Category: Nevin Manimala

Stat Med. 2023 Aug 30;42(19):3547-3567. doi: 10.1002/sim.9819. Epub 2023 Jun 12.

ABSTRACT

Mendelian randomization is a technique used to examine the causal effect of a modifiable exposure on a trait using an observational study by utilizing genetic variants. The use of many instruments can help to improve the estimation precision but may suffer bias when the instruments are weakly associated with the exposure. To overcome the difficulty of high-dimensionality, we propose a model average estimator which involves using different subsets of instruments (single nucleotide polymorphisms, SNPs) to predict the exposure in the first stage, followed by weighting the submodels’ predictions using penalization by common penalty functions such as least absolute shrinkage and selection operator (LASSO), smoothly clipped absolute deviation (SCAD) and minimax concave penalty (MCP). The model averaged predictions are then used as a genetically predicted exposure to obtain the estimation of the causal effect on the response in the second stage. The novelty of our model average estimator also lies in that it allows the number of submodels and the submodels’ sizes to grow with the sample size. The practical performance of the estimator is examined in a series of numerical studies. We apply the proposed method on a real genetic dataset investigating the relationship between stature and blood pressure.

PMID:37476915 | DOI:10.1002/sim.9819

Turk J Med Sci. 2023 Jun;53(3):647-658. doi: 10.55730/1300-0144.5627. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Hepayocyte loss may develop secondary to liver surgery and at this point liver regeneration plays a significant act in terms of liver reserve. The purpose of this research was to investigate the efficacy of apocynin on liver regeneration and preservation after partial hepatectomy in rats.

METHODS: A total of 32 rats, have been divided into 4 groups (n: 8) for hepatectomy model. Inflammatory and antiinflammatory parameters were measured from blood and liver tissue samples. In addition, the effects of apocynin were examined immunohistochemically and histopathologically from liver tissue.

RESULTS: In liver tissue samples, a significant difference has been found in glutathione peroxidase, total nitrite, catalase, oxidative stress index, total antioxidant and total oxidant status between sham and hepatectomy groups. A significant difference has been achieved between hepatectomy and posthepatectomy-Apocynin in terms of glutathione peroxidase and oxidative stress index. Total antioxidant status, oxidative stress index, and total oxidant status were significantly different only between the sham and the hepatectomy groups. Statistical differences were found between sham and hepatectomy groups and between hepatectomy and pre+post-hepatectomy-Apocynin groups in terms of serum glutathione, malondialdehyde, total nitrite, and L-Arginine. There were significant differences between the sham and hepatectomy groups, between hepatectomy and posthepatectomy-apocynin groups, between posthepatctomy-apocynin and pre+posthepatectomy-apocynin groups in terms of sinusoidal dilatation, intracytoplasmic vacuolization and glycogen loss (p < 0.001), in all histopathologic parameters except sinusoidal dilatation (p < 0.05). However, significant Ki-67 increases have been elaborated in hepatectomy, posthepatectomy-apocynin, and pre+posthepatectomy-apocynin groups compared to sham group (p < 0.001), in pre+posthepatectomy apocynin group compared to hepatectomy and posthepatectomy-apocynin groups (p < 0.001).

DISCUSSION: Histopathology, immunohistochemistry, and biochemistry results of this study revealed that apocynin has a protective effect on enhancing liver regeneration in partial hepatectomy cases in rats.

PMID:37476910 | DOI:10.55730/1300-0144.5627

Turk J Med Sci. 2023 Jun;53(3):760-752. doi: 10.55730/1300-0144.5638. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Hydrochlorothiazide (HCTZ) possesses well-described photosensitizing properties, and a causal association with nonmelanoma skin cancer (NMSC) was recently shown. However, previous studies have not shown whether HCTZ use is associated with the risk of recurrence of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). This study aims to investigate the association between HCTZ use and recurrence in patients with NMSC.

METHODS: We identified cases with NMSC from our hospital archives during the period between 2013 and 2019. Patients were divided into groups according to the pathological diagnosis, HCTZ use, and recurrence. Multivariable analysis was performed to determine factors associated with recurrence in BCC and SCC.

RESULTS: Recurrences of BCC were significantly higher in HCTZ users with ORs of 4.839221 (95% confidence interval [CI], 1.22-19.12).In HCTZ users, NMSC cases were associated with increased age (p < 0.001 for both BCC and SCC). BCC recurrences were statistically significant with age, longer follow-up, and positive margins after excision in HCTZ users (p = 0.048, 0.020, and, 0.003, respectively). SCC recurrences were not significantly associated with HCTZ use.

DISCUSSION: HCTZ use is significantly associated with BCC recurrences. Especially in the elderly population, cases with a positive margin should be followed closely.

PMID:37476909 | DOI:10.55730/1300-0144.5638

Turk J Med Sci. 2023 Jun;53(3):761-770. doi: 10.55730/1300-0144.5639. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Considering its early bactericidal activity, isoniazid (H) is an important first-line agent in tuberculosis (TB) treatment.The aim of this study was to evaluate the treatment regimens and results of H-resistant pulmonary TB patients.

METHODS: We retrospectively evaluated treatment regimens and results of 188 H-resistant pulmonary TB patients who were treated in our center between January 2015 and December 2017. Treatment regimens applied were noted and treatment outcomes were recorded. The long-term results were evaluated.

RESULTS: Totally 174 (92.6%) of 188 patients with H-resistant pulmonary TB achieved treatment success. Ninety-seven patients (51.6%)were cured and 77 patients (41.0%) completed treatment. Five patients (2.7%) had treatment failure. Four patients (2.1%) having treatment success relapsed during one-year follow-up. Eighteen patients (9.6%) had unfavorable outcomes, including treatment failure in five (2.7%), death in nine (4.8%), and relapse in four patients (2.1%). The treatment success rate was found to be statistically higher in group 1 (9-month regimen 2HREZ/7HRE) compared with those in group 2 (9HREZ) (97.4% vs. 85.9%; p = 0.010). Group 3 (HREZFQ) and group 1 had statistically significant favorable outcomes, compared to group 2 (group 2 vs. group 3, p = 0.048; group 1 vs. group 2, p = 0.022). Interestingly, no relapse and acquired rifampicin resistance in patients occurred who received an FQ-containing regimen.

DISCUSSION: Our study results show higher treatment success and positive results with the treatment regimen containing FQ and that treatment with HREZ for nine months is associated with a lower treatment success rate.

PMID:37476899 | DOI:10.55730/1300-0144.5639

Turk J Med Sci. 2023 Jun;53(3):685-691. doi: 10.55730/1300-0144.5631. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Mechanisms to explain inflammation in male infertility of unknown cause are still being investigated. The inflammasome is a key regulator of innate immunity in the inflammatory response to infections. Our study aims to investigate the effects of varicocele on infertility, its relationship with antioxidant and inflammasome mechanisms, and how it could be guided in azoospermic or nonazoospermic patients.

METHODS: A cross-sectional cohort study was conducted at the department of urology in our university hospital. Eightyeight randomly selected men aged 20-45 admitted to our hospital because of infertility between September 2019 and July 2020 were included in the study. Patients were divided into four equal groups according to their clinical status, those with/without azoospermia and with/without varicocele. Blood and semen samples were taken from the patients. NOD-like receptor pyrin domain-containing 3 (NLRP3) and interleukin-1 beta (IL1β) and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were measured in serum and semen, and the groups were compared statistically.

RESULTS: Serum and semen NLRP3, IL1β, TAS, TOS, and OSI values of the patients with varicocele or azoospermia were significantlyhigher than those without either varicocele or azoospermia (p < 0.05). The oxidative stress markers TAS, TOS, and OSI values were significantly higher in the other groups than those without azoospermia and varicocele (p < 0.05).

DISCUSSION: Inflammasome mechanisms, such as NLRP3 and IL1-β molecules, may provide additional benefit in evaluating the need and benefit of surgical or medical treatment in infertility with and without vascular pathology and with and without azoospermia.

PMID:37476898 | DOI:10.55730/1300-0144.5631

Turk J Med Sci. 2023 Jun;53(3):803-813. doi: 10.55730/1300-0144.5643. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Allergic rhinitis can be associated with bronchial hyperreactivity (BHR) and create an increased risk for allergic asthma development. We aimed to investigate the effects of subcutaneous immunotherapy (SCIT) on BHR and asthma development in adult patients with allergic rhinitis.

METHODS: The retrospective case-control study was carried out between November 2018 and May 2019 in Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital. In this study, data was recorded for patients with a mite and/or grasses/cereals pollen allergy who were tested for BHR before planned SCIT, and who had allergic rhinitis, with or without asthma. The SCIT group was selected as those who received SCIT for at least one year. The control group was selected from those who were scheduled to receive SCIT but were waived and still receiving medication. Symptom scores, prick test results, PC20 levels (methacholine challenge that is a provocative concentration causing a 20% fall in FEV1), and the presence of asthma were recorded and compared with data from at least one year after treatment.

RESULTS: A total of sixty-eight subjects (22 males, 46 females; mean age 40.54 ± 12.27 years; SCIT: 40, Control: 28) were enrolled.Although the changes in log PC20 levels were not statistically significant in both SCIT and control groups after an average of 30-35 months of treatment, it was found to be significant in favor of the SCIT group when two groups were compared in terms of the change in log PC20 (p = 0.026). The development and improvement of asthma were not significantly different between the SCIT and control group but tended to increase in the control group. The percentage of patients with progressed/BHR was significantly higher in the controls (70.6% vs. 38.1%, p = 0.046).

DISCUSSION: In our real life study we have demonstrated the preventative effect of SCIT on BHR, but not on asthma developmen.

PMID:37476897 | DOI:10.55730/1300-0144.5643

Turk J Med Sci. 2023 Jun;53(3):701-711. doi: 10.55730/1300-0144.5633. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Texture analysis (TA) provides additional tissue heterogeneity data that may assist in differentiating peripheral zone(PZ) lesions in multiparametric magnetic resonance imaging (mpMRI). This study investigates the role of magnetic resonance imaging texture analysis (MRTA) in detecting clinically significant prostate cancer (csPCa) in the PZ.

METHODS: This retrospective study included 80 consecutive patients who had an mpMRI and a prostate biopsy for suspected prostate cancer. Two radiologists in consensus interpreted mpMRI and performed texture analysis based on their histopathology. The first-, second-, and higher-order texture parameters were extracted from mpMRI and were compared between groups. Univariate and multivariate logistic regression analyses were performed using the texture parameters to determine the independent predictors of csPCa. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of the texture parameters.

RESULTS: : In the periferal zone, 39 men had csPCa, while 41 had benign lesions or clinically insignificant prostate cancer (cisPCa). Themajority of texture parameters showed statistically significant differences between the groups. Univariate ROC analysis showed that the ADC mean and ADC median were the best variables in differentiating csPCa (p < 0.001). The first-order logistic regression model (mean + entropy) based on the ADC maps had a higher AUC value (0.996; 95% CI: 0.989-1) than other texture-based logistic regression models (p < 0.001).

DISCUSSION: MRTA is useful in differentiating csPCa from other lesions in the PZ. Consequently, the first-order multivariate regressionmodel based on ADC maps had the highest diagnostic performance in differentiating csPCa.

PMID:37476894 | DOI:10.55730/1300-0144.5633

Turk J Med Sci. 2023 Jun;53(3):692-700. doi: 10.55730/1300-0144.5632. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: Pathophysiologic changes associated with chronic inflammation occur with aging and more prominently in patients with chronic kidney disease (CKD), and an association between chronic inflammation and muscle wasting has been identified. The microcirculation is extremely sensitive to the inflammatory process and actively participates in it. In a healthy adult, angiogenesis is a strictly controlled and rare occurrence. However, aberrant angiogenesis and the development of new tiny blood vessels are known in chronic inflammatory diseases. Superb microvascular imaging (SMI) is a noninvasive technique that can evaluate tiny vessels with low blood flow and provide quantitative data. Our goal was to detect increased blood flow secondary to low-grade chronic inflammation in micro-circulation in the rectus femoris (RF) muscle using SMI.

METHODS: This cross-sectional study involved 30 patients with CKD, 30 adults without CKD or other chronic illnesses, and 32 young healthy volunteers. This study was conducted in our university hospital between March and December 2021. The RF cross-sectional area (CSA) was measured, and vascular index (VI) values were obtained using SMI. All three groups’ RF-CSA and VI values were compared.

RESULTS: Although there was no statistically significant difference in RF-CSAs between the groups, the VI values of all three groups were statistically different (p < 0.001). The median (min-max) VI values were 0.90 (0.60-1.30), 0.50 (0.20-1.0), and 0.30 (0.10-0.50) for the CKD, adult control, and young healthy groups, respectively. The VI significantly differentiated patients with CKD from all other patients and the adult control group. When a cutoff value of 6.5 was used for the VI in detecting increased blood supply in RF muscle in patients with CKD, the accuracy, positive predictive value, and negative predictive value were 93.5%, 85.3%, and 98.3%, respectively.

DISCUSSION: SMI can detect increased blood supply caused by low-grade inflammation in the RF muscle.

PMID:37476893 | DOI:10.55730/1300-0144.5632

Turk J Med Sci. 2023 Jun;53(3):780-790. doi: 10.55730/1300-0144.5641. Epub 2023 Jun 19.

ABSTRACT

BACKGROUND: To have country-wide information about multidrug resistance (MDR) in isolates from community-acquired urinary tract infections (CAUTI) of Turkey, in terms of resistance rates and useful options.

METHODS: We used a geocode standard, nomenclature of territorial units for statistics (NUTS), and a total of 1588 community-acquired isolates of 20 centres from 12 different NUTS regions between March 2019 and March 2020 were analysed.

RESULTS: Of the 1588 culture growths, 1269 (79. 9%) were Escherichia coli and 152 (9.6%) were Klebsiella spp. Male sex, advancedage, and having two or more risk factors showed a statistically significant relation with MDR existence (p < 0.001, p: 0.014, p < 0.001, respectively) that increasing number of risk factors or degree of advancing in age directly affects the number of antibiotic groups detected to have resistance by pathogens. In total, MDR isolates corresponded to 36.1% of our CAUTI samples; MDR existence was 35.7% in E. coli isolates and 57.2% in Klebsiella spp. isolates. Our results did not show an association between resistance or MDR occurrence rates and NUTS regions.

DISCUSSION: The necessity of urine culture in outpatient clinics should be taken into consideration, at least after evaluating risk factorsfor antibacterial resistance individually. Community-acquired UTIs should be followed up time- and region-dependently. Antibiotic stewardship programmes should be more widely and effectively administrated.

PMID:37476892 | DOI:10.55730/1300-0144.5641

Turk J Med Sci. 2023 Apr;53(2):603-609. doi: 10.55730/1300-0144.5621. Epub 2023 Apr 19.

ABSTRACT

BACKGROUND: The Level of Sitting Scale (LSS) is a valid and reliable classification index that categorizes sitting ability. The aim of this study is to establish the Turkish validity and reliability of the LSS in children with cerebral palsy (CP).

METHODS: In total, 165 children (75 girls and 90 boys) between the ages of 4 and 18 years who were diagnosed with CP were included in the study. All children were evaluated by two independent physiotherapists for the interrater reliability analysis of the LSS and were reevaluated 1 week later by the same physiotherapist for the intrarater reliability analysis. The Gross Motor Function Classification System (GMFCS) was used for validity analysis.

RESULTS: The intrarater reliability analyses of the LSS showed an intraclass correlation coefficient of 0.999 (ICC 95% CI [0.999-1]),and the interrater reliability analyses showed an intraclass correlation coefficient of 0.998 (ICC 95% CI [0.998-0.999]). A statistically significant, negative, and strong correlation was found between the GMFCS and the LSS (p < 0.001, r = -0.770).

DISCUSSION: The Turkish version of the LSS in children with CP is a valid and reliable scale. The Turkish LSS can be used by researchersand clinicians in research and to determine the sitting level of children with CP.

PMID:37476883 | DOI:10.55730/1300-0144.5621