Galician Medical Journal

The Relationship Between Eating Behaviors and Functional Status in Female Patients Diagnosed with Fibromyalgia

Alper Mengi — 2023-05-20

Aim. To evaluate whether eating behaviors of female patients with fibromyalgia syndrome differ from those of the healthy population, what factors affect these behaviors, and whether eating behaviors are effective on patients’ life quality and functional status.

Materials and Methods. This cross-sectional and observational study included 55 female fibromyalgia patients and 55 healthy female volunteers. All participants were assessed using demographic data, body mass index (BMI), and the Three-Factor Eating Questionnaire (TFEQ) (Uncontrolled Eating, Cognitive Restraint, Emotional Eating, and Hunger Susceptibility). Fibromyalgia patients were assessed using the Visual Analogue Scale (VAS) and Fibromyalgia Impact Questionnaire (FIQ).

Results. BMI, Uncontrolled Eating, and Hunger Susceptibility scores differed significantly between fibromyalgia patients and healthy volunteers (p < 0.05). In fibromyalgia patients, the TFEQ subscores were not correlated with the FIQ (p > 0.05). There was a positive correlation between the Cognitive Restraint score and age, rest and night pain scores in fibromyalgia patients (p< 0.05). Increasing age was an independent predictor of Cognitive Restraint in fibromyalgia patients (p=0.003).

Conclusions. The proportion of overweight/obese patients, BMI, Uncontrolled Eating, and Hunger Susceptibility were significantly higher among fibromyalgia patients. Fibromyalgia patients’ eating behaviors were not associated with their quality of life and functional status. Increasing age appeared to be a predictor of Cognitive Restraint degree.

Visualization in Anatomical Sciences for Effective Teaching and Learning

Nagavalli Basavanna Pushpa — 2023-05-20

Anatomy is one of the basic subjects of medical science. Medical students gain detailed knowledge of human body by dissecting cadavers. Hence, cadaveric dissection has become an essential tool in teaching and learning anatomy. In anatomy, visualization plays an important role in understanding the spatial orientation of structures. Due to technological advancement and a shortage of cadavers, there is a need to look for various complementary tools which can provide an adequate visualization of bodily structures. This issue was very well understood and reflected during the recent pandemic when cadaveric dissection was substituted by experimenting with various teaching tools. In this paper, we have tried to briefly describe the various options that can complement/supplement dissection and assist in self-directed learning.

Evaluation of the Tpeak-Tend Interval as an Arrhythmogenicity Index in Graves' Disease

Cem Onur Kirac — 2023-05-20

Introduction.Graves’ disease is the most common cause of hyperthyroidism. The mortality rate increases by 20% in hyperthyroid patients; cardiac problems are the leading cause of death and arrhythmia is the most common cardiac complication.

Our study aimed to evaluate the corrected QT interval (QTc), the Tpeak-Tend interval (Tp-e), and the Tp-e/QTc ratio to predict arrhythmia risk in patients with Graves’ disease.

Methods. The study included 64 patients with Graves’ disease and 57 euthyroid controls. The 12-lead electrocardiograms of the individuals under study were evaluated. The QTc interval, the Tp-e interval, and the Tp-e/QTc ratio of all participants were determined and statistically evaluated with thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) values.

Results. Tp-e (p < 0.001) and QTc (p < 0.05) were significantly prolonged in the group of patients with Graves’ disease as compared to the control group. Heart rate was higher in patients with Graves’ disease as well (p < 0.05). Correlation analysis in patients with hyperthyroidism demonstrated that Tp-e (r=0.372, p=0.002), QTc (r=0.291, p=0.020), and fT3 levels were significantly and positively correlated. Similarly, Tp-e (r=0.271, p=0.030), QTc (r=0.259, p=0.039), and fT4 levels were significantly and positively correlated.

Conclusions. We observed a significant prolongation of the Tp-e and QTc intervals with the increase in fT3 and fT4 levels. On the other hand, our study demonstrated that the sensitivity and specificity of Tp-e in the prediction of hyperthyroidism were 70.3% and 70.1%, respectively (AUC=0.724 (CI: 0.629-0.818)), the optimal cut-off value=83.5 ms). The Tp-e interval, which has recently been used as one of the arrhythmogenicity indices, may be an indicator of arrhythmia risk in patients with Graves’ disease.

Turkish Dental Students’ Perceptions and Awareness of Dental Implant Education: A Questionnaire Study

Eda Izgi — 2023-05-20

Objective. This study aimed to assess Turkish dental students’ awareness of and attitudes toward dental implant therapy, as well as the effectiveness of dental implantology lecture from their point of view.

Materials and Methods. This study used a cross-sectional online survey. A total of 425 third-, fourth- and fifth-year dental students enrolled in Gazi University School of Dentistry during the 2020-2021 academic year were invited to participate in the survey anonymously and voluntarily. Following the descriptive part (age, gender, and education status), all the participants were asked 11 questions.

Results. Total of 415 questionnaires were analyzed. The 3^rd-year students stated that they were“ poorly” informed about dental implants (n=88, 64.7%), while the 4^th- and 5^th-year students were“ moderately” infromed (n=78, 54.2% and n=60, 44.4%, respectively) (p < 0.001). All the students were believed that they needed to get more information during their undergraduate studies (p < 0.01). More than half of all students preferred to have PhD or speciality training after graduation (p > 0.05). Approximately 80% of all students believed that dentists should receive specialized training in order to practice implant dentistry (p > 0.05).

Conclusions. The results of this study show that some Turkish dental students find DI treatment a difficult operation and that they do not know enough about it. As a result, it is anticipated that improving the current curriculum will contribute to the course success and make dental students feel better prepared for dental implantology following graduation.

“What IVC?”: Deep Vein Thrombosis in the Context of IVC Dysgenesis

Thomas C. Varkey — 2023-05-20

Among young, otherwise healthy adults with unprovoked deep vein thrombosis (DVT), uncommon causes like variation in the normal sequential development of the inferior vena cava (IVC), must be explored. Anomalous IVC conditions are estimated to occur in up to 9% of the general population, with the rarest anomaly being IVC agenesis at 0.0005% - 1% general population prevalence. DVTs are more likely to develop in this population due to venous stasis from decreased venous return, even with the formation of extensive collateral veins. Herein, the authorial team presents a 22-year-old patient with leg pain and swelling who was found to have acute DVT, and, incidentally, the absence of the suprarenal IVC with a robust collateral system on further imaging studies. The morbidity of DVTs in this population is very high, and attention should be given to young patients who present with new-onset DVT in the setting of normal coagulation studies and lack of personal or family history of clotting disorders, as the need for specialized imaging such as venograms is necessary to secure the proper diagnosis.

“MedEd” on Twitter: A Social Network Analysis

Shazia Iqbal — 2023-05-20

Background. In the current era, Twitter is an increasingly popular tool for the dissemination of information as a social media voice. Social media is a valid, but underutilized, education tool at medical education institutions. Social media technologies provide opportunities for the presentation of information in alternative and multiple formats to enhance engagement, content creation, and motivation for individual and collaborative learning.

Objective. This study examined the type of social structure and sub-clusters do exist regarding “MedEd” on the Twitter network. Additionally, it determined the top opinion leaders in these networks and which type of topics generates users’ interest regarding “MedEd”.

Methods. This study applied NodeXL to analyze the results and retrieved Twitter data on November 1, 2022 by using the keywords “MedEd”. The data were saved and interpreted in the “vertices” and “edges” on the NodeXL worksheets.

Results. We found that the top opinion leader (vertex) “Cryptovitas” had the highest in- betweenness and out-degree centrality. “Innov_medicine” had the in-degree centrality for networks. “In-Degree” and “Out-Degree” are the count of Tweets an opinion leader gets and forwards messages out, correspondingly. The study found that although “Cryptovitas” had the highest in-betweenness centrality, “taylorswift13” had the maximum number of followers (91,523,045) with in-betweenness centrality of 0.0. This indicates that the vertex having maximum influence with the largest number of in-betweenness centrality has not linked with several followers.

Conclusions. Using Twitter embodies a potential prospect to engage the medical education community. The content of top networks’ tweets was around the number of “MedEd” innovations with the potential to significantly improve medical education delivery and innovative technologies in healthcare services. There is no link between the number of followers and in-betweenness centrality to influence the strength of social media voice. Although clinical and social tweets were there, not much was discussed regarding the curriculum reforms, continued professional development, technical issues in MedEd, and assessments. This triggers the insistence for rapid and innovative adaptations to the new learning environments and remarkable revolutions in medical education, including the encouragement of evidence-based education. The Twitter discussions promoted a research network circulating a wide range of informative innovations and collaborations.

Saving Lives Under Fire: The Extraordinary Efforts of ICU Health Professionals in the Ukrainian War

Raman Kalia — 2023-05-20

Amid the Ukrainian War, the heroes of the intensive care unit (ICU) - doctors, nurses, respiratory therapists, and many others - valiantly confront unprecedented challenges, showcasing resilience and dedication in the face of adversity. Despite limited resources and electricity backup issues, these health professionals worked tirelessly to provide life-saving care to critically ill patients, including those with gunshot wounds, shrapnel injuries, burns, and traumatic brain injuries. The article highlights the need to denounce attacks on medical personnel during conflicts, and strategies for supporting ICU health professionals in war zones are suggested, including hazard pay, comprehensive insurance coverage, safety training and equipment, support networks and mental health services, and ongoing education and professional development. The heroic efforts of ICU health professionals during times of war highlight the crucial role they play in healthcare systems worldwide.

Renin-Angiotensin System: A Review of Historical Perspectives

Olga Kovalyova — 2023-05-20

The article is a review of publications concerning historical perspectives of the renin-angiotensin system. The discovery of its components is presented in chronological order, beginning with the initial identification of renin and proceeding to the subsequent discoveries of angiotensin-converting enzyme 2, angiotensin- (1-7), Mas receptor.

This paper presents a modern classification of the renin-angiotensin system, dividing it into classical and non-classical branches, based on the determination of the biological effects of its components. Significant attention is devoted to elucidating the biochemical cascade of the renin-angiotensin system, its physiological transformations, and its implications in human body processes. The detrimental cardiac effects of the classical renin-angiotensin system are highlighted, along with the crucial role played by its alternative axis in counteracting the development of cardiovascular diseases.

The article presents data on the involvement of angiotensin-converting enzyme 2 and its receptors in coronavirus infections, susceptibility to infection, and disease progression.

Self-Perceived Sources of Stress and Burnout Determinants in Dentistry - A Systematic Review

Nadya Avramova — 2023-03-01

Introduction. In recent decades, under the influence of various factors, there has been a serious increase in psycho-emotional tension and stress. Furthermore, considering unprecedented times of global pandemic threat, stress levels can rise significantly. Dental profession is physically and mentally stressful as dentists encounter a number of occupational hazards of a biological, chemical, physical, and psycho-emotional nature.

Objective. The current review paper aimed to answer the question: what are the most important stressors and burnout determinants in daily dental practice?

Materials and Methods. The Web of Science Core Collection database was searched for according to the PRISMA guidelines in September 2022. Empirical studies - observational, experimental, cross-sectional, and longitudinal studies published in English were considered for inclusion.

Results. The initial search yielded 355 articles. Eighteen studies met inclusion criteria and were considered for the final analysis. Two articles reported identical data; therefore, they were not included in the current report. Finally, this review presented 16 reports with a total of 8, 824 subjects.

Conclusions. Both long-term and short-term stress can cause negative effects on practitioner’s physical, mental, and emotional functioning. As healthcare providers, dentists should be aware of these risk factors, as well as they need to be sufficiently motivated to know the risks and inconveniences of their profession, learning effective strategies how to deal with adverse conditions, factors, and relationships. Providing information on this issue will contribute to increasing dentists’ awareness and improving their personal and professional performance.

The Relationship Between Healthy Lifestyle Beliefs and Hygiene Behaviors of Adolescents During the COVID-19 Pandemic Process

Semra Kose — 2023-03-01

Aim. The research was carried out to determine the relationship between healthy lifestyle beliefs and hygiene behaviors of adolescents during the COVID 19 pandemic process.

Materials. This descriptive-correlational research was carried out with 418 Turkish adolescents at the age of 13 to 18 years between March and August 2021. The data were collected online with a data collection tool, including a question form, the Healthy Lifestyle Belief Scale for Adolescents (HLBSA), and the Hygiene Behavior Scale (HBS). Percentage, mean, independent sample t-test, Mann-Whitney U-test, Kruskal-Wallis H test, Pearson correlation, and multiple regression analyses were used to analyze the data.

Results. In the study, the variables of socioeconomic status, health perception, and knowledge of healthy living have shown a significant influence on the total HLBSA score; the variables of gender, maternal occupation, health perception and knowledge of healthy living have shown a significant impact on the total HBS score (p< 0.05). The total mean score of the HLBSA was 52.97 ± 19.71, and the total mean score of the HBS was 102.07 ± 23.02. There was a statistically significant relationship between the total HLBSA score and the total HBS score during the COVID-19 epidemic (p < 0.05).

Conclusions. The study found that hygiene behaviors of adolescents during the pandemic process were good if their healthy lifestyle beliefs were good.

Von Willebrand Factor and Intima-Media Thickness in Patients With Rheumatoid Arthritis: A Cross-Sectional Study

Khristina Fedorovych — 2023-03-01

Background. Cardiovascular risk assessment in patients with rheumatoid arthritis (RA) is often a real challenge and requires the search for new indicators to reveal the potential threat of developing atherosclerotic vascular lesions in the early stages.

The study aimed to analyse the association between von Willebrand factor (vWF), disease activity, and intima-media thickness (IMT) score in RA patients.

Materials and Methods. The study involved 60 RA patients divided into three groups based on the Disease Activity Score 28 (DAS-28) activity index and 20 individuals as healthy controls. Clinical and laboratory assessments included determining the number of swollen (SJ) and painful joints (PJ), the visual analogue scale (VAS) score, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen. The concentration of vWF in blood plasma was determined by an enzyme-linked immunosorbent assay (ELISA). The IMT was measured at the bifurcation of the external and internal carotid arteries. Asymptomatic vascular damage was identified as the IMT > 0.9 mm; an atherosclerotic plaque was verified when a focal structure encroached ≥ 0.5 mm or 50% of the adjacent IMT value into the carotid lumen or the IMT > 1.5 mm.

Results. Most RA patients (39/60; 65.0%) showed an increase in the IMT (> 0.9 mm); atherosclerotic plaques (IMT > 1.5 mm) were confirmed in 16 (26.7%) individuals, which was significantly more as compared to the control group. VWF was positively associated with the IMT [OR 1.1 (1.06-1.2), p < 0.001]. In addition, elevated levels of vWF were associated with disease activity. The highest values of vWF were found in patients with moderate RA activity (43.3 [21.2-56.9]). There was a positive correlation between vWF and ESR, CRP, DAS-28 (0.564, 0.455, and 0.573, respectively).

Conclusions. There was a positive correlation between vWF, inflammatory markers, and disease activity. VWF appeared to be a reliable predictor of the IMT score in RA patients.

Associations Between Chronotype, Adherence to the Mediterranean Diet, and Attitude to Healthy Nutrition

Tuba Yalcin — 2023-03-01

Background. Chronotype is the attitude of a subject in determining the individual circadian preference in behavioral and biological rhythm associated with eating behaviors and health.

Objective. The aim of this study was to evaluate the associations between chronotype, adherence to the Mediterranean diet, and attitudes to healthy nutrition in Turkish adults.

Methods. A survey was conducted online using online platforms. A total of 1,197 volunteers between 18-65 years of age participated in our study. Participants’ adherence to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener (MEDAS); their healthy eating attitude and chronotype were assessed using the Attitude Scale for Healthy Nutrition (ASHN) and the Morning-Evening Questionnaire (MEQ), respectively.

Results. Most of the participants were classified as those with an intermediate chronotype. More than half of evening-type participants and nearly half of intermediate-type participants had poor Mediterranean diet adherence. In addition, the percentages of individuals with morning and evening chronotypes in the very low and moderate classification ranges were similar and lower than the percentages of those with an intermediate chronotype. Linear regression analysis revealed that participants with higher MEQ values had higher ASHN and MEDAS scores and a lower body mass index as compared to those with lower MEQ values.

Conclusions. Chronotype was associated with Mediterranean diet adherence and healthy eating attitude. In particular, morning-type subjects showed higher adherence to the Mediterranean diet than intermediate- and evening-type subjects.

The Impact of SARS-CoV-2 Pandemic on Medical Students: Knowledge, Attitudes, and Practices towards E-Learning: An Online Cross-Sectional Study in the Kurdistan Region, Iraq

Ahmed A. Mosa — 2023-03-01

Background. After COVID-19 emergence, medical education witnessed a shift from face-to-face education to digital education, which inevitably affected medical students. Globally, due to the closure of schools and universities, medical education was shifted to electronic learning (E-learning).

This paper aimed to assess the effects of the COVID-19 pandemic on medical education and determine medical students’ knowledge, attitude, and practices towards E-learning in the Kurdistan Region of Iraq.

Materials and Methods. An online cross-sectional study was conducted among 500 undergraduate students of seven medical colleges in the Kurdistan Region, Iraq, in November 2021, to assess their state during the COVID-19 pandemic and how this affected their education.

Results. There were 50.6% of males and 49.4% of females. The mean age was 20.6 (± 1.5 SD) years. Approximately 17% of participants mentioned having financial issues, while 19.2% of students experienced health-related problems. As many as 67% of participants reported that the Internet quality was good or very good, whereas 46.8% of students disagreed that E-learning was a possible substitute for traditional learning. About two-thirds of participants agreed or were neutral that downloadable content was better than live content; however, only 19.2% of students agreed that E-learning could be used in the clinical aspect. A total of 52.2% of participants disagreed that E-testing could replace traditional learning methods. Surprisingly, 86.4% of students stated that they regularly used the Internet in their study.

Conclusions. E-learning was the main adjustment made in the educational system, including medical education. The study concluded with insights into how different circumstances could have different consequences on the efficacy of medical education. E-learning showed effective results in continuing learning until the educational system switched to a blended system. Training programs for medical education personnel are vital in effective E-learning opportunities.

Knowledge and Attitudes Towards Child Abuse and Neglect Among Dental Students from North Macedonia

Vesna Ambarkova — 2023-03-01

Introduction. Signs of child abuse and neglect are often found in the orofacial region and, therefore, it is very important for dental students, as future dentists, to recognize and report them.

The aim of the study was to investigate the knowledge and attitudes towards child abuse and neglect among dental students.

Material and Methods. The study was performed at the Faculty of Dental Medicine, Saints Cyril and Methodius University, among all dental students of the six-year undergraduate dental programme. The data were collected between January and February 2022 using a Google Form and shared via available social media platforms. The definition of physical indicators of abuse, awareness regarding legal and ethical issues, students’ experience of child abuse recognition were evaluated by a questionnaire.

Results. The questionnaire completion rate was 70%. As many as 20.86% of dental students very rarely received training on recognizing and reporting child abuse and neglect; 79.75% of dental students had never received any information about child abuse during their university education; about 91.41% of students wanted to receive more knowledge about child abuse and neglect. No differences were observed in terms of gender and year of study.

Conclusions. Dental students in North Macedonia are not sufficiently prepared for their role in diagnosing suspected cases of child abuse. An educational program about diagnosing, reporting, and preventing child abuse and neglect should be involved in the curriculum of undergraduate students from North Macedonia.

Nisin: Prerequisites and Prospects for Application in the Medical Field

Oksana Knysh — 2023-03-01

Nisin is a typical representative of class I bacteriocins belonging to subtype A1 lantibiotics. This lantibiotic is produced by gram-positive bacteria of the genera Lactococcus, Streptococcus, Staphylococcus, and Blautia. Currently, at least twelve natural variants of nisin are known. They differ in some physicochemical properties and biological activity. Nisin is generally recognized as safe (GRAS) and has been used as a food additive for seven decades. The current review presents the data from scientific reports over the past decade supporting the value of this lantibiotic as a therapeutic agent. Most research works demonstrate a high inhibitory potential of nisin against antibiotic-resistant bacteria when using alone and in combination with antibiotics. A number of studies prove the ability of nisin to modulate the composition of oral and intestinal microbiomes, to inhibit the growth of both bacteria causing infectious processes and bacterial pathogens associated with cancer. Nisin has been shown to have its own antitumor potential and to be able to enhance the therapeutic effect of chemotherapeutic drugs. There is convincing evidence of its immunomodulatory and anti-inflammatory activity. The reasons limiting its widespread application in clinical practice can be successfully eliminated via modern bioengineering technologies that improve the functional characteristics and stability of nisin in various physiological conditions.

COVID-19 Through the Eyes of a Physiatrist: Back Pain Can Be a Symptom and May Predict Pneumonia in COVID-19

Cuma Uz — 2022-12-01

The study aimed to determine whether back pain is a clinical manifestation in patients with COVID-19 and whether several demographic and disease characteristics could be an effective indicator of back pain.

Materials and Methods. A total of 99 patients with COVID-19 were recruited from the Department of Infectious Diseases of the Kirikkale High Specialized Hospital in Turkey and divided into two groups depending on the presence (n=50) or absence of back pain (n=49). The primary outcomes included were demographic and disease characteristics, the Nord-Trøndelag Health Study Physical Activity Level for Work (HUNT), and the 6-minute walking test.

Results. The most common symptom was fatigue (n=63, 63.6%), followed by back pain (n=50, 50.5%). In the back pain group, the number of patients with sedentary lifestyle, oxygen requirement, pneumonia, and typical pneumonia pattern were significantly higher (p=0.009, p=0.026, p=0.001, p=0.001, respectively), while aerobic capacity was lower (p=0.001). In a logistic regression analysis, back pain was found to be associated with pneumonia presence.

Conclusions. Back pain may be associated with the presence of COVID-19 pneumonia and should be evaluated as its early warning symptom.

Neurogenic Myositis Ossificans of the Hip in a Patient with Axonal Polyneuropathy

Oubaddi Tlaite — 2022-12-01

Background. Neurogenic myositis ossificans is a rare entity defined by the development of soft tissue ossifications in patients with paraplegia or tetraplegia following neurological pathologies, often after cranial or spinal cord trauma. The diagnosis is based on imaging, in particular CT scan, which often reveals the presence of intramuscular ossifications of periarticular location. Treatment is based on analgesics, physiotherapy, and surgery as a last resort.

Case Report. We present a case of neurogenic myositis ossificans in a 26-year-old patient followed for axonal polyneuropathy secondary to vitamin deficiency.

Conclusions. Neurogenic myositis ossificans is a rare entity but is easily diagnosed, given the context of severe neurological disorders and the characteristic appearance on CT scan. In doubtful and atypical cases, a biopsy with histological study is recommended.

An Unusual Presentation of “Two-Thirds Tumor” in the Mandible – A Diagnostic Quandary with a Review of the Literature

Jayapriya T — 2022-12-01

An adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of the oral cavity commonly found in the maxillary anterior region and is associated with impacted canines in young females. It rarely occurs in the mandibular region with no impacted or missing teeth. A 21-year-old female reported to the clinic with swelling on the right side of the face for the past six months with no history of pain. Radiographic features such as unilocular radiolucency with thinning of the cortical borders and considerable buccal cortical expansion, as well as some evidence of radiopaque specks were noted. Histopathological examination revealed cells with hyperchromatic nuclei, rosette-like structures with focal areas of calcified mass, and concentric rings resembling Liesegang rings, suggestive of AOT. The tumor was treated surgically by enucleation and cauterization. Although follicular type is a common variant, the tumor presented in this case was of extrafollicular type noted in the mandibular canine and premolar regions of a young female patient with no related impacted tooth.

Prognostic Value of Serum Interleukin-6 Level in Hypertensive Patients with COVID-19-Associated Pneumonia

Oleksii Skakun — 2022-12-01

Background. An interleukin-6 (IL-6) is a proinflammatory cytokine which plays an important role in COVID-19-associated hyperinflammation.

Aim. This study aimed to assess the predictive ability of serum IL-6 levels for the development of severe/critical clinical conditions, a hypoxemic state requiring supplemental oxygen, and lethal outcomes in patients with COVID-19-associated pneumonia and arterial hypertension (AH).

Materials and Methods. One hundred and thirty-five unvaccinated patients hospitalized for COVID-19-associated pneumonia were enrolled in the study. AH was diagnosed in 78.5% of cases. Pneumonia was confirmed radiologically. SARS-COV-2 as an etiological factor was confirmed by either PCR or ELISA. In addition to conventional laboratory tests, IL-6, ferritin, and soluble interleukin-2 levels were measured.

Results. Among AH patients, the median levels of IL-6 were higher in non-survivors (95.1 [37.8 - 158.8] pg/mL) as compared to survivors (39.5 [13.6 - 81.1] pg/mL) (p=0.04). Among AH patients, the median serum level of IL-6 was 98.3 [37.8 - 158.8] pg/mL in critically ill patients, 41.7 [11.8 - 83.4] pg/mL in severely ill patients, 37.8 [13.6 - 74.4] pg/mL in moderately ill patients (p=0.051). The median serum level of IL-6 was lower at the time of discharge (6.5 [2.0 - 21.5] pg/mL) as compared to that on admission (43.2 [16.1 - 92.0] pg/mL) (p< 0.001). IL-6 level failed to predict severe/critical condition (AUC=0.59, p=0.13) and the need for supplemental oxygen (AUC=0.61, p=0.06); however, it might be used for the prediction of the lethal outcome (AUC=0.69, p=0.03). The cut-off value of IL-6 level for lethal outcome prediction of 91.0 pg/mL showed a sensitivity of 58.3% and a specificity of 78.7%. Patients with IL-6 levels > 91.0 pg/mL on admission had higher odds of lethal outcomes (OR = 4.87 [1.40 - 16.92], p=0.01).

Conclusions. Serum IL-6 level on admission did not show significant predictive ability for severe/critical conditions and hypoxemic states requiring supplemental oxygen in AH patients. However, serum IL-6 levels on admission were higher in non-survivors and might be used for the prediction of lethal outcomes with a cut-off value of 91.0 pg/mL in AH patients.

Curcumin Attenuates Lipopolysaccharide-Induced Neuroinflammation and Memory Deficiency by Inhibiting Microglia Activation in Mice Hippocampus

Kingsley Iteire — 2022-12-01

Background. Curcumin has a variety of properties, including antioxidant and anti-inflammatory ones, and has demonstrated some protective prospects on neurological conditions.

Aim: This study explored the neuroprotective ability of curcumin in lipopolysaccharide-induced neuroinflammation in an animal model.

Methods. A total of thirty-two adult male mice were randomly assigned to four groups (A, B, C, and D, n=8): Group A (Control) received distilled water; Group B was administered lipopolysaccharide (LPS) only to induce neuroinflammation for seven days; Group C was treated with both LPS and curcumin simultaneously for fourteen days; Group D received only curcumin for fourteen days. After appropriate exposure to the mice, their cognitive abilities were assessed using the Y-maze and novel object recognition tests. At the termination of the administration period, the mice were sacrificed, and the hippocampi were dissected for histology and immunostaining using GFAP and Iba1. Statistical analysis for the data generated was done with GraphPad prism. Tests of significance were with one-way ANOVA and Tukey tests for post-hoc.

Results. Curcumin significantly (p < 0.05) increased object recognition, mean alternation, and markedly restored neuronal distortion caused by LPS toxicity in the CA3 region and the dentate gyrus of the hippocampus of Group C animals as compared to Group B. In addition, curcumin significantly down-regulated Iba1 expression and GFAP cell activities of both the CA3 region and the dentate gyrus.

Conclusions. Curcumin showed a promising role in attenuating LPS-induced neuroinflammation in the brain by inhibiting microglial activation and improving memory of neurotoxic mice.

The Effect of the Mucinous Component Presence on the Clinical Outcomes of Colorectal Cancer

Ibrahim Ali Ozemir — 2022-12-01

Background. The effect of colorectal cancer (CRC) histological subtypes on the prognosis is still a controversial issue. We aimed to compare clinical findings, histopathologic data, and survival outcomes in CRC patients with classical and mucinous subtypes.

Methods. Patients who were operated on for CRC between 2010 and 2017 were included in the study. Patients were classified into two groups according to the presence of a mucinous component: mucinous adenocarcinoma (MAC) - mucinous component > 50% and classical adenocarcinoma (CAC). Clinical and histopathologic findings, recurrence, metastasis, and survival rates were compared.

Results. Data of the 484 CRC patients were documented. Sixty-nine patients (14.3%) were in the MAC group and 415 (85.7%) patients were in the CAC group. The mean age of patients with MAC and CAC was 63.4 ± 13.5 and 68.5 ± 12.7 years, respectively (p = 0.002). Proximal colon localization was found in 30 (43.5%) MAC patients and 123 (29.6%) CAC patients (p = 0.029). The number of patients with metastatic lymph nodes was higher in the MAC group (58% vs. 41.2%, p = 0.03). Nevertheless, there was no significant difference between the CAC and MAC groups in terms of disease-free survival (63.1% vs. 69.6%, p = 0.37) and disease-related mortality (23.6% vs. 23.2%, p = 0.94) over the follow-up period. Multivariate analysis showed that the presence of perineural invasion, patient’s age, and disease stage were associated with mortality in CRC patients.

Conclusions. MACs occurred at a younger age than CACs and were more likely localized in the proximal colon as compared to CACs. Despite increased lymph node metastasis in MAC patients, no statistical significance was detected in overall survival or disease-free survival. Multivariate analysis revealed that age, perineural invasion, and disease stage were relevant to mortality in CRC patients.

Microbiological Assessment of Glycyrrhizic Acid Effectiveness in Bacterial Vaginosis – A Comparative Study

Svitlana Ostafiichuk — 2022-12-01

Background. Bacterial vaginosis (BV) is one of the most common female diseases, which is currently characterized by an increasing rate of clinical sign reccurence, the appearance of asymptomatic carriers, and atypical forms.

This study was aimed to evaluate the effectiveness of glycyrrhizic acid administration in the prevention of BV recurrence.

Materials and Methods. The study involved 88 women after BV treatment (metronidazole per os for seven days). Participants were randomly divided into two groups: the main group included 46 patients who were administered 0.1% glycyrrhizic acid intravaginally for three months after the main treatment; the control group comprised 42 women who received no anti-recurrence BV course. The effectiveness was assessed three and six months after the beginning of treatment and included gynecological examination and laboratory assessments (pH, amine test, microbiological investigation).

Results. After recommended BV treatment without anti-recurrence course, the recurrence of laboratory criteria for BV increased three months after the treatment, including the increase in vaginal pH to > 4.5 in all subjects, positive amine test in 35.7% of patients, the presence of Gardnerella vaginalis at a concentration of 10⁴-10⁵ CFU/ml in 31.0% of women, reduction in the frequency of Lactobacillus detection with worsening of the condition and the onset of clinical manifestations of the disease six months later. In the main group, after glycyrrhizic acid administration, laboratory criteria of BV recovery three months after the treatment, and clinical and laboratory markers of BV recovery six months after the treatment were lower as compared to the control group.

Conclusions. The anti-recurrence course of BV (vaginal administration of 0.1% glycyrrhizic acid) demonstrated a decrease in the frequency of complaints, clinical and laboratory markers, stabilization of the species composition of Lactobacillus, and a decrease in facultative anaerobe concentration in the vaginal microbiome as compared to group without anti-recurrence treatment.

Combined Effects of Cadmium- and Cyanide-Contaminated Diet on Oxidative Stress Biomarkers in Different Tissues of Rats

Ovigueroye Ekayoda — 2022-10-18

Background. Several toxicants present simultaneously in the environment have combined toxicological effects. In addition, various xenobiotics have distinct effects on oxidative stress biomarkers in animal cells and tissues.

The aim of this study was to analyze the effect of cadmium (Cd) and cyanide (CN) through the food chain on some antioxidant indices in the tissues (lungs, testes, heart, and brain) of male Wistar rats.

Materials and Methods. The study included sixty African catfish allocated to four groups, each comprising fifteen fish, treated with potassium cyanide (KCN) and cadmium chloride (CdCl₂), held at a temperature of 25°C in a 100-litre fish tank aquarium with water contaminated with 0.4 mg of both cyanide and cadmium/100 ml of water. All the fish were later killed, dried, and used to prepare diet for experimental animals. Twenty male rats divided into four groups, each comprising five rats, were used for this study as well, and fed for 28 days as follows: Group A - control diet; Group B - cyanide-contaminated diet; Group C - cadmium-contaminated diet; Group D - diet contaminated with cyanide + cadmium. Subsequently, they were sacrificed. Biochemical analysis of the tissues excised from the rats was done.

Results. There was a significant (p < 0.05) increase in lipid peroxidation level and a significant decrease in superoxide dismutase, catalase and reduced glutathione activities in the lungs, testes, heart, and brain of rats fed a catfish diet containing both cyanide and cadmium as compared to controls. In addition, contaminated diet altered acetylcholinesterase activity in the brain, glutathione peroxidase activity, glutathione-S-transferase activity, and glutathione reductase activity in the tissues of experimental rats.

Conclusions. Cadmium and cyanide, via the food chain, induce oxidative stress in the lungs, testes, heart, and brain of rats.

Utilizing Proximity for Increasing Student Knowledge Retention: A Near-Peer Tutoring Program Needs Study

Johnathon S. Lueck — 2022-09-01

The purpose of this study was to demonstrate the desire and need for peer-to-peer tutoring programs at Division 1 Dell Medical School at the University of Texas.

Materials and Methods. Two sets of surveys were created and sent to students at the Dell Medical School, University of Texas, USA. One survey asking about the need or desire to engage with a peer tutor was sent to first-year students, and another one asking about the desire to provide these services to underclassmen as a potential leadership course option was sent to third-year students.

Results. For the first-year student survey, 52.9% of respondents disagreed or strongly disagreed of being aware of near-peer tutoring and 70.5% of respondents either agreed or strongly agreed that it would be an option utilized by students. For the third-year student survey, 75% of students either disagreed or felt neutral in being aware of near-peer tutoring as an option to serve underclassmen, whereas 65% of upperclassmen either agreed or strongly agreed that if near-peer tutoring had been offered, they would have chosen this leadership course option in the effort to teach their underclassmen peers.

Conclusions. Numerous studies have demonstrated peer-to-peer tutorial options to be of high utility to students in the medical education space. This particular paper obtained results demonstrating students’ desire to engage in peer tutoring voluntarily for their own course success goals and upperclassmen’s desire to participate as near-peer tutors for the benefit of underclassmen.

Immunohistochemical Expression of IMP3 in Cutaneous Basal Cell Carcinoma

Vladimir Bartos — 2022-09-01

Background. Insulin-like growth factor-II mRNA-binding protein 3 (IMP3) is an oncofetal protein upregulated in tumor cells during carcinogenesis. It has been linked to adverse clinical outcome in many malignancies.

This study was aimed to evaluate an immunohistochemical expression status of IMP3 in cutaneous basal cell carcinoma (BCC) and to correlate it with the Ki-67 index values.

Methods. Biopsy specimens from 32 cases of BCC were enrolled into this analysis. All samples were immunohistochemically stained for IMP3 (Clone 69.1) and Ki-67 antigen (Clone MIB-1).

Results. IMP3 showed a weak expression in 11 (34.4%) cases, a moderate expression in 11 (34.4%) cases, a strong expression in 5 (15.6%) cases, and negative staining in 5 (15.6%) cases. Among seven BCCs exhibiting aggressive-growth features, all but one showed weak reactivity. In contrast, all five BCCs manifesting strong IMP3 positivity consisted of the indolent-growth histologic subtypes. BCCs with infiltrative histomorphology did not appear to have a tendency towards more striking production of IMP3. There was no significant relationship between the IMP3 expression status and the proliferation status (Ki-67 ≤ 50% vs. Ki-67 > 50%) of the tumor tissue (p > 0.05).

Conclusions. The vast majority of cutaneous BCCs express IMP3, suggesting this oncoprotein is implicated in BCC carcinogenesis. However, more pronounced expression does not seem to be associated with aggressive-growth phenotype of BCC or higher proliferative activity of neoplastic cells.

Hyperostosis Frontalis Interna and Temporalis Interna: A Rare Case Report

Mathada Vamadevaiah Ravishankar — 2022-09-01

Hyperostosis is a slow-growing benign bone tumour often seen in the bones of the cranial vault, more commonly found in elderly females. It is an incidental finding noted during radiological examination. The clinical manifestation of such tumour depends on its location inside the cranial cavity: the proximity to the paranasal sinuses, brain tissue, nerves, or blood vessels, etc. Its clinical findings may range from mild obstruction of the paranasal sinuses or blood vessels to severe compression of the surrounding cranial nerves. Here a rare case of hyperostosis of the frontal and temporal bones found during a routine cadaveric dissection in the Department of Anatomy is presented. Causes of the formation of such unusually enlarged bone masses inside the cranial cavity and their clinical presentation are discussed.

Awareness of and Attitudes Towards Domestic Violence in Turkish Society

Havva Gezgin Yazici — 2022-09-01

The objective of this study was to identify domestic violence awareness and attitudes towards violence among adult individuals in Turkish society.

Materials and Methods. This descriptive and cross-sectional study was conducted online between September 15, 2021 and November 15, 2021 and included 353 individuals. The data were collected using the snowball sampling method, the Google Forms, the Socio-Demographic Descriptive Information Form, the Domestic Violence Awareness Scale, and the Attitudes Towards Domestic Violence (ADV) Scale. For data analysis, the number, percentage, mean, standard deviation, Student’s t-test, one-way analysis of variance (ANOVA), post hoc (Tukey, LSD) analyses, Cohen’s d and Eta squared (η ²) coefficients, and correlation analysis were used.

Results. Most research participants were females (79.0%), with the average age of 30.53 ± 13.11 years. Of all the participants, 56.9% stated that they witnessed domestic violence, 22.7% stated that they experienced violence against women, 8.2% stated that they used violence. While the mean Domestic Violence Awareness Scale score was calculated as 41.09 ± 3.98, the mean score of the ADV Scale was calculated as 20.18 ± 7.82. The scores of domestic violence awareness differed significantly depending on education level (p=0.042; η ²=0.018). The scores of women’s attitude towards domestic violence (19.10) were lower than those in men (24.26) (p=0.05; d=0.684; η²=0.072). Participants’ attitudes towards domestic violence varied significantly by family type (p=0.006; η²=0.029), education level (p=0.007; η²=0.028), and occupation (p=0.007; η²=0.040). There was a significant positive relationship between awareness of and attitudes towards domestic violence (r=0.226).

Conclusions. Study participants had a high sense of awareness towards domestic violence and a negative attitude towards violence. Their awareness of domestic violence was affected by education level, while their attitudes towards domestic violence was affected by gender, type of family, education level, and occupation.

Perceived Stress and Quality of Life in Healthcare Workers of Non-COVID-19-Designated Hospitals During the COVID-19 Pandemic in Ukraine

Oksana Mats — 2022-09-01

Introduction. Healthcare workers are more vulnerable to negative influences of the Covid-19 pandemic than cross-border travelers as they experience greater occupational stress, exacerbated by the possibility of self-contamination or contamination of their relatives through direct contact with patients, reduced social communication, deterioration in self-care and quality of life due to lack of energy and time.

The aim of the study was to assess the level of stress and quality of life in healthcare workers of non-COVID-19-designated hospitals in Ukraine during the COVID-19 pandemic.

Materials and Methods. There was carried out a case-control study that included 150 respondents divided into three groups: experimental groups (EG) 1 and 2 comprised 50 physicians and 50 nurses of non-COVID-19-designated hospitals, respectively; the control group (CG) included 50 healthy individuals not working in the healthcare field. The data were collected using paper questionnaires involving sociodemographic questions, the Perceived Stress Scale, and the 36-Item Short Form Health Survey.

Results. EG 1 and EG 2 had significantly increased stress levels as compared to the CG. Physical functioning criterion in EG 2 was significantly lower than those in EG 1 and the CG. Vitality and social functioning indicators were significantly lower in EG 1 and EG 2 as compared to the CG. Quality of mental health was worse in EG 1 than in the CG.

Conclusions. During the COVID-19 pandemic, healthcare workers of non-COVID-19-designated hospitals experienced a significant reorganization of their work environment, which required them to adjust rapidly to new conditions and psychological difficulties. The medical staff was found to have an increased level of perceived stress and decreased quality of life, which could affect the quality of medical care. Our findings suggest that the COVID-19 pandemic necessitates the development and implementation of stress coping measures to improve mental and physical health of healthcare workers, which can be used to achieve proper work and rest routines, create a microclimate within the team, and restore the work-life balance.

Antibacterial Polyacrylamide and Dextran-Graft-Polyacrylamide Hydrogels for the Treatment of Open Wounds

Pavlo Virych — 2022-09-01

Background. Open wound treatment requires a use of bandage material to prevent the development of pathogenic microflora and to provide the necessary conditions for tissue regeneration.

The aim of the study was to compare the effectiveness of polyacrylamide (PAA) and dextran-graft-polyacrylamide (D-PAA) hydrogels loaded with silver nanoparticles (AgNPs), antibiotics, and photosensitizers for the treatment of bacterial infection of open wounds.

Materials and Methods. PAA and D-PAA hydrogels with AgNPs, methylene blue (0.001%) without (MB) and with red light irradiation (660 nm) (MB+L), chlorhexidine (0.05%) and cefuroxime (0.1%) were used. There were tested in vitro and in vivo (a rat model) antibacterial activities against wild-type Staphylococcus aureus, Escherichia coli, antibiotic-resistant Escherichia coli and Klebsiella pneumoniae strains obtained from the wound. Clinical investigations were performed in patients with chronic venous ulcers of the lower extremities with no response to traditional treatments.

Results. S. aureus, E. coli, and K. pneumoniae strains were sensitive to PAA and D-PAA hydrogels with AgNPs, chlorhexidine, and cefuroxime. Antibiotic-resistant E. coli was not inhibited by the hydrogels with cefuroxime. This strain was less sensitive to chlorhexidine and MB+L. There were no differences between unloaded PAA and D-PAA hydrogels; the antibacterial properties of the dressing were determined by an antibacterial component loaded into the hydrogel. The use of unloaded D-PAA hydrogels in vivo helped reduce the size of the wound by 28.6% and 42.8% three and five days after wound modeling, respectively. Similar results were obtained for D-PAA hydrogels loaded with cefuroxime, chlorhexidine, and MB+L. D-PAA hydrogel with AgNPs reduced wound size by 50% and 62.5% three and five days after wound induction, respectively, demonstrated greater antibacterial activity and was selected for clinical investigations. In a patient, 14 days after bandage application, the fibrin membrane disappeared, the ulcers were covered with pink granulations, marginal epithelialization appeared.

Conclusions. PAA and D-PAA hydrogels can be loaded with the antibacterial compounds of various types. The type of polymer does not affect the antibacterial properties of the final hydrogels. The hydrogels with chlorhexidine and MB+L can be potentially used to treat bacterial contamination of wounds and ulcers. Nevertheless, their disadvantage is the inability to absorb or precipitate tissue breakdown products that interfere with normal regeneration and inflammation. D-PAA/AgNPs are the best option for treating ulcers due to the ability to control the properties of the hydrogels and nanoparticles, as well as multiple mechanisms of antibacterial action.

The Effect of Preoperative Anxiety on Postoperative Symptoms in Patients Without a History of Anxiety Scheduled for Coronary Artery Bypass Grafting

Nurten Arslan Isik — 2022-09-01

The aim of this study was to measure the level of preoperative anxiety in patients scheduled for coronary artery bypass grafting (CABG) to assess the relationship between anxiety and postoperative symptoms.

Materials and Methods. This descriptive study was conducted at a single university hospital from February to November 2021. Seventy-four CABG patients who completed the Anxiety Specific to Surgery Questionnaire, the Visual Analogue Scale, the Modified Borg Scale, the Rhodes Index of Nausea, Vomiting and Retching were included in the study. The data were analyzed by the mean, standard deviation, frequency distribution, Mann-Whitney U Test, and Spearman’s correlation analysis.

Results. The average age of participants was 65.55 ± 8.35; 66.2% of them were males. The ASSQ total scores of female participants were significantly higher as compared to male participants (p < 0.05). There was a statistically significant positive relationship between the levels of anxiety in patients before CABG and the levels of postoperative pain and dyspnea severity (p < 0.05).

Conclusions. Patients were found to experience predominantly moderate to severe anxiety before CABG, and increased dyspnea complaints and pain in the postoperative period. A coordinated, multidisciplinary approach to preoperative training of healthcare professionals may offer a promising way to provide more efficient and productive services.