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Objective: Ceftriaxone and metronidazole (CEF/MET) combination therapy is commonly used in the empirical therapy of intra-abdominal infections (IAIs). We aimed to evaluate the treatment response in patients started on empirical CEF/MET therapy and contribute current treatment data on IAIs. Methods: A retrospective analysis was conducted on patients receiving parenteral antibiotic therapy in the general surgery department between 2016 and 2018. Patients aged 18 and older who received CEF/MET therapy for more than 24 hours with a diagnosis of IAI were included. Patient characteristics, antibiotic use and/or surgical history in the last three months, infection source, need for surgical intervention, and clinical and laboratory data were evaluated. Treatment response was analyzed in groups of patients with or without treatment changes. Results: 10,649 patients were evaluated; 591 (5.5%) received CEF/MET therapy, and 297 (50.2%) met the study criteria. Among them, 243 (81.8%) received only CEF/MET treatment (Group 1), while 54(18.2%) received additional antibiotics (median day 5) (Group 2). There was a statistically significant correlation between malignancy, antibiotic use in the last three months and history of surgical intervention and treatment change (p=0.001). The gallbladder (63%) or the biliopancreatic tract (12.1%) were the infection foci in 75.1% of all patients. Treatment was modified in 9.6% of the patients with an infection focused on the gallbladder and 55.6% of the patients with an infection focused on the biliopancreatic tract (p=0.001). Patients with treatment modification had more extended hospital stays and higher mortality rates (p=0.001). Conclusion: Empirical CEF/MET initiation is appropriate for IAIs with a gallbladder focus, yielding a favourable response in four out of five patients. However, CEF/MET therapy may be insufficient in patients with a biliopancreatic tract focus, a history of antibiotic use, malignancy, or surgical intervention, despite source control. Therefore, learning the source of infection and patient characteristics will contribute to the determination of the antibiotic to be selected in empirical treatment, increase treatment success, shorten the hospitalization period, and reduce mortality. [ABSTRACT FROM AUTHOR]

Background: aim of this study was to investigate the long-term clinical, functional and oncologic outcomes of patients with aneurysmal bone cyst (ABC). It was also aimed to reveal the effect of treatment options on recurrence and complications. Materials and Methods: Patients who underwent surgical treatment and follow-up with the diagnosis of ACS between 2000 and January 2023 were included in the study. Data were collected retrospectively using the hospital database and patient follow- up files. Only patients with a histologically confirmed diagnosis of ABC and a minimum follow-up period of 12 months were included in the study. Data such as age, gender, side, bone location of the tumor, extremity localization, preferred surgical method (curettage+allograft, curettage+allograft, curettage+autograft, curettage+cement and resection), whether internal fixation was applied, follow-up period, presence of recurrence and date of recurrence were recorded. The last follow-up was performed with the MSTS (Musculoskeletal Tumor Society) scoring system in outpatient clinic controls. On the basis of these data, the clinical, radiological, functional and oncological outcomes of the patients, complication rates, presence of recurrence and factors affecting the occurrence of recurrence were retrospectively analyzed. Results: A total of 103 patients, 51 women and 52 men, were included in the study. The mean follow-up period was 30.94±4.43 months. Recurrence was seen in 24.3% (n=25) of the patients. The age of patients with recurrence was significantly higher than those without recurrence (p<0.001). There was a statistically significant correlation between recurrence and internal fixation (p=0.020). The MSTS scores of patients who underwent internal fixation during surgery were significantly higher than those of patients who did not undergo internal fixation (p<0.001). Conclusions: In conclusion, in line with the data obtained in our study, the choice of treatment for aneurysmal bone cysts depends on localization, size, pathological fracture risk, symptoms and surrounding tissues. We believe that more caution should be exercised in the surgical treatment of ACCs with fracture risk, lower extremity localizations, and patients with incomplete skeletal development. Prevention of recurrence and internal fixation in patients with fracture risk increase patient satisfaction and positively affect functional outcomes. [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]

Background: Cutaneous leishmaniasis (CL) is a skin disease caused by protozoan parasites belonging to the Leishmania genus. The most commonly preferred treatment option for CL treatment is pentavalent antimony compounds. The aim of this study is to investigate the clinical characteristics and treatment responses of patients diagnosed with CL treated with systemic antimony. Materials and Methods: This retrospective study included 52 patients diagnosed with CL and treated with systemic antimony in our skin and venereal diseases clinic between May 2018 and May 2020. The clinical and demographic characteristics recorded in the patients' files were examined. Systemic antimony (intramuscular meglumine antimonate (IM MA)) was administered Results: 30 (57.7%) of the patients in our study w ere female a nd 22 (42.3%) were male. The average age of the patients was 26.5±14.23 years. Lesions were most frequently located in the facial region, and noduloulcerative type lesions were most frequently seen. The diagnosis of CL was made by observing amastigotes in the cutaneous smear in 48 (92.3%) patients and in the histopathological examination of the lesioned skin in 4 (7.7%) patients. When the patients receiving IM MA treatment were evaluated at the 12th week in terms of treatment response, complete clinical recovery of the lesions was observed in 50 (96.1%) patients and partial clinical improvement was observed in 2 (3.9%) patients. Conclusions: As a result, the data in our study were similar to the clinical and demographic data on CL previously published in our country. [ABSTRACT FROM AUTHOR]

Background: The aim of our study is to compare laparoscopic and abdominal myomectomies performed in our clinic and to evaluate the feasibility and safety of laparoscopic myomectomies. Materials and Methods: In this study, we retrospectively evaluated 314 cases who were threated with myomectomy operation in our clinic between 2012-2022. All of the cases were divided into two groups with respect to the surgical procedure performed. 314 patients were in the abdominal myomectomy group, 47 patients were in the laparoscopic myomectomy group and the groups were compared. Results: There was no statistically significant difference between the groups in terms of demographic data (p>0.05). When the groups were evaluated in terms of postoperative white blood cell(WBC), hemoglobin, hematocrit, platelet values, operation time, hospitalisation time, postoperative blood transfusion and perioperative complications, no statistically significant difference was observed (p>0.05). There were no statistically significant difference in terms of preoperative WBC and CRP values between the groups, but postoperative WBC and CRP values were lower in the laparoscopic myomectomy group (p<0.05). Conclusions: Laparoscopic myomectomy has a short recovery time and aesthetic advantage. However, equipment and the need of experienced surgeons limit its applicability. With the development of laparoscopic technologies and increasing the experience of surgeons with laparoscopic surgery, it will provide a serious advantage over the abdominal method in terms of less blood loss, less hospital stay, shorter operation times, less trauma and better cosmetic results. [ABSTRACT FROM AUTHOR]

Background: Gonadotropin-releasing hormone (GnRH) analogues have been widely used in the treatment of patients with central precocious puberty (CPP) for many years. In previous studies regarding the effects of GnRH analogues therapy on body mass index (BMI), conflicting results have been obtained. In this study, it was aimed to evaluate the effects of GnRH analogues therapy on BMI in girls diagnosed with CPP. Materials and Methods: In the study, a total of 145 female patients, who were treated and followed up due to CPP between September 2016 and June 2021, were included. In the retrospective review of medical records of the patients, age at admission, height, weight, BMI and standard deviation scores (SDS), bone age, Tanner stage, serum follicle-stimulating hormone (FSH) levels, luteinizing hormone (LH) levels, estradiol (E2) levels and the peak LH level in the GnRH stimulation test in the beginning and after the first year of treatment were evaluated. Results: The mean age of 145 patients with central precocious puberty in the beginning of treatment was 7.27±0.97 years, and the mean bone age was 9.12±1.10 years. At the beginning of treatment, 118 (81.38%) of the patients were at a normal weight or underweight, and 27 (18.62%) patients were overweight or obese. In terms of stages of puberty, 109 (75.17%) of the patients were Tanner stage 2, 30 (20.69%) patients were Tanner stage 3, and 6 (4.14%) patients were Tanner stage 4. While the mean BMI-SDS of all patients was 0.11±0.99 before the treatment, it increased significantly (p<0.001) by the end of the first year of treatment and was found as 0.35 ± 0.95. While the mean BMI-SDS of patients who were at a normal weight or underweight was -0.21± 0.78 before the treatment, it was found as 0.09±0.84 after the treatment (p < 0.001). The initial BMI-SDS of overweight or obese patients was 1.53±0.40, and it was found as 1.48±0.49 after the treatment (p=0.412). Conclusions: cious puberty increased the BMI-SDS in patients who were at a normal weight or underweight, but it did not cause any change in patients who were overweight or obese. [ABSTRACT FROM AUTHOR]

Background: In this study, it was aimed to determine the distribution and antibiotic resistance rates of bacteria isolated from endotracheal aspirate (ETA), blood and catheter samples taken from COVID-19 patients admitted Adana City Training and Research Hospital. Materials and Methods: Between April 1, 2020 and March 31, 2021, 254 patients PCR positive patients were included in the study. Blood, catheter and respiratory tract culture growths and antibiotic susceptibility test results were retrospectively analyzed from the microbiology laboratory database. Results: 433 bacterial growths were detected in clinical samples taken from 254 COVID-19 PCR positive patients. Among the bacterial agents, Acinetobacter baumannii (25.17%; n =109) was the most common pathogens, followed by Escherichia coli (5.54% n =24) and Klebsiella pneumoniae (5.31%; n =23). While imipenem and meropenem resistance rates for A. baumannii were 86.8% and 85.9%, ertapenem and meropenem resistance rates for K. pneumoniae and E. coli were 83.3%, 75%, and 12.5%, 4,1%, respectively. I n this study, 15 o f 21 S.aureus strains were found to be MRSA (Methicillin-resistant S.aureus) (71,4%). Conclusions: Avoiding unnecessary antibiotic use in COVID-19 patients is critical to prevent resistance development and increase culture sensitivity. [ABSTRACT FROM AUTHOR]

Background: Pancreatic neuroendocrine tumors (pNET) are rare diseases and surgical treatment is promising. In this study, we retrospectively analyzed the patients who underwent surgical treatment for pancreatic neuroendocrine tumor in our hospital in the last 11 years; We aimed to present our findings to the literature. Materials and Methods: The files of the patients who applied for pNET between January 2011 and March 2022 were retrospectively analyzed. Patients with multiple data deficiencies, who did not undergo surgery, and who were younger than 18 years of age were excluded from the study. The patients were evaluated in terms of age, gender, type of operation, tumor size, type and histological features, hospital stay, recurrent disease and survival. Results: Of the 33 patients included in the study, 13 were female and 20 were male, and the median age was 56 (18-86). There were 8 patients with functional tumors, one was somatostatinoma and the others were insulinomas. Enucleation in 7 of the patients; Pancreatectomy was performed in 26 of them. There were three patients whose main lesion was adenocarcinoma and serous cystadenoma, who underwent resection and whose specimen pathology had incidental pNET. We had 23, 7 and 3 patients with grade 1,2 and 3 tumors, respectively. The median value of tumor diameter was 24 (3-80) mm. The median value for hospital stay was 7 (2-50) days. The median value of follow-up was 24 (1-71) months; disease-free survival was 14 (1-71) months. Conclusions: pNETs are a rare disease that can be detected incidentally and should be carefully managed. Studies with larger series are needed to reach a consensus on the surgical and conservative treatment of pNET. [ABSTRACT FROM AUTHOR]

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Background: In our study, we aimed to compare the efficiency and reliability of using semirigid ureteroscopy (S-URS) and flexible ureteroscopy (F-URS) in the treatment of patients with stones smaller than 2 cm in isolated renal pelvis. Materials and Methods: The data of 45 patients who underwent ureteroscopic stone treatment for isolated renal pelvis stones smaller than 2 cm were evaluated retrospectively. S-URS was routinely applied to all patients. If the stones can be accessed in the renal pelvis with S-URS, direct treatment with holmium laser was applied. If the stone was not accessible, F-URS was made. Groups were compared in terms of stone-free rates, operation times, hemoglobin reduction, and complications. Results: S-URS was performed in 24 (53.3%) patients and F-URS in 21 (46.7%) patients. There was no significant difference between the two groups in terms of age, degree of hydronephrosis, mean stone size and stone side. Mean operation time was 64.62 ± 9.34 minutes in the S-URS group and 96.43 ± 14.26 minutes in the F-URS group (p=0.001). There was no statistically significant difference between the groups in terms of postoperative complications (p = 0.548). In the postoperative 1st day and 1st month follow-up, stone-free rates were 79.2% and 83.3% in the S-URS group, and 80.9% and 85.7% in the F-URS group, respectively (p = 0.768 and p = 0.574). Conclusions: We observed that the use of S-URS and F-URS were very successful and safe methods in kidney stones smaller than 2 cm. S-URS is a safe treatment method that can be applied if the stone in the renal pelvis can be reached without any problem, especially in selected cases. [ABSTRACT FROM AUTHOR]

Background: Our a im i s t o e valuate t he t reatment r esults o f c hildren w ho u nderwent E SWL f or urolithiasis Materials and Methods: Records of children who underwent ESWL between October 2018 and October 2020 were retrospectively reviewed. The patients were divided into two groups according to success and compared in terms of age, gender, stone size, stone location, complications, and additional interventions. Results: Of the 50 cases, 34(68%) were boys and 16(32%) were girls. The mean age was 8.8 ± 5.0 years. 36 of the stones were located in the kidney and 14 were in the proximal ureter. The average stone size was 9.4±1.8 mm in the successful ESWL group and 13.8±3.2 mm in the unsuccessful group (p <0.05). While the success was 90% for stones less than 10 mm, it was found to be 56.7% for stones over 10 mm (p <0.05). T otal success w as 70%. T here w as no significant correlation between age, gender, side and localization of stones and ESWL success (p> 0.05). Conclusion: ESWL is an effective and safe treatment method for children with urolithiasis. Stone size is an important factor affecting success. Especially for stones ≥10 mm, there is a need for studies that will provide the maximum benefit per session and reveal the predictions that can prevent an unsuccessful application. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome is the most common periodic fever syndrome. The aim of this study was to evaluate the clinical and laboratory findings of patients with PFAPA syndrome at the time of the attack and the response to the given treatments. MATERIALS and METHODS: Sixty-three individuals that applied to the pediatric rheumatology policlinic due to recurrent fever and throat infection and diagnosed with PFAPA syndrome were enrolled in this study. Patients' folders were evaluated retrospectively concerning demographic, clinical and laboratory data. RESULTS: Forty-two (66.7%) of the patients were male, 21 (33.3%) were female. The age of onset of complaints was 2.72±1.59 years. The average delay in diagnosis was 1.71 ± 1.28 years. The remarkable finding which was seen all of our patients was the high fever. Lymphadenitis was detected in 59 (93.7%) of the patients and aphthous stomatitis was found in 56 (88.9%) of the patients. As a laboratory finding, leukocytosis, the increase in C-reactive protein and sedimentation was observed in patients. Fever decreased within a mean of 2.24 ± 1.13 hours after steroid treatment. Another remarkable finding after the first steroid treatment was the resolution of exudative tonsillitis 24 hours after the treatment. CONCLUSIONS: Signs and symptoms of PFAPA syndrome are among the most common signs and symptoms in pediatric outpatient clinics. With increased awareness of PFAPA syndrome in clinicians, patients will be prevented from unnecessary laboratory procedures and medical treatments. [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: 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]

Objectives: Lacosamide is a third-generation antiepileptic agent that selectively enhances slow inactivation of sodium channels that take part in generation and propagation of action potentials and results in the diminution of neuronal excitability. Because of this new mechanism of action, it is expected to be efficacious in patients with drug-resistant epilepsy. In this study, we aimed to assess the efficacy and tolerability of lacosamide add-on treatment in refractory epilepsy patients by presenting our experience in a tertiary referral center. Methods: Medical records of refractory focal epilepsy patients who were followed in epilepsy outpatient clinic between October 2014 and May 2017 were retrospectively reviewed in this study. Patients who were treated with add-on lacosamide and completed minimum of six months follow-up period were included. ≥50% reduction in seizure frequency was defined as treatment response. Results: In this study, 88 patients were included. The percentage of seizure-free patients after six months follow-up was 4.6% and the treatment response rate was 55.6%. We also evaluated the effect of concomitant use of sodium channel blockers, the presence of abnormal findings on magnetic resonance imaging and the introduction stage of lacosamide. No significant difference was observed in the response rate regarding the mentioned parameters. 19% of the patients reported side effects, the majority of which were dizziness, vertigo and somnolence. None of them discontinued treatment because of side effects. Conclusion: Our findings suggest that lacosamide add-on therapy is effective in refractory focal epilepsy and has an appropriate tolerability and safety profile since none of the patients stopped treatment due to side effects. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The aim of this study was to evaluate the clinical and laboratory findings and treatment responses of patients with arthritis. MATERIALS and METHODS: The medical records of 111 children (0-18 years) were evaluated who were hospitalized with the diagnosis of arthritis between January 2010 and January 2019 retrospectively. The aim of this study was to evaluate the clinical and laboratory findings and to investigate the treatment and prognostic features of the patients. RESULTS: A total of 111 patients, 66% were male and the mean age was 91±56 (median 83,1-215) months. The most of the patients (n=62,56%) were between 3-10 years of age. Septic arthritis was diagnosed in 60% (n=67) of the patients. This diagnosis was followed by reactive arthritis (10%), juvenile idiopathic arthritis (10%), toxic/transient synovitis (5%) and other arthritis. On admission, there were pain in 96%, joint swelling in 63%, redness in 21%, increased temperature of the joint in 41%, decreased range of motion in 64%, and inability to walk in 38% of the patients. The most frequently involved joints were knee (51%) and hip (35%). The possibility of septic arthritis was significantly higher in patients with high fever (p=0,0001). The response to ibuprofen was higher in non-septic arthritis (p=0,0001). Arthrocentesis was performed in 55% (n=61) of the cases and 34% (n=38) of the patients had underwent intra-articular debridement surgery. Staphylococcus aureus and Streptococcus pyogenes were the most common microorganisms growth in joint fluid culture. When septic arthritis and other arthritis cases were compared, the effusion amount, the amount of fluid taken by puncture were significantly higher and the level of CRP and leukocytes were higher in septic arthritis group (p=0,001; p=0,025; p=0,018; p=0,032, respectively). Osteomyelitis was observed in 19% (n=21) of the cases. CONCLUSIONS: In this study, the probability of septic arthritis was found to be statistically significant in patients with fever, leukocyte>12100/mm³, CRP>3 mg/dl, and effusion measured 8.5 mm or more by ultrasonography. Also, ibuprofen response was higher in non-septic arthritis group. [ABSTRACT FROM AUTHOR]