Estimation of alcohol and nicotine consumption in 11 cities of Turkey using wastewater-based epidemiology

Alcohol and tobacco are the most frequently consumed substances in the world. Both are significantly associated with the increasing number of different diseases. Thus, monitoring nicotine and alcohol use is vital for public health planning and intervention strategies. This study aimed to calculate estimates of alcohol and nicotine use in 11 cities of Turkey using wastewater-based epidemiology. In 2019, daily composite wastewater samples from 18 wastewater treatment plants were collected for a week per season. The 24-h composite samples were collected via auto-samplers. Sample preparation for wastewater samples collected was done using liquid–liquid extraction and solid-phase extraction. Nicotine and ethyl sulfate (EtS) were analyzed using validated liquid chromatography–tandem mass spectrometry method. The estimated average nicotine consumption was 2.84 mg/p/day, and the average alcohol consumption was 3.46 ± 1.83 ml/p/day. The highest nicotine consumption was observed in Kayseri city; the highest alcohol consumption was calculated for Mersin city. In this study, the cigarette and alcohol consumption estimate obtained by wastewater-based epidemiology (WBE) was found to be higher than the Turkey Tobacco and Alcohol Market Regulatory Authority report. To our knowledge, this study is the most comprehensive one so far applied using WBE for 11 cities in Turkey and evaluates alcohol and nicotine use together.     

Perioperative and follow-up results in carotid artery stenting with contralateral carotid occlusion

Purpose

Contralateral carotid occlusion (CCO) increases the risk of carotid endarterectomy (CEA). We determined the outcome of carotid angioplasty and stenting (CAS), an alternative to CEA, in the setting of CCO through an independent analysis of imaging and clinical outcome.

Materials and methods

Medical records of 26 consecutive patients with CCO who underwent CAS by a single operator using the same procedural protocol (with distal protection and closed-cell stents) were retrospectively evaluated. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) scores before and after CAS, periprocedural complications, and the restenosis rate were analyzed by independent stroke neurologists who were not involved in the care of the patients.

Results

The median mRS score for the 26 patients was 1 (range 0–5) before and after CAS. All of the patients underwent clinical and imaging follow-up (mean 19.5 ± 14.3 and 11.6 ± 11.2 months, respectively). Thirty-day mortality/permanent morbidity rates were 0 %. One patient had hyperperfusion syndrome and was managed medically without sequelae; however, he had stent occlusion after 30 days, resulting in a decline in his mRS from 4 (preprocedure) to 5. Otherwise, there was no decline in mRS during the post-discharge follow-up.

Conclusion

According to an independent analysis of this single-operator series, CAS is safe and effective for the treatment of patients with CCO.

     

Fluorosis and its hematological effects

Although it has been reported that fluoride ingestion has no influence on various indices of hematopoiesis, some research has been published that excessive fluoride developed anemia and eosinophilia of leukocytes. Isparta is situated on the lake region of Turkey where fluorosis is endemic. Our aim was to explore the hematological effects in rats induced by fluoride. In this study, Wistar-Albino rats were used, divided into two groups as control and fluorized. While the control group was administered commercial water (including 0.07 ppm fluoride), the fluorized group was administered 100 ppm fluoride in commercial drinking water for four months. At the end of four months, hematological indices (Hb, Hct, MCV, MCH, RDW, RBC, WBC, and platelet counts) were measured. In addition, bone marrow samples were investigated. Mean leukocyte counts (WBC) in the control group and fluorized group were 7.07 (2.62-12.25) and 2.76 (3.13-5.24)x 10(3)/mm3, respectively. We observed displastic changes on granulocytes in the bone marrow samples of the fluorized group. Although there were significant statistical changes in WBC, we did not determine red blood cell and platelet changes in the fluorized group.     

The influence of socio-demographic features and rotation of plastic, reconstructive and aesthetic surgery on the attitudes of Turkish medical students’ choice of careers

The choice of specialization branch is one of the most important decisions for the medical students during the medical education all over the world. It is known that short rotation period causes insufficient information about the subspecialty branches of medicine during the rotation period of medical education. The objective of the present study was to examine the tendency of students toward plastic, reconstructive and aesthetic surgery (PRAS), which has one of the short rotation periods during medical education in Turkey. In this study, 90 male and 63 female fourth year medical students were included. According to our findings, 133 students agreed that PRAS will be one of the splendid occupations of the future. However, only 10 students (6.5%) primarily chose PRAS as a specialization branch. The high complication risks which were believed to be following the reconstructive surgery was the deterrent factor to prefer PRAS as a specialization branch (P=0.036), and also the long educational period and the requirement of experience for PRAS specialization (94.1%) have influence on the choice of students making career in PRAS. The socio-demographic features of the students did not have any statistically significant effect on their responses to questions (P>0.05).     

Significant angiogenic potential is present in the microenvironment of muscle flaps in humans

The purpose of this study was to determine the presence of growth factors and the quality of angiogenic potential in the wound microenvironment in different types of flaps in humans. The wound exudates from 23 flaps were processed for analysis of transforming growth factor beta1 (TGF-beta1), epidermal growth factor (EGF), interleukin 1alpha (IL-1alpha), platelet-derived growth factor-AB (PDGF-AB), vascular endothelial growth factor (VEGF), and insulin-like growth factor (IGF-1) by enzyme-linked immunosorbent assay (ELISA) or radio immuno assay (RIA). Angiogenic activity of wound fluid from latissimus flaps was determined by thymidine incorporation in porcine microendothelial cells exposed to various concentrations of wound fluid and control media. Angiogenic and matrix growth factors were altered in a linear fashion during the wound-healing process. Regression analysis provided evidence for decreasing levels of PDGF and EGF for latissimus flaps. Also, statistically significant differences of growth factor levels were found for paired comparison of flap types at different times after operation. Growth of in-vitro endothelial cells was stimulated most by 10 percent wound fluid, compared to any of the individual recombinant angiogenic factors or combinations of these factors. The data suggest that vascularized tissue flaps will promote wound healing by providing sufficient sources of growth factors in the wound environment. The particular type of flap, i.e., muscle or fasciocutaneous flap, does not seem to have an impact on growth-factor expression.     

Effect of chronic fluorosis on lipid peroxidation and histology of lung tissues in first and second generation rats

This experiment was designed to investigate the lipid peroxidation and histological effects of chronic fluorosis on first and second generation rat lung tissues. Sixteen, virgin, female Wistar rats were mated with eight males (2:1) for approximately 12 h to obtain first-generation rats. Pregnant rats were divided into two experimental groups (control and fluoride supplemented). The pregnant rats in the fluoride-supplemented group were exposed to 30 mg/L sodium fluoride (NaF) in commercial drinking water containing 0.07 mg/L NaF throughout the gestation and lactation periods. After the lactation period, young animals (first generation; F1) were exposed to the same amount of NaF in drinking water for four months. At the end of the four-month experimental period, nine randomly-chosen male rats (F1) were sacrificed and lung tissues were removed for histopathological and enzymatic lipid peroxidation examination. The second generation rats were obtained from the remaining rats by the same method. They were also treated similarly. At the end of the four-month experimental period, nine randomly-chosen male rats (F2) were sacrificed, and the lungs were removed for histological and lipid peroxidation examination. The rats in the control groups underwent the same procedure without NaF supplementation. It was found that the plasma fluoride and the lung TBARS levels of fluoride supplemented F1 and F2 rats were higher than controls. There were marked histological changes in the lung tissues of fluoride supplemented F1 and F2 rats, as follows: in F1 rats; loss of alveolar architecture, emphysematous areas, descuamation of alveolar epithelium and alveolar congestion were observed. There were thickened interalveolar septae and congestion of alveolar septal vessels. Intraparenchymal thick-walled vessels were also observed. There were markedly perivascular and intraparenchymal focal mononuclear cell infiltrations. In F2 rats, in addition to these changes, there were lipid cell hyperplasia and increased connective tissue mass in the parenchymal areas. It is concluded that chronic fluorosis causes a marked destruction in lung tissues of F1 and F2 rats by causing lipid peroxidation.     

Cranio-cerebral erosion: delayed diagnosis and treatment

Cranio-cerebral erosion is a well-known complication of calvarian fracture with underlying dural tear and cerebral injury in infancy and early childhood. The anatomy, pathogenesis and natural evolution of these lesions remain obscure. The common clinical symptoms are seizures, focal neurological deficits, impairment of consciousness and a soft subgaleal mass. Three patients of cranio-cerebral erosion who underwent delayed surgery in their adult lives are presented to illustrate the common and uncommon features, and their long-term outcome is discussed.     

Comparison of uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty and cautery-assisted uvulopalatoplasty in the treatment of primary snoring

OBJECTIVE: Our aim was to compare the postoperative pain and surgical results of uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP), and cautery-assisted uvulopalatoplasty (CAUP) procedures in the treatment of primary snoring. METHODS: 54 patients were stratified according to a modified Friedman staging system (MFSS) for sleep-disordered breathing. Tonsil size (1, 2, 3) and palatal position scale (grade 1-2) and body mass index <30 according to the MFSS were included for standardization. Three workgroups consisting of 18 patients each were formed and UPPP, LAUP and CAUP procedures were performed. The success of the surgical procedures was evaluated by applying the Epworth Sleepiness Scale to the patients, and the patients' bed partners were asked to evaluate the snoring level preoperative and 45 days after the operation to determine any improvement in snoring complaints. Patients were followed for postoperative pain, secondary infection, bleeding, permanent velopharyngeal insufficiency and nasopharyngeal stenosis. RESULTS: Snoring was relieved in 83.3% of UPPP and CAUP groups and in 88.8% of LAUP 45 days after operation. The mean pain duration was 5.71 days for the UPPP patients, 6.28 days for the LAUP patients and, 4.12 days for the CAUP patients. The mean pain score was 2.1 for the UPPP patients, 2.38 for the LAUP patients, and 1.6 for the CAUP patients. Only 1 patient was hospitalized due to pain in the LAUP group. CONCLUSION: The effectiveness of UPPP, LAUP and CAUP procedures were found to be similar (more than 83%). Postoperative pain was mostly seen in LAUP and UPPP cases. The CAUP procedure was easy and the least painful.