Congenital Agenesis of Right Internal Carotid Artery: A Report of Two Cases

Congenital unilateral agenesis of the internal carotid artery (ICA) is a rare anomaly. Due to proper sufficient collateral circulation via the circle of Willis most cases are asymptomatic, but patients can also present with ischemic or hemorrhagic cerebrovascular insults. The absence of the bony carotid canal is essential to differentiate this anomaly from chronic ICA occlusion. Awareness of this situation by clinicians and radiologists is essential because these patients have an increased incidence of various intracranial pathologies. We report two cases of this rare developmental congenital abnormality occurring in two young patients and describe the presentation, diagnosis, determined developmental causes, imaging findings, and complications

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

THE PREDICTIVE POWER OF RELIGIOUS ORIENTATION TYPES ON AMBIVALENT SEXISM

Objective: The purpose of this study is to examine stress and stress related factors in tuberculosis patients. In addition, to determine the impact of socio-demographic variables such as age, gender and educational level over stress symptoms hereby comprises a further objective of this study. Method: The study included totally 129 tuberculosis patients and 161 non-patients (normal group) participants. Tuberculosis patients registered in Ankara Tuberculosis Dispensary No.4, and Atatürk Chest Diseases and Chest Surgery Hospital. There are 75 Pulmonary Tuberculosis (AC TB) and 54 Extra- Pulmonary Tuberculosis (AD TB) patients. As regards data collection tools; Demographic Information Form, Brief Symptom Inventory, Stress Symptoms Scale, Stress Vulnerability Scale, and Stress Coping Scale were used. Results: Within the context of diagnosis groups; it was found that; stress symptoms of tuberculosis patients are higher than the normal group, they use their ineffective coping ways more and their life satisfactions are lower. There exists no gender and diagnosis group main effect in terms of the psychological symptoms of stress, however “gender x diagnosis group” interaction effect draws attention herein. In tuberculosis patients, ineffective coping the stress and relation pleasure variables are confronted as joint variables which are predicting both the psychological and physical health. Another point which draws attention in regression analyzes is that; “education” variable takes place among the variables which predict the psychological symptoms of stress in tuberculosis patients. Conclusion: Under the light of these findings, tuberculosis patients, during their treatment processes, may be encouraged to attend various training programs prepared for stress management and effective dealing strategies with stress. By increasing the patients’ motivation towards the treatment, these programs may provide supplementary benefits to the treatment by the elimination of risk factors, which are important challenging factors against treatment, such as irregular use of drugs and/or interruption of treatment. Besides, allowing various techniques (relaxation, biofeedback, etc.) for physical complaints may provide the patients to get relaxed and to obtain better results from the treatment

Electrophysiological basis of metabolic syndrome-induced cardiac dysfunction

Myocardial contractility is controlled by intracellular Ca2+-cycling with the contribution of sarcoplasmic reticulum (SR). In this study we aimed to investigate the role of altered SR function in defective regulation of intracellular Ca2+ levels in rats with metabolic syndrome (MetS) induced by a 16-week high-sucrose drinking-water diet. Electric-field stimulated transient intracellular Ca2+-changes in MetS-cardiomyocytes exhibited significantly reduced amplitude (30%) and prolonged time courses (2-fold) as well as depressed SR-Ca2+ loading (55%) with increased basal Ca2+ level. Consistent with these data, altered ryanodine receptor (RyR2) function and SERCA2a activity were found in MetS-cardiomyocytes through Ca2+ spark measurements and caffeine application assay in a state in which sodium calcium exchanger was inhibited. Furthermore, tetracaine application-assay results and hyperphosphorylated level of RyR2 also support the “leaky RyR2” hypothesis. Moreover, altered phosphorylation levels of phospholamban (PLN) support the depressed SERCA2a-activity thesis and these alterations in the phosphorylation of Ca2+-handling proteins are correlated with altered protein kinase and phosphatase activity in MetS-cardiomyocytes. In conclusion, MetS-rat heart exhibits altered Ca2+ signaling largely due to altered SR function via changes in RyR2 and SERCA2a activity. These results point up RyR2 and SERCA2a as potential pharmacological targets for restoring intracellular Ca2+-homeostasis and thereby combatting dysfunction in MetS-rat heart.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

A SGLT2 inhibitor dapagliflozin suppresses prolonged ventricular-repolarization through augmentation of mitochondrial function in insulin-resistant metabolic syndrome rats

Abstract Background Metabolic syndrome (MetS) is a prevalent risk factor for cardiac dysfunction. Although SGLT2-inhibitors have important cardioprotective effects in hyperglycemia, their underlying mechanisms are complex and not completely understood. Therefore, we examined mechanisms of a SGLT2-inhibitor dapagliflozin (DAPA)-related cardioprotection in overweight insulin-resistant MetS-rats comparison with insulin (INSU), behind its glucose-lowering effect. Methods A 28-week high-carbohydrate diet-induced MetS-rats received DAPA (5 mg/kg), INSU (0.15 mg/kg) or vehicle for 2 weeks. To validate MetS-induction, we monitored all animals weekly by measuring body weight, blood glucose and HOMO-IR index, electrocardiograms, heart rate, systolic and diastolic pressures. Results DAPA-treatment of MetS-rats significantly augmented the increased blood pressure, prolonged Q–R interval, and low heart rate with depressed left ventricular function and relaxation of the aorta. Prolonged-action potentials were preserved with DAPA-treatment, more prominently than INSU-treatment, at most, through the augmentation in depressed voltage-gated K+-channel currents. DAPA, more prominently than INSU-treatment, preserved the depolarized mitochondrial membrane potential, and altered mitochondrial protein levels such as Mfn-1, Mfn-2, and Fis-1 as well as provided significant augmentation in cytosolic Ca2+-homeostasis. Furthermore, DAPA also induced significant augmentation in voltage-gated Na+-currents and intracellular pH, and the cellular levels of increased oxidative stress, protein-thiol oxidation and ADP/ATP ratio in cardiomyocytes from MetS rats. Moreover, DAPA-treatment normalized the increases in the mRNA level of SGLT2 in MetS-rat heart. Conclusions Overall, our data provided a new insight into DAPA-associated cardioprotection in MetS rats, including suppression of prolonged ventricular-repolarization through augmentation of mitochondrial function and oxidative stress followed by improvement of fusion–fission proteins, out of its glucose-lowering effect

Applying postoperative radioiodine therapy before 3 months seems to decrease ablation success in patients with differentiated thyroid carcinoma

Objectives Radioiodine can be applied for remnant ablation in low and low to intermediate-risk patients with differentiated thyroid cancer (DTC). A controversy still exists about the application time interval of radioiodine following total thyroidectomy. In this study, we investigated the effect of radioiodine (RAI) therapy timing on the success rates of the ablation. Methods We retrospectively reviewed the data of DTC patients who underwent total thyroidectomy and were treated with radioiodine remnant ablation during 2013-2017. Because the objective of this study was to determine the success of ablation according to the postoperative RAI therapy timing, any patients with a pathologic uptake outside the thyroid bed as well as high-risk patients determined before and at RAI therapy were excluded from the study. Finally, 503 patients with low and low to intermediate-risk groups were included in the study. Successful ablation was defined as no visible focal uptake on the neck on I-131 whole body scan with stimulated thyroglobulin (Tg) level of 3 months in 352 (70.0%) patients. The ratio of successful ablation was statistically higher in patients with a titRAI > 3 months (81.2% of patients) than in patients with 0.5). Conclusion Investigated the effect of radioiodine therapy initiated before 3 months after total thyroidectomy and it seems to decrease ablation success