Volume 47, Issue 3

Background Considering medical humanities, medicine and art are two areas that resemble each other at several features. Clinical diagnosis involves the observation, description and interpretation of information of which visual ones take an important one. The skills described are important skills in the field of visual arts, as well. Underlying a good clinical practice; clinical examination and observation skills constitute an important place. Although in several studies, these skills are shown to be improved by analyzing visual art pieces, courses intended to improve visual thinking skills are not that much common in medical faculty curriculums. Methods In this article, we share our opinion about the use of visual thinking in medical education by providing preliminary reflection results of learners from the second year of medical education about the visual thinking course that we have recently started to apply in Faculty of Medicine in collaboration with Faculty of Fine Arts in Izmir University of Economics in order to improve the observational skills of learners. Results Reflection results of the learners support the view that training art-viewing skill is helpful to improve observational and descriptive skills. Conclusions Increasing interdisciplinary programs on visual thinking in medical curriculums have the potential to overcome several professional development challenges in clinics.

Objectives We aimed to investigate the effects of the COVID-19 disease on kidney functions and early prognosis. Methods All cases were divided into those discharged and exitus cases. The patients were diagnosed with acute kidney injury (AKI) according to the KDIGO criteria. Results As a result of the ROC analysis, the patients with a creatinine value above 1.05 for day 1 and 0.975 for creatinine value on day 7 would be mortal (AUC values of 0.641 (0.569–0.714) and 0.757 (0.689–0.825), respectively). As a result of Univariate analysis; D-Dimer, Procalcitonin, BUN and creatinine values are risk factors and a one-unit increase in these values is 1.184; 1.105; It was determined that it would increase 1.024 and 1.304 times (p values 0.008; 0.007; <0.001; 0.002), respectively. Decreased in e-GFR value would increase the risk of death 1.026 (1/0.975) times (p<0.001). Conclusions We observed the high creatinine, D-dimer, procalcitonin, ferritin, and low e-GFR levels were risk factors for severity and mortality for COVID-19 disease. While physicians and all stakeholders focus on the prognosis and mortality of the disease of COVID-19 disease, it is necessary to be thorough about kidney involvement as much as respiratory system involvement.

Objectives Matrix Gla protein (MGP) is a calcification inhibitor that plays a role in preventing soft tissue calcification and local mineralization of the vascular wall. The present study aimed to assess the expression of MGP in Peripheral Blood Mononuclear Cells (PBMC) in adult patients with CVD pathologies and its association with the presence and severity of coronary artery calcium score (CACS) and conventional CVD risk factors. Methods MGP expression was measured in 87 individuals using real time qPCR. Subgrouping was performed according etiologic and metabolic CVD risk factors. Results A clear trend for a decreased MGP expression was observed in all subgroups with high CVD risk. This decrease was significant in abdominally obese hypertensive individuals and in those with dyslipidemia. MGP expression was significantly lower in patients representing high Total cholesterol and LDL cholesterol levels. A positive correlation between MGP expression and smoking status in patients with coronary calcium and in the CVD group was established. Atrial hypertension duration correlated negatively with MGP expression in the group without coronary calcium deposits. Conclusions The current study supports the hypothesis that MGP expression in PBMC probably reflects CVD pathology and is related to lipid metabolism dysregulation.

Objectives This article aims to explain the altered oxidative status and thiol/disulfide homeostasis before and after surgery in children with congenital heart disease (CHD). Methods Blood samples were taken from the patients (n=50) before the operation (baseline), at the 1st hour, and at the 24th hour after the operation. Thiol-disulfide levels, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), myeloperoxidase (MPO), ceruloplasmin, albumin, ischemia-modified albumin (IMA), and prolidase activities of all samples were measured. Pre-operative oxygen saturation (SaO 2 ) values and neutrophil/lymphocyte ratios (NLR) were also measured. Results Before the operation, TOS, OSI, MPO, ceruloplasmin, IMA, NRL, and disulfide levels were higher in the cyanotic group than in the acyanotic group. When the indicated three different time points were compared, the TOS, OSI levels, and MPO activities of the 24th hour were significantly lower than the baseline and 1st hour. In comparison, ceruloplasmin levels of 1st hour were significantly higher than of the baseline and 24th hour. Native thiol and total thiol levels in the baseline group were significantly lower than in the 1st and 24th hours. Disulfide levels of the 24th hour were significantly lower than of the baseline. Conclusions The operation leads to changes in the thiol-disulfide balance and oxidant status in CHD.

Objectives Left ventricular thrombus is regarded as one of the main myocardial infarction complications. Knowing the left ventricular thrombus symptoms prevents serious complications that may occur. This study aims to reveal any association between SCUBE-1 and left ventricular thrombus, thought to be involved in platelet aggregation and adhesion. Methods The study included 80 patients diagnosed with heart failure following acute myocardial infarction, applying for the cardiology outpatient clinic for third-month follow-up. The patients were included in two groups to see if the left ventricular thrombus was present. Thus, 22 patients were found to have left ventricular thrombus. The two groups were compared based on clinical laboratory and echocardiographic parameters. Results It was found that the patients with left ventricular thrombus had significantly higher Serum SCUBE-1 levels (p<0.001). The optimal cutoff point of SCUBE-1 levels for predicting the LVT was >35.1 ms, with the specificity of 86% and sensitivity of 68.4% (AUC=0.815; 95% CI, 0.699–0.931; p<0.0001). SCUBE -1 level (OR=1.090, 95% CI: 1.034–1.150, p<0.001) in the multiple logistic regression model continue to significantly predict LVT after adjusting for the confounding variables, as statistically significant in the univariate analysis of the variables which correlated with the SCUBE-1 levels. Conclusions SCUBE-1 level was determined to independently predict the left ventricular thrombus after a previous anterior myocardial infarction.

Objectives In this study, we aimed to compare modified Krauss polyacrylamide gradient gel electrophoresis (PAGGE) and high-performance liquid chromatography (HPLC) methods in classification, quantification, and separation of lipoproteins and determining low-density lipoprotein (LDL) size. Methods Blood specimens were obtained from eighty-seven volunteers. We measured LDL size using the PAGGE method and HPLC method with total cholesterol (TC) and triglyceride (TG) peaks. In the PAGGE method, Coomassie Brilliant Blue (CBB) staining was used instead of Sudan black staining, unlike the original method. The relationship between PAGGE and HPLC methods was evaluated by Pearson correlation test and Passing-Bablok regression analysis. Agreement between them was evaluated by Kappa analysis and Bland-Altman plots. Results Statistically significant correlation was found between the LDL size with PAGGE and HPLC methods under the cholesterol curve (HPLC-TC) (r=0.924, p<0.001). Similarly, there was a statistically significant correlation between PAGGE and HPLC methods under the TG curve (HPLC-TG) (r=0.910, p<0.001). In the PAGGE method, within-day precision was found as 2% and between-day precision as 3%. It was determined agreement between HPLC-TC vs. HPLC-TG methods and HPLC-TG vs. PAGGE methods was higher than HPLC-TC vs. PAGGE (Kappa values; 0.68, 0.71, and 0.44, respectively). Conclusions The PAGGE method can be a reliable method for measuring LDL size. HPLC method under cholesterol and triglyceride peaks may be used in clinical practice interchangeably, but clinical decision limits should be different. In addition, our study demonstrated that measurement methods for LDL size could be simplified with several modifications.

Objectives Recent advances in hematology analyzers have enabled to improve the reliability in the results and also provided additional hematological parameters. In the present study, we aimed to determine the reference ranges for automated erythrocyte and reticulocyte parameters in healthy individuals on Sysmex XN 1000 hematology analyzer. Methods One hundred and thirty-three subjects with normal physical examination and complete blood count results within the reference ranges were included in the study. Venous blood samples collected in tubes containing K 2 -EDTA were analyzed on Sysmex XN-1000. The references intervals for IRF, RBC He, Ret He, LFR, MFR, HFR, Delta He, Micro R, Macro R, Hypo He and Hyper He were determined according to CLSI EP28-A3c. Results The reference ranges of the parameters were estimated with 90% confidence intervals. The reference ranges were 3.4–17% for IRF, 26.9–32.8 pg for Ret-He, 25.2–30.5 pg for RBC-He and 0.5–3.7 pg for delta-He. Gender specific reference ranges were calculated for of Ret-He (male (M): 26.8–32.9 pg, female (F): 23.9–33.6 pg), RBC-He (M: 26.3–30.8 pg, F: 25.3–30.5 pg) and delta-He (M: 0.5–3.7 pg, F: 0.3–3.7 pg). Conclusions The new reticulocyte and erythrocyte parameters may be conveniently used in clinical diagnosis and follow-up of patients, as they offer reliable, automated and cheap results. Each laboratory is recommended to determine its own reference intervals considering the differences like the instrument used and population studied.

Objectives The antibodies interact with the “Human Leukocyte Antigen (HLA) antigens” at specific epitopes. “Epitopes” are present on a single HLA or shared by multiple antigens. In this study, we aim to determine the frequency of prevalent epitopes common in the Turkish population. Methods Non-related 644 healthy volunteers were recruited, and The “HLA-A, -B, -C, -DR -DQ’s” were typed using the “Next Generation Sequencing”. The provisional and confirmed epitopes were identified using the “HLA Epitope Registry databases, HLA Epitopia Maps and Immucor Epitope databases” dated 07.02.2018. Epitope frequencies were calculated by counting the shared epitopes in the total number of shared HLA Class epitopes in our sample database. Results Class I HLA’s had 298 epitopes that repeated a total of 158,117 times with frequencies ranging between 0.0006 and 2.03%, and the most frequent epitope was 170RY found on 119 different alleles. Class II HLA’s had 193 epitopes that repeated a total of 93,082 times with frequencies ranging between 0.002 and 1.36%, and the most frequent epitope was 108P found on 42 different alleles. Conclusions Our findings summarize both the provisional, and confirmed epitope frequencies in the Turkish population and may help clinicians and immunogeneticists develop a better understanding of HLA epitope mismatches.

Objectives This study aimed to investigate the effects of specific gene silencing in colorectal cancer cells. Clusterin protein was found in the serum samples of colorectal cancer patients infected with Schistosoma mansoni previously. Methods For this reason, silencing clusterin mRNA in colorectal cancer cells was first performed to study the cytotoxic effect by lactate dehydrogenase assay. Next, propidium iodide staining and flow cytometry were performed to investigate the cell cycle profile in clusterin-silenced cells. A wound-healing assay was also used to examine the migration rate of clusterin-silenced cells. The mRNA expression of cell proliferation- and migration-related genes was then assessed by real-time PCR. Results Clusterin mRNA silencing caused a significant reduction in cell growth but induced no cell cycle arrest or potential apoptosis in all cells. It was found in this study that cell migration rate was inhibited in clusterin-silenced cells. Surprisingly, significantly induced chemokine (C–C motif) ligand 5 (CCL5) mRNA expression was detected in clusterin-silenced Caco2, which indicated that the cell proliferation and migration of clusterin-silenced Caco2 were likely associated with CCL5 mRNA expression. Conclusions Clusterin may be a potential target for regulation, staging, surveillance, and developing a cost-effective therapeutic agent for treating parasite-infected Caco2 type of colorectal cancer patients.

Objectives Osteoarthritis (OA) is a common degenerative disease of the joints. It has become one of the main diseases that cause the disability of the elderly in the world, and it has a severe impact on the quality of life of patients. It has been reported that miRNAs are involved the occurrence and development of OA. In the current work, we evaluated the effects of miR-22-3p on osteoarthritis in vivo and in vitro . Methods Confocal Laser Scanning Microscope (CLSM), flow cytometry analysis, indirect immunofluorescence (IFA) and Western-blot assays were performed to study the effect of miR-22-3p on osteoarthritis (OA). Results An LPS-induced osteoarthritis cell model was first constructed on C28/I2 cells ( in vitro ), and the model of mice OA was established by operation ( in vivo ). The results form RT-qPCR indicated that miR-22-3p expression was reduced by LPS (lipopolysaccharides) stimulation. Additionally, inflammatory cytokines and apoptosis-related markers were also obviously elevated with LPS treatment. Furthermore, up-regulation of miR-22-3p relieved the osteoarthritis in vivo and in vitro . Additionally, up-regulation of miR-22-3p obviously reduced the production of proinflammatory factors and cell apoptosis induced by LPS. Further research indicated that miR-22-3p may alleviate osteoarthritis by targeting inflammasome. Conclusions In conclusion, the upregulation of miR-22-3p could effectively alleviate osteoarthritis in vivo and in vitro , suggesting that miR-22-3p can be used to treat OA.

Objectives The PI3K (Phosphatidylinositol 3-kinase) is the member of lipid kinase family that plays important roles in tumorigenesis, cancer development and cell proliferation. In our study, we aimed to investigate the relationships between breast cancer risk and prognosis with PIK3CA rs6443624 (C>A) intron region gene polymorphism and serum PI3K levels. Methods A total of 61-patients with breast cancer and 101 controls were included to the study. PIK3CA polymorphism was detected by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) technique. Serum PI3K levels were measured by Enzyme-Linked Immuno Sorbent Assay (ELISA). Results PIK3CA (C>A) gene polymorphism genotype and allele distributions were no significant in cases and controls (p>0.05). The serum PI3K levels of breast cancer patients were found significantly higher than the control groups (p=0.033). There were not significant association between PIK3CA (C>A) gene polymorphism and clinic and prognostic parameters in our study group. We also evaluated serum PI3K levels in the term of tumor progression, but we did not observe any significant data. Conclusions We suggest that serum PI3K levels may play role in breast cancer risk and larger patient groups may have clinical value in assessment of the genetic risk and tumor progression of breast cancer.

Objectives The purpose of this study is to predict sarcopenia by analyzing the composition of the gut microbiota. Methods We collected fecal samples for 16S rRNA sequencing, then we used the data results to analyze the diversity and composition of the gut microbiota and calculated the relationship between biochemical indexes and the microbiota. Results According to PCA and heatmap analysis, the characteristics of patients could be divided into two categories. Moreover, the P/B ( Prevotella/Bacteroides ) ratio of the sarcopenia group was higher than that of the control group in terms of relative abundance. A box plot based on the Chao1 and observed OTU values indicated both the relative abundance and diversity of the gut microbiota in sarcopenia patients were lower than those in the control group. After we applied binary logistic regression and ROC curve analysis to the data, we confirmed that three indexes (P/B value, Coprococcus , and Lachnospiraceae ) could be used to predict sarcopenia. Conclusions We can distinguish sarcopenia patients through the gut microbiota P/B index (over 1.7), the relative amount of Coprococcus (1.00–3.70%), and the relative amount of Lachnospiraceae (0.00–1.68%). Sarcopenia can be predicted with the help of the gut micro-community, which provides an improvement in methodology.

Objectives Sugammadex (also known as bridion) is a modified γ-cyclodextrin, which is a reversal agent for the neuromuscular block. Growth hormone (GH) has an important biological effect on muscle, regulating muscle growth and development. In the current work, we explored the effect of Sugammadex on GH’s bioactivities. Methods Confocal laser scanning microscope (CLSM), flow cytometry, indirect immunofluorescence, Western-blot, and IP-WB were used to explore the effect of Sugammadex on GH’s bioactivities. Results We found that Sugammadex reduced the activity of GH on muscle cells, which down-regulated GH/GHR-mediated intracellular signaling pathway, such as Janus kinase 2 (JAK2) and signal transducers and activators of transcription 5 (STAT5). We further study the potential biological mechanism by which Sugammadex down-regulated GH/GHR-mediated signaling pathway, a series of related experiments were conducted, and found that Sugammadex may inhibit the proliferation of C2C12 cell via regulating the membrane-localized GHR, which may be the underlying mechanism by which Sugammadex suppressed GHR-induced signaling transduction. This work has laid the theoretical and experimental basis for further exploring the relationship between Sugammadex and GH’s activity. Conclusions In conclusion, this study laid a foundation for further study on the relationship between Sugammadex and GH’s activity.

Objectives The consumption of popular tobacco products has adverse effects on public health. Early diagnosis and treatment practices are essential based on the disease-symptom relationship in public health problems. There is a need to evaluate biochemical parameters to elucidate the pathophysiological mechanisms of these problems with experimental studies. We aimed to investigate the biochemical and physiological effects of cigarettes, hookahs, and electronic cigarettes (e-cigarettes) that people commonly use. Methods We have used Wistar albino rats, and the rats were exposed to cigarette smoke, e-cigarette smoke, and hookah smoke for 60 min/day for seven days. We detected malondialdehyde (MDA), nitric oxide (NOx), protein carbonyl oxidation (PCO), 8-hydroxy-2′-deoxyguanosine (8-OHdG), total antioxidant status (TAS), total oxidant status (TOS), reduced glutathione (GSH), and superoxide dismutase (SOD) levels in blood samples taken after the experiment. Results We observed that the redox balance was disturbed in all groups. E-cigarettes mainly triggered lipid peroxidation; only hookah activated the intracellular antioxidant system. Conclusions Cigarette, hookah, and e-cigarette smoking should be considered high-risk factors for individual and public health. The use of tobacco products adversely affects public health.

Objectives Phosphodiesterases (PDEs) mediate several physiological activities, and alterations in PDE expressions might cause conflicts between functional and clinical effects. This study clarifies the eventual relationship between the hepatic insulin resistance-associated signaling elements and PDEs together with inflammatory markers and investigates the role of kefir in the treatment. Methods Male Wistar rats were grouped as Control, Kefir, HFCS (high-fructose corn syrup), and HFCS + Kefir. Daily HFCS (20% w/v) and kefir (1 mL/100 g weight) were given for 8-weeks. Hepatic expressions of PDE isoforms and insulin signaling elements were determined with qPCR and Western blot. The changes in hepatic phospholipase A2 (cPLA2) and insulin-like growth factor 1 receptor-α (IGF-1Rα) were investigated histologically. Results HFCS upregulated hepatic PDEs while repressed primary insulin signaling elements at gene and protein levels. It also augmented cPLA2 and IGF-1Rα expression. Kefir suppressed the PDEs and normalized the insulin signaling, and down-regulated cPLA2 and IGF-1Rα in the liver of HFCS-fed rats. Conclusions The disruption of the insulin signaling pathway and activation of PDEs were negatively correlated in liver tissues of the HFCS-fed rats. Kefir treatment achieved a remarkable improvement in HFCS-dependent modifications, and it could be an excellent functional food against HFCS-induced insulin resistance, PDE hyperactivity, and inflammation.

Objectives Neuroinflammation is an important factor in the pathogenesis of neurodegenerative disesases. The following study aimed to clarify the effects of β-lactam antibiotics to the cholinergic system, on acetylcholinesterase (AChE), butyrylcholinesterase (BuChE) activities, considering the structural differences of antibiotics, to evaluate the underlying mechanism of effects provided by protein-antibiotic interactions, and to clarify possible effects of the antibiotics on the aggregation of Aβ-peptides. Methods The inhibition/activation mechanisms for each antibiotic were examined kinetically by Ellman method. Destabilization effects of them on amyloid peptide fibrillation were examined and protein-ligand interactions were evaluated with most potent antibiotics by molecular docking studies. Results The most powerful inhibitions were detected by the inhibition studies of AChE with ceftazidime (CAZ) and BuChE with amoxicillin (AMX). CAZ was exhibited dose-related dual effect on AChE activity. CAZ was actually the dose-related modifier of AChE. At higher concentrations, CAZ was a nonessential activator of AChE. Molecular docking studies have been confirmed by kinetic studies. Interested β-lactam antibiotics did not prevent fibrillation rate as rifampicin. Conclusions Inhibition/activation behaviours of studied β-lactam antibiotics on both cholinesterases may suggest that cholinergic transmission is one of the crucially important components of the β-lactam antibiotics-induced central nervous system adverse reactions.

Objectives Mobile applications, social media platforms are changing Internet user behavior; creating a new era of education in a connected world. We have previously reported training needs of health providers in the Climate Change. Aim is to develop and test an Android ® mobile app as an effective smart learning environment for climate change health impacts. Methods The quasi-experimental design method was used in five phases: easy-to-reach, rich content Mobile app design and development for Android ® operating system, scale development, finalizing scales to be used, implementation, data collection, analysis. Dependent t-test of pre-test and post-test awareness scores was analyzed. Usability and satisfaction were assessed with two scales; quantitative data with descriptive statistics. Results The developed Mobile app was effective in enhancing students’ learning experience, and well-received in terms of adopting and using such technology for educational purposes. Pre-test and post-test scores different statistically (p<0.05); increasing participants’ awareness level and were satisfied. Conclusions We conclude that our Mobile app, m-learning project, is successfully incorporated into the learning context; when tested, raised awareness about climate change and health effects for the public. To our knowledge, no currently existing tool to provide new mobile application for climate change education and promote awareness exists.

Objectives Today’s trainers met with technologies later in their life and these were not available before however trainers learned to use them. Students, on the contrary were born to the environment that these devices were widely used, technology-internet is one of the indispensable elements of life today. The aim of this study is to analyze medical students’ habit of accessing to information at Ege University. Methods The research is in cross-sectional design. The research data were collected from the students of Ege University Medical Faculty. A 17-item questionnaire was used for data collection. Results A total of 293 students responded to the survey. All of the students have at least one technological product to reach information. While 79.9% of the students stated that they have the ability of multitasking, 55.3% of the students indicated that they were able to focus less than 25 min. A majority (68.3%) of the students use technology in all areas of life, while 46.6% of the students use technology in the area of education. Conclusions The knowledge that there may be changes in learning and teaching between generations is especially important for medical education. Nowadays, educators in medical education are generation X while students are generation Y-Z. The educators should be aware of these differences and manage rationally.