OCJENA MNOGOSTRUKIH PODRUČJA NA SREDNJESAGITALNIM SLIKAMA MAGNETSKE REZONANCIJE MOZGA U BOLESNIKA S MULTIPLOM SKLEROZOM

The aim of the study was to compare the first and last magnetic resonance images (MRIs) in patients diagnosed with multiple sclerosis (MS) with MRIs of normal subjects. We wanted to investigate the region initially involved in MS patients. In this retrospective study, midsagittal plane was explored on brain MRIs taken at the time when MS diagnosis was established and the last MRI was obtained following treatment for MS. Comparison was done between healthy subjects and patients diagnosed with MS. The measures included the area of corpus callosum, cerebrum, cerebellum, pons, bulbus, fourth ventricle and pituitary gland. As a result, while there was growth in the fourth ventricle area, there was shrinkage in the other areas in MS patients. In women, the tissues involved at the beginning of the disease were pituitary gland, cerebrum and bulbus, and in men corpus callosum and cerebrum. Atrophy was not time-dependent. Assessment of the correlation between the Expanded Disability Status Scale (EDDS) and atrophy revealed an increase in EDDS (disease progression) to be associated with a decrease in the area of cerebrum and corpus callosum in men, and an increase in the fourth ventricular area in women. In conclusion, we demonstrated that pituitary gland atrophy develops in the early stage of MS, especially in women. Additional studies are needed to investigate the phenomenon of early pituitary and bulbus atrophy in women versus late atrophy of these tissues in men.Cilj rada bio je usporediti prve i posljednje slike magnetske rezonancije (MR) u bolesnika s multiplom sklerozom (MS) sa slikama zdravih osoba. Kod bolesnika s MS htjeli smo ispitati najranije zahvaćeno područje. U ovoj studiji se srednjesagitalno područje kod bolesnika s postavljenom dijagnozom MS pregledalo na slikama MR mozga u vrijeme postavljanja dijagnoze i nakon liječenja. Uspoređivalo se zdrave osobe s bolesnicima kojima je dijagnosticirana MS. Mjerenje je uključilo područje korpusa kalozuma, mozga, malog mozga, ponsa, bulbusa, četvrtog ventrikula i hipofi ze. Kod bolesnika s MS došlo je do porasta na području četvrtog ventrikula, a do smanjenja u drugim područjima. Utvrđeno je da su zahvaćena tkiva u žena na početku bolesti bila hipofi za, mozak i bulbus, a kod muškaraca korpus kalozum i mozak. Otkriveno je da atrofi ja ne ovisi o vremenu. Kada se promatralo korelaciju između zbira na Expanded Disability Status Scale (EDDS) i atrofi je, vidjelo se da s povećanjem EDDS (kada bolest napreduje) dolazi do smanjenja područja malog mozga i korpusa kalozuma u muškaraca, a povećanja područja četvrtog ventrikula u žena. Pokazali smo da se atrofi ja hipofi ze razvija u ranoj fazi MS, osobito u žena. Pozornost privlači rana atrofi ja hipofi ze i bulbusa u žena te kasna atrofi ja ovih tkiva u muškaraca

Association of liver function tests with severity of disease in patients with COVID-19

Background: We aimed to investigate the association of liver function tests with disease severity at admission and during hospitalization in patients with coronavirus disease 2019 (COVID-19). Methods: Blood tests of patients who were hospitalized due to COVID-19 were retrospectively analyzed. Liver tests included serum aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, total bilirubin, and albumin. Besides these, C-reactive protein and ferritin were also analyzed in the study. Levels of these tests at admission and peak levels during hospitalization were then recorded. Severe COVID-19 infection was defined as the reason for ICU admission. Both the associations of the levels of liver tests at admission and peak levels during hospitalization with severe disease were evaluated. Results: The study included a total of 602 patients, and 127 (21.1%) of the patients were hospitalized in the ICU. In our study, only albumin level abnormality was significantly associated with severe disease in COVID-19 patients at admission. However, during hospitalization, a significant association was found between severe disease and abnormal AST, ALT, GGT, T.BIL, albumin, and ferritin levels. During hospitalization, it was also observed that the rates of severe disease cases increased as AST, ALT, GGT, and T.BIL levels increased. Conclusions: Abnormal liver function tests may be a predictor for severe disease in patients with COVID-19. It is therefore important to monitor liver function tests in hospitalized patients

An analysis of 214 cases of rib fractures

INTRODUCTION: Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs. MATERIALS AND METHODS: Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4%), 2) patients with two rib fractures (RF2) (n = 53, 24.8%), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9%). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems. FINDINGS: The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30% in group RF1, 24.6% in group RF2, and 75.6% in group RF3 (p<0.05). Co-existing injuries to other systems were 24% in group RF1, 23.2% in group RF2, and 52.6% in group RF3 (p<0.05). Two patients (4%) in group RF1, 2 patients (3.8%) in group RF2, and 5 patients (4.5%) in group RF3 (total n = 9; 4.2%) died. CONCLUSION: Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment

An analysis of 214 cases of rib fractures

INTRODUCTION: Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs. MATERIALS AND METHODS: Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4%), 2) patients with two rib fractures (RF2) (n = 53, 24.8%), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9%). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems. FINDINGS: The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30% in group RF1, 24.6% in group RF2, and 75.6% in group RF3 (

Relationship between intracellular pathogens Toxoplasma gondii and Borrelia burgdorferi infections and migraine

Aim: In this study, the serological values of our patients followed up with a diagnosis of migraine were compared with the results of healthy controls in terms of possible association with intracellular pathogens, Toxoplasma gondii and Borrelia burgdorferi. Methods: Fifty patients with migraine, randomly selected among migraine patients without any additional disease, who applied to Bolu Abant Izzet Baysal Training and Research Hospital between January 1, 2015 and August 31, 2019 were included in the study. Fifty subjects without headache were included as control group. The history of infectious diseases of the patient and control groups (Toxoplasma gondii, Borrelia burgdorferi- causing Lyme disease) was determined by serological diagnostic methods. Results: The study group consisted of 64 women with a mean age of 45.5±13.1 (15-76) years. Migraine and control groups were found to be similar in terms of age (p=0.059) and gender (p=0.211) distributions. The frequency of Toxoplasma gondii positivity in the migraine group was 28% (n=14) and 10% (n=5) in the control group. The frequency of Lyme was 19.6% (n=11) in the migraine group and 14.3% (n=8) in the control group. The frequency of Toxoplasma gondii positivity was statistically significantly higher in the migraine group (p=0.022), while the frequency of Lyme was found to be similar in the migraine and control groups (p=0.450). Conclusion: The results of our study suggest that there are statistically significant differences between migraine and control groups only in terms of Toxoplasma gondii positivity rates, not Lyme. However, we believe that larger sample studies are needed to determine the detailed relationship between migraine and Toxoplasma gondii infection

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ABSTRACT. Objective. To compare the Quantiferon-TB Gold test (QTF-G) with the tuberculin skin test (TST) for the detection of latent tuberculosis infection (LTBI) among patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), with reevaluation of the patients treated with tumor necrosis factor-α (TNF-α) antagonists in the followup. Methods. The study involved 140 consecutive patients, 82 with RA and 58 with AS. Thirty patients were evaluated with QTF-G for detection of LTBI before and after 6 months of TNF-α antagonist treatment. QTF-G was also performed on 49 healthy controls. QTF-G results were recorded as positive, negative, or indeterminate. A positive TST was defined as ≥ 5 mm for RA and AS. Results. The percentages of positive QTF-G were comparable in RA and AS (37% vs 32%). The rate of positive QTF-G in healthy controls (29%) was also similar to RA and AS. In contrast to QTF-G results, a high rate of TST positivity was observed in AS compared to RA (82% vs 55%; p = 0.02). The total agreement between QTF-G and TST was observed to be 61% (κ = 0.29) in the whole group, 70% (κ = 0.42) in RA, and 49% (κ = 0.14) in AS. After 6 months of treatment with TNF-α antagonists, a high rate of QTF-G change was observed in patients with indeterminate results (23% vs 3%; p = 0.03)

Agreement between quantiferon-TB gold test and tuberculin skin test in the identification of latent tuberculosis infection in patients with rheumatoid arthritis and ankylosing spondylitis

ABSTRACT. Objective. To compare the Quantiferon-TB Gold test (QTF-G) with the tuberculin skin test (TST) for the detection of latent tuberculosis infection (LTBI) among patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), with reevaluation of the patients treated with tumor necrosis factor-α (TNF-α) antagonists in the followup. Methods. The study involved 140 consecutive patients, 82 with RA and 58 with AS. Thirty patients were evaluated with QTF-G for detection of LTBI before and after 6 months of TNF-α antagonist treatment. QTF-G was also performed on 49 healthy controls. QTF-G results were recorded as positive, negative, or indeterminate. A positive TST was defined as ≥ 5 mm for RA and AS. Results. The percentages of positive QTF-G were comparable in RA and AS (37% vs 32%). The rate of positive QTF-G in healthy controls (29%) was also similar to RA and AS. In contrast to QTF-G results, a high rate of TST positivity was observed in AS compared to RA (82% vs 55%; p = 0.02). The total agreement between QTF-G and TST was observed to be 61% (κ = 0.29) in the whole group, 70% (κ = 0.42) in RA, and 49% (κ = 0.14) in AS. After 6 months of treatment with TNF-α antagonists, a high rate of QTF-G change was observed in patients with indeterminate results (23% vs 3%; p = 0.03)

Clinical Study Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy

Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively. Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun's electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.Peer reviewe