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Fabry disease (FD) is associated with inflammation, proteinuria, and chronic kidney disease. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) plays an important role in inflammation in diabetic nephropathy and lupus nephritis. Since there is a close relationship linking serum TWEAK (sTWEAK), inflammation, and carotid intima-media thickness (CIMT) in various kidney diseases, we aimed to determine the relationship between sTWEAK levels and CIMT in subjects with and without proteinuria in a cross-sectional study involving 15 FD patients (seven females, eight males) and seven healthy controls (four females, three males). There were no differences in age, sex, estimated glomerular filtration rate, and biochemical parameters (serum glucose, albumin, creatinine, uric acid, C-reactive protein (CRP), low-density lipoprotein, and high-density lipoprotein) between FD patients and healthy controls. The spot urine protein-creatinine ratios of healthy controls and FD patients were 90 mg/g and 185 mg/g, respectively (P = 0.022). STWEAK levels were higher in FD patients than in healthy controls (P = 0.007). The CIMT of FD patients and healthy controls was 0.55 ± 0.14 mm and 0.42 ± 0.04 mm, respectively (P = 0.007). STWEAK was positively correlated with CRP and CIMT, and negatively with proteinuria (P = 0.005, P = 0.013, and P = 0.018, respectively). In the multivariate analysis, only sTWEAK was an independent variable of increased CIMT. We demonstrated that sTWEAK and CIMT were increased in FD patients. STWEAK might have a role in the pathogenesis of subclinical atherosclerosis in FD.

Aim:Coronavirus disease-2019 (COVID-19) pneumonia is characterized by a clinical picture showing similar features in severe patients. Some studies evaluate the pathophysiology, prognosis, and treatment of COVID-19 pneumonia. Different laboratory tests have been used to assess the severity and prognosis of rigorously ill COVID-19 patients in addition to clinical and radiological findings. There is no precise indicator for predicting prognosis. We aimed to analyze disease severity by using extracellular water (ECW) measurements.Methods:Extracellular water values and cardiac parameters as cardiac output (CO), and stroke volume (SV) measurements of patients were performed using a non-invasive, easy-to-use, validated device non-invasive cardiac system (NICaS) within the first 2 h after admission. Hemodynamic parameters and ECW values were measured by connecting the NICaS device to make 12 measurements for 2 h at 5 min intervals during admission to service and intensive care patients.Results:Comparing the ward and intensive care groups, there was not any statistically significant difference found between demographic data and ECW, SV, and CO measurements.Conclusion:Although we could not find a statistically significant difference between our measurements, we believe that the NICaS device can play a significant role in the fluid treatment of COVID-19 patients.

Key Clinical Message Arteriovenous malformations (AVM) are extremely rare on the face and especially on the lip. Lip can be more easily exposed to traumas due to their anatomical location. Especially superficial AV malformations are very susceptible to trauma and can bleed very seriously after being exposed to such effects. AVMs management generally based on their hemodynamic characteristics and growth modalities. The surgical treatment requires elaborate planning and multidisciplinary approach. When evaluating a mass with a clinical manifestation of lip swelling, ruling out a vascular anomaly before any intervention is also crucial. Abstract Arteriovenous malformations (AVM) are abnormal fistulas between an artery and a vein, without an intervening capillary bed. AVM may occur everywhere in the body, with the brain being of particular concern, as AVM can be complicated by bleeding. Herein, we present the case of a patient with a very atypical AVM location consisting of a lip mass. Given the possibility of hemorrhage and airway obstruction, early detection and timely intervention are mandatory.

Abstract As in many countries, there is neither a surveillance system nor a study to reveal the hemodialysis (HD) related infection rates in Turkey. We aimed to investigate the infection rate among HD outpatients and implement CDC’s surveillance system. A multicenter prospective surveillance study is performed to investigate the infection rate among HD patients. CDC National Healthcare Safety Network (NHSN) dialysis event (DE) protocol is adopted for definitions and reporting. During April 2016–April 2018, 9 centers reported data. A total of 199 DEs reported in 10,035 patient-months, and the overall DE rate was 1.98 per 100 patient-months. Risk of blood culture positivity is found to be 17.6 times higher when hemodialysis was through a tunneled catheter than through an arteriovenous fistula. DE rate was significantly lower in patients educated about the care of their vascular access site. Staphylococcus aureus was the most causative microorganism among mortal patients. Outcomes of DEs were hospitalization (73%), loss of vascular access (18.2%), and death (7.7%). This first surveillance study revealed the baseline status of HD related infections in Turkey and showed that CDC National Healthcare Safety Network (NHSN) DE surveillance system can be easily implemented even in a high workload dialysis unit and be adopted as a nationwide DE surveillance program.

Abstract Background The self-video feedback method may have the potential to provide a low-cost alternative to physician-driven simulation-based training. This study aimed to assess the utility of two video feedback methods by comparing the improvement in performing cricothyroidotomy procedure following self video feedback (trainees review their performance by themselves) and expert-assisted video feedback (trainees review their performance while an emergency physician provides additional feedback). Methods This study was pretest-posttest and two-group designed research performed at a university simulation center with 89 final-year medical students and used a cricothyroidotomy simulation model. After seeing an educational presentation and a best practice video, trainees were randomized into two groups; self video feedback group (SVFG) and expert-assisted video feedback group (EVFG). They performed the cricothyroidotomy before and after the feedback. The procedures were also recorded and scored by two emergency physicians. Results There was a statistically significant improvement between pre-feedback and post-feedback assessments in terms of scores received and time needed for the procedures in both SVFG and EVFG groups (p

Objective. This study aims to compare two different methods of regional anesthesia applied for knee arthroscopy in terms of patient and surgeon satisfaction. Materials and Methods. Eighty patients who underwent knee arthroscopy either with spinal anesthesia (SA) or unilateral sciatic and femoral nerve block (SFNB) were included in the study. A nurse conducted a blind study questionnaire to assess the surgeon and patient satisfaction from anesthesia performed at the end of the surgery. Pain score, demographical data, duration of surgery, motor and sensory block duration, time of first rescue analgesia were recorded and analyzed statistically. Results. A statistically significant difference was found between the patient (p = 0.001; p

Abstract Background Integration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns’ patient management skills, ethical decision-making, and reflection skills. Methods A multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists. Multiple educational techniques involving lectures, case discussions, and role-playing a crisis scenario were applied. Pre-test and post-test, debriefing on performances on video records, video-recorded performance assessment, and reflective essays about their own and group’s performances were used to assess various aspects of the student performances. Additionally, a meeting was organized with the presence of the authors to create qualitative data obtained through the program evaluation meeting conducted on three themes: influences of teaching methods, students’ performances, and common achievements and mistakes of students. Results 133 students participated. Post-test multiple-choice question (MCQ) test scores were slightly higher than pre-test. A low and medium correlation was detected among pre-test and post-test patient management problem (PMP) and reflection scores, which was more prominent for female students. Multiple linear regression showed that pre-test and post-test PMP scores significantly contributed to reflection scores. These results might support that better patient management predicts more robust reflective practice. Teachers observed that students appreciated being inspired by well-performing peers, particularly noting the empathic needs of patients, companions, and other health professionals. However, students overlooked summoning forensic or social services and were inhibited by the pressure of the contextual traits of the drill. Conclusion The multimodal learning environment created by multidisciplinary collaboration contributed to the improvement of components of situational awareness of the interns: patient management skills, ethical decision-making, and reflective practice. During this research, we created a toolbox better to capture the richness and diversity of student interactions. Considering the scarcity of context-specific assessment methods and widespread use of MCQs or generic scales for higher-order thinking skills in medicine, this study might be regarded as a step forward in that context.

Abstract Symptoms of autonomic dysfunction are common in Fabry disease. In this study we aimed to evaluate alterations in the pupillary response to white light stimulation in patients with Fabry disease and their association with the severity of autonomic symptoms. Fourteen consecutive patients with Fabry disease and 14 healthy control participants were enrolled in this cross-sectional study. The Mainz Severity Score Index (MSSI) was used to measure the severity of Fabry disease and the Composite Autonomic Symptom Scale 31 (COMPASS 31) questionnaire was used to evaluate the severity of autonomic symptoms. The pupil light responses were assessed with an infrared dynamic pupillometry unit. There were significant reductions in the amplitude (P = 0.048) and duration (P = 0.048) of pupil contraction, and the latency of pupil dilation (P = 0.048) in patients with Fabry disease compared to control subjects. The total weighted COMPASS 31 score correlated with MSSI (r = 0.592; P = 0.026) and the duration of pupil dilation (ρ = 0.561; P = 0.037). The pupillomotor weighted sub-score of the COMPASS 31 correlated inversely with the duration of pupil contraction (r = − 0.600; P = 0.023) and latency of pupil dilation (ρ = − 0.541; P = 0.046), and directly with the duration of pupil dilation (ρ = 0.877; P

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by skin and joint involvement. The disease may present with various joint pattern involvement, which sometimes may lead to joint destruction and deformity. Early diagnosis and treatment with disease-modifying anti-rheumatic drugs may prevent joint deformity. Recently there are many new treatment options including biologic drugs. Ustekinumab, an interleukin 12/23 inhibitor, has proven efficacy in the treatment of psoriatic arthritis. Like other biologic drugs (anti-TNF-), there are contradictory data about the safety of ustekinumab and possible relationship with cancer development. Herein we report the development of chronic lymphocytic leukemia in a patient with PsA treated with ustekinumab.

Kidney donor profile index (KDPI) is a method developed to assess donor kidney quality for cadaveric transplants. We investigated the relationship between kidney donor risk index (KDRI) and KDPI scores of cadaveric transplants in the last five years in our clinic and current graft conditions. Forty people (12 females, 28 males; mean age, 46.35 + 8.94 years), who underwent cadaveric transplantation between January 2013 and March 2018, were participated in this study. At the same time, the KPDI and KDRI scores of the donor’s kidneys were calculated and then compared with that of the recipients’ data. The mean KDRI value of donors was 1.11 ± 0.33 and the median KDPI value was 60.50%. KDRI/KDPI scores were found to be high in women (P = 0.021) and, when the posttransplant findings of the recipients were evaluated by bivariate correlation analysis KDRI/KDPI scores were positively correlated with the day when creatinine (Cr) values started to fall off spontaneously (r = 0.457, P = 0.003). It was observed that recipients who were transplanted from the donors with high KDRI/KDPI scores had higher Cr levels (P

Endothelial cell dysfunction proceeding with increased inflammation and monocyte increase is one of the main causes of vessel injury in CAD. SIRT1 (Sirtuin 1) protein plays an important role in the regulation of cellular physiological mechanisms. SIRT1 has roles in regulating angiogenesis and preventing endothelial dysfunction and reperfusion injury due to ischemia. Suppression of SIRT1 causes monocyte affinity due to endothelial dysfunction. Sirtuins activators are involved in pathologies of many diseases with promising treatments. The objective of this review is to summarize the current progress and future directions of sirtuin protein in the field of CAD.

A significant decrease in late diagnosis and requirement for surgical treatment have been observed due to the implementation of the National Developmental Hip Dysplasia (DDH) Early Diagnosis and Treatment Program, which has been in existence for about 10 years. However, patients with delayed diagnosis are still admitted to our clinic for treatment. In this study, we aimed to evaluate the effectiveness of this program and reveal its deficiencies. Patients and methods: Sixty-one patients diagnosed or treated for ddh later than six months of life were included in the study. Patients born between 2011 and 2014 (Group 1) and between 2015 and 2018, during which time the early screening program was performed intensively (Group 2), were compared. The patients risk factors, whether a hip ultrasound (US) was performed, and the reasons for the delay in diagnosis and treatment were questioned retrospectively. The number of DDH patients in Group 2 decreased by approximately 3 times (45/16) (p = 0.0009). Although 37 (61%) patients had a hip US assessment within the first 6 months, their treatment was delayed, and normal USs were reported for 20 (33%) of them. Hip US was not performed in 24 (39%) patients within the first 6 months. The number of late-diagnosed and -treated babies with DDH decreased significantly in recent years, but this is not sufficient. Preventing late diagnoses should be the main goal. This study detected families negligence and lack of information, family physicians non-compliance with the program, and improper US assessment as the confounding reasons. [Med-Science 2020; 9(4.000): 1023-6]

Vasospasm following subarachnoid haemorrhage (SAH) is a process yet to be fully clarified in terms of its aetiology and results. According to one of the many theories about vasospasm developing after SAH, the process results from an increase of pro-inflammatory agents and decrease in antioxidant agents. Other hand experimental studies on rats found a significant decrease in the pro-inflammatory parameters TNF-α and IL-1β in the blood values obtained after the use of sertraline. In this study, the findings regarding the effectiveness of sertraline in the treatment of vasospasm developing an experimental SAH model are presented. In this study, adult males of Spraque-Dawley breed, not used in any previous study and weighing between 250350 g, were used. Rats were divided into 4 groups with the control group (n=5) and other groups (n=6 in each). Group 1 was the control, and Group 3 was the sertraline group. In Groups 2 and 4, SAH was initiated by giving rats autologous arterial blood in the cisterna magna. The tissues were examined in terms of mononuclear cell infiltration, vascular congestion, and neuron degeneration. In the experimental SAH model based on these values, it was found that the use of sertraline significantly reduced mononuclear cell infiltration, vascular congestion, and neuron degeneration. Moreover, in animal studies, it was shown that SSRIs increased neurogenesis and release of neurotrophins from the hippocampus. In our study, it was concluded that sertraline was effective in dissolving vasospasm in the experimental SAH model. However, we further believe that more experimental studies to investigate other SSRI compounds of the same family can contribute to the knowledge and understanding of this process. [Med-Science 2020; 9(4.000): 817-22]

Abstract In this case report, we presented a case of myocarditis as a rare complication that developed after Covid mRNA‐1273 vaccine. Cases of post‐vaccine myocarditis usually progress with mild symptoms. However, it should be a situation that healthcare workers should keep in mind, that myocarditis may develop after vaccination.

Coronary artery disease (CAD) is one of the severe diseases that may cause significant moral and financial burden on society today. There are many studies in the literature on whether psychiatric disorders may cause CAD or an increase in prevalence after CAD. Although many studies have emphasized the importance of early diagnosis and treatment of depression in CAD patients, clinicians do not attach much attention to depression in daily practice. Several scales have been developed that are comfortable to use to describe anxiety and depression in CAD patients. High depression and anxiety scores predicted by psychological symptom scales following CAD treatment are closely related to treatment success and prognosis of the CAD. We believe that patients with CAD should be followed carefully for the diagnosis of depression and anxiety disorders; since the treatment of them may improve the prognosis of CAD.

Quality of life in pregnancy plays a key role in maternal healthcare. This study sought to determine the effects of sociodemographic characteristics, maternal risk factors and pregnancy complaints on pregnant womens quality of life. This descriptive study assessed the quality of life of 327 pregnant women using the short form of the World Health Organizations Quality of Life Assessment in conjunction with a questionnaire about sociodemographic and obstetric characteristics. Results were statistically analyzed using Independent Samples t-tests, Kruskal Wallis Variance Analysis, the Mann-Whitney U test and multiple regression analysis. Physical symptoms of pregnancy, such as fatigue, constipation, dizziness and frequent urination, decreased womens physical quality of life. Caesarean deliveries, higher spousal education levels and fewer children were significantly correlated with a higher environmental quality of life. Poor social quality of life was correlated with a history of mental illness and lower education levels (p [Med-Science 2020; 9(3.000): 549-55]

The aim of this study was to examine the frequency, origin, histopathology, and risk factors of PE, the vascular characteristics causing obstruction and the direct or indirect effect on mortality. A retrospective examination was made of autopsies conducted between 2013 and 2016 in the Malatya Forensic Medicine Group Directorate. Cases determined with PE were evaluated in respect of age, gender, event origin, risk factors, history of hospitalization, size of the vessels obstructed by the thromboembolism and histopathological examination. Pulmonary embolism is a frequently seen complication during hospitalization and is one of the leading causes of preventable hospital deaths. When advanced diagnostic methods are used, deep vein thrombosis is determined in 79% of PE patients. The annual incidence in Turkey is approximately 15/10,000 cases, which is comparable to rates in western populations. Although PE is seen more at advanced ages, attention must be paid to young cases with trauma-related injuries. Histopathological examination is of the greatest importance as the mortality rate associated with large vessel obstruction is high and obstructions in small vessels alone also contribute to mortality. [Med-Science 2020; 9(3.000): 569-72]

INTRODUCTION: Clomiphene (diethylethanamine structure) is an anti-estrogen agent that is often used for ovulation induction in the treatment of infertility. Tamoxifen, another anti-estrogen agent of similar chemical structure, has been shown to prolong the QT distance. The aim of this study was to evaluate superficial ECG changes and especially QT, QTc and Tp-e intervals in patients under clomiphene treatment. METHODS: Forty-two female patients were included in the study. Clomiphene citrate 50 mg daily for 5 days was started on the day of cycle 3-7. The electrocardiograms of the patients were reached before treatment and on the day of peak luteinizing hormone increase. QRS duration, QTc interval, Tp-e, Tp-e / QT ratio and Tp-e / QTc ratio analysis were performed with MATLAB program in digital environment. Paired sample T and Wilcoxen Sum Rank test were used. RESULTS: When the basal level and post-treatment values were compared, no significant difference was observed in terms of Tp-e interval, QTc interval, QRS duration, Tp-e / QT and Tp-e / QTc ratio. Basal level versus clomiphene citrate values; Tp-e: 95.90 +- 19.50 milliseconds [ms] versus 103.30 +- 16.55 ms, QTc: 460.25 +- 30.08 ms to 430.52 +- 25.19 ms, QRS duration: 102.10 +- 14.98 ms to 109.70 +- 13.61 ms, Tp-e / QT: 0.24 +- 0.04 versus 0.25 +- 0.02, Tp-e / QTc: 0.20 +- 0.03 versus 0.21 +- 0.02 (p> 0.05). DISCUSSION AND CONCLUSION: Our study showed that clomiphene citrate had no effect on QT distance, did not carry increased proarrhythmic risk and could be used safely in ovulation induction.

INTRODUCTION: Contrast induced nephropathy (CIN) may arise after the use of contrast agents. Estimating of real glomerular filtration rate (GFR) is very important in order to prevent CIN. The most used GFR estimating equations are Cockroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) but their superiority to each other is unknown in contrast media used patients. METHODS: : Total of 165 patients enrolled to our study. Serum urea, creatinine and cystatin C levels of all patients were measured just before and fifth day of coronary angiography/angioplasty procedure. Alteration in serum cystatin C level was accepted as reference and GFR changes according to both equations were compared with serum cystatin C level variations. RESULTS: Decreased GFR values according to both formulas were related with an increasing in serum cystatin C levels (p¬=0.042). However, there wasn't any superiority of formulas to each other in terms of GFR alterations (r¬= -.276 and r= -.275 for CG and MDRD equations respectively). DISCUSSION AND CONCLUSION: Both CG and MDRD equations are useful to detect the GFR changes in coronary angiography performed patients and there was not superiority of them to each other. To our knowledge, this is a first study about the comparison of MDRD and CG equations in coronary artery visualized patients.

Cardiac troponin is the preferred biomarker for the diagnosis of the acute coronary syndrome (ACS), but many other diseases can be identified with elevated troponin levels in the absence of ACS. The recent development of a high-sensitive cardiac troponin T (hs-cTnT) assay permits the detection of very low levels of cTnT. The use of hs-cTnT assay has emerged as a tool for identifying high-risk individuals for primary preventive treatment and can detect subclinical injury in asymptomatic patients. Hs-cTnT analyses are generally related to ischemia in the literature. Thus, we made an evaluation of hs-cTnT analysis in non-coronary patients, which may contribute to the literature.

OBJECTIVE: In this study, we analyzed surgico-pathologic factors of mucinous type endometrial carcinoma and examined its frequency of recurrence. METHODS: In this study, eleven cases, definitely diagnosed as pure mucinous type endometrium carcinoma between January 1993 and May 2013, were reviewed. RESULTS: Of 1640 women with endometrium carcinoma, 11 (0.67%) of them had a mucinous cell type. Mean age of the study group was 55 years. According to the FIGO 2009, 10 (90.9%) cases were evaluated as stage I and 1 (9.1%) as stage IIIC1. The presence of lymph node metastasis was noticed in only one (12.5%) of eight patients who underwent lymphadenectomy. In this case, metastasis was detected in the pelvic lymph node. Four patients underwent adjuvant therapy as pelvic radiotherapy. Median follow-up time was 50 months (range, 5–84). Recurrence was observed in one (9.1%) patient with stage IIIC1 endometrial cancer in 30 months after primary surgery. The site of recurrence was only in the upper abdominal region. CONCLUSION: Based on our study, mucinous endometrial carcinoma has good prognostic factors, and long term survival can be achieved surgically alone in patients with stage I.

Abstract Arteriovenous malformation at the finger and without trauma is a rare condition. Surface‐located arteriovenous malformations are susceptible to trauma. Therefore, they can cause severe bleeding and, such bleeding can seriously endanger the blood supply and circulation of the limb.

Patient satisfaction is an important issue for patients overall health status and perception. Aim of the present study was to evaluate spinal anaesthesia related complications and other factors related with overall satisfaction level and compare satisfaction levels of patients from 3 different regions of Turkey whom underwent caesarean section (CS) procedure under spinal anesthesia. Satisfaction levels of 285 patients underwent caesarean section under spinal anaesthesia were evaluated at postoperative 1st and 3rd days using a questionnaire form. Also perioperative complications and possible correlations between satisfaction levels were investigated. Patients satisfaction levels were not affected by origins of patients. Most of the patients expressed satisfaction after spinal anaesthesia both at 1st and 3rd days postoperatively (82.1% vs 79.6% respectively). Postoperative pain at surgical site, backache and headache were top 3 factors related with decreased patient satisfaction. Also recurrent spinal puncture attempts, painful puncture attempts, inadequate analgesia, postoperative nausea and vomiting were correlated with decreased satisfaction levels (p [Med-Science 2019; 8(4.000): 941-6]

This study investigated the anxiety and depression levels in hospitalized healthy pregnants and pregnants with gestational diabetes mellitus (GDM) before the cesarean section. This case control study included 64 healthy pregnant (control) and 26 pregnants with GDM (case). Patients were assessed with the form of a socio-demographic and clinical characteristic and Hospital Anxiety Depression Scale (HADS). The mean age was 35.5±5.1 years in the case group and 29.4±4.3 in the control group. There was a significant difference between pregnant women with GDM and healthy pregnant in terms of total anxiety, total depression, psychomotor agitation, restlessness, laughing and seeing funny things, and being cheerful. 21% of the pregnant with GDM and 15% of the healthy pregnant had anxiety. Also, 34% of the pregnant with GDM and 23% of the controls had depression. Anxiety and depressive symptoms should be considered for hospitalized pregnant women with GDM before the cesarean section. [Med-Science 2022; 11(2.000): 942-3]

This study was performed to investigate whether there is a relationship between cervical region pain threshold and joint position sense (JPS) in healthy subjects. The subjects were 38 healthy volunteers in the Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department. Pain thresholds in the right and left cervical paravertebral regions of participants were assessed with a digital algometer (Wagner Instruments, Greenwich, USA). The JPS of the cervical region was assessed with the Cervical Range of Motion 3 (CROM 3) device. While the pain thresholds in the left and right cervical paravertebral regions increased, the JPS error levels in the cervical region of the extension direction decreased (right and left cervical paravertebral region p = 0.003 and r = -0.475, p = 0.020 and r = -0.377, respectively). At the end of this study, the position sense error was higher in the participants with a low pain threshold. In participants in which the pain threshold is lower, prematurely stimulated pain receptors can decrease JPS by causing suppression of proprioceptive receptors. JPS should be assessed in individuals who define pain in the neck region. According to the result of this study, it is necessary to improve JPS in patients with neck pain, or healthy individuals who have lower pain threshold may be able to avoid neck pain when they receive appropriate proprioceptive training to improve their JPS. In conclusion, when healthy individuals were included in proprioceptive training, it was observed that neck pain could be prevented in the early period. [Med-Science 2019; 8(1.000): 97-101]

Renal transplantation is the most effective treatment modality for end-stage renal failure. According to the Ministry of Health Organ Transplant Registration System, despite the presence of 14,936 renal transplant recipients in Turkey, there are not enough data about the prognosis of these patients. Therefore, we aimed to ascertain the rate of patients returning to hemodialysis (HD) due to nonfunctioning graft in our country. One thousand four hundred and ninety-eight (males: 826, females: 672) HD patients who undergo HD at 22 HD centers in total, from different geographical regions to represent our country were examined retrospectively. The informations were obtained from patient registry files and anamnesis which were in HD centers. The number of patients returning to HD due to the loss of graft function was 77 (males: 56, females: 21). Eleven of the patients had transplantation from cadavers (14%) and 66 from living donors (86%). Prevelance of patients, who return to HD after the failure of renal transplantation, between HD patients was 5.1. The mean duration of return to HD after renal transplantation was 6.7 ± 5.9 years for all patients. There was no significant difference in the duration without HD after transplantation between two groups when cadaveric and living donor transplants were compared (P = 0.759). There was no statistically significant difference in duration without HD after transplantation between patients receiving HD treatment before transplantation and preemptive transplant (P = 0.212). The prevelance of patients, who return to HD due to nonfunctioning graft among HD patients was 5.1. The duration without HD were similar after transplantation from both cadavers and living donors. The duration without HD was found longer among those who were operated before 2000.

Background: Vasculopathy is a major cause of mortality and morbidity in Behcet’s Disease (BD). Subclinical atherosclerosis can even be detected in the early stage of BD. Soluble tumor necrosis factor-like (TNF) weak inducer of apoptosis (TWEAK) is known as a good marker of the inflammation in vascular tree. The aim of this study is to examine the relationship between carotid artery intima-media thickness (cIMT) and serum TWEAK levels in patients with BD. Materials and Methods: In line with International BD Study Group criteria, 48 BD, and 30 controls were included in our study. Disease activity was evaluated according to BD current activity form (BDCAF). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lipid parameters, serum TWEAK levels, and cIMT were measured. Results: Disease activity score of BD patients was found as 2 (range 0–7). cIMT, serum TWEAK, CRP and ESR levels of BD patients were significantly higher comparing to cIMT (0.62 ± 0.13 mm vs. 0.43 ± 0.09 mm, p < 0.001), serum TWEAK (667.5 ± 130.6 vs. 603.4 ± 89.6 pg/ml, p = 0.015), CRP (3.9 ± 4.3 vs. 1.4 ± 1.0 mg/dl, p < 0.001) and ESR (10.2 ± 10.0 vs. 5.6 ± 3.7 mm/h, p = 0.005) levels of the control group. There was a positive correlation between serum TWEAK level and disease activity (r = 0.251, p = 0.030) and cIMT (r = 0.463, p < 0.001). Our study also revealed an independent correlation between cIMT and serum TWEAK levels (beta = 0.354, p < 0.001). Conclusion: Increased serum TWEAK levels can play a part in the development of atherosclerotic heart disease in BD. Due to their liability to atherosclerosis, patients with BD must followed closely.

INTRODUCTION[|]The early-period results of our technique for performing a medial biplanar retrotubercle open-wedge proximal tibial osteotomy for the surgical treatment of varus gonarthrosis were evaluated and compared with those reported in the literature.[¤]METHODS[|]The clinical and radiological results of a medial biplanar retrotubercle open-wedge proximal tibial osteotomy performed on 23 knees in 22 patients with medial gonarthrosis with varus alignment were analyzed.[¤]RESULTS[|]Twenty patients were female and 2 were male. At the time of surgery, the mean age was 56.22 years (44–66 years), the mean body mass index was 31.95 kg/m2 (23.4–44.9 kg/m2), and the mean Hospital for Special Surgery (HSS) score was 68.7 (48–83). The mean preoperative femorotibial anatomical axis angle was 186.39° (173–194°), and the mean Insall-Salvati index value was 1.04 (0.94–1.171). The mean length of follow-up was 30.19 months (6–42 months). At the last follow-up examination, the mean HSS score was 86.48 (74–100), the mean femorotibial anatomical axis angle was 175° (168–171°), and the mean Insall-Salvati index value was 1.06 (0.857–1.32). Comparison of the final follow-up values with the preoperative values demonstrated significant improvement in the HSS score and femorotibial anatomical axis angle, but no significant difference in the Insall-Salvati index value.[¤]DISCUSSION AND CONCLUSION[|]The results of this study indicated that frontal and sagittal plane deformities in patients with varus gonarthrosis can be treated with biplanar retrotubercle open-wedge proximal tibial osteotomy with good clinical results that achieve patellar tendon length stability and avoid patellofemoral problems.[¤]

Introduction : Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. Material and methods : Forty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. Results: Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. Conclusions : Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.

Acute phase rehabilitation has beneficial effects on functional results, activities of daily living, mobility and cognition in glioma patient. Two insular glioma patients had acute phase rehabilitation were presented in this study. The Karnofsky Performance Scale, The Stroke Rehabilitation Assesment of Movement Scale, the Berg Balance Scale, and the Functional Independence Measure were used to assess patients. While Case 1 was treated with Neurodevelopmental Therapy (Bobath approach) (12 sessions), Case 2 was treated with cervical vibration in addition to Neurodevelopmental Therapy (15 sessions). Besides observing positive developments in the balance and functional levels of the two cases after treatment, there was more improvement in the balance parameter of Case 2. As a result of the study, cervical vibration application in addition to the rehabilitation program of patients with insular tumor could be useful in terms of balance development. [Med-Science 2018; 7(2.000): 448-50]

3,4-methylenedioxymethamphetamine (MDMA), substance known as "Ecstasy" among the people and used due to entertainment, euphoric and energy booster effect, is one of the famous synthetic stimulants. 22-year-old man was found as unconscious in the early morning. According to the expressions of his family and friends, it was learned that he drank alcohol until late in the previous evening and took ecstasy besides this before he died. It was reported that he was taken to intensive care unit with temperature of 41oC and death occurred 12 hours later. At autopsy in external examination, petechial and purpuric hemorrhages in purple and red color were detected on body. In internal examination, petechial hemorrhages on the surface of the heart and lungs, subendocardial hemorrhage in the heart, hemorrhage on the mucosal surface of the stomach were seen. In the toxicological analyses of the blood, Paracetamol (4870 ng/ml), MDMA (847 ng/ml), MDA (94,2 ng/ml), Lidocaine (23 ng/ml), Pantoprazole (10,5 ng/ml), Midazolam (1,83 ng/ml) were detected. The death occurred due to coagulopathy related MDMA intoxication. Here, we present a case of autopsy, clinical findings and histopathologic findings, laboratory results in medicolegal literature.

Background: Monitoring of chemokines, CXCL9 and CXCL10, in serum may present a non-invasive detection method for rejection. Objective: To investigate the relationship between urinary levels of CXCL9 and CXCL10 and graft function following renal transplantation. Methods: 75 living-related donor renal transplant recipients were studied. Urinary levels of chemokines were collected pre-operatively, on post-operative 1st day, 7th day, 1st month, 3rd month, and at the time of rejection. Chemokines levels were assayed using and enzyme-linked immunosorbent assay. Results: Clinical variables were monitored. 10 (15%) patients had biopsy-proven rejection during the follow-up period. The urinary CXCL9 level in those with rejection was significantly higher than that in those with non-rejection group at the 1st day (p

As a kind of child abuse MbPS cases are the forensics ones, in which illness is produced and/or simulated by an adult, particularly parent or someone who is in loco parentis, to gain interest. By interest mentioned here is not pecuniary but providing psychological and emotional needs like getting attention insatiably and coexisting with the healthcare professionals. Because of the sentimental connection between child and the adult (particularly the mother), it is complicated to prove and demonstrate this kind of child abuse with evidences in these cases. Besides health care profesionals are responsible to inform judicial authorities in case any criminal suspicion. In MbPS cases, if the illness is produced and/or simulated via active subtance of a medicine, it makes serious contribution to get biological samples from victim for toxicological analysis to diagnose the maltreatment. This review is aimed to manifest the difference between unintended drug intoxication by negligence and MbPS cases, also create awareness about the importance of collecting biological evidence and using appropriate analysis methods in mentioned incidents. [Med-Science 2015; 4(4.000): 2947-66]

Amalgam or its components may cause delayed hypersensitivity reactions and constitute lesions compatible with lichenoid mucositis in relation to localization. A white colored lesion was detected in the buccal mucosa of a 37-year-old male patient with amalgam filling in the tooth number 46. The lesion was histopathologically reported as lichenoid mucositis. This rare lesion with a specific morphology is presented with the literature. [Med-Science 2019; 8(2.000): 466-7]

Terra firma-forme dermatosis is a dermatosis with unknown etiology which causes dirt-like colour changes on the skin. It is frequently seen in children and adolescents. Its clinical emergence is in the form of gray-brown, mildly papillomatous, pigmented plaques especially on the face, neck, trunk and ankles. Lesions cant be cleaned by water and soap; they can only be cleaned by rubbing with isopropyl alcohol or ethyl alcohol. In this study, two cases with terra firma-forme dermatosis were defined and the subject was reviewed in the light of literature. [Med-Science 2019; 8(1.000): 237-8]

BACKGROUND AND OBJECTIVE: Intoxications related to “mad honey” are frequently encountered in the Black Sea region of Turkey. Intoxication is established on the basis of whether honey was consumed when history was taken at presentation. The search for a simple and reliable method for showing the grayanotoxins (GTXs) in mad honey in body fluids and in honey consumed by patients is still at the research stage. The purpose of this preliminary study was to investigate GTX levels in blood, urine, and honey consumed by patients with mad honey intoxication and to determine whether there is an association with clinical status. DESIGN AND SETTINGS: This descrptive study was conducted at the department of Emergency Medicine of Karadeniz Technical University Medical Faculty in Turkey. Mad honey, blood, and urine samples were obtained from patients between September 2013 and October 2014. METHODS: Four cases presenting the Department of Emergency Medicine and diagnosed with mad honey intoxication were included in the study. GTX levels in blood, urine, and honey consumed by patients were determined using liquid chromatography–tandem mass spectrometry. RESULTS: Patients' mean blood GTX I level was 30.62 ng/mL, GTX III level 4.917 ng/mL, urine GTX I level 0.447 mg/mL, and GTX III level 1.998 mg/mL. The mean GTX I level in the honey samples consumed was 4.683 mg/g and GTX III level 8.423 mg/g. CONCLUSION: The present study is unique in representing the first time that GTXs have been determined in human body fluids. There is now an urgent need for a large series of studies to provide statistical evidence whether there is a relationship between levels of toxins in human body fluids and clinical picture.