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Yönetimin eylem ve işlemlerinin halka açıklığı, hesap verebilirlik, şeffaflık, siyasal katılım ve bilgi edinme hakkı; halkla ilişkilerde, devlet-yurttaş ilişki ve etkileşiminde öne çıkan kavramlardır. Makalede, Türkiye’de, Covid-19 pandemisi sürecinde de önemli yerleri olan, T.C. Sağlık Bakanlığı, T.C. İçişleri Bakanlığı ile T.C. Aile ve Sosyal Hizmetler Bakanlığı’nın, bilgi edinme hakkı kapsamındaki uygulamalarının, “aktif şeffaflık” ve “pasif şeffaflık” ölçütleri temelinde değerlendirilmesi amaçlanmaktadır. Tüm veriler, nitel içerik analizi yöntemi ile değerlendirilmiştir; tanımlayıcı ve ilişkisel bulgulara odaklanılarak kesitsel araştırma deseni kullanılmıştır. Sonuç olarak, Covid-19 pandemisi sürecinde, T.C. Sağlık Bakanlığı, T.C. İçişleri Bakanlığı ile T.C. Aile ve Sosyal Hizmetler Bakanlığının hem aktif hem de pasif şeffaflık ölçütleri çerçevesinde önemli hizmetler sunduğu görülmektedir. Bununla birlikte, yurttaşların, bilgi edinme hakkından daha etkin biçimde yararlanmalarını sağlamak bakımından söz konusu bakanlıkların atmaları gereken adımların olduğu da belirtilmelidir.

In NE Türkiye, an almost 30,000 km2 area is covered by young volcanic rocks, ranging in age from Miocene to Quaternary and spanning the whole compositional spectrum from basanites/tephrites to high silica rhyolites. The region exhibits a plateau morphology, known as the Erzurum-Kars Plateau, at ~2 km above sea level. That volcanic plateau continues far beyond the state border into Georgia (ie., the Samtskhe-Javakheti plateaus). Although there are a few studies, the petrological evolution of the these volcanic plateaus is still not well known. To better understand the origin, magmatic history, and geodynamic setting of the volcanism on these plateaus, we, Turkish and Georgian researchers, have been conducting a joint cross-border research project (i.e., TÜBİTAK- SRGNSF project #118Y272) across the region. The volcanic units making up those plateaus are composed of numerous volcanic cones of different shapes and sizes, lava domes, pyroclastic layers, and widespread plateau-forming lavas.Preliminary findings of our research have revealed that the composition and structure of the lithospheric domains below the plateau might have significant effects on the geochemical character and the lithological features of the volcanics. The volcanic succession covering the Pontide Block in the north is dominated by Late Miocene-Pliocene calc-alkaline andesitic and dacitic lavas, which mostly form medium-sized volcanic edifices. These edifices are partially overlain by Upper Pliocene to Quaternary aged low-viscosity, plateau-forming basic lavas which are also calc-alkaline. Notably, pyroclastics are scarce in the north.The portion of the plateau that overly the Northeastern Iranian Block and the ophiolitic mélange in the south consists of a much wider variety of lava and pyroclastic lithologies. It starts with a ~5.5 Mys old acid pyroclastic layer at the base, consisting of rhyolitic pyroclastics, domes, and obsidian. It is overlain by the plateau-forming basic to intermediate lavas, Pliocene in age. In turn, the plateau sequence is overlain by a previously unknown caldera-like volcanic complex, which we named “the Digor volcanic complex”, located between Kars and Digor. It has a diameter of ~60 km and consists of lavas and pyroclastics of Late Pliocene to Quaternary in age, displaying both calcalkaline and alkaline character.All those volcanics contain a clear inherited subduction signature from previous subduction events (i.e., Pontide Arc in the north). Our petrological melting modellings revealed that the magmas were possibly derived from two contrasting metasomatized lithospheric mantle sources: (1) a spinel peridotite with or without minor amphibole and, (2) a pyroxenitic mafic source with a minor amount of phlogopite. Our data indicate that the melts derived from these two sources were mixed into each other en route to the surface. Most of the plateau lavas might have been derived from the first type (i.e., spinel-peridotite) while the younger alkaline Digor volcanics were dominantly from the second type (i.e., pyroxenite). The thinning of the lithospheric mantle by delamination and the gradual increase of heat coming from the upwelling asthenospheric mantle might be responsible for these variations. Our FC and AFC models show that plateau lavas experienced intense amphibole±garnet fractionation and moderately assimilated continental crust.

One of the youngest volcanic areas in the Circum-Mediterranean region is located on a horst and graben system in the western Anatolian extensional province in Turkey, north of the city of Manisa. It is essentially made up of Quaternary-aged fresh primitive basic lavas and pyroclastics, which erupted from monogenetic cones and fissures. These volcanic materials cover an area of ~300 km2. In that area, there are over 80 scoria cones. Radiometric dating results published to date have revealed that the volcanism occurred in three different phases. The presence of human footprints pyroclastic material of the last stage in Kula can be proof of active volcanism during the Holocene period.Lavas erupted during the first stage range in composition from basanite to Phono-tephrite. They formed a small plateau in the N and NE of Kula, which was consequently deeply eroded in response to the uplift of the horsts. At present, the remnants of that plateau stand higher than the Elekçitepe and Divlittepe Stages in the form of mesas. Volcanic products of the 2nd Stage has a compositional range spanning from foidite to basanite, basalt, hawaiite, potassic trachy basalt, and phono-tephrite. 3rd stage volcanics display the narrowest compositional range, classifying as phono tephrite. Characteristically, they are made up of calcic plagioclase, zoned clinopyroxene, olivine.Lavas of the Kula volcanics display a clear within-plate geochemical signature which is more enriched than the average OIB. All lavas display a clear within-plate pattern with no Nb and Ta depletion on N-MORB-normalized multielement spidergrams. Hence they have no subduction signature. Chondrite-normalized REE patterns show a slight concave upward pattern in MREEs, indicating the possible involvement of amphibole in fractionation. Results of our petrological melting models based on trace elements, and distribution of data points on some diagrams which are used for the determination of source characteristics of the magmatic series indicate the presence of three contrasting sources for basic magmas. Two of these are of mantle origin, while, one is crustal. Our results indicate that first mantle source was a PM-like garnet peridotite, possibly asthenospheric in origin, from which foiditic mafic lavas containing MgO greater than 11 wt.% were derived. The second mantle source was represented by a Fe-rich metasomatized Gt-Peridotite. This mantle was probably of lithospheric origin, owing to its metasomatic nature. The third one was a Px + Phlg-bearing mafic crustal lithology highly metasomatized by the addition of magmatic batches. Most of the basic lavas from Kula appear to be mixtures of melts derived from the metasomatic peridotitic mantle and mafic (lower) crustal sources. We link the magma genesis to the combined effects of extension that created thinning of the lithosphere (also resulting in a static upwelling of the mantle altogether) and a tear in the slab beneath the region that gave way to much hotter upwellings from the sub-slab asthenosphere. We argue that the abovementioned metasomatism events both in the lithospheric mantle and mafic continental (lower) crust may be linked to that asthenospheric upwelling that brought a much hotter and primordial mantle below the lithosphere.

İslam Düşünce Tarihinin en büyük ekolu olan Eş’arilik, şüphesiz imamı ve kurucusu olarak kabul edilen İmam Eş’arî’nin fikrilerinin temel alındığı bir mezheptir. Eş’arî’nin inanca dair düşünceleri içinde en dikkati çekenlerden biri de iman konusundaki görüşleri oluşturmaktadır. Ona has iman görüşü İslam düşüncesindeki iman anlayışları içinde farklı bir yere sahiptir. Bu çalışmada bu farklılıklar öne çıkarılarak İslam Mezheplerinin temel ayrılık noktalarından biri olan iman konusuna Eş’arî’nin bakışı ve onun bu konu ile ilgili telif ettiği İman Risalesi ele alınmıştır. İmam Eş’arî yüzden fazla eser yazmış olmasına rağmen bize ulaşan ve mevcudiyeti bilinen çok az eseri vardır. Bunlardan Makâlat, el-İbâne, el-Luma’, Risale ila Ehli Sağr ve İsthisanu’l-Havd eserleri ilim dünyasında şöhret bulmuş, üzerinde çalışmalar yapılmış ve Türkçeye de çevrilip yayınlanmıştır. Adı geçen beş eser açısından durum bu iken bu makalede söz konusu edeceğimiz İman ile alakalı eseri ilim dünyasında pek şöhret bulmadığı gibi tespit edebildiğimiz kadarıyla ülkemizde üzerinde bir çalışma veya çeviri yapılmadığı gibi eserin Arapça metni de yayınlanmamıştır. Bu boşluğu doldurmak amacıyla hem Eş’arî’nin iman görüşü hem de sözü edilen eserin değerlendirilmesi ve Türkçe çeviri ile birlikte Arapça metninin de yer aldığı bir çalışma yapılmıştır. Böylece bu makale ile Eş’arî’nin mevcut eserlerinin tümünün ülkemizdeki ilim taliplerinin istifadesine sunulmasına katkı sağlanması hedeflemiştir.

IntroductionThere have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection.MethodsThis is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year.ResultsThe percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic (p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic (p < 0.0001) and also higher among children with new onset Type 1 diabetes (p < 0.0001). HbA1c levels, duration of insulin infusion, and length of PICU stay were significantly higher/longer during the pandemic period. Eleven patients tested positive for SARS-CoV-2, eight were positive for new onset Type 1 diabetes, and nine tested positive for severe DKA at admission.DiscussionThe frequency of new onset of Type 1 diabetes and severe cases among children with DKA during the first year of the COVID-19 pandemic. Furthermore, the cause of the increased severe presentation might be related to restrictions related to the pandemic; however, need to evaluate the potential effects of SARS-CoV-2 on the increased percentage of new onset Type 1 diabetes.

Introduction: Recurrent epistaxis is a common medical problem faced by ENT specialists, emergency physicians, and pediatricians. The facts that many treatment modalities are being searched and no single treatment method is universally accepted yet support this information. Objective: We aimed to compare the clinical efficacy of topical antiseptic ointment, topical decongestant ointment and chemical cauterization treatments, which are frequently used in recurrent anterior epistaxis, both singly and in combination. Material-methods: Between August 2017 and February 2018, 137 patients who were diagnosed with recurrent anterior epistaxis were randomly divided into 5 groups. group I received topical antiseptic ointment, group II received topical decongestant ointment, group III received chemical cauterization, group IV received topical antiseptic ointment + chemical cauterization and group V received topical decongestant ointment + chemical cauterization treatment. All patients were phoned 2 weeks and 1 month after the treatment and questioned about the presence (failure) or absence (success) of at least 1 episode of epistaxis. Patients with comorbid diseases were excluded. Treatment success was statistically analysed. Results: There was no significant difference (p > 0.05) between the groups in the success rate at 15th day after treatment. Group IV and group V had higher success rates at 30th day after treatment compared with group I and group II (p 0.05). Conclusion: Although the number of patients who improved with chemical cauterization (group III) was higher in our study, no significant difference was observed in single treatment modalities (group I‒III) at 14th day and 30th day after treatment. Although no statistically significant difference was observed between combined treatments (group IVV) and single treatments (group I‒III) in the 2nd week after treatment, combined treatments were significantly more effective in the 1st month.

Objective Sepsis diagnosis is challenging due to nonspecific symptomatology in newborns. Timely diagnosis is essential for reducing sepsis-related morbidity and mortality. This study was performed to determine the diagnostic value of the delta neutrophil index (DNI) for detection of neonatal sepsis and to compare its efficacy with other conventional markers. Methods This study was conducted at a tertiary hospital in newborns with confirmed sepsis (n = 59), suspected sepsis (n = 46), and in age- and weight-matched controls (n = 49). DNI, white blood cell count, C-reactive protein (CRP) level, and platelet measurements were determined, and blood cultures were performed at the onset of symptoms. Results The mean DNI was significantly higher in confirmed and clinical sepsis groups compared with the control group. (6.9 ± 9.3, 1.9 ± 2.1, and 0.4 ± 0.5, respectively, p Conclusion DNI could be used as a reliable diagnostic marker for neonatal sepsis, and high DNI could predict sepsis development and unfavorable outcomes. The diagnostic capability of DNI may be increased by assessing CRP measurements simultaneously.

Introduction:Video head impuls test (vHIT) is used in the diagnosis of vestibular dysfunction. There is no study conducted on vHIT application and its results on children in our country. Our study aimed to examine vHIT tests in children with normal hearing function and to determine normal value ranges.Methods:This study was made up of a total of 78 children under 16 years of age with normal hearing function. All children received vHIT and the values found were recorded.Results:Of the 78 children participating in the study, 44 (56.4%) were boys and 34 (43.6%) were girls. There was no significant difference in the results of vHITs between the ages of 4-6, 7-9 and 10-12 in terms of mean left lateral, right lateral, left anterior, right posterior, left posterior and right anterior values (p>0.05 for each). However, in the analysis performed by combining 4-12 age groups, there was a significant difference between the ages of 4-12 and 12 years in terms of left posterior mean values (p=0.012).Conclusion:When the findings of our study and combined reports were evaluated, it was observed that normal vestibuloocular reflex gain values should be determined in the paediatric population by the vHIT method. We consider that, paediatricians may use the findings of our study as guide for the evaluation of vestibular function in children. Extensive studies are needed to ensure that the normal value ranges reach a higher level of reliability.

Objective: Turkish Directorate of Public Health introduced the first pilot screening program for congenital adrenal hyperplasia (CAH) in four Turkish cities in 2017, and in 2018 extended the program, with a slight change in screening strategy, to fourteen cities. To evaluate the performance of the extended study and update previously reported outcomes. Methods: Retrospective, descriptive study. Neonates of >= 32 gestational weeks and >= 1500 gr birth weight from fourteen cities, born between May-December 2018, were included. Screening protocol included one sample, two-tier testing as applied in the previous pilot study. In the first step, 17 alpha-hydroxyprogesterone (17-OHP) was measured by fluoroimmunoassay in dried blood spots (DBS) obtained at 3-5 days of life. Cases with positive initial screening underwent second tier testing by steroid profiling in DBS using liquid chromatography-tandem mass spectrometry to measure 17-OHP, 21-deoxycortisol (21-S), cortisol (F), 11-deoxycortisol and androstenedione. The babies with a steroid ratio (21-S+ 17-OHP)/F of >= 0.7 (increased from >= 0.5 in the earlier pilot study) were referred to pediatric endocrinology clinics for diagnostic assessment. Results: In the evaluated period, 241,083 newborns were screened. 12,321 (5.11 %) required second-tier testing and 880 (0.36 %) were referred for clinical assessment, twenty of whom were diagnosed with CAH (10 females, 10 males). Sixteen were diagnosed as classical 21-hydroxylase deficiency (21-OHD) CAH (12 with salt-wasting and four with simple virilising CAH), and four cases were identified with 11 beta-OHD CAH. No case of salt-wasting CAH was missed by neonatal screening (sensitivity was 100 %). The incidence of classical 21-OHD and 11 beta-OHD in the screened population was 1:15,067 and 1:60,270, respectively. Conclusion: Turkish neonatal CAH screening effectively led to earlier diagnosis of 21-OHD and 11 beta-OHD, using steroid profiling as a second-tier test. This will result in improved care of these patients in the future.

Background The olfactory bulb (OB) and eyeball size change depending on age and puberty. There is a well-established trade-off between sensory structures of the brain such as the eye and the olfactory bulb that depend on environmental circumstances in the evolutionary history of animals. The aim of this study was to developmentally investigate the potential reciprocal changes between OB and eyeball volumes (EV) in girls with precocious puberty (PP). Methods A total of 148 girls aged between 5 and 8 years (63 PP, 85 healthy) were included in the study. Exclusion criteria: Cases of anosmia/hyposmia, neurodegenerative disorder, refractive errors and trauma. The pituitary height (PH), EV and OB volumes were measured on segmentation of a magnetic resonance image (MRI) slice using manual countering. The corrected measurements by body surface were used in all statistical analyses. Results In girls with PP, the means of the OB volume and PH were larger (71.11 ± 20.64 mL) and higher (4.62 ± 1.18 mm), respectively, while the mean of EVs was smaller (11.24 ± 2.62 cm3) (p = 0.000). Cut-off values were 62.27 mL, 10.7 cm3 and 4.71 mm for OB volume, EV and PH, respectively. While negative correlations were found between OB volume-EV and EV-PH (r63 = −0.224, p = 0.001 and r63 = −0.116, p = 0.001, respectively), OB volume was positively correlated with PH (r63 = 0.578, p = 0.001). Conclusions The present study demonstrates that girls with PP have significantly larger OB volume, but smaller EV, and there is negative correlation between the two structures. These results indicate that there is trade-off between anatomical dimensions of OB and eyeball in favor of OB in PP girls.

Childhood obesity is a growing public health burden in many countries. The lipid perilipin 1 (PLIN1) gene is involved in regulation of lipolysis, and thus represents a viable candidate mechanism fo...

There is conflicting data regarding the role of transforming growth factor-β1 (TGF-β1) in the pathogenesis of airway hyper-reactivity and asthma exacerbation.To investigate the role of exhaled-TGF-β1 in exercise-induced bronchospasm (EIB) in asthmatic and nonasthmatic healthy children, and in asthma exacerbation and asthma control.The exhaled-TGF-β1 levels of 56 stable asthmatic children and 15 nonasthmatic healthy children were evaluated before and 30 min after an exercise challenge. The exhaled-TGF-β1 levels of 20 additional children with asthma exacerbation were evaluated.While no significant difference in the exhaled-TGF-β1 levels was found at the baseline, exhaled-TGF-β1 levels after the exercise challenge were significantly higher in the non-EIB (Our results suggest that TGF-β1 may play a role in suppressing airway reactivity and its deficiency is associated with asthma exacerbation.

Objective Several studies have established a relationship between low serum vitamin D levels and the onset of asthma in childhood. In this study, we aim to assess the relationship between vitamin D and asthma. Methods This study included 29 mild and 30 moderate persistent asthma and 38 healthy control group. Evaluation of the three groups was carried out in respect of serum vitamin D levels, Respiratory Function Test (RFT), and Exercise Provocation Test (EPT). The two asthma groups were also examined using the Asthma Control Test (ACT) and Nitric Oxide in Exhaled Breath (FeNO) level. Results The vitamin D levels of the mild and the moderate persistent asthma groups were determined to be lower than the vitamin D levels of the control group (p=0.007). A significant negative correlation was determined in all cases between the vitamin D levels and the broncho-reversibility percentage (p=0.0002). The negative correlation between the vitamin D levels and the broncho-reversibility percentage was more evident in the moderate persistent asthma group (p=0.0001). In the moderate persistent asthma group, a significant positive correlation was determined between the lowness of the maximum forced expiratory volume in EPT and a low vitamin D level (p=0.009). The ACT scores were lower, and the FeNO levels were higher in the moderate asthma group compared to the mild asthma group (p=0.0001). Conclusion The findings showed that low serum vitamin D levels were observed more often in children with asthma, and there was a correlation with increased broncho-reversibility in the RFT and increased bronchial hyper-reactivity in the EPT.

Background/aim: Biotinidase deficiency (BTD) is characterized by broad genotypic variants and unsteady biotinidase activity. Increasing enzyme activity and maturation throughout childhood. This study aims to reveal the course of biotinidase activities in a long-term follow-up period and concordance with their genotypes .Participants/Methods: A total of 1,773 biotinidase enzyme (BT) activity measurements were performed in 711 newborns with variants in the BTD gene over a 4-year follow-up period. Biochemical phenotyping was classified into four groups based on the highest measured enzyme activity level during the follow-up: Profound(≤10%), Partial(10.1-30%), Heterozygous(30.1-66.5%), and Normal(>66.6%). Results: The number of participants with BTD in the biochemical phenotype groups assigned based on the first measurement was 59, 217, 314, and 121 in the profound, partial, heterozygous, and normal groups respectively. Based on the highest measurement value during follow-up, the number and net changes of participants in groups were 22(-37), 95(-122), 333(+19), and 261(+140), respectively. The overall concordance between genotypes and biotinidase activities based on the highest measurement was 50.7%. A moderate correlation was found between the highest enzyme value and age (r=-0.573, p=0.002) in heterozygous plus normal biochemical phenotype groups in first months.Conclusion:This study shows that the biotinidase activities increase at a later age after neonatal period during long-term follow-up, and there is low concordance between the biochemical phenotype and their genotype. These findings indicate the important role of the monitoring the course of biotinidase enzyme activities for a longer period of time to determine the treatment decision.

Introduction: Ultrasonography and fine needle aspiration biopsy are reliable diagnostic methods used to predict malignancy in thyroid nodules. They are useful in identifying patients for therapy or preventing unnecessary surgery. Materials and Methods: The aim of this study was to compare clinical and ultrasonographic findings with fine needle aspiration biopsy and histopathological examination results in children with thyroid nodules. Retrospective study. This multicentre study included pediatric patients with thyroid nodules, followed up between July 2002 and November 2019 in nine Turkish Pediatric Endocrinology Units. Clinical, ultrasonographic, cytological and histopathological findings (malignant or benign) were analyzed retrospectively. Fine needle aspiration biopsy findings were classified according to American Thyroid Association criteria. Results: A total of 203 children were included, of whom 82.3% (n=167) were female. Mean±standard deviation age was 14.06±2.26 (range 3.7-19) years. Cytological diagnoses were: non–diagnostic or unsatisfactory 1.9%; benign 59.6%; atypia or follicular lesion of undetermined significance, suspicious for follicular neoplasm in 2.4%; suspicious for malignancy 12.8%; and malignant in 1.9%. Surgery was performed in 59 (29.1%) patients. In total 33 (16.3%) patients were diagnosed with malignancy. In patients with benign fine needle aspiration biopsy results, malignancy was detected in 17.6% when they underwent surgery. Malignancy was present in 44.4% of the patients with cytologically determined atypia or follicular lesion of undetermined significance. The diagnostic accuracy of fine needle aspiration biopsy was 79%. Conclusion: This study is first multicentre study investigating thyroid nodules in children and adolescents in Turkey. In this population fine needle aspiration biopsy has an important role in diagnosis, but ultrasonographic features of nodule should also be taken into consideration. Atypia or follicular lesion of undetermined significance may be of greater clinical significance than has previously been reported. Giriş: Ultrasonografi ve ince iğne aspirasyon biyopsisi, tiroid nodüllerinde maligniteyi öngörmede kullanılan güvenilir tanı yöntemleridir. Doğru hastayı bulmada ve gereksiz ameliyatları önlemede faydalıdırlar. Bu çalışmanın amacı tiroid nodülü bulunan çocuklarda ince iğne aspirasyon biyopsisi ile klinik, ultrasonografik bulgular ve histopatolojik inceleme sonuçlarını karşılaştırmaktır. Gereç ve Yöntem: Bu çok merkezli çalışmada, Türkiye’den 9 farklı Pediatrik Endokrinoloji Ünitesinde Temmuz 2002-Kasım 2019 tarihleri arasında takip edilen tiroid nodüllü hastaların verileri incelendi. Tiroid nodüllü çocuk hastaların klinik, ultrasonografik, sitolojik ve histopatolojik bulguları (malign veya benign) retrospektif olarak incelendi. İnce iğne aspirasyon biyopsisi ile takip edilen hastaların bulguları Amerikan Tiroid Birliği’ne göre sınıflandırıldı. Bulgular: Çalışmaya toplam 203 çocuk dahil edildi, hastaların %82,3’ü (n=167) kadındı. Hastaların ortalama yaşı 14,06±2,26 yıl (dağılım 3,7-19 yıl) idi. Hastaların sitolojik tanıları şu şekildeydi: %1,9’u tanı dışı veya yetersiz, %59,6’sı benign, önemi belirsiz atipi veya foliküler lezyon, %2,4’ü foliküler neoplazm şüpheli, %12,8’i malignite şüphesi, %1,9’u malign idi. 59 hastaya cerrahi uygulandı. Otuz üç hastaya malignite tanısı konuldu. Benign ince iğne aspirasyon biyopsisi sonucu olan hastaların %17,6’sında ameliyat olduklarında malignite saptandı. Önemi belirlenemeyen sitolojiye sahip atipi veya foliküler lezyonu olan hastaların %44,4’ünde malignite mevcuttu. İnce iğne aspirasyon biyopsisinin tanısal doğruluğu %79 idi. Sonuç: Bu çalışma, Türkiye’de çocuk ve ergenlerde tiroid nodüllerini araştıran ilk çok merkezli çalışmadır. Tiroid nodülü olan çocuklarda ince iğne aspirasyon biyopsisi tanıda önemli bir yere sahiptir ancak nodülün ultrasonografik özellikleri de dikkate alınmalıdır. Atipi veya önemi belirsiz foliküler lezyon bilinenden daha önemli olabilir.

In this study, the effects of heating and cooling rate on the thermal properties of high nickel-rich Ni55Ti45 shape memory alloy were investigated. Transformation temperatures and enthalpies were determined by differential scanning calorimetry. R-phase was observed with two-stage phase transformation during cooling. Transformation finish temperatures were affected, while the transformation start temperatures were not changed by heating–cooling rate. Kissinger, Takhor, and Ozawa methods were applied to find activation energy that is needed for phase transformation. The average activation energy value of 200.5 kJ mol−1 was calculated for Ni55Ti45 alloy. The calculated activation energy was found lower than the ones reported in the literature.

Objective: To contribute to the explanation of the etiology of enuresis, which is quite prevalent, by investigating its relationship with urine pH and density. Methods: A total of 45558 children were included in the study. Based on screening results, 44201 children without enuresis were assigned to Group 1 and 1357 children with enuresis to Group 2. Complete urinalysis results of all children who had been identified were scanned and values of urine pH and density were obtained. Intergroup differences with regard to urine pH and density were analyzed using Student’s t-test. A p value of

Cancers of unknown primary (CUP) that we rarely encounter,conversely rank fourth in cancer-related deaths in males and females. In this case, we aimed to present how the primary of an inguinal mass, which could have been diagnosed as CUP in the 80’s, could be detected using advanced immunohistochemical methods.

Objective: First objective of this study was to find out factors influencing development of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PNL). Secondary objective was to point out the role of preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in SIRS estimation. Method: The data of 756 patients that underwent PNL for kidney stones between 2012 and 2019 were evaluated retrospectively. Patients were divided into 2 groups as non-SIRS and SIRS group. The effects of NLR, PLR and other operative and demographic variables on development of SIRS were investigated. Multivariate logistic regression analysis that was performed on variables that were significant in the univariate analyses was used to establish independent risk factor for post-PNL SIRS. Results: Univariate analysis revealed a significant association between presence of SIRS and preoperative PLR (p120.5, NLR >2.75, and blood transfusions should be monitored closely due to the possible development of serious complications.

Although it is known that there is generally a good correlation between genotypes and phenotypes, the number of studies reporting discrepancies has recently increased, exclusively between milder genotypes and their phenotypes due to the complex nature of the CYP21A2 gene and methodological pitfalls. This study aimed to assess CYP21A2 genotyping in children with 21-hydroxylase deficiency (21-OHD) and establish their predictive genotype–phenotype correlation features using a large cohort in Southeastern Anatolia’s ethnically diverse population. The patients were classified into three groups: salt-wasting (SW), simple virilizing (SV) and non-classical (NC). The genotypes were categorized into six groups due to residual enzyme activity: null–A–B–C–D–E. CYP21A2 genotyping was performed by sequence-specific primer and sequenced with next generation sequencing (NGS), and the expected phenotypes were compared to the observed phenotypes. A total of 118 unrelated children with 21-OHD were included in this study (61% SW, 24.5% SV and 14.5% NC). The pathogenic variants were found in 79.5% of 171 mutated alleles (60.2%, 22.2%, and 17.6% in SW, SV and NC, respectively). Patient distribution based on genotype groups was as follows: null—16.1%, A—41.4%, B—6.0%, C—14.4%, E—22%). In2G was the most common pathogenic variant (33.9% of all alleles) and the most common variant in the three phenotype groups (SW—38.8%, SV—22.2% and NC—23.3%). The total genotype–phenotype correlation was 81.5%. The correlations of the null and A groups were 100% and 76.1%, respectively, while it was lower in group B and poor in group C (71.4% and 23.5%, respectively). This study revealed that the concordance rates of the severe genotypes with their phenotypes were good, while those of the milder genotypes were poor. The discrepancies could have resulted from the complex characteristics of 21-OHD genotyping and the limitations of using NGS alone without integrating with other comprehensive methods.

Background Given the rarity of 11β-hydroxylase deficiency (11βOHD), there is a paucity of data about the differences in clinical and biochemical characteristics of classic (C-11βOHD) and nonclassic 11βOHD (NC-11βOHD). Objective To characterize a multicenter pediatric cohort with 11βOHD. Method The clinical and biochemical characteristics were retrospectively retrieved. CYP11B1 gene sequencing was performed. Seventeen plasma steroids were quantified by liquid chromatography-mass spectrometry and compared to that of controls. Results 102 patients (C-11βOHD, n = 92; NC-11βOHD, n = 10) from 76 families (46,XX; n = 53) had biallelic CYP11B1 mutations (novel 9 out of 30). Five 46,XX patients (10%) were raised as males. Nineteen patients (19%) had initially been misdiagnosed with 21-hydroxylase deficiency. Female adult height was 152 cm [−1.85 SD score (SDS)] and male 160.4 cm (−2.56 SDS).None of the NC-11βOHD girls had ambiguous genitalia (C-11βOHD 100%), and none of the NC-11βOHD patients were hypertensive (C-11βOHD 50%). Compared to NC-11βOHD, C-11βOHD patients were diagnosed earlier (1.33 vs 6.9 years; P 2.2, Conclusion NC-11βOHD can escape from clinical attention due to relatively mild clinical presentation. However, steroid profiles enable the diagnosis, differential diagnosis, and subtyping of 11βOHD.

BACKGROUND/AIM Biotin is a vital micronutrient that plays a role in metabolic homeostasis and the regulation of innate and adaptive immune system functions. Biotinidase deficiency (BTD) leads to impairment in biotin-dependent immune functions. This study focused on immunophenotypic analysis of lymphocyte subsets in newborns with BTD. PATIENTS AND METHODS A total of 181 (95 female and 86 male; 114 had BTD and 67 were healthy) newborns underwent biotinidase enzyme activity, molecular and lymphocyte immunophenotyping analyses. BTD is classified into four biochemical phenotypes: profound, partial, heterozygous and normal. The following lymphocyte subsets were studied in all participants: total B lymphocyte (CD19), total T lymphocyte (CD3), helper T lymphocyte (CD3/CD4), cytotoxic T lymphocyte (CTL) (CD3/CD8), natural killer T lymphocyte (CD16/56) and a T-lymphocyte activation marker (HLA-DR). RESULTS The percentages of lymphocyte subsets were similar in newborns with and without BTD. In all newborns with BTD, the mean CD3/CD4 levels were higher in females, while the CD3/CD8 levels were higher in males (P

Etiology of ISSNHL includes cessation of vascular perfusion, viral infection and cochlear membrane injury. Precise location of injury should be defined for a target-oriented treatment. Vestibular complaints in ISSNHL are hypothesized as involvement of vestibule. Vestibular complaints can be either due to involvement of inner ear or neural tract at any level.In the present study we aimed to demonstrate involvement of vestibular organs in the absence of vestibular symptoms. It was aimed to evaluate superior and inferior vestibular neural pathways.c-vemp and o-vemp were applied to patients suffering ISSNHL without vertigo. Pure tone averages, audiogram configurations, degree of hearing loss were analyzed. Latencies of P1 and N1 waves, amplitudes of P1-N1 waves were evaluated. Asymmetrical vemp wave patterns were compared between two ears regarding difference of PTA.Latencies of c-vemp waves were longer and amplitudes were smaller. o-vemp parameters were similar on both sides. Positive correlation was observed between c-vemp latencies and degree hearing loss.Inferior vestibular nerve pathway is affected in the absence of vertigo in ISSNHL with spared superior vestibular nerve pathway. Damage in IVN pathway correlates with degree of ISSNHL.

The Erzurum-Kars Volcanic Plateau (EKVP) was formed by volcanic eruptions during the Messinian-Zanclean (~5.5 Ma) period, related to a continental collision event between Eurasia and Arabia, initiated ~15 Ma ago. The EKVP unconformably overlies a series of older sedimentary formations spanning in age from Cretaceous to Miocene. It starts with a ~400 m thick pyroclastic-rich layer at its bottom, named the Akkoz basal tuff, consisting of rhyolitic and dacitic ignimbrites, pyroclastic fall and surge deposits, which are intercalated with andesitic and dacitic lavas. Upper layers of the plateau are dominated by andesitic and basaltic andesitic lavas (~100 m).In the northwest of the study area, an eroded stratovolcano, named Hamamlı volcano, which is possibly coeval with the plateau volcanism is present. It covers ~280 km2 area and consists of a thick sequence of rhyolitic lavas, tuffs, ignimbrites, perlites and obsidians. The best preserved volcanic edifice in the study area is the Greater Aladağ Stratovolcano with a footprint of ~230 km2. It is composed of intermediate lavas with andesitic, dacitic, trachy-andesitic compositions, erupted ~3.55 Ma in Piacenzian. A small volcanic cone, named in this study as the Lesser Aladağ volcano, sits on the northern flank of the Greater Aladağ. Lesser Aladağ has an elliptical shape and is composed of basaltic-andesitic and basaltic trachy-andesitic lavas. Three semi-circular shaped rhyolitic domes called the Odalar rhyolite sit on the southern and eastern slopes of the Greater Aladağ. In the N and NE, the Aladağ volcanic sequence is unconformably overlain by a younger (~2.7 Ma) sequence of olivine basalts and basaltic andesites, which is known as the Kars volcanic plateau.All volcanic products in the study area are calc-alkaline in character with a clear subduction signature. Results from our petrological modelling studies indicate that the magmas that fed the Aladağ volcanic system were evolved in a chamber, which was periodically replenished by fresh and primitive basaltic magma. Our assimilation model results based on the equations of DePaolo (1981) and Aitcheson and Forrest (1994) show that fractional crystallization was more important than crustal assimilation process in evolved lavas of the Aladağ system. Interestingly, EC-AFC model results indicate that some of the youngest basalts from the Kars volcanic plateau contain higher degrees of crustal assimilation relative to more evolved lavas.Crystal chemistry of amphiboles by EMP from the amphibole-bearing lavas of the Akkoz basal tuff layer indicates that they had experienced crystallization pressures between 5.63 and 6.45 kbar and temperatures between 949 and 1026 °C during their magma chamber evolution. On the other hand, pyroxene thermo-barometry of the Aladağ units has given crystallization pressures between 0.8 and 4.8 kbar, and temperatures from 1025 to 1078 °C, implying polybaric fractionation. Calculated crystallization pressures and temperatures from the younger lavas of the Kars volcanic plateau are ~8.8 kbar and ~1179 °C respectively. Our partial melting models indicate that the primitive basaltic magmas might have been derived from a metasomatised spinel peridotite source with varying melting degrees from 0.7% to 2%.

In many ancient and active volcanic provinces dyke systems represent radial and concentric patterns. In İstanbul, NW Turkey, late Cretaceous dykes, which are emplaced in pre-Cretaceous basement rocks consisting of sedimentary rocks of Palaeozoic and Triassic ages, have both patterns. In the region, late Cretaceous volcanism is represented by three elements, (1) The Çavuşbaşı granitoid, (2) volcano-sedimentary units and (3) dykes.Age of the Çavuşbaşı granitoid is given as 67.91±0.63 to 67.59±0.5 Ma. It is emplaced in shallow depth and has an indistinct contact aureole. Volcano sedimentary units were deposited in an intra-arc basin. Three types of dykes are reported in the region: lamprophyre, diabase and intermediate to felsic dykes (72.49±0.79 to 65.44±0.93 Ma). Different petrology and the crystallization depths of the crystals in the dykes and the Çavuşbaşı granitoid suggest two different magma chambers emplaced at two different depths, the Çavuşbaşı granitoid representing the shallower one.Upper Cretaceous dykes are concentrated around the Çavuşbaşı granitoid and extend almost as far as 30 km away from the pluton. The intrusion of the plutonic body of the Çavuşbaşı granitoid caused a dome structure in the basement rocks. The formation of this dome structure may have controlled the stress field and the orientation of the dyke system. Similar patterns are observed in the British Tertiary igneous province, Galapagos volcanoes, Boa Vista (Cape Verde), Summer Coon volcano, Spanish Peak Mountain and Dike Mountain (Colorado), Vesuvio, Etna and Stromboli (Italy).We suggest that Upper Cretaceous volcanic edifice in the İstanbul region is related to an arc volcano similar to the andesitic volcanoes in the Sumatra Island; we name it the Bosphorus Volcano.

Background: Given the rarity of 11β-hydroxylase deficiency (11βOHD), there is a paucity of the data about the differences in clinical and biochemical characteristics of classic (C-11βOHD) and non-classic 11βOHD (NC-11βOHD).Objective: To characterize a multicenter pediatric cohort with 11βOHD. Method: The clinical and biochemical characteristics were retrieved. CYP11B1 gene sequencing was performed. Seventeen plasma steroids were quantified by liquid chromatography-mass spectrometry and compared to that of controls. Results: 102 patients (C-11βOHD; n=92, NC-11βOHD; n=10) from 76 families (46,XX; n=53) had biallelic CYP11B1 mutations (novel 9 out of 30). Five 46,XX patients (10%) were raised as males. Nineteen patients (19%) had initially been misdiagnosed with 21-hydroxylase deficiency. Female final height was 152 cm (-1.85SDS) and male 160.4 cm (-2.56SDS). None of the NC-11βOHD girls had ambiguous genitalia (C-11βOHD 100%) and none of the NC-11βOHD patients were hypertensive (C-11βOHD 50%). Compared to NC-11βOHD, C-11βOHD patients were diagnosed earlier (1.33 vs. 6.9 years, p 2.2

Urinary stone disease is a very common disease in our country. Some problems may be experienced in stone surgery of physically disabled patients. This special patient group may require both minimally invasive and open stone surgery techniques. In this study, the difficulties encountered in the surgery of two physically disabled patients who were operated for stone disease were shared.

Aim: This study aims to determine the age interval for which the flexible nasopharyngoscopy (FNP) and lateral nasopharyngeal X-ray radiography (LNX) used in the diagnosis of adenoid hypertrophy more effectively in a pediatric population. Study Design: Prospective Cohort Study. Materials and Methods: 281 pediatric patients (1 to 15 years old) who were admitted to our ENT outpatient clinic with the complaints of nasal obstruction, snoring, sleep apnea through April 2016 and February 2017 and who were examined with FNP with the pre-diagnosis of adenoid hypertrophy were included in our study. All FNP examinations were evaluated by a single physician. The degree of choanal obstruction was recorded as percentage (%) with the help of the adenoid tissue image. The patients were divided into four groups according to the quality of the endoscopic examination performed during FNP examination; optimal assessment (group-1), assisted optimal assessment (group-2), assisted suboptimal assessment (group-3), and inability to assess despite assistance (group-4). LNX was performed for the re-evaluation of adenoid tissue in the patients in Group-3 and 4. Statistical analysis was performed among the groups according to the ages of the patients. Results: Optimal images were obtained with FNP in the patients aged between 1 and 2 years and 8-15 years and the expected images were obtained for choanal obstruction. However, no image could be obtained with FNP for assessment of choanal obstruction in more than 30% of patients between the ages of 3 and 8 years (31.2% and 33.3%, respectively), also in more than 50% of the patients who were 4,5,6 and 7 years old (60.6%, 56.7%, 55.8%, 66 , 6%, respectively). For this reason, their degrees of choanal obstruction were determined with LNX. Conclusion: For the optimal assessment of adenoid hypertrophy, we suggest that using LNX for the pediatric patients who are 4, 5, 6 and 7 years old and using FNP for the other age groups are more appropriate methods respectively in order not to disturb the polyclinic process of physician and for patient compliance.

Objective: To investigate the prevalence of obesity and associated factors during childhood in Southeastern Turkey. Another objective was to determine the cut-off points of Waist to Height Ratio (WHtR) values for defining obesity/abdominal obesity. Methods: The community-based descriptive cross-sectional study was conducted in Gaziantep Turkey between November 2011 and December 2011 with 2718 primary school/high schools students aged 6-17 years. The SPSS 22.00 was used for the analysis of data. Results: The prevalence of overweight, obesity, abdominal obesity, was 13.2%, 4.2% ,26.4%, respectively. There was a reverse relationship between BMI/WC values and sleep durations (p

We report new U-Pb zircon ages, major and trace element data, mineral chemistry, and Sr-Nd isotopic analyses of the mafic-intermediate dykes and intrusions in the Istanbul Zone. Mafic dykes are represented by calc-alkaline to alkaline lamprophyre and diabase. Intermediate dykes and subvolcanics are andesitic to dacitic in composition and calc-alkaline in character, while intrusive rocks (stocks and small plutons) are granodioritic and dioritic in composition. New zircon U-Pb laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) dating yielded ages from 72.49 +/- 0.79 (Upper Cretaceous-Campanian) to 65.44 +/- 0.93 Ma (Lower Paleocene-Danian) for the intermediate dykes, and 58.9 +/- 1.8 Ma (Upper Paleocene-Thanetian) for a small granodiorite stock. Sr-87/Sr-86(i) values of the mafic and intermediate dykes and small stocks span a range from 0.703508 to 0.706311, while their Nd-143/Nd-144(i) values vary from 0.512614 to 0.512812 and eNd((i)) values from 5.09 to 1.24. Nd-TDM model ages range between 0.46 and 0.77 Ga.

Gaucher disease is an autosomal-recessive lysosomal storage disease characterised by the accumulation of glucocerebroside in macrophages; it is caused by mutations in glucocerebrosidase gene-1 in many organ tissues such as the liver, spleen, and bone marrow. Its different clinical subtypes, according to the presence and severity of neurological symptoms, are as follows: type I, non-neuronopathic (95%); type II, acute neuronopathic; and type III, chronic neuronopathic. Type IIIC is a rare subgroup characterised by cardiovascular involvement as well as eye-movement disorders and late-onset neurological symptoms. In such cases, homozygous D409H is the most frequently detected mutation. In this article, we report the case of a patient, aged 15 years and 8 months, with complaints of syncope and a diagnosis of type IIIC Gaucher disease.

Objective: To investigate the prevalence of obesity and associated factors during childhood in Southeastern Turkey. Another objective was to determine the cut-off points of Waist to Height Ratio (WHtR) values for defining obesity/abdominal obesity. Methods: The community-based descriptive cross-sectional study was conducted in Gaziantep Turkey between November 2011 and December 2011 with 2718 primary school/high schools students aged 6-17 years. The SPSS 22.00 was used for the analysis of data. Results: The prevalence of overweight, obesity, abdominal obesity, was 13.2%, 4.2% ,26.4%, respectively. There was a reverse relationship between BMI/WC values and sleep durations (p

Context The clinical effects of classical 3β-hydroxysteroid dehydrogenase 2 (3βHSD2) deficiency are insufficiently defined due to a limited number of published cases. Objective To evaluate an integrated steroid metabolome and the short- and long-term clinical features of 3βHSD2 deficiency. Design Multicenter, cross-sectional study. Setting Nine tertiary pediatric endocrinology clinics across Turkey. Patients Children with clinical diagnosis of 3βHSD2 deficiency. Main Outcome Measures Clinical manifestations, genotype-phenotype-metabolomic relations. A structured questionnaire was used to evaluate the data of patients with clinical 3βHSD2 deficiency. Genetic analysis of HSD3B2 was performed using Sanger sequencing. Novel HSD3B2 mutations were studied in vitro. Nineteen plasma adrenal steroids were measured using LC-MS/MS. Results Eleven homozygous HSD3B2 mutations (6 novel) were identified in 31 children (19 male/12 female; mean age: 6.6 ± 5.1 yrs). The patients with homozygous pathogenic HSD3B2 missense variants of > 5% of wild type 3βHSD2 activity in vitro had a non-salt–losing clinical phenotype. Ambiguous genitalia was an invariable feature of all genetic males, whereas only 1 of 12 female patients presented with virilized genitalia. Premature pubarche was observed in 78% of patients. In adolescence, menstrual irregularities and polycystic ovaries in females and adrenal rest tumors and gonadal failure in males were observed. Conclusions Genetically-documented 3βHSD2 deficiency includes salt-losing and non-salt–losing clinical phenotypes. Spared mineralocorticoid function and unvirilized genitalia in females may lead to misdiagnosis and underestimation of the frequency of 3βHSD2 deficiency. High baseline 17OHPreg to cortisol ratio and low 11-oxyandrogen concentrations by LC-MS/MS unequivocally identifies patients with 3βHSD2 deficiency.

Aim Although newly diagnosed type 1 diabetes mellitus (T1DM) occurs sporadically in childhood, there is an increased risk of T1DM for first-degree relatives of patients that endure into the advanced years. Determination of T1DM incidence in siblings of children with T1DM helps predict the development of new cases. This study focuses on the incidence of the disease in siblings of children with T1DM. Method A total of 1497 siblings of 850 children (403 female; 447 male) diagnosed with T1DM between 2007 and 2018 years were retrospectively screened for T1DM. The patients were divided into four onset age groups: 0-4, 5-9, 10-14 and ≥15. The annual incidence was calculated for the region. Results A total of 34 siblings diagnosed with T1DM were detected. The incidence relating to the years investigated was between 7.42 and 11.73/100 000 for the newly diagnosed indexes while it ranged between 0 and 5.8% for siblings. The 5-9 year group was the most commonly diagnosed onset age group in index (n = 312) and siblings (n = 20). For siblings, the male sex and 5-9 aged at diagnosis of index were significant risk factors for development of T1DM (OR:2.35 and 2.85). Conclusion This study shows that in the first years following the diagnosis of an index, incidence of T1DM among the siblings can rise up to 5.8%, and the age group of 5-9 in the index and the male sex in the sibling are the most important risk factors. These findings show that the risk for siblings of children with T1DM remarkably increases in the first years after diagnosis in index cases.

Introduction: Renal artery pseudoaneurysm is a well-described complication of open and laparoscopic partial nephrectomy. Delayed bleeding from a renal artery pseudoaneurysm is rare after open partial nephrectomy. Case description: Here, we present a 75-year-old man who, 14 days after undergoing an open right partial nephrectomy for an endophytic 4.5 cm tumor, developed painless macroscopic hematuria. Prompt computer tomography angiography imaging, followed by therapeutic angio-embolization of segmental renal artery with coils, treated the pseudoaneurysm successfully. Conclusion: Renal artery pseudoaneurysm can be treated rapidly, effectively, and with minimal patient morbidity via percutaneous renal artery embolization.

EgeUn###, Introduction: Hereditary angioedema (HAE) may be fatal and diagnosis can be delayed up to 10 years. We aimed to screen HAE in two villages based on an index case of HAE and to investigate for the mutation of the C1 esterase inhibitor (C1-INH) gene. Material and methods: A total of 124 people were screened in two villages. The frequency and severity of symptoms were scored. C4, C1-INH levels and C1-INH activity were measured. We investigated for mutations of the C1-INH gene. Results: Thirty-five cases of type I HAE and 7 cases of type II HAE were determined. Thirty-one (73.8%) patients diagnosed with HAE were 18 years old or younger. There was a positive correlation between C4 levels, C1-INH levels (p < 0.0001, r = 0.81), and C1-INH activity levels (p < 0.0001, r = 0.631) and between the age at diagnosis and severity score (p < 0.0001, r = 0.651). A positive correlation was found between the age at first symptom onset and C4 levels (p = 0.002, r = 0.774), and C1-INH levels (p = 0.006, r = 0.714). A marginally significant negative correlation was found between C1-INH activity levels and severity scores (p = 0.1, r = -0.515). We identified a novel heterozygous 1033G>T missense variant of the C1-INH gene, SERPING1, in patients with type I HAE. Conclusions: There are long delay periods in the diagnosis of HAE and when the index case is present, family screening may be very important and even life-saving, in particular, in paediatric patients without symptoms. Furthermore, the present study provides evidence to link a novel mutation, c.1033G>T, to the development of HAE in a large HAE family from Turkey. © 2019 Termedia Publishing House Ltd.. All rights reserved.