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Obesity is a public health problem that needs to be treated and it occurs as a result of excessive fat accumulation in the body. The relationship between obesity and pulmonary hypertension is well known. The aim of this study is to evaluate the relationship between pulmonary artery stiffness, right ventricular functions and bioelectrical impedance parameters in obese, overweight, and healthy individuals.In this study, 41 obese (17 female and 24 male, mean age 43.5±10.3), 39 overweight (20 female and 19 male, mean age 38.6±10.4), 34 healthy control group (19 female and 15 male, mean age 40.5±8.6) were included. Anthropometric measurements and bioelectrical impedance parameters of all participants were performed. Right ventricular functions and pulmonary artery stiffness were evaluated by using conventional echocardiography.Right ventricle myocardial performance index, pulmonary artery stiffness values were statistically different between groups. Positive correlation was observed between pulmonary artery stiffness and Body Mass Index, Waist and Hip circumferences. Significant negative correlation was observed between muscle to fat ratio and pulmonary artery stiffness. In the linear regression analysis, it was observed that the muscle to fat ratio was independent predictor of pulmonary artery stiffness (β = -1.835; 95%CI(-2.434 - - .784); p 0.001).This study showed that right ventricular function was impaired and pulmonary artery stiffness increased in obese individuals. These findings could be considered as early markers of pulmonary hypertension in obese patients who do not yet have clinical evidence of cardiovascular disease.

Objective: Familial hypomagnesemia with secondary hypocalcemia (HSH) is an autosomal recessive disease caused by a mutation in the transient receptor potential melastatin 6 (TRPM6) gene and is characterized by selective magnesium malabsorption. Affected cases are usually diagnosed during infancy and usually present with seizures due to hypocalcemia and hypomagnesemia. Irreversible neurological deficits and arrhythmias can be observed without appropriate treatment. The aim was to evaluate the long-term follow-up of patients with genetically confirmed HSH. Methods: A total of six patients with HSH, two of whom were siblings, were included. Age at diagnosis, clinical, laboratory and follow-up data on admission were recorded. All 39 exons of the TRPM6 gene and flanking exon-intron junctions from genomic DNA were amplified and sequenced in all cases. Results: The median (range) follow-up duration was 12.1 (7.6-21.7) years. All cases were diagnosed in infancy. Four different mutations, three of which had not been previously reported, were detected in the TRPM6 gene. Treatment compliance was good and there were no severe complications in the long-term follow-up of cases. However, mental retardation, specific learning difficulty and attention deficit/hyperactive disorder were observed as comorbidities. Conclusion: Of the four different TRPM6 mutations in this small cohort, three had not been previously reported. The long-term prognosis of HSH appears to be good, given early diagnosis and good treatment compliance. This long-term follow-up and prognostic data and the three novel mutations will contribute to the published evidence concerning this rare condition, HSH, and it is hoped will prevent negative outcomes.

This study aimed to determine whether or not there was a relationship between complete hydatidiform mole (CHM) and serum Vitamin D level by comparing CHM patients with two control groups and to determine whether or not Vitamin D deficiency is a risk factor for CHM.This prospective study included 30 patients diagnosed with CHM (case group), 30 patients in the first trimester of a healthy pregnancy (control group), and 30 healthy non-pregnant subjects (control group). A record was made of serum 25-hydroxyvitamin D (25-OH D vitamin) levels, age, body mass index (BMI), gravida, parity, and the number of abortus. The serum 25-OH D vitamin levels were examined in each group and compared between groups.The 25-OH D vitamin level of all the patients in the study was determined as 11.16±8.64 ng/mL. No significant difference was determined between the groups in respect of 25 OH-D vitamin levels. When comparisons were made between the four subgroups according to the 25-OH-D level, no significant difference was determined between the CHM and control groups. When the patients were separated as obese and non-obese groups, no significant difference was determined between the groups.Severe deficiency, deficiency, or insufficient levels of serum Vitamin D are not thought to be risk factors for CHM patients.

BACKGROUND Behcet's disease (BD) is a chronic systemic inflammatory disease in which early detection of cardiac involvement is essential. The aim of this study was to assess the left ventricular (LV) functions in BD patients using four-dimensional (4D) speckle tracking echocardiography (STE) and to test the correlation between LV dysfunction and the presence of QRS fragmentation. METHODS This cross-sectional study included 64 Behcet's patients and 48 healthy volunteers. The BD group was divided into two subgroups depending on the presence (fQRS+) or absence (fQRS-) of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with 4D echocardiography. RESULTS GAS, GRS, GLS, and GCS values were significantly different in Behcet's patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-15.8 ± 1.8 and -17.9 ± 1.6, P = .001 vs -25.0 ± 3.1 and -29.2 ± 4.2, P

Objectives To compare anterior segment parameters and biomechanical analysis of the cornea in children with joint hypermobility (JH) and healthy children. Materials and methods Cross-sectional case-control study. Fifty eyes of 25 children with JH were compared with 74 eyes of 37 healthy age- and sex-matched controls in terms of refractive, anterior segment topographic, and corneal biomechanical measurements. Axial length (AL) was measured with a Nidek AL-Scan biometry device; corneal-compensated intraocular pressure (IOPcc), Goldmann-correlated IOP (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF) were measured with a Reichert ocular response analyzer (ORA). Central corneal thickness (CCT), anterior chamber depth (ACD), K1/K2 values, iris diameter, and anterior chamber volume (ACV) were measured with a Sirius topography device. Results Mean age in the JH group was 10.56±4.03 years, while that of the control group was 11.27±2.59 years (p=0.23). Spherical equivalent was -0.22±1.02 diopter (D) in the JH group and -0.12±1.12 D in the control group (p=0.60); CCT was 23.01±0.82 µm in the JH group and 23.17±0.82 µm in the control group (p=0.33). There were no significant differences between the two groups in terms of age, sex, IOP, IOPcc, IOPg, CH, CRF, AL, K1, K2, iris diameter, ACD, and ACV. Conclusion JH, which causes increased flexibility of the joints, was concluded not to cause a significant change in the corneal biomechanical markers of CRF and CH or in anterior segment topographic parameters.

BACKGROUND Malnutrition commonly occurs in patients with heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan, which is an AT1 neprilysin inhibitor, has been shown to reduce mortality and hospitalization in patients with HFrEF. However, its effects on nutritional status remain unclear. METHODS Sacubitril/valsartan was initiated in 164 symptomatic patients with HFrEF receiving an optimal medical treatment with angiotensin inhibition (mean age: 63 ± 20 years; 120 males, 60% ischemic cause). The New York Heart Association (NYHA) functional class and nutritional statuses of the patients were evaluated at the switching to AT1 neprilysin inhibitor and at the 6th-month follow-up of the maximum sacubitril/valsartan dose using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and prealbumin. RESULTS After the sacubutril/valsartan treatment, a significant reduction in the number (%) of malnourished patients was observed according to CONUT (before 47% vs. after 7%, P

CO-RADS scoring system is used as a diagnostic tool. However, the data about its association with co-morbid diseases and effectiveness in predicting intensive care need and short-term mortality are lacking. In our study, we aimed to investigate the association among CO-RADS score, co-morbid diseases, intensive care need, and 28-day-mortality.The study included 665 patients with COVID-19 infection suspicion between 30 May 2020 and 30 October 2020.The sensitivity of CT was 77%, and specificity was 52%. A higher CT score was associated with the rate of positive PCR test results (p0.001), and older patients had higher CO-RADS scores than younger patients (p0.001). Hypertension (OR: 7.956; p=0.005) and diabetes mellitus (OR: 5.902; p=0.015) were associated with significantly higher CO-RADS scores. Most patients treated in the intensive care unit (ICU) had a CO-RADS score of 5. The CO-RADS score was 4 and above in 115 (89.2%) patients who were transferred to the intensive care unit due to worsening of clinical condition (p0.001). The 28-day mortality was significantly higher in patients with a CO-RADS score of 4 and above than in patients with a score of 3 and below (97.3% vs. 2.7%) (p0.001).Irrespective of PCR results, a higher CO-RADS score gives us useful information about ICU need or mortality risk and alerts us for early treatment to reduce the risk of further transmission, intensive care need, and mortality particularly in patients with co-morbid diseases.

Background Aldosterone synthase deficiency (ASD) caused by mutations in the CYP11B2 gene is characterized by isolated mineralocorticoid deficiency. Data are scarce regarding clinical and biochemical outcomes of the disease in the follow-up. Objective Assessment of the growth and steroid profiles of patients with ASD at the time of diagnosis and after discontinuation of treatment. Design and method Children with clinical diagnosis of ASD were included in a multicenter study. Growth and treatment characteristics were recorded. Plasma adrenal steroids were measured using liquid chromatography-mass spectrometry. Genetic diagnosis was confirmed by CYP11B2 gene sequencing and in silico analyses. Results Sixteen patients from 12 families were included (8 females; median age at presentation: 3.1 months, range: 0.4 to 8.1). The most common symptom was poor weight gain (56.3%). Median age of onset of fludrocortisone treatment was 3.6 months (range: 0.9 to 8.3). Catch-up growth was achieved at median 2 months (range: 0.5 to 14.5) after treatment. Fludrocortisone could be stopped in 5 patients at a median age of 6.0 years (range: 2.2 to 7.6). Plasma steroid profiles revealed reduced aldosterone synthase activity both at diagnosis and after discontinuation of treatment compared to age-matched controls. We identified 6 novel (p.Y195H, c.1200 + 1G > A, p.F130L, p.E198del, c.1122-18G > A, p.I339_E343del) and 4 previously described CYP11B2 variants. The most common variant (40%) was p.T185I. Conclusions Fludrocortisone treatment is associated with a rapid catch-up growth and control of electrolyte imbalances in ASD. Decreased mineralocorticoid requirement over time can be explained by the development of physiological adaptation mechanisms rather than improved aldosterone synthase activity. As complete biochemical remission cannot be achieved, a long-term surveillance of these patients is required.

Early detection of total coronary artery occlusion (TO) in non-ST elevation myocardial infarction (NSTEMI) patients may be beneficial since invasive treatments are initiated more rapidly in appropriate patients. Previous studies have shown that the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age between 65 and 74 years, female gender) score is associated with thrombus burden in acute coronary syndromes. We investigated the association between the CHA2DS2-VASc risk score and TO in patients with NSTEMI who underwent coronary angiography. TIMI (thrombolysis in myocardial infarction) flow 0 was defined as TO and TIMI flow 1-3 was defined as non-total occlusion (non-TO). The NSTEMI patients (n = 400) included were separated into two groups: those with (n = 138) and without (n = 262) TO. We observed that the CHA2DS2-VASc score was higher in the TO group (3.86 ± 2.32 vs 2.15 ± 1.79, P

This study details the relationship between maternal plasma oxidant-antioxidant enzymes with colostrum quality, serum gamma glutamyl transferase (GGT), immunoglobulin G (IgG) and IgM concentrations of calves in the different calving seasons. Holstein breed cows between two and eight lactations and their calves were enrolled in the study. Holstein cows calving in winter (n=45) and their calves (n=45) were assigned to the winter group, while cows calving in summer (n=45) and their calves (n=45) were assigned to the summer group. Samples for malondialdehyde (MDA) and glutathione peroxidase (GSH-Px) were collected on day -21±3 before expected calving and also on calving day (Day 0). IgG and the specific gravity of the colostrum were determined after calving. Serum GGT and IgG and IgM were measured before the feeding, with colostrum, of calves (0 hours) and also in the 24th hour following the feeding of colostrum. Plasma MDA levels at -21±3 and 0 days in the summer cows were determined to be higher. GSH-Px activity was higher in the winter cows. IgG levels and the specific gravity of the colos- trum were also higher in the winter cows. Calf IgG levels at the 24th hour of life were higher in the winter cows. In the winter group, IgM levels at 0 and 24 hours were also higher. While MDA was negatively correlated with IgG, IgM, GGT, IgG and the specific gravity of colostrum, GSH-Px activity had a positive correlation with IgG, IgM, GGT, IgG and the specific gravity of colostrum. The observed differences in plasma MDA, GSH-Px, calf serum IgG and IgM levels, and colostrum quality between both groups suggest a possible seasonal effect. The relationship between maternal oxidant-antioxidant enzymes, colostrum quality, and passive calf immunity revealed that these enzymes could be used as indicators in the evaluation of calf health and colos- trum quality.

Objective Antimullerian hormone (AMH) concentrations in mini puberty are higher than those reported for the prepubertal period. In this study we investigated AMH concentrations in infants with premature thelarche (PT). A healthy control group was used for comparison. Methods Forty five female infants with PT, aged between one and three years and a control group consisting of 37 healthy girls in the same age range were included in the study. Bone age, pelvic ultrasonography, and concentrations of luteinizing hormone, follicle-stimulating hormone (FSH), estradiol and AMH of the patient group were evaluated. Only serum AMH concentration of the control group was evaluated. Results Median (range) serum AMH concentrations in the subjects were 1.66 ng/mL (11.85 pmol/L) [0.15-6.32 ng/mL (1.07-45.12 pmol/L)] and were significantly lower (p=0.025) than for the control group; 1.96 ng/mL (13.99 pmol/L) [0.60-8.49 ng/mL (4.28-60.64 pmol/L)]. AMH and FSH were negatively correlated (r=-0.360, p=0.015) in infants with PT. There was no correlation between AMH and uterine size, uterine volume, endometrial thickness, fundocervical ratio, ovarian size or volume, follicle size and follicle number. Conclusion This is the first study that investigates AMH concentrations in infants with PT. The low AMH levels in these infants and the negative correlation between AMH and FSH suggests that AMH may play a role in suppressing pubertal findings during infancy and that decreased AMH may cause PT in infancy.

Buyukinan, Muammer/0000-0002-2937-823X; Kilinc, Suna/0000-0002-0760-2640; AYDIN, MURAT/0000-0001-7374-229X; bayramoglu, elvan/0000-0002-6732-8823; Aycan, Zehra/0000-0003-4584-2976; esen, ihsan/0000-0003-1700-6778; Onal, Hasan/0000-0001-9676-7086; Kor, Yilmaz/0000-0003-1645-5416; bolu, semih/0000-0002-8183-2188 WOS:000469271100008 PubMed ID: 30488822 Objective: To determine the demographic and biochemical features of childhood and juvenile thyrotoxicosis and treatment outcome. Methods: We reviewed the records of children from 22 centers in Turkey who were diagnosed with thyrotoxicosis between 2007 to 2017. Results: A total of 503 children had been diagnosed with thyrotoxicosis at the centers during the study period. Of these, 375 (74.6%) had been diagnosed with Graves' disease (GD), 75 (14.9%) with hashitoxicosis and 53 (10.5%) with other less common causes of thyrotoxicosis. The most common presenting features in children with GD or hashitoxicosis were tachycardia and/or palpitations, weight loss and excessive sweating. The cumulative remission rate was 17.6% in 370 patients with GD who had received anti-thyroid drugs (ATDs) for initial treatment. The median (range) treatment period was 22.8 (0.3-127) months. No variables predictive of achieving remission were identified. Twenty-seven received second-line treatment because of poor disease control and/or adverse events associated with ATDs. Total thyroidectomy was performed in 17 patients with no recurrence of thyrotoxicosis and all became hypothyroid. Ten patients received radioiodine and six became hypothyroid, one remained hyperthyroid and restarted ATDs and one patient achieved remission. TWo patients were lost to follow up. Conclusion: This study has demonstrated that using ATDs is the generally accepted first-line approach and there seems to be low remission rate with ATDs in pediatric GD patients in Turkey.

Background: In acromegaly patients; it has been observed that heart failure may develop even in the absence of predisposing factors such as hypertension, diabetes mellitus, so a specific acromegali...

Background The management options for Graves’ disease in children are limited and there is controversy regarding optimal treatment. Remission rate with anti-thyroid drug (ATD) treatment in children is said to be lower than in adults. Definitive treatments are effective, but they often result in permanent hypothyroidism. The objective of this study was to investigate the outcome of methimazole treatment, identify significant predictors of a remission and evaluate the adverse effects of methimazole in a pediatric population of GD patients. Methods Medical records of the patients who had been diagnosed with Graves’ disease were screened retrospectively. Diagnostic criteria included elevated free thyroxine (fT4) and total triiodothyronine (T3), suppressed thyroid-stimulating hormone (TSH) and either positive thyroid-stimulating immunoglobulin (TSI) or thyroid receptor antibodies (TRABs) or clinical signs suggestive of Graves’ disease, for example, exophthalmos. Remission was defined as maintenance of euthyroidism for more than 12 months after discontinuing methimazole treatment. Results Of the 48 patients, provisional remission was achieved in 21 patients. Of the 21 patients, 14 experienced a relapse (66.6%). Remission was achieved in seven (24.1%) of 29 patients who received methimazole treatment for more than 2 years. In patients who achieved long-term remission, the male sex ratio and fT4 levels at diagnosis were significantly lower than the relapsed and non-remission groups, whereas the free triiodothyronine (fT3)/fT4 ratio and duration of methimazole treatment were significantly higher than the relapse group. Conclusions Long-term methimazole treatment in pediatric Graves’ disease would be appropriate. High fT4 levels at the time of diagnosis and male sex were associated with a risk of relapse.

Background/aims The cardiovascular system is one of the major targets of thyroid hormones. Subclinical hypothyroidism (SCH) is a common disease that can represent "early" thyroid failure. Our aim was to evaluate left atrial (LA) volume and functions in patients with SCH using real time three-dimensional echocardiography (RT3DE) and also to investigate changes in LA parameters after the levothyroxine treatment. Methods In total, 44 patients with SCH and 40 age- and gender-matched controls were studied. Assessments included history, physical examination and echocardiography. All patients with SCH were followed up with replacement therapy until the euthyroid status was achieved. Results In patients with SCH, LA total emptying volume, passive emptying volume, and passive ejection fraction were significantly reduced while LA minimal volume, active emptying volume, and active emptying fraction were significantly increased than in control group. Following the levothyroxine treatment, LA volume and function parameters were observed to be significantly improved. A negative correlation between the change of thyroid stimulating hormone (TSH) and change of LA active emptying volume and a positive correlation between the change of TSH level and change of LA passive emptying volume were found. Conclusion It was shown that volume and functions of LA were impaired in patients with SCH. However, impaired parameters were improved after the levothyroxine treatment. These findings may be indicative of subclinical heart involvement that could lead to functional and structural changes in patients with SCH.

Evaluation of vascular leakage and retinal vascular development with fundus fluorescein angiography for infants diagnosed with aggressive posterior retinopathy of prematurity who underwent intravitreal anti-VEGF treatment.Medical recordings of 30 patients who received RetCam fluorescein angiography during follow-up and had been treated with anti-VEGF on diagnosis of aggressive posterior ROP in the zone I or zone II between the dates of April 2014-January 2017 were evaluated retrospectively.Fifty-nine eyes of 30 patients were included in the study. Mean birth weight was 1145 g; gestation week was 28.4. Recurrence occurred in 30.5% of the patients, and 10.1% of them were given a second dose of injection of anti-VEGF. Leakage was detected in 15.3% of the eyes during angiography, and all of these eyes were treated with laser photocoagulation. Evaluation of vascular development revealed that in the temporal, complete retinal vascular development was achieved in only 8% of the eyes. It was detected that complete retinal vascularization was not observed in any of the cases which were given second dose of injection due to recurrence. The patients were distributed into groups according to postmenstrual week taken to angiography as 32 eyes of 16 patients in group 1, 17 eyes of 9 patients in group 2 and 10 eyes of 5 patients in group 3. The vascular leakage rate of group 3 patients was statistically significantly higher (p 0.05) and vascular development between groups was not statistically significant (p 0.05).With the initiation of FFA usage in pediatric cases, especially treated with anti-VEGF due to retinopathy of prematurity (ROP), more findings (vascular arrest, leakage, and abnormalities, etc.) are obtained than those achieved via ophthalmoscopic examination. In the light of these findings, early intervention with laser photocoagulation in early stages becomes possible enabling prevention of possible blindness.

SCI-Expanded PMID: 33565750 Q3 WOS:000688079700008 Objective: To investigate clinical characteristics and response to growth hormone (GH) treatment in patients with Prader-Willi syndrome (PWS) in Turkey. Methods: The data of 52 PWS patients from ten centers was retrospectively analyzed. A nation-wide, web-based data system was used for data collection. Demographic, clinical, genetic, and laboratory data and follow-up information of the patients were evaluated. Results: The median age of patients at presentation was 1.5 years, and 50% were females. Genetic analysis showed microdeletion in 69.2%, uniparental disomy in 11.5%, imprinting defect in 1.9% and methylation abnormality in 17.3%. Hypotonia (55.7%), feeding difficulties (36.5%) and obesity (30.7%) were the most common complaints. Cryptorchidism and micropenis were present in 69.2% and 15.3% of males, respectively. At presentation, 25% had short stature, 44.2% were obese, 9.6% were overweight and 17.3% were underweight. Median age of obese patients was significantly higher than underweight patients. Central hypothyroidism and adrenal insufficiency were present in 30.7% and 4.7%, respectively. Hypogonadism was present in 75% at normal age of puberty. GH treatment was started in 40% at a mean age of 4.7±2.7 years. After two years of GH treatment, a significant increase in height SDS was observed. However, body mass index (BMI) standard deviation (SDS) remained unchanged. Conclusion: The most frequent complaints were hypotonia and feeding difficulty at first presentation. Obesity was the initial finding in 44.2%. GH treatment was started in less than half of the patients. While GH treatment significantly increased height SDS, BMI SDS remained unchanged, possibly due to the relatively older age at GH start. https://pubmed.ncbi.nlm.nih.gov/33565750/

Objectives Polycystic ovary syndrome (PCOS) is an endocrinopathy, in which hyperandrogenism and hyperinsulinism have both occurred. Fetuin-A, a natural inhibitor of tyrosine kinase, leads to insulin resistance. The aim was to evaluate the relationship between fetuin-A and hyperandrogenism and hyperinsulinism and the role of fetuin-A in the pathophysiology of PCOS. Methods Thirty-eight cases with PCOS and 40 healthy adolescents were included in the study. PCOS and controls were divided into obese/non-obese subgroups. LH, FSH, total and free testosterone (TT, FT), SHBG, androstenedione, DHEAS were measured in patients with PCOS. Fasting glucose, insulin, lipid profile, AST, ALT, HsCRP, and fetuin levels of PCOS patients and healthy controls were also measured. Results Fetuin-A levels were higher in PCOS patients than in controls. In the obese-PCOS group, when compared to non-obese PCOS patients; the levels of SHBG and HDL were low while cholesterol, LDL, triglyceride, HOMA-IR, FT, FAI, and HSCRP levels were high, but Fetuin-A levels were similar. In the obese-PCOS group, fetuin-A levels were higher than in obese-controls. HOMA-IR and fetuin-A levels were higher in non-obese PCOS patients than in non-obese controls. In the PCOS group, fetuin-A was positively correlated with TT, FT, FAI and androstenedione and negatively correlated with SHBG. Regression analysis demonstrated that FT, SHBG, and androstenedione significantly predicted fetuin-A levels (R2=54%). In non-obese PCOS patients and controls, fetuin-A was positively correlated with insulin and HOMA-IR. Conclusions These results suggest a relationship between androgen levels and fetuin-A in PCOS cases, independent of insulin resistance, and may shed light on further studies.

Objectives: Caesarean section (CS) is one of the most frequently performed surgical procedures in the world and Turkey. In this study, we aimed to investigate the relationship between re-approximation of the rectus muscles during CS and the severity of diastasis recti abdominis in the first postoperative month. To investigate the relationship between re-approximation of the rectus muscles during CS and the severity of diastasis recti abdominis in the first postoperative month. Material and methods: The study was designed as a prospective cross-sectional study. Patients were divided into two groups: parietal peritoneum closure only (Group 1), and closure of the parietal peritoneum and re-approximation of rectus muscle (Group 2). The distance between the rectus muscles and the thickest rectus muscle thickness were measured one month after CS from three anatomic regions using superficial ultrasonography by the same blinded physician. The anatomic regions were described as xiphoid, 3 cm above the umbilicus, and 2 cm below the umbilicus. The relation of the measurements between the groups was evaluated. Results: There was a total of 128 patients, 64 in Group 1 and 64 in Group 2. There were no statistical differences between the groups in terms of the distance between rectus muscles and the thickness of rectus muscle at the described anatomic regions (p > 0.05). Conclusion: Re-approximation of rectus muscles has no effect on the prevention of diastasis recti, which is an important cosmetic problem.

Introduction: Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. Objective: To assess choroidal thickness measurements of patients with marked nasal septal deviation. Methods: The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000 μm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. Results: In the study group, 52 eyes of 26 patients with a mean age of 26.34 ± 8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69 ± 7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p > 0.05). Conclusion: Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening. Resumo: Introdução: A obstrução crônica das vias aéreas superiores devido a acentuado desvio do septo nasal pode causar hipóxia crônica. Pode alterar o equilíbrio do sistema simpático-parassimpático e afetar o fluxo sanguíneo na coroide. Objetivo: Avaliar as medidas da espessura da coroide em pacientes com acentuado desvio de septo nasal. Método: Foram incluídos no estudo pacientes que apresentavam sintomas de obstrução nasal, com diagnóstico de acentuado desvio de septo realizado por rinoscopia anterior e endoscopia nasal, e com septoplastia programada. O grupo controle consistiu de indivíduos saudáveis pareados por idade, sexo e índice de massa corporal. As medidas da coroide na fóvea central e a 1.000 μm da fóvea nas regiões nasal e temporal foram feitas com tomografia de coerência óptica com imagem de profundidade melhorada. Resultados: No grupo de pacientes, 52 olhos de 26 pacientes com média de 26,34 ± 8,14 anos foram examinados. No grupo controle, 52 olhos de 28 indivíduos saudáveis com média de 26,69 ± 7,84 anos foram examinados. Não houve diferença estatisticamente significante em termos de medidas da espessura da coroide entre os grupos (p > 0,05). Conclusão: Nossos resultados sugerem que desvios do septo nasal acentuados podem não levar à hipóxia significativa e ativação simpática, resultar na deterioração do fluxo sanguíneo coroidal e consequente espessamento da coroide. Keywords: Nasal septal deviation, Choroidal thickness, Sleep-disordered breathing, Palavras-chave: Desvio do septo nasal, Espessura da coroide, Distúrbios respiratórios do sono

Androgens play a pivotal role in non-reproductive organs such as the kidney, heart, liver, and pancreas. As androgen receptors are expressed in pancreatic and liver cells, excess testosterone can result in hypersecretion of insulin and fetuin-A, a protein produced in the liver. The expression of fetuin-A, a natural inhibitor of tyrosine kinase activity in muscle and liver, leads to insulin resistance. In addition, insulin and fetuin-A levels are thought to be affected by drugs such as glucocorticoids (GCs) and fludrocortisone. However, whether fetuin-A and insulin levels are affected by androgens and GCs in patients with classic congenital adrenal hyperplasia (CAH) is unknown. This cross-sectional study included 56 CAH patients and 70 controls. Analyses were stratified by sex and prepubertal/pubertal status to control for potential changes in serum metabolic/inflammatory markers associated with the production of sex steroids. Fasting blood glucose, insulin, triglyceride, total cholesterol, high density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, fetuin-A, and high-sensitivity C-reactive protein (hs-CRP) levels were measured in blood samples. In addition, 17α-hydroxyprogesterone, androstenedione, total testosterone, free testosterone, and dehydroepiandrosterone sulfate levels were measured before medication was administered. Insulin and fetuin-A levels were significantly higher in CAH patients than in controls. The unfavourably high levels of these substances exhibited a positive correlation with total and free testosterone. Regression analysis revealed that fetuin-A and free testosterone were the only independent predictors of the insulin level, while insulin and free testosterone levels significantly predicted the fetuin-A level (R2=42.7% and 59.8%). Differences were also observed in triglyceride and hs-CRP levels between the pubertal and prepubertal groups. We conclude that serum fetuin-A and insulin levels may be associated with androgens in CAH patients.

WOS:000558055200001 PubMed: 32623717 Objective To report the perioperative outcomes of 200 patients with gynecologic cancer who underwent surgery during the Novel Coronavirus Disease (COVID-19) pandemic and the safety of surgical approach. Methods Data of patients operated between March 10 and May 20, 2020, were collected retrospectively. Data were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows v. SP21.0. Results Data of 200 patients were included. Their mean age was 56 years. Of the patients, 54% (n=108), 27.5% (n=55), 12.5% (n=25), and 2% (n=4) were diagnosed as having endometrial, ovarian, cervical, and vulvar cancer, respectively. Of them, 98% underwent non-emergent surgery. A minimally invasive surgical approach was used in 18%. Stage 1 cancer was found in 68% of patients. Surgeons reported COVID-related changes in 10% of the cases. The rate of postoperative complications was 12%. Only two patients had cough and suspected pneumonic lesions on thoracic computed tomography postoperatively, but neither was positive for COVID-19 on polymerase chain reaction testing. Conclusion Based on the present findings, it is thought that gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to the measures. Postponement or non-surgical management should only be considered in patients with documented infection. Gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to measures. Only 1% of patients developed COVID-19-related symptoms during the postoperative follow-up period.

Objective In recent years, epicardial fat tissue (EFT) has been found to be strongly associated with the development of atrial fibrillation (AF) and post-ablation long-term recurrence. The current study investigated the procedural success rate of electrical cardioversion (ECV) and potential predictors of treatment failure in patients with nonvalvular persistent AF. Methods A total of 262 nonvalvular persistent AF patients who were scheduled for elective ECV were included in this prospective study. Routine transthoracic echocardiography was performed before the procedure and EFT thickness was measured. The presence of left atrial appendage thrombus was evaluated by transesophageal echocardiography. The patients were followed up for 6 months to examine any recurrence after ECV. Results The success rate of ECV was 85% and the recurrence rate was 35% during the 6-month follow-up period. The mean EFT thickness was 8.67 ± 1.2 mm in the persistent AF group with unsuccessful ECV and 6.81 ± 0.8 in the patients in whom sinus rhythm (SR) was maintained, the EFT was significantly thicker in the AF group (P = 0.001). EFT (P = 0.001) and left ventricular end-diastolic diameters (LVEDD) (P = 0.001) were significantly different between those who had maintained SR and those with recurrent AF during the 6-month follow-up period after ECV. In the multiple logistic regression analysis, LVEDD (odds ratio [OR]: 1.320 (1.023-1.703 95% confidence interval [CI]), P = 0.032)] and EFT [OR: 3.029 (1.013-9.055 95% CI), P = 0.047)] were identified as independent predictors of successful ECV. Conclusion Epicardial fat tissue thickness can be effectively used for the prediction of successful ECV and AF recurrence during follow-up in AF patients.

Objective ROS1 is an orphan receptor protein tyrosine kinase which is supposed to undergo genetic rearrangement in carcinogenesis. In the current study, we aimed to investigate the frequency and clinicopathologic features associated with ROS1 gene fusion and ROS1 protein expression in patients with ovarian serous carcinoma or serous borderline tumors. Materials and methods Tissue samples of 102 patients with high or low grade serous carcinoma and borderline serous tumors were selected randomly from the archives of Department of Gyneco-pathology, and analyzed for ROS1 gene expression. (Fluorescence in situ hybridization (FISH) method was used to assess ROS1 gene rearrangement, while ROS1 protein expression was analyzed using immunohistochemistry. Results The study consisted of 94 cases of high-grade serous carcinoma (92.1%), 2 cases of low-grade serous carcinoma (%2) and 6 cases of serous borderline tumor (5.9%). ROS1 gene rearrangement analysis revealed that 4 patients (3.9%) were FISH-positive; whereas the immunohistochemical analysis yielded only 1 patient (0.9%) exhibiting faint positive expression of ROS1 protein. Given the low incidences of ROS1 gene rearrangement and protein expression, their relationships with clinicopathologic parameters could not be statistically analyzed. Conclusion Although rare, patients with ovarian serous carcinoma or serous borderline tumor may exhibit ROS1 gene rearrangement and ROS1 protein expression. Further large-scale studies are necessary to explore the clinicopathologic significance of ROS1 gene expression in ovarian serous carcinoma.

Objective: There have been recent advances in the understanding of the etiology of idiopathic central precocious puberty (iCPP) including new genetic associations. The aim of this clinical study was to determine the frequency of MKRN3 mutation in cases of familial iCPP. Methods: Potential sequence variations in the maternally imprinted MKRN3 gene were evaluated in 19 participants from 10 families using next-generation sequencing analysis. Results: MKRN3 variation was found in only one of the 19 (5.3%) subjects. The male patient, who had a medical history of precocious puberty, had a heterozygous mutation, NM_005664.3:c.630_650delins GCTGGGC (p.P211Lfs*16). The father of this patient also had a history of precocious puberty and had the same mutation. p.P211Lfs*16 is a novel variant and it was identified as probably pathogenic by in silico analysis, consistent with the clinical findings. Conclusion: Given that MKRN3 mutation was detected in only one patient, with a paternal history of precocious puberty, this reinforces the importance of accurate family history taking. The detected incidence of MKRN3 variants in our case series was much lower than reported elsewhere which suggests a need for further studies in Turkish iCPP patients.

Background It is controversial to test for urinary tract infection (UTI) in patients with unexplained indirect hyperbilirubinemia in the first 2 weeks of life. We aimed to study the prevalence and significance of UTIs in such neonates who were requiring phototherapy. Methods Subjects were 2- to 14-day-old neonates with indirect bilirubin levels above phototherapy limit with no other abnormality in their bilirubinaemia-related etiologic workup. UTI was diagnosed by 2 consecutive positive cultures obtained by catheterisation, documenting growth of >10,000 colonies of the same microorganism with consistent antibiograms. The UTI (+) patients were evaluated by renal ultrasonography (US), and some were followed up for possible recurrent UTI. Results 262 neonates were included in the study. UTI prevalence was 12.2%, and bacteraemia was 6.2% among UTI (+) patients. The two most common pathogens (81.2%) were Escherichia coli and Klebsiella. pneumonia. All UTI (+) patients had undergone US, revealing 12.5% pelvicaliectasis, other 12.5% increased renal parenchymal echogenicity, 3.1% concurrent pelvicaliectasis and increased renal parenchymal echogenicity. 53.1% of UTI (+) patients had undergone follow-up, after which 23.5% recurrent UTI were found at the end of a mean of 52 months. Conclusion We suggest that the neonates with unexplained pathological jaundice should be tested for possible UTI. Consequently, all newborns with UTI shall be evaluated by the urinary US and followed up for recurrent UTI.

OBJECTIVE Postoperative AF (POAF) is the most common cause of morbidity after coronary artery bypass surgery. In this study, we aimed to show the relationship between POAF and N-terminal pro-atrial natriuretic peptide (NT-pro ANP) levels and the relationship between mechanical functions and left atrial volume measured using preoperative three-dimensional echocardiography (3D ECHO) among patients that will undergo isolated coronary artery bypass grafting (CABG) in elective conditions. METHOD Sixty-six consecutive patients (51 male, 15 female) who were decided to undergo CABG and had normal sinus rhythm were involved in the study. Patients were followed by continuous electrocardiography monitoring and daily electrocardiogram. LA volume and mechanical functions were calculated with 3D ECHO. In addition, for the analysis of plasma levels of NT-pro ANP, blood samples were collected before the surgery. RESULTS During follow-up after the operation, 15 patients (22.7%) had postoperative atrial fibrillation. LA Vmax, Vmin, VpreA values were higher (P

To assess choroidal thickness in children with adenoid hypertrophy versus normal controls using enhanced depth imaging optical coherence tomography (EDI-OCT). Twenty-six children (left and right eyes, total 52 eyes), which were scheduled to adenoidectomy with severe adenoid hypertrophy and 26 age, sex and body mass index-matched healthy subjects (left and right eyes, total 52 eyes) were included in the study. Choroidal thicknesses (CT) were evaluated using enhanced depth imaging optical coherence tomography. The CT measurement was taken at the fovea and 1000 μ away from the fovea in the nasal and temporal regions. The macular retinal thickness was also measured. There was no statistically significant difference in the CT of all regions between the groups (p > 0.05). No statistically significant difference was found between two groups in terms of macular choroidal thickness (p > 0.05). These results revealed that severe adenoid hypertrophy did not cause a significant effect on choroidal thickness. Short-term exposure to obstructive symptoms in children and preserved sympathetic–parasympathetic balance may explain this result.

PURPOSE: To investigate the association of the severity of obstructive sleep apnea syndrome (OSAS) with peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL). MATERIALS AND METHODS: In this cross-sectional study, 145 patients with OSAS and 40 healthy subjects were enrolled. OSAS patients were further divided into mild (n=50), moderate (n=36), and severe (n=59) OSAS groups according to their apnea–hypopnea index (AHI) values. Spectral-domain optical coherence tomography was used to measure the peripapillary RNFL and GC-IPL thicknesses. RESULTS: There was no statistical difference between the RNFL thickness in OSAS and control groups (P>0.05). Both average GC-IPL and minimum GC-IPL thicknesses were significantly lower in severe OSAS group than in healthy controls (P

BACKGROUND No-reflow is associated with a poor prognosis in STEMI patients. There are many factors and mechanisms that contribute to the development of no-reflow, including age, reperfusion time, a high thrombus burden, Killip class, long stent use, ejection fraction ≤40, and a high Syntax score. In this study, we aimed to evaluate the parameters associated with no-reflow prediction by creating a new scoring system. METHODS The study included 515 consecutive STEMI patients who underwent PCI; 632 STEMI patients who had undergone PCI in another center were included in the external validation of the scoring system. The correlations between 1-year major adverse cardiac events and low/high risk score were assessed. RESULTS In this study, seven independent variables were used to build a risk score for predicting no-reflow. The predictors of no-reflow are age, EF ≤40, SS ≥22, stent length ≥20, thrombus grade ≥4, Killip class ≥3, and pain-balloon time ≥4 h. In the derivation group, the optimal threshold score for predicting no-reflow was >10, with a 75% sensitivity and 77.7% specificity (Area under the curve (AUC) = 0.809, 95%CI: 0.772-0.842, P

Aim: To report a case of bilateral posterior scleritis associated with giant cell arteritisCase Report: A 62-year-old female patient presented with bilateral progressive vision loss was diagnosed with bilateral posterior scleritis. According to clinical signs and symptoms and laboratory testing, Giant cell arteritis was also diagnosed. Within 8 weeks of the corticosteroid treatment, the serous retinal detachments completely resolved and choroidal thickness decreased in both eyes. Visual acuity increased, and the symtoms related to Giant cell arteritis improved.Conclusion: Posterior scleritis is an inflammatory disease that may be associated with many autoimmune systemic diseases. GCA should be thought of particularly in patients over the age of 50 with bilateral involvement, and a relevant detailed history should be obtained for early and correct diagnosis and treatment.

The Miller-McKusick-Malvaux (3M) syndrome is a rare autosomal disorder that can lead to short stature, dysmorphic features, and skeletal abnormalities with normal intelligence. A 16-month-old female patient had been referred to our clinic due to short stature. Case history revealed a birth weight of 1740 grams on the 39th week of gestation, with a birth length of 42 cm and no prior hereditary conditions of clinical significance in her family. On physical examination, her length was 67 cm [-3.6 standard deviation (SD) score], weight 7.2 kg (-2.9 SD score), and head circumference 42 cm (below 3rd percentile). She also had numerous characteristic physical features such as a triangular face, fleshy nose tip, a long philtrum, prominent mouth and lips, pointed chin, lumbar lordosis, and prominent heels. As her growth retardation had a prenatal onset and the physical examination results were suggestive of a characteristic profile, the diagnosis of 3M syndrome was strongly considered. Genetic assessment of the patient revealed a novel homozygous p.T425Nfs*40 [corrected] mutation in the OBSL1 gene. It is recommended that physicians pay further attention to this condition in the differential diagnosis of children with severe short stature.

Objective: It is well known that the altitude may affect the cardiovascular system. However, there were a few data related to the effect of altitude on the adverse outcome in patients with heart failure with reduced ejection fraction (HFREF). The aim of the present study was to investigate the role of intermediate high altitude on the major adverse cardiovascular outcome in patients with HFREF. Methods: Patients with HFREF admitted to the outpatient clinics at the first center at sea level and the second center at 1890 m were prospectively enrolled in the study. HFREF was defined as symptoms/signs of heart failure and left ventricular ejection fraction

In this prospective, randomized, controlled study we investigated the effect of subcutaneous rifampicin and povidone-iodine irrigation on incisional surgical site infection. Superficial incisional surgical site infection (SSI) following gynecologic surgery is a serious problem for both patient and surgeon in terms of increased morbidity, length of hospital stay, anxiety, and costs. Three hundred patients scheduled for abdominal surgery due to various benign gynecological pathologies were randomly assigned to one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in group 1; saline + rifampicin in group 2; saline +10% povidone iodine in group 3. Patients were invited to follow-up once every 10 days in a 30-day period for evaluation. Patients who developed a superficial incisional SSI were recorded. The superficial incisional SSI rate increased significantly with the use of saline alone (p = 0.006). There was no significant difference between saline +10% povidone iodine and saline + rifampicin (p=0.055). The results suggest that the incidence of superficial incisional SSI is significantly reduced when irrigation is performed using rifampicin and povidone-iodine compared with using saline alone.

Çalışmada 24 yazar bulunmaktadır. Bu yazarlardan sadece Bursa Uludağ Üniversitesi mensuplarının girişleri yapılmıştır. Objective: Hypophosphatemic rickets (HR) is a rare renal phosphate-wasting disorder, which is usually X-linked and is commonly caused by PHEX mutations. The treatment and follow-up of HR is challenging due to imperfect treatment options. Methods: Here we present nationwide initial and follow-up data on HR. Results: From 24 centers, 166 patients were included in the study. Genetic analysis (n = 75) showed PHEX mutation in 80% of patients. The mean follow-up period was 6.7 +/- 2.4 years. During the first 3-years of treatment (n = 91), mild increase in phosphate, decrease in alkaline phosphatase and elevation in parathyroid hormone (PTH) levels were detected. The height standard deviation scores were -2.38, -2.77, -2.72, -2.47 at initial, 1st, 2nd and 3rd year of treatment, respectively (p > 0.05). On follow-up 36% of the patients showed complete or significant improvement in leg deformities and these patients had similar phosphate levels at presentation with better levels in 1st and 2nd years of treatment; even the treatment doses of phosphate were similar. Furthermore, 27 patients developed nephrocalcinosis (NC), the patients showed no difference in biochemical differences at presentation and follow-up, but 3rd year Pill was higher. However, higher treatment doses of phosphate and calcitriol were Found in the NC group. Conclusion: HR treatment and follow-up is challenging and our results showed higher treatment doses were associated with NC without any change in serum phosphate levels, suggesting that giving higher doses led to increased phosphaturia, probably through stimulation of fibroblast growth factor 23. However, higher calcitriol doses could improve bone deformities. Safer and more efficacious therapies are needed.

WOS: 000478163600001, PubMed: 31352843, Intravenous leiomyomatosis (IVL) is a variant of leiomyoma characterised by intravascular proliferation and originates from the uterine mesoderm. The main pathogenesis of IVL has not been exactly assessed, yet (Xu et al. 2013; Li et al. 2014). There are two main theories; the first one is: a tumour arises from the walls of venous structures and the second one is: a primary tumour (e.g. myoma) directly spreads into adjacent small venouses (Moniaga and Randall 2012). The early studies have reported an incidence of 0.25–0.41% of IVL in patients with uterine fibroid tumours (Ma et al. 2016; Low et al. 2017). Here, we presented a case suspected of IVL during the operation; although it was reported as uterine sarcoma and vena cava inferior thrombus on radiological imaging methods, pre-operation.

Purpose: To investigate whether diabetes mellitus (DM) affects ocular surface of children with well-controlled type 1 DM. Methods: Sixty-five diabetic patients and 55 age-matched controls enrolled to study. Detailed ocular surface assessment including, ocular surface disease index (OSDI) questionnaire, tear film break-up time (TBUT) analysis, Schirmer test, and conjunctival impression cytologic analysis were performed. Results: Schirmer test and TBUT results were significantly lower in DM group than controls (p = 0.001, for all). OSDI scores of all participants were within normal range. Impression cytology analysis showed grade 0 changes in all participants and there was no difference between groups for goblet cell density (p > 0.05). The TBUT results were significantly associated with duration of DM (r = ?0.309, p = 0.036). Conclusion: Diabetic children without symptoms, signs, and definite diagnosis of dry eye still had lower TBUT and Schirmer test results than controls; however, impression cytology analysis was similar in both groups. © 2019, © 2019 Taylor & Francis Group, LLC.

There are few data on the effects of low hemoglobine levels on the left atrium (LA) in anemic patients. Our aim was to evaluate left atrial (LA) volume and functions in anemic patients using real time three-dimensional echocardiography (RT3DE) and also to investigate changes in variables of LA after the correction of anemia. In total, 55 iron-deficiency anemia patients without traditional cardiovascular (CV) risk factors and 30 age- and gender-matched controls were studied. Assessments included history, physical examination and echocardiography. Of the 55 patients with anemia enrolled, 50 (39 females and 11 males 40.3 years) were followed and underwent echocardiography after correction of the anemia. LA maximum volume (LAVmax), LA minimal volume (LAVmin), LAVmax index (LAVI), before atrial contraction volume (LAVpreA), LA total emptying fraction, LA active emptying volume were higher in anemic patients. LA passive emptying fraction was significantly lower in anemic patients. Following correction of anemia, LA volume and function parameters were observed to be significantly reduced. Moreover, significant increase was noted in LA passive emptying fraction. Correlation analysis was performed and a significant negative correlation was noted between the percentage change in hemoglobin level and percentage change in LAVI (r = − 0.382, p = 0.003). It was shown that volume and functions of LA are impaired in anemic patients. However impaired parameters were improved after correction of anemia. It may be thought that RT3DE LA parameters can be used as an important preclinical marker of disease pathogenesis before developing heart failure or atrial arrhythmia.

Extended Summary Objective To evaluate ectopic adrenal cortical tissue (EACT) and identify clinical, pathological and radiological aspects. Study design Retrospective review of pathology reports in a single tertiary institution between 2010 and 2020 was conducted. Patients diagnosed with EACT were included for analysis. Demographic characteristics, accompanying pathologies and clinicopathological and radiological findings of these patients were analyzed. Results There was a total of 17 patients in the cohort. Fifteen were boys and 2 were adults (1 male). The mean diameter of the EACT nodule was 0.25 cm (range 0.2–0.5 cm). All EACTs were incidentally diagnosed. Seven EACTs were diagnosed during an inguinal hernia repair, 6 during orchidopexy, 1 during partial orchiectomy, 2 during orchiectomy and 1 during hysterectomy and bilateral salpingoophorectomy due to uterine prolapse. Discussion EACT is a rare entity that is mostly found incidentally during inguinoscrotal interventions. Radiological discrimination of EACT may not be easy and thus, not detected prior to surgery. Clinical significance of EACT is not very well understood, however it tends to be a benign pathology. Although it is more commonly found in children, adults may present with EACT, as well. Conclusion A tiny yellowish nodule detected in the inguinoscrotal region should be suspected for EACT by pediatric urologists, surgeons, and pathologists.

The aim of this study was to evaluate the relationship between the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score and left ventricular end-diastolic pressure (LVEDP) measured with an invasive method and with speckle-tracking echocardiography (STE).The study included 124 patients who underwent cardiac catheterization. LVEDP values and coronary images were obtained for all patients. SYNTAX scores were calculated and separated into three tertiles (SYNTAX = 0, SYNTAX 22, and SYNTAX 22). Standard echocardiography and STE were performed on all the patients. Peak LA strain (LAs strain) in ventricular end-systole and LA strain during LA contraction (LAa strain) values were obtained with STE.In univariate analysis, a strong correlation was observed between the SYNTAX score and LAs strain and a moderate correlation with LAa strain. A moderate correlation was also found between both LAs strain and LAa strain and LVEDP. In multiple regression analysis, LAs strain and LVEDP were observed to be independent predictors of SYNTAX score.LAs strain and LVEDP were observed to be independent predictors of SYNTAX scores. The relationship between LAs strain, LVEDP, and SYNTAX score could be useful in clinical practice.

Objective: We recently described the CHA2DS2-VASc-HS score as a novel predictor of coronary artery disease (CAD) severity in stable CAD patients. We aimed to assess the accuracy of the CHA2DS2-VASc-HS score in the determination of CAD severity and complexity and its availability in the risk stratification of in-hospital major adverse cardiovascular events (MACE) in non-ST elevation acute coronary syndrome (NSTE-ACS) patients. Methods: We prospectively analyzed the clinical and angiographic data of consecutive NSTE-ACS patients in our clinic. Patients were classified into three tertiles according to their SYNTAX score (SS): tertile 1 had an SS of 0–22; tertile 2 had an SS of 23–32; and tertile 3 had an SS of >32. There were no specific exclusion criteria except for previous coronary artery bypass grafting (CABG) because SS was validated for only native coronary arteries for this study. We used the following analyses: χ2 or Fisher’s exact tests, one-way analysis of variance or Kruskal–Wallis tests, Pearson’s or Spearman’s tests, the receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) or C-statistic, and pairwise comparisons of the ROC curves. Results: A total of 252 patients were enrolled. There were 131 patients in tertile 1, 79 in tertile 2, and 42 in tertile 3. The number of diseased vessels was correlated with the Global Registry for Acute Coronary Events (GRACE) (p5 with a sensitivity of 69.6% and specificity of 90.3% (AUC: 0.804, 95%: CI 0.750–0.851, p

Uterine perforation after first trimester dilatation and curettage is a rare complication (Kaali et al. 1989; Chen et al. 1995). Large defects in the uterine wall or injury to other intra-abdominal organs can result in serious problems and require immediate surgical treatment (Augustin et al. 2013; Counghlin et al. 2013). Small perforations usually resolve on their own without any complications. The implantation and growth of trophoblastic tissue along the perforation site is a very rare entity (Lam et al. 2002; Pascual et al. 2003). This situation can be confused with benign or malignant processes. We describe two cases that were diagnosed with retained trophoblastic tissue in the myometrium after first-trimester dilatation and curettage.

OBJECTIVE: Atrial fibrillation (AF) is the most common cardiac rhythm disorder with the associated risks of stroke and mortality. The usefulness of platelet to lymphocyte ratio (PLR), a recently described inflammatory marker, in predicting adverse cardiovascular events has been demonstrated in several studies. In the current study, we investigated the role of PLR in predicting recurrence after successful electrical cardioversion (ECV) in patients with non‐valvular persistent AF. METHODS: A total of 287 patients with non‐valvular persistent AF achieving restoration of the sinus rhythm after successful ECV were included in this study. At study entry, complete blood count, routine biochemistry tests, and transthoracic echocardiography (TTE) were performed routinely in all subjects. Patients were followed up for 6 months following the procedure and comparisons were performed between patients who recurred and who maintained the sinus rhythm (SR). RESULTS: At 6 months of follow‐up, AF recurred in 108 patients, corresponding to a recurrence rate of 39%. Mean PLR values in the “AF recurrence group” (mean age 57.4 ± 12.0 years, 47.6% [n = 80] female) and in “SR maintenance” group (mean age 65.0 ± 9.4 years, 55.6% [n = 60] female) were 184.8 ± 44.2 and 103.3 ± 44.2, respectively, with a significant difference between the two groups (p

OBJECTIVE Smoking is a known risk factor for cardiovascular diseases and may cause myocardial damage independently of coronary artery disease. Fragmented QRS (fQRS) is an important marker of myocardial fibrosis, while speckle-tracking echocardiography is a method used to show subclinical left ventricle dysfunction. METHODS Our study included 230 healthy individuals aged 18-40 years. The patients included were separated into two groups: those smokers (n = 130) and non-smokers (n = 100). After that healthy smokers group were divided into two groups: those with fQRS (n = 24) and those without (n = 106). In both groups, the arithmetic mean of three images was used to obtain the left ventricle global longitudinal strain (LV-GLS). The E/SRe ratio was also calculated and analyzed. RESULTS There were significant differences between the smokers and non-smokers in terms of, E/SRe (55.7 ± 17.9 vs 50.3 ± 14.8; P = 0.015), LV-GLS (23.1 ± 1.9 vs 24.0 ± 1.7; P = 0.001), and fQRS (18.5% vs 6%; P = 0.005). As a result of subgroup analysis, pack-year history was higher in the fQRS positive group (16.7 ± 3.7 vs 11.2 ± 3.7, P

Tuberculosis continues to be a major health problem worldwide. Multidrug resistant tuberculosis (MDR-TB) infection that occurs in childhood is caused by adult MDR-TB agents which are in circulation and resistant to primary drugs. In this case report a 17-month-old child with MDR-TB who was cured after a 24-month therapy regimen was presented. Physical examination of a 17-month-old girl admitted to the hospital with the cause of recurrent pneumonia revealed a rubbery lymphadenopathy less than 2 cm in the right upper cervical region. Crepitant rales were detected in the right basal on auscultation of the lung. Interferon gamma release assay (IGRA) and tuberculin skin (TST) tests were negative. Computed tomography (CT) scan of the chest showed mediastinal conglomerate pathologic lymphadenopathy and air bronchograms were detected near the lower lobe of the left lung. Treatment of isoniazid, rifampicin, pyrazinamide with the diagnosis of epituberculosis was started by taking a sample of gastric aspirate culture sample. In the sixth month of the treatment patient was admitted to our clinic with enlarged cervical rubbery lymphadenopathy. It was determined that microbiological test of gastric aspirate culture specimen was positive for M.tuberculosis complex resistant to isoniazid, rifampin, ethambutol, streptomycin, ethionamide and rifabutin. Control CT showed residual peribronchial infiltrations and hilar calcific lymph nodes. Hearing test, vision control and, thyroid function tests were performed and treatment of moxifloxacin, amikacin, para-amino salicylic acid, protionamide and pyrazinamide was started based on minor drug susceptibility results of M.tuberculosis isolate which was still growing in gastric aspirate culture. Gastric aspirate culture for M.tuberculosis was still positive after 3 months of treatment and the current treatment was continued. Amikacin was stopped after 6 months. Therapy regimen was stopped after 24-months. Over the course of a follow-up period of more than 3 years, the clinical and radiological resultsof the patient has improved significantly. The clinical presentation of TB in children is often nonspecific and differs from the patterns seen in adults. MDR-TB cases can be seen in this age group since tuberculosis in children is mainly caused by transmission of drug-resistant strains from adults. This situation is particularly problematic due to the long-term treatment and the lack of specific drug formulations for children.

To investigate the effects of acute hypovolemia induced by blood donation on the eye. Methods or Study Design: This prospective, observational study included a single eye from each of 48 healthy men between 20 and 40 years of age who had donated 500 ml of blood and 28 eyes of 28 healthy, age- and gender-matched control subjects. The ocular parameters including ocular perfusion pressure (OPP), intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), choroidal and retinal thicknesses, and retinal nerve fiber layer (RNFL) were measured before blood donation and at 10 min and 1, 2, 3, and 4 h after blood donation.The mean OPP was significantly reduced following blood donation (baseline, 43.4 ± 4.9 vs. 40.8 ± 4.6 mmHg; p = 0.003). The mean subfoveal choroidal thickness (SFCT) was measured as 322.96 ± 76.23, 291.63 ± 77.85, 309.77 ± 75.72, 312.31 ± 75.98, 315.73 ± 75.43, and 317.75 ± 75.73 µm before blood donation, at baseline, 10 min, and 1, 2, 3, and 4 h following donation, respectively [F(2.462, 115.731) = 22.618, p 0.001]. In the control group, the SFCT was measured as 302.04 ± 32.04, 301.43 ± 35.16, 298.07 ± 37.33, 298.96 ± 39.17, 302.54 ± 39.24, and 301.61 ± 40.41 µm at baseline, 10 min, and 1, 2, 3, and 4 h following donation, respectively [F(2.124, 57.340) = 0.592, p = 0.566]. There was no difference in AL, CCT, RNFL, retinal thicknesses, and IOP measurements performed before and after blood donation (p 0.05).Acute hypovolemia caused a significant reduction in SFCT which persisted for 3 h. This study may pave way for better understanding of choroidal thickness changes in disease states.

This study assessed the clinical significance of endometrial fluid collection (EFC) in asymptomatic postmenopausal women.A total of 564 postmenopausal females were enrolled into this retrospective study, of whom 141, with EFC, comprised the study group; the remaining 423 postmenopausal women (the three consecutive patients) who had been admitted to the menopause outpatient clinic for their routine annual check formed the control group. Data, including age, gravidity, parity, body mass index, hypertension, diabetes mellitus, menopause duration, endometrial thickness and histopathological endometrium results, were compared between groups using the SPSS for Windows software package (version 15.0; SPSS Inc., Chicago, IL, USA).There were no significant group differences in gravidity, parity, body mass index, rates of hypertension and diabetes mellitus, endometrial thickness or histopathological endometrium results. However, there were group differences in age (62.0 ± 7.6 vs. 57.2 ± 8.9 years, p0.001) and menopause duration (13.4 ± 7.8 vs. 7.9 ± 5.4 years, p0.001).The results indicate that EFC in asymptomatic postmenopausal women is a benign condition, influenced by older age and commensurately longer menopause duration due to a lack of hormonal stimulation. The presence of EFC by itself does not affect the decision to provide further evaluation; that is determined by the presence of confirmed risk factors (e.g. thickened endometrial stripe). However, further studies are needed to assess any long-term prognostic impact of this finding.

Triple A syndrome (TAS) or Allgrove syndrome (OMIM #231550) is a rare autosomal recessive disorder characterised by adrenocorticotropic hormone-resistant adrenal insufficiency, alacrima, achalasia, and neurological and dermatological abnormalities. Mutations in the AAAS gene on chromosome 12q13 encoding the nuclear pore protein ALADIN have been reported in these patients. Between 2006 and 2017, we evaluated six patients with a clinical diagnosis of TAS, based on the presence of at least two symptoms, usually adrenal insufficiency and alacrima. In all cases, genetic analysis revealed homozygous mutations in the AAAS gene. One novel mutation was detected: a homozygous 10-bp deletion (c.1264_1273del, p.Q422NfsX126) in exon 14 of the AAAS gene that caused a frameshift that introduced an aberrant stop codon after 126 amino acids. This genetic variant is likely to be pathogenic because it caused a significant change in protein structure. A precise genotype-phenotype correlation was impossible to establish.Based on our experience, we recommend that molecular analysis should be performed in the presence of alacrima and at least one more symptom of TAS. Our cases share many clinical features of TAS and underline the variability in this syndrome, as well as the need for thorough investigation following a multidisciplinary approach. What is known: • Triple A syndrome is characterised by achalasia, alacrima, adrenal insufficiency, neurological impairment, and dermatological abnormalities. • A precise genotype-phenotype correlation has proved impossible to establish. What is new: • These cases add to a large number of similar case reports with limited novel information. • The newly identified AAAS gene mutation was reported.

Objective In the present study, we investigated the effectiveness and reliability of a new method that reveals whether guidewire advanced distal to the lesion is in the lumen in patients with acute (ATO) or chronic coronary total occlusion (CTO). Methods Forty-one patients with symptomatic ATO and 22 patients with CTO who were admitted into our catheterization laboratory between January 2016 and March 2017 were included. In patients in whom antegrade filling could not be demonstrated after passing 0.014″ guidewire beyond the total lesion, a 1.25 × 15 mm balloon was punctured with a needle outside the operative field to visualize the total lesion. This perforated balloon was then used to deliver an opaque substance through this hole to visualize the distal part. Results The mean age of our 63 patients was 66 ± 12 years. They had diabetes (57%), hypertension (100%), and a history of PCI (85%). The mean procedural time was 27 ± 6.8 min, and the mean volume of contrast material used was 93.9 ± 24 mL. This technique was 100% successful in accurately demonstrating the distal lumen and preventing complications. Conclusion This new method we developed is much simpler and more useful than other methods for visualization of the true lumen because we can re-orient the balloon at the time of opaque injection and use 190 cm guidewire without additional costs. Additionally, one balloon is sufficient for the operation.

To investigate whether abnormal glucose metabolism and duration of diabetes mellitus (DM) affected the corneal and lens clarity in children with well-controlled type 1 DM and to compare the results obtained with those in healthy children.Cross-sectional prospective study.This multicenter study enrolled 56 patients with DM and 51 control subjects. The duration of DM and the glycosylated hemoglobin (HbA1c) levels of the patients in the DM group were recorded. The Pentacam HR imaging system was used for corneal densitometry (12-mm corneal diameter) measurements. Furthermore, the lens densitometry and lens thickness (LT) measurements were performed after dilation of the pupils, using the same Pentacam HR device.The corneal densitometry values were similar in all concentric zones and layers in both groups (P.05, for all). The mean values of the average and maximum lens densitometry measurements of the 2 groups, as well as the mean LT values, were statistically significantly different (P = .021, P = .011, and P.001, respectively). There were statistically significant correlations between the lens densitometry values and the duration of DM (P.05, for all). Conversely, no statistically significant relationship was found between the lens densitometry values and HbA1c levels (r = 0.743; P = .084).The children with type 1 DM had decreased lens clarity and increased LT, even in cases of well-controlled DM, without DR. It is reasonable to think that these changes might have been caused by the type 1 DM.