Nicotinamide Effects Oxidative Burst Activity of Neutrophils in Patients with Poorly Controlled Type 2 Diabetes Mellitus

Neutrophil functions are impaired in patients with diabetes mellitus. Bacterial phagocytosis and oxidative burst activity are reduced at high glucose concentrations in diabetic patients. Defects in neutrophil oxidative burst capacity are of multifactorial origin in diabetes mellitus and correlate with glucose levels. It has been reported that neutrophil NADPH oxidase activity is impaired and superoxide production is reduced in diabetic patients with or without any infections. Nicotinamide is a vitamin B3 derivative and a NAD precursor with immunomodulatory effects. In vitro studies demonstrated that nicotinamide increases NAD and NADH content of beta cells. The authors hypothesized that nicotinamide may restore the impaired oxidative burst capacity of neutrophils in diabetic patients by increasing the NADH content as an electron donor and possibly through NADPH oxidase activity of the cell. In order to test the hypothesis, this placebo-controlled and open study was designed to evaluate neutrophil functions in infection-free poorly controlled type 2 diabetic patients as compared to healthy subjects and assess the effects of nicotinamide on neutrophil phagocytosis as well as oxidative burst activity. Thirty patients with type 2 diabetes mellitus were enrolled in the study. Sixteen were females and 14 were males, with a mean age 58 ± 10. All patients were on sulphonylurea treatment and their hemoglobin A1c (HbA1c) levels were above 7.5%. The control group consisted of 10 voluntary healthy subjects. Diabetic and control subjects were not significantly different in terms of age, body mass index (BMI), leucocyte and neutrophil counts, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR), but HbA1c and fasting glucose levels were significantly higher in patients with diabetes mellitus. Phagocytic activity and respiratory burst indexes were measured by flow cytometric analyses as previously described by Rothe and Valet (Methods Enzyml., 233, 539–548, 1994) and compared in diabetic subjects and healthy controls. Diabetic patients were grouped to receive either 50 mg/kg oral nicotinamide (n = 15) or placebo (n = 15) for a period of 1 month. The 2 groups did not differ in terms of treatment, frequency of hypertension, BMI, diabetes duration, age, fasting plasma glucose (FPG), HbA1c, CRP, ESR, polymorphonuclear leukocyte (PNL) and neutrophil counts. Neutrophil functions were reassessed after the treatment period. Phagocytic activity represented as indexes were lower in diabetic patients when compared to healthy subjects, but the differences were not statistically significant (P > .05). Patients with diabetes mellitus had significantly lower oxidative burst indexes when compared to healthy controls (P values < .05). In diabetic patients, a negative correlation between neutrophil functions and HbA1c was found which was not statistically significant (P values > .05). Phagocytic indexes were similar in nicotinamide and placebo groups after treatment period (P > .05). But oxidative burst activity in patients receiving nicotinamide was greater when compared with placebo and the difference was statistically significant at 30 and 45 minutes (P values .04 and .03). This effect of nicotinamide may be due to increased NADH content and NADPH oxidase activity of the cell, which needs to be further studied. Impaired neutrophil functions may aggravate various infections in patients with diabetes mellitus and blood glucose regulation is an important target of treatment to improve neutrophil functions. But nicotinamide treatment may help to improve prognosis in diabetic patients with severe infections

Our experience on brachial plexus blockade in upper extremity surgery

Objective: Peripheral nerve blocks are usually used either alone or along with general anesthesia for postoperative analgesia. We also aimed to present the results and experiences.Materials and methods: This retrospective study was conducted to scan the files of patients who underwent orthopedic upper extremity surgery with peripheral nerve block between September 2009 and October 2010. After ethics committee approval was obtained, 114 patients who were ASA physical status I-III, aged 18-70, performed upper extremity surgery in the Orthopedics and Traumatology Clinic were included to study. Patients’ demographic data, clinical diagnoses, premedication status, peripheral block type, local anesthetic dose, stimuplex needle types, hemodynamic parameters at the during surgery, the first postoperative analgesic requirements, complications and patient satisfaction were recorded.Results: Demographic data were similar to each other. Brachial plexus block was commonly performed for the forearm surgery. Infraclavicular block was performed the most frequently to patients. As the classical methods in the supine position were preferred in 98.2% of patients, Stimuplex A needle (B. Braun, Melsungen AG, Germany) have been used for blockage in 80.7% of patients. Also, in 54.4% of patients, 30 ml of local anesthetic solution composed of bupivacaine + prilocaine was used for blockade. Blocks applied to patients had provided adequate anesthesia.Conclusion: Since the brachial plexus blockade guided peripheral nerve stimulator for upper extremity surgery provide adequate depth of anesthesia and analgesia, it may be a good alternative to general anesthesia because of unwanted side effect

Secondary sulfonamides as effective lactoperoxidase inhibitors

Secondary sulfonamides (4a–8h) incorporating acetoxybenzamide, triacetoxybenzamide, hydroxybenzamide, and trihydroxybenzamide and possessing thiazole, pyrimidine, pyridine, isoxazole and thiadiazole groups were synthesized. Lactoperoxidase (LPO, E.C.1.11.1.7), as a natural antibacterial agent, is a peroxidase enzyme secreted from salivary, mammary, and other mucosal glands. In the present study, the in vitro inhibitory effects of some secondary sulfonamide derivatives (4a–8h) were examined against LPO. The obtained results reveal that secondary sulfonamide derivatives (4a–8h) are effective LPO inhibitors. The Ki values of secondary sulfonamide derivatives (4a–8h) were found in the range of 1.096 × 10−3 to 1203.83 µM against LPO. However, the most effective inhibition was found for N-(sulfathiazole)-3,4,5-triacetoxybenzamide (6a), with Ki values of 1.096 × 10−3 ± 0.471 × 10−3 µM as non-competitive inhibition

Mandibular üçüncü molar dişlerin inferior alveoler kanalla ilişkisinin KIBT ile değerlendirilmesi

Amaç: Gömülü mandibular üçüncü molarların inferior alveolar kanalla ilişkisini incelemek, bu bölgede yapılan operasyonlarda inferior alveolar nörovasküler yapıya zarar vermemek için önemlidir. Bu çalışmadaki amaç gömülü mandibular üçüncü molarların inferior alveolar kanalla ilişkisini incelemek, pozisyonuna göre sınıflamak ve kontak durumunu belirlemektir.Gereç ve Yöntemler:&nbsp;Çalışmamıza 54 hastadan 100 mandibular gömülü üçüncü molar diş dahil edilmiştir. İnferior alveolar kanalın gömülü üçüncü molar dişlerin kökleriyle ilişkisi bukkal, lingual, inferior ve interradiküler olmak üzere 4 ayrı sınıfta iki gözlemci tarafından değerlendirilmiştir. İnferior alveolar kanalın diş kökleriyle kontak durumu olup olmadığı da incelenmiştir. Gözlemciler arası uyum yüksek olduğundan, iki gözlemcinin farklı değerlendirdiği vakalar gözlemciler tarafından birlikte tekrar değerlendirilip fikir birliğine varılarak prevalans değerleri hesaplanmıştır.Bulgular:&nbsp;Dişin pozisyonunun değerlendirildiği incelemede κ: 0.854, kontak durumuna göre değerlendirilen incelemede κ: 0.774 bulunmuştur. Gömülü mandibular üçüncü molarların % 52 oranında inferior, % 29 lingual, % 11 bukkal % 8&nbsp;interradiküler konumda olduğu tespit edilmiştir. İnferior alveolar kanalın dişle kontak ilişkisi % 71 kontaklı, % 29 kontaksız olarak bulunmuştur.Sonuç: Gömülü mandibular üçüncü molarların cerrahi operasyonlarında sinir yaralanmalarına yol açmamak için Konik-ışınlı bilgisayarlı tomografi (KIBT) değerlendirmeleri önemlidir. KIBT sayesinde operasyon bölgesini üç boyutlu olarak inceleyebilir ve mandibular kanalın gömülü üçüncü molara göre pozisyonunu belirleyebiliriz.ANAHTAR KELİMELER Gömülü mandibular üçüncü molar, inferior alveolar kanal, KIB

Mental foramenin mandibular kemikle ilişkisinin ultrasonografi ile değerlendirilmesi

Amaç: Mental foramen (MF) görüntülenmesi, etkili bir sinir bloğu gerçekleştirmede ve nörovasküler yaralanmaları önlemede önemli bir yere sahiptir. Çalışmamızın amacı MF’nin mandibular kemiğe olan uzaklıklarının USG ile tespiti, cinsiyete göre ve sağ-sol arasında farklılık olup olmadığının değerlendirilmesidir.Gereç ve Yöntemler: 15 kadın ve 15 erkek toplam 30 gönüllünün (22-27 yaş aralığında) sağ ve sol MF’leri USG ile değerlendirildi. MF’nin mandibular kemiğin üst ve alt sınırına olan uzaklıkları tespit edildi.Bulgular: MF’nin mandibular kemikteki sürekliliğin bozulması şeklindeki görüntüsü USG ile tespit edildi. MF’nin üst ve alt mandibular sınırla olan uzaklığı 2 ayrı gözlemci tarafından değerlendirildi. Birinci ve ikinci gözlemciler arasındaki uyum iyi olduğundan (0,709≤r≤0,902)&nbsp; ölçümlerin ortalaması kullanıldı. Sağ ve sol ölçümler arasında fark olup olmadığını değerlendirmek için yapılan Wilcoxon Signed Rank testi sonucuna göre kadınlarda anlamlı bir fark yokken erkeklerde anlamlı bir fark çıkmıştır. Cinsiyetler arasında fark olup olmadığını değerlendirmek için yaptığımız Mann Whitney U testi sonucuna göre kadın ve erkekler arasında erkeklerde daha yüksek değerde olmak üzere istatiksel olarak anlamlı bir fark çıkmıştır (p ˂0,05).Sonuç: USG, MF’nin tespitinde ve saptanabilen mandibular kemikle olan ilişkisini değerlendirmede non invaziv, iyonize radyasyon içermeyen, hasta başında uygulanabilen bir görüntüleme metodudur. Bu avantajları, ileride yapılabilecek daha geniş çalışma gruplarından elde edilen referans değerleriyle bu bölgede yapılan operatif işlemlerde hasta başında tespitinin kolaylıkla yapılmasını mümkün kılacaktır.ANAHTAR KELİMELER Anatomik landmark, mandibula, mental foramen, ultrasonograf

Acute cholangitis and pancreatitis caused by fasciola hepatica: a case report

Fasciola hepatica Türkiye'de endemik bir parazittir. Bu parazit genellikle sığır ve koyunlarda enfeksiyona yol açar. Ancak endemik bölgelerde insanlar, kontamine içme suyu ve sebze tüketimi nedeni ile bu parazit için tesadüfen konak olabilmektedir. Kronik Fasciola hepatica infeksiyonu biliyer obstrüksiyon ve inflamasyona neden olmaktadır. Aynı zamanda, biliyer fasciolosis asemptomatik de olabilir. Bu gibi olgularda teşhiste ERCP önemli rol oynar ve güvenle kullanılmaktadır. Özellikle endemik bölgelerde konvansiyonel yöntemlerle etkeni saptanamayan olgularda Fasciola hepatica gibi paraziter enfestasyonlar akla gelmelidir. Bu çalışmada, Fasiola hepatikanın sebep olduğu bilier obstrüksiyona sekonder tıkanma sarılığı ile başvuran 37 yaşında bayan hasta sunulmaktadır. Hasta bulantı, kusma, karın ağrısı ve sarılık şikayeti ile acil polikliniğine başvurdu. Akut kolonjit ve pankreatit tanısı konulan hastaya ERCP yapıldı. ERCP' nin başarılı olmaması üzerine ameliyata alınan hastaya kolesistektomi ve koledok eksplorasyonu yapıldı. Safra kesesi ve koledok içerisinden parazit çıkartılan hasta, postoperatif dönemde şifa ile taburcu edildi.become a host of this parasite by ingesting contaminated water and plants in endemic areas. Chronic Fasciola hepatica infestation is known to cause biliary obstruction and inflammation. Also, biliary fasciolosis may be asymptomatic. ERCP plays an important role in the diagnosis of the disease and can be used safely in these cases. Especially in cases that could not be diagnosed by conventional methods, parasitic infestations such as Fasciola hepatica should be kept in mind, in endemic areas. We report a case of a 37-year-old lady with obstructive jaundice secondary to biliary obstruction with Fasciola hepatica. Our patient admitted to the emergency unit with the compliants, nausea, vomiting, abdominal pain and jaundice. An ERCP recommended because of acute cholangeitis and pancreatitis. ERCP coluldn't performed effectively, so the case operated, and cholecystectomy and choledoc exploration performed. In the operation, the parasites removed from the gall bladder and common bile duct. Our patient discharged after hospital care postoperatively without any complication

COVID-19 in pediatric nephrology centers in Turkey

Background/aim: There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. Materials and methods: This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. Results: Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10–15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. Conclusion: COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients’ susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels &gt;2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p &lt; 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168