but the difference was not statistically significant (p>0.05).
Conclusion: There was no significant difference in MPV between premature and mature male CAD patients compared to NCA group. A positive but non-significant correlation was found between the MPV values and the severity of CAD.
Keywords: Mean platelet volume, platelet count, premature atherosclerotic coronary artery disease, stable angina pectoris
The knowledge level of chest physicians about the pulmonary rehabilitation topic
Hadice Selimoğlu Şen, İclal Hocanlı, Özlem Abakay, Cengizhan Sezgi, Süreyya Yılmaz, Mahsuk Taylan, Abdurrahman Abakay, Abdullah Çetin Tanrıkulu
J Clin Exp Invest 2014;5(3):386-390.
https://doi.org/10.5799/ahinjs.01.2014.03.0425
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Objective: The pulmonary rehabilitation (PR) is multidisciplinary, evidence-based and personalized treatment approach for patients with a symptomatic chronic respiratory disease and reduced daily living activities. In this study, we aimed to determine the knowledge level of chest physicians about PR in our city.
Methods: A standardized questionnaire consisting of 10 questions was conducted to a total of 40 chest diseases specialist and assistant doctors who are working at the university hospital, training and research hospital and a private hospital in Diyarbakir city and its purlieus. The questions about the definition of PR, goals, evaluation criteria, patient who candidate for rehabilitation and rehabilitation team, were asked in questionnaire. Ten points was given for each correct answer to closed-ended questions. The knowledge level were identified as low, moderate and high when points were <50, 50-79 and 80-100 respectively.
Results: The mean age of participants was 36.1 ± 7.79 and working duration time in chest disease department was 5.57 ± 7.71 years. Seventy-eight point nine percent of university hospital doctors, 57.1% of training and research hospital doctors, 50% of private hospital doctors were answered correctly more than half of the questions.
Conclusion: The knowledge of chest physicians about PR is substantially in low and moderate levels in our city. The creation of a curriculum about PR in medical schools, and postgraduate training of physicians in the field will raise awareness about this issue, and might increase the interest of physicians and patients to PR.
Keywords: Pulmonary rehabilitation, chest diseases, knowledge
Nonfermentative gram-negative microorganisms isolated from intensive care units and their resistance profiles in a training and research hospital
Fulya Bayındır Bilman, Zeynep Ayaydın, Mine Turhanoğlu, Arzu Onur, Gülseren Samancı Aktar
J Clin Exp Invest 2014;5(3):391-396.
https://doi.org/10.5799/ahinjs.01.2014.03.0426
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Objective: The aim of this study was to determine the pathogenic agents, which have been isolated in ICUs and determine their antimicrobial susceptibility in the first two years of our hospital.
Methods: A total 368 strains (194 Pseudomonas aeruginosa, and 174 Acinetobacter baumannii) that were considered as an infectious agent and isolated from different clinical samples of hospitalized patients in intensive care units between January 2011 and December 2012 were included in the study. Conventional methods and automatized system were used for the identification and antibiotic susceptibility of the isolates with according to guidelines of Clinical and Laboratory Standarts Institute (CLSI). Imipenem and meropenem resistance has been confirmed by the E test method and interpreted according to CLSI.
Results: Resistance rates of P.aeruginosa strains were as follows: Meropenem 35%, imipenem 36%, cefepim 21%, ceftazidim and ciprofloxacin 29%, gentamicin 33%, piperacilin/tazobactam 35%, amikacin 37%. Resistance rates of A.baumannii strains were as follows: Meropenem 85%, imipenem 87%, amikacin 22%, trimethoprim/sulfamethoxazole 25%, gentamicin 46%, piperacilin/tazobactam 54%, ampicilin/sulbactam 59%, cefepim 64%, ciprofloxacin 71%, ceftazidim 83%.
Conclusion: Increased carbapenem resistance in our ICUs demonstrates importance of antimicrobial susceptibility tests. The antibiotic susceptibility tests should be surveyed continuously to avoid the spread of intensive care unit isolates carrying high level antibiotic resistance for better achievement of treatment regimens.
Keywords: Antimicrobial resistance, A.baumannii, P.aeruginosa, intensive care unit
The effects of 10 cmH 2 O positive end-expiratory pressure on arterial oxygenation, respiratory mechanics and hemodynamic parameters in laparoscopic cholecystectomy operations
Fatma Çiçek, Canan Ün, Oya Kılcı, Mehmet Gamlı, Dilşen Örnek, Derya Türkaslan, Bayazit Dikmen
J Clin Exp Invest 2014;5(3):397-402.
https://doi.org/10.5799/ahinjs.01.2014.03.0427
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Objective: The effects of 10cmH2O Positive End-expiratory Pressure (PEEP) on respiratory mechanics, arterial oxygenation and hemodynamics in laparoscopic cholecystectomy operation were investigated.
Methods: The study was planned on ASA I-II, 18-65 years old, forty patients scheduled for laparoscopic cholecystectomy under general anesthesia. The patients were divided into two groups which PEEP implemented Group 0 and 10 cmH2O PEEP applied Group P (Group 0, n=20; Group P, n=20). Heart rate, Mean arterial blood pressure, arterial oxygen saturation (SpO2), partial pressure of end-tidal carbon dioxide (PEtCO2), Peak inspiratory pressure (PİP), plato pressure (Pplato), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2 ) values were evaluated at 5 minutes after induction, 5 minutes after CO2 insufflation, after the head-up position and the right side in the 10th and 30th minutes, After 10 minutes desufflation and in the recovery room. The Alveolar–arterial oxygen pressure gradient (P(A-a) O2), the ratio of physiologic dead space over tidal volume (VD/VT), Arterial to End Tidal CO2 gradient (P(a-et) CO2), static compliance (CS), dynamic compliance (CD) were assessed same times.
Results: The assessment between the groups, there were not statistical differences about mean blood pressure, heart rate, SpO2, PetCO2, PaO2, plateau pressure, and P (A-a) values (p>0.05). Peak inspiratory pressure was higher in Group P (p<0.05). Peak inspiratory pressure and plateau pressure increased with CO2 insufflation in both groups. PaCO2 and P(a-et) CO2 were higher statistically significantly in Group 0 (p<0.05). There was no difference between the groups in terms of the PetCO2 values. VD/VT ratios were statistically significantly lower in the Group P (p<0.05). There was no difference at static compliance values between the groups, dynamic compliance was lower in Group P. According to the initial values, there was a decrease in compliance in both groups after CO2 insufflation.
Conclusion: 10 cmH2O PEEP was shown to improve oxygenation and respiratory mechanics without causing any hemodynamic side effect in laparoscopic cholecystectomy operation.
Keywords: Laparoscopic cholecystectomy, positive end-expiratory pressure, respiratory mechanics, oxygenation
The outcome of conservative treatment of adult distal radius fractures compared with the other wrist: radiological and functional evaluation
Mustafa Uslu, Mehmet Arıcan, Cengiz Işık, Hakan Sarman, İsmail Boyraz
J Clin Exp Invest 2014;5(3):403-409.
https://doi.org/10.5799/ahinjs.01.2014.03.0428
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Objective: This study was designed to evaluate anatomical and functional results of closed reduction-long arm cast treatment for distal radius fractures and compared other healthy wrist in the adults.
Methods: 77 patients with distal radius fracture were treated conservatively between January 2010 and December 2010. The fractures were classified according to AO and Frykman classification system and investigated prospectively. The radiological and anatomical results were assessed by the Stewart score criteria. The functional results were assessed by Quick-Disability of Arm, Shoulder and Hand questionnaire (Q-DASH) and the Stewart II score criteria. The mean follow-up of patients was 12 months.
Results: The forty patients had right wrist fractured, 37 patients had left wrist fractured. According to Frykman classification 46 patients were type I-II fractured, according to AO classification 59 patients were type 23,A2,1 and 23,A2,2 fractured. According to Stewart the radiological and anatomical, the result were excellent in 57, good in 17, fair in 3. According to Stewart II functional criteria, the results were assessed excellent in 57, good in 8, fair in 12 The mean Q-DASH score was 6,37. The overall complication rate was 12.98%. Mild Carpal tunnel syndrome was observed in the two patients, ulna styloid nonunion in the four patients, pain of distal radioulnar joint in the one patient, mild carpal tunnel syndrome and tenderness of distal radioulnar joint in the three patients.
Conclusion: Closed reduction and cast immobilization is still an effective and inexpensive treatment method in distal radial fractures.
Keywords: Adult, radius distal, fracture, conservative treatment
Effects of various factors on bacteria colonization at the mobile phones and on the hands of medical faculty students
Elif Ünal, Irmak Tahmaz, Gülce Cansu Serin, Ayşe Yılmaz, Gönül Or, İrem Hazal Torıslu, Julide Sedef Göçmen
J Clin Exp Invest 2014;5(3):410-414.
https://doi.org/10.5799/ahinjs.01.2014.03.0429
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Objective: Microorganisms ping pong effect from hand to cell phone can actualize. The aim of this study was to investigate the bacterial diversity and to compare the similarities of bacteria of the thumb, forefinger cultures and smart phones surface swab cultures taken from the Baskent University Faculty of Medicine students. We also targeted that to compare bacterial disparity of clinical and preclinial students and to see the affect of hand washing, cell phone cleaning practice on bacterial variability.
Methods: after voluntary informed consent forms were signed, students from Baskent University Faculty of Medicine were included to the study. Finger cultures were taken from thumb, forefinger of their active hands. Swab cultures collected from surface of the smart phones. Identifications of isolated colonies were performed with conventional methods.
Results: Smartphone and finger cultures were collected from total 230 subjects, including 143 women 87 men's. 65% of cultures were taken from preclinical student and the rest from clinical students. Bacterial similarity was recovered from finger cultures and Smartphone cultures in 79% of volunteers (p<0.001).
Conclusion: Our study was revealed that hand cleaning was affecting bacterial diversity and the frequency of hand washing influenced the bacterial variety. Although we expected to find a significant difference for bacterial diversity between preclinical and clinical students, our study did not confirm this opinion.
Keywords: Mobil phone, hand, culture, bacteria, colonization
Effect of erythropoietin use on mean platelet volume in children undergoing chronic dialysis
Kadriye Özdemir, Orhan Deniz Kara, Nida Dinçel, İpek Kaplan Bulut, Ebru Yılmaz, Sevgi Mir
J Clin Exp Invest 2014;5(3):415-419.
https://doi.org/10.5799/ahinjs.01.2014.03.0430
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Objective: In this study, it was aimed to determine the relationship between erythropoietin (EPO) use and mean platelet volume (MPV) in the children undergoing dialysis.
Methods: MPV values before and after EPO use in 36 patients (16 hemodialysis - HD, 20 peritoneal dialysis - PD) were retrospectively evaluated. Patients were divided into two groups according to weekly EPO need as; given less than 150 U/kg defined as low EPO and more than 150 U/kg as high EPO groups. The age, weight, primary cause of chronic renal failure, dialysis methods and EPO dosages of patients were recorded. Blood samples were taken before and 4 weeks after EPO usage and MPV values were noted from complete blood counts.
Results: While significant increase was seen in the MPV values after EPO in comparison to MPV values before EPO in the HD group (8.18±1.52 fL vs. 9.20±1.46 fL; p=0.046); near significant difference was found in the MPV levels after EPO (8.28±1.80 fL vs. 9.39±1.50 fL; p=0,051) in PD group. In HD patients when high dose of EPO was given, MPV levels were found to be significantly elevated (7.81 ± 1.04 vs 9.61 ± 1.05; p=0.06) after EPO. However, no difference was seen with the lowe dose EPO subgroup (8.64 ± 1.97 ve 8.67 ± 1.81; p>0,05). No effect of EPO dose was found on MPV values in PD patients (9.57 ± 1.58 ve 9.1 ± 1.42; p>0.05).
Conclusion: It was observed that EPO influenced MPV values in children undergoing HD, while no effect of erythropoietin was found on MPV values of PD patients. Physicians should be careful while using high dose erythropoietin in children with high thrombosis risk.
Keywords: Mean platelet volume, erythropoietin, hemodialysis, child
The evaluation of rubella and sitomegalovirus IgG avidity tests in pregnants: four-year experience
Berrin Uzun, Serdar Güngör, Hakan Er, Ayşegül Gökmen, Bayram Pektaş, Aslı Gamze Şener
J Clin Exp Invest 2014;5(3):420-423.
https://doi.org/10.5799/ahinjs.01.2014.03.0431
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Objective: In this study, we aim to evaluate the retrospective IgG avidity index (AI) test results of the pregnant, who have applied to our hospital and had pregnancy screening test and have been asked for rubella and cytomegalovirus antibody tests and IgG AI test in 4 year period.
Methods: Anti-rubella IgM, anti-rubella IgG, anti-CMV IgM and anti-CMV antibodies were performed by IMMULITE 2000XPi™ Immunoassay System (Siemens, Germany) whereas IgG AI tests were performed by commercial kits of rubella and cytomegalovirus antibody tests (Dia.Pro® Diagnostic, Milano-Italy).
Results: Between January 2010 and December 2013, 23 (7.32 %) of 314 pregnant women tested rubella IgG AI had low AI, and 266 cases had high AI rate; 14 (17.28%) of 81 pregnant women tested CMV IgG AI, had lower AI rate, 52 of them had high AI. 9 out of 23 pregnant women, who were detected low rubella were requested only AI without any IgM and IgG value; the IgG antibody of 13 pregnant was reactive, and IgM antibody was not requested; IgG and IgM antibody of 1 pregnant was detected positive. When 5 pregnant, who were detected low CMV AI were requested AI without IgG and IgM value; the IgG and IgM of 4 was reactive; 4 of them had IgG reactive but IgM negative; 1 had IgG and IgM negative.
Conclusion: As a result, our low rubella AI rate has been detected lower than the rates in our country since our study population contains only the pregnant. Our low CMV AI rate varies due to the same reasons as literature data. During pregnancy scanning, performing of AI testing together with specific IgG and IgM will save both time and will be more meaningful in clinical evaluation for pregnant women.
Keywords: Avidity index, IgG avidity test, rubella, cytomegalovirus
Evaluation of dynamic hyperinflation and exercise capacity in patients with COPD
Erkan Ceylan
J Clin Exp Invest 2014;5(3):424-428.
https://doi.org/10.5799/ahinjs.01.2014.03.0432
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Objective: The aim of this study was to investigate changes in dynamic hyperinflation in response to exercise in patients with COPD and healthy individuals.
Methods: In this study, resting in the spirometric measurements, exercise capacity of patients with chronic obstructive pulmonary diseases (COPD) compared with healthy individuals. Exercise capacity of COPD patients and healthy controls were performed and were compared in terms of dynamic hyperinflation.
Results: Patients with stable COPD (n=19) and healthy controls (n=13) were included. Subjects performed pulmonary function tests and an incremental exercise test on cycle ergometry (Inspiratory capacity (IC), end expiratory lung volume (EELV)). Statistically significant differences (p<0.05) were found regarding exercise test parameters including exercise duration, maximum oxygen uptake, breathing reserve, maximum minute ventilation, and breathing pattern between groups. There was significant increase in EELV (p<0.05) and decrease in IC (p<0.05) at maximum exercise when hyperinflation parameters were compared at baseline and maximum exercise.
Conclusion: Hyperinflation was evident at maximal exercise, although there were no hyperinflation findings at rest in subjects with COPD. It was concluded that it is better to evaluate hyperinflation at maximal exercise than at rest in patients with COPD.
Keywords: COPD, cardiopulmonary exercise testing, hyperinflation
The assessment of knowledge level about their disease in patients with rheumatoid arthritis
Ali Yavuz Karahan, Sinan Bağçacı, Ender Salbaş, Kemal Erol, Savaş Karpuz, Adem Küçük
J Clin Exp Invest 2014;5(3):429-434.
https://doi.org/10.5799/ahinjs.01.2014.03.0433
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Objective: This study aims to evaluate, the level of knowledge about the disease of patients with rheumatoid arthritis (RA) and its relationship with the disease activity.
Methods: A total of 50 patients with RA, diagnosed according to 2010 ACR/EULAR Rheumatoid Arthritis classification criteria, included in this study. Demographic features of patients were recorded. Turkish version of Patient Knowledge Questionnaire (PKQ) used to evaluate the level of knowledge about the disease of patients with RA. Daily activity score (DAS-28), Health Assessment Questionnaire (HAQ) and visual analog scale (VAS) were used to evaluate the activity of the disease.
Results: The mean age of patients was 57.2±12.2 (36 females and 14 males). The mean of disease duration was 6.2±5.8 years. The mean was 3.2 (maximum value 9) for etiology, symptom and laboratory components, the mean of medication component: 2.9 (maximum value 7), the mean of exercise component: 2.4 (maximum value 7), the mean of protection of joints and energy component: 2.4 (maximum value 7) of PKQ. The total mean point was 10.9 (maximum value 30). There was no correlation between PKQ points and HAQ, DAS-28 and VAS parameters but there was a positive correlation between disease duration and PKQ points.
Conclusion: The results of the study show no relationship between level of knowledge about the disease and disease activity and also functional status. On the other hand the level of knowledge about disease of patients with RA is very low. The results show the need for education programs and informative activities about RA.
Keywords: Level of knowledge, education, disease activity, rheumatoid arthritis
The predictors of atrial fibrillation in patients with rheumatic mitral stenosis
Nihat Polat, Mesut Aydin, Abdulkadir Yildiz, Murat Yuksel, Yahya Islamoglu, Tuba Kurt, Sait Alan, Nizamettin Toprak
J Clin Exp Invest 2014;5(3):435-440.
https://doi.org/10.5799/ahinjs.01.2014.03.0434
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ABSTRACT
Objective: In this study we aimed to investigate the relationship between the presence of atrial fibrillation (AF) and serum albumin levels which is a negative acute phase protein.
Methods: This study is single-center and has a retrospective design. We included patients with a diagnosis of rheumatic mitral stenosis (RMS) and having serum albumin levels between 2011 and 2014. Then the patients were divided into two groups according to presence of AF. Clinical and laboratory data of these two groups were compared.
Results: The study included 74 patients having the inclusion criteria. Seventy seven percent of patients were female, mean age was 44±12 years. Atrial fibrillation was detected in 34% of the patients. Hypertension presence, age, left atrial diameter, creatinine, C-reactive protein were higher in AF group while serum albumin, left ventricular ejection fraction and mean transmitral gradient was significantly lower. Multivariate logistic regression analysis showed that aging, lower albumin and anemia (respectively, odds ratio [OR]: 1.124, 95% confidence interval [CI], [1.049-1.205], OR: 0.022, 95% CI; [0.002-0.268] and OR: 5.941, 95% CI; [1.031-34.222]) were found to be independent predictors of AF presence.
Conclusion: Lower serum albümin levels, aging and anemia were associated with the presence of AF in patients with RMD. Low albümin levels can be a surrogate marker of increased inflammation and may serve as a risk factor for AF development.
Keywords: Mitral stenosis, atrial fibrillation, albumin, anemia, predictor
Chondroid Syringoma: A case with unusual localization
Serdar Yüce, Mustafa Öksüz, Yılmaz Sultanoğlu, Muhammet Eren Ersöz, Yavuz Özsular
J Clin Exp Invest 2014;5(3):441-443.
https://doi.org/10.5799/ahinjs.01.2014.03.0435
Case Report
[Abstract]
[PDF]
ABSTRACT
Chondroid syringoma is a skin tumour with benign character that is named as mixcutaneous tumour. Chondroid syringoma grows slowly without pain and ulcer and is seen as subcutaneous or intracutaneous in 0.5-3 cm size. Chondroid syringoma is generally seen in middle age and old men in head and neck region. It can rarely trunk, back, extremities and genital organs. Since chondroid syringoma is a benign lesion, it was reported in malign and atypic forms. The most important clinical finding of malign tumours is a rapid growing bulk. Malign chondroid syringoma is generally seen in young female patients in body and extremity localizations. Because of malign transformation, potential, total excision is the preferred treatment in benign chondroid syringomas. Despite being rare lesions, in subcutaneous nodules in body and extremities, particularly in head and neck region, chondroid syringoma should be thought. In this study, benign a case chondroid syringoma locating in extremity of young female patient was presented.
Keywords: Chondroid syringoma, benign, extremity
Cytogenetic and clinic evaluation of two cases that have 45,X/46,X,i(Xq) and 46,X,i(Xq) karyotype
Etem Akbaş, Faik Gürkan Yazıcı, Hüseyin Durukan, Harika Topal, Nazan Eras Erdoğan
J Clin Exp Invest 2014;5(3):444-448.
https://doi.org/10.5799/ahinjs.01.2014.03.0436
Case Report
[Abstract]
[PDF]
ABSTRACT
In this study, cytogenetic and clinic findings of 46,X,i(Xq) and 45,X/46,X,i(Xq) which are the rare types of Turner syndrome are evaluated. Two patients were directed to the Cytogenetic Laboratory from Gynecology Clinic with chromosomal anomaly indication. Their peripheric blood samples are analyzed karyotypically using Giemsa-Tripsin Bantama method.
Case 1. The patient is 17 years old, has short height, a low-posterior hairline, short neck, small and wide apart breasts, normal external genitals and underdeveloped internal genitals. Her karyotype was 45,X/46,X,i(Xq).
Case 2. The patient is 19 years old, has primer amenore, short height, a low-posterior hairline, wide apart and underdeveloped breasts, normal external genitals, underdeveloped uterus, obscure ovarium. Her karyotype was determined to be 46,X,i(Xq). Although symptoms progress slightly weaker, our 45,X/46,X,i(Xq) and 46,X,i(Xq) cases, which are rare types of Turner Syndrome, are generally consistent with phenotypic findings of Turner syndrome.
Keywords: Turner syndrome, 45,X/46,XY, 46,X,i(Xq), mosaisizm
Atropine-induced non-sustained polymorphic ventricular tachycardia: A rare case
Mesut Aydin, Abdulkadir Yıldız, Nihat Polat, Halit Acet, Yahya İslamoğlu
J Clin Exp Invest 2014;5(3):449-451.
https://doi.org/10.5799/ahinjs.01.2014.03.0437
Case Report
[Abstract]
[PDF]
ABSTRACT
A 40 years old male with history of unexplained recurrent presyncope and palpitation episodes referred to cardiology department. Patient had no past medical history. Subsequently, electrophysiology study was performed to detect any underlying atrioventricular nodal disease or inducible tachyarrhythmias. During this period, 1.0 mg of atropine was injected intravenously to performed stimulation and patient suddenly developed polymorphic ventricular tachycardia that could not be terminated with overdrive pacing. Ventricular tachycardia was terminated spontaneously, two minutes later.
Keywords: ventricular tachycardia, atropine, presyncope
A rare and dangerous infectious lesion: Hydatid disease of the cervical spine
Kevser Ozdemir, Mustafa Korucu, Muhammet Ibrahimoglu, Mevci Ozdemir, Bayram Cirak
J Clin Exp Invest 2014;5(3):452-455.
https://doi.org/10.5799/ahinjs.01.2014.03.0438
Case Report
[Abstract]
[PDF]
ABSTRACT
Hydatidosis is an infectious disease caused mostly by Echinococcus granulosus. A 63-year-old male was admitted to our institute with the complaints of tetraparesis. Magnetic resonans imaging revealed a multilobular, cystic lesion in the cervical epidural region. Using posterior cervical approach, total cyst excision was performed. Histopathological examination revealed as a hydatid cyst. Cervical spinal hydatid cyst is an extremely rare pathology. The goal of surgery is to remove all the cysts without rupture in the early course of the disease. Surgical area should be washed with saline solution and albendazole is the first line drug in the treatment.
Keywords: Echinococcus granulosus, infection, spinal cyst, albendazole
Bilateral exotropia following pterygium surgery: Case report
Fethiye Gülden Turgut, Elvan Yalçın
J Clin Exp Invest 2014;5(3):456-458.
https://doi.org/10.5799/ahinjs.01.2014.03.0439
Case Report
[Abstract]
[PDF]
ABSTRACT
We present an evaluation of a bilateral exotropia case following a bilateral pterijium surgery that was treated by medial rectus muscle advancement and right muscle transposition in a 52-year-old women. At the examination performed after pterygium surgery with autograft, adduction in the right eye was lost and in the left eye was restricted. Diplopia was revealed in the primary up-down direction of gaze position. Orbital and magnetic resonance imaging was normal. Bilateral medial rectus advancement was planned but because of right medial rectus muscle was not found during the operation, right muscle transposition and left medial rectus muscle advancement operations were performed. The presence of an incomitant exotropia with diplopia immediately after pterygium surgery should alert us to the possibility of having injured the medial rectus during the surgery and the surgery of pterygium should not be left in unexperienced hands
Keywords: Pterygıum, exotropia, complications
Anesthetic management of a case with adrenoleukodistrophy and mitochondrial myopathy
Şennur Uzun, Zeynep Şener
J Clin Exp Invest 2014;5(3):459-461.
https://doi.org/10.5799/ahinjs.01.2014.03.0440
Case Report
[Abstract]
[PDF]
ABSTRACT
In this case report, general anesthesia practice was reported in a patient with adrenoleukodystrophy and mitochondrial myopathy for lumbar spondylolisthesis operation. The important points to take care during anaesthesia in patients with these diseases were emphasised.
Keywords: Adrenoleukodystrophy, mitochondrial myopathy, malign hyperthermia
Mass mimicking tuberculosis cases diagnosed postoperatively
Fatih Meteroğlu, Özlem Abakay, Serdar Monis, Ali Birak
J Clin Exp Invest 2014;5(3):462-465.
https://doi.org/10.5799/ahinjs.01.2014.03.0441
Case Report
[Abstract]
[PDF]
ABSTRACT
Tuberculosis is a disease that occurs with different radiological manifestations. Although not frequent, tuberculosis cases seen as pulmonary masses have been reported in the literature. It is difficult to diagnose pulmonary tuberculosis definitely and to rule out a tumor in patients presenting with image of a pulmonary mass. In this paper, we discussed difficulties in diagnosis of two patients, aged 42 and 65 years, who admitted with a mass image on their chest x-rays to our clinic. Positron emission tomography images were taken following computerized tomography. Acid fast bacteria, bronchoalveolar lavage and bronchoscopic biopsies were not diagnostic. Therefore, surgery was used to establish the diagnosis. In the first patient, lobectomy was carried out with wedge resection due to peroperative suspected malignancy report of frozen section. Definitive report, however, yielded tuberculosis. Both patients received antituberculosis treatment and both were well at routine follow up examinations. Tuberculosis should be kept in mind when a mass is encountered in an endemic area such as our country.
Keywords: Lung cancer, tuberculosis, mass
Multiple drugs poisoning resulting in ARDS
Ersagun Tuğcugil, Ahmet Şen, Başar Erdivanlı, Abdullah Özdemir, Hızır Kazdal
J Clin Exp Invest 2014;5(3):466-468.
https://doi.org/10.5799/ahinjs.01.2014.03.0442
Case Report
[Abstract]
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ABSTRACT
Inappropriate use of prescribed antidepressants and antipsychotics may frequently cause death due to cardiac complications. Lung complications are rare. We present a case of acute respiratory distress syndrome due to suicide attempt with quetiapine, carbamazepine, and clomipramine. The patient developed pulmonary edema and hypoxemia refractory to oxygen treatment. The patient died due to septic shock and multi-organ failure at the tenth day of intensive care treatment, despite recruitment maneuvers and lung-protective ventilation. Cases of allergic lung edema due to clomipramine are very rare in the literature. When considering the fact that all three drugs may elevate serum concentrations of each other, we are in opinion that the sinergistic effect of three drugs may be the cause.
Keywords: Acute respiratory distress syndrome (ARDS), poisoning, carbamazepine, clomipramine, quetiapine
A case of pneumothorax due to non-invasive mechanical ventilation
İbrahim Koç, Ayşen Dökme, Adem Bayraktar, Abdulaziz Kaya
J Clin Exp Invest 2014;5(3):469-471.
https://doi.org/10.5799/ahinjs.01.2014.03.0443
Case Report
[Abstract]
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ABSTRACT
Emphysema is enlargement of alveolus, alveolary ducts and destruction of alveolary wall. One of complications of non-invasive mechanical ventilation (NIMV) is barotrauma of damaged lung. Here we present a 75 years old male who had Chronic Obstructive Pulmonary Disease (COPD), emphysema for 5 years and suffered from pneumothorax after NIMV. During treatment with NIMV his general condition deteriorated and oxygen saturation decreased immediately. Chest X-ray and tomography revealed pneumothorax. Chest tube inserted under local anesthesia. Although NIMV might seem like innocent, in patients whose general condition immediately worsens, oxygen saturation decreases, has emphysema and bullous lesions pneumothorax must be excluded.
Keywords: Emphysema, non-invasive ventilation, pneumothorax
Can femoral dialysis catheter insertion cause a life threatening complication?
Nurkay Katrancıoğlu, Umut Serhat Sanrı, Şevki Hakan Eren
J Clin Exp Invest 2014;5(3):472-474.
https://doi.org/10.5799/ahinjs.01.2014.03.0444
Case Report
[Abstract]
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ABSTRACT
Venous catheter (VC) insertion may be necessary for the patients with renal failure facing vascular access problem. Femoral VCs are commonly used for their lower complication rates especially in emergency clinics. The incidence of bleeding associated with VC is reported 0.5-1.6%, however, life threatening hemorrhage and complications requiring surgical intervention are very rare. In this manuscript, we aimed to present a case with hemolytic uremic syndrome complicated with retroperitoneal hematoma after femoral VC insertion.
Keywords: Hemodialysis, hemolytic uremic syndrome, femoral venous catheter
Giant cell tumor of bone: current review of morphological, clinical, radiological, and therapeutic characteristics
Georgi Petrov Georgiev, Svetoslav Slavchev, Iva Dimitrova, Boycho Landzhov
J Clin Exp Invest 2014;5(3):475-485.
https://doi.org/10.5799/ahinjs.01.2014.03.0445
Review
[Abstract]
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ABSTRACT
Giant cell tumor of bone accounts for about 5% of all primary bone tumors in adults and is still one of the most obscure and intensively examined tumors of bone. This largely results from the lack of uniform clinical, radiographic, histological or morphological aspects that allow prediction of recurrence. Classified by the World Health Organization as “an aggressive, potentially malignant lesion”, the giant cell tumor of bone could give lung metastases, could undergo malignant degeneration or could have multicentric localization. It usually develops in long bones but can also occur in unusual locations. The common presenting symptom is increasing pain at the tumor site. Standard treatment ranges from curettage to wide resection, with reports of varying oncological and functional results. The recurrence rate is high during the first 2-3 years after surgery regardless of pre-operative tumor stage. Herein, we discuss the morphological, clinical, radiological, and therapeutic characteristics of this pathologic entity as well as its differential diagnosis.
Keywords: Giant cell tumor of bone, diagnosis, treatment, review
Human embryonic stem cells and microenvironment
Banu İskender, Kenan izgi, Salih Şanlıoğlu, Halit Canatan
J Clin Exp Invest 2014;5(3):486-495.
https://doi.org/10.5799/ahinjs.01.2014.03.0446
Review
[Abstract]
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ABSTRACT
Human embryonic stem cells (hESCs) possess a great potential in the field of regenerative medicine by their virtue of pluripotent potential with indefinite proliferation capabilities. They can self renew themselves and differentiate into three embryonic germ layers. Although they are conventionally grown on mitotically inactivated mouse feeder cells, there are in vitro culture systems utilizing feeder cells of human origin in order to prevent cross-species contamination. Recently established in vitro culture systems suggested that direct interaction with feeder cells is not necessary but rather attachment to a substrate is required to ensure long-term, efficient hESC culture in vitro. This substrate is usually composed of a mixture of extracellular matrix components representing in vivo natural niche. In hESC biology, the mechanism of interaction of hESCs with extracellular matrix molecules remained insufficiently explored area of research due to their transient nature of interaction with the in vivo niche. However, an in vitro culture system established using extracellular matrix molecules may provide a safer alternative to culture systems with feeder cells while paving the way to Good Manufacturing Practice-GMP production of hESCs for therapeutic purposes. Therefore, it is essential to study the interaction of extracellular matrix molecules with hESCs in order to standardize in vitro culture systems for large-scale production of hESCs in a less labor-intensive way. This would not only provide valuable information regarding the mechanisms that control pluripotency but also serve to dissect the molecular signaling pathways of directed differentiation for prospective therapeutic applications in the future.
Keywords: Human embryonic stem cells, extracellular matrix, pluripotency, in vitro culture systems
Current approaches for informed consent in pediatrics
Hatice Betül Gemici, Özlem Evrim Göksoy, Ahmet Doğan, Murat Doğan, Vefik Arıca
J Clin Exp Invest 2014;5(3):496-503.
https://doi.org/10.5799/ahinjs.01.2014.03.0447
Review
[Abstract]
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ABSTRACT
Today in medical practis; codes of ethic are becoming important. New aprroaches has emerged that about to participate with patient’s consent and child absent understand the own situation should be taken for treatment or process on child. Means of child informing is to given simple information about understandable language. Physicians should support to be shared with the patient’s medical decision according to the child’s age and understanding capacity. Informed consent in pediatric patients makes contribution to develepmont of future individuals; therefore that is an important ethic assignment for doctors.
Keywords: Children, ethic, informed consent
Cardiopulmonary exercise testing
Erkan Ceylan
J Clin Exp Invest 2014;5(3):504-509.
https://doi.org/10.5799/ahinjs.01.2014.03.0448
Review
[Abstract]
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ABSTRACT
Cardiopulmonary exercise testing (CPET) is a noninvasive procedure that provides diagnostic and prognostic information and evaluates an individual’s capacity for dynamic exercise. CPET is an investigation of the respiratory, cardiovascular and cellular response to the exercise that can be done under controlled metabolic conditions. It provides assessment of the integrative exercise responses involving not only the pulmonary and cardiovascular systems but also skeletal muscle system, which are not adequately reflected through the measurement of individual organ system function. Furthermore, it is being performed increasingly in a wide spectrum of clinical applications for evaluation of undiagnosed exercise intolerance or for objective determination of functional capacity. CPET with extensive hardware and educated staffs can be used for the diagnosis of different types of clinical problems. Additionally, the increasing number of applications for which CPET is currently employed, attests to the growing recognition of its importance in medicine.
Keywords: Cardiopulmonary exercise testing, dynamic hyperinflation, diagnosis, functional capacity