Delay in the diagnosis of SLE: the importance of arthritis/arthralgia as the initial symptom.

Despite the current diagnostic and serologic testing for SLE, the interval between the onset of symptoms and the diagnosis is still long. In this study, we aimed to show the interval between the initial symptoms and the diagnosis of SLE and to investigate the presence of any relationship between the interval and the initial symptoms. One hundred and thirty-six patients were diagnosed with SLE using the 1982 ARA criteria. The mean age of the patients at diagnosis was 29.9 +/- 10.5 years. The mean interval between the onset of symptoms and the diagnosis of SLE was 21.82 +/- 30.32 months. The subjects were evaluated twice, at intervals of &#60; or = 3 and &#60; or = 12 months after the onset of symptoms. Although arthritis and/or arthralgia were the most common initial symptoms (60.3%), only 26.8% of the patients with these symptoms were diagnosed earlier than 3 months after the onset. If the first initial symptoms were butterfly rash or pericarditis, pleuritis, spontaneous abortion or cognitive dysfunction, they led to early diagnosis. In conclusion, since arthritis and/or arthralgia are the most common initial symptoms of the disease, every young woman with these symptoms should be carefully evaluated for SLE.</p

Paraesthesia Caused by the Separated Endodontic Instrument: Case Report

Abstract In endodontics, separated endodontic instruments located in the mandibular canal may cause an injury of the inferior alveolar nerve (IAN) resulting in disabling sensory disturbances such as pain, paraesthesia, and dysaesthesia of the lower lip and chin area. In clinically paraesthesia usually manifests as numbness, tingling or any deviation from normal sensation. The suggested therapeutic sequence for endodontic related paraesthesia is the control of pain and inflammation and, whenever possible, the surgical elimination of the cause. A healthy 33-yearold woman was referred to the Department of Endodontics, Oral and Dental Healthy Hospital, Eskişehir suffering from pain and paraesthesia in the left lower lip and chin. Radiographic examination revealed the presence of a separated endodontic instrument beyond the apex of the mandibular left second molar and this instrument was inside the left mandibular canal. Damage to the IAN secondary to extrusion of a separated endodontic instrument was diagnosed. Extraction of the tooth was decided and after prednisone and pregabalin treatments both pain and paraesthesia on the left side of the lower lip and chin were gone

Using Expert Opinion to Quantify Uncertainty in and Cost of Using Nondestructive Evaluation on Bridges

A previous literature review indicated that there is little published experimental data that can be used to determine quantities such as bias, accuracy, reliability, and cost of common Nondestructive Evaluation (NDE) methods as far as their use on bridges is concerned. This study attempts to quantify these parameters for common bridge NDE methods through a four-round Delphi method survey with experts in the NDE bridge field. The survey results indicate that most commonly used bridge NDE methods tend to be underbiased and relatively reliable. Furthermore, the accuracy of commonly used bridge NDE methods tends to be relatively variable with the average test measuring a true response between 80% and 85% of the time. In general, it was shown by the participant responses that the more expensive the method was, the better the bias, accuracy, and reliability the method had, and vice versa. The information presented in this paper can serve as a starting point for characterizing different NDE methods for use in bridge management and inspection planning and identifies the type of information that is still needed. As such, this research has the potential to promote further research on this subject

Predictors of mortality in patients with prosthetic valve infective endocarditis: A nation-wide multicenter study

Background: Our aim was to investigate the clinical and prognostic features of the patients with prosthetic valve endocarditis (PVE) in a multicenter nation-wide study.Methods: The present nation-wide study consisted of 75 consecutive patients with PVE treatedat 13 major hospitals in Turkey from 2005 to 2012.Results: The patients who died during follow-up were significantly older than the survivors and had higher C-reactive protein (CRP), creatinine, poor NYHA functional class and large vegetations. High creatinine level (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.14–6.13), poor functional status (OR 24.5; 95% CI 3.1–196.5) and high CRP (OR 1.02; 95% CI1.00–1.03) measured on admission were independent risk associates for in-hospital mortality.Conclusions: High creatinine level, poor functional status and high CRP measured on admission were independent risk associates for in-hospital mortality, whereas a NYHA class ofIII/IV and high CRP reflected independent risk for stroke/mortality end point

N-Ethyl-N-(2-meth­oxy­phen­yl)benzene­sulfonamide

In the title mol­ecule, C15H17NO3S, the C—S—N—Cbenzene torsion angle is 81.45 (16)°, and the two aromatic rings form a dihedral angle of 45.83 (12)°. In the crystal structure, weak inter­molecular C—H⋯O hydrogen bonds link the mol­ecules into chains parallel to the b axis

N-Cyclo­hexyl-4-meth­oxy­benzene­sulfonamide

In the title mol­ecule, C13H19NO3S, the S atom has a distorted tetra­hedral geometry with an O—S—O bond angle of 120.39 (18)°. The cyclo­hexane ring has a chair conformation. In the crystal, mol­ecules are connected by inter­molecular N—H⋯O hydrogen bonds, forming zigzag hydrogen-bonded chains directed along the c axis

Inactivating KISS1 mutation and hypogonadotropic hypogonadism

Gonadotropin-releasing hormone (GnRH) is the central regulator of gonadotropins, which stimulate gonadal function. Hypothalamic neurons that produce kisspeptin and neurokinin B stimulate GnRH release. Inactivating mutations in the genes encoding the human kisspeptin receptor (KISS1R, formerly called GPR54), neurokinin B (TAC3), and the neurokinin B receptor (TACR3) result in pubertal failure. However, human kisspeptin loss-of-function mutations have not been described, and contradictory findings have been reported in Kiss1-knockout mice. We describe an inactivating mutation in KISS1 in a large consanguineous family that results in failure of pubertal progression, indicating that functional kisspeptin is important for puberty and reproduction in humans. (Funded by the Scientific and Technological Research Council of Turkey [TÜBİTAK] and others.)http://www.nejm.org/nf201

Volume CXIV, Number 4, November 7, 1996

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespa