Incisional hernia as an unusual cause of hepatic encephalopathy in a 62-year-old man with cirrhosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hepatic encephalopathy may be initiated by many factors such as gastrointestinal bleeding, infections, fluid and electrolyte disturbances. Hypokalemia is one of the most commonly encountered electrolyte abnormalities causing hepatic encephalopathy in patients with cirrhosis.</p> <p>Case presentation</p> <p>We present the case of a 62-year-old Caucasian man with decompensated liver cirrhosis having multiple episodes of hepatic encephalopathy precipitated by vomiting. He had an incisional hernia at the right lumbar region. A barium contrast study of the small intestine and magnetic resonance imaging showed that the hernial sac included gastric antrum and bowel. We observed that hepatic encephalopathy coincided with hypokalemia as a result of a large volume of vomiting triggered by the collapsed hernial sac. Hepatic encephalopathy was resolved by administration of intravenous potassium.</p> <p>Conclusion</p> <p>This case illustrates that a hernia causing a large volume of vomiting may be a precipitant factor in the development of hepatic encephalopathy.</p

Güçlendirilmiş dental seramiklerin vickers sertlikleri ve yük altında kırılma davranışları

Objective: The objectives of this study were to determine the Vicker`s hardness of reinforced dental ceramics and determine the modes of fractures under load. Methods: Four ceramic core groups (n=7/group) from leucite (Evopress,Wegold&amp;De), low leucite (Finesse, Ceramco), glass-infiltrated (Inceram Alumina,Vita) and lithium disilicate materials (E.max press, Ivoclar) were fabricated according to each manufacturers’ instructions (thickness: 3 mm, diameter: 5 mm). Their individual veneering ceramics were vibrated, condensed in a stainless steel mold (diameter: 5 mm, height: 5 mm) and fired on the core materials. The specimens were stored in distilled water at 37°C for 24 hours prior to indentation tests and embedded in polyesther moulds. Vickers hardness values (DUH±SD) were measured (cross-head speed:7,2 gf/s, load:200 gf) and statistically analysed (ANOVA). A load of 400 N was applied on the surfaces of specimens with a diamond indentor (diameter:1 mm) at the macro hardness test machine for crack formation. The crack modes for each group were observed under the scanning electrone microscope. Results: The Vickers hardness values for low leucite veneering ceramic were significantly (P&lt;0.05) higher (236±17), followed by the leucite (129±51), glass-infiltrated (117±38), and lithium disilicate (85±34) veneering ceramic materials in decreasing order. Mainly radial or cone cracks were observed after the application of load. Conclusion: The increase in the hardness of the material led to more crack formation and resulted in longer cracks. No crack formation extending to the core materials were observed in neither of the ceramic groups under these experimental conditions. ÖZET Amaç: Bu çalışmanın amacı güçlendirilmiş dental seramiklerin Vickers sertlik değerlerinin ve yük altındaki kırılma şekillerinin belirlenmesidir. Gereç ve Yöntem: Lösit (Evopress,Wegold&amp;De), düşük lösit (Finesse, Ceramco), cam infiltrasyonlu aluminöz seramik (Inceram Alumina,Vita) ve lityum disilikat (E.max press, Ivoclar) bazlı dört farklı seramik alt yap_ materyali (n=7/grup) her bir üretici firmanın önerileri doğrultusunda hazırlandı (3 mm kalınlıkta; 5 mm çapta). Her bir alt yapı seramiğine özgü kaplama seramikleri; paslanmaz çelik bir metal kalıpta (5mm çap 5mm yükseklikte) vibrasyonla kondanse edildi ve alt yapı seramiklerinin üzerine pişirildi. Örnekler batırma testlerinden önce 37°C’ de 24 saat distile suda bekletildikten sonra polyester kalıplara gömüldü. Vickers sertlik değerleri (DUH±SD) ölçüldü (çene hızı:7,2 gf/s, yük:200 gf) ve veriler istatistiksel olarak analiz edildi (ANOVA). Çatlak oluşumu için örneklerin üst yüzeylerine makro sertlik test cihazında batıcı elmas uç ile (1 mm çaplı) 400 N yük uygulandı. Alınan taramalı elektron mikroskop görüntüleri ile her bir gruba ilişkin çatlak şekilleri gözlemlendi. Bulgular: Gruplar arasında ortalama Vickers sertlik değerleri düşük lösit grubu için anlamlı olarak (P&lt;0.05) en yüksek bulunur iken (236±17), bunu lösit (129±51), cam infiltrasyonlu aluminöz seramik (117±38), ve lityum disilikat (85±34) kaplama seramik materyalleri azalan sırayla izledi. Yük uygulaması sonrasında genellikle ışınsal ya da koni şekilli çatlakların oluştuğu gözlendi. Sonuç: Seramik materyalin sertliğinin artması daha fazla ve daha uzun çatlak oluşumuna yol açtı. Bu çalışmadaki deneysel koşullar altında kaplama seramik gruplarının hiçbirinde alt yapı seramiklerine ulaşan çatlak oluşumu gözlenmedi

Could an Increased Percentage of Immature Granulocytes Accompanying Dyspepsia Predict COVID-19?

Background and Aim: Although vaccination practices continue at a fast pace around the world, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still threatens people&rsquo;s lives. In this study, we aimed to determine the presence of SARS-CoV-2 in patients who do not have the typical symptoms of the novel coronavirus disease 2019 (COVID-19), but only present with dyspepsia, and to investigate the role of immature granulocytes in the early diagnosis of these patients. Material and Methods: Adult and pediatric patients suffering from dyspepsia were included in the study. The patients were divided into two groups, &lsquo;&lsquo;positive&rsquo;&rsquo; and &lsquo;&lsquo;negative&rsquo;&rsquo;, based on their SARS-CoV-2 polymerase chain reaction test results. Immature granulocyte count (IG), immature granulocyte percentage (IG%), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) values were recorded. Results: A total of 238 patients, including 25 (10.5%) pediatric and 213 (89.5%) adult patients, were included in the study. A total of 2 (8%) pediatric patients and 17 (7.9%) adult patients tested positive for SARS-CoV-2. The IG, IG%, and CRP parameters were significantly higher in the SARS-CoV-2-positive patients compared to the SARS-CoV-2-negative patients. The optimal cut-off value predictive of COVID-19 infection was determined to be &ge;0.650 (sensitivity: 52.6% and specificity: 95.5%, p = 0.001) for IG%. Conclusions: It should be noted that dyspepsia may also be a COVID-19 symptom. IG% values, which can be determined with a hemogram test, a cheap and easily accessible test, may be a warning in the early detection of patients who do not have the typical symptoms of COVID-19

Effect of Perceived Social Support on Psychosocial Adjustment of Turkish Patients with Breast Cancer

Aims: To identify the psychosocial adjustment of Turkish patients with breast cancer and the effects of perceived social support on their adjustment. Materials and Methods: The sample comprised 100 volunteering patients diagnosed with breast cancer in the last six months reporting to the Outpatient Chemotherapy Unit at the Medical Faculty Hospital in northern Turkey. The data for the study were collected through the Descriptive Information Form, the Psychosocial Adjustment to Illness Scale-Self-reflection (PAIS-SR) and the Cancer-Specific Social Support Scale and analyzed via SPSS 16.0 for Windows. Descriptive statistics, Chi square test, ANOVA and correlation were used to evaluate data. Results: There was a negative significant correlation between mean scores in the sub-scales of the social support scale and the ones in the sub-scales of the psychosocial adjustment to illness scale (p<0.05). Similarly, there was a negative significant correlation between confidence support and health care orientation as well as adjustment to social environment. Likewise, emotional support was in a negative significant correlation with health care orientation, adjustment to domestic environment, extended family relationships and adjustment to social environment. Conclusions: It was concluded that social support for patients with breast cancer had an influence on their psychosocial adjustment to illness. Holistic care should be given to breast cancer patients by oncology nurses especially in the first six months of treatment. It could be concluded that patients should be accompanied by their family/relatives in treatment and care following their diagnosis with breast cancer, that their family should be made more aware of the fact that the patient should be physically and psychologically supported, that patients with breast cancer should be provided with domiciliary care, and that they should be encouraged to participate in social support groups

Integration search strategies in tree seed algorithm for high dimensional function optimization

Kiran, Mustafa Servet/0000-0002-5896-7180; CINAR, Ahmet Cevahir/0000-0001-5596-6767WOS: 000512019400002The tree-seed algorithm, TSA for short, is a new population-based intelligent optimization algorithm developed for solving continuous optimization problems by inspiring the relationship between trees and their seeds. The locations of trees and seeds correspond to the possible solutions of the optimization problem on the search space. By using this model, the continuous optimization problems with lower dimensions are solved effectively, but its performance dramatically decreases on solving higher dimensional optimization problems. In order to address this issue in the basic TSA, an integration of different solution update rules are proposed in this study for solving high dimensional continuous optimization problems. Based on the search tendency parameter, which is a peculiar control parameter of TSA, five update rules and a withering process are utilized for obtaining seeds for the trees. The performance of the proposed method is investigated on basic 30-dimensional twelve numerical benchmark functions and CEC (congress on evolutionary computation) 2015 test suite. The performance of the proposed approach is also compared with the artificial bee colony algorithm, particle swarm optimization algorithm, genetic algorithm, pure random search algorithm and differential evolution variants. Experimental comparisons show that the proposed method is better than the basic method in terms of solution quality, robustness and convergence characteristics

A case of idiopathic pulmonary alveolar proteinosis

AbstractIdiopathic pulmonary alveolar proteinosis (PAP) is a rare disease due to impaired alveolar macrophage function caused by neutralising anti-granulocyte-macrophage colony-stimulating autoantibodies. A nineteen years old male patient was admitted with the complaints of cough, sputum production, dyspnea and fever. There were bilaterally inspiratory fine crackles. The chest radiographs showed bilateral air-space consolidation. On thorax computed tomography; pre-carinal lymph nodes enlargement, ground glass opacities, septal thickening and crazy-paving appearance were determined. Bronchoalveolar lavage was performed and reported was PAP

Effects of Sulphasalazine in Cerebral Ischemia Reperfusion Injury in Rat

DINCEL, Gungor Cagdas/0000-0002-6985-3197; KISA, Ucler/0000-0002-8131-6810WOS: 000411909400004PubMed: 28923326Background. Management of cerebral ischemia/reperfusion (I/R) injury is still difficult process today. Aims of the Study. Aim of present study was to investigate therapeutic properties of sulfasalazine in cerebral transient I/R injury in rat. Methods. Except Control group (n = 5), 20 Wistar albino rats were allocated for acute and chronic stage investigation of I/R injury, and temporary aneurysm clips were attempted to both internal carotid arteries for thirty min. Four hours later, 40 mg/kg once a day sulfasalazine was administered to animals of SL-A and SL-C groups, orally. Animals were decapitated, following which pyknotic and necrotic neuronal cells, perivascular edema, irregularities of intercellular organization (IIO) of hippocampal regions, and cortical necrotic neurons of parietal lobe were counted or scaled histopathologically. Tissue malonyldialdehyde (MDA), myeloperoxidation (MPO), total nitrite/nitrate (NO), interleukin 1-beta (IL-1 beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) level values were evaluated biochemically. Results. Sulfasalazine could reduce perivascular edema, 110, cortical and hippocampal neuronal cell death in both stages. It could decrease MDA in acute stage, but not reduce IL-1 beta, IL-6, MPO, NO, and TNF alpha levels. It could increase IL-1 beta levels in chronic stage but not affect to IL-6, MPO, MDA, NO, TNF-alpha levels. Conclusion. Sulfasalazine could improve histopathological architecture of hypoxic tissue in both stages of FR injury in rat. It could inhibit lipid peroxidation cascades just in acute stage. These results suggested that therapeutic mechanisms of sulfasalazine in cerebral I/R injury should be investigated by using more specific laboratory methods in future studies. (C) 2017 IMSS. Published by Elsevier Inc