The importance of CBCT imaging to determine the characteristics of a bone sequestrum in a case of chronic osteomyelitis

Chronic osteomyelitis may show a suppurative course with abscess or fistula formation and sequestration at some stages, and persist for a variable period up to many years with intermittent exacerbation. The importance of imaging in osteomyelitis is threefold: to localize the condition, to find out its extent, and to assess the response after treatment. Conventional multislice computed tomography is a useful method of preoperative assessment, but it is not considered as the initial choice for imaging in osteomyelitis because of its reported lack of sensitivity in bone marrow disease. The Cone Beam Computed Tomography (CBCT) is used in dentistry to image high-contrast objects such as teeth and bone and it is particularly important for several applications including treatment planning for dental implants and evaluating dental and osseous diseases in the jaws and temporomandibular joints. However, CBCT provides a lower dose, lower cost alternative to conventional CT that promises to improve the practice of oral and maxillofacial radiology. In this case report the management of a patient with persistent suppurative osteomyelitis and its treatment assisted by Cone Beam Computed Tomography (CBCT) are presented

Kisspeptin levels in idiopathic hypogonadotropic hypogonadism diagnosed male patients and its relation with glucose-insulin dynamic

WOS: 000390162300014PubMed ID: 27616469Male hypogonadism is defined as the deficiency of testosterone or sperm production synthesized by testicles or the deficiency of both. The reasons for hypogonadism may be primary, meaning testicular or secondary, meaning hypothalamohypophyseal. In hypogonadotropic hypogonadism (HH), there is indeficiency in gonadotropic hormones due to hypothalamic or hypophyseal reasons. Gonadotropin-releasing hormone (GnRH) is an important stimulant in releasing follicular stimulant hormone (FSH), mainly luteinizing hormone (LH). GnRH omitted is under the effect of many hormonal or stimulating factors. Kisspeptin is present in many places of the body, mostly in hypothalamic anteroventral periventricular nucleus and arcuate nucleus. Kisspeptin has a suppressor effect on the metastasis of many tumors such as breast cancer and malign melanoma metastases, and is called "metastin'' for this reason. Kisspeptin is a strong stimulant of GnRH. In idiopathic hypogonadotropic hypogonadism (IHH) etiology, there is gonadotropic hormone release indeficiency which cannot be clearly described. A total of 30 male hypogonatropic hypogonadism diagnosed patients over 30 years of age who have applied to Haydarpasa Education Hospital Endocrinology and Metabolic Diseases Service were included in the study. Compared to the control group, the effect of kisspeptin on male patients with hypogonatropic hypogonadism and on insulin resistance developing in hypogonadism patients was investigated in our study. A statistically significant difference was detected between average kisspeptin measurements of the groups (p < 0.01). Kisspeptin measurement of the cases in the patient group were detected significantly high. No statistically significant relation was detected among kisspeptin and LH/FSH levels. Although a positive low relation was detected between kisspeptin measurements of patient group cases and homeostasis model assessment of insulin resistance (HOMA-IR) measurements, this relation was statistically insignificant. When the patient and control groups were compared for HOMA-IR, no statistically significant difference was detected. The reason for high kisspeptin levels in the patient group compared to the control group makes us consider that there may be a GPR54 resistance or GnRH neuronal transfer pathway defect. When patients and control groups were compared for HOMA-IR, the difference was not statistically significant. It is considered that kisspeptin is one of the reasons for hypogonatropic hypogonadism and has less effect on insulin resistance

Impact of glucocorticoid receptor gene (NR3C1) polymorphisms in Turkish patients with metabolic syndrome

WOS: 000374102700010PubMed ID: 26596278Background The metabolic syndrome (MetS) is characterized by a cluster of metabolic factors, including insulin resistance and type-2 diabetes, abdominal obesity, dyslipidemia, hypertension and microalbuminuria. Impaired glucocorticoid receptor (GR) activity also plays an important role in the etiology of MetS. The objective of our study is to evaluate the effects of GR gene polymorphisms (BclI, N363S, TthIII1 and ER22/23EK) in Turkish patients with MetS. Materials and methods Seventy subjects with MetS and 185 healthy controls were enrolled in the study. PCR-RFLP analysis was used for genotyping. Results for each polymorphism have been verified by allele-specific oligonucleotide analysis. Results BclI GG genotype was significantly associated with an increased risk of MetS (p = 0.02). Also, only in women, the G allele carriers were significantly associated with higher C-peptide. T allele carriers of TthIII1 polymorphism were significantly associated with higher C-peptide, triglyceride, insulin and C-reactive protein (CRP, p value 0.048, 0.022, 0.005 and 0.022, respectively), and lower fasting blood glucose (FBG, p = 0.02). The combined carriers of BclI polymorphism G allele and TthIII1 polymorphism T allele were significantly associated with higher diastolic blood pressure in all patients, and lower FBG and postprandial blood glucose in only men. All the ER22/23EK polymorphisms coexisted with polymorphic variant of TthIII1 (p = 0.0058). Conclusion The presence of homozygote polymorphic variant of BclI might be good predictive markers for the disease susceptibility. The BclI and the TthIII1 polymorphism are associated with sex-specific clinical parameters. Our findings also suggest that the combination of BclI and TthIII1 polymorphisms may play a protective role in blood glucose.Scientific and Technological Research Council of Turkey (TUBITAK) [104S272, SBAG-K-60]; Research Foundation of Marmara University (BAPKO) [SAG-C-DRP-101011-0286]The authors appreciate Dr. Can Erzik for his critical revision of the manuscript. This work was partly supported by a grant (104S272, SBAG-K-60 to SC) from the Scientific and Technological Research Council of Turkey (TUBITAK) and grants (SAG-C-DRP-101011-0286 to AO) from the Research Foundation of Marmara University (BAPKO)

A Randomized Controlled Comparison of Effects of Three Different Agents Used for Local Anesthesia in Transrectal Ultrasound-Guided Prostate Biopsy

Objective: To evaluate the effects of three different local anesthetic agents in patients who underwent Transrectal ultrasoun guided prostate needle biopsy. Materials and Methods: One hundred and sixty patients who were admitted to our clinic between January 2012 and May 2012 for prostate biopsy were divided into 4 groups: no anesthesia-administered group (group 1), lidocaine-administered group (group 2), levobupivacaine-administered group (group 3) and bupivacaine-administered group (group 4). Pain intensity was evaluated in each group using the visual analog scale (VAS): during administration of local anesthetic (VAS 1), during the biopsy (VAS 2), just after the biopsy (VAS 3) and one hour after the biopsy (VAS 4). Results: There was not any significant difference among the groups in terms of VAS 1 (p=0.152). Pain scores were significantly lower during biopsy (VAS 2) in groups 1, 2 and 3 compared to that in group 1 (p=0.001, p=0.005 and p=0.007, respectively). VAS 3 scores were significantly lower in group 2 and group 3 compared to group 1 while no difference was found in group 4 (p=0.003, p=0.032, and p=0.136, respectively). VAS 4 scores were significantly lower only in group 3 compared to group 1 (p=0.001). Conclusions: It was observed that all the three local anesthetics effectively diminished pain during prostate biopsy. However, we found that levobupivacaine, which improved pain scores in all steps of pain evaluation compared to the control group, was relatively superior for pain management in the transrectal biopsy setting

Post-Burn Skin Deformities of the Face and Neck Region in Pediatric Patients: Single-Stage Treatment Using Collagen Elastin Matrix

Objective: Treating severe post-burn deformities of the face and neck region in pediatric populations is challenging because of technical difficulties (e.g., limited full thickness skin graft donor site, limited flap options, unavailability for expander placement) and increased donor site morbidity (e.g., related to flap and graft donor sites). In this study, we present the single-stage treatment of severe post-burn skin deformities of the face and neck region in pediatric patients using collagen-elastin matrix (Matriderm®) combined with partial thickness skin grafts. Material and Methods: The total number of cases was eight (four females, four males), and the ages were between two and 11 years. All cases were operated on for only one region. Following the release of contractures and/or excision of wide excessive/ unfavorable dermal scars, defects were reconstructed using collagen- elastin matrix (Matriderm®) combined with partial-thickness skin grafts. The final functional and aesthetic results were evaluated using photography and examination. Results: The deformities were in the form of contractures and/ or excessive dermal scarring. The involved regions were the face (n=3) and neck (n=5). The grafts yielded favorable plication and texture, and no recurrence of excessive dermal scarring was observed. All contractures healed unproblematically. Two patients were re-operated on for regrafting caused by minor graft loss (5% and 12% of the total area, respectively). Conclusion: In this study, we observed that collagen elastin matrix combined with partial-thickness skin grafts provides a favorable option for the treatment of pediatric late post-burn complications in the face and neck region with limited surgical options

Autosomal recessive spastic tetraplegia caused by AP4M1 and AP4B1 gene mutation: Expansion of the facial and neuroimaging features

Adaptor protein complex-4 (AP4) is a component of intracellular transportation of proteins, which is thought to have a unique role in neurons. Recently, mutations affecting all four subunits of AP4 (AP4M1, AP4E1, AP4S1, and AP4B1) have been found to cause similar autosomal recessive phenotype consisting of tetraplegic cerebral palsy and intellectual disability. The aim of this study was analyzing AP4 genes in three new families with this phenotype, and discussing their clinical findings with an emphasis on neuroimaging and facial features. Using homozygosity mapping followed by whole-exome sequencing, we identified two novel homozygous mutations in AP4M1 and a homozygous deletion in AP4B1 in three pairs of siblings. Spastic tetraplegia, microcephaly, severe intellectual disability, limited speech, and stereotypic laughter were common findings in our patients. All patients also had similar facial features consisting of coarse and hypotonic face, bitemporal narrowing, bulbous nose with broad nasal ridge, and short philtrum which were not described in patients with AP4M1 and AP4B1 mutations previously. The patients presented here and previously with AP4M1, AP4B1, and AP4E1 mutations shared brain abnormalities including asymmetrical ventriculomegaly, thin splenium of the corpus callosum, and reduced white matter volume. The patients also had hippocampal globoid formation and thin hippocampus. In conclusion, disorders due to mutations in AP4 complex have similar neurological, facial, and cranial imaging findings. Thus, these four genes encoding AP4 subunits should be screened in patients with autosomal recessive spastic tetraplegic cerebral palsy, severe intellectual disability, and stereotypic laughter, especially with the described facial and cranial MRI features. (c) 2014 Wiley Periodicals, Inc

ABSTRACT Are Family Physicians and Medical Students Aware of Chronic Hepatitis C Infection?

Introduction: Chronic hepatitis C is a public health problem that can result in cirrhosis, liver cancer, and death, which can be cured with current treatments. In our study, we evaluated the level of knowledge and awareness of medical school students and family physicians about chronic hepatitis C.Materials and Methods: Our study was carried out between 01.06.2022 and 01.08.2022, between the 1st and 6th grade medical students, family physicians (family medicine residents, family medicine specialists) using an online questionnaire.Results: In our study, 536 medical faculty students and 162 family physicians were recruited. Two hundred seventy one (50.6%) of the students were male and the median age was 23.0 (2.0) years. Of the family physicians, 84 (51.2%) were male, the median age was 30 (24-68) years and the median time in the profession was 14.5 (1-40) years. Students answered 69.2% of the questions correctly, and family physicians answered 73% correctly. While the students knew the transmission routes of hepatitis C mostly (97.2%), they got the less information about the testing (34.9%) and treatment (21.9%). Family physicians answered the questions about the transmission routes of hepatitis C with a high rate (99.4%), and the questions about the groups that should be tested (28%) and the questions about the treatment of hepatitis C less correctly (29.4%). In the multivariate analysis, the factors affecting the median knowledge score of the students were male gender (p= 0.019), the student's class (p= 0.002), having Infectious diseases and clinical microbiology committee (p= 0.005) and gastroenterology committee (p= 0.027). The only factor affecting the median knowledge score of family physicians was the use of online presentations by experts in their fields as a source of information (p= 0.003). 67% of the students and 87.2% of the family physicians answered the question How do you manage the person when the anti-HCV screening test is positive? as I will refer the patient to the infectious diseases and clinical microbiology or gastroenterology .Conclusion: In our study, it was found that awareness of screening and treatment was low in both groups. Considering that the main factors related to the level of knowledge of medical students are having committee of the gastroenterology and infectious diseases and clinical microbiology, and online presentations of experienced teachers in family physicians, preparing a special content for these groups may be useful in raising awareness and level of knowledge