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Introduction: compression of the labyrinthine segment of the facial nerve by edema has been considered as an important pathology in the majority of the cases of idiopathic facial nerve paralysis. Hence, it is suggested that total decompression of the facial nerve should also include the labyrinthine segment by a middle fossa approach. However, the middle fossa approach requires craniotomy and temporal lobe retraction, which increases the morbidity. The labyrinthine segment of the facial nerve can also be reached through mastoidectomy. However, many ear surgeons are not familiar with this approach due to the lack of anatomical data on this surgical area. Objective: to study the anatomical limitations of decompression of the labyrinthine segment via transmastoid approach. Methods: complete mastoidectomy was performed in six adult cadavers heads. Dissection was extended in the zygomatic root and posterior bony wall of the external auditory canal to visualize the incudomallear joint completely. The bone between tympanic segment, lateral and superior semicircular canal's ampullas and middle fossa dural plate was removed. Fine dissection was carried out over tympanic segment of the facial nerve in an anterosuperomedial direction the labyrinthine segment was reached. Results: all the mastoids were well pneumatized. Distances between the labyrinthine segment and middle fossa dura, and between the labyrinthine segment and superior semicircular canal, were 2.5 and 4.5 mm on average, respectively. In addition, distances between the middle fossa dura and dome of the lateral semicircular canal, and between the middle fossa dura and tympanic segment were 4.6 mm and 4.3 mm on average, respectively. Conclusion: it is possible to expose the labyrinthine segment of the facial nerve through mastoidectomy by dissecting the bone in the area between the tympanic segment of the facial nerve, middle fossa dural plate and ampullary ends of the lateral and superior semicircular canals., NA

Introduction: This study aimed to evaluate the correlation between different densitometric parameters on chest computed tomography (CT) and pulmonary function tests (PFT) of patients with emphysema-predominant chronic obstructive pulmonary disease (COPD). Materials and methods: A retrospective evaluation was made of 56 patients with COPD. The lungs were segmented into nine sections. Normal and emphysematous parenchyma were measured using low attenuation area percentage (%LAA), percentile density (PD), and mean lung density (MLD) parameters. The effects of emphysema distribution on PFT were evaluated using %LAA, PD, MLD, kurtosis and skewness methods. Result: Fifty-six patients, all diagnosed with COPD, were evaluated. The %LAA-910 method showed significant correlation with forced expiratory volume in one second (FEV1) compared to other densitometric parameters (p=

Extraskeletal osteosarcoma is a very rare type of sarcoma that is considered as one of the subtypes of osteosarcoma. This sarcoma type is very rare in the head and neck area. There is no reported case in the parapharyngeal area. Our case is the first in the literature since it is located in the parapharyngeal area. We present the 69- year-old male patient with extra-skeletal osteosarcoma arising from the parapharyngeal area, with current literature.

Objective: to determine flap success rate and complications in patients who underwent microvascular free tissue reconstruction after major head and neck ablative surgery and to report the improvement in the results. Methods: medical records of 124 patients who were operated on in 2012 to 2019 were retrospectively reviewed. Indications for different free flap types, success rates and re-exploration rates, donor site morbidities, and reasons for flap loss were analyzed. Patients were divided into two groups to identify the effects of the anticoagulant and the antiaggregant treatments on postoperative results. Results: there were 127 flaps in 124 patients, including two different free flaps each in three patients that were harvested and used in the same surgical session. Of the total 127 flaps, 82 (64.6%) were radial forearm flaps, 39 (30.7%) were fibula flaps, and 6 (4.7) were rectus abdominis flaps. Four patients were re-explored for flap perfusion problems, and 18 patients were re-explored for hematoma drainage (n=22/124, %17.3). The rate of hematoma and re-exploration was higher in patients who received anticoagulant and antiaggregant treatments synchronously (p=0.02). Three flaps were lost, and the overall success rate was 97.6%. Two patients died from perioperative complications. No major complications were observed at the donor site; minor complications were observed in 30 patients. Conclusion: the success rate for the 127 flaps in 124 patients were found comparable to those reported in the literature. These results show that successful outcomes can be achieved with experience and a head and neck team dedicated to improving the results in microsurgical reconstruction, and flap failure rarely occurs if perioperative care of the patients is given meticulously., NA

Purpose To investigate the adherence rate of neovascular age-related macular degeneration (nAMD) patients in treat-and-extend (TAE) protocol to their anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection (IVI) appointments and to evaluate the functional and anatomical outcomes of the patients who attended and did not attend their IVI appointments during the coronavirus disease 2019 (COVID-19) restriction period (RP). Methods The patients with nAMD having IVI appointments between March 16 and June 1, 2020 (RP in Turkey) were included in this retrospective study. For adherence analysis, the patients who attended (Group 1, n = 44) and who did not attend (Group 2, n = 60) their IVI appointment visits during the RP (V-RP) were evaluated according to their last visit before the RP (V-0). For outcome analysis, the patients who attend V-RP and have follow-up (Group 1a, 46 eyes) and who did not attend V-RP but later attended for follow-up (Group 2a, 33 eyes) were evaluated for functional (best-corrected visual acuity, BCVA [logMAR]) and anatomical (optical coherence tomography [OCT] disease activity) outcomes at the first visit after RP (V-1) and last visit within six months after RP (V-2). Patients received a complete ophthalmologic evaluation with anti-VEGF (Aflibercept) IVI administration at all visits. Results The adherence rate of the patients to V-RP was 42.3% (44/104). The patients in Group 1 were significantly younger (mean +/- SD years, 71.0 +/- 8.1 vs. 74.7 +/- 8.0, p = 0.024), had better median [IQR] BCVA at their first presentation (0.30 [0.54] vs. 0.61 [1.08], p = 0.023) and V-0 (0.40 [0.48] vs. 0.52 [0.70], p = 0.031), and had less hypertension (36.4% vs. 58.3%, p = 0.044) than Group 2. The mean +/- SD delay of planned IVI at V-RP in Group 2a was 13.9 +/- 6.2 weeks. Disease activity in OCT was significantly higher in Group 2a than Group 1a at V-1 (60.6% vs. 32.6%, p = 0.025). In Group 2a, the median (IQR) BCVA was significantly worse at V-1 (0.70 [0.58]) and V-2 (0.70 [0.59]) than V-0 (0.52 [0.40], p = 0.047 and p = 0.035, respectively). Conclusions More than half of the scheduled nAMD patients in TAE protocol missed their IVI visits during the RP, which resulted in a delay of their treatments. The delay of IVI treatment in those patients resulted in an increase in OCT disease activity and a decrease in BCVA.

Gastric adenomyomas are rare benign tumours and most often localized in the gastric antrum. The tumour generally consists of glandular cells and smooth muscle bundles. The size of a gastric adenomyoma (GA) can be up to 4.5 cm and can affect patients any age of their life. In cases with GA most of the patients are asymptomatic. However, non-specific gastrointestinal symptoms such as epigastric pain, vomiting and nausea can be seen. Differential diagnosis of GA difficult due to non-specific radiological and endoscopic findings. Imaging techniques and endoscopic examinations can not distinguish GAs from other intramuscular lesions of the stomach. Surgical excision is used in both diagnosis and treatment. In this article, we present a 46-year-old male patient with long-term dyspeptic complaints admitted to our department and diagnosed as gastric adenomyoma by performing subtotal gastrectomy. WOS:000632351500001 Q4

ObjectiveTo evaluate tear functions and Meibomian glands’status in patients with cutaneous rosacea.Material and MethodsRight eyes of 38 patients with cutaneous rosacea(study group) and 30 healthy volunteers (controlgroup) were evaluated. After Ocular Surface DiseaseIndex (OSDI) score was calculated, tear osmolarityand tear break-up time (T-BUT) were measured, andthe Schirmer test was applied respectively. Meibomianglands in the lower and upper eyelids were evaluatedby meibography using the Sirius anterior segmentanalysis system.ResultsNo statistically significant difference was detectedbetween the groups in respect of age and gender(p>0.05). No statistically significant difference wasdetermined between the groups in respect of theOSDI score, tear osmolarity, and Schirmer test values(p>0.05 for all). The T-BUT values of the study groupwere detected to be significantly shorter than thoseof the control group (p, AmaçCilt rozaseası olan hastalarda gözyaşı fonksiyonlarınıve Meibomian bezlerin durumunu değerlendirmek.Gereç ve YöntemCilt rozaseası olan 38 hasta (çalışma grubu) ile 30sağlıklı gönüllü bireyin (kontrol grubu) sağ gözlerideğerlendirildi. Oküler yüzey hastalık indeksi (OSDI)skoru hesaplandıktan sonra sırasıyla gözyaşı ozmolaritelerive gözyaşı kırılma zamanları (T-BUT) ölçülüpve Schirmer testi yapıldı. Alt ve üst kapaktaki meibomianbezler Sirius ön segment analiz sistemi ile meibografiyapılarak değerlendirildi.BulgularGruplar arasında yaş ve cinsiyet açısından istatistikselolarak anlamlı fark saptanmadı (p>0.05). OSDIskoru, gözyaşı ozmolaritesi ve Schirmer değerleriaçısından gruplar arasında istatistiksel olarak anlamlıfark saptanmadı (tümü için p>0.05). Çalışma grubununT-BUT değerlerinin kontrol grubuna göre anlamlıolarak daha kısa olduğu tespit edildi (p

Objectives: This study aimed to investigate the accuracy of conventional Sagittal Turbo spin Echo T2-weighted (Sag TSE-T2W), variable flip angle 3D TSE (VFA-3D-TSE) and high-resolution 3D heavily T2W (HR-3D-HT2W) sequences in the diagnosis of primary aqueductal stenosis (PAS) and Superior Medullary Velum Stenosis (SMV-S), and the effect of stenosis localization on diagnosis. Methods: Seventy-seven patients were included in the study. The diagnosis accuracy of the HR-3D-HT2W, Sag TSE-T2W and VFA-3D-TSE sequences, was classified into three grades by two experienced neuroradiologists: grade 0 (the sequence has no diagnostic ability), grade 1 (the sequence diagnoses stenosis but does not show focal stenosis itself or membrane formation), and grade 2 (the sequence makes a definitive diagnosis of stenosis and shows focal stenosis itself or membrane formation). Stenosis localizations were divided into three as Cerebral Aquaduct (CA), Superior Medullary Velum (SMV) and SMV+CA. In the statistical analysis, the grades of the sequences were compared without making a differentiation based on localization. Then, the effect of localization on diagnosis was determined by comparing the grades for individual localizations. Results: In the sequence comparison, grade 0 was not detected in the VFA-3D-TSE and HR-3DHT2W sequences, and these sequences diagnosed all cases. On the other hand, 25.4% of grade 0 was detected with the Sag TSE-T2W sequence (P Conclusion: In our study, we found that the VFA-3D-TSE and HR-3D-HT2W sequences were successful in the diagnosis of PAS and SMV-S contrary to the Sag TSE-T2W sequence and especially SMV localization decreases the diagnostic accuracy of Sag TSE-T2W sequence.

Objective: Hormonal changes and abnormalities in reproductive function may occur in patients with epilepsy. This study aimed to investigate the abnormalities in the reproductive functions in male patients with epilepsy under antiepileptic treatment and its negative impact on their children. Materials and Methods: A total of 104 participants were included in the study, wherein 52 were patients and 52 were healthy controls. Medical history and completed neurological examination were performed on all participants. Each participant filled out the International Index of Erectile Function (IIEF) and Beck depression scale. Serum hormones and biochemistry tests were also checked. Electroencephalography that was performed within the last 6 months and cerebral imaging anytime during the follow-up period were retrospectively evaluated. The Statistical Package for the Social Sciences 20.0 program was used for statistical evaluation. Results: The mean age of the male patients with epilepsy was 29.1±5.5 years. The prevalence of erectile dysfunction was 63.5% in male patients with epilepsy, and 40.4% of the patients developed erectile dysfunction after antiepileptic drug use. Patients on polytherapy were found to have a higher risk of depression. Furthermore, patients with intractable seizures were more depressed (p=0.044). Beck scale and IIEF scores negatively affected each other (rs: -0.568). Patients with polytherapy have higher estrogen levels, whereas the luteinizing hormone levels were lower. Congenital malformation percentage is defined by 4.2% in children of male patients with epilepsy. Two of them have atrial septal defects and 1 with foramen ovale. Conclusion: The possibility of congenital malformation and abnormalities in the children of male patients with epilepsy should not be overlooked. Patients and their relatives should be provided with the necessary support and information after careful risk assessment.

The phages that infect Staphylococcus species are dominant residents of the skin microbiome that play critical roles in health and disease. While temperate phages, which can integrate into the host genome, have the potential to promote staphylococcal pathogenesis, the strictly lytic variety are powerful antimicrobials that are being exploited for therapeutic applications. This article reviews recent insights into the diversity of staphylococcal phages and newly described mechanisms by which they influence host pathogenicity. The latest efforts to harness these viruses to eradicate staphylococcal infections are also highlighted. Decades of research has focused on the temperate phages of Staphylococcus aureus as model systems, thus underscoring the need to broaden basic research efforts to include diverse phages that infect other clinically relevant Staphylococcus species.

Introduction In 2019, The EWGSOP2 group made updates on the definition and diagnosis of sarcopenia. The aim of this study is to determine the possible risk factors for chemotherapy dose-limiting toxicity (DLT). Methods Newly diagnosed gastrointestinal (GI) cancer patients were included in this prospective observational study. Chemotherapy DLTs were recorded in patients receiving platinum-based therapy. The patients were divided into two groups according to the current sarcopenia criteria. Results 75 patients were included in the final analysis. Chemotherapy DLT occurred in 52% (n = 39) of all patients who received platinum-based chemotherapy. DLT rates were 78.9% and 42.9% in sarcopenic and non-sarcopenic patients, respectively (p = 0.007). According to the results of the multivariate analysis, the only sarcopenia was found as a statistically significant risk factor for DLT. Conclusion Assessment of sarcopenia evaluated with the current EWGSOP2 diagnostic criteria is useful in predicting chemotherapy DLT development in patients with a diagnosis of GI cancer. In the future, current EWGSOP2 recommendations should be considered while designing a study investigating the correlation between sarcopenia and chemotoxicity.

Background: Neurogenic bowel dysfunction (NBD) following spinal cord injury (SCI) represents a major source of morbidity, negatively impacting quality of life and overall independence. The long-term changes in bowel care needs are not well-reported, preventing consensus on the natural course and optimal management of NBD following injury. Objectives: To understand the changes in bowel management needs over time following SCI. Methods: A retrospective observational study using the National Spinal Cord Injury Model Systems database evaluated the degree of independence with bowel management at discharge from inpatient rehabilitation across time (1988–2016). The prevalence and consecutive trajectory of bowel management was also evaluated at discharge and at each 5-year follow-up period, for 25 years. Results: The majority of individuals discharged from inpatient rehabilitation (n = 17,492) required total assistance with bowel management, a trend that significantly increased over time. However, by 5-years post injury, there was a significant shift in bowel management needs from total assistance to modified independence. In those with consecutive 25-year follow-up data (n = 11,131), a similar shift in bowel management to a less dependent strategy occurred even at chronic time points post injury, primarily in individuals with paraplegia and classified as motor and sensory complete. Conclusion: The findings of this study highlight the need for providing continued multipronged interventions (e.g., rehabilitative, educational, psycho-social) at the different stages of SCI to support individuals not only in the immediate years after discharge but also well into the chronic stages after injury.

The use of medicinal plants and secondary metabolites increases in treating numerous diseases such as hepatocellular carcinoma (HCC), one of the leading causes of cancer-related death worldwide. Oxidative stress contributes to the development of liver cancer, and promoting antioxidant systems might provide better insights for the treatment. In the present study, the antioxidant potential of Pseudevernia furfuracea (L.) Zopf lichen species were investigated. Besides, effects of major secondary metabolites, olivetoric acid (OA) and physodic acid (PA), which were isolated from P. furfuracea, on hepatic gene expressions of antioxidant enzymes, were evaluated in both cancerous (HepG2) and healthy (THLE2) human liver cells. According to the results, the total phenolic content of P. furfuracea was 71.52 µg/mg and 8.16 µg/mg gallic acid equivalent for ethanolic and aqueous extracts, respectively. Likewise, β-carotene and lycopene contents were also higher in ethanolic extracts. In line with these antioxidant ingredients, DPPH (2,2-diphenyl-1-picrylhydrazyl) radical scavenging activity of ethanol extract (IC50: 158.79 mg/L) was remarkably high as compared with its aqueous extracts (IC50: 630.33 mg/L). OA and PA strongly augment all antioxidant enzymes’ gene expressions in HepG2 cells, while only gpx expression was upregulated in healthy THLE2 cells. Conversely, these two metabolites suppress cat, sod1, and sod2 expressions in THLE2 cells. These results together suggest that P. furfuracea not only has high antioxidant potential, but its secondary metabolites might also reduce oxidative stress in cancer cells by upregulating antioxidant enzymes, which would prevent oncogenesis and tumor progression in liver cancer., Dünyada kansere bağlı ölümlerin önde gelen nedenlerinden biri olan hepatosellüler karsinom (HCC) gibi çok sayıda hastalığın tedavisinde tıbbi bitkilerin ve sekonder metabolitlerin kullanımı artmaktadır. Oksidatif stres, karaciğer kanseri gelişimine katkıda bulunur ve antioksidan sistemlerin teşvik edilmesi, tedavi için daha iyi bilgiler sağlayabilir. Bu çalışmada, Pseudevernia furfuracea (L.) Zopf likeninin antioksidan potansiyeli araştırılıştır. Ayrıca, P.furfuracea'dan izole edilen ana sekonder metabolitler olan olivetorik asit (OA) ve fisodik asitin (PA) hepatik antioksidan enzimlerin gen ekspresyonları üzerindeki etkileri hem kanserli (HepG2) hem de sağlıklı (THLE2) insan karaciğer hücrelerinde değerlendirilmiştir. Sonuçlara göre, P. furfuracea'nın toplam fenolik içeriği etanolik ve sulu ekstraktlar için sırasıyla 71.52 µg/mg ve 8.16 µg/mg gallik asit eşdeğeri bulunmuştur. Aynı şekilde β-karoten ve likopen içerikleri de etanolik ekstraktlarda daha yüksek olarak belirlenmiştir. Bu antioksidan bileşenlerle uyumlu olarak, etanol özütünün DPPH (2,2-difenil-1-pikrilhidrazil) radikal süpürme aktivitesi (IC50: 158.79 mg/L), sulu ekstraktlar (IC50: 630.33 mg/L) ile karşılaştırıldığında oldukça yüksektir. OA ve PA, HepG2 hücrelerinde tüm antioksidan enzimlerin gen ifade düzeylerini arttırırken, sağlıklı THLE2 hücrelerinde ise sadece gpx ekspresyonu yukarı yönde regüle olmuştur. Bundan farklı olarak, her iki metabolit de THLE2 hücrelerinde cat, sod1 ve sod2 ekspresyonlarını baskılamıştır. Bu sonuçlar P. furfuracea'nın sadece yüksek antioksidan potansiyeline sahip olmadığını, aynı zamanda sekonder metabolitlerinin de karaciğer kanserinde onkogenezi ve tümör ilerlemesini önleyecek antioksidan enzimleri yukarı regüle ederek kanser hücrelerinde oksidatif stresi azaltabileceğini göstermektedir.

Objective: The aim of this study is to review the effects of high-intensity interval training (HIIT)/sprint interval training (SIT) on asthma symptoms, cardiorespiratory functions, and other variables among asthmatic patients.Data Sources: Randomized controlled trials published between January 2000 and January 2021 were searched in PubMed/MEDLINE, Web of Science, and Cochrane Library databases.Study Selections: Following pre-specified inclusion criteria, this review included 7 randomized controlled studies that compare HIIT/SIT as an intervention with any other intervention and/or control group.Results: Of the included studies only 4 reported the chronic phase effects of the HIIT/SIT protocols. HIIT and SIT protocols applied in studies differ. HIIT improved forced expiratory volume in 1 s (FEV1) in the acute phase and maximal oxygen consumption (VO2max) in the chronic phase in the asthmatic patients (p < 0.05).Conclusion: To our knowledge, our systematic review is the first study evaluating the effects of HIIT/SIT protocols on asthma patients. HIIT/SIT protocols have beneficial effects on asthma patients. In order to better understand the results of these training procedures, studies that will be designed with high methodology are needed. 2-s2.0-85119153256 WOS:000716785000001 34706200 Q3

Aim: Covid-19 mortality rate varies according to age and the presence of chronic disease. In this study, demographic characteristics, comorbidities, presenting symptoms, physical examination findings, laboratory findings, and administered drugs of the discharged or deceased patients admitted to our hospital and hospitalized with the COVID-19 diagnosis were compared to investigate the factors that affect mortality Methods: A retrospective study was performed and included COVID-19 pneumonia patients. 390 consecutive discharged or deceased patients, who were hospitalized in our hospital between March 20 and May 20, 2020, after detection of pneumonia and diagnosis of COVID-19, were included in the study. Result: Of the 390 patients included in the study, 352 (90.25%) were discharged after recovery, while 38 (9.75%) were deceased. The average age of all the patients was 49.46±17,86, the average age of the discharged patients was 47.19±16.76, and the average age of the deceased patients was 70.42±13.7. The average age of deceased patients was significantly higher. Of all the patients, 40.8% was PCR positive Conclusion: The present study revealed that the drugs that patients take due to their comorbidities have no effect on the prognosis of the disease and that the presence of comorbidity itself is indicative of the poor prognosis. Taking into account the PCR positivity of 57.9%, even in deceased patients, we believe PCR is inadequate in the diagnosis, and CT is much more valuable in this regard.

Objectives\udThe aim of this study was to define the variability of maximal wall thickness (MWT) measurements across modalities and predict its impact on care in patients with hypertrophic cardiomyopathy (HCM).\ud\udBackground\udLeft ventricular MWT measured by echocardiography or cardiovascular magnetic resonance (CMR) contributes to the diagnosis of HCM, stratifies risk, and guides key decisions, including whether to place an implantable cardioverter-defibrillator (ICD).\ud\udMethods\udA 20-center global network provided paired echocardiographic and CMR data sets from patients with HCM, from which 17 paired data sets of the highest quality were selected. These were presented as 7 randomly ordered pairs (at 6 cardiac conferences) to experienced readers who report HCM imaging in their daily practice, and their MWT caliper measurements were captured. The impact of measurement variability on ICD insertion decisions was estimated in 769 separately recruited multicenter patients with HCM using the European Society of Cardiology algorithm for 5-year risk for sudden cardiac death.\ud\udResults\udMWT analysis was completed by 70 readers (from 6 continents; 91% with >5 years’ experience). Seventy-nine percent and 68% scored echocardiographic and CMR image quality as excellent. For both modalities (echocardiographic and then CMR results), intramodality inter-reader MWT percentage variability was large (range –59% to 117% [SD ±20%] and –61% to 52% [SD ±11%], respectively). Agreement between modalities was low (SE of measurement 4.8 mm; 95% CI 4.3 mm-5.2 mm; r = 0.56 [modest correlation]). In the multicenter HCM cohort, this estimated echocardiographic MWT percentage variability (±20%) applied to the European Society of Cardiology algorithm reclassified risk in 19.5% of patients, which would have led to inappropriate ICD decision making in 1 in 7 patients with HCM (8.7% would have had ICD placement recommended despite potential low risk, and 6.8% would not have had ICD placement recommended despite intermediate or high risk).\ud\udConclusions\udUsing the best available images and experienced readers, MWT as a biomarker in HCM has a high degree of inter-reader variability and should be applied with caution as part of decision making for ICD insertion. Better standardization efforts in HCM recommendations by current governing societies are needed to improve clinical decision making in patients with HCM.

Kidney cysts are quite common in adults. Though small simple renal cysts in an adult over 30-40 years of age are not too unusual, however, if the same cysts are seen in a child, and especially if there are additional findings, then several diagnostic possibilities may come to mind. The role of ultrasound, together with the help of intravenous contrast agents and Doppler mode, are very critical in describing the morphologic features and follow-up of the complex or multiple and bilateral renal cysts. These sonographic signs are occasionally specific for diagnosis, but in many cases sonographic clues should be evalu-ated together with the other genetic and clinical data to reach diagnosis. The first part of this pictorial essay included the introduction into the subject and the classification of non-genetic cystic renal diseases. The key features for the non-genetic cystic renal diseases are illustrated. In the second part, eye-catching fea-tures of genetic cystic renal diseases are demonstrated., NA

Objective: To elucidate the prognostic factors for intracytoplasmic sperm injection cycle cancellation in patients with endometriosis-related infertility. Study Design: This was a retrospective cohort study and conducted at the Assisted Reproductive Technology center of Uludag University School of Medicine, between the years 2011-2017. The electronic database was screened and infertile patients with endometriosis, without male factor infertility, systemic disease, or undefined adnexal mass, and aged

© 2021, Institute of Chemistry, Slovak Academy of Sciences.In this study, new sulfonyl hydrazone derivatives were synthesized. New sulfonyl hydrazones and their Pd (II) complexes were purified and characterized. Theoretical calculations of the sulfonyl hydrazone materials were done with the B3LYP method in the Gaussian program with the 6–31 (d, p) and 6–311 (d, p) basis sets. The DTA/TG studies investigated at what steps the materials were degraded. Liver tissues were collected from one male and one female healthy albino rats. The effects of the substances on these tissues were examined, and cytotoxic activity results against human breast adenocarcinoma (MDA-MB-231) and human lung epithelial (Beas-2B) were obtained. In the final stage of this study, new sulfonyl hydrazone derivatives Palladium (II) complexes were carried out using LC/MS, 1H NMR, FT-IR, 13C NMR, Magnetic Susceptibility, UV–Vis, Conductivity Measurements. HOMO–LUMO and cytotoxic activities were determined against the human breast adenocarcinoma MDA-MB-231 cell line.

Objective To compare the accuracy of glomerular filtration rate (GFR) estimation by 24-hour urinary creatinine clearance with GFR estimation by the Modification of Diet in Renal Disease (MDRD) equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the Mayo Clinic Quadratic equation (MCQE), and the modified Cockcroft-Gault formula in patients with spinal cord injury (SCI). Design Cross-sectional study. Participants Fifty-nine consecutive subjects, who were admitted to our hospital SCI rehabilitation and no additional acute medical disorders, were enrolled in this study. A 24-hour urine sample was collected for the determination of 24-hour urinary creatinine clearance, which was assumed as the standard technique for estimation of the GFR. The accuracy of several estimation formulas includes the 4-variable MDRD equation, the 6-variable MDRD equation, the Cockcroft and Gault equation, the CKD-EPI equation, and the MCQE. Results GFRs calculated by the Cockcroft-Gault equation and 4-variable MDRD were significantly different from the 24-hour urinary creatinine clearance, whereas there were no significant differences in GFRs calculated by CKD-EPI (P = 1.000), Mayo Clinic Quadratic formula (P = 0.794), and 6-variable MDRD equations (P = 0.435) and 24-hour urinary creatinine clearance. Both the 6-variable MDRD equation and CKD-EPI were accurate within ±20 of the reference methods in 52.54% of the subjects. Conclusions Among the methods used for estimation of the GFR including the 4- and 6-variable MDRD, the CKD-EPI, the modified Cockcroft-Gault equation, and the MCQE, the 6-variable MDRD equation and the CKD-EPI demonstrated best performance to estimate the GFR. However, none of the formulas were sufficient to estimate the GFR in SCI patients accurately.

Aim and objective According to the literature, gastrointestinal (GI) involvement may have a remarkable influence on the course of coronavirus disease-2019 (COVID-19). Our aim with this article is to appraise clinical characteristics and presumptive biological mechanisms of digestive tract involvement of COVID-19. Background In this review article, the English language literature was reviewed by using PubMed and MEDLINE databases, up to February 2021. Review results The patients with GI involvement are generally presented with diarrhea, nausea/vomiting, anorexia, abdominal pain, and rarely GI bleeding. However, frequencies of these manifestations are diverse in studies published so far, depending on the countries where the studies were conducted, characteristics of the study populations, and methodological differences. Several studies proved that this novel coronavirus gets into the enterocytes by attaching to angiotensin-converting enzyme 2 receptor. Some of them have shown a direct viral invasion and replication of the virus within enterocytes. Along with detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients' fecal materials, all these results explicitly indicate that the virus has the capability to invade the GI system. These findings may represent a potential risk indicator for fecal-oral spread of the virus. Although pathophysiology of COVID-19 associated GI manifestations remains elusive, direct viral damage, dysfunction in renin-angiotensin-aldosterone system, effects of gut-lung axis, and GI tract microbiome dysbiosis have been proposed as culprit mechanisms of the GI symptoms and inflammatory response. Conclusion The patients with COVID-19 can be presented with diverse clinical manifestations including the GI symptoms. Understanding the actual impact of the virus on the GI tract depends on uncovering the pathophysiology of COVID-19. Clinical significance GI involvement of COVID-19 appears to be crucial not only for its clinical consequences but also for its impacts on public health and prevention. How to cite this article Aslan AT, Simsek H. Clinical Features and Pathophysiological Mechanisms of COVID-19-associated Gastrointestinal Manifestations. Euroasian J Hepato-Gastroenterol 2021;11(2):81-86.

Background: Substance use can vary in extraordinary periods, such as natural disasters and epidemics. This study scrutinized the toxicological test results of the people who used different types of substances during the 2020 COVID-19 pandemic period in Izmir. Methods: Due to the COVID-19 outbreak, extreme security measures were implemented in March, April, and May of 2020, and the lockdown was imposed at different levels. The patients who were urine tested for illegal substances were also investigated from the point of the socio-demographic characteristics and clinical data. Results: Thirty-six percent of the cases (n = 32) were positive for illegal substances in urinalysis. These substances were: 60% (n = 12) amphetamine-type stimulants (ATS), 20% (n = 4) benzodiazepine, 10% (n = 2) cannabis, 5% (n = 1) buprenorphine, 5% (n = 1) cocaine. Multiple substance use observed in 12 cases. Conclusions: When the pandemic period data were compared with the previous years, the drug test positive rate in the same periods of 2017 and 2018 was 25.9% and 23.9%, respectively. However, this rate increased to 36% during the pandemic period in 2020. In 2017 and 2018, cannabis was the most frequently found substance in the urine on testing with the rate of 41.5% (n = 184) and 50.8% (n = 219), respectively, it was ATS with 60% (n = 2) in 2020.

Background This study was to investigate the frequency of self-reported dizziness symptom in cases with Crimean-Congo hemorrhagic fever (CCHF) and the severity of dizziness, if any, by using various scales. The frequency and severity of the self-reported dizziness symptom of CCHF patients, level of disability caused by dizziness, and to what extent vestibular symptoms affected activities of daily living were assessed by various scales. The frequency and severity of the self-reported dizziness symptom of CCHF patients, level of disability caused by dizziness, and to what extent vestibular symptoms affected activities of daily living were assessed by various scales. Results The frequency of dizziness in CCHF cases included in the study was 11.11% and all the cases were involved in the mild category in terms of disease severity. When the results of the scales applied to all of the cases were evaluated in general, it was seen that there was no vertigo or dizziness. Conclusion According to the results of the present study, we consider that multicenter studies with large series investigating pathophysiological mechanisms underlying these clinical symptoms are needed in order to evaluate dizziness symptom and to make definitive interpretations in CCHF disease.

Background A first-in-human study of [18F]-BF3-Cy3-ACUPA, a small-molecule imaging agent that can be unimolecularly both positron emitting and fluorescent, is conducted to determine its safety, biodistribution, radiation dosimetry, feasibility in tumor detection by preoperative positron emission tomography (PET), as well as its intraoperative fluorescence imaging utility in patients with prostate-specific membrane antigen positive (PSMA+) tumors. Methods Ten patients aged 66 ± 7 years received a 6.5 ± 3.2 mCi intravenous injection of [18F]-BF3-Cy3-ACUPA and underwent PET/computed tomography (CT) imaging. Radiation dosimetry of [18F]-BF3-Cy3-ACUPA, normal organ biodistribution, and tumor uptakes were examined. Two patients were prescheduled for radical prostatectomy (RP) with extended pelvic lymphadenectomy approximately 24 hours following [18F]-BF3-Cy3-ACUPA injection and imaging. Without reinjection, intraoperative fluorescence imaging was performed on freshly excised tissue during RP. Frozen sections of excised tissue during RP were submitted for confirmatory histopathology and multiphoton fluorescence and brightfield microscopy. Results Absorbed doses by organs including the kidneys and salivary glands were similar to 68Ga-PSMA-11 imaging. [18F]-BF3-Cy3-ACUPA physiologic radiotracer accumulation and urinary/biliary excretion closely resembled the distribution of other published PSMA tracers including [18F]-JK-PSMA-7, [18F]-PSMA-1007, [18F]-DCFPyL, and [18F]-DCFBC. 19F-BF3-Cy3-ACUPA was retained in PSMA+ cancer tissues in patients for at least 24 hours, allowing for intraoperative fluorescence assessment of the prostate and of the embedded prostate cancer without contrast reinjection. After 24 hours, the imaging agent mostly decayed or cleared from the blood pool. Preoperative PET and fluorescence imaging findings were confirmed with final histopathology and multiphoton microscopy. Conclusion Our first-in-human results demonstrate that [18F]-BF3-Cy3-ACUPA is safe and feasible in humans. Larger trials with this PET tracer are expected to further define its capabilities and its clinical role in the management of PSMA+ tumors, especially in prostate cancer.

Introduction: The sudden emergence and rapid spread of the Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has dangered global health. For this reason, there has been an urgent need to develop strategies to control the spread of the virus. In this study, we aimed to evaluate the clinical, laboratory and chest computed tomography (CT) findings of COVID-19 cases with positive results of SARS-CoV-2 reverse transcription quantitative polymerase chain reaction (RT-qPCR). Materials and Methods: A total of 278 patients aged 18 years and over who had positive SARS-CoV-2 RT-qPCR results and had access to laboratory and chest CT examinations between 15 April 2020 and 31 August 2020 were included in the study. Clinical classification of patients was performed as asymptomatic, mild and severe. Demographic information, laboratory tests and chest CT results of the patients were created with the data obtained from the hospital system and the relevant branch physicians. The data were analyzed statistically. Results: In the study, 150 (54%) of the patients were males and 128 (46%) were females. Forty-two (15%) of these patients were classified as asymptomatic, 200 (72%) as mild and 36 (13%) as severe cases. Mean age of the patients was found to be 45.5 ± 17.5 years and 72 (25.9%) patients were found to have at least one comorbidity. Findings consistent with COVID-19 pneumonia were observed in the chest CT examinations of 42.4% (118/278) of the patients. The rate of findings in chest CT of severe patients (91.7%) was found higher than mild (38.5%) and asymptomatic cases (19%) (p< 0.05). When we examined the laboratory findings;59.4% of the patients had elevated CRP, 42.1% lymphopenia, 41.1% elevated LDH, 40.6% elevated creatinine, 36% elevated AST, 20.1% leukopenia, 8% elevated ALT, 7.2% elevated leukocyte, 5.4% elevated troponin I and 3.3% elevated CK-MB were detected. In severe patients, lymphopenia (83.3%), neutrophil elevation (41.7%), CRP elevation (97.2%), LDH elevation (91.3%), troponin I elevation (21.4%) and AST elevation (63.9%) findings were observed at a higher rate than asymptomatic and mild cases (p< 0.05). Conclusion: In our study, it was shown that the findings of high age, hypertension, diabetes mellitus, dyspnea, lymphopenia and the increase in neutrophil, CRP, LDH, troponin I and AST values were associated with severe clinical presentation. These findings are thought to be helpful in understanding the differences between clinical classes in COVID-19 patients.

Introduction: To date, over 165 million people have been infected in the COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 which emerged in Wuhan, China in December 2019. This study examined the relation between serum monocyte chemoattractant protein-1 and surfactant protein-A levels and the clinical course and prognosis of COVID-19. Materials and Methods: The study included a total of 108 subjects. Those in the patient group (n= 88) were diagnosed with COVID-19 using real-time PCR analysis of nasopharyngeal swab samples and treated in the Pulmonary Diseases Intensive Care Unit and the Infectious Diseases Department between March 24 and May 20. The control group (n= 20) included asymptomatic healthcare workers whose real-time PCR results during routine COVID-19 screening in our hospital were negative. Results: The COVID-19 patient group had significantly higher monocyte chemoattractant protein-1 and SP-A levels compared to the control group (p= 0.001, p= 0.001). Patients who developed macrophage activation syndrome had significantly higher monocyte chemoattractant protein-1 and surfactant protein-A levels than those who did not both at admission (p= 0.001, p= 0.001) and on day 5 of treatment (p= 0.05, p= 0.04). Similarly, monocyte chemoattractant protein-1 and surfactant protein-A levels were significantly higher in patients who developed acute respiratory distress syndrome compared to those who did not at both time points (p= 0.001 for all). Both parameters were significantly higher in non-surviving COVID-19 patients compared to survivors (p= 0.001 for both). Conclusion: Monocyte chemoattractant protein-1 and surfactant protein-A are on opposing sides of the inflammatory balance, and SP-A may be a pneumoprotein of importance in the presentation, course, prognosis, and possibly the treatment of COVID-19 in the future.

Objective This study aimed to investigate the effects of clinical Pilates exercises in patients with fibromyalgia (FM) and to compare the effects of one-to-one and group-based exercise methods. Methods A total of 42 women (mean age, 50.90±7.78 years) with FM were included. The participants were randomly divided into 2 groups (one-to-one exercise, n=16; group-based exercise, n=26). Disease impact was evaluated with the FM Impact Questionnaire, functional status with the Health Assessment Questionnaire, anxiety with the Beck Anxiety Inventory, quality of life with short form-36, and biopsychosocial status with the Bilissel Egzersiz Terapi Yaklasimi-biopsychosocial questionnaire. All the evaluations were performed pre- and post-treatment. Clinical Pilates exercises were carried out 2 days a week for 6 weeks. Results When the pre- and post-treatment data were compared, significant improvement was seen in all parameters in the group-based exercise group; in the one-to-one exercise group, improvement was noted in disease impact, quality of life, and biopsychosocial status. When post-treatment data were compared, only disease impact was significant for the one-to-one exercise group. Effect size results were found to be moderate and high for both methods. Conclusion For clinical Pilates exercise in FM, one-to-one method was suggested to have high disease impact and low quality of life, whereas group-based exercise method showed high anxiety.

OBJECTIVE: In this study it was aimed to evaluate the types of trauma, accompanying solid organ injuries, treatments, and treatment outcomes in children admitted to our clinic in the last 10 years due to blunt liver trauma. MATERIAL AND METHOD: The data of 47 patients who were involved in liver injuries owing to blunt abdominal trauma between July 2010-May 2020 assessed retrospectively. RESULTS: There were 30 (63.8%) male, 17 (36.2%) female patients who had carried out with blunt liver injuries between 1-17 (7.8±5.8) years were involved in this study. The induces of these injuries included traffic accidents 29 ( 61.7%), falls from height 12 25.5 %), bicycle accidents 4 (8.5%), objects falling on the body 1(2.1%), and 1(%2.1) after the assault. Twenty-seven (57.4%) of the patients had isolated liver injuries and 20 (42.6%) of other organ injuries.. Liver injuries were 8 patients (17.3%) stage I, 12 patients (26%) stage II, 18 patients (38.2%) stage III, 8 patients (17%) stage IV, 1 patient (2%) stage V. While all patients of stage I and II were treated conservatively, 4 patients (22.2%) who underwent surgery were stage III, 3 patients (37.5%) were stage IV and 1 patient (100%) were stage V. There was an additional ileum perforation in 2 patients in stage III and 1 patient in stage IV who underwent surgery. Thirty-nine patients (83%) were carrıed out by conservatively in these series of liver injury, whereas eight patients (17%) who had unstable vital signs underwent surgery. The mortality rate, duration of stay in intensive care and hospital, and the number of blood transfusions were higher in surgically managed patients, while hemoglobin level and blood pressure were particularly lower in surgically conducted patients. CONCLUSION: Conservative treatment method should be chosen in patients with a liver injury who have stable hemodynamics after blunt trauma. The shorter duration of hospital stay, less blood transfusion requirement, and lower morbidity and mortality rates are important reasons for this method to be preferred.

BACKGROUND Skincare products and cosmetic procedures are used as an adjunct or complementary to conventional drug therapy for acne vulgaris (AV). OBJECTIVE To evaluate the use of skincare products and the frequency of cosmetic procedures in AV treatment. METHODS A total of 1,755 patients with AV completed the survey prepared by the researchers and the Cardiff Acne Disability Index (CADI) questionnaire. The clinical findings and the Food and Drug Administration (FDA) severity scores were recorded by the dermatologists. RESULTS For AV, 66.7% of the patients stated that they used skincare products and 26.7% had undergone cosmetic procedures. The use of skincare products was statistically significantly higher in women (female: 74.5%, male: 57.7%, p

Migraine is one of the major neurovascular diseases that recur, can persist for a long time, cripple or weaken the brain. This study uses electroencephalogram (EEG) signals for the diagnosis of migraine, and a computer-aided diagnosis system is presented to support expert opinion. A Tunable Q-Factor Wavelet Transform (TQWT) based method is proposed for the analysis of the oscillatory structure of EEG signals. With TQWT, EEG signals are decomposed into sub bands. Then, the features are statistically calculated from these bands. The success of the obtained features in distinguishing between migraine patients and healthy control (HC) subjects was performed using the Kruskal Wallis test. Feature values ​​obtained from each sub band were classified using well-known ensemble learning techniques and their classification performances were tested. Among the evaluated classifiers, the highest classification performance was achieved as 89.6% by using the Rotation Forest algorithm with the features obtained with Sub band 2. These results reveal the potential of the study as a tool that will support expert opinion in the diagnosis of migraine.

OBJECTIVE We examined cardiac surgery patients who underwent monitoring of postoperative vital parameters using medical monitoring devices which transferred data to a mobile application and a web-based software. METHODS From November 2017 to November 2020, a total of 2340 patients were enrolled in the remote patient monitoring system after undergoing cardiac surgery. The medical devices recorded vital parameters, such as blood pressure, pulse rate, saturation, body temperature, blood glucose, and electrocardiography were measured via the Health Monitor DakikApp and Holter ECG DakikApp devices which reported data to web-based software and a mobile application (DakikApp Mobile Systems, Remscheid, Germany). During the follow-up period, patients were contacted daily through text and voice messages, and video conferences. Remote Medical Evaluations (RMEs) concerning patients' medical states were performed. Medication reminders, daily treatment were communicated to the patients with the DakikApp Mobile Systems Software. RESULTS During a mean follow-up period of 78.9 ± 107.1 (10-395) days, a total of 135,786 patient contacts were recorded (782 video conferences, 2805 voice messaging, and 132,199 text correspondence). The number of RMEs handled by the Telemedicine Team was 79,560. A total of 105,335 vital parameter measurements were performed and 5024 hospital application requests (6.3% per RME) were addressed successfully and hospitalization was avoided. A total of 144 (6.1%) potentially life-threatening complications were found to have been diagnosed early using the Telemedicine System. CONCLUSION Remote Patient Monitoring Systems combined with professional medical devices are feasible, effective, and safe for the purpose of improving postoperative outcomes.

Background Anorexia nervosa is a complex psychiatric illness that includes severe low body weight with cognitive distortions and altered eating behaviors. Brain structures, including cortical thicknesses in many regions, are reduced in underweight patients who are acutely ill with anorexia nervosa. However, few studies have examined adult outpatients in the process of recovering from anorexia nervosa. Evaluating neurobiological problems at different physiological stages of anorexia nervosa may facilitate our understanding of the recovery process. Methods Magnetic resonance imaging (MRI) images from 37 partially weight-restored women with anorexia nervosa (pwAN), 32 women with a history of anorexia nervosa maintaining weight restoration (wrAN), and 41 healthy control women were analyzed using FreeSurfer. Group differences in brain structure, including cortical thickness, areas, and volumes, were compared using a series of factorial f-tests, including age as a covariate, and correcting for multiple comparisons with the False Discovery Rate method. Results The pwAN and wrAN cohorts differed from each other in body mass index, eating disorder symptoms, and social problem solving orientations, but not depression or self-esteem. Relative to the HC cohort, eight cortical thicknesses were thinner for the pwAN cohort; these regions were predominately right-sided and in the cingulate and frontal lobe. One of these regions, the right pars orbitalis, was also thinner for the wrAN cohort. One region, the right parahippocampal gyrus, was thicker in the pwAN cohort. One volume, the right cerebellar white matter, was reduced in the pwAN cohort. There were no differences in global white matter, gray matter, or subcortical volumes across the cohorts. Conclusions Many regional structural differences were observed in the pwAN cohort with minimal differences in the wrAN cohort. These data support a treatment focus on achieving and sustaining full weight restoration to mitigate possible neurobiological sequela of AN. In addition, the regions showing cortical thinning are similar to structural changes reported elsewhere for suicide attempts, anxiety disorders, and autistic spectrum disorder. Understanding how brain structure and function are related to clinical symptoms expressed during the course of recovering from AN is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s40337-021-00466-w., Plain English summary Anorexia nervosa is a life-threatening mental illness defined in part by an inability to maintain a body weight in the normal range. Malnutrition and low weight are factors typically present in the anorexia nervosa and can affect brain structure. We conducted a detailed analysis of brain structure using Freesurfer, focusing on regional cortical thicknesses, areas, and volumes, in adult outpatient women with anorexia nervosa. The study included both a partially weight-restored cohort with anorexia nervosa, a cohort sustaining a healthy body weight with history of anorexia nervosa, and a healthy comparison cohort. Reduced cortical thicknesses were observed in eight regions, primarily in the frontal lobe and cingulate for the cohort recently with anorexia nervosa but only one frontal region in the weight-maintained cohort. These data emphasize the importance of sustained weight-restoration for adult women with anorexia nervosa. Further, the impacted neural regions have been associated with impulsivity, attention, self-regulation, and social interactions in other clinical cohorts, suggesting that these neuropsychological processes may warrant study in patients recovering from anorexia nervosa. Future work should consider whether these factors have clinical relevance in the outpatient treatment of adults with anorexia nervosa. Supplementary Information The online version contains supplementary material available at 10.1186/s40337-021-00466-w.

Background: Every year, lung cancer contributes to a high percentage deaths in the world. Early detection of lung cancer is important for its effective treatment, and non-invasive rapid methods are usually used for diagnosis. Introduction: In this study, we aimed to detect lung cancer using deep learning methods and determine the contribution of deep learning to the classification of lung carcinoma using a convolutional neural network (CNN). Methods: A total of 301 patients diagnosed with lung carcinoma pathologies in our hospital were included in the study. In the thorax, Computed Tomography (CT) was performed for diagnostic purposes prior to the treatment. After tagging the section images, tumor detection, small and non-small cell lung carcinoma differentiation, adenocarcinoma-squamous cell lung carcinoma differentiation, and adenocarcinoma-squamous cell-small cell lung carcinoma differentiation were sequentially performed using deep CNN methods. Result: In total, 301 lung carcinoma images were used to detect tumors, and the model obtained with the deep CNN system exhibited 0.93 sensitivity, 0.82 precision, and 0.87 F1 score in detecting lung carcinoma. In the differentiation of small cell-non-small cell lung carcinoma, the sensitivity, precision and F1 score of the CNN model at the test stage were 0.92, 0.65, and 0.76, respectively. In the adenocarcinoma-squamous cancer differentiation, the sensitivity, precision, and F1 score were 0.95, 0.80, and 0.86, respectively. The patients were finally grouped as small cell lung carcinoma, adenocarcinoma, and squamous cell lung carcinoma, and the CNN model was used to determine whether it could differentiate these groups. The sensitivity, specificity, and F1 score of this model were 0.90, 0.44, and 0.59, respectively, in this differentiation. Conclusion.: In this study, we successfully detected tumors and differentiated between adenocarcinoma- squamous cell carcinoma groups with the deep learning method using the CNN model. Due to their non-invasive nature and the success of the deep learning methods, they should be integrated into radiology to diagnose lung carcinoma.

IgG4-related disease (IgG4-RD) is a systemic autoimmune disorder that has been defined in various organs. The disease is characterized by typical clinicopathological features including a dense lymphoplasmacytic infiltrate rich in IgG4 positive plasma cells, storiform fibrosis, obliterative phlebitis, and often an elevated serum IgG4 level. Esophageal IgG4-RD is rare, and its presentation as a solid mass is even more rare. Only 15 previous cases of IgG4-related esophageal disease have been described. We herein present a case of giant IgG4-related pseudotumor of the esophagus resected with endoscopic submucosal dissection (ESD) and a review of the literature. The patient was a 67-year-old man who was admitted to our hospital for assessment of progressive dysphagia. Upper gastrointestinal endoscopy revealed a 9 cm mass in the cervical esophagus. In the previous two hospitals, the patient's mass could not be diagnosed despite repeated biopsies. Because of concerns regarding malignancy, endoscopic submucosal dissection was performed. Histopathological examination showed dense lymphoplasmacytic infiltration with predominant IgG4-positive plasma cells on a sclerotic background. The patient was diagnosed with IgG4-RD. During the follow-up, no residual mass was detected but the patient was diagnosed with lung adenocarcinoma. We present a unique case of giant IgG4-related pseudotumor of the esophagus. Resection with ESD of such a big mass of IgG4-RD in the esophageal region has never been reported before in the literature.

Background Limited data exists on occupational allergic contact dermatitis (OACD) in Turkey. Objectives To investigate the epidemiologic profile of OACD in Turkey. Methods A retrospective cohort study on 294 patients with OACD among 2801 consecutively patch-tested patients in the allergy unit of the dermatology department of Istanbul Faculty of Medicine between 1996-2019. Results The overall prevalence of OACD was 10.5%, showing a male predominance. OACD was most frequently seen in construction workers (45.2%), followed by hairdressers, metalworkers, healthcare workers, and miscellaneous. The main relevant allergens were chromium in cement, thiurams in rubber gloves, hairdressing chemicals, resins/glues/plastics, metals, isothiazolinones, and fragrances. Hands were the mainly involved site (95.6%). Airborne eczema was observed in 21.4%. Hand&foot eczema and co-sensitizations to chrome&thiuram and chrome&cobalt were significantly associated with being a construction worker. Sensitizations to isothiazolinones in house painters, ammonium persulfate and p-phenylenediamine in hairdressers, and colophonium increased after 2010. Conclusion These were the largest data on OACD from Turkey, reflecting the importance of rubber glove allergy in all occupations and the striking increase in ammonium persulfate allergy among hairdressers. Chrome and cobalt were still the main cement allergens in Turkey, where the cement directive is not yet in force. This article is protected by copyright. All rights reserved.

Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (Covid-19), which has been declared as a pandemic by the World Health Organization. The aim of the study described here was to determine the severity of pneumonia and the clinical parameters related to a modified lung ultrasound score (mLUS) in patients with COVID-19 pneumonia. The study included 44 patients with proven COVID-19 pneumonia. Patients were divided into three groups on the basis of pneumonia severity: mild/moderate pneumonia (group I), severe pneumonia (group II) and critically ill patients (group III). It was determined that mLUS values in groups I–III were 6.51 ± 4.12, 23.5 ± 5.9 and 24.7 ± 3.9, respectively. mLUS values were significantly higher in group II and III patients than in group I patients. There was a positive relationship between mLUS and age and N-terminal pro-brain natriuretic peptide level and a negative relationship with PaO2/FiO2 (p = 0.032, β = 0.275 vs. p = 0.012, β = 0.315 vs. p = 0.001, β = –0.520, respectively). In patients with COVID-19 pneumonia, mLUS increases significantly with the severity of the disease.

Objectives DM (Diabetes mellitus) is a serious community health problem and considered a burden of disease for social security institutions, households, and society. The objective was to analyse the costs of inpatients with diabetes mellitus. Study Design This study has a descriptive, cross-sectional and retrospective research approach. Method In the study, diagnosis related groups (DRGs) related with diabetes mellitus were analysed with regard to hospital invoices and DRG costing. This is a retrospective study on 649 patients who were hospitalized with the diagnosis of Type 1 (83 patients) and Type 2 diabetes mellitus (566 patients) in the year of 2013 at Ankara Numune Education and Research Hospital in Turkey. The study included patients with diagnoses of “E10” Type 1 diabetes mellitus and “E11” Type 2 diabetes mellitus. Type 1 and Type 2 DM costs were calculated by examining inpatient treatment invoices of related patients. DM treatment costs were limited according to hospital services. Results The average age of diabetes mellitus patients in the study was 57.24 ± 15.79 years old and the average length of stay for these patients was calculated as 9.56 ± 10.35 days. The average amount of service activity invoice was calculated as $714.90 and average DRG amount was $1223.40 for 649 inpatients with the diagnosis of diabetes mellitus in 2013. A significant difference was found in average hospital costs between Type 1 and Type 2 diabetes mellitus patients. Conclusion Disease cost analyses in hospitals are required in order to prioritize healthcare services, use resources efficiently and decrease the financial burden of diseases on the society.

Background/aim: Mesenteric panniculitis MP is an idiopathic benign disease characterized by fat necrosis, chronic inflammation, and fibrosis. The relationship between obesity and chronic low-grade inflammation has been reported. This study investigated the relationship of MP diagnosed using multidetector computed tomography MDCT with visceral adipose tissue VAT and subcutaneous adipose tissue SAT areas.Materials and methods: We retrospectively enrolled 104 patients with no radiological findings other than MP. Additionally, 76 individuals without any indicative radiological findings were included as controls. VAT and SAT were separately calculated cm2 using a 3-dimensional workstation. The abdominal circumference was measured cm . Results: The mean abdominal circumference was 99.9 ± 7.9 cm, SAT was 195.3 ± 89.1 cm2, and VAT was 203.9 ± 72.8 cm2 in the MP group. The abdominal circumference, VAT, and SAT were significantly higher in the MP group than in the control group P < 0.001 . According to the receiver operating characteristic ROC analysis, cut-off level VAT and SAT were 167.5 cm2 sensitivity 71%, specificity 69% and 117.5 cm2 sensitivity 78%, specificity 51 % , respectively.Conclusion: Increased VAT and SAT were associated with MP, suggesting their role in the etiology of MP.

Giriş ve Amaç: Beyin ölümü apne, koma ve beyin sapı reflekslerinin bulunmamasına ek olarak elektroserebral sessiz elektroensefalografi (EEG) bulunması durumudur. Çocuklarda beyin ölümü en sık travma ve anoksik ensefalopati sonucu ortaya çıkar. Beyin ölümü insidansının %0,65 ila %1,2 arasında değiştiğini bildirmiştir. Beyin ölümü tanısı iyi bir anamnez, fizik muayene ve yardımcı testler ile konulur. Pediatrik hastalar EEG açısından değerlendirilirken mutlaka medikasyon, metabolik ensefalopati, hipotermi, elektrolit dengesizliği, asit-baz dengesizliği açısında değerlendirilmelidir.Hastalar ve Metod: Çalışmamıza 2010-2017 yılları arasında İnönü Üniversitesi Turgut Özal Tıp Merkezi çocuk yoğun bakım ünitesinde beyin ölümü gerçekleşen hastalar alınmıştır. Hastaların dosyaları retrospektif olarak tarandı. Çalışmamıza alınan hastaların tamamına EEG çekildi. Hastalarımızın tamamına apne testi yapıldı. Beyin kan akımı (CSF) akımı ölçümünde bilgisayarlı tomografi anjiyografi (BTA), manyetik rezonans anjiyografi (MRA), transkraniyal doppler ultranografi (TCD) yapıldı.Sonuçlar: Çalışmamıza alınan 20 hastanın 9’u (%45) kız, 11’i (%55) erkekti. Yaş ortalaması ise 8,47±5,73 yaş idi. Hastalarımızın 7’si fulminan hepatit, 3’ü travma, 3’ü sepsis, 2’si suda boğulma, 2’si SVO tanısı, birer hasta ise lenfoma, suicide, elektrik çarpması ile takip edilmişti. Yirmi hastamızın sadece 2’si (%10) için aile organ bağışında bulunmuştu. Yirmi hastamızın 4’ü Suriyeli idi ve 4 hastanın tamımı da karaciğer yetmezliği ile takip edilmekteydi. Tüm hastaların apne testi pozitifti, hastalarımızın tamamında EEG bulguları beyin ölümünü destekleyici nitelikteydi. Hastalarımızın 11’ine (%55) CSF akımının yokluğunu gösterebilmek adına görüntüleme yöntemleri yapıldı. Beyin ölümü gerçekleşen hastalarımızın 9’unda (%45) DI gelişti.Sonuç: Sonuç olarak beyin ölümü tanısı multidisipliner yaklaşım gerektirir. Fizik muayenenin yanında laboratuvar bulgularının EEG’nin birlikte değerlendirilmesi özellikle klinğimiz gibi 50’den fazla pediatrik transplantın yapıldığı merkezler açısından önemlidir. Hastalarda hipernatremi ve DI gelişimi beyin fonksiyonlarında kaybın bir göstergesidir., Introduction: Brain death is defined as a status of apnea, coma and the absence of brainstem reflexes, in addition to the presence of electrocerebral silence (ECS) on an electroencephalography (EEG). Trauma and anoxic encephalopathy are the most common causes of brain death in children, with incidences of brain death reported to vary between 0.65–1.2 percent. A diagnosis of brain death can be made based on a detailed anamnesis, physical examination findings and supportive test results. When pediatric patients are being evaluated by EEG, they should also be assessed in terms of medications, metabolic encephalopathy, hypothermia, electrolyte imbalance and acid-base imbalance.Patients and Methods: The present study included patients who suffered brain death during hospitalization in the pediatric intensive care unit of Inonu University Turgut Ozal Medical Center between 2010 and 2017. The medical files of the patients were reviewed retrospectively. All patients included in the study underwent an EEG and an apnea test was performed on all patients. The cerebral blood flow (CBF) measurement was obtained through a Computerized Tomography Angiography (CTA), and all patients underwent a Magnetic Resonance Angiography (MRA) and a Transcranial Doppler Ultrasonography (TCD).Results: Of the 20 patients included in the study, nine (45%) were female and 11 (55%) were male, with a mean age of 8.47±5.73 years. Of the total, seven patients presented with fulminant hepatitis, three with trauma, three with sepsis, two with drowning, two with cerebrovaskuler disease (CVD), and one patient each with lymphoma, suicide and electric shock. The families of only two (10%) patients donated the organs of the deceased. Of the 20 patients, four were Syrian, and of which were being monitored with the diagnosis of liver failure. An apnea test was positive in all patients, and in all patients, the EEG findings supported brain death. Imaging methods were carried out to demonstrate the absence of CBF flow in 11 (55%) patients, and diabetes insipidus (DI) developed in nine (45%) of the patients with brain death.Conclusion: In conclusion, a multidisciplinary approach is required for the diagnosis of brain death. An evaluation of laboratory findings and EEG results together with the findings of a physical examination is important, particularly in centers like our clinics where more than 50 pediatric transplantations are carried out each year. The development of hypernatremia in patients with DI is now an important parameter in the loss of brain function.

Tendon stores, releases, and dissipates energy to efficiently transmit contractile forces from muscle to bone. Tendon injury is exceedingly common, with the spectrum ranging from chronic tendinopathy to acute tendon rupture. Tendon generally develops according to three main steps: collagen fibrillogenesis, linear growth, and lateral growth. In the setting of injury, it also repairs and regenerates in three overlapping steps (inflammation, proliferation, and remodeling) with tendon-specific durations. Acute injury to the flexor and extensor tendons of the hand are of particular clinical importance to plastic surgeons, with tendon-specific treatment guided by the general principle of minimum protective immobilization followed by hand therapy to overcome potential adhesions. Thorough knowledge of the underlying biomechanical principles of tendon healing is required to provide optimal care to patients presenting with tendon injury.

Objective This research was conducted to determine the psychometric characteristics of the “Spiritual Needs Assessment Scale of Patients with Cancer” in Turkish patients with cancer. Methods This study used psychometric methods to test the adapted tool. The participants of this study were patients with a diagnosis of cancer in the outpatients and inpatients medical oncology and hematology clinics of a university hospital in Turkey. 400 patients determined by power analysis were included in the study. The data were collected in 2018. We used the descriptive form and “Spiritual Needs Assessment Scale of Patients with Cancer.” The obtained data were evaluated using Cronbach's α reliability coefficient, Pearson's correlation coefficient, and factor analysis. Results In the present study, the factor loads of the items were sufficient and explained 39.18% of the total variance. Cronbach's α value of the scale was 0.85. Significance of results As a result, it was found that the validity and reliability of the “Spiritual Needs Assessment Scale of Patients with Cancer” were ensured and they could be used in Turkish patients.

BACKGROUND: In the literature, novel physiotherapy and rehabilitation approaches are getting significant attention as a way to cope with secondary complications in the management of asthma. OBJECTIVE: To investigate the effectiveness of core stabilization exercises combined with the Asthma Education Program (AEP) and breathing exercises in patients with asthma. METHODS: The study sample consists of 40 asthmatic patients (age 52.25 ± 11.51 years) who were randomly divided into a Training Group (TG) (n= 20) and a Control Group (CG) (n= 20). All subjects were included in the AEP, and both groups were trained in breathing retraining exercises (2 times/wk, 6-week duration in the clinic). The core stabilization exercise program was also applied in the TG. Respiratory muscle strength (maximum inspiratory and expiratory pressures), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ)), health-related quality of life (Asthma Quality of Life Questionnaire (AQOL)), functional exercise capacity (six-minute walking test (6MWT)), and dynamic balance (Prokin PK200) were assessed before and after the interventions. RESULTS: The TG showed more significant improvements in MIP (ΔTG:4.55 cmH2O, ΔCG:0.95 cmH2O), IPAQ (ΔTG:334.15 MET-min/wk., ΔCG:99 MET-min/wk.), 6MWT (ΔTG:24.50 m, ΔCG:11.50 m), and dynamic balance sub-parameters compared to the mean difference between the initial assessment and after a 6-week intervention program, which included twelve exercise sessions (p< 0.01). CONCLUSIONS: The findings present greater improvements in inspiratory muscle strength, physical activity level, functional exercise capacity, and dynamic balance when core stabilization exercises are included in the pulmonary rehabilitation program for the management of asthma.

Objective: Optic neuritis (ON) is an autoimmune disease that starts with acute and subacute vision loss and is characterized by the demyelination of the optic nerve. It may appear as an iso lated, idiopathic condition, or it may be a precursor of diseases such as Multiple Sclerosis (MS) or Neuromyelitis Optica (NMO). In the study, we aimed to evaluate ON patients and the long term prognosis in pediatric patients. Material and Method: In this study, 13 patients who applied to the pediatric neurology clinic between years 2010-2017 and were diagnosed with acute ON were assessed retrospectively. Results: Thirteen patients diagnosed with ON were included in our study, six of whom were diagnosed with isolated ON (6/13, 46.15%). Nine of them were female. The average age of our patients was 12.8±3.07 years. Seven patients (53.85%) had unilateral involvement. A complete recovery was provided in 12 patients. There were recurrences in the follow-up of two patients, diag nosed with MS. Conclusion: ON should absolutely be considered in every child with blurred vision and vision loss. Early stage steroid treatment is the most efficient therapy.

Introduction 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. Objective To investigate the prognostic value of these parameters in patients with head and neck cancers. Methods We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. Results The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63 cm3 (0.6-34.3), 68.9 g (2.58-524.5 g), 13.89 (4.89-33.03 g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. Conclusion Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer. Resumo Introdução Os parâmetros da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose, como os máximos valores de captação padronizados, o volume metabólico tumoral padrão e a glicólise total da lesão são importantes biomarcadores prognósticos de câncer. Objetivo Investigar o valor prognóstico desses parâmetros em pacientes com câncer de cabeça e pescoço. Método Fizemos um estudo retrospectivo que incluiu 47 pacientes com câncer de cabeça e pescoço e que foram submetidos à tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose antes do tratamento. Volume metabólico tumoral, glicólise total da lesão e valores de captação padronizados foram aferidos em cada paciente. O valor prognóstico de parâmetros quantitativos da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose e das variáveis clínico-patológicas sobre a sobrevida livre de doença e a sobrevida geral foi analisado. Resultados A média (intervalo) de volume metabólico tumoral e glicólise total da lesão e valores de captação padronizados foram 7,63 cm3 (0,6-34,3), 68,9 g (2,58-524,5) e 13,89 g/mL (4,89-33,03), respectivamente. Metástase nos nódulos linfáticos e diferenciação tumoral foram variáveis significativas de sobrevida livre de doença e sobrevida geral; contudo, nenhum parâmetro da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose estava associado a sobrevida livre de doença e sobrevida geral. Conclusão As quantidades dos parâmetros da tomografia por emissão de pósitrons pré-tratamento não previram a sobrevida em câncer de cabeça e pescoço.

Objective: This study was aimed to investigate the complications arising during follow-up and the reasons for hospitalization in pediatric patients who were operated on for esophageal atresia (EA) and tracheoesophageal fistula (TEF). Materials and Methods: Between 2007 and 2019, all patients operated for EA and TEF were evaluated in terms of age, gender, age at diagnosis, post-op, and complications in follow-up. Results: In the study, 28 of 50 patients were operated on for EA and TEF, 14 for isolated EA, and 8 for isolated TEF. The mean age of the patients was 4.9 ± 4.4 years, and 18 (36%) of them were female. The median age of diagnosis was 1 (IQR: 1-3) day and the mean follow-up duration was 4.6 ± 4.1 years. During follow-up, 84% of patients had recurrent pneumonia, 60% gastroesophageal reflux (GER), 34% growth retardation, 30% restrictive lung disease, and 18% scoliosis. Postoperative pneumonia, hospitalization, development of stricture and growth retardation were more frequent in patients with GER (P < .05). Patients with scoliosis had more frequent pneumonia and hospitalization rates (P < .05). Conclusion: Hospital admissions of the patients with EA and TEF were higher due to GER, recurrent pneumonia, restrictive lung disease, and scoliosis in the follow-up. Pneumonia, hospitalization, stricture in the esophagus, and growth retardation were observed more frequently in patients with GER. Patients should be followed up by the pediatric pulmonology, gastroenterology, and orthopedic departments.

Purpose: The aim of this study was to investigate the corrective effect of Oxford phase 3 medial unicompartmental knee arthroplasty (UKA) on the lower extremity axis, tibiofemoral subluxation and lateral joint distance. Materials and Methods: The study included 105 knees that had undergone UKA. The Oxford Knee Score, EQ-5D-3LD and visual analog scale, and The Knee injury and Osteoarthritis Outcome Score were evaluated. Radiological evaluation was made of the lower extremity axis, tibiofemoral subluxation, and lateral knee joint distance. Results: The postoperative mean improvement in the mechanical axis was 1.4° and in the tibiofemoral subluxation distance, 1.59 mm compared to preoperative values. The difference between the preoperative and postoperative lateral joint distance values was on average 0.25 mm lateral inner joint distance, 0.08 mm in the lateral middle joint distance and 0.34 mm in the outer joint distance. There was no significant difference in clinical results between the groups. Conclusion: There were significant improvements in the postoperative period after cemented, cementless, and hybrid medial UKA in the measurements of lower extremity mechanical axis, tibiofemoral subluxation distance and lateral joint distances compared to the preoperative period.

Objectives To evaluate the effect of the COVID-19 pandemic restrictions on myopia progression (MP) in school age children. Methods A total of 115 children aged 8–17 years with a diagnosis of myopia who had been followed-up for at least 3 years, were included in this study with a retrospective and single-center design. The subjects’ age, the history of myopia in the family, the time spent in front of a screen, the digital devices used during home education (computer, tablet, smartphone, television), the time spent in open air (hours/day), the refractive error (RE) (spherical equivalent value) detected before the home education period and the changes in the myopia over the years, were recorded. Results The mean age was 12.06(± 2.29) years. Only the right eyes were included. The glasses use duration was 3.57(± 0.74) years. The annual MP amount 0.49(± 0.26), 0.41(± 0.36) and 0.54(± 0.43) diopters (D) for the 2017, 2018, and 2019 years before home education, respectively, (p > 0,05), and 0.71(± 0.46) D in 2020, during home education. The increase in MP amount in 2020 compared to the 2019 and 2018 years was statistically significant (p