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Objective: The study aimed to evaluate the clinical effects of levofloxacin (LEVO) and moxifloxacin (MOXI) prophylaxis during the treatment of acute myeloid leukemia (AML). Methods: This study had a prospective observational design and included AML patients who were scheduled for standard remission-induction (RI) or consolidation (C) chemotherapy. Prophylactic LEVO or MOXI was started at a ratio of 1:1 when neutropenia developed, and two groups were created. The primary endpoint was the frequency of febrile neutropenia (FN) and the time to FN. Results: 120 patients (60 patients in each group) were enrolled in the study. The frequency of FN tended to be higher in the LEVO group but was statistically insignificant (82.1% vs. 75.5%; p=0.702). The time to FN was 10.8±5.7 days and 10.1±5.7 days in the LEVO and MOXI groups, respectively (p=0.393). Microorganisms were izolated in 50.8% of patients who developed FN. The documented infection and bacteremia rate tended to be higher in the MOXI group (71.1% vs. 56.6%; p=0.331 and 87.5% vs. 80.5%; p=0.906). The rates of quinolone resistance were 69.2% and 75% in the LEVO and MOXI groups, respectively (p=0.451). The frequency of FN was higher during the RI phase than the C phase (89.1% vs. 70%; p=0.010). The frequency of documented infection was higher during the C phase than during the RI phase (77.1% vs. 49.1%; p=0.008). Conclusion: This study showed that prophylactic MOXI and LEVO have similar efficacy in AML patients. [ABSTRACT FROM AUTHOR]

Objective: There is not a definitive virological treatment for chronic hepatitis B . Withdrawal of nucleos(t)ide analogue (NA) therapy frequently results in viral recurrence, necessitating lifetime treatment. We aimed to look into the results of discontinuation of nucleos(t)ide analogue therapy in HBeAg negative patients. Methods: Treatment of HBeAg-negative patients without cirrhosis who had suppressed HBV DNA for a mean of ≥7 years and underwent nucleos(t)ide analogue therapy for a mean of ≥7 years were stopped according to the EASL guideline stopping rule. Standard laboratory tests, such as HBV DNA viral load, HBsAg, alanine aminotransferase, and adverse events, were monitored for more than four years during therapy and afterwards. Results: HBsAg loss was not observed in any of the patients during the four-year follow-up period. After the first 12 weeks, HBV-DNA was detected in all patients whose nucleos(t)ide analogue treatment was discontinued. The percentage of patients with HBV DNA >2000 IU/mL was 70% at 6 months, 74% at 12 months, 78% at 24 months, and 79.7% at 36 months, HBV DNA >2000 IU/mL was not detected in remaining patients over a four-year period. In the first year, 26% (n=18) of patients were started treatment for relapse, 46% (n=32) in the second year, 49% (n=34) in the third year, and 55% (n=38) in the fourth year. 45% (n=31) of the patients were still being followed without treatment at the end of the fourth year. Conclusion: Although the follow-up of hepatitis B e antigen-negative CHB patients on NA therapy was longer than in the literature, our recurrence rates were similar to other studies, and no patient lost HBsAg. The most significant benefit was that we were able to follow half of the patients without therapy for more than four years, eliminating the need for the patients to use drugs. [ABSTRACT FROM AUTHOR]

Objective: Urinary tract infections are the most common bacterial infections among community-acquired infections in all age groups. In this study, we aimed to evaluate the distribution of Escherichia coli and Klebsiella spp. in community-acquired urinary tract infections by years and the resistance rates to trimethoprim-sulfamethoxazole (TMP-SXT) and ciprofloxacin antibiotics, which are used as the first choice in community-acquired urinary tract infections. Methods: All urine culture samples from all age groups admitted to the medical microbiology laboratory from outpatient clinics and emergency services between January 2011 and August 2021 were retrospectively analyzed. Samples with E. coli and Klebsiella spp. detected as causative agents in urine cultures were included in the study. Conventional methods and automated systems were used to identify bacteria and for antibiotic susceptibility tests. Results: E. coli (n=50 430) and Klebsiella spp. (n=7763) isolated from urine cultures between January 2011 and August 2021 were evaluated. The lowest and highest resistance rates for ciprofloxacin and TMP-SXT for E. coli were 25-40% and 35-51%, respectively. Ciprofloxacin and TMP-SXT resistance rates for Klebsiella spp. were the lowest and highest at 17-43% and 31-43%, respectively. Conclusion: Knowing the resistance rates of antibiotics used as the first choice against common agents such as E. coli and Klebsiella spp. in treating community-acquired urinary tract infections may guide the empirical antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Background and Design: Various lasers, mainly nanosecond Q-switched (QS), and picosecond lasers, have been successfully used to treat solar lentigines. However, picosecond lasers are expensive, and QS lasers have a higher risk of post-inflammatory hyperpigmentation (PIH) in darker skin types. The aim of our study is to examine retrospectively the efficacy and safety of long-pulsed alexandrite laser in the treatment of solar lentigines, compare our findings to previous studies with nano and pico-second lasers, and evaluate long-term outcomes regarding recurrence. Materials and Methods: We retrospectively analyzed 39 patients with a clinical diagnosis of solar lentigo treated by long pulsed alexandrite laser. Patients' photographs and clinical charts were reviewed in terms of demographic features, areas of treatment, number of sessions, laser settings, recurrence of lesions, Fitzpatrick's skin type, and any side effects observed. Results: The rate of improvement was excellent in 33 (84.6%), moderate in 4 (10.3%), and mild in 2 (5.1%) patients. Seven (17.9%) patients with Fitzpatrick's skin type III and IV developed PIH. Lesion recurrence was observed in 5 patients (12.8%). Mean time to recurrence was 57.98±4.45 months. Conclusion: Our study suggests that long pulsed alexandrite laser is an effective and safe option in the treatment of solar lentigines. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study, is to investigate the presence of Helicobacter pylori (H. pylori) infection by culture, histology and rapid urease test (RUT) in gastric antrum biopsy samples taken from patients presenting with dyspeptic complaints and to determine the resistance of the isolates to amoxicillin, clarithromycin, levofloxacin and metronidazole by antibiotic gradient method (E-test). Methods: Microbiological and histopathological examinations of 278 biopsy specimens taken from antrum and corpus regions were performed. The presence of H. pylori in biopsy samples was investigated by culture, histology and RUT. Antimicrobial resistance of the isolates against amoxicillin, clarithromycin, levofloxacin and metronidazole was determined by antibiotic gradient method. Sensitivity and specificity of histology and RUT were calculated by accepting culture as the gold standard. Sensitivity and specificity for culture was also calculated by taking the co-positivity of both histology and RUT as the gold standard. Results: H. pylori positivity was detected in 140 of 278 patients with culture, 174 with histology, and 191 with RUT. Sensitivity and specificity of the culture, histology and RUT methods of the patients were 76.5% and 88.3%, 87.8% and 63%, 94.2% and 57.2%, respectively. Antibiotic resistance was investigated by antibiotic gradient method in 140 H. pylori strains isolated from culture. The resistance rates of H. pylori strains to the amoxillin, clarithromycin, levofloxacin and metronidazole were detected as 9 (%6.4), 22 (%15.7), 17 (%12.1), 57 (%40.7), respectively. Conclusions: In the study, RUT was found to be the most sensitive test among culture, histology and RUT methods. Although the specificity of the culture method was high, its sensitivity was found to be quite low compared to other methods. The low sensitivity of H. pylori culture may be caused by factors that affect the chances of direct isolation such as dealing with a fastidious microorganism, clinical sample retrieval and transport conditions. [ABSTRACT FROM AUTHOR]

Objective: Hepatitis B virus is an important health problem leading to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. This study aimed to compare the efficacy and side effects of antiviral drugs used in chronic hepatitis B (CHB). Methods: Five hundred seventy-two patients who were followed and treated with CHB in our clinic were evaluated retrospectively. Results: Fifty-six point five of 572 patients were male, 43.5% were female, and the mean age of the patients was 43.4 ± 12.4. Of the patients, 153 (26.8%) used tenofovir disoproxil fumarate (TDF), 134 (23.4%) telbivudine (LdT), 114 (20%) entecavir (ETC), 92 (16%) lamivudine (LAM), 26 (4.5%) adefovir (ADV), 27 (4.7%) pegylated interpheron alpha (PEG-IFN-α), and 26 (4.6%) used PEG-IFN-α + nucleoside analogue (NA). No significant difference was detected between the treatment groups in terms of age, sex ratio, fibrosis, histological activity index (HAI) score, baseline platelet, international normalized ratio (INR), alpha-fetoprotein (AFP) values (p> 0.05). Seventy (12.3%) of 568 patients were HBeAg (+), 498 (87.7%) were HBeAg (-). At the end of the first year, the virological response rates were 92.5% in LdT, 82.6% in LAM, 72.8% in ETV, 60.7% in TDF, 26.9% in ADV, 22.2% in PEG-IFN-α, 65.3% in PEG-IFN- α+NA groups. Twenty-three point eight of the patients had treatment changes, and 76.3% of these patients preferred TDF as a new treatment. Virological breakthrough was observed at 43.5% in LAM, 13.4% in LdT, 7% in ETV and 0.6% in TDF groups. At the end of 3, 4, and 5 years without treatment change, all patients who continued TDF, ETV, LdT, ADV, and LAM treatment were HBV DNA negative. HBsAg clearance developed in 13 (2.3%) patients. At least one side effect was observed in 169 (29.5%) of all patients, and the group with the most frequent side effects was PEGIFN- α+NA (92.3%) and PEG-IFN-α (77.8%). Amylase increase in LAM (%3.2), CPK increase in LdT (%27.6), CPK increase in TDF (%3.2) groups were the most common side effects. Conclusions: The drug with the lowest virological response rate and the most common side effect is PEG-IFN-α, so its use should be limited to selected patient groups. Treatments with the lowest incidence of side effects and development of resistance were found to be with TDF and ETV. Considering the high virological response rates, TDF and ETV should be preferred in the treatment of CHB. When all treatments are evaluated, HBsAg loss and cure rates are inadequate. [ABSTRACT FROM AUTHOR]

Objective: Skull base osteomyelitis (SBO) is a rare, life-threatening infection and frequently followed and treated by otolaryngologists previously. In this study, we analyzed the diagnosis, treatment and long-term outcomes of SBO from the perspective of infectious diseases and clinical microbiology (IDCM). Methods: Hospitalized patients with SBO between 2012-2019 were evaluated retrospectively. Epidemiological, clinical, laboratory data of the patients were recorded. The patients who recovered with and without sequelae were compared. Results: The mean age of 16 SBO cases was 66 years, 75% of them were male and 87.5% had diabetes mellitus (DM). Cranial nerve and vascular/dural involvement were present in 75% and 56.3% of them, respectively. The most common isolated microorganism were P. aeruginosa, staphylococci and Candida spp. 81.2%, 43.7%, and 56% of the patients received anti-pseudomonal antibiotics, additional glycopeptide and additional antifungal drugs, respectively. The sequelae rate was 46.7% in a 24-month follow-up. Hypertension (p=0.041), duration of complaints (p=0.003), bilateral involvement of skull base (p=0.001), vascular thrombosis/inflammation or dural involvement (p=0.007), previous surgical intervention (p=0.041) and elevated ESR at the end of treatment (p=0.014) were defined as risk factors for permanent sequelae. There was no in-hospital mortality. Conclusions: SBO mainly affects older male patients with DM and causes significant sequelae in half of them. In the cases unresponsive to anti-pseudomonal agents, the addition of antifungal therapy empirically may provide a clinical response. Permanent sequelae are more common in cases with delayed diagnosis/treatment, bilateral, vascular or dural involvement, and elevated ESR at the end of treatment. ESR can be used to determine the treatment response and duration. The follow-up and treatment of SBO cases by IDCM with the support of experienced surgeons may contribute to the positive clinical results. [ABSTRACT FROM AUTHOR]

Objective: Carbapenem-resistant Klebsiella pneumoniae (CRKp) is among the leading causes of hospital-acquired infections worldwide and causes serious and life-threatening infections. Treatment options are very limited for blood stream infections (BSIs) and prognosis is poor due to increasing multi-drug resistance. The aim of this study was to assess risk factors for the mortality due to CRKp-BSI. Methods: A retrospective study was conducted in a university hospital from September 2013 to October 2017. Patients (aged >16 years) with CRKp-BSI were included in this study. Data, including demographics, Charlson comorbidity index (CCI), acute physiology and chronic health evaluation II (APACHE II) score on hospitalisation date, minimum inhibitory concentration (MIC) of CRKp, antibiotic treatment and outcome (30-day mortality) data were collected from the electronic medical records and microbiology databases. Results: A total of 82 patients with CRKP-BSIs were analysed. The median age was 54.5 years, and 48 (58.5%) of them were male. The median APACHE II score on hospitalisation was 14 (IQR 6-28) and CCI was 4.0 (IQR 0-12). Forty-six (56.1%) patients had ICU-acquired bacteremia and 36 (43.9%) had central-line associated bacteremia and 25 (30.5%) had primary bacteremia. Fifty (61.0%) patients had combination therapy, colistin/tigecycline (28%) was the most used antibiotic combination. The mortality of all patients was 56.1% (46/82) and 65.2% (30/46) in ICU patients. In univariate analysis, risk factors for the mortality of CRKp-BSI were high CCI, not having clinical response on the fifth day of treatment, high APACHE II score on hospitalisation and infection date and multiple organ dysfunction syndrome. In multivariate analysis, the most significant risk factor for mortality was APACHE II score on infection day (OR: 1.190; 95% CI: 1.088-1.301). Treatment regimens and combination therapy vs. monotherapy were not found to be significantly associated with survival. In addition, MIC values of CRKp were not associated with mortality. Conclusions: Patients with CRKp-BSI had high mortality (56.1%). APACHE II score on infection day was significantly associated with mortality. The outcome was similar between patients receiving combination (54.3%) or monotherapy (45.7%). [ABSTRACT FROM AUTHOR]

Objective: Central or mixed apneas may accompany obstructive apneas in patients with Obstructive Sleep Apnea syndrome (OSAS). There is scant evidence about the potential impact of mixed apneas on the therapy modalities. Here, apneas/hypopnoeas' central and/or mixed effects on the positive airway pressure (PAP) modes chosen to be effective in patients with OSAS were evaluated. Materials and Methods: Patients who underwent a whole night polysomnography within last 2 years in our Sleep and Disorders Unit were consecutively examined. The patients included were those diagnosed with OSAS associated with central and/or mixed apneas. To determine the effective PAP modes, a second night polysomnography for titration was performed in these patients. Results: A total of 70 patients were included in the study, wherein 55 (78.6%) were males, with a mean age of 55.4±11.7 years. Continuous mode PAP (CPAP) therapy was effective in 60 patients (85.7%, group 1), whereas other modes (as BPAP-ST/ASV) were needed in 10 patients (14.3%, group 2). No statistically significant difference was found between the two groups in terms of gender, age or comorbid diseases (p=0.314, p=0.193 and p=0.081, respectively). Although BPAP-ST/ASV mode was needed in the presence of central apneas (p=0.039), CPAP mode was effective in OSAS patients with mixed apneas (p=0.055). Conclusion: The results showed that gender, age or comorbid conditions did not play a significant role in the determination of effective PAP mode. Mixed type abnormal respiratory events differed from central apneas/hypopnoeas as they did not require the use of BPAP-ST/ASV mode, and CPAP mode was effective enough in OSAS patients that manifested mixed type abnormal respiratory events. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the epidemiological and clinical characteristics, laboratory and imaging findings and outcome of patients with COVID-19 diagnosis who were hospitalized during the first wave of the COVID-19 pandemic. Methods: A total of 124 cases followed with the diagnosis of COVID-19 were evaluated, retrospectively. Patients with SARSCoV- 2 RT-PCR test result positivity in respiratory specimen were accepted as the confirmed cases. Despite of a negative RT-PCR test result, patients having a combination of compatible symptoms and typical findings of viral pneumonia on thorax computed tomography (CT) were accepted as possible cases. Severe illness was defined as SpO2 ≤93% on room air and to need supplemental oxygen support or mechanical ventilation (MV) or extracorporeal membrane oxygenation. Patients achieving clinical improvement were defined by defervescence of fever for 48 hours, improvement of leukopenia and increase in lymphocyte and thrombocyte count, decrease in demand for oxygen support or weaning from MV. Results: The median age of 124 cases was 54 (minimum-maximum 17-98) years and 59.7% of them were male. Among the overall population, 58% had comorbidities. Most frequent was hypertension (33.9%) followed by diabetes mellitus (16.1%) and cardiac disorders (13.7%). Most common clinical complaints were fever 73.4%), cough (70.2%), and shortness of breath (30.7%). SARSCoV- 2 RT-PCR tests of 81 (65.3%) patients were positive. Severe illness was present in 43 (34.6%) patients and 18 of them were followed in the intensive care unit. Patients with severe illness had higher mean ages, more accompanying comorbidities, and prolonged hospitalization compared to the patients with non-severe illness. Among the laboratory findings, leukocytosis was more than leukopenia. In addition to presence of lymphopenia, thrombocytopenia and hypoalbuminemia, increases in levels of creatinine, D-dimer, and acute phase reactants were more prominent in patients with severe illness. Main thorax CT findings were ground glass opacities (93.3%), often bilateral (73%), involving the lower and lower-middle lobes (48.7%) and showing a peripheral distribution (49.6%). No serious side effects developed during the treatment given according to the recommendations of Ministry of Health Guidelines. Overall mortality rate was 3.2%, and 2 (2.2%) patients died were confirmed cases. Conclusions: The sensitivity of available RT-PCR tests is not sufficient for diagnosis and management of COVID-19. Therefore, combining the imaging methods and serum antibody testing are also needed for management of the disease process. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate the results of contraction- and relaxation-based biofeedback (BF) in children with lower urinary tract dysfunction (LUTD). Materials and Methods: Between 2007 and 2017, we randomly directed children with the diagnosis of LUTD and refractory to standard urotherapy modifications via BF by using two different animations: animation A with relaxation nature BF (RBF) and animation B with contraction nature BF (CBF). The categories of non-response, partial response, and full response were defined as a 0-49% decrease, 50-99% decrease, and 100% decrease in the LUTD Symptom score, respectively. Results of biofeedback using RBF or CBF were compared. Results: There were 100 and 70 children in the RBF and CBF groups, respectively. Patients with an abnormal voiding pattern (abnormalVP) and a positive electromyography (EMG) activity (positive EMG) had a better resolution with RBF (p=0.001), whereas patients with abnormalVP and a negative EMG activity (negative EMG) had a better resolution with CBF (p=0.039). Despite being statistically insignificant, patients with a normal voiding pattern (normalVP) and positive EMG had a better resolution with CBF (p=0.452), whereas patients with normalVP and negative EMG had a better resolution with RBF (p=0.083). Conclusion: The EMG activity identifies the BF nature in children with LUTD and abnormalVP. Importantly, positive EMG had better results with RBF, whereas negative EMG had better results with CBF. [ABSTRACT FROM AUTHOR]

Objective: Resistin is an important factor in the pathogenesis of obesity-induced insulin resistance and endothelial dysfunction-mediated cardiovascular system diseases. Endothelial dysfunction is one of the most important causes of erectile dysfunction. Polyphenol resveratrol has several pharmacological functions, such as preventing endothelial dysfunction and inducing endothelium-dependent vascular relaxation via redox regulation and nitric oxide production. The present study tested the hypothesis that resveratrol restores endothelium-mediated responses that are disrupted by resistin. Materials and Methods: After a 24 h incubation period of tissues with resistin, endothelium-dependent and independent relaxation responses and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase level were evaluated in the presence and absence of resveratrol in rabbit corpus cavernosum (CC). Results: Resistin caused no impairment in the endothelium-dependent and -independent relaxation responses. In the presence of resistin, NADPH oxidase levels increased by 28% in the CC tissues. However, the difference was not statistically significant. Resveratrol administration caused a significant decrease in NADPH oxidase activity in the resistin-treated group compared with the resistin-alone group. Conclusion: Resistin caused no changes in the functional responses of CC and NADPH oxidase activity, but resveratrol incubation significantly reduced NADPH oxidase activity in penile tissue. Based on the results of the study, resveratrol may be a treatment target under conditions in which NADPH oxidase activity is increased in penile tissue. In line with the results of this study, the effect of resistin on CC must be investigated at different concentrations and incubation times. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to evaluate and compare the sperm parameters and spontaneous pregnancy rates of patients with varicocele and primary infertility at three and six months after surgery. Materials and Methods: We retrospectively evaluated the sperm parameters of 134 male patients who presented with clinical varicocele and primary infertility between July 2016 and May 2019. All the patients underwent microscopic inguinal varicocelectomy. We compared the sperm parameters (count, movement, and morphology) and spontaneous pregnancy of the patients preoperatively, and at three and six months postoperatively. Results: In total, 134 patients with a mean age of 26.2 (20-38) years underwent the surgery. We found an increase in all the sperm parameters in the third and sixth months postoperatively. We also examined the differences among the sperm parameters in the third month and sixth month, and found a significant increase in the sperm count and motility at six months (p<0.001). The postoperative third-month pregnancy rates were 2.9% (n=4) and 26.8% (n=36) in the sixth month. Conclusion: The improvement in sperm parameters in the third month after varicocele operation continued and increased by the postoperative sixth month. Therefore, patients with varicocele and primary infertility should be aware that the rate of spontaneous pregnancy could increase within six months and should wait for at least that period before applying for assistive reproductive techniques. [ABSTRACT FROM AUTHOR]

Objective: To show our retrograde intrarenal surgery (RIRS) experience in anomalous kidney stones and compare its safety and efficiency with normal kidney stones. Materials and Methods: Between 2012 and 2018, patient data was reviewed retrospectively and 1700 procedures were taken into consideration. Forty-seven anomalous kidney stones were included in the study (group A). In these patients, 18 had calyx diverticulum, 12 had horseshoe kidney, 8 had ureteral duplication, 2 had ectopic kidneys, 1 had malrotation, and 1 had bifid pelvis. After making a matched pair analysis, 47 normal kidney stones with similar demographic and stone characteristics were included in our study (group N). Demographic, stone, intraoperative and postoperative data were recorded. We compared these groups regarding efficiency and safety. Results: Average scope time, hospitalization time, and postoperative double J-stent rate were higher in group A. The difference was statistically insignificant (p>0.05). Ureteral access sheath usage was higher in group N, though the difference was statistically insignificant (p=0.63). Stonefree rates and success rates were higher in group N though the difference was not statistically significant (p>0.05). The rate of complications was statistically significantly higher in group A (p=0.02). Conclusion: RIRS can be used in the management of anomalous kidney stones. It is an efficient and safe method. Prospective and larger patient numbered studies are needed. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to investigate the infections and their clinical outcomes in pregnant women who were hospitalized with a diagnosis of any infectious disease. Methods: Distribution of bacterial and viral infections in 60 pregnant women who were hospitalized due to any infectious disease between years 2015 and 2018 during a three-year period were evaluated retrospectively. Results: Urinary tract infections (65%) and gastroenteritis (8.3%) were the most common bacterial infections, and human immunodefficiency virus (HIV) infection and chickenpox were most common viral infections. All patients were followed at the inpatient clinic except two patients who had hospitalized in intensive care unit due to influenza and Listeria meningitis. An HIV-positive pregnant woman received zidovudin intrapartum and was followed up later. All the other infections recovered without complications. Conclusions: Urinary tract infection was the most common infectious disease among pregnant women. The necessity of hospitalization due to community-acquired but avoidable and vaccine-preventable diseases verified that informing pregnant women about the prevention of infections and screening them before pregnancy against vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

Objective: Colistin is a concentration-dependent antibiotic which belongs to the polymyxin group of cyclic cationic polypeptide antibiotics. Clinical use of colistin varies due to its complex pharmacokinetic and pharmacodynamic features. In this study, we aimed to evaluate the use of colistin in multidrugresistant Gram-negative bacterial infections. Methods: 193 patients aged ≥18 years who were hospitalized from May 2014 to January 2015 and who received colistin were included in the study. Patient's data were retrospectively evaluated. Pathogens, their resistance rates, dose of colistin, its duration and route of administration, its side effects, and clinical and microbiological responses were recorded. Results: Colistin was administered to the patients with confirmed or suspected infections due to multidrug-resistant Gram-negative organisms approximately on the 20th day of hospital admission. Another antimicrobial was used in combination with colistin administered by IV or intrathecal route in all patients and a carbapenem was the drug most used for combination therapy. IV colistin doses varied widely among patients and a loading dose was not administered in 98% of patients. Inhaled and intrathecal treatment doses were administered in accordance with the literature. Intrathecal colistin administration was always with IV colistin, however inhaled colistin was occasionally administered without IV form. When inhaled colistin alone and combined with IV form were compared, no difference was found in cure rates. The most common side effect of colistin was nephrotoxicity in 33 (25.4%) patients and neurotoxicity in 7 (3.6%) patients. Analyses revealed that advanced age was the only factor which affected the development of nephrotoxicity (p<0.001). Colistin treatment was terminated in 19 patients out of 193 due to side effects. Rate of colistin resistance among infectious agents was 4.3%. Colistin resistance developed on the 19.9±9.4 days of treatment. Cure rate in colistin receiving patients was 56% and the most crucial factor determining the mortality was advanced age (63.9±2) (p=0.001). Conclusions: Nephrotoxicity is the most common side effect of colistin which is one of the treatment options for multidrug-resistant Gramnegative bacterial infections. It has been observed that there were different modes of administration in the same hospital regarding the application of colistin, and the loading dose recommended in the drug package and in the literature was not applied in almost all patients. [ABSTRACT FROM AUTHOR]

Objective: Approximately 10-16% of patients with hepatitis C virus (HCV) infection develop kidney disease and the prevalence of HCV infection in patients with impaired renal function is higher than the general population. HCV-positive patients undergoing hemodialysis (HD) have a higher mortality rate compared to HCV-negative patients, not only because of liver-related complications, but also because this contributes to atherogenesis and chronic inflammation. The purpose of antiviral treatment in chronic HCV infection is to eliminate HCV RNA, to obtain a sustained virologic response (SVR), i.e. negative HCV RNA at the end of the 3-month treatment, and to prevent liver complications. Introduction of direct-acting antivirals (DAAs), for the treatment of HCV infection has provided over 90% SVR in the general population. In this study, we aimed to evaluate the demographic characteristics, laboratory values and treatment results of HCV-infected hemodialysis patients treated with DAA. Methods: In this retrospective, single-center observational study, patients undergoing HD in Istanbul Training and Research Hospital Hemodialysis Unit were evaluated. Anti-HCV-positive patients with HCV RNA >15 IU/ml were divided into 2 groups as patients receiving and not receiving DAA treatment. Age, gender, duration of hemodialysis, laboratory values and treatment protocols were recorded. Results: Of the 289 patients followed in the HD unit, 11.4% (33/289) were anti-HCV-positive and 63.6% (21/33) were male, with a mean age of 50.87±7.18 years and HD treatment was given for 84.58±43.44 months. Only 13 patients were using DAA among 18 patients with HCV RNA >15 IU/ml. Standard dose of paritaprevir/ritonavir-ombitasvir/dasabuvir (PrOD) therapy was applied as the DAA protocol and ribavirin was added to the treatment protocol in HCV genotype 1a. All patients were found to have SVR. The most common side effects were fatigue and loss of appetite, and none of the patients had any side effects requiring discontinuation of the drug. Four of the five patients who did not receive treatment were foreign nationals and their DAA treatments could not be provided by Social Security Institution. Conclusions: In HD patients, detection of HCV infection after its screening, and started treatment protocols with low side effects and high SVR will provide source control of HCV infection and decrease mortality and morbidity related to this infection. [ABSTRACT FROM AUTHOR]

Aim: To demonstrate the demographic data, subgroup distributions, responses to treatment and outcomes of long-term follow-up in patients who were followed up and treated in our clinics with a diagnosis of juvenile idiopathic arthritis, and to compare these data with national and international data. Material and Methods: The files of 116 patients who had been diagnosed as having juvenile idiopathic arthritis, were initiated on treatment and presented for regular follow-up visits between January 2012 and January 2018, were examined. Their demographic findings, treatments, active/inactive disease states (on-medication and off-medication) and treatment response states were evaluated. Results: According to the International League of Associations for Rheumatology criteria, the subtypes were specified as enthesitis-related arthritis (n=38), oligoarticular (n=37), rheumatoid factor (-) polyarticular (n=17), systemic (n=15), rheumatoid factor (+) polyarticular (n=5), and psoriatic juvenile idiopathic arthritis (n=4). In total, the female/male ratio was found to be 1.5. The mean delay time between the first complaint and the diagnosis was found to be 5.7±5.2 months. The patients with systemic type were diagnosed at the earliest, while the patients with polyarticular and enthesitis-related subtypes were diagnosed at the latest. Thirty-two percent of the patients were treated with methotrexate alone, and 38% were given additional biologic drugs. In both treatment groups, the time to achieve inactive disease was the shortest in the oligoarticular group and the longest in the enthesitis-related arthritis group. In the study period, 38 patients were in remission off-medication (the highest rate (53.3%) was observed in the systemic group) and 71 patients were in remission on-medication (the highest rate (70.2%) was observed in the oligoarticular group). Remission was obtained in 94% of the patients. Conclusion: Enthesitis which is the remarkable finding of enthesitis-related arthritis, should not be overlooked in routine physical examination. Awareness of enthesitis can contribute to the prevention of diagnostic delay in children with enthesitis-related arthritis. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to assess the effect of hypnotherapy on sleep quality levels of obesity patients, who applied to hypnotherapy for healthy and balanced nutrition. Materials and Methods: Studying group; consisted of 44 individuals who applied to a state hospital psychiatry outpatient clinic, who voluntarily agreed to participate in the study, who had a Body Mass index of 30 and above, and completed at least 10 weeks of sessions. Firstly, an information form was prepared for the participants and body mass index were determined. Pittsburgh Sleep Quality index was applied to each participant before starting to session. Then, hypnotherapy session was applied to participants for at least 10 weeks, one session per week. After at least 10 sessions of hypnotherapy, Body Mass index and Pittsburgh Sleep Quality index were measured. The efficacy of hypnotherapy was assessed by the comparison of Body Mass index and Pittsburgh Sleep Quality index at the beginning and end of the therapy. Results: Statistically significant differences were detected in the comparison of body mass index and Pittsburgh Sleep Quality index scores before and after the hypnotherapy (p<0.001). There was no significant correlation between the scores of Body Mass index and Pittsburgh Sleep Quality index. Conclusion: This study showed that hypnotherapy in the treatment of obesity has a positive effect on sleep quality in obese patients. There is a need for new studies that will examine the effectiveness of this group by establishing a control group in more people and the long term. [ABSTRACT FROM AUTHOR]

Objective: Clinical studies in childhood multiple sclerosis (MS) are very limited compared with adults. Although first-line injection therapies are well tolerated in this patient group, there are difficulties in the long-term treatment of patients due to the difficulty and adverse effects of injections for children. Oral therapies are better tolerated for use and adverse effects compared with injection therapies. This study aimed to evaluate the clinical features and treatment outcomes of patients aged under 18 years with relapsing-remitting MS (RRMS) who received fingolimod treatment. Materials and Methods: In this study, the clinical records of 22 patients with RRMS who received fingolimod treatment were examined. The patients were prospectively followed up between February 2015 and December 2018. The patients were evaluated in terms of relapse rate, Expanded Disability Status Scale (EDSS) scores, brain and cervical magnetic resonance imaging, and adverse effects before and after fingolimod treatment. Results: The median age of 13 (59%) female and 9 (41%) male patients was 18 (range: 10-21) years. The median fingolimod treatment duration was 2.5 (range: 1.3-3.9) years. The median age of disease onset was 13 (range: 8-17) years. Fifteen patients (68%) received a first-line treatment prior to fingolimod. The reason for switching to fingolimod was inefficacy in 33%, adverse effects in 40%, and both in %27 of patients. In 32% of patients, fingolimod was started as a first-line treatment. A total of three patients had recurrent relapses under treatment with fingolimod. The median annualized relapse rate (ARR) before fingolimod was 1.9 (range: 0.3-8.0), and the ARR with fingolimod was 0 (range: 0-2.0) (Wilcoxon's signed-rank test; p<0.001). The median EDSS was 1.5 (range: 1.0-4.0) before fingolimod, and the EDSS after treatment was 1.5 (range: 1.0 to 5.0) (Wilcoxon's signed rank test; p=0.3). None of the patients had any adverse effects during the first dose monitoring. Conclusion: Our study shows that fingolimod is an effective and safe treatment alternative in childhood MS. [ABSTRACT FROM AUTHOR]

Objective: Patients with drug-resistant focal or generalized epilepsy are important in terms of treatment and polytherapy necessity, adverse effect profiles of drugs, and seizure control difficulties. Clobazam (CLB), which has a lesser sedative effect than other benzodiazepines, is frequently used in different countries. In this study, we aimed to present the results related to the demographic characteristics, adverse effects, and treatment efficacy of patients under CLB treatment. Materials and Methods: Patients who were followed up in the outpatient clinic of Cerrahpaşa Medical Faculty were screened retrospectively. Sex, age of seizure onset, duration of epilepsy, seizure type, duration of drug use, frequency of seizures before and after CLB, and drug adverse effects were investigated. The decrease in seizure frequency could not be quantitatively evaluated in some patients because the study was retrospective. For this reason, two groups were identified as having a significant reduction in seizure frequency and being seizure-free according to the information provided by the parents and the recorded data. Results: Forty-one patients with CLB who were followed in the epilepsy clinic were examined. The mean age of 26 male and 15 female patients was 30.30 years. The mean duration of epilepsy was 20.4 years. It was determined that 16 patients were either seizure-free or had intervening rare, mild seizures. There was a significant decrease in seizure frequency in nine patients. Headache was observed in one patient, and sedation and dizziness in two patients. Conclusion: CLB is especially recommended for add-on therapy in Lennox-Gastaut syndrome. In this study, it was observed that in focal/generalized, idiopathic/ cryptogenic different groups, 39% of the patients were seizure-free. However, this effect was not lost during the mean follow-up period of 12.2 months. Although the value of this data decreases due to its retrospective nature, the place of CLB in the treatment of focal/generalized epilepsy is important. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical characteristics, risk factors, and prognosis of pertussis in the pediatric intensive care unit. Material and Methods: Patients who were hospitalized in pediatric intensive care unit between January 2017 and January 2019 and diagnosed as having pertussis were retrospectively evaluated. Samples were taken from tracheal aspirate material in intubated patients and nasopharyngeal swabs in the other patients. Samples for Bordetella pertussis were studied using multiplex real-time polymerase chain reaction. Results: Eighteen patients were admitted to our pediatric intensive care unit with a diagnosis of pertussis. Ten patients were female (55.5%), and all patients were unvaccinated. The median age was 40 (range, 38-47.5) days and the median intensive care unit stay was 9 (range, 5-14) days. All patients had respiratory distress, 14 patients had cough (77.7%), four patients had fever (22.2%), and three patients had convulsions (16.6%). Seven patients were intubated. Three patients died of multiple organ failure and cardiogenic shock despite extracorporeal treatment. Respiratory syncytial virus was found in two patients and rhinovirus was found in one patient. The median leukocyte count was significantly higher in non-survivors than in survivors. Blood exchange was performed in three patients due to hyperleukocytosis. Pulmonary hypertension was the most common cardiac pathology detected in echocardiographic examinations. Conclusion: We found that high leukocyte count, viral co-infection, and severe pulmonary hypertension were associated with mortality and morbidity in pertussis. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the procedure duration and complications of standard percutaneous dilatational tracheostomy (PDT) with PDT via fiberoptic bronchoscopy. Methods: Patients over 18 years of age who were dependent on mechanical ventilation were included in this prospective study. The patients were divided into two groups as PDT (group F n=28) performed by using fiberoptic bronchoscopy and standard PDT (group S, n=30) performed without fiberoptic bronchoscopy. Age, gender, cause of hospitalization, hemogram, blood gas values, duration of tracheostomy and complications during and after the procedure were recorded in all patients. Results: A total of 58 patients were included in the study. Twenty-one (36.2%) patients were female. There was no difference between the two groups in terms of demographic characteristics except age, and laboratory values (p=0.006). The most common cause of hospitalization were respiratory diseases in both groups (28.6% in group F and 40% in group S). There was no difference in the duration of the procedure (6.07±4.72 and 7.50±1.79 minutes in group F and group S, respectively (p=0.12). The most common postoperative complications were minor bleeding (28.5% in group F and 43.3% in group S) and bleeding around the stoma (21.4% in group F and 20% in group S), respectively. None of the patients had pneumothorax, subcutaneous emphysema, major bleeding, or tracheal posterior wall damage. Conclusion: In our study, there was no difference in terms of procedure duration and early complications between patients undergoing PDT with and without bronchoscopy. In the tracheostomy procedure, the method to be used should be decided by considering the patient's condition and the materials available to the practitioner. [ABSTRACT FROM AUTHOR]

Aim: To analyze the effect of double-J stent placement on shockwave lithotripsy (SWL) success in the treatment of relatively large (15-25 mm) upper and middle calyceal stones. Methods: A total of 167 patients who had 15-25 mm opaque upper or middle calyceal stones and scheduled for SWL were included in the study. Patients with solitary kidney, urinary system anomalies, skeletal anomalies, previous urologic surgery, severe calyceal dilatation, untreated urinary tract infection, bleeding disorder, eGFR<60 and suspected pregnancy were excluded from the study. The remaining 148 patients were randomized into two groups as stented and non-stented. Thirty-one patients whose stones could not be fragmantated despite three sessions were also excluded. A total of 117 patients (30 stented and 87 non-stented) were further analyzed. The groups were compared in terms of patient- and stone-related factors. Results: Eighty-nine (76%) patients were male and 28 (24%) were female. There was no significant difference between the groups in terms of age, gender, body mass index, stone side, stone size, skin-to-stone distance, Hounsfield unit and renal parenchymal thickness. The success rate was 70% and 51.7% in the stented and non-stented groups, respectively (p=0.31). Conclusion: Prestenting does not affect the success of SWL in the treatment of 15-25 mm upper and middle calyceal stones. [ABSTRACT FROM AUTHOR]

Aim: Valganciclovir is the preferred drug for chemoprophylaxis for the prevention of cytomegalovirus (CMV) infection in kidney recipients. Low-dose (450 mg/day) valganciclovir use is gaining popularity because standard dose (900 mg/day) has negative effect on renal function and side effects such as leukopenia. We present our results with low-dose valganciclovir prophylaxis in kidney recipients. Methods: One hundred thirteen kidney transplant recipients who were operated between 1 December 2017 and 1 September 2018 in İstanbul Aydın University Faculty of Medicine, Training and Research Hospital and İstinye University Training and Research Hospital were retrospectively evaluated. Demographic data, preoperative CMV status, incidence of CMV infection and leukopenia rates were recorded. Results: A total of 113 patients (46 women, 67 men) with a mean age of 42.85 years were evaluated. All the recipients and donors were preoperative CMV IgG-positive. The mean follow-up was seven (6-13) months. In this period, only two (1.76%) CMV infection occurred and treated with intravenous ganciclovir. There were no complications due to CMV infection. There was no leukopenia related with valganciclovir. Conclusion: This study showed that low-dose valganciclovir is an effective prophylaxis for CMV infection in kidney transplantation with CMV-positive donors and recipients. We recommend low-dose valganciclovir due to low incidence of CMV infection found in our study. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the effects of preoperative aspirin use on postoperative complications, especially risk of bleeding, in patients undergoing bilateral total thyroidectomy. Methods: A total of 201 patients who underwent bilateral total thyroidectomy between 15 August 2016 and 1 February 2019 were included in the study. The patients were divided into two groups: preoperative aspirin group (n=42, 20%) and aspirinnaïve group (n=168, 80%). Parameters, including demographic characteristics, complications and length of hospital stay were compared between the groups. Results: Eight (4.4%) patients in aspirin-naïve group and three (7.1%) in preoperative aspirin group had minor hematoma and ecchymosis not requiring any intervention. There was only one patient in aspirin-naïve group (0.5%) who required surgical intervention due to bleeding in the postoperative period, whereas there were not any in the other study group. Conclusion: The results of this study showed that aspirin had no significant effect on the development of postoperative complications in patients undergoing bilateral total thyroidectomy. However, large-scale prospective and randomized series are warranted for more accurate and precise results. [ABSTRACT FROM AUTHOR]

Aim: Hyperthermic intraperitoneal chemotherapy with cytoreductive surgery has a positive effect on survival in advanced abdominal cancers. We aimed to present our experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer patients with peritoneal carcinomatosis and a review of the literature. Methods: Ten patients (seven male, three female) who were diagnosed with gastric cancer between June 2017 and November 2018 were included in the study. Data on demographic characteristics, short-term follow-up results, surgical findings, peritoneal carcinomatosis index score, completeness of cytoreduction score, and morbidity and mortality rates were retrospectively analyzed. Results: The mean age of the patients was 60.3 years. The mean follow-up period was six months (1-15 months). One patient developed an anastomotic leak. In the other nine cases, there was no morbidity leading to mortality. Conclusion: While gastric cancer with peritoneal carcinomatos has a poor survival, less than six months with non-operative approach, treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy offers better outcomes and overall survival. Our first results in our study with a limited number of patients are satisfactory and multicentric randomized studies are needed on this subject. [ABSTRACT FROM AUTHOR]

Aim: Atherosclerotic peripheral arterial disease is frequently seen with critical leg ischemia. Despite the benefits of pharmacological agents in the lesions, the most effective treatment method is revascularization. In this study, we aimed to compare the results of drug-eluting balloon and standard balloon endovascular treatment methods. Material and Methods: One hundred and ninety-six patients who underwent infrapopliteal revascularization in Cardiovascular Surgery clinic in Namık Kemal University Hospital between January 2015 and June 2017 were included in the study. During the study, 100 patients were treated with drug-eluting balloon (DEB) (Lutonix, Bard, USA), while 96 patients were treated with standard balloon (PTA) (Nanocross, Medtronic, USA). The one-year patency rates were compared between the two groups. The patients were followed up at 1st, 3rd, 6th and 12th months after the procedure and followed by Ankle-Brachial Index (ABI) measurements and Rutherford classification. Results: Eighty three female and 113 male patients were included in the study. The mean age of the patients was 63.56±11.21. The median Rutherford classification was 4 (3-5) in the drug-eluting group according to the Rutherford classification and 4 (3-5) in the naked balloon group. During the 12-month follow-up period, limb salvage rate was 82.0% (n=82) in drug-eluting balloons and this rate was found to be 65.6% (n=63) in naked balloon group. In terms of amputation rates, the drug-eluting balloon group was found to be statistically superior (p=0.009). Conclusion: In this study, 12-month patency rates were found to be superior to naked balloons at 12-month patency rates and clinical follow-up. [ABSTRACT FROM AUTHOR]

Objective: To describe the causes of intubation in patients who have been diagnosed with middle cerebral artery (MCA) infarction requiring mechanical ventilation (MV) by evaluating the clinical and radiologic features in the neurological intensive care unit (NICU). Materials and Methods: The patients with MCA infarction who required MV in the NICU were evaluated retrospectively. All patients' age, sex, risk factors of stroke, lesion topography, etiology and treatment of stroke, cause of intubation, percentage of extubation, death/discharge status were recorded. Results: It is found that between June 1st, 2009, and December 31st, 2015, 91 patients with stroke with MCA infarction were mechanically ventilated in the NICU. Fifty patients were intubated with neurologic causes and 40 patients needed intubation due to cardiopulmonary problems. One patient was treated in the NICU after surgery for a diaphragmatic hernia. Conclusion: The patients with MCA infarction who are followed up on a mechanical ventilator have poor prognosis. This group of patients constitutes elderly individuals who are at risk for vascular and organ failure. Their follow-up must be conducted in NICUs. [ABSTRACT FROM AUTHOR]

Aim:Our aim in this study was to evaluate the surgical treatment of hyperhidrosis versus oxybutynin medical treatment comparing the response and long-term complications. Methods: We evaluated medical and surgical treatment results of 56 palmar and axillary hyperhidrosis patients (29 female, 27 male). Patients mean age was 26.6±6.3 (minimum: 18 - maximum: 48) years old. Sympathetic ganglion ligation was performed in patients treated with surgery.In patients we used medical treatment, oxibutinin treatment was started at 2.5 mg/day and the doses of the drug were increased according to the treatment response. The quality of life index implemented by Amir was adapted into Turkish and used for evaluating life quality of the patients in the study. Results: Postoperative the quality of life scores of palmar hyperhidrosis patients were found to be higher in T3-T4 levels than in T2-T3-T4 levels (p=0.015). In patients with axillary hyperhidrosis, there was no difference between T2-T3-T4 and T4-T5 level surgical operations (p>0.05). The average the quality of life score of patients who received medical treatment was 28.54±5.74. There was no significant difference in the quality of life scores between patients treated with surgery and medical therapy with oxybutynin. Conclusion: We assume that the response rates to oxybutynin are as favorable as surgery in the treatment of hyperhidrosis. [ABSTRACT FROM AUTHOR]

Objective: Rheumatoid Arthritis (RA) is a chronic destructive inflammatory disorder. This study is aimed to investigate the effects of balneotherapy and aquatherapy in the treatment of RA patients. Materials and Methods: A total of 59 patients who fulfilled the American College of Rheumatology diagnostic criteria for RA were included this study. Patients were randomly assigned into three groups. Group 1 (n=20) received balneotherapy, group 2 (n=20) received an aquatic exercise program and group 3 (n=19) was accepted as control group. These programs were applied five times a week, over three weeks (15 sessions). Patients were evaluated for clinical and laboratory parameters. Clinical parameters included pain,duration of morning stiffness, number of swollen and tender joints, disease activity score (DAS28), Modified health assessment questionnaire (mHAQ), physician's and patient's global assessment and hand grip strength. Laboratory evaluation included erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP). The assessment parameters were measured before, at the end of and after 3 months of the therapy. Results: The mean age of the patients was 54±10.7 (25-75) years and the mean disease duration was 122.3±98.1 (1-424) months. In aquatic exercise group we observed an improvement in DAS28 scores (p<0.001), in the number of tender joints (p<0.005), in VAS scores (p<0.005), mHAQ (p<0.05), physician's and patient's global assessments (p<0.05). Also there was a statistically significant decrease in ESR results in aquatherapy group compared to other groups (p<0.05). However no statistically significant difference was obtained between three groups (p>0.05). Conclusion: This study shows that aquatic exercise program is beneficial in the management of DAS28, pain, HAQ parameters and should be taken in to consideration in planning exercise therapy for RA patients. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the indications and outcomes of amniotic membrane transplantation (AMT). Materials and Methods: A total of 87 eyes who underwent amnion membrane transplantation in our clinic between February 2010 and April 2013 were included in this study. Mean follow-up period was 7.49±7.84 months (range 1-29 months). Amnion membrane defrosted at room temperature and washed three times with saline covered all over the cornea independent of the position and size of the lesion and was sutured to the peripheral cornea circumferentially by 10/0 monofilament suture. At the end of the operation, therapeutic contact lens was placed. All cases were evaluated with respect to duration of surface epithelial healing, visual acuity, presence of recurrence, and infection. Results: Forty-six of the 87 patients (52.8%) were men and 41 (47.1%) were women. The mean age was 57.02±19.74 years (range 31-89 years) in men and 66.69±16.56 years (range 8-88 years) in women. The indications were: ulcers in 27 eyes, keratitis in 24 eyes, topical anesthetic abuse in 10 eyes, bullous keratopathy in 7 eyes, conjunctival mass in 7 eyes, symblepharon in 3 eyes, chemical burns in 3 eyes, pterygium in 2 eyes, endophthalmitis in 2 eyes, dellen in 1 eye, and conjunctival laceration in 1 eye. After AMT, 12 patients required second AMT, and 2 cases required third AMT. 2 eyes were eviscerated, 1 eye was exenterated. At the final follow-up visit, except for patients who underwent evisceration and exenteration, improved visual acuity was observed in 45 of the 84 eyes (53.5%). The average of healing time was between 4 and 6 weeks. No infectious, inflammatory, immunologic, or toxic/allergic reactions related to AMT was observed. Conclusion: Amniotic membrane transplantation is a safe and effective technique in ocular surface diseases. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effects of artificial tears on corneal higher order aberrations in dry eye patients. Materials and Methods: 30 right eyes of 30 newly diagnosed dry eye patients were evaluated in this prospective study. After routine ophthalmological examination, Schirmer test and tear break-up time (TBUT) test were performed in all patients. Anterior corneal aberrations were derived from conversion of the corneal elevation profile into corneal wavefront data with 6.0 mm pupil diameter using Zernike polynomails by corneal topography before and 5 minutes after instillation of artificial tear (Eyestil®). Corneal optical aberrations were compared before and after instillation of eyedrop. Results: The study included 17 women and 13 men; the average age of the patients was 44.36±13.22 years. Mean TBUT was 4.78±2.78 seconds and mean Schirmer value was 3.58±2.45 mm/5 minutes. After instillation of artificial tear, significant reductions in corneal total aberration from 1.120±0.35 μm to 0.960±0.34 μm, higher order aberration from 0.674±0.26 μm to 0.464±0.18 μm, coma-like aberration from 0.283±0.10 μm to 0.238±0.09 μm, and spherical-like aberration from 0.254±0.11 μm to 0.221±0.08 μm were detected (all, p<0.001). After eyedrop instillation, statistically significant increment was observed in Strehl ratio (p<0.001). Conclusion: As well as reducing the dry eye symptoms, artificial tears also cause increment in optical quality of the eye. Benefits of artificial tears on visual quality can be evaluated objectively via corneal wavefront aberrations. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the indications, intra- and post-operative complications, and visual results of combined cataract surgery and pars plana vitrectomy. Materials and Methods: Medical records of patients who underwent combined surgery between January 2008 and January 2011 were retrospectively evaluated. Indications for surgery, complications, pre-operative and post-operative visual acuities were recorded. Results: Sixty-four eyes of 64 patients were included in the study. Thirty-fve (55%) of the patients were men and 29 (45%) were women; mean age was 53±21 (6-88) years. Mean follow-up time was 13±12 (1-51) months. The main indications for combined surgery were intravitreal hemorrhage in 19 patients (29.7%), epiretinal membrane in 12 (18.8%), intraocular foreign body in 11 (17.2%), retinal detachment in 9 (14.1%), and macular edema in 7 (11%) patients. Posterior capsule rupture in 3 cases and corneal edema in 2 cases were the complications encountered during surgery. Postoperatively, hypotonia occurred in 5 cases and corneal edema in 1. Intraocular pressure elevation was observed in 1 silicon-injected case and 1 propane gas-injected case. The average preoperative visual acuity was 1.90±1.9 (0.22 to 3.10) LogMAR. The average postoperative visual acuity at the last visit was 1.1±1.0 (0.00 to 4.00) LogMAR. The visual acuity increase was statistically signifcant (p<0.001). Conclusion: Combined surgery is a feasible option for patients with vitreoretinal diseases and cataract. Visual results and complications depend primarily on the underlying posterior segment pathology. [ABSTRACT FROM AUTHOR]

Objectives: To compare the outcomes of external dacryocystorhinostomy (DCR) and transcanalicular multidiode dacryocystorhinostomy (TC-DCR) operations in our clinic. Materials and Methods: This retrospective study included patients diagnosed with acquired nasolacrimal duct obstruction. The results of external DCR surgery performed in 15 eyes of 15 patients were compared with the results in 15 eyes of 13 patients who underwent TC-DCR surgery. The patients with external DCR were followed for an average of 9.7±3.2 months, and the cases that underwent TK-DSR were followed for an average of 8.3±2.9 months. Results: The surgical success rate was 53.3% in patients with TK-DCR, while it reached 87% in cases with external DCR. Mean operative time was 50.0±2.5 minutes in external DCR group and 30.0±2.0 minutes in TK-DCR group. There was no significant complication during operations in both groups. Conclusion: In dacryostenosis surgery, external DCR is the golden standard with high success rates. Even though success rate of TCDSR is less than that of external DSR, no need of skin incision, less damage to the lacrimal pump system, less bleeding, and a shorter duration of the operation are the main advantages of this method. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of amniotic membrane transplantation (AMT) in the treatment of corneal ulcers resulting from herpetic keratitis (HK) and bacterial keratitis (BK). Material and Method: Forty-six patients (25 HK, 21 BK) treated with AMT for HK or BK-related corneal ulcers between January 2009 and September 2011 were followed prospectively. The visual acuities and ulcer characteristics (depth and localization) prior to AMT and epithelialization time, as well as final visual acuities after AMT, were evaluated. Results: The mean age was 51.9±17.0 years in HK and 53.3±22.0 years in BK and the mean follow-up time was 12.6±6.1 (5-33) months and 10.2±6.8 (3-27) months, respectively. The ulcers were mostly central in HK (72%) and paracentral in BK (52.4%) (p=0.03). Ulcer depth was deeper than 1/2 of the cornea in 14 (56%) HK and in 7 (33.3%) BK (p=0.290). Eight HK patients had scars from previous herpetic keratitis episodes. The mean epithelialization time was 22.3±8.5 (12-50) days in HK and 22.1±10.9 (8-45) days in BK (p=0.488). While epithelialization was achieved in all the patients with BK, 3 HK patients needed adjunctive surgeries (conjunctival flap, tectonic penetrating keratoplasty) in spite of three AMTs. Although visual acuities improved significantly in both groups, this improvement was more evident in BK cases (p=0.018 for HK and p<0.001 for BK). Discussion: Amniotic membrane transplantation is an effective and safe treatment for bacterial and herpetic corneal ulcers. The reason for the lower final visual acuities in the herpetic group was thought to be related to a more central location, deeper involvement and scars due to previous attacks [ABSTRACT FROM AUTHOR]

Purpose: To present our results of limbal conjunctival autograft technique (LCAT) for recurrent pterygium which developed after different surgical techniques for primary pterygium. Material and Method: Cases, who underwent LCAT for the treatment of recurrent pterygium, were evaluated. The cases were divided into three groups based on the primary surgery performed. Recurrent pterygium developed after bare sclera technique in group 1, LCAT in group 2, and amniotic membrane graft technique in group 3. Corneal epithelization, recurrence rate, and postoperative complications were compared among groups. Results: Forty-two eyes of 42 patients were evaluated. Nineteen eyes of 19 patients formed group 1, 11 eyes of 11 patients - group 2, and 12 eyes of 12 patients - group 3. Mean age (years) was 45.38±12.22 (24-72) in group 1, 46.81±13.41 (25-73) in group 2, and 44.83±11.92 (27-66) in group 3. Follow-up (months) was 19.38±6.03 (9-32) in group 1, 21.37±7.41 (11-34) in group 2, and 20.93±7.26 (10-34) in group 3. Postoperative corneal epithelization was completed after 5.62±1.74 (2-7) days in group 1, 4.33±0.91 (2-7) days in group 2, and 4.79±1.39 (2-7) days in group 3 (p=0.035). Recurrence was detected in 4 eyes in group 1 (21%), 3 eyes in group 2 (27%), and 3 eyes in group 3 (25%) (p=0.092). Postoperative complications were not observed in neither of the groups. Discussion: LCAT seems to be an efficient treatment for recurrent pterygium with high success and low recurrence rates regardless of the primary surgery. Low recurrence rates in LCAT may be due to the limbal stem cells transplanted with conjunctival autograft to pterygium excision area. Early corneal epithelization in recurrences following LCOT may be an indication of the maintenance to a certain degree of activities of the limbal stem cells transplanted in the primary surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare pain response of patients undergoing panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) using 532 nm standard laser versus multispot pattern scan laser and to evaluate the relationship between pain response and patient characteristics. Material and Method: Thirty-five patients had PRP with the Pascal system in a single session, while other 35 patients had PRP with conventional laser in 2 sessions. Parameters used in conventional laser were as follows: spot size 200 μm, exposure time 0.2 s, and power sufficient to produce visible grey-white burns. We used same spot size, 20-30 ms exposure time, and higher levels of laser power in order to get a similar endpoint in the Pascal system. The patients were required to evaluate the severity of pain on a visual analog scale (VAS) and verbally 5 minutes after PRP with Pascal and 5 minutes after the first session of PRP with conventional laser. The relationship between pain experienced and patient characteristics was evaluated. Results: At baseline, both groups did not differ significantly (p >0.05, for all) with respect to sex, age, duration of diabetes, most recent HbA1c, treatment regimen, or patient experience. The patients in the Pascal group had a mean pain score of 0.55±0.70 on verbal scale and 1.54±1.22 on VAS compared to 2.17±1.18 and 5.54±3.28, respectively in the conventional laser group which was, statistically, significantly different in both scales (p<0.05). Discussion: Our study confirms that new generation pattern scanning photocoagulators satisfactorily decrease the pain by shortening the exposure time while increasing the laser power. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of 23-gauge (23G) pars plana vitrectomy (PPV) in dislocated intraocular lens (IOL) cases: In early- and late-term follow-up. Material and Method: In this retrospective study, the medical records of 17 patients who underwent 23 G PPV treatment for dislocated IOL between January 2009 and June 2011 were analyzed. Detailed ophthalmologic examination was performed in all patients; intraoperative and postoperative complications were recorded. Results: In this study, mean follow-up time was 9.0 (4-22) months and mean age was 60.8 (8-82) years. Mean time after cataract surgery was variable (mean of 28.3 (0-80) months). Four patients had trauma history, five patients had pseudoexfoliation syndrome, and two patients had pathologic myopia. Dislocated IOL was placed into the sulcus in nine patients (52.9%). In two cases (11.7%), the IOLs were removed, and the patients were left aphakic. In two cases out of other 6 (11.7%), the dislocated IOL was changed with scleral fixation lens, whereas in the other four cases (23.5%), IOL was changed with iris claw lens. One patient (5.8%) remained at the same level of vision, while twelve (70.5%) cases increased two or more lines in BCVA. The vision was decreased in two cases. Intraocular pressure elevation controlled by medication was observed in one case. For two days, hypotony was observed in one patient. Discussion: 23 G PPV technique is an effective and safe method for removing and repositioning of dislocated IOL in the vitreous. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the intraoperative complications and postoperative visual outcomes of phacoemulsification surgery for the secondary cataract in vitrectomized eyes. Material and Method: We retrospectively evaluated 51 previously vitrectomized eyes of 51 patients who had undergone phacoemulsification and intraocular lens (PHACO+IOL) implantation surgery. PHACO+IOL surgery was performed in our clinic between October 2008 and May 2011. Intraoperative complications and postoperative best-corrected visual acuity (BCVA) outcomes were analyzed. Results: In this study, 31 out of 51 eyes had posterior subcapsular cataract. Cataract surgery was performed after a mean of 21.39±26.4 (6- 120, median 10.75) months following PPV. Mean preoperative and postoperative BCVA was measured to be 1.52±0.88 logMAR and 0.74±0.73 logMAR, respectively. In 25 eyes which had been filled with silicon oil, mean BCVA was 1.95±0.91 logMAR preoperatively and 1.15±0.84 logMAR postoperatively. In 18 (35.3%) eyes which had been filled with sulfur hexafluoride tamponade, mean BCVA was 1.17±0.47 logMAR preoperatively and 0.38±3.6 logMAR postoperatively. Peroperative zonular dialysis with instable deep anterior chamber occurred in two eyes, and posterior capsular tear occurred in one eye. Four eyes had Nd:YAG capsulotomy due to the posterior capsular opacity during the follow-up period. Discussion: Despite the well-known difficulties encountered in vitrectomized eyes such as zonular weakness, increased mobility of the lens-iris diaphragm, posterior capsular instability and posterior capsular plaques, phacoemulsification in vitrectomized eyes proved to be a safe surgery, and increase in visual acuity can be achieved. [ABSTRACT FROM AUTHOR]

Aim: Minerals and trace elements affect bone formation and resorption through direct or indirect effects on bone cells or bone mineral. Strontium has several effects on bone cells and anabolic activity. Materials and Methods: The effects of strontium ranelate on pain and bone mineral density were assessed in an open, noncontrolled trial conducted in postmenopausal women. Oral strontium ranelate was given at a daily dose of 2 g for six months in 31 patients. All women received calcium and vitamin D supplements. Measurements of bone mineral density were performed before treatment and at the sixth month. Blood biochemistry analysis was performed at the beginning and at the 6th month. Results: Pain (visual analog scala) score was 6.12±1.05 at baseline and 4.25±0.92 at sixth month of treatment. Pain decreased significantly at 6th month (p<0.05). New fractures did not occur during the study. Strontium renalate treatment increased bone mineral density at 6th month at the total lumbar spine and the femoral total region. The changes were found to be statistically significant (p<0.05). There were no serious adverse events. None of the patients discontinued treatment due to adverse effects. The blood biochemistry was normal at baseline and end of the trial. Global efficacy was good in 64.5% of patients at sixth month. Tolerability was excellent during the study (80.6%). Conclusion: Treatment of postmenopausal osteoporosis with strontium ranelate can decrease pain, and increase bone mineral density beginning at six months following treatment. The results have to be considered as preliminary, the study was planned for a longer duration on a greater number of patients. (Turkish Journal of Osteoporosis 2012;18: 53-7) [ABSTRACT FROM AUTHOR]

Objective: In this study we aimed to evaluate the results of pathology that patients undergoing laparoscopic and open appendectomy with suspected appendicitis from August 2012 to August 2014. Material and Method: In this study data from 131 patients undergoing laparoscopic and open appendectomy between August 2012 and August 2014 in Van Training and Research Hospital were examined retrospectively for demographic characteristics. Results: In the laparoscopic appendectomy group handmade endoloop technique was used for closing the base of the appendix. Mc Burney's incision was used for open appendectomy. 47% of patients was female (n=61), 53% of patients were male (n=69). The average age of the patients was 27.7 years. According to surgical technique, open appendectomy was performed 15% (n=20), laparoscopic appendectomy was performed 85% (n=110). Postoperative drainage tube was put to 15% of patients (n=20). Wound infection was seen in 4 open appendectomy performed patients (20%). Laparoscopic appendectomy was associated with a shorter hospital stay (2.2 days vs 2.8 days). When the pathology results are analyzed, 2 malignancies are revealed (1,5%), 1 carcinoid tumor, 1 neuroendocrine tumor. After pathology results hemicolectomy was performed. Conclusion: Appendectomy is the most frequently performed surgery, even if macroscopic pathology is not present the risk of malignancy can not be underestimated. [ABSTRACT FROM AUTHOR]