RESUMO
BACKGROUND: Pyoderma Gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers. OBJECTIVE: We aimed to evaluate the demographic, clinical characteristics, treatments and factors affecting the treatment responses of patients with PG. METHODS: We performed a multicenter study of 12 tertiary care centers. We analyzed the data of the patients who were followed up with a diagnosis of PG between the years 2012â2022 retrospectively. RESULTS: We included a total of 239 patients of whom 143 were female and 96 were male, with an average age of 54.2⯱â¯17.4 years. The most common treatment was systemic steroids (nâ¯=â¯181, 75.7%). Among these patients, 50.8% (nâ¯=â¯92) used systemic steroids as the sole systemic agent, while 49.2% (nâ¯=â¯89) used at least one adjuvant immunosuppressive agent. The independent factors determined in regression analysis to influence response to systemic steroids positively were disease onset age ≥ 30-years, negative pathergy, absence of leukocytosis, negative wound culture, presence of a single lesion, and absence of upper extremity involvement. Biological agents were used in 18.4% (nâ¯=â¯44) of the patients in the present study. We also analyzed pathergy positive PG and early onset (onset age < 30) PG separately due to their distinct clinical features which were revealed during statistical analysis. STUDY LIMITATIONS: Retrospective nature of the present study. CONCLUSIONS: Analyses of the factors influencing treatment responses are addressed in this study. Also, we concluded that investigation for accompanying autoinflammatory diseases of pathergy positive PG and early onset PG is necessary and the patients in these two groups are more resistant to treatment, necessitating more complicated treatments.
RESUMO
Ligula intestinalis is a cestode parasite that affects freshwater fish in different countries of the world. The current study aims to reveal the phylogenetic, genetic and haplotype diversity of mt-CO1 gene sequences sent to the NCBI database from different countries by using in-silico analysis. The 105 mt-CO1 (371 bp) gene sequences of L. intestinalis obtained from NCBI were used for bioinformatics analyses. Sequences were subjected to phylogenetic and haplotype analysis. As a result of the haplotype analysis of L. intestinalis, 38 haplotypes were obtained from 13 different countries. Hap24 constituted 44.76% of the obtained haplotype network. Changes in nucleotides between haplotypes occurred at 1-84 different points. China and Turkey have highest fixation index (Fst) values of 0.59761, while the lowest (-0.10526) was found between Russia and Turkey. This study provides a baseline for future studies on extensive scale on the epidemiology, ecological aspects, distribution pattern, transmission dynamics and population dispersion of L. intestinalis worldwide.
Ligula intestinalis é um parasita cestódeo que acomete peixes de água doce em diversos países do mundo. O presente estudo visa revelar a diversidade filogenética, genética e de haplótipos das sequências do gene mt-CO1 enviadas ao banco de dados do NCBI de diferentes países, por meio de análise in-silico. As sequências gênicas de 105 mt-CO1 (371 pb) de L. intestinalis obtidas do NCBI foram utilizadas para análises bioinformáticas. As sequências foram submetidas a análise filogenética e de haplótipos. Como resultado da análise de haplótipos de L. intestinalis, 38 haplótipos foram obtidos de 13 países diferentes. Hap24 constituiu 44,76% da rede de haplótipos obtida. Mudanças nos nucleotídeos entre os haplótipos ocorreram em 1-84 pontos diferentes. A China e a Turquia apresentam os maiores valores do índice de fixação (Fst), 0,59761, enquanto o menor (-0,10526) foi encontrado entre a Rússia e a Turquia. Este estudo fornece uma linha de base para futuros estudos em larga escala sobre epidemiologia, aspectos ecológicos, padrão de distribuição, dinâmica de transmissão e dispersão populacional de L. intestinalis em todo o mundo.
Assuntos
Animais , Parasitos , Filogenia , Variação Genética , Haplótipos , Peixes , Água DoceRESUMO
OBJECTIVE: To evaluate the origin and ultrastructure of the coarse granules in the perivitelline space (PVS) of oocytes of a group of couples attending assisted reproduction treatment. METHODS: The ultrastructure of five oocytes with coarse granulues in the PVS obtained from three patients were evaluated by transmission electron microscopy (TEM). The influence of the ovulation induction regimen on the formation of granules in the PVS of the oocytes of 214 couples and the developmental capacity of these oocytes presenting granules in the PVS was analyzed retrospectively. RESULTS: In TEM analysis, the microvilli structure was irregular, short, and loosely scattered through the oolemma in the oocytes presenting coarse granules in the PVS. Furthermore, dense lipid droplets were identified within the PVS and the surrounding cumulus cells. In retrospective analysis, the number of oocytes with coarse granules in the PVS was positively correlated with the duration of antagonist administration (r=0.23, p=0.013). Regardless of the type of granule, the presence of coarse or moderately coarse granules in the PVS was positively correlated with low-quality embryos on D3 (r=0.29, p=0.005) and the total number of arrested embryos up to D3 (r=0.33, p<0.001). Furthermore, the presence of coarse granules in the PVS severely exacerbated miscarriage rates. CONCLUSIONS: Our findings suggest that the presence of especially coarse granules in the PVS is correlated with the reduction of further embryonic developmental capacity in post-implantation stages of embryonic development, indicating a negative impact from aggressive ovulation induction protocols on developing oocytes.
RESUMO
OBJECTIVE: The aim of this study was to assess the effect of lymphovascular space invasion on recurrence and disease-free survival in patients with low-risk endometrial cancer. METHODS: The study included patients with stage 1A, grade 1-2 endometrioid endometrial cancer who underwent a total hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Independent prognostic predictors of endometrial cancer recurrence were assessed using the Cox regression model. Binary logistic regression analysis was used to identify the predictors of distant recurrence. Kaplan-Meier analysis was used to describe survival curves, and the log-rank test was used to compare the differences in survival curves. RESULTS: A total of 189 patients met the inclusion criteria, of whom 24 (12.7%) had lymphovascular space invasion. The median follow-up time was 60 (3-137) months. Distant recurrence was present in 11 of 22 patients who developed recurrence. Kaplan-Meier survival analysis showed that the 5-year disease-free survival rates of patients with lymphovascular space invasion(+) and lymphovascular space invasion(-) were 62.5 and 91.9%, respectively, which were significantly lower (p<0.001). In multivariate Cox regression analysis, the presence of lymphovascular space invasion (p<0.001) and age ≥60 years (p=0.017) remained as prognostic factors for reduced disease-free survival. In binary logistic regression analysis, only lymphovascular space invasion (adjusted OR=13, 95%CI=1.456-116.092, p=0.022) was a prognostic factor for distant recurrence. CONCLUSION: lymphovascular space invasion is a prognostic risk factor for recurrence and distant metastasis and also a predictor of poorer disease-free survival outcomes in low-risk endometrial cancer.
Assuntos
Carcinoma Endometrioide , Neoplasias do Endométrio , Feminino , Humanos , Pessoa de Meia-Idade , Relevância Clínica , Estudos Retrospectivos , Recidiva Local de Neoplasia , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia , Prognóstico , Carcinoma Endometrioide/cirurgia , Carcinoma Endometrioide/patologia , Estadiamento de Neoplasias , Invasividade Neoplásica/patologiaRESUMO
BACKGROUND: Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach â TAPP). METHODS: Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. RESULTS: The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). CONCLUSION: In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. REGISTER NUMBER: NCT05199922.
Assuntos
Hérnia Inguinal , Laparoscopia , Bloqueio Nervoso , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Hérnia Inguinal/cirurgia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , BupivacaínaRESUMO
BACKGROUND: Hypertension causes subendothelial inflammation and dysfunction in resulting atherosclerosis. Carotid intima-media thickness (CIMT) is a useful marker of endothelial dysfunction and atherosclerosis. The uric acid to albumin ratio (UAR) has emerged as a novel marker for predicting cardiovascular events. OBJECTIVE: We aimed to investigate the association of UAR with CIMT in hypertensive patients. METHODS: Two hundred sixteen consecutive hypertensive patients were enrolled in this prospective study. All patients underwent carotid ultrasonography to classify low (CIMT < 0.9 mm) and high (CIMT ≥ 0.9 mm) CIMT groups. The predictive ability of UAR for high CIMT was compared with systemic immune inflammation index (SII), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein/albumin ratio (CAR). A two-sided p-value <0.05 was accepted as statistically significant. RESULTS: Patients with high CIMT were older and had higher UAR, SII, NLR, and CAR than low CIMT. Age, UAR, SII, NLR, and CAR, but not PLR, were associated with high CIMT. In multivariable analysis, age, CRP, SII, and UAR were independent predictors of high CIMT. The discrimination ability of UAR was higher than uric acid, albumin, SII, NLR, and CAR, and UAR had a higher model fit than those variables. UAR had higher additive improvement in detecting high CIMT than other variables, as assessed with net-reclassification improvement, IDI, and C-statistics. UAR was also significantly correlated with CIMT. CONCLUSION: UAR might be used to predict high CIMT and might be useful for risk stratification in hypertensive patients.
FUNDAMENTO: A hipertensão causa inflamação subendotelial e disfunção na aterosclerose resultante. A espessura média-intimal da carótida (EMIC) é um marcador útil de disfunção endotelial e aterosclerose. A razão ácido úrico/albumina (RUA) emergiu como um novo marcador para prever eventos cardiovasculares. OBJETIVO: Nosso objetivo foi investigar a associação da RUA com a EIMC em pacientes hipertensos. MÉTODO: Duzentos e dezesseis pacientes hipertensos consecutivos foram incluídos neste estudo prospectivo. Todos os pacientes foram submetidos a ultrassonografia de carótida para classificar baixos (EMIC < 0,9 mm) e altos (EMIC≥0,9 mm) grupos de EMIC. A capacidade preditiva da RUA para EMIC alta foi comparada com o índice de inflamação imune sistêmica (IIS), razão neutrófilo/linfócito (RNL), razão plaqueta/linfócito (RPL) e razão proteína C reativa/albumina (RCA). Um valor de p bilateral <0,05 foi aceito como estatisticamente significativo. RESULTADOS: Os pacientes com EMIC alta eram mais velhos e tinham maior RUA, IIS, RNL e RCA do que baixo EMIC. Idade, RUA, IIS, RNL e RCA, mas não RPL, foram associados a EMIC alta. Na análise multivariada, idade, PCR, IIS e RUA foram preditores independentes de EMIC alta. A capacidade de discriminação de RUA foi maior do que ácido úrico, albumina, IIS, RNL e RCA, e RUA teve um ajuste de modelo maior do que essas variáveis. RUA teve maior melhoria aditiva na detecção de EMIC alta do que outras variáveis, conforme avaliado com melhoria de reclassificação líquida, MDI e estatísticas C. RUA também foi significativamente correlacionada com EMIC. CONCLUSÃO: RUA pode ser usado para prever EMIC alta e pode ser útil para estratificação de risco em pacientes hipertensos.
Assuntos
Aterosclerose , Hipertensão , Humanos , Aterosclerose/complicações , Proteína C-Reativa/análise , Espessura Intima-Media Carotídea , Hipertensão/complicações , Inflamação , Estudos Prospectivos , Ácido Úrico , Albumina Sérica HumanaRESUMO
Abstract Objectives: multi-system ınflammatory syndrome in children (MIS-C) is an immune-mediated process that develops after infections like SARS-CoV-2. The authors aimed to reveal the mucocutaneous findings of patients diagnosed with MIS-C at presentation and evaluate the frequency of these mucocutaneous findings and their possible relationship with the severity of the disease. Methods: A prospective study was conducted of 43 children admitted to a tertiary hospitals between January 2021 and January 2022 who met Centers for Disease Control and Prevention criteria for MIS-C. Results: 43 children (25 [58.1%] male); median age, 7.5 years [range 0.5-15 years]) met the criteria for MIS-C. The most common symptom was cutaneous rash 81.4%, followed by gastrointestinal symptoms 67.4%, oral mucosal changes 65.1%, and conjunctival hyperemia 58.1%. The most common mucosal finding was fissured lips at 27.9%, diffuse hyperemia of the oral mucosa at 18.6%, and strawberry tongue at 13.9%. Urticaria (48.8%) was the most common type of cutaneous rash in the present study's patients. The most common rash initiation sites were the trunk (32.6%) and the palmoplantar region (20.9%). The presence or absence of mucocutaneous findings was not significantly associated with disease severity. Study limitations: The number of patients in the this study was small. Conclusions: The present study's prospective analysis detected mucocutaneous symptoms in almost 9 out of 10 patients in children diagnosed with MIS-C. Due to the prospective character of the present research, the authors think that the characteristic features of cutaneous and mucosal lesions the authors obtained will contribute to the literature on the diagnosis and prognosis of MIS-C.
RESUMO
OBJECTIVE: The aim of this study was to investigate the predictive importance of the previously validated log(ER)*log(PgR)/Ki-67 predictive model in a larger patient population. METHODS: Patients with hormone receptor positive/HER-2 negative and clinical node positive before chemotherapy were included. Log(ER)*log(PgR)/Ki-67 values of the patients were determined, and the ideal cutoff value was calculated using a receiver operating characteristic curve analysis. It was analyzed with a logistic regression model along with other clinical and pathological characteristics. RESULTS: A total of 181 patients were included in the study. The ideal cutoff value for pathological response was 0.12 (area under the curve=0.585, p=0.032). In the univariate analysis, no statistical correlation was observed between luminal subtype (p=0.294), histological type (p=0.238), clinical t-stage (p=0.927), progesterone receptor level (p=0.261), Ki-67 cutoff value (p=0.425), and pathological complete response. There was a positive relationship between numerical increase in age and residual disease. As the grade of the patients increased, the probability of residual disease decreased. Patients with log(ER)*log(PgR)/Ki-67 above 0.12 had an approximately threefold increased risk of residual disease when compared to patients with 0.12 and below (odds ratio: 3.17, 95% confidence interval: 1.48-6.75, p=0.003). When age, grade, and logarithmic formula were assessed together, the logarithmic formula maintained its statistical significance (odds ratio: 2.47, 95% confidence interval: 1.07-5.69, p=0.034). CONCLUSION: In hormone receptor-positive breast cancer patients receiving neoadjuvant chemotherapy, the logarithmic model has been shown in a larger patient population to be an inexpensive, easy, and rapidly applicable predictive marker that can be used to predict response.
Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Biomarcadores Tumorais/análise , Antígeno Ki-67/análise , Receptor ErbB-2/uso terapêutico , Terapia Neoadjuvante , Receptores de Progesterona/análise , Receptores de Progesterona/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estudos RetrospectivosRESUMO
Since SARS-CoV-2 disease (COVID-19) has been labeled as a pandemic, it took the spotlight in the differential diagnosis for patients presenting with acute respiratory and systemic symptoms. Leptospirosis is one of the most common zoonoses in the world, yet it is mainly a disease of differential diagnosis for places that do not have it as an endemic. Due to the high burden of COVID-19 on the healthcare field, patients suffering from other infections may have been inadvertently neglected. COVID-19 infection can mimic other infectious diseases and can confuse physicians in their search for a confirmatory diagnosis. Nonetheless, it is very crucial to broaden the differential diagnosis and keep diseases like leptospirosis within the differential diagnosis despite its rarity, especially in patients presenting with unexplained systemic infectious symptoms. This is a unique case of a patient who presented with dyspnea, jaundice and change in urine color who was suspected to be COVID-19 positive. After a detailed investigation, the patient was diagnosed with leptospirosis instead of COVID-19 and was treated with plasmapheresis and antibiotics accordingly.
Assuntos
COVID-19 , Leptospirose , Animais , Humanos , Pandemias , SARS-CoV-2 , Leptospirose/complicações , Leptospirose/diagnóstico , ZoonosesRESUMO
SUMMARY OBJECTIVE: The aim of this study was to investigate the predictive importance of the previously validated log(ER)*log(PgR)/Ki-67 predictive model in a larger patient population. METHODS: Patients with hormone receptor positive/HER-2 negative and clinical node positive before chemotherapy were included. Log(ER)*log(PgR)/Ki-67 values of the patients were determined, and the ideal cutoff value was calculated using a receiver operating characteristic curve analysis. It was analyzed with a logistic regression model along with other clinical and pathological characteristics. RESULTS: A total of 181 patients were included in the study. The ideal cutoff value for pathological response was 0.12 (area under the curve=0.585, p=0.032). In the univariate analysis, no statistical correlation was observed between luminal subtype (p=0.294), histological type (p=0.238), clinical t-stage (p=0.927), progesterone receptor level (p=0.261), Ki-67 cutoff value (p=0.425), and pathological complete response. There was a positive relationship between numerical increase in age and residual disease. As the grade of the patients increased, the probability of residual disease decreased. Patients with log(ER)*log(PgR)/Ki-67 above 0.12 had an approximately threefold increased risk of residual disease when compared to patients with 0.12 and below (odds ratio: 3.17, 95% confidence interval: 1.48-6.75, p=0.003). When age, grade, and logarithmic formula were assessed together, the logarithmic formula maintained its statistical significance (odds ratio: 2.47, 95% confidence interval: 1.07-5.69, p=0.034). CONCLUSION: In hormone receptor-positive breast cancer patients receiving neoadjuvant chemotherapy, the logarithmic model has been shown in a larger patient population to be an inexpensive, easy, and rapidly applicable predictive marker that can be used to predict response.
RESUMO
OBJECTIVE: The aim of this study was to compare the efficiency of fetal thymic-thoracic ratio and fetal thymus transverse diameter measurements in gestational diabetes mellitus. METHODS: Fetal thymic-thoracic ratio and fetal thymus transverse diameter were assessed in 360 pregnant women. Patients were examined in two groups: 180 gestational diabetes mellitus (study group) and 180 healthy pregnant women (control group). RESULTS: There were no statistically significant differences between the cases with gestational diabetes mellitus and the control group in terms of fetal thymus transverse diameter; however, the fetal thymic-thoracic ratio was found to be significantly lower in cases with gestational diabetes mellitus compared to that in the control group (p<0.001). CONCLUSION: The fetal thymic-thoracic ratio is superior to the fetal thymus transverse diameter in evaluating the fetal thymus size.
Assuntos
Diabetes Gestacional , Gravidez , Humanos , Feminino , Diabetes Gestacional/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Feto , Timo/diagnóstico por imagem , Cuidado Pré-NatalRESUMO
SUMMARY OBJECTIVE: The aim of this study was to compare the efficiency of fetal thymic-thoracic ratio and fetal thymus transverse diameter measurements in gestational diabetes mellitus. METHODS: Fetal thymic-thoracic ratio and fetal thymus transverse diameter were assessed in 360 pregnant women. Patients were examined in two groups: 180 gestational diabetes mellitus (study group) and 180 healthy pregnant women (control group). RESULTS: There were no statistically significant differences between the cases with gestational diabetes mellitus and the control group in terms of fetal thymus transverse diameter; however, the fetal thymic-thoracic ratio was found to be significantly lower in cases with gestational diabetes mellitus compared to that in the control group (p<0.001). CONCLUSION: The fetal thymic-thoracic ratio is superior to the fetal thymus transverse diameter in evaluating the fetal thymus size.
RESUMO
OBJECTIVES: multi-system inflammatory syndrome in children (MIS-C) is an immune-mediated process that develops after infections like SARS-CoV-2. The authors aimed to reveal the mucocutaneous findings of patients diagnosed with MIS-C at presentation and evaluate the frequency of these mucocutaneous findings and their possible relationship with the severity of the disease. METHODS: A prospective study was conducted of 43 children admitted to a tertiary hospitals between January 2021 and January 2022 who met Centers for Disease Control and Prevention criteria for MIS-C. RESULTS: 43 children (25 [58.1%] male); median age, 7.5 years [range 0.5â15 years]) met the criteria for MIS-C. The most common symptom was cutaneous rash 81.4%, followed by gastrointestinal symptoms 67.4%, oral mucosal changes 65.1%, and conjunctival hyperemia 58.1%. The most common mucosal finding was fissured lips at 27.9%, diffuse hyperemia of the oral mucosa at 18.6%, and strawberry tongue at 13.9%. Urticaria (48.8%) was the most common type of cutaneous rash in the present study's patients. The most common rash initiation sites were the trunk (32.6%) and the palmoplantar region (20.9%). The presence or absence of mucocutaneous findings was not significantly associated with disease severity. STUDY LIMITATIONS: The number of patients in the this study was small. CONCLUSIONS: The present study's prospective analysis detected mucocutaneous symptoms in almost 9 out of 10 patients in children diagnosed with MIS-C. Due to the prospective character of the present research, the authors think that the characteristic features of cutaneous and mucosal lesions the authors obtained will contribute to the literature on the diagnosis and prognosis of MIS-C.
Assuntos
COVID-19 , Doenças do Tecido Conjuntivo , Hiperemia , Criança , Humanos , Masculino , Lactente , Pré-Escolar , Adolescente , Feminino , COVID-19/complicações , COVID-19/epidemiologia , SARS-CoV-2 , Estudos Prospectivos , Pandemias , Síndrome de Resposta Inflamatória Sistêmica/epidemiologiaRESUMO
INTRODUCTION: Compression of the labyrinthine segment of the facial nerve by edema has been considered as an important pathology in the majority of the cases of idiopathic facial nerve paralysis. Hence, it is suggested that total decompression of the facial nerve should also include the labyrinthine segment by a middle fossa approach. However, the middle fossa approach requires craniotomy and temporal lobe retraction, which increases the morbidity. The labyrinthine segment of the facial nerve can also be reached through mastoidectomy. However, many ear surgeons are not familiar with this approach due to the lack of anatomical data on this surgical area. OBJECTIVE: To study the anatomical limitations of decompression of the labyrinthine segment via transmastoid approach. METHODS: Complete mastoidectomy was performed in six adult cadavers heads. Dissection was extended in the zygomatic root and posterior bony wall of the external auditory canal to visualize the incudomallear joint completely. The bone between tympanic segment, lateral and superior semicircular canal's ampullas and middle fossa dural plate was removed. Fine dissection was carried out over tympanic segment of the facial nerve in an anterosuperomedial direction the labyrinthine segment was reached. RESULTS: All the mastoids were well pneumatized. Distances between the labyrinthine segment and middle fossa dura, and between the labyrinthine segment and superior semicircular canal, were 2.5 and 4.5â¯mm on average, respectively. In addition, distances between the middle fossa dura and dome of the lateral semicircular canal, and between the middle fossa dura and tympanic segment were 4.6â¯mm and 4.3â¯mm on average, respectively. CONCLUSION: It is possible to expose the labyrinthine segment of the facial nerve through mastoidectomy by dissecting the bone in the area between the tympanic segment of the facial nerve, middle fossa dural plate and ampullary ends of the lateral and superior semicircular canals.
Assuntos
Orelha Interna , Nervo Facial , Adulto , Humanos , Nervo Facial/cirurgia , Orelha Interna/cirurgia , Orelha Média/cirurgia , Processo Mastoide/cirurgia , Membrana TimpânicaRESUMO
OBJECTIVE: To investigate microanatomic organizations of the extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve. METHODS: Nerve samples were dissected in 12 postmortem autopsies, and histomorphometric analyses were conducted. RESULTS: There was no significant difference between the right and left sides of the nerve samples for the nerve area, fascicle area, number of fascicles and average number of axons. The lowest mean fascicle number was found in the hypoglossal nerve (4.9⯱â¯1.4) while the highest was in great auricular nerve (11.4⯱â¯6.8). The highest nerve area (3,182,788⯱â¯838,430⯵m2), fascicle area (1,573,181⯱â¯457,331⯵m2) and axon number (14,772⯱â¯4402) were in hypoglossal nerve (pâ¯<â¯0.05). The number of axons per unit nerve area was higher in the facial nerve, truncus temporofacialis, truncus cervicofacialis and hypoglossal nerve, which are motor nerves, compared to the sural nerve and great auricular nerve, which are sensory nerves (pâ¯<â¯0.05). The number of axons per unit fascicle area was also higher in motor nerves than in sensory nerves (pâ¯<â¯0.05). CONCLUSION: In the present study, it was observed that each nerve contained a different number of fascicles and these fascicles were different both in size and in the number of axons they contained. All these variables could be the reason why the desired outcomes cannot always be achieved in nerve reconstruction.
Assuntos
Nervo Facial , Nervo Sural , Humanos , Nervo Facial/cirurgia , Nervo Hipoglosso/cirurgia , Axônios , AutopsiaRESUMO
Abstract Background: Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). Methods: Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. Results: The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). Conclusion: In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. Register Number: NCT05199922.
Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Laparoscopia , Hérnia Inguinal/cirurgia , Bloqueio Nervoso , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , BupivacaínaRESUMO
ABSTRACT Since SARS-CoV-2 disease (COVID-19) has been labeled as a pandemic, it took the spotlight in the differential diagnosis for patients presenting with acute respiratory and systemic symptoms. Leptospirosis is one of the most common zoonoses in the world, yet it is mainly a disease of differential diagnosis for places that do not have it as an endemic. Due to the high burden of COVID-19 on the healthcare field, patients suffering from other infections may have been inadvertently neglected. COVID-19 infection can mimic other infectious diseases and can confuse physicians in their search for a confirmatory diagnosis. Nonetheless, it is very crucial to broaden the differential diagnosis and keep diseases like leptospirosis within the differential diagnosis despite its rarity, especially in patients presenting with unexplained systemic infectious symptoms. This is a unique case of a patient who presented with dyspnea, jaundice and change in urine color who was suspected to be COVID-19 positive. After a detailed investigation, the patient was diagnosed with leptospirosis instead of COVID-19 and was treated with plasmapheresis and antibiotics accordingly.
RESUMO
Resumo Fundamento A hipertensão causa inflamação subendotelial e disfunção na aterosclerose resultante. A espessura média-intimal da carótida (EMIC) é um marcador útil de disfunção endotelial e aterosclerose. A razão ácido úrico/albumina (RUA) emergiu como um novo marcador para prever eventos cardiovasculares. Objetivo Nosso objetivo foi investigar a associação da RUA com a EIMC em pacientes hipertensos. Método Duzentos e dezesseis pacientes hipertensos consecutivos foram incluídos neste estudo prospectivo. Todos os pacientes foram submetidos a ultrassonografia de carótida para classificar baixos (EMIC < 0,9 mm) e altos (EMIC≥0,9 mm) grupos de EMIC. A capacidade preditiva da RUA para EMIC alta foi comparada com o índice de inflamação imune sistêmica (IIS), razão neutrófilo/linfócito (RNL), razão plaqueta/linfócito (RPL) e razão proteína C reativa/albumina (RCA). Um valor de p bilateral <0,05 foi aceito como estatisticamente significativo. Resultados Os pacientes com EMIC alta eram mais velhos e tinham maior RUA, IIS, RNL e RCA do que baixo EMIC. Idade, RUA, IIS, RNL e RCA, mas não RPL, foram associados a EMIC alta. Na análise multivariada, idade, PCR, IIS e RUA foram preditores independentes de EMIC alta. A capacidade de discriminação de RUA foi maior do que ácido úrico, albumina, IIS, RNL e RCA, e RUA teve um ajuste de modelo maior do que essas variáveis. RUA teve maior melhoria aditiva na detecção de EMIC alta do que outras variáveis, conforme avaliado com melhoria de reclassificação líquida, MDI e estatísticas C. RUA também foi significativamente correlacionada com EMIC. Conclusão RUA pode ser usado para prever EMIC alta e pode ser útil para estratificação de risco em pacientes hipertensos.
Abstract Background Hypertension causes subendothelial inflammation and dysfunction in resulting atherosclerosis. Carotid intima-media thickness (CIMT) is a useful marker of endothelial dysfunction and atherosclerosis. The uric acid to albumin ratio (UAR) has emerged as a novel marker for predicting cardiovascular events. Objective We aimed to investigate the association of UAR with CIMT in hypertensive patients. Methods Two hundred sixteen consecutive hypertensive patients were enrolled in this prospective study. All patients underwent carotid ultrasonography to classify low (CIMT < 0.9 mm) and high (CIMT ≥ 0.9 mm) CIMT groups. The predictive ability of UAR for high CIMT was compared with systemic immune inflammation index (SII), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein/albumin ratio (CAR). A two-sided p-value <0.05 was accepted as statistically significant. Results Patients with high CIMT were older and had higher UAR, SII, NLR, and CAR than low CIMT. Age, UAR, SII, NLR, and CAR, but not PLR, were associated with high CIMT. In multivariable analysis, age, CRP, SII, and UAR were independent predictors of high CIMT. The discrimination ability of UAR was higher than uric acid, albumin, SII, NLR, and CAR, and UAR had a higher model fit than those variables. UAR had higher additive improvement in detecting high CIMT than other variables, as assessed with net-reclassification improvement, IDI, and C-statistics. UAR was also significantly correlated with CIMT. Conclusion UAR might be used to predict high CIMT and might be useful for risk stratification in hypertensive patients.