The impact of serum vitamin D concentration on median nerve conduction
Gökhan Özer
J Clin Exp Invest 2018;9(2):63-66.
https://doi.org/10.5799/jcei.433800
Research Article
[Abstract]
[PDF]
[References]
ABSTRACT
Objectives: To perform nerve conduction studies (NCS) and to evaluate distal latency, amplitude and conduction velocity values of the median nerve in relation to serum vitamin D levels in patients with neuropathic symptoms compared to controls.
Patients and Methods: Patients with neuropathic symptoms of numbness, tingling and burning sensation were included in the study. Serum 1,25(OH) D3 levels were measured and patients were stratified by vitamin D status into three subgroups. Electrophysiological assessments of the median nerve were performed as recommended by the American Society of Electrodiagnostic Medicine. SPSS for Windows, version 24 was used for statistical analyses. Median nerve conduction values were compared between patient and control groups in relation to vitamin D concentration.
Results: The study enrolled 39 patients including 24 (61.5%) males and 15 (38.5%) females and 39 control subjects including 22 (56.4%) males 17 (43.6%) females. Patient and control groups had a mean age of 45 years. Average vitamin D concentration was 8.5 ng/ml in the patient group and 8.8 ng/ml in the control group. There was no statistically significant difference between two groups with respect to age and average vitamin D concentration (p=0.552). Greater distal latency values and a statistically significant association between median nerve distal latency and vitamin D deficiency were found in the vitamin D-deficient subgroup (p=0.024).
Conclusion: Given the neuroprotective action of vitamin D and the involvement of vitamin D deficiency in several neurological diseases as well as evidence that it might be an independent risk factor and a potential biomarker for neuropathy, we believe that patients presenting with mononeuropathy or polyneuropathy to a healthcare facility should be screened for vitamin D deficiency.
Keywords: 25-hydroxyvitamin D, median nerve, conduction
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The Infections of Cardiac Implantable Electronic Devices: Four Year Experience of the Center
Ali Deniz, Muhammet Bugra Karaaslan, Aziz Inan Celik, Aslıgul Cureoglu, Hakan Gelincik, Mehmet Kanadasi, Mesut Demir, Ayhan Usal
J Clin Exp Invest 2018;9(2):67-70.
https://doi.org/10.5799/jcei.433805
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: Cardiac implantable electronic devices (CIED) have been increasingly used in recent years. The incidence of infection has ranged from 0.5 % to 12% in the literature. The purposes of this study was to investigate the frequency of CIED infection and to find the causes of infection.
Patients and methods: Totally, 211 patients with CIED infection were retrospectively evaluated. For each patient, all the following data were recorded; age, sex, CIED type, accompanying diseases, complete blood count, serum biochemistry, echocardiographic findings and whether first implantation or replacement. In addition, wound culture, antibiotic regime, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), glomerular filtration rate (GFR) and anticoagulation test results were recorded in infected patients.
Results: CIED infection was detected in 18 of the 211 patients (8.5%). 15 cases developed infection following the first implantation (10%), and 3 cases after replacement (5%). Infection was detected within 60 days in 5 patients. CIED pocket cultures were positive in 12 patients (66.7%). 13 of 18 infected devices were removed (72.2%). Diabetes mellitus [Odds Ratio, OR: 4.56 (1.449-14.408)] (p=0.010), male sex [OR: 3.84 (1.034-14.232)] (p=0.045) and increasing age [OR: 0.96 (0.932-0.998)] (p=0.038) were found as significant independent variables on development of CIED; but, pacemaker, implantable cardioverter defibrillator and cardiac resynchronization were not independent variables [OR: 1.66 (0.469-5.929)] (p=0.43).
Conclusions: Increasing age, male sex, diabetes mellitus were related to increased frequency of CIED infections. Identification of comorbid conditions prior to CIED implantations may be important in reducing risk of CIED infections.
Keywords: Cardiac Implantable Electronic Devices, Staphylococcus Epidermidis, Infection
Levels of Th1 and Th2 Cytokines in Patients with Nasal Polyps
Adnan Ekinci, Müge Özcan
J Clin Exp Invest 2018;9(2):71-75.
https://doi.org/10.5799/jcei.433807
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: We aimed to investigate Th1 / Th2 (T helper) cell balance by examining Interleukin-4 (IL-4), Interleukin-5 (IL-5), Interleukin-10 (IL-10), Interleukin-17 (IL-17) and Interferon gamma (IFN γ) levels in serum in patients with nasal polyps (NPs).
Patients and Methods: This study included 45 patients (mean age: 34.8 years) with NPs and a control group (mean age: 37.9) consisting of 45 healthy volunteers.
Results: The mean IL-17 level in the NPs group (4.096 pg/ml) was significantly higher than the control group (2.219 pg/ml) (p<0.001). IL-5 levels were significantly higher in the control group. NPs group had significantly lower IL-5 level compared with the control group (1.981 pg/ml vs. 2.720 pg/ml, respectively: p<0.001).
The mean IFN γ concentration was significantly lower in the NPs group (0.379 pg/ml) compared to the control group (0.439 pg/ml) (p=0.011). No significant differences were found in the IL-4 (3.25 pg/ml vs. 3.38 pg/ml) and IL-10 (11.249 pg/ml vs. 12.156 pg/ml) concentrations between NPs and the control groups (p=0.799 and p=0.255, respectively).
Conclusions: Increased IL-17 levels were found in NPs patients. There was no significant differences in IL-4 and IL-10 values of the Th1 cytokines among the groups, whereas IL-5 was found to be low in the NPs group. IFN gamma values of Th2 cytokines were found to be low in the NPs group. According to these results, low IFN gamma levels and regulatory cytokine IL-7 activation may be effective in the etiopathogenesis of NPs.
Keywords: Nasal Polyps, Interleukin-4, Interleukin-5, Interleukin-10, Interleukin-17, Interferon Gamma
Autonomic Dysfunction in Epileptic Patients
Gökhan Özer
J Clin Exp Invest 2018;9(2):76-80.
https://doi.org/10.5799/jcei.433809
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: To investigate autonomic symptoms in different types of epilepsy in comparison to control subjects. To observe whether autonomic symptoms cause possible morbidity and mortality and to make a preliminary remedy
Patients and Methods: A retrospective chart review was conducted for 28 patients diagnosed with epilepsy including 18 patients with complex partial epilepsy (CPE) and 10 patients with primary generalized epilepsy (PJE). Their autonomic symptoms were assessed using the COMPASS-31 questionnaire in comparison to a control group of 18 subjects.
Results: No statistically significant differences were found in autonomic dysfunction symptoms between patients with CPE and patients with PJE. However, constipation and insomnia which autonomic symptoms were statistically significantly more common in epileptic patients compared to the control group.
Conclusions: It is important to recognize and watch out for symptoms of autonomic dysfunction in patients with epilepsy. We believe that awareness for these symptoms is essential both to reduce associated disability and develop specific treatment strategies and to predict sudden unexpected death in epileptic patients.
Keywords: Epilepsy, autonomic dysfunction
Does Tracheostomy Affect the Mortality and Morbidity Rate After Cardiac Surgery?
Serkan Burc Deser
J Clin Exp Invest 2018;9(2):81-86.
https://doi.org/10.5799/jcei.433810
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: This retrospective study aims to investigate the timing and outcomes of tracheostomy, mortality and morbidity rates, length of in-hospital and cardiovascular intensive care unit (ICU) stay in patients with post-cardiac surgery.
Patients and Methods: Between October 2014 and October 2016, a total of 401 cardiac surgery were performed in our hospital. Thirteen patients who needed post-operative prolong ventilation (7 female; 6 male; mean age was 67.7 ± 9.8 years; range 47 to 86 years) undergoing tracheostomy procedure, were included in this retrospective study.
Results: The mean intubation time between the cardiac surgery and tracheostomy was 14.5±2.9 days (range 11 to 21). The mean intensive care unit stay time was 27.4 ±9.4 days (range 12 to 49) and the mean in-hospital stay was 43.1±23.7 days (range 16-91). 8 patients passed away and the in-hospital mortality rate was 61%. After a mean follow-up of 161.4±151.1 days (range 57 to 417), 3 patients (7%) passed away while one patient (7%) was decannulated. One patient (7%) is currently under follow-up at home using a home-type ventilator. Regarding patients who passed away after discharge, the overall mortality rate was 84.6%. In addition, the number of extubation attempts was 0.65±1.12 (range 0 to 4).
Conclusion: Tracheostomy is performed in need of prolonged mechanical ventilation in patients with post cardiac surgery. We thought that tracheostomy does not decrease the incidence of nosocomial pneumonia in hospital/ICU stay and morbidity/mortality as expected.
Keywords: Cardiac surgery, tracheostomy, outcomes, intensive care unit, pneumonia
Is digit ratio (2D:4D) an indicator for patients with epilepsy?
Gülsüm Akdeniz, Orhan Deniz, Gönül Vural, Şadiye Gümüşyayla, Hesna Bektaş
J Clin Exp Invest 2018;9(2):87-90.
https://doi.org/10.5799/jcei.433812
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: The aim of the study was to investigate the possible association between the 2D:4D ratio and epilepsy in male and female adults, and to compare the ratios of epilepsy patients and healthy control subjects.
Patients and Methods: A case-control study carried out at a neurology and biophyiscs department in Ankara Yıldırım Beyazıt University, Faculty of Medicine from May 2016 to January 2017. The 2D:4D ratios of both the left and right hands of 172 epilepsy patients and 202 matched healthy controls were recorded. All participants also completed the Edinburgh handedness inventory.
Results: A significant positive correlation between the 2D:4D ratio and epilepsy was found for both females and males; a lower ratio for the left hand was associated with a higher possibility of epilepsy. In addition, a lower ratio in a specific hand was associated with that hand being used to complete the handedness test.
Conclusions: The 2D:4D ratio serves as a predictor for increased risk of epilepsy. Thus, it could be used as a marker to differentiate patients with epilepsy from healthy controls.
Keywords: Digit ratio, 2D:4D, Edinburg handedness test, epilepsy, hand
The Positivity Ratios of HBsAg, Anti-HBs and Isolated Anti-HBc in Patients with Breast and Gynecologic Cancers Prior to Chemotherapy
Ayşe İnci, Özgür Açıkgöz, Mustafa Uygar Kalaycı, Volkan Ülker
J Clin Exp Invest 2018;9(2):91-94.
https://doi.org/10.5799/jcei.433817
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: Chemotherapy may lead to HBV re-activation. The aim of this study is to evaluate screening results for HBV infection before chemotherapy, treatment status in patients who are being followed up and planned to receive chemotherapy in our hospital.
Patients and Methods: A total of 83 patients who were admitted to Medical Oncology Outpatient Clinic of S.B.Ü. Kanuni Sultan Süleyman Research and Training Hospital between June 2015 and January 2018 and planned to receive chemotherapy were included in the study. Age, diagnoses, HBsAg, anti-HBs, anti-HBc, and HBV-DNA results of the patients were recorded through screening files.
Results: When a total of 83 patients who were planned to receive chemotherapy were analyzed with regard to cancer type; breast and ovarian cancers were found to be the most common. HBsAg positivity ratio of our patients was 3.6%, anti-HBs positivity was fund as 38.6%. Ratio of the patients whose anti-HBc was positive when HbsAg, anti-HBs negative was 7.2% (6/83) and HBV-DNA positivity was found in no of these patients.
Conclusion: In conclusion, patients should be screened for HBV infection considering risk factors like reactivation, hepatic failure, interruption of chemotherapy; we consider that conducting further studies with larger series would be important.
Keywords: HBV, chemotherapy, cancer
Evaluation of Malignancy Risk in Patients Who Underwent Hysteroscopy for Preliminary Diagnosis of Endometrial Polyp
Taner Günay, Oğuz Devrim Yardımcı, Mesut Polat, Kemal Sandal, Hatice Şeneldir
J Clin Exp Invest 2018;9(2):95-99.
https://doi.org/10.5799/jcei.433819
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: To determine the prevalence of premalignant or malignant (atypical hyperplasia or endometrial cancer) disease that develops in polyps or coexist it and the relationship between the demographic and clinical characteristics of the patients and malignancy by examining the pathology results of patients who underwent hysteroscopy for a preliminary diagnosis of endometrial polyp.
Patients and Methods: We retrospectively evaluated 527 patients whose preliminary diagnoses made by transvaginal ultrasonographic findings or with clinical suspicion and tissue samples taken by hysteroscopy between June 2012 and June 2017. The demographic and clinical data of patients who were reported as pathologic diagnosis of benign endometrial pathologies and premalign (polyp + atypical hyperplasia) or malign (polyp + endometrial cancer) were evaluated.
Results: We detected endometrial polyp in 405 (76.8%) patients, polyp and endometrial hyperplasia without atypia in 51 (9.6%) patients, other benign conditions in 60 (11.3%) patients (leiomyoma uteri, proliferative/secretory/atrophic endometrium), polyp and atypical endometrial hyperplasia in 4 (0.8%) patients and endometrium adenocarcinoma in 7 (1.3%) patients. The incidence of premalignant or malignant disease associated with endometrial polyp was 2.1%.
Conclusions: Endometrial polyps are quite common and are not often considered to be cancerous lesions but rarely associated with cancer, especially with advancing age. The most risky group of patients with endometrial polyps for endometrial cancer who have postmenopausal bleeding consists of those with additional risk factors for this malignancy. The management of endometrial polyp cases should be individualized considering the patient’s age, menopausal status, symptoms and clinical risk factors.
Keywords: Endometrial polyp, endometrial cancer, hysteroscopy
Pregabalin intoxication-induced Prolonged PR Interval on Electrocardiogram
Erdinç Şengüldür, Celal Katı, İskender Aksoy, Türker Yardan, Ahmet Baydin
J Clin Exp Invest 2018;9(2):100-102.
https://doi.org/10.5799/jcei.433821
Case Report
[Abstract]
[PDF]
ABSTRACT
Pregabalin is a lipophilic analogue of gamma-aminobutyric acid (GABA) and has a similar chemical structure to gabapentin and is more potent than gabapentin. This report documents the case of a 28-year-old male presenting with suicidal attempt by pregabalin intake. The patient had an abnormal PR interval (reversible AV-block). He was managed with general supportive care and symptomatic approach such as discontinuation of the drug, hydration with IV fluids, oxygenation, gastric lavage and activated charcoal administration.
Keywords: Pregabalin, intoxication, AV-block
Current Treatment Approaches to Multiple Myeloma with New Agents
Senem Maral, Murat Albayrak, Çiğdem Pala öztürk
J Clin Exp Invest 2018;9(2):103-112.
https://doi.org/10.5799/jcei.433823
Review
[Abstract]
[PDF]
ABSTRACT
Multiple myeloma is a hematological malignancy which results organ damage due to increased abnormal plasma cell growth in bone marrow and immunoglobulin or light chain overproduction. In myeloma treatment, it is aimed to control the disease quickly and effectively, to correct and prevent disease-related complications and to reduce the risk of premature death, with the least possible toxicity. In recent years, the survival of patients has dramatically increased with the addition of a large number of new generation agents to the treatment. Current therapies with new agents have good results related with the survival and disease-free survival but cannot prevent the recurrence of the disease. Although autologous stem cell transplantation protects its location in treatment, ıt seems to promise hope for a new generation of agents.
Keywords: Multipl myeloma, proteozome Inhibitors, monoclonal antibodies, immune modulators, histone deasetilase inhibitors