• Online ISSN : 2313-1519
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  • Editorial
    Remove the crown from the virus
    DOI:10.23950/1812-2892-JCMK-00837
    The UN celebrates its 75th anniversary in the time of huge upheaval across the world. They are compounded by the unprecedented crisis in health care caused by the COVID-19 pandemic, with serious economic and social consequences. The situation changes every day. Global negative trends in demography, information, politics, military affairs, climate, ecology and technology have raised risks to a completely different level. New warnings are emerging: fires, floods, droughts, food shortages, wars and pandemics. All of these are alarm signals, indicating that people's way of life is in danger, which is not a surprise for scientists, since they have been sounding the alarm for a long time. But threats from climate change, ecosystem collapse, loss of biological diversity and depletion of land and water resources must penetrate the mass social consciousness. We want to be heard and understood. If you believe that the mind is a person's ability to comprehend the relationship between phenomena, then there were many wonderful minds on Earth who were able to catch among the phenomena of material life the most intimate connections of people with the world around them.
  • Original Article
    The anti-tumoral effects of different local anesthetics on human endometrial carcinoma cell line: An in-vitro study
    DOI:10.23950/1812-2892-JCMK-00804
    Background: There is accumulating evidence on the inhibitory effect of local anesthetic agents on metastasis and tumor recurrence on various cancer types. In this study, we aimed to test the effects of lidocaine, bupivicaine and prilocaine on cellular viability and apoptosis on human endometrial adenocarcinoma cell lines (Ishikawa cells). Material and methods: Human Endometrial adenocarcinoma cells (Ishikawa cells) were exposed to different concentrations of local anesthetic agents for 24, 48, and 72 hours. The cell viability assay was performed via MTT and concentrations corresponding to 50% effective concentration (EC50) of cells were determined for each agent. Apoptosis was evaluated via commercial Biocolor ApoPercentage assay. Results: All of the three local anesthetics reduced the amount of viable tumor cells in a dose-dependent manner. The EC50 values (mM) at 24, 48 and 72 h incubation periods were 11.67, 1.915, 2.114 for lidocaine 11.4, 5.21, 3.12 for bupivacaine 7.64 mM, 7.3 mM, and 2.83 mM, for prilocaine respectively. Conclusion: Lidocaine, bupivacaine, and prilocaine have anti-tumoral effects on Ishikawa cell lines. All of the tested agents induced apoptosis and necrosis at high concentrations in a dose dependent-manner. Key words: lidocaine, bupivacaine, prilocaine, Ishikawa cell lines, local anesthetics, cancer surgery, metastasis Corresponding author: Erel Varlik, E-mail: varlik.erel@gmail.com References 1. Johnson SM, Saint John BE, Dine AP. Local anesthetics as antimicrobial agents: a review. Surg Infect (Larchmt). 2008; 9:205-13. https://doi.org/10.1089/sur.2007.036 2. Borgeat A, Aguirre J. Update on local anesthetics. Curr Opin. Anaesthesiol. 2010; 23:466-71. https://doi.org/10.1097/ACO.0b013e328339eef2 3. Cummings, K. C. 3rd, Xu, F., Cummings, L. C. & Cooper, G. S. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study. Anesthesiology. 2012; 116:797-806. https://doi.org/10.1097/ALN.0b013e31824674f6 4. Exadaktylos, A. K., Buggy, D. J., Moriarty, D. C., Mascha, E. & Sessler, D. I. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006; 105:660-664.https://doi.org/10.1097/00000542-200610000-00008 5. Biki, B. et al. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. 2008; 109:180-187. https://doi.org/10.1097/ALN.0b013e31817f5b73 6. Snyder, G. L. & Greenberg, S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Brit. J. Anaesth. 2010; 105:106-115. https://doi.org/10.1093/bja/aeq164 7. Sakaguchi, Masahiro, Yoshihiro Kuroda, and Munetaka Hirose. "The Antiproliferative Effect of Lidocaine on Human Tongue Cancer Cells with Inhibition of the Activity of Epidermal Growth Factor Receptor. Anesthesia and Analgesia. 2006; 102:1103-7. https://doi.org/10.1213/01.ane.0000198330.84341.35 8. Tavare, Aniket N, Nicholas J. S. Perry, Laura L. Benzonana, Masao Takata, and Daqing Ma. Cancer recurrence after surgery: direct and indirect effects of anesthetic agents. Int J Cancer. 2012; 1250:1237-50. https://doi.org/10.1002/ijc.26448 9. Jiang Y, Gou H, Zhu J, Tian S, Yu L. Lidocaine inhibits the invasion and migration of TRPV6-expressing cancer cells by TRPV6 downregulation. Oncologyb Letters. 2016; 12:1164-1170. https://doi.org/10.3892/ol.2016.4709 10. Chang YC, Liu CL, Chen MJ, Hsu YW, Chen SN, Lin CH, Chen CM, Yang FM, Hu MC. Local anesthetics induce apoptosis in human breast tumor cells. Anesth Analg. 2014; 118:116-24. https://doi.org/10.1213/ANE.0b013e3182a94479 11. Nakamura K, Kido H, Morimoto Y, Morimoto H, Kobayashi S, Morikawa M, Haneji T.Prilocaine induces apoptosis in osteoblastic cells. Can J Anaesth. 1999; 46:476-82. https://doi.org/10.1007/BF03012949 12. Werdehausen R, Fazeli S, Braun S, Hermanns H, Essmann F, Hollmann MW, Bauer I, Stevens MF. Apoptosis induction by different local anaesthetics in a neuroblastoma cell line. Br J Anaesth. 2009; 103:711-8. https://doi.org/10.1093/bja/aep236 13. Perez-Castro R, Patel S, Garavito-Aguilar ZV, Rosenberg A, Recio-Pinto E, Zhang J, Blanck TJ, Xu F. Cytotoxicity of local anesthetics in human neuronal cells. Anesth Analg. 2009; 108:997-1007. https://doi.org/10.1213/ane.0b013e31819385e1 14. Chang YC, Liu CL, Chen MJ, Hsu YW, Chen SN, Lin CH, Chen CM, Yang FM, Hu MC. Local anesthetics induce apoptosis in human breast tumor cells. Anesth Analg. 2014; 118:116-24. https://doi.org/10.1213/ANE.0b013e3182a94479 15. Xuan W, Zhao H, Hankin J, Chen L, Yao S, Ma D. Local anesthetic bupivacaine induced ovarian and prostate cancer apoptotic cell death and underlying mechanisms in vitro. Sci Rep. 2016; 19(6):262-77. https://doi.org/10.1038/srep26277 16. Mammoto T, Higashiyama S, Mukai M, Mammoto A, Ayaki M, Mashimo T, Hayashi Y, Kishi Y, Nakamura H, Akedo H. Infiltration anesthetic lidocaine inhibits cancer cell invasion by modulating ectodomain shedding of heparin-binding epidermal growth factor-like growth factor (HB-EGF). J Cell Physiol. 2002; 192:351-8. https://doi.org/10.1002/jcp.10145 17. Wang HW, Wang LY, Jiang L, Tian SM, Zhong TD, Fang XM. Amide-linked local anesthetics induce apoptosis in human non-small cell lung cancer. J Thorac Dis. 2016; 8:2748-2757. https://doi.org/10.21037/jtd.2016.09.66 18. Chang YC, Hsu YC, Liu CL, Huang SY, Hu MC, Cheng SP. Local anesthetics induce apoptosis in human thyroid cancer cells through the mitogen-activated protein kinase pathway. PLoS One. 2014; 21:9. https://doi.org/10.1371/journal.pone.0089563 19. Kawasaki C, Kawasaki T, Ogata M, Sata T, Chaudry IH. Lidocaine enhances apoptosis and suppresses mitochondrial functions of human neutrophil in vitro. J Trauma. 2010; 68:401-8. https://doi.org/10.1097/TA.0b013e3181af6e56 20. Kamiya Y, Ohta K, Kaneko Y. Lidocaine-induced apoptosis and necrosis in U937 cells depending on its dosage. Biomed Res. 2005; 26:231-9. https://doi.org/10.2220/biomedres.26.231 21. Friederich P, Schmitz TP. Lidocaine-induced cell death in a human model of neuronal apoptosis. Eur J Anaesthesiol. 2002; 19:564-70. https://doi.org/10.1017/S0265021502000911 22. Werdehausen R, Braun S, Essmann F, Schulze-Osthoff K, Walczak H, Lipfert P, Stevens MF. Lidocaine induces apoptosis via the mitochondrial pathway independently of death receptor signaling. Anesthesiology. 2007; 107:136-43. https://doi.org/10.1097/01.anes.0000268389.39436.66 23. Lee HT, Xu H, Siegel CD, Krichevsky IE. Local anesthetics induce human renal cell apoptosis. Am J Nephrol. 2003; 23:129-39. https://doi.org/10.1159/000069304 24. Hirata M, Sakaguchi M, Mochida C, Sotozono C, Kageyama K, Kuroda Y, Hirose M. Lidocaine inhibits tyrosine kinase activity of the epidermal growth factor receptor and suppresses proliferation of corneal epithelial cells. Anesthesiology. 2004; 100:1206-10. https://doi.org/10.1097/00000542-200405000-00024
  • Original Article
    Effects of fluoroscopy-guided conventional radiofrequency ablation in dissatisfed patients after total knee arthroplasty
    DOI:10.23950/1812-2892-JCMK-00807
    Objective: Osteoarthritis is a chronic progressive disease that can be treated with several conservative and surgical methods. One commonly used surgical method is total knee arthroplasty. However, some patients have persistent annoying pain afterward. The aim of our study was to investigate the effectiveness of radiofrequency treatment accompanied by fluoroscopy in patients who underwent total knee arthroplasty and had no other reason for their persistent pain. Material and methods: Twenty-eight patients who had undergone total knee arthroplasty for osteoarthritis were retrospectively analyzed and included in the study. Patients who are dissatisfied after total knee arthroplasty procedure, were performed radiofrequency ablation by fluoroscopy. All patients were examined in terms of visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores preoperatively and 2 weeks and 1 and 3 months postoperatively. Results: The VAS and WOMAC scores at postoperative week 2 and months 1 and 3 were statistically significantly different than the preoperative values for all patients (P=0.001). Conclusion: Patients with persistent pain after total knee arthroplasty obtained good results in terms of pain and knee function after conventional radiofrequency ablation accompanied by fluoroscopy but more studies with more patients are needed. Key words: radiofrequency, total knee, dissatisfied patients Corresponding author: Sezgin Bahadır Tekin. E-mail: sezginbahadirtekin@gmail.com References 1. Nguyen US, Zhang Y, Zhu Y, Niu J,Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011; 155 (11):725-732. https://doi.org/10.7326/0003-4819-155-11-201112060-00004 2. Losina E, Weinstein AM, Reichmann WM, Burbine SA, Solomon DH, Daigle ME, Rome BN, Chen SP, Hunter DJ, Suter LG, Jordan JM, Katz JN. Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res (Hoboken). 2013; 65(5):703-711. https://doi.org/10.1002/acr.21898 3. Karlsson J, SjoÅNgren LS, Lohmander LS. Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis: a controlled, randomized, double- blind, parallel-design multicentre study. Rheumatology. 2002; 41(11):1240-1248 https://doi.org/10.1093/rheumatology/41.11.1240 4. Lowry AM, Simopoulos TT. Spinal cord stimulation for the treatment of chronic knee pain following total knee replacement. Pain Physician. 2010; 13(3):251-256. 5. Vallejo R, Benjamin RM, Aliaga L. Radiofrequency vs. pulse radiofrequency: The end of controversy. Tech Region Anesth Pain Manage. 2010; 14(3):128-132. https://doi.org/10.1053/j.trap.2010.06.003 6. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, Shin JW. Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain. 2011; 152(3):481-487. https://doi.org/10.1016/j.pain.2010.09.029 7. Iannaccone F, Dixon S, Kaufman A. A Review of Long-Term Pain Relief after Genicular Nerve Radiofrequency Ablation in Chronic Knee Osteoarthritis. Pain Physician. 2017; 20(3):E437-E444. https://doi.org/10.36076/ppj.2017.E444 8. Gupta A, Huettner DP, Dukewich M. Comparative Effectiveness Review of Cooled Versus Pulsed Radiofrequency Ablation for the Treatment of Knee Osteoarthritis: A Systematic Review. Pain Physician. 2017; 20(3):155-171. https://doi.org/10.36076/ppj.2017.171 9. Karaman H, Tüfek A, Kavak G., Yildirim ZB, Uysal E, Celik F, Kaya S. Intra-articularly applied pulsed radiofrequency can reduce chronic knee pain in patients with osteoarthritis. J Chin Med Assoc. 2011; 74(8):336-340. https://doi.org/10.1016/j.jcma.2011.06.004 10. Ogalla IR, Martin AM, Pineda MMS, Huertas FR. Eficacia de la radiofrecuencia convencional de los geniculados para el tratamiento del dolor en la gonartrosis moderada- severa. Rev. Soc Esp Dolor. 2014; 21:212-218. https://doi.org/10.4321/S1134-80462014000400005 11. Protzman NM, Gyi J, Malhotra AD, Kooch JE. Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty. PM R. 2014; 6:373-376. https://doi.org/10.1016/j.pmrj.2013.10.003 12. Ogalla IR, Martin AM, Pineda MMS, Huertas FR. Eficacia de la radiofrecuencia convencional de los geniculados para el tratamiento del dolor en la gonartrosis moderada- severa. Rev. Soc Esp Dolor. 2014; 21:212-218. https://doi.org/10.4321/S1134-80462014000400005 13. Mata J, Valentí P, Hernández B, Mir B, Aguillar. Study protocol for a randomised con- trolled trial of ultrasound-guided pulsed radiofrequency of the genicu- lar nerves in the treatment of patients with osteoarthritis knee pain. BMJ Open. 2017; 7(11): e016377 14. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, Shin JW. Radiofrequency treatment relieves chron- ic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011; 152(3):481-87. https://doi.org/10.1016/j.pain.2010.09.029 15.Franco CD, Buvanendran A, Petersohn JD, Menziez RD, Menziez LP. Innervation of the anterior capsule of the human knee: Implications for radiofrequency ablation. Reg Anesth Pain Med. 2015; 40(4): 363-68. https://doi.org/10.1097/AAP.0000000000000269 16. Yasar E, Kesikburun S, Kılıç C, Güzelküçük Ü, Yazar F, Tan AK. Accuracy of ultrasound-guided genicu- lar nerve block: A cadaveric study. Pain Physician. 2015; 18(5):899-904 17. Cheng PH, Kim HJ, Ottestad E, Narouze S. Ultrasound-guided injections of the knee and hip joints. Tech Reg Anaesth Pain Manag. 2009; 13:191-97 https://doi.org/10.1053/j.trap.2009.06.022 18. Huntoon MA: Ultrasound in pain medicine: Advanced weaponry or just a fad? Reg Anesth Pain Med. 2009; 34(5):387-88. https://doi.org/10.1097/AAP.0b013e3181b494f5 19. Patel N, Cohen SP, Response to: Cheng. Comparative outcomes of cooled versus traditional radiofrequency ablation of the lateral branches for sacroiliac joint pain. Clin J Pain. 2013; 29(2):132-137. https://doi.org/10.1097/AJP.0b013e31828c88e0
  • Original Article
    Real time strain elastography for differentiation of solid renal masses
    DOI:10.23950/1812-2892-JCMK-00806
    Objective: The aim of this study was to investigate the diagnostic performance of real time strain elastography for evaluation of solid renal masses. Material and methods: Forty two patients who were incidentally detected solid renal masses underwent Real Time Strain Elastography. Strain index value was detected for each lesion by dividing ROI of lesion to ROI of adjacent renal cortex. Strain index values and color encoding patterns of lesions and renal parenchyma were obtained. Mean strain index values and color encoding patterns for benign and malignant lesions were compared. Also by using ROC curve, cut-off value was obtained and diagnostic performance of method was evaluated. Results: Any statistically significant difference of mean ages of patients was not found. Mean strain index value of malignant lesions were significantly higher than benign lesions. When cut-off value for strain index ratio was taken 0.3, high diagnostic performance was obtained for differentiation of solid renal masses as benign or malignant. Conclusion: Real time strain elastography can be useful for differentiation of solid renal masses as malignant or benign. Key words: elastography, solid renal mass, kidney, strain Corresponding author: Fatih Mehmet Tezcan. fatihtezcan427@gmail.com References 1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics 2007. CA Cancer J Clin. 2007; 57:43-66. https://doi.org/10.3322/canjclin.57.1.43 2. Luciani LG, Cestar R, Tallarigo C. Incidental renal cell carcinoma-age and stage characterizatıon and clinical implications: study of 1092 patients. Urology. 2000; 56:58-62. https://doi.org/10.1016/S0090-4295(00)00534-3 3. Stakhovskyi O, Yap SA, Leveridge M, Lawrentschuk N, Jewett MA. Small renal mass: what the urologist needs to know for treatment planning andassessment of treatment results. AJR Am J Roentgenol. 2011; 196:1267-1273. https://doi.org/10.2214/AJR.10.6336 4. Kutikov A, Fossett LK, Ramchandani P, et al. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology. 2006; 68:737-740. https://doi.org/10.1016/j.urology.2006.04.011 5. Chang JY, Moon JH, Koh SH, Park SY, Lee KS. Clinical Application of ShearWave Elastography in Breast Masses. Iran J Radio. 2017; 14(1):e39585. https://doi.org/10.5812/iranjradiol.39585 6. Altunkeser A, Alkan E, Günenç O, Tolu I, Körez MK. Evaluation of a Healthy Pregnant Placenta with Shear Wave Elastography. Iran J Radio. 2018; 16(1):e68280. https://doi.org/10.5812/iranjradiol.68280 7. Dumitriu D, Dudea S, Botar-Jid C, Baciut M, Baciut G. Real-time sonoelastography of major salivary gland tumors. AJR Am J Roentgenol. 2011; 197:924-930. https://doi.org/10.2214/AJR.11.6529 8. Onur MR, Poyraz AK, Bozgeyik Z, et al. Utility of semiquantitative strain elastography for differentiation between benign and malignant solid renal masses. J Ultrasound Med. 2015; 34(4):639-647. https://doi.org/10.7863/ultra.34.4.639 9. Aydin S, Yildiz S, Turkmen I, Sharifov R, Uysal O, Gucin Z, ArmaganA, Kocakoc E. Value of shear wave elastography for differentiatingbenign and malignant renal lesions. Med Ultrason. 2018; 1:21-26. https://doi.org/10.11152/mu-1161 10. Pallwein-Prettner L, Flöry D, Rotter CR, et al. Assessment and characterisation of common renal masses with CT and MRI. Insights Imaging. 2011; 2:543-556. https://doi.org/10.1007/s13244-011-0116-1 11. Lyshchik A, Higashi T, Asato R, et al. Thyroid Gland Tumor Diagnosis at US Elastography. Radiology. 2005; 237:202-211. https://doi.org/10.1148/radiol.2363041248 12. Lyshchik A, Higashi T, Asato R, et al. Cervical Lymph Node Metastases: Diagnosis at Sonoelastography-Initial Experience. Radiology. 2007; 243 :258-267. https://doi.org/10.1148/radiol.2431052032 13. Kumar V, Cotran RS, Robbins Sl. Basic Pathology 6th ed. Ankara: Çevikbaş U. 2000; 475-476. 14. Lee JW, Lorenzo EI, Ahn B, et al. Palpation device for the identification of kidney and bladder cancer: a pilot study. Yonsei Med J. 2011; 52:768-772. https://doi.org/10.3349/ymj.2011.52.5.768 15. Derieppe M, Delmas Y, Gennisson JL, et al. Detection of intrarenal microstructural changes with supersonic shear wave elastography in rats. Eur Radiol. 2012; 22:243-250. https://doi.org/10.1007/s00330-011-2229-9 16. Emelianov SY, Lubinski MA, Weitzel WF, Wiggins RC, Skovoroda AR, O'Donnell M. Elasticity imaging for early detection of renal pathology. Ultrasound Med Biol. 1995; 21:871-883. https://doi.org/10.1016/0301-5629(94)00146-5 17. Gallotti A, D'Onofrio M, Pozzi Mucelli R. Acoustic Radiation Force Impulse (ARFI) technique in ultrasound with Virtual Touch tissue quantification of the upper abdomen. Radiol Med. 2010; 115:889-897. https://doi.org/10.1007/s11547-010-0504-5 18. Arda K, Ciledag N, Aktas E, Aribas BK, Köse K. Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. AJR Am J Roentgenol. 2011; 197:532-536. https://doi.org/10.2214/AJR.10.5449 19. Clevert DA, Stock K, Klein B, et al. Evaluation of Acoustic Radiation Force Impulse (ARFI) imaging and contrast-enhanced ultrasound in renal tumors of unknown etiology in comparison to histological findings. Clin Hemorheol Microcirc. 2009; 43:95-107. https://doi.org/10.3233/CH-2009-1224 20. Onur MR, Poyraz AK, Bozgeyik Z, et al. (2015) Utility of semiquantitative strain elastography for differentiation between benign and malignant solid renal masses. J Ultrasound Med. 34(4):639-647. https://doi.org/10.7863/ultra.34.4.639 21. Aydin S, Yildiz S, Turkmen I, Sharifov R , Uysal O, Gucin Z, Armagan A, Kocakoc E. Value of Shear Wave Elastography for Differentiating Benign and Malignant Renal Lesions. Med Ultrason. 2018;1(1):21-26. doi: 10.11152/mu-1161. https://doi.org/10.11152/mu-1161
  • Original Article
    Comparative study of in vitro prepared Rose Bengal Plate Test (RBPT) antigen with commercially available antigens
    DOI:10.23950/1812-2892-JCMK-00802
    Background and aim: Brucellosis is one of the world most common zoonotic diseases. The current study was aimed to prepare the Rose Bengal Plate Test (RBPT) antigen for the diagnosis of brucellosis and to determine its specificity and sensitivity. Material and methods: The Rose Bengal plate test antigen prepared from Brucella abortus (B. abortus) strain 99 was compared with two commercial Rose Bengal Plate Test antigens and its specificity and sensitivity are determined. Results: The Rose Bengal plate test and I-ELISA result show that the in vitro antigen was superior to RBPT antigen University Diagnosis Laboratory (UDL) Lahore Pakistan, and RBPT antigen Veterinary Laboratory Agency (VLA) UK. Out of 196 samples analyzed by in vitro RBPT antigen, RBPT antigen (UDL), RBPT antigen (VLA), and an indirect enzyme-linked immunosorbent assay (I-ELISA) 56.63 %, 53.57%, 41.84%, 35.71% were found B. abortus positively. The sensitivity calculated for the in vitro RBPT antigen was 96.62, while RBPT antigen (UDL) and RBPT antigen (VLA) were 89.77, 63.91 correspondingly. However, the specificity of the in vitro RBPT antigen was lower (77.57%), than the commercial RBPT antigen (VLA) (79.79%). Conclusions=: A very sensitive and low-cost in vitro RBPT antigen compared to commercial RBPT was magnificently developed in the current study. It was determined that the in vitro RBPT antigen could substitute the available commercial RBPT antigen, which is comparatively expensive and less sensitive in the detection of brucellosis. Therefore, it is concluded that the in vitro RBPT antigen could be used for epidemiological surveillance of brucellosis. Key words: brucella, antigen, diagnosis, serology, animals Corresponding author: Mujeeb ur Rahman. Email: mujeeb@stumail.nwu.edu.cn References 1. Godfroid J, Scholz H, Barbier T, Nicolas C, Wattiau P, Fretin D, et al. Brucellosis at the animal/ecosystem/human interface at the beginning of the 21st century. Preventive veterinary medicine. 2011; 102(2):118-131. https://doi.org/10.1016/j.prevetmed.2011.04.007 2. Scholz HC, Revilla-Fernández S, Al Dahouk S, Hammerl JA, Zygmunt MS, Cloeckaert A, et al. Brucella vulpis sp. nov., isolated from mandibular lymph nodes of red foxes (Vulpes vulpes). International journal of systematic and evolutionary microbiology. 2016; 66(5):2090-2098. https://doi.org/10.1099/ijsem.0.000998 3. Aparicio ED. Epidemiology of brucellosis in domestic animals caused by Brucella melitensis, Brucella suis and Brucella abortus. Rev Sci Tech. 2013; 32(1):53-60. https://doi.org/10.20506/rst.32.1.2187 4. Saleem MZ, Akhtar R, Aslam A, Rashid MI, Chaudhry ZI, Manzoor MA, et al. Evidence of Brucella abortus in non-preferred caprine and ovine hosts by real-time PCR assay. Pak J Zool. 2019; 51:1187-1189. https://doi.org/10.17582/journal.pjz/2019.51.3.sc3 5. Saeed U, Ali S, Khan TM, El-Adawy H, Melzer F, Khan AU, et al. Seroepidemiology and the molecular detection of animal brucellosis in Punjab, Pakistan. Microorganisms. 2019; 7(10):449. https://doi.org/10.3390/microorganisms7100449 6. Jamil T, Melzer F, Khan I, Iqbal M, Saqib M, Hammad Hussain M, et al. Serological and molecular investigation of Brucella species in dogs in Pakistan. Pathogens. 2019; 8(4):294. https://doi.org/10.3390/pathogens8040294 7. Fatima S, Khan I, Nasir A, Younus M, Saqib M, Melzer F, et al. Serological, molecular detection and potential risk factors associated with camel brucellosis in Pakistan. Tropical animal health and production. 2016; 48(8):1711-1718. https://doi.org/10.1007/s11250-016-1148-9 8. Foster JT, Walker FM, Rannals BD, Hussain MH, Drees KP, Tiller RV, et al. African lineage Brucella melitensis isolates from Omani livestock. Frontiers in microbiology. 2018; 8:2702. https://doi.org/10.3389/fmicb.2017.02702 9. Norman FF, Monge-Maillo B, Chamorro-Tojeiro S, Pérez-Molina J-A, López-Vélez R. Imported brucellosis: a case series and literature review. Travel medicine and infectious disease. 2016; 14(3):182-199. https://doi.org/10.1016/j.tmaid.2016.05.005 10. Neha A, Kumar A, Ahmed I. Comparative efficacy of serological diagnostic methods and evaluation of polymerase chain reaction for diagnosis of bovine brucellosis. Iranian journal of veterinary research. 2017; 18(4):279. 11. Franc K, Krecek R, Häsler B, Arenas-Gamboa A. Brucellosis remains a neglected disease in the developing world: a call for interdisciplinary action. BMC public health. 2018; 18(1):1-9. https://doi.org/10.1186/s12889-017-5016-y 12. Seleem MN, Boyle SM, Sriranganathan N. Brucellosis: a re-emerging zoonosis. Veterinary microbiology. 2010; 140(3-4):392-398. https://doi.org/10.1016/j.vetmic.2009.06.021 13. Corbel MJ. Brucellosis in humans and animals: World Health Organization; 2006. 14. Akhtar S, Mirza M. Rates of seroconversion in the progeny of Brucella abortus seropositive and seronegative cattle and buffalo. Revue scientifique et technique (International Office of Epizootics). 1995; 14(3):711-718. https://doi.org/10.20506/rst.14.3.861 15. Dadar M, Shahali Y, Whatmore AM. Human brucellosis caused by raw dairy products: A review on the occurrence, major risk factors and prevention. International journal of food microbiology. 2019; 292:39-47. https://doi.org/10.1016/j.ijfoodmicro.2018.12.009 16. Hakeem M, Saeed S. Brucellosis: A case report and literature review. J Postgrad Med Ed Res. 2019; 53:126-127. https://doi.org/10.5005/jp-journals-10028-1328 17. Young E, Hall W, Evans A, Brachman P. Bacterial infection of humans: epidemiology and control. 1998. 18. Rubach MP, Halliday JE, Cleaveland S, Crump JA. Brucellosis in low-income and middle-income countries. Current opinion in infectious diseases. 2013; 26(5):404. https://doi.org/10.1097/QCO.0b013e3283638104 19. Glynn MK, Lynn TV. 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  • Case Report
    Does intervention always essential for aorto-right ventricular outflow tract fistula after surgical aortic valve replacement? : A case report
    DOI:10.23950/1812-2892-JCMK-00805
    Surgical aortic valve replacement is an effective treatment for symptomatic severe aortic stenosis in patients with low-intermediate operative risk. Prosthetic valve endocarditis is a complication after aortic valve replacement and accounts for 20% of infective endocarditis. Prosthetic valve endocarditis sometimes complicates with abscess formation, pseudoaneurysm and aorto-cardiac fistula. Although severity of symptoms mostly depend on shunt’s size, aorto-cardiac fistula has high mortality rate despite aggressive surgical and percutaneous intervention. Rarely, small shunts can be tolerated. We describe a case of aorto-right ventricle outflow tract fistula presented with signs and symptoms of congestive heart failure and remained asymptomatic under medical therapy. Key words: aortic valve replacement, pseudoaneurysm, aorto-right ventricle outflow tract fistula Corresponding author: Dr. Ibrahim Halil INANC. E-mail: dr.ibrahimhalilinanc@outlook.com ORCID: https://orcid.org/0000-0003-4046-6748 References 1. Lindman BR, Clavel M-A, Mathieu P, Iung B, Lancellotti P, Otto CM, et al. Calcific aortic stenosis. Nature reviews Disease primers. 2016; 2(1):1-28. https://doi.org/10.1038/nrdp.2016.6 2. Razzolini R, Covolo E. Severe Aortic Stenosis Treatment: Percutaneous Options, Patient Selection, and Preoperative Evaluation. Percutaneous Interventions for Structural Heart Disease: Springer. 2017; 3-13. https://doi.org/10.1007/978-3-319-43757-6_1 3. Glaser N, Jackson V, Holzmann MJ, Franco-Cereceda A, Sartipy U. Prosthetic valve endocarditis after surgical aortic valve replacement. Circulation. 2017; 136(3):329-31. https://doi.org/10.1161/CIRCULATIONAHA.117.028783 4. Lalani T, Chu VH, Park LP, Cecchi E, Corey GR, Durante-Mangoni E, et al. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. JAMA internal medicine. 2013; 173(16):1495-504. https://doi.org/10.1001/jamainternmed.2013.8203 5. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, Del Zotti F, et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European heart journal. 2015; 36(44):3075-128. https://doi.org/10.1093/eurheartj/ehv319 6. Konda MK, Kalavakunta JK, Pratt JW, Martin D, Gupta V. Aorto-right ventricular fistula following percutaneous transcatheter aortic valve replacement: case report and literature review. Heart views: the official journal of the Gulf Heart Association. 2017; 18(4):133. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_115_16 7. Foster TJ, Amin AH, Busu T, Patel K, Farjo P, Al Hallak A, et al. Aorto-cardiac fistula etiology, presentation, and management: A systematic review. Heart & Lung. 2019; https://doi.org/10.1016/j.hrtlng.2019.11.002 8. Al-Maskari S, Panduranga P, Al-Farqani A, Thomas E, Velliath J. Percutaneous closure of complex paravalvular aortic root pseudoaneurysm and aorta-cavitary fistulas. Indian heart journal. 2014; 66(3):358-62. https://doi.org/10.1016/j.ihj.2014.03.015 9. Anguera I, Miro JM, San Roman JA, de Alarcon A, Anguita M, Almirante B, et al. Periannular complications in infective endocarditis involving prosthetic aortic valves. The American journal of cardiology. 2006; 98(9):1261-8. https://doi.org/10.1016/j.amjcard.2006.05.066

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