Ischemia modified albumin in the differential diagnosis of pleural effusions

The differential diagnosis of pleural effusion often requires invasive procedures. Up to 25 percent of pleural effusions can remain undiagnosed with an unclear pathogenesis. Therefore new biological markers may increase diagnostic yield and provide better understanding of pathogenesis of pleural effusion. We hypothesized that new ischemia biomarker, “ischemia modified albumin (IMA)” would help in both the differentiation of the underlying etiologies and provide a better understanding of pathogenesis of pleural effusions. This study was done between December 2009 and September 2010 in the Department of Pulmonary Diseases of Gaziantep University Hospital. One hundred and sixteen subjects with pleural effusion were included. Pleural and blood IMA levels were measured by ELISA. The underlying etiologies of pleural effusions were as follows: transudates (n = 50), malignancy (n = 32), tuberculosis (n = 12), pulmonary thromboembolism (n = 6), pneumonia (n = 16). The median pleural IMA levels were significantly different between the groups (p < 0.000). There were no such differences in the blood levels of IMA. The most striking difference in the median pleural IMA levels was between transudates and exudates (7986 (25–75%, 5145–56.505) ng/mL; 3376 (25–75%, 1935–4660) ng/mL; respectively, p = 0.000). The area under the ROC curve was 0.837 ± 0.038 for the cut-off level higher than 4711 ng l/mL for the differentiation of transudates from exudates (sensitivity, 82%; specificity, 78%; 95% CI, 0.76 to 0.91; p = 0.0000). In conclusion, the pleural IMA levels are higher in transudates compared to exudates. No such differences were observed in blood levels of IMA suggesting that there are reasons other than ischemia that cause an increase in pleural fluid IMA levels.     

The evaluation of bond strength of a composite and a compomer to white mineral trioxide aggregate with two different bonding systems

The purpose of this study was to evaluate the bond strength of a resin composite and a polyacid modified composite or "compomer" to white mineral trioxide aggregate (WMTA) with two different bonding systems (total-etch one bottle and self-etch one step). Forty specimens of WMTA were prepared and divided into four groups. In group one, Single Bond (3M/ESPE, St Paul, MN) and Z250 (3M/ESPE) were placed over WMTA. In group two, Prompt L-Pop (3M Dental Products, St Paul, MN) and Z250 were applied. In group three, Single Bond was applied with Dyract AP (Dentsply DeTrey, Konstanz, Germany), and, in group four, Prompt L-Pop was applied with Dyract AP. The shear bond strength was measured, and the fractured surfaces were examined. The results of the shear bond strength tests were analyzed by one-way analysis of variance test. The results of this study have suggested that the total-etch one-bottle adhesive system mediated a stronger bond to WMTA for both the resin composite and the compomer investigated. The placement of composite (Z250) and compomer materials (Dyract AP), used with total-etch one-bottle adhesive (Single Bond), over WMTA as final restoration may be appropriate.     

Pseudocholinesterase in gestational diabetes: positive correlation with LDL and negative correlation with triglyceride

Objective

Low pseudocholinesterase (PChE) activity accompanies pregnancy, liver disease, renal failure, and certain drug therapies. The aim of this study was to investigate a possible relationship among PChE and plasma insulin levels, lipid profile, and inflammatory response in gestational diabetes.

Methods

This study included 165 women aged 20?C40 years. Subjects were divided into four groups as follows: Control group, 29 non-pregnant healthy women; Group NGT, 61 healthy pregnant women (normal glucose tolerance); Group GD, 62 pregnant women with gestational diabetes; and Group AGT, 13 pregnant women with abnormal glucose tolerance. Gestational ages were between 34 and 40 weeks. Plasma PChE, triglyceride, high-/low-density lipoprotein (HDL, LDL), glycated hemoglobin A1c (HbA_1c), insulin, C-reactive protein (CRP), and white blood cell (WBC) levels were measured in all subjects.

Results

There were no statistically significant differences in plasma PChE, insulin, and LDL levels between the groups. Plasma triglyceride, HbA_1c, WBC, and CRP levels were significantly higher in Group GD and Group AGT compared to the other groups (P?1c and a negative correlation among CRP and LDL and triglyceride in Group GD.

Conclusion

PChE activity was not significantly different between the groups. However, there was a positive correlation between PChE and LDL levels in pregnant women with GD, suggesting that LDL levels in pregnant women with GD may help to predict the risk of prolonged apnea in situations in which PChE activity cannot be measured.     

Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara,Turkey

Aim: To determine risk factors for severe complications during and after cesarean delivery (CD) in placenta previa (PP).

Methods: We reviewed retrospectively collected data from women with PP who underwent CD during a 6-year study period. We identified the complicated group based on the modified WHO near-miss criteria. Complicated and noncomplicated groups were compared considering clinical, laboratory, and sonographic features.

Results: Thirty-seven of 256 cases classified as near miss consisting of 14 peripartum hysterectomies, 12 uterine balloon placements, 10 great artery ligations, and four B-lynch suture placement procedures without maternal mortality. Perioperative complications included surgical wound infections (n?=?5), bladder injury (n?=?4), pelvic abscess (n?=?1), and uterine rupture (n?=?1). Logistic regression analyses demonstrated following features to be associated with maternal near miss in PP: (1) coexistent abruption (aOR 13.2, 95% CI 5.8–75.3), (2) morbidly adherent placenta (aOR 11.92, 95% CI 3.24–43.82), (3) number of hospitalizations for vaginal bleeding (≥3) (aOR 8.88, 95% CI 3.32–26.69), and (4) transvaginal cervical length (CL) measurement?<10th percentile (aOR 5.5, 95% CI 2.1–15.4).

Conclusion: Short cervical length, recurrent vaginal bleeding, morbidly adherent placenta, and concurrent placental abruption are independent predictors for subsequent severe maternal morbidity in PP cases. Early identification of these risk factors during PP follow-up may improve maternal outcome.     

Macular involvement in secondary systemic amyloidosis

PURPOSE. A patient with subretinal and preretinal hemorrhage after secondary systemic amyloidosis due to familial Mediterranean fever is presented. METHODS. Case presentation. RESULTS. A 30-year-old woman with secondary systemic amyloidosis secondary to familial Mediterranean fever presented with painless visual loss in the right eye. The examination demonstrated multiple subretinal and preretinal hemorrhages, massive deposits which may represent amyloid material at the left macular region. After 6 months, the hemorrhages disappeared, but deposits persisted. CONCLUSIONS. The macular deposition and hemorrhage is an uncommon manifestation of secondary systemic amyloidosis secondary to familial Mediterranean fever. Further evidence is necessary to understand the nature of these deposits and their relevance to secondary systemic amyloidosis and/or familial Mediterranean fever.     

The role of expectations in patient assessments of hospital care: an example from a university hospital network, Turkey

PURPOSE: The aim of this paper is to document a study, in which the SERVQUAL scale was used to evaluate hospital services, conducting a preliminary assessment of patient attitudes regarding the important aspects of service dimensions. DESIGN/METHODOLOGY/APPROACH: The SERVQUAL scale was implemented into routine use at the Baskent University Hospitals Network in Baskent, Turkey. The study consisted of 550 randomly chosen patients who presented to any member hospital in that network during January and February 2006 and received treatment as inpatients or outpatients at those healthcare facilities. The SERVQUAL scale was utilised to evaluate hospital services. FINDINGS: A questionnaire was completed by a total of 472 (86.0 per cent) patients. The perceived scores of the patients were higher than expected for an ordinary hospital but lower than expected for a high-quality hospital. The highest difference between the perceived service score and the expected service score was found at the Alanya Application and Research Center in Alanya, Turkey. ORIGINALITY/VALUE: The paper demonstrates the use of the SERVQUAL scale in measuring the functional quality of the hospitals assessed.     

Relationship between the 1359 G/A polymorphism of the Central Cannabinoid Receptor 1 (CNR1) gene and susceptibility to cannabis addiction in a Turkish population

In this study, we investigate the existence of a possible genetic association between 1359 G/A polymorphism of the Central Cannabinoid Receptor 1 (CNR1) Gene CNR1 (p.Thr453Thr; rs1049353) single nucleotide polymorphism (SNP) and cannabis addiction. DNA samples used in this work are purified from venous leukocytes of 145 unrelated Turkish cannabis-dependent subjects and 140 Turkish control subjects. No significant difference is observed in genotype or allele frequencies of CNR1 1359 G/A polymorphism between these two groups. We also compared CNR1 1359 G/A polymorphism allele frequency distribution in our healthy Turkish population with other healthy populations. The comparison of healthy Turkish subjects with the healthy subjects from English-Irish, Chinese, European-American, African-American, Italian, German and Japanese populations revealed significant differences in allele frequencies. Data indicate that the 1359 G/A CNR1 polymorphism does not contribute to susceptibility to cannabinoid addiction in Turkish subjects. To the best of our knowledge, this is the first study on 1359 G/A CNR1 polymorphism in the Turkish population.     

Case report: Evaluation of supernumerary teeth with computerized tomography

Radiographs play an important role in assessment of both the location and the typing of supernumerary teeth. In general, periapical, occlusal, and/or panoramic radiographs are sufficient for providing the information required by the clinician. These modalities, however, do not provide detailed information concerning the 3-dimensional relationship between supernumerary or ectopically impacted teeth and adjacent structures. This case report discusses the value of computerized tomography (CT) for evaluation of the root relationships of supernumerary teeth located palatally to maxillary permanent central incisors. CT accurately demonstrated the relationship between the supernumerary teeth and the permanent tooth roots.