Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center

Objective: This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs).Methods: 407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, one-way analysis of variance (ANOVA) and Spearman correlation analysis.Results: The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of High-density lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients.Conclusion: This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. Most importantly, Meggit Wagner, one of the four different classification systems used in the DFUs, was determined to be highly associated with patients’ amputation risk.Level of Evidence: Level IV, Prognostic Study     

Endovascular management of renal angiomyolipomas: Do coils have a benefit in terms of clinical success rates?

PURPOSEThis study evaluated single-center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy, and retreatment rates.METHODSA retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome, and complications were recorded. Patients were divided into 2 groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the 2 groups in terms of tumor size reduction, retreatment, and complication rates. RESULTSIn this study, 42 patients (37 (88.1%) females and 5 (11.9%) males) harboring 48 AMLs were included. The mean age was 43.46 (range, 20-78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94 ± 1 cm (P  < .001) after treatments; however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (P  = .21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48 ± 25.71 (range, 2-102) months.CONCLUSIONIn this study, no clear supplementary benefit was observed in terms of safety and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs.

Main points

• Transarterial embolization is safe and effective in reducing lesion size and bleeding rates in the management of angiomyolipomas.
• Lesion size reduction can be achieved with both techniques; solely microparticle embolization or distal microparticle embolization plus proximal coil embolization.
• Proximal coil embolization does not provide an additional benefit with lesions having intratumoral microaneurysms ≥5 mm as the study showed no difference in complication and bleeding rates.

Renal angiomyolipoma (AML) is one of the most common benign tumors of the kidney, with an incidence of 0.4% in the general population.^1,2 AMLs are seen in 2 forms; sporadic and tuberosclerosis (TSC) related. Sporadic form accounts for 80% of the AML cases. TSC-related AMLs tend to be bilateral, multifocal, larger with a faster growth rate and are more symptomatic than the sporadic type.³ AMLs have slow growth rates and rarely necessitate invasive treatment at all times.⁴ Historical data suggest that AMLs equal to or larger than 4 cm and those that have 5 mm or larger microaneurysms tend to be more symptomatic and prone to hemorrhage.^5,6 Although a treatment indication based on tumor size larger than 4 cm is subject to dispute,⁷ treatment decisions are often made using these cut-off values in the literature. Treatment options consist of medical treatment, surgery, transarterial embolization (TAE), and thermal ablation with no definitive recommendation on the first-line treatment choice.^8,9 However, because of its less-invasive nature, TAE is a favored choice in the management of AMLs over surgery. So far, various embolic agents (ethanol, microparticles, coils, gel foam, etc.) have been used in the management of patients with AML.¹⁰ Concerning the embolic materials, Patatas et al.¹¹ compared solely coil embolization with solely microparticle embolization in transarterial embolization of AMLs. They found similar reduction rates on computed tomography (CT) follow-up between the 2 groups. Ewalt et al.¹² showed that microparticle plus coil embolization is effective in terms of size reduction in large (>4 cm) and symptomatic and TSC-related AMLs. Although based on the literature, coils, microparticles, and microparticle + coil embolization are all safe and efficient, there are no clear data on the additional benefit of adding coil embolization to microparticle embolization in terms of treatment efficacy. Therefore, this study aimed to evaluate within single-center results whether there is clinical relevance of adding proximal coil embolization to distal microparticle embolization in terms of safety, efficacy, and retreatment rates.     

Response to trastuzumab and investigation of expression profiles of matrix metalloproteinase-related proteins in primary breast cancer stem cells

Clinical and Experimental Medicine - Breast cancer (BC) is the leading cause of cancer deaths in women. One of the reasons for the failure of BC treatment is reportedly the ineffectiveness of...     

Effects of Different Over – the - Counter Whitening Products on the Microhardness,Surface Roughness,Color and Shear Bond Strength of Enamel

ObjectiveThe purpose of this in vitro study was to evaluate the effects of four over-the-counter (OTC) whitening products on the microhardness, surface roughness, color, shear bond strength (SBS) and surface charecteristics of human enamel compared with a product used for dentist-supervised home whitening.Materials and methodsSeventy eight enamel specimens allocated into 6 groups (n=13): 1-Opalescence PF 10% (OP) dentist prescribed home whitening product, 2-Opalescence Go prefilled tray (PT), 3-Opalescence Whitening Toothpaste (WT), 4-Listerine Healthy White whitening mouth rinse (WMR), 5-Cavex Bite&White whitening pen (WP) and 6- no treatment (Con). The microhardness (VHN), surface roughness (Ra) and color of the specimens were measured (T₀). The specimens were then subjected to whitening protocols for 14 days (T₁.) followed by artificial saliva storage for 14 days (T₂). The measurements were repeated at T₁ and T₂. The SBS test was done after the application of 35% phosphoric acid (Scotchbond Universal Etchant), followed by a universal adhesive (G-Premio Bond) and a micro hybrid/universal resin composite (Essentia) into a Teflon tube attached to the enamel surface (p<0.05). Surface morphologies of the enamel surfaces were examined by SEM. p value was set at 0.05ResultsApplication of OP, PT and WP decrased the microhardness of enamel specimens (p<0.05) whereas, no significant changes were seen in the microhardness of enamel specimens treated with WT and WMR (p>0.05). Ra values of enamel specimens increased with the application of OP, PT and WT (p<0.05); whereas no changes were observed after the applications of WMR and WP (p>0.05). OP, PT, WMR, and WP changed the color of the enamel(p<0.05). There were not any significant differences among the SBSs groups, apart from OP applied enamel specimens. OP showed the least SBS values (p=0.001). SEM observations revealed smooth enamel surfaces.ConclusionsThe whitening products affected the microhardness, surface roughness, color of enamel differently. Only OP decreased the SBS of the enamel.     

A case of rhabdomyolysis associated with thyrotoxicosis

Rhabdomyolysis is found to be associated with trauma; alcohol; drugs; viral infections, such as HIV, Epstein-Barr virus, cytomegalovirus and influenza; metabolic disorders; dermatomyositis; polymyositis; and hypothyroidism. Few cases of rhabdomyolysis associated with thyrotoxicosis have been reported. A patient who presented with delirium to the emergency department and was diagnosed with thyrotoxicosis and rhabdomyolysis is hereby presented.     

Sulcus vocalis in monozygotic twins

Sulcus vocalis is the presence of a groove extending along the vibratory surface of a vocal fold and may result in dysphonia. Depending on the level of severity, this condition may require treatment involving complicated surgical techniques. Cases of sulcus vocalis are classified as physiological, vergeture, or pouch type. A clear explanation of the etiology has not been established, and the currently proposed congenital origin, as described in the literature, remains controversial. This paper presents findings from monozygotic twin sisters with bilateral sulcus vocalis; these patients had similar morphologies, vibratory characteristics, and vocal quality measurements, which support the theory of a congenital etiology.     

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES:

To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis.

METHODS:

We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed.

RESULTS:

Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival.

CONCLUSIONS:

Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.     

An intention to achieve better postnatal in-hospital-growth for preterm infants: Adjustable protein fortification of human milk

Objective

We assessed the effect of human milk (HM) fortification with extra protein supplement by an adjustable protein fortification method according to the weekly blood urea nitrogen (BUN) levels on growth in hospitalized preterm infants.

Method

A prospective observational intervention study in 58 preterms born ≤ 32 weeks of gestation and fed with breast milk was conducted. Preterms who were given a commercial HM fortifier which provides an additional protein of 0.8 g/3 scales according to the standard feeding strategy served as a historical control group. Infants who were given extra protein in addition to the HM fortifier with another commercial protein supplement which provides an additional protein of 2.2 g/1 scale comprised the intervention group. Additional protein supplementation was adjusted according to BUN levels weekly in the intervention group. Weight gain velocities (g/kg/day), length, head circumferences (HC) gain velocities (mm/day) and daily growth indexes for weight, height and HC (percentage per day) were calculated.

Results

The median amount of daily enteral protein intake [4 (3.4–4.6) vs. 2.78 (2.1–3.1) g/kg/day, p < 0.0001] was significantly higher in the interventional group. Length (p = 0.008) and HC (p < 0.0001) gain velocities were significantly higher in the intervention group. Daily growth indexes for weight (2.2% vs. 1.8%, p = 0.026), for length (0.4% vs. 0.3%, p = 0.027) and for HC (0.48% vs. 0.36% per day, p = 0.003) were significantly higher in the intervention group.

Conclusion

A higher protein intake by adjustable protein fortification method without energy or volume change leads to improved postnatal in-hospital-growth in very low birth weight infants.