Medical Science and Discovery

The COVID-19 Pandemic as a threatening for bone health

2021-03-29T20:29:51+03:00

The worldwide predominance of coronavirus disease 2019 (COVID-19) pandemic will have tremendous consequences on bone health of the general population and specifically to the bone mineral density of both young and elderly adolescents, due to sedentary lifestyle resulting from the prolonged and repeated lockdown. Scientific articles argue about the short and long term consequences on bone health resulting from the social isolation and the subsequent sedentary behaviors, whereas experts focus their scientific interest at guidelines for diagnosis, management and prevention of osteoporosis in the era of the COVID-19 pandemic

COVID-19 infection in patients receiving hemodialysis in Athens: findings, experience, outcome from a single Dialysis Unit.

2021-03-29T20:29:49+03:00

Our Nephrology Department during the spring period on the first wave of COVID-19 was the referral Dialysis Unit for Covid-19 positive HD patients in the district area of Athens, Greece. This study aims to report the characteristics, rates, and outcomes of all patients affected by infection with SARS-CoV-2 undergoing HD and treated under our care. 22 Covid-19 positive HD patients were treated under the care of our facility during the period 8 April 2020-17 June 2020. 16 patients were symptomatic at admission and 13 patients were admitted with or developed during their stay pleural effusions. 12 patients (8 male) of our group died during their hospitalization. The mean age of our patients was 74.5 years. It has to be pointed out that 13 patients were over 75 years old. Mean age was higher in those who died compared with those who were discharged with double negative Covid-19 tests (79 vs 74,5 years old respectively). It seems that despite the fact that the immune response of this population has not been clearly clarified, age comorbidities and above all end-stage renal disease by its self is a significant and unpredictable risk factor for clinical outcome of HD patients with COVID-19 infection.

Cranial hyperthermia resulting from decreased parotid gland salivation induced by ischemic degeneration of glossopharyngeal network in subarachnoid hemorrhage

2021-04-05T21:34:41+03:00

Objective: We speculated that subarachnoid hemorrhage (SAH) induces ischemic lesions in the cranial parasympathetic nerves, which may decrease saliva secretion and lead to hyperthermia. We tested this hypothesis by examining histologic features of parotid glands and glossopharyngeal nerves (GPNs) in a rabbit model of SAH.

Material and Methods: Rabbits (n = 25) were divided into control (n = 5), sham (n = 5), and SAH (n = 15) groups. Animals in the sham and SAH groups were examined over a 3-week period before sacrifice. Salivation score (SC) was determined by measuring the mean wetted area of an orally inserted cotton ball. Sections of parotid glands and intracranial and intraparotideal branches of the GPNs were stained with hematoxylin and eosin and SAH-induced damage was analyzed by terminal deoxynucleotidyl transferase dUTP nick end labeling of apoptotic cells. Specimens were stereologically examined to determine saliva-filled total vesicle volume (TVV) per cubic meter; vasospasm index (VSI) based on wall/lumen ratio of parotid glands arteries, and degenerated neuron density (DND) of glossopharyngeal ganglia.

Results: The mean oral temperature was 36.9°C. In the control group, mean values were as follows: SC, 46±8 mm2; DND, 19±4/mm3; VSI, 1.065±0.049; and TVV, (780±1187) × 106/µm3. In the sham group, mean values were as follows: SC, 31±6 mm2; DND, 98±23/mm3; VSI, 1.67±0.32; and TVV, (617±110) × 106/µm3. In the low hyperthermia SAH group, mean values were as follows: SC, 16±5 mm2; DND, 1520±261/mm3; VSI, 2.12±0.21, and TVV, (314±98) × 106/µm3. In the high hypothermia SAH group, mean values were as follows: SC, 9±2 mm2; DND, 3210±912/mm3; VSI, 3.18±0.30; and TVV, (432±99) × 106/µm3.

Conclusions: Decreased salivary secretion due to secretory gland atrophy originated from ischemia-induced GPN network degeneration at the brainstem, which may be responsible for cranial hyperthermia following SAH.

Assessment of radiation dose to pediatric patients during routine digital chest X-ray procedure in a government medical centre in Asaba, Nigeria

2021-03-29T20:29:45+03:00

Objective: Radiation dose to pediatric patients have been widely reported, it is however necessary that imaging expert keep doses as low as possible to forestall stall long term cancer risk. This study is aimed at determining pediatric entrance surface dose (ESD), 75th percentile ESD, absorbed dose (D) and effective dose (E) for 0-15 years.

Material and Methods: The study used a digital radiography (DR) unit with a grid system for each chest X-ray. The thermoluminescent dosimeter (TLD) used was encapsulated in transparent nylon, it was then attached to the patient skin (chest wall) and the second was placed directly at the posterior end of it.

Results: The mean ESDs for the 4 age groups were as follows: 0- < 1 (1.54±0.74mGy), 1- < 5 (1.53±0.83mGy), 5- < 10 (0.55±0.39mGy) and 10- ≤15 (1.30±0.57mGy), with an overall mean of 1.23mGy. The 75th percentile ESD for each age group above 10 patients (excluding 5- < 10yrs) was 2.18, 2.19 and 1.75mGy respectively. The absorbed dose (D) ranged from 0.03-2.39mGy. The mean effective dose (E) for the 4 age groups was 0.18±0.03mSv. There was a good correlation between ESD and D (P = 0.001). A One-Way ANOVA shows that the field size and focus to film distance (FFD) affected the ESD and D (P < 0.001) respectively. The risk of childhood cancer from a single radiograph was of the order of (1.54-23.4) ×10^-6.

Conclusion: The 75th percentile ESD, E and childhood risk of cancer was higher than most studies it was compared with. The study reveals that machine parameters such as the field size and FFD played a major role in dose increase. Protocol optimization is currently needed for pediatric patients in the studied facility.

Antimicrobial resistance profiles of Enterobacter cloacae and Klebsiella aerogenes a tertiary hospital in Turkey: A five-years study

2021-03-29T20:29:44+03:00

Objective: Enterobacter cloacae and Klebsiella aerogenes species have multiple drug resistance and antibiotic resistance is a growing problem regarding to treating infections.

Objective: The aim of this study was to determine and evaluate the antimicrobial resistance profiles of E. cloacae and K. aerogenes isolated from various clinical samples in our laboratory, retrospectively.

Material and Methods: Totally 223 patients who applied to Karabuk University Training and Research Hospital microbiology laboratory between October2016-December2020 were included in this study. Conventional methods and automated systems were used for the identification and antibiotic susceptibilities of strains. Antibiotic susceptibility results were evaluated as per the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines.

Results: Total of 223 clinical samples (urine 68.6%, blood 12.6%, endotracheal aspirate 7.2%, wound 4.9%, sputum 3.6%, bronchoalveolar lavage fluid 2.7%, and ear fluid 0.4%) obtained from 223 patients; 119 (53%) females and 104 (47%) females, were analysed. The identified species were E. cloacae (132 strains, 59.2%) and K. aerogenes (91 strains, 40.8%). The Enterobacter cloacae and Klebsiella aerogenes positivity was detected as 30(13.4%) and 20(9.0%) in the samples. The highest resistance was found against cefixime at a rate of 60%; the lowest resistance was against amikacin, meropenem and imipenem ranged between 3% and 4% in both E. cloacae and K. aerogenes strains.

Conclusions: Amikacin, imipenem and meropenem were the most effective antibiotics against E. cloacae and K. aerogenes. We may prefer TMP-SMX and ciprofloxacin, as oral antibiotic agents in the treatment of E. cloacae/K. aerogenes infections. Amikacin, gentamicin and carbapenems may be the first choice for parenteral antibiotics therapy

Investigation of the Value of Coagulation Parameters in Thromboembolic Events Among Patients Not Receiving Anticoagulant Therapy

2021-03-29T20:29:34+03:00

Objective: The main causes of thromboembolic events are atherosclerosis, vascular endothelial injury, and hypercoagulability. Coagulation is activated through two basic mechanisms, including intrinsic and extrinsic pathways, leading to thrombin production as a result of a series of enzymatic reactions. The intrinsic pathway is evaluated with activated partial thromboplastin time (aPTT) and extrinsic pathway with prothrombin time (PT). This study aimed to investigate the relationship between thromboembolic diseases and coagulation parameters.

Material and Methods: Patients diagnosed with acute ischemic stroke (AIS) (n=216), acute coronary syndrome (ACS) (n=25), pulmonary thromboembolism (PTE) (n=15), and patients without an emergency pathology (n=71) (Control Group) in the emergency department were retrospectively reviewed in the period from 01 November 2016 to 31 March 2019.

Results: The aPTT (25.61±5.93 sec), PT (12.05±2.26 sec), and INR (1.04±0.19) values of the AIS group were statistically significantly lower compared to values of the control group (p = ˂0.001, ˂0.001 and ˂0.001 respectively). Similarly, the aPTT (27.15±8.97 sec), PT (12.26±2.75 sec), and INR (1.03±0.25) values of the ACS group were statistically significantly lower compared to those of the control group (p=0.012, 0.030, and 0.001, respectively). There was no statistically significant difference between the PTE group and control group in terms of aPTT, PT, and INR values (p= 0.133, 0.758, and 0.711, respectively).

Conclusion: Shortened aPTT levels in cases without a history of anticoagulant use at the time of admission can be considered to be a predictive and effective tool for clinicians in arterial embolic events (AIS and ACS).

Investigation of the change in the biological structure of the tumor in metastatic breast cancer

2021-03-29T20:29:39+03:00

Objective: When metastasis develops in some breast cancer patients, hormone receptors (HR) and Human Epidermal Growth Factor-2 (Her-2) status can change and the tumor alters its character. We tried to determine the rate of these changes in tumor biology in 110 patients that we followed in our clinic and performed the change of the biopsy from the metastatic site (re-bx). We aimed to determine the biological changes of tumors and, contribute to the literature by examining the relationship of these changes with the adjuvant endocrine treatments (ET) or chemotherapy type (CT).

Material and Methods: We included 110 metastatic breast cancer patients in our study. These patients had previously completed their local treatments followed by CT, and those with positive HR completed ET. After the first metastasis developed in the patients, we performed metastasectomy or biopsy from the metastatic site.

Results: The median ki-67 value was 25% at the time of primary diagnosis and 30% in re-bx. 20.9% of patients estrogen receptor (ER), 31.8% of patients progesterone receptor (PR) and 26.3% of patients Her-2 changed when metastasis developed.

Conclusions: We found that the metastatic tumor has more aggressive properties than the primary tumor. Adjuvant chemotherapy and endocrine treatments or the location of metastasis did not make a significant difference in tumor biology.

Ultrasonographic assessment of lower uterine segment thickness and perinatal Outcomes in patients with a previous cesarean history

2021-04-04T13:28:38+03:00

Objective: The purpose of the study was to establish the validity of the abdominal evaluation of lower uterine segment (LUS) thickness in patients having a previous cesarean section (CS) in predicting uterine rupture, and to evaluate if there is any effect of the number of a previous surgeries on adverse maternal and perinatal outcomes.

Materials and methods: A prospective case-control study was carried out between December 2017 and June 2018 in Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital. 555 patients were classified into three groups; Group 1: patients having one previous CS, Group 2: patients having two previous CS, Group 3: patients having more than the two previous CS). Ultrasonographic measurements of the LUS, intraoperative findings and, adverse pregnancy outcomes were assessed.

Results: LUS thickness of group 2 was significantly less than the LUS thickness of the other groups (p=0.022). The feeling of pain was significantly more in the patients of group 2, when compared with the other groups (p=0.019). Pregnancy interval was the only parameter that had significant predictivity for adverse pregnancy outcomes for group 1(#CS=2) and group 3 (#CS≥4) (p=0.042, and p=0.021, respectively). In group 2 (#CS=3), age, the thickness of LUS, and thickness of subcutaneous adipose tissue were found to have significantly high predictivity for adverse pregnancy outcomes (p=0.012, p≤0.001, and p=0.007, respectively).

Conclusion: Measurement of LUS, in the patients who had previous CS, can be used for risk assessment and management. It is a non-invasive, reliable and, easily applicable method. Standardization of the measurement technique is a necessity.

Total or less than total thyroidectomy for multinodular goiter long term follow-up

2021-03-29T20:29:36+03:00

Objective: Multinodular goiter is a common surgical disease. There is no common consensus regarding the extent of thyroidectomy for multinodular goiter. This study aims to present personal experience on treating patients with multinodular goiter and to compare complication rates and results of total and partial thyroidectomy for multinodular goiter.

Material and Method: Three hundred fifty patients underwent thyroidectomy for multinodular goiter between May 2003 and October 2010. All patients were diagnosed as multinodular goiter and were referred to surgery by one endocrinologist. All operations were also performed by one surgeon using microsurgical techniques. Partial thyroidectomy (bilateral subtotal or unilateral total thyroidectomy and contralateral subtotal thyroidectomy) was performed in 65 patients (Group-1) and extracapsular total thyroidectomy was performed in 285 patients (Group-2). All patients are being followed followed from the day they were diagnosed until now by the same endocrinologist. Fisher exact test was used for statistical analysis.

Results: In Group-1, one patient had transient vocal-cord palsy and but none had hypoparathyroidism. On the other hand, in Group-2, two patients had transient vocal-cord palsy, five had hypocalcemia (one was permanent), and one had a hematoma. Mortality and wound infection were absent in both groups. The histopathological studies showed that 40 incidental thyroid carcinomas occurred among Group-2 patients. During long-term follow-up, 13 patients had goiter recurrence (n = 65, 20%) in Group-1, whereas none had goiter recurrence in Group-2.

Conclusion: There were no statistically significant differences in the complication rate between subtotal and total thyroidectomy groups (p>0.05). However, the recurrence rate was higher (statistically significant) after subtotal thyroidectomy than after total thyroidectomy (p<0.05). Total thyroidectomy eliminated future recurrence of the disease and is also curative in incidental thyroid carcinomas. In addition, it can be safely performed using microsurgical techniques.

A rare lesion of cervical lymph nodes: Angiomyomatous hamartoma

2021-03-29T20:29:42+03:00

Objective: Angiomyomatous hamartomas are extremely rare, tumor-like lesions of the lymph nodes. They are usually seen in the inguinal region lymph nodes. They are rarely seen in the lymph nodes of the cervical region. Histopathologically, fibrous tissues, smooth muscle cells, and vascular structures are seen in the lymph node structure. It is important to distinguish it from benign and malignant lesions of the lymph node.

Case: A 1 cm diameter lymph node excision material removed from the cervical region of a 26-year-old male patient was sent to the pathology laboratory with a pre-diagnosis of lymphadenitis. 4- micron sections were taken from the paraffin blocks prepared from the tissues belonging to the lesion. The samples were examined by staining Hematoxylin-Eosin. In histopathological examination, it was found that almost all of the lymph node structure consisted of vascular structures and smooth muscle cells located on a fibrous ground. The case was reported as angiomyomatous hamartoma.

Conclusion: Angiomyomatous hamartomas are extremely rare lesions of the cervical lymph nodes and their consideration in differential diagnosis will reduce the risk of possible diagnostic error.

A Rare Entity in Cushing’s Disease: Severe Hypokalemia and Metabolic Alkalosis

2021-03-30T00:05:16+03:00

Objective: This case report aimed to highlight the prominence of considering Cushing's disease (CD) in the differential diagnosis of severe hypokalemia and metabolic alkalosis.

Case Report: A 63-year-old woman who was admitted to the emergency room with fatigue and severe weakness of extremities. Biochemistry results indicated severe hypokalemia (potassium = 1.2 mmol/L) and metabolic alkalosis (pH = 7.83) and based on further endocrinological investigations, the final diagnosis of CD was confirmed, and magnetic resonance imaging revealed a microadenoma in the right side of the pituitary gland. Transsphenoidal surgery was performed. After surgery, biochemical assessments showed normal potassium levels and corrected metabolic alkalosis without any further treatment. The hypothalamic–pituitary–adrenal axis recovered in nearly eight months and the patient was in remission.

Conclusions: Although hypokalemia could be present in CD, none of the previous studies have reported hypokalemia as severe as in this case. This case report highlighted the prominence of considering CD in the differential diagnosis of severe hypokalemia and metabolic alkalosis that could be a crucial part of biochemical features in CD.