Eozinofilik özofajitlerin klinik izlemi, epidemiyolojisi ve uygulanan tedavilerin değerlendirilmesi

Eozinofilik özofajit (EoE), özefagusta işlev bozukluğuna neden olan eozinofilik inflamasyon ile karakterize kronik immün aracılı bir hastalıktır. Eozinofilik özofajit patofizyolojisinde genetik faktörler ve gıda alerjisinin rol oynadığı düşünülmektedir. Bu çalışmada kliniğimizde EoE tanısı konulan hastaların klinik ve laboratuvar bulguları sunulmuş olup tedavi süreçleri incelenmiştir. Medipol Üniversitesi Çocuk Alerji ve Çocuk Gastroenteroloji Bilim Dalları tarafından Şubat 2014 – Mart 2022 tarihleri arasında endoskopik, klinik ve patolojik bulgularla EoE tanısı konulan hastaların verileri retrospektif olarak değerlendirildi. Hastalardan EoE tanısı ESPGHAN/NASPGHAN'ın 2011 yılında yayınladığı tanı algoritmasına göre konuldu. Hastaların demografik özellikleri, endoskopi ve biyopsi sonuçları, eozinofil sayısı, Ig E düzeyi, atopi deri testleri, alerjen spesifik Ig E düzeyleri, aldıkları tedaviler ve yanıtları analiz edildi. Ayrıca EoE'li çocuklarda semptomları ölçmek için semptom sıklığı ve bu semptomların şiddeti sorgulayan Pediatrik Eozinofilik Özofajit Semptom Skoru (PEÖSS) anketi zamanlı uygulandı. Çalışmaya 49 hasta dahil edilmiştir. EoE tanılı hastaların, ortanca yaşı 73±50 ay olup, 36'sı (%73,5) erkek, 13'ü (%26,5) kızdı. Hastaların ortalama izlem süresi 10ay (2,5-22) idi. Hastaların 15'inde (%31,2) reaktif havayolu hastalığı, 28 hastada alerjik rinit (%55), 8 hastada atopik dermatit (%16) mevcuttu. Hastaların %31,3'ünde ailesinde atopi vardı. Hastaların başvuru anındaki en sık görülen semptomları kusma (%51,2), karın ağrısı (%49,1), bulantı (%46,1), beslenme reddi (%36), takılma hissi (%30,8) idi. İzlem süresi boyunca hastaların %38'ine 1, %40'ine 2, %14,3'üne 3 defa, %2'sine 4, %2'sine 5 defa endoskopi yapılmıştır. İlk endoskopiden alınan biyopside bakılan ortalama eozinofil sayısı 45 ± 28,2 /BBA idi (15-130). Endoskopide en sık görülen bulgular özofagusta tren rayı %81,6 (n=40), trakealizasyon %59,2 (n=29), hiperemi %46,9 (n=23), beyaz noktalanma %44,9 (n=22) saptanmıştır. Kanda spesifik IgE pozitifliği; yumurta (n=14), inek sütü (n=13), ev tozu akarları (n=10), fx7 besin paneli (n=8) şeklinde bulunuştur. Deri prick testinde en yaygın gözlenen duyarlılıklar ise ev tozu akarları (n=7), inek sütü (n=5), 2 yumurta beyazı (n=3) olarak saptandı. Son yıllarda çocuklarda EoE sıklığı giderek artmaktadır. Özellikle alerjik rinit, astım gibi alerjik hastalıklar nedeni ile takip edilmekte olan çocukların izleminde, standart tedavilerle yanıt alınamayan gastrointestinal sistem bulguları olması durumunda EoE ayırıcı tanıda mutlaka düşünülmelidir. Ayrıca tedavinin zor olması, tedavi ve takipteki uyum problemleri hastalığın uzun dönemde multidisipliner bir şekilde takip edilmesini gerektirmektedir.Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by eosinophilic inflammation that causes dysfunction in the esophagus. Genetic factors and food allergy are thought to play a role in the pathophysiology of eosinophilic esophagitis. In this study, clinical and laboratory findings of patients diagnosed with EoE in our clinic were presented and their treatment processes were examined. The data of patients diagnosed with EoE by endoscopic, clinical and pathological findings between February 2014 and March 2022 by Medipol University, Department of Pediatric Allergy and Pediatric Gastroenterology were evaluated retrospectively. The diagnosis of EoE was made according to the diagnosis algorithm published by ESPGHAN/NASPGHAN in 2011. Demographic characteristics, endoscopy and biopsy results, eosinophil count, Ig E level, atopy skin tests, allergen-specific Ig E levels, treatments and responses of the patients were analyzed. In addition, the Pediatric Eosinophilic Esophagitis Symptom Score (PEOSS) questionnaire, which questions the frequency of symptoms and the severity of these symptoms, was applied in time to measure symptoms in children with EoE. 49 patients were included in the study. The median age of patients with EoE was 73±50 months, 36 (73.5%) male and 13 (26.5%) female. The mean follow-up period of the patients was 10 months (2.5-22). Reactive airway disease was present in 15 (31.2%) patients, allergic rhinitis in 28 patients (55%), and atopic dermatitis in 8 patients (16%). There was atopy in the family in 31.3% of the patients. The most common symptoms at the time of admission were vomiting (51.2%), abdominal pain (49.1%), nausea (46.1%), feeding rejection (36%), and a feeling of being stuck (30.8%). During the follow-up period, 38% of the patients underwent endoscopy once, 40% of them 2 times, 14.3% of them 3 times, 2% of them 4 times, and 2% of them 5 times. The mean eosinophil count in the biopsy taken from the first endoscopy was 45 ± 28.2 /BBA (15-130). The most common findings in endoscopy were train rail in the esophagus 81.6% (n=40), trachealization 59.2% (n=29), hyperemia 46.9% (n=23), 4 white spotting 44.9% (n=22) ) was detected. Specific IgE positivity in blood; eggs (n=14), cow's milk (n=13), house dust mites (n=10), fx7 food panel (n=8). The most common sensitivities observed in the skin prick test were house dust mites (n=7), cow's milk (n=5), and egg white (n=3). In recent years, the frequency of EoE has been increasing in children. EoE should definitely be considered in the differential diagnosis, especially in the follow-up of children who are being followed up for allergic diseases such as allergic rhinitis and asthma, and in case of gastrointestinal system findings that do not respond to standard treatments. In addition, the difficulty of treatment and the problems of compliance in treatment and follow-up require long-term multidisciplinary follow-up of the disease

The effects of vitamin D deficiency on mandibular bone structure: a retrospective radiological study

Objective The aim of the study was to evaluate the effects of vitamin D deficiency on the mandibular bone structure by fractal analysis and panoramic morphometric indices. Methods Ninety participants were divided into three groups as 30 individuals with severe vitamin D deficiency, 30 individuals with vitamin D deficiency, and 30 individuals with vitamin D sufficiency. Fractal dimension analysis (FD), panoramic mandibular index (PMI), mandibular cortical index (MCI), and mandibular cortical thickness measurement (CTM) were evaluated on panoramic radiographs. Results FD values of the patients with vitamin D deficiency were found to be statistically lower than the patients with vitamin D sufficiency (p 0.05). PMI was significantly lower in patients with severe vitamin D deficiency (p < 0.001). There was a significant difference in MCI values between the groups (p < 0.05). Conclusion Vitamin D deficiency causes a decrease in bone mineral density in the mandible, and an increase in alveolar porosity. FD analysis and radiomorphometric indices in panoramic radiographs can be used to assess osteoporotic changes in patients with vitamin D deficiency

EXAMINING THE EFFECTS OF THE PLIOMETRIC (JUMP SQUAT) EXERCISE ON VERTICAL JUMP IN FEMALE VOLLEYBALL PLAYERS

The aim of present study was to examine the effects of plyometric jump (jump squat) exercises on vertical jump, and to investigate the relation between these exercises and some physical fitness and other defining characteristics in female volleyball players. The sampling of the study consisted of 10 voluntary female players, who were active licensed players at Bursa Nova Sports Club in Turkey Volleyball 2nd League, and who had the following defining characteristics; age: 16±0.8 years; sports age: 9.5±0.1 years; height: 176±6.7 cm; body weight: 65.8±5.7 kg; fat %: 26.9±4.3; fat amount: 17.7±4.2 kg; lean weight 47.6 ± 3.1 kg, total body fluid 34.9±2.3. The participants did not face any disabilities or diseases in the past six months; and participated in the training program regularly. They applied a normal diet during the entire study process. A total of 6 trainings a week, 3 sets in each training, 30 jumps in each set, which means a total of a total of 24 trainings, 72 sets and 2160 plyometric jumps (jump squat) were added to the seasonal training programs of the players for 4 weeks. The Bosco Test was used. On Sunday, one day before the plyometric studies were started, the other 4 Vertical Jump Measurement Tests (T2, T3, T4, T5) -including the determining the vertical jump measurements test (T1) - were carried out on Sundays every weekend. The body composition was determined by the Tanita Body Composition Analyzer TBF-300. The data that were obtained in this way were analyzed with One-Way ANOVA and Pearson Correlations Coefficient tests in the SPSS for Windows 22 Statistical Program. As a result, a statistically significant relation was detected between the vertical jump, which is one of the descriptive characteristics of volleyball players, and the amount of fat % and fat (p˂0.05). The vertical jump arithmetic averages were determined to be T1 33.8±4.8 cm; T2 34.4±4.5 cm; T3 35.2±4.7 cm; T4 36.5±4.9 cm; T5 36.4±4.7 cm (F=34.353; p&lt;0.05). The effects of the plyometric exercises on vertical jump were found to be F=34.353 (p&lt;0.001). It can be claimed that the plyometric exercises that were applied on the volleyball players have positive effects and an inversely-proportional relation with body fat %, fat amount, and vertical jump.  Article visualizations

Efecto de diferentes dosis de esmolol sobre la respuesta hemodinámica, BIS y respuesta de movimiento durante la intubación orotraqueal: estudio prospectivo, aleatorizado y doble ciego

ResumenObjetivoEstudio prospectivo, aleatorizado y doble ciego para identificar la dosis ideal de perfusión de esmolol con el fin de suprimir el aumento de los valores del BIS y los movimientos y respuestas hemodinámicas a la intubación traqueal.Materiales y métodos120 pacientes fueron aleatoriamente ubicados en uno de los 3 grupos usando el método doble ciego. El propofol (2,5mgkg−1) se administró para la inducción de la anestesia. Después de la pérdida de la conciencia y antes de la administración del rocuronio (0,6mgkg−1), se aplicó un torniquete a un brazo y se insufló a 50mmHg por encima de la presión sistólica. Los pacientes fueron divididos en 3 grupos; se administró una dosis de 1mgkg−1h−1 de esmolol como carga, y se inició la perfusión de 50μgkg−1min−1 de esmolol en el grupo ES50, de 150μgkg−1min−1 en el grupo Es150, y de 250μgkg−1min−1 en el grupo ES250. Cinco minutos después del inicio de la perfusión, la tráquea se intubó, y se registró el total de movimientos al primer minuto después de la intubación orotraqueal.ResultadosLa incidencia de la respuesta de movimientos y los valores máximos de ΔBIS fueron comparables en los grupos ES250 y Es150, pero esos valores fueron significativamente más elevados en el grupo ES50 que en los otros 2 grupos. En los 3 grupos, los valores de frecuencia cardíaca y presión arterial promedio fueron significativamente mayores en el primer minuto postintubación, comparados con los valores preintubación (p<0,05). No hubo diferencia significativa entre los grupos con relación a la frecuencia cardíaca y a la presión arterial promedio durante el período de estudio.ConclusiónEn la práctica clínica, creemos que después de una dosis con carga de 1mgkg−1, una dosis de 150μgkg−1min−1 de esmolol i.v. es suficiente para suprimir la respuesta a la intubación traqueal sin aumentar los efectos colaterales.AbstractObjectiveA prospective, randomized and double-blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation.Materials and methods120 patients were randomly allocated to one of three groups in a double-blind fashion. 2.5mgkg−1 propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6mgkg−1 rocuronium, a tourniquet was applied to one arm and inflated to 50mmHg greater than systolic pressure. The patients were divided into 3 groups; 1mgkg−1h−1 esmolol was given as the loading dose and in Group Es50 50μgkg−1min−1, in Group Es150 150μgkg−1min−1, and in Group Es250 250μgkg−1min−1 esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded.ResultsIncidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation (p<0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure.ConclusionIn clinical practise we believe that after 1mgkg−1 loading dose, 150μgkg−1min−1 i.v. esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects

Post-traumatic stress disorder after terrorist attack in healthcare professionals

INTRODUCTION: On the date of 15 July 2016 a terrorist organization launched a terrorist attack using helicopters and heavy combat weapons in the city centers of Istanbul and Ankara simultaneously. Numerous civilian were hurt and many of them lost their lives during the attacks. Terrorism is a form of combat designed to cause the highest psychological influence on the masses. Post-traumatic stress disorder (PTSD) is one of the most common psychological disorders after such disasters. The aim of this study is to determine the associated risk factors and PTSD rates in healthcare professionals who were on call during the 15 July 2016 terrorist attacks. METHOD: Since the hospital is in a neighbouring the street to where terror attacks occurred, all healthcare professionals ≥ 18 years of age who were on duty that night in the Dr. Ridvan Ege Training and Research Hospital and were auditory or visual witnesses of the event were included in the study as the first group while healthcare professionals who work in the same hospital but were not on duty that night were included as the control group. RESULTS: The mean post-traumatic diagnostic scale stress score of the control group was 11.87. The mean post-traumatic diagnostic scale stress score of the Group 1 was 21.91. There was a significant difference between the groups in terms of posttraumatic diagnostic scale stress score (p &lt; 0.05). While the healthcare professionals on duty on July 15, 2016 (Group 1) had moderate-severe (21.91 ± 5.11) stress disorder, the healthcare professionals who were not at the hospital on July 15, 2016 (Control Group) had moderate stress disorder (11.87 ± 6.86). CONCLUSION: Our country is at risk from the fact that such attacks may be experienced again because of its unique conditions. The results of our work support the data on the high level of exposure to PTSD when exposed to a terrorist attack. For this reason, the identification of the characteristics of pre-traumatic health individuals at risk is useful in planning the presentation of preventive and curative health services. At the same time, there is a need for longer-term work and wider samples to reveal the psychological consequences of such attacks

Effect of the Toll-Like Receptor 4 Antagonist Eritoran on Retinochoroidal Inflammatory Damage in a Rat Model of Endotoxin-Induced Inflammation

Purpose. We investigated the effect of eritoran, a Toll-like receptor 4 antagonist, on retinochoroidal inflammatory damage in an endotoxin-induced inflammatory rat model. Methods. Endotoxin-induced inflammatory model was obtained by intraperitoneal injection of 1.5 mg/kg lipopolysaccharide (LPS). Group 1 had control rats; in groups 2-3 LPS and 0.5 mg/kg sterile saline were injected; and in groups 4-5 LPS and 0.5 mg/kg eritoran were injected. Blood samples were taken and eyes were enucleated after 12 hours (h) (groups 2 and 4) or 24 hours (Groups 3 and 5). Tumor necrosis factor-α (TNF-α) and malondialdehyde (MDA) levels in the serum and retinochoroidal tissue and nuclear factor kappa-B (NFκB) levels in retinochoroidal tissue were determined. Histopathological examination was performed and retinochoroidal changes were scored. Results. Eritoran treatment resulted in lower levels of TNF-α, MDA, and NFκB after 12 h which became significant after 24 h. Serum TNF-α and retinochoroidal tissue NFκB levels were similar to control animals at the 24th h of the study. Eritoran significantly reversed histopathological damage after 24 h. Conclusions. Eritoran treatment resulted in less inflammatory damage in terms of serum and retinochoroidal tissue parameters

Syndecan-1 (CD138) expression in acute myeloblastic leukemia cells - An immuno electron microscopic study

Syndecan-1 (CD138), an important transmembrane heparan sulfate proteoglycan is expressed in distinct stages of cell differentiation. Although its expression in acute lymphoblastic leukemia (ALL) cells is well known; its function or presence in acute myeloblastic leukemia (AML) cells is still largely unknown. The expression of syndecan-1 was studied in bone marrow biopsies of three patients with AML using electron microscopic immunocytochemistry. Positive expression of syndecan-1 was found in AML cells. These results suggest that syndecan-1 expression is not only a characteristic phenotypic marker for ALL, but is also expressed in AML cells