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Introduction: Factors related to mortality after intertrochanteric femur fractures (ITFF) have been investigated intensively in the literature except for radiographic osteoporotic hip morphology. The aim of this study is to investigate the relationship between mortality and radiographic osteoporotic hip morphology of patients with ITFF. Patients and methods: Patients who underwent surgery between the dates of January 2012 and June 2018 due to ITFF were retrospectively reviewed. Osteoporotic status of the proximal femur was determined based on Singh Index grading and Dorr classification systems on preoperative anteroposterior pelvis radiographs of contralateral hips. The mortality rates of the patients were measured at 1st, 3rd, 6th, and 12th months. For controlling the confounders, multiple regression analysis was performed. Results: A total of 321 consecutive ITFFs were included in the study. The mean age of the patients was 81.5 ± 6.6 years. All patients were treated with osteosynthesis utilizing a cephalomedullary nail. The overall mortality rates at 1st, 3rd, 6th, and 12th months were 7.2%, 13.4%, 16.2%, 22.7%, respectively. There was 2.196 (1.140 - 4.229) folds increase in the mortality rate of patients with the Dorr type C femurs at 6th month (p=0.019). However, Singh index grade was not significantly associated with mortality. Conclusion: Patients with Dorr type C femur seem to have 2.1 times increased mortality at 6th months following ITFFs. A simple anteroposterior pelvis radiograph obtained during the initial evaluation of the patients may be used to estimate the mortality rate after ITFF.

The aims of this study were to describe the trends in the behavior of pediatric CD during the last decade and to describe the seasonal variation of disease presentation.Patients under 18 years old and diagnosed between 2009 and 2019 were included. The clinical, endoscopic, histological, and laboratory data were collected from the medical records. We analyzed the trends of these parameters according to the year and season of diagnosis.654 patients were included in the study. The number of incident CD cases increased yearly. Patients diagnosed between 2015 and 2019 were younger at diagnosis (OR 2.53, p = 0.02), had more perianal diseases (OR: 2.30, p 0.0001) and more granulomas (OR: 1.61, p = 0.003), but fewer eosinophils (OR: 0.35, p 0.0001) and less chronic lymphoplasmacytic infiltrate (OR: 0.56, p = 0.008) as compared to the 2009-2014 cohort. There was fewer CD diagnosis during winter. Patients diagnosed in the fall had lower PCDAIs, less failure to thrive and less extensive digestive involvement. Colonic disease was significantly more frequent during summer and fall.The clinical and histological phenotype of CD has changed over time and there are important seasonal trends in the frequency and severity on disease behavior suggesting possible disease triggers.

Background/aim The aim of this study was to evaluate the value of PET Vascular Activity Score (PETVAS) during the follow-up of patients with Takayasu arteritis. Materials and methods Takayasu arteritis patients who underwent 18F-Fluorodeoxyglucose (FDG) PET imaging were evaluated retrospectively. In 8 patients both 1 and 2-hour imagings were also performed prospectively. For PETVAS, 9 arterial areas were scored between 0-3 according to the FDG uptake. Results Forty-six images of 34 patients were evaluated. PETVAS was higher in patients with clinically active disease (p=0.03) and in C-reactive protein (CRP) elevated group among clinically inactive patients (p=0.0015). PETVAS correlated with CRP (p=0.003, r=0.53) and erythrocyte sedimentation rate (p=0.005, r=0.41), whereas age, disease duration, immunosuppressive and glucocorticoid (GC) treatments were not associated with PETVAS. First vs 2nd-hour PETVAS was similar in patients who had both 1st and 2nd hour PET scans (p=0.67). Conclusion We observed higher PETVAS in patients with active disease and elevated acute phase reactants. Although scores in our study (performed at one-hour) were lower compared to the original PETVAS study performed at two hours, PETVAS seems to be a reliable tool to quantify FDG PET scores in routine practice.

Lipoprotein apheresis (LA) is an extracorporeal therapy which removes apolipoprotein B-containing particles from the circulation. We evaluated techniques and efficiency of lipoprotein apheresis procedures applied to patients with familial and non-familial hypercholesterolemia (FH) at our center.We retrospectively evaluated 250 LA procedures applied to 27 patients with dyslipidemia between March 2011 and August 2019.A total of 27 patients, of whom 19 (70.4%) were male and 8 (29.6%), female, were included. Eighteen (66.7%), 6 (22.2%) and 3 (11.1%) patients were diagnosed with non-FH, homozygous FH (HoFH) and heterozygous FH (HeFH), respectively. Two different apheresis techniques, direct adsorption of lipoproteins (DALI) (48.8%) and double filtration plasmapheresis (DFPP) (51.2%), were used. The change in the serum total cholesterol (TC) level was the median 302 mg/dl (171-604 mg/dl) (60.4%) in HoFH patients, 305 mg/dl (194-393 mg/dl) (60.8%) in HeFH patients and 227 mg/dl (75-749 mg/dl) (65.3%) in non-FH patients. The change in the serum low-density lipoprotein (LDL) level was the median 275 mg/dl (109-519 mg/dl) (64.2%), 232 mg/dl (207-291 mg/dl) (64.5%) and 325 mg/dl (22-735 mg/dl) (70.9%) in patients with HoFH, HeFH and non-FH, respectively. A significantly effective reduction in serum lipid levels, including TC, LDL and triglycerides, was achieved in all patients, regardless of the technique, p .001. The decrease in the serum TC and LDL levels was significantly higher in the DFPP, compared to the DALI, being 220 mg/dl (-300 to 771) vs 184 mg/dl (64-415), p .001 and 196 mg/dl (11-712) vs 157 mg/dl (54-340), p .001, respectively.Our results showed that LA is a highly effective treatment in reducing serum lipid levels and safe, without any major adverse event.

Background and Aim : This study is designed to investigate the physical, psychological and quality of life (QoL) effects of a 16 week supervised and structured intensive aerobic and strength training during the first line chemotherapy of lymphomas. Patients and Methods This pre-post study with two groups enrolled ≥18 years of age lymphoma patients scheduled for the first line chemotherapy. Eligible patients were assigned upon patients’ preference either to control group (Group C) involving simple counselling, or intervention group (Group I) involving supervised intensive training. Baseline, interim and final evaluations were performed per protocol. Repeated measures analysis of variance was used to investigate the effect of intervention. Results The mean age of 47 enrolled patients was 44 [standard deviation (SD) ± 17] and 27 (57.4%) of them were male. Patients in Group C (n = 19) and Group I (n = 28) had similar baseline characteristics. Tmax was significantly higher in Group I (P = .03) without a significant change during the study course (P = .98). Significant increases were observed in the power of some muscle groups, irrespective of the intervention type. The mean adherence rates were 83.0% (SD ± 22.0) and 54.0% (SD ± 23.0); the discontinuation rates were 10.7% (n = 3) and 42.9% (n = 12), at interim and final evaluations, respectively. Conclusion Both supervised and structured schemes and simple counselling, prevent further muscle wasting and lead to modest improvements in aerobic performance and muscle strength during lymphoma chemotherapy. These results do not translate into a significant improvement in QoL measures. Non-adherence and discontinuation are important issues to be solved.

The paper describes the case of a 60-year-old male patient with a mass in the left jugulodigastric area, which was later identified as synovial sarcoma. Differential diagnoses such as cystic lesions, metastatic lymph nodes, and salivary gland tumors were considered. The characteristics of various tumors were discussed, including their imaging features on CT and MRI scans. Synovial sarcoma, a rare malignant tumor, was found to present as a well-circumscribed, ovoid, hypodense lesion with heterogeneous enhancement on CT. The importance of accurate diagnosis and imaging modalities in guiding treatment decisions and achieving early detection was emphasized. The importance of this case lies in the accurate diagnosis and management of synovial sarcoma, a rare malignant tumor. Early detection through imaging modalities like CT and MRI is crucial for timely intervention and treatment planning. Understanding the imaging characteristics of synovial sarcoma helps differentiate it from other lesions, leading to appropriate surgical resection and improved patient outcomes.

ObjectiveNumerous techniques for the reduction of anteriorglenohumeral joint dislocations have been described.However, there is no consensus on the best techniquefor reducing a dislocated glenohumeral joint. Thisstudy aimed to evaluate the approach of emergencyspecialists and orthopedic surgeons in the treatmentof acute traumatic first-time anterior shoulderdislocation.Material and MethodsData used in this cross-sectional study were obtainedthrough a web-based survey from the TurkishOrthopedics and Traumatology Association mail groupand Emergency Medicine Physicians Associationof Turkey mail group. All orthopedic surgeonsand emergency medicine physicians who wereregistered in the database received an informationmail regarding the aim of the questionnaire and a linkto the online survey form (Google Forms, AlphabetInc., Mountain View, CA). The survey consisted of 13questions, which are shown with their correspondinganswer options. The current practices regarding themanagement of acute traumatic first-time anteriorshoulder dislocation among orthopedic surgeonsand emergency medicine physicians in Turkey wereevaluated.ResultsA total of 152 orthopedic surgeons and 151 emergencyphysicians participated in this survey. The mostcommon maneuvers used by emergency physiciansto reduce shoulder dislocations were the Hippocratestechnique (19.2%) and Cunningham technique(19.2%), while orthopedic surgeons preferred theHippocrates technique (23.7%) and Kocher technique(29.6%). It was found that orthopedic surgeonspreferred Kocher and Milch maneuvers more forshoulder joint dislocation reduction compared toemergency physicians (p < 0.001 and p = 0.005,respectively). Both the pre- reduction and postreductionprocedures showed variability betweenorthopedic surgeons and emergency physicians.ConclusionIt would be more appropriate for the emergencyphysician and orthopedic surgeons to treat apatient with shoulder dislocation together as a teamand beneficial to establish a national guideline forconsensus., AmaçAnterior glenohumeral eklem çıkıklarının yerine oturtulmasına(redüksiyonuna) yönelik çok sayıda tekniktarif edilmiştir. Bununla birlikte, glenohumeral eklemçıkığı redüksiyonu için en iyi teknik konusunda fikirbirliği yoktur. Bu çalışma, akut travmatik ilk kez öne(anterior) omuz çıkığının tedavisinde acil uzmanlarıve ortopedi cerrahlarının yaklaşımlarını değerlendirmeyiamaçlamaktadır.Gereç ve YöntemBu kesitsel çalışmada kullanılan veriler, Türkiye Ortopedive Travmatoloji Derneği posta grubu ve TürkiyeAcil Tıp Hekimleri Derneği posta grubundan webtabanlı bir anket yoluyla elde edilmiştir. Veritabanınakayıtlı tüm ortopedi cerrahları ve acil tıp doktorları anketinamacına ilişkin bir bilgilendirme postası ve çevrimiçianket formuna (Google Forms, Alphabet Inc.,Mountain View, CA) bir bağlantı aldı. Anket, karşılıkgelen cevap seçenekleriyle gösterilen 13 sorudanoluşuyordu. Türkiye'deki ortopedi cerrahları ve aciltıp hekimleri arasında akut travmatik ilk kez anterioromuz çıkığının tedavisine yönelik güncel uygulamalardeğerlendirildi.BulgularBu ankete toplam 152 ortopedi cerrahı ve 151 aciluzmanı katılmıştır. Acil uzmanlarının omuz çıkığınıredükte etmek için en sık kullandıkları manevralarHipokrat tekniği (% 19,2) ve Cunningham tekniği (%19,2) iken, ortopedi cerrahları Hipokrat tekniğini (%23,7) ve Kocher tekniğini (% 29,6) tercih etti. Ortopedicerrahlarının omuz eklemi çıkığını azaltmak için aciluzmanlarına göre daha çok Kocher ve Milch manev-ralarını tercih ettikleri bulundu (sırasıyla p

BACKGROUND Newborn screening (NBS) for cystic fibrosis (CF) was implemented in our country on January 1st, 2015, based on immunoreactive trypsinogen tests (IRT/IRT). Here, we aimed to evaluate the diagnoses of patients and follow-up process within the first 5 years of NBS from a tertiary care center. METHODS This retrospective cohort study was conducted on patients who were admitted to our pediatric pulmonology department for sweat test (ST) via NBS. Patients with CF with negative NBS results and those with CF with positive NBS and joined our follow-up were also investigated. Clinical outcome measures were compared between patients with CF with positive and negative NBS. RESULTS Six hundred sixty infants who were referred for ST via NBS were included. Across the entire study population(n=683), 11.4% of patients had CF (14.1% of had negative NBS in this CF group). The sensitivity of NBS was found as 84.9% and the positive predictive value (PPV) was 9.4%. The median age at diagnosis was older (p

Objective: This study aimed to investigate pathological lymph node involvement in selected patients and the relationship of prostate-specific antigen (PSA) progression-free survival rates between patients with and without lymph node involvement on preoperative conventional radiologic imaging. Limited data is available about local treatment outcomes in patients with prostate cancer (PCa) having clinical lymph node involvement.

Aim:P-wave dispersion (PWD) is a noninvasive electrocardiographic (ECG) marker of atrial remodeling. Inflammations are likely to cause atrial remodeling. This study aims to determine the relationship between PWD and intrahospital mortality in Coronavirus disease-2019 (COVID-19) patients.Methods:One hundred eighty-nine patients who tested positive for polymerase chain reaction for a diagnosis of COVID-19 between March 2020 and January 2021 were included in the cross-sectional study. PWD was calculated from the pre-treatment ECG of all patients at the time of hospitalization.Results:Mean PWD values were numerically and statistically significant in the group who died in hospital compared to the group discharged after recovery (46.37±19.00 ms vs. 31.86±11.08 ms, p

Leptomeningeal metastasis (LM) is a devastating complication of cancer with variable clinical presentation and limited benefit from existing treatment options. In this review, we discuss advances in LM diagnostics and therapeutics with the potential to reverse this grim course. Emerging cerebrospinal fluid circulating tumor cell and cell-free tumor DNA analysis technologies will improve diagnosis of LM, while providing crucial genetic information, capturing tumor heterogeneity, and quantifying disease burden. Circulating tumor cells and cell-free tumor DNA have utility as biomarkers to track disease progression and treatment response. Treatment options for LM include ventriculoperitoneal shunting for symptomatic relief, radiation therapy including whole-brain radiation and focal radiation for bulky leptomeningeal involvement, and systemic and intrathecal medical therapies, including targeted and immunotherapies based on tumor mutational profiling. While existing treatments for LM have limited efficacy, recent advances in liquid biopsy together with increasing availability of targeted treatments will lead to rational multimodal individualized treatments and improved patient outcomes.

Objectives Inhaled recombinant human deoxyribonuclease (dornase alfa) and osmotic agents such as inhaled mannitol are used for improving the clearance of secretions of cystic fibrosis (CF) patients. We aimed to evaluate the long-term clinical effects of adding dry powder inhaled (DPI) mannitol in subjects with CF who are taking daily dornase alfa. Method We conducted a retrospective case-control study on subjects with CF. The effect of DPI mannitol was assessed by comparing DPI mannitol and dornase alfa combination with daily dornase alfa alone in children with CF during a 12-month period. The primary outcome measures of the study were absolute changes in percent predicted forced expiratory volume in 1 s (FEV1) and FEV1 z-scores and the secondary outcomes included other spirometry indices, body mass index, frequency of pulmonary exacerbations, SPO2 , and sputum microbiology. Result Of a total of 28 patients who committed to use DPI mannitol treatments during the study period, five had a positive challenge with DPI mannitol and two were aged over 18 years. Therefore, the mannitol treatment group consisted of 21 patients. However, the effect of DPI mannitol was analyzed using 15 patients in the mannitol treatment group who received DPI mannitol for at least 12 months, and 18 patients who only used dornase alfa constituted the control group. The median absolute change in FEV1 between baseline and the third month; and baseline and the 12th month were significantly higher in the mannitol treatment group (p = 0.038, p = 0.004, respectively). When the groups are compared with respect to absolute z-score changes, all spirometry indices, except FVC at the end of 3 months, showed statistically significant improvements in the mannitol treatment group. Some secondary outcomes like pulmonary exacerbation frequency during the study year and median absolute body mass index z-score changes from baseline to the end of the study showed no significant differences between the groups (p = 0.735, p = 0.161, respectively). No colonization changes were observed in the treatment group. Conclusions This study showed that in those patients who tolerated long-term (12 months) treatment with DPI mannitol and dornase alfa made greater improvements in FEV1, FVC, FEV1/FVC, FEF25-75 z-scores than treatment with dornase alfa alone in children with CF.

Background/aim Common variable immunodeficiency (CVID) characterized by defective immunoglobulin production is the most prevalent form of symptomatic primary immunodeficiency (PID) in adults. We aimed to reveal the clinical features of adults with CVID and to evaluate the effects of immunoglobulin replacement treatment (IRT) on hemato-immunological findings. Materials and methods This study included 26 adult patients receiving IRT. Two measurements of complete blood counts and major immunoglobulin levels obtained at the beginning-end of follow up period were used for comparisons. Lymphocyte subsets and B-cell subgroups were measured only at the time of presentation. Results The most common complications were related to respiratory and digestive systems and organomegaly. Chronic diarrhoea and low body weight were positively correlated with the percentage of CD8+ T cells (p = 0.019 and p = 0.003, respectively) but negatively correlated with the CD4/CD8 ratio and the percentage of CD19+ B cells (p = 0.019 and p = 0.005 for both parameters, respectively). At the end of period, the distribution of haematological parameters significantly improved, and immunoglobulin M (IgM) level increased to detectable levels (p = 0.035). Conclusions There are apparent relationships among chronic diarrhoea and low body weight, and deterioration of T and B cell immunity in adults with CVID. IRT improves the whole blood parameters and stimulates immunoglobulin M (IgM) production. The later effect supports the immunomodulatory feature of this therapy.

BACKGROUND Non-tuberculous mycobacteria (NTM) can cause chronic lung infection particularly in patients who have structural lung disease such as cystic fibrosis (CF). We evaluated the incidence and management of NTM infections in patients with CF in our center. METHODS A retrospective cohort study was carried out on CF patients having at least one positive NTM isolate between 2012 and 2020. RESULTS Ten patients (2.1%) had at least one positive NTM culture from respiratory samples. All of them were vaccinated with Bacille Calmette-Guerin (BCG) vaccine, which is in the national vaccination program in our country. Eight patients had the Mycobacterium abscessus complex, one had Mycobacterium avium, and one had Mycobacterium szulgai growth in their respiratory samples. Three patients had transient NTM infection, two had persistent, and five had active NTM infection (NTM pulmonary disease). Patients with NTM pulmonary disease received antibiogram-directed antimycobacterial therapy. In patients with NTM pulmonary disease, the median ppFEV1 and BMI decreased by 17% and 1%, respectively, at the time of the first NTM isolation when compared with the values one year before the first NTM isolation. Culture conversion was not seen in any patient infected with Mycobacteriunm abscessus complex. CONCLUSIONS The NTM infection incidence is lower in our country than in those countries where the BCG vaccine is not routinely applied. The BCG vaccine may be a protective factor for NTM infection. Further studies are needed about the prevalence of NTM infections, facilitating and protective factors, and appropriate management of NTM infections in patients with CF.

Objective In this study, we aimed to report early outcomes of catheter-directed thrombolysis (CDT) with alteplase in patients with subacute limb ischemia and to assess whether there is a link between malnutrition (determined by Controlling Nutritional Status [CONUT] score) and response to thrombolysis and bleeding. Methods This was a retrospective study conducted between 2007 and 2020 with 118 patients with Rutherford class 3 (34.7%), class 4 (40.7%), and class 5 (24.6%) symptoms owing to infraaortic subacute thrombotic occlusion who were treated with catheter-directed thrombolysis. Results Immediate technical success (Thrombolysis in Myocardial Infarction [TIMI] grade 2/3) was achieved in 56%, overall technical success after all adjunctive procedures was seen in 83.9%. Clinical success was obtained in 74.5% within 30 days. Major bleeding occurred in 11.8%. When we excluded access site hematomas, the rate of major bleeding was 5.1%. In-hospital mortality rate was 5.1%, and the amputation rate within 30 days was 12.7%. Any-degree malnutrition was detected in 48.3% according to CONUT score (≥2). Any-degree malnutrition was associated with failed thrombolysis and bleeding. The CONUT score predicted insufficient lytic response even after adjustment for confounding factors; however, serum C-reactive protein or neutrophil/lenfosit ratio did not. Other predictors of immediate technical failure after thrombolysis were symptom duration, Rutherford class 4/5 symptoms, and worsened distal runoff. Conclusion In patients with subacute limb ischemia, CDT combined with adjunctive interventions was effective in many patients at the expense of a substantial risk of bleeding and death. Malnutrition was associated with insufficient lytic response and bleeding. Physicians should be aware of malnutrition and consider the nutritional status of patients with limb ischemia when selecting appropriate treatment.

There are few case reports in the literature about the cardiac involvement in this tumor-like disease that primarily involves the liver. Although the liver is the most commonly affected organ, other organs may also be affected, including the heart. A 62-year-old male patient, who had been operated three years ago due to hepatic alveolar cyst hydatid, was admitted to the General Surgery clinic with complaints of dyspnea and abdominal pain, and as recurrence was observed in the computed tomography of the patient who had cardiac involvement. In cases with liver AE, other organs must also be evaluated for involvement.

Background Postoperative cerebrospinal fluid (CSF) fistula following cranial or spinal surgery is associated with increased morbidity and mortality. To prevent CSF fistulas, various techniques have been described. Here, we describe the arachnoid membrane continuous-running suture technique in cisterna magna reconstruction for preventing postoperative CSF leakage. Methods After craniotomy and dural opening, the incision of the arachnoid of the cisterna magna was performed using a diamond blade. To prevent the arachnoid from drying out and shrinking during surgery, it was periodically irrigated with warm saline solution. Posterior fossa surgery was performed. When closing the membranes, the arachnoid membrane was closed with the running-suture technique. After the first surgical knot was made in the cranial end of the arachnoid opening, continuous suturing with a 2-mm distance between the stitches was performed without stretching them. After every 3 stitches, the free end of the thread was pulled gently along the suturing axis, and the edges of the arachnoid were closed. After the arachnoid edges were approximated, the surgical knot was tied. Watertight closure was checked by performing the Valsalva maneuver at the end of the surgery. Results No CSF leakages were observed after surgery. Conclusions Arachnoid membrane suturing seems to be safe and effective in preventing postoperative CSF leakage and CSF-related complications. Using continuous running suturing alone, without any sealant, might be effective in cases with untraumatized arachnoid membrane.

Background: to evaluate the utility of pretreatment systemic immune-inflammation index (SII) in predicting the teeth caries and need for tooth extraction after concurrent chemoradiotherapy (C-CRT) for locally advanced squamous-cell head and neck cancer (LASCHNC) patients. Methods: the records of LA-SCHNC patients who underwent formal dental evaluations at pre and post-C-CRT periods were retrospectively analyzed. The pretreatment SII values were calculated using the platelet, neutrophil, and lymphocyte measures acquired on the first day of C-CRT: SII=Plateletsxneutrophils/lymphocytes. Receiver operating characteristic (ROC) curve analysis was employed to identify the ideal pre-C-CRT SII cutoff that may predict the teeth caries and the need for tooth extraction after the C-CRT. The primary endpoint was the link between the pre-C-CRT SII and the need for tooth extraction during the follow-up period. Results: a sum of 126 patients were included. Median follow-up was 4.9 years (range: 2.7-7.8). Nasopharyngeal and laryngeal cancers comprised the majority (75.4%) study cohort. Posttreatment teeth extractions were reported in 62.7% patients. The optimal cutoff was 558 [Area under the curve (AUC): %76.8 sensitivity: 72.3%; and specificity: 70.9%] that grouped the patients into two subgroups with significantly different post-C-CRT tooth extraction rates: Group 1: SII558 (n = 56), respectively. Correlation analysis revealed a significant relationship between the pretreatment SII and the tooth extraction rates after the C-CRT (rs:0.89: P = 0.001). The comparative analysis displayed that the teeth extractions rates were significantly higher in the SII>558 group (77.1% versus 51.4% for SII558 was the unique factor associated with meaningfully higher necessities for post-C-CRT teeth extractions. Conclusion: the present outcomes intimated that high pretreatment SII levels were linked to significantly increased post-treatment teeth extractions in LA-SCHNC patients undergoing definitive C-CRT., NA

Hypophysitis is rarely reported in patients receiving pembrolizumab-only immunotherapies. Since the clinical presentation is usually as isolated adrenocorticotrophic hormone (ACTH) deficiency, patients may be misjudged as having clinical symptoms due to cancer or chemotherapy. A 49-year-old male with laryngeal cancer applied to our clinic just after the tenth cycle of his pembrolizumab treatment, with weakness and nausea/vomiting. Serum morning cortisol and ACTH were 0.47 mcg/dl and 10.1 pg/ml, respectively; the remaining anterior pituitary hormone levels were normal. Pituitary MRI revealed mild glandular enlargement and loss of posterior pituitary bright-spot. All symptoms and signs improved with low-dose prednisolone. This is the second reported case of pembolizumab-associated isolated ACTH deficiency having abnormal pituitary MRI findings as we have reviewed all reported cases in the literature.Lay abstract Immune check point inhibitors (ICIs) are used in order to enhance antitumoral immune mechanisms in certain cancers. As a result, immune-related side effects have commonly been reported in patients taking ICIs, one of which is hypophysitis. Pembrolizumab is a type of ICI which has rarely been associated with hypophysitis. Since the clinical presentation of pembrolizumab-associated hypophysitis is usually as isolated adrenocorticotrophic hormone deficiency and related cortisol insufficiency, patients may be misjudged as having clinical symptoms due to cancer or chemotherapy, due to shared symptoms such as fatigue, loss of appetite and nausea. Here we have reported a case with pembrolizumab-associated isolated adrenocorticotrophic hormone deficiency and reviewed all other cases available in the literature to improve our understanding of such patients.

BACKGROUND Functional luminal imaging probe (FLIP) measures pressure-geometry relationships of digestive luminal space. When used in esophageal disorders, it provides several luminal parameters that help better understand the pathophysiology. Data about the potential utility of FLIP in pediatrics are scarce and there is no standardized use in children. We aim to describe the use of FLIP in our center, its safety, feasibility, and clinical impact in esophageal disorders in children. METHODS Consecutive FLIP recordings performed at the CHU-Sainte-Justine, Montreal, Canada between February 2018 and January 2021 were extracted. A chart review was conducted for demographics and medical history. Symptomatology after the procedure was evaluated with validated dysphagia scores. 19 patients were included (11 girls, median age 16 years, range 3.2-19.6) with achalasia (n = 5), post Heller's myotomy dysphagia (n = 3); esophagogastric junction outflow obstruction (EGJOO) (n = 3); congenital esophageal stenosis (n = 2); post esophageal atresia repair stricture (n = 3), post-fundoplication dysphagia (n = 3). There was no significant correlation between integrated relaxation pressure measured with high resolution manometry and distensibility index (DI). The use of FLIP made it possible to differentiate between dysphagia related to an esophageal obstruction (DI ≤ 2.8 mm2/mmHg) and dysphagia without major motility disorder (DI > 2.8 mm2/mmHg) that guided the indication for dilation. FLIP led to a change in management in 47% of the patients. Forty-seven percent of the patients were symptom free at the time of the evaluation.Conclusions & Inferences: FLIP provides key esophageal luminal values and therefore can play an important role in pediatric esophageal disorders management.

The objectives are to explore the demographic and polysomnographic features of children with Down syndrome and to determine the predictive factors associated with severe sleep apnea. A total of 81 children with Down syndrome referred for full-night polysomnography were analyzed. In addition, parental interviews were performed for each child. Data were available for 81 children, with a mean age of 4.8 years. Severe obstructive sleep apnea was determined in 53.1%. Age, sex, exposure to second-hand smoke, clinical findings, anthropometric features, and the presence of comorbidities were not predictors of severe obstructive sleep apnea. Children who were exposed to second-hand smoke had more sleep-related symptoms. Even in children without symptoms, the prevalence of severe obstructive sleep apnea was 40%. Moreover, 86% of parents had no previous information regarding possible sleep breathing disorders in their children. Clinically significant central apnea was present in 10 patients (12.3%). Conclusion: Our results demonstrate that severe obstructive sleep apnea is common in children with Down syndrome, even in children without a history of symptoms of sleep apnea. It is not possible to predict patients with severe apnea; thus, screening of children with Down syndrome beginning from young ages is very important. Central apneas could be a part of the spectrum of sleep abnormalities in Down syndrome.

Background Pulmonary involvement which can be infectious or noninfectious is one of the most frequent complications in patients with primary immunodeficiency (PID). Objective The aim of this study is to assess the pulmonary system of the pediatric patients with PID and report the demographical, clinical, and radiological findings regarding the underlying PID. Methods The present study included pediatric patients who were receiving immunoglobulin replacement therapy (IGRT) for PID (combined immunodeficiency [CVID] (23), common variable immunodeficiency (15), and agamaglobulinemia [10]) so far or newly diagnosed and started IGRT at Hacettepe University Immunology Department, between January 2015 and January 2018. Results A total of 48 patients (60.4% male), aged 9.9 (6.1-14) years were included. Time of delay in the diagnosis of immundeficiency was 2.27 (interquartile range: 1.0-6.75) years. CVID patients exhibited higher respiratory system symptoms, as well as a history of recurrent lung infection and hospitalization. Hilar and mediastinal lymphadenopathies, peribronchial thickening, and bronchiectasis were the most common pulmonary complications and more than three lung lobes were affected in 69%. Among the newly diagnosed patients, bronchiectasis was present in 25% and more than three lobes were affected in 62.5%. Although pulmonary nodules and mediastinal lymphadenopathy were frequently computed tomography findings in our patients, only two patients (4.16%) were diagnosed with interstitial lung disease. Conclusion Although bronchiectasis is predominantly reported as a long-term complication in adult patients with PID, half of our pediatric patient cohort with PID had bronchiectasis, even the newly diagnosed patients. Long-term follow-up is needed to assess the extent to which these pulmonary complications that develop in the natural course of the disease can be prevented by IGRT.

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5–10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Background and objectives Although arterial involvement for advanced tumors is rare, vascular resection may be indicated to achieve complete tumor resection. Given the potential morbidity of this approach, we sought to evaluate perioperative outcomes, vascular graft patency, and survival among patients undergoing tumor excision with en bloc arterial resection and reconstruction. Methods From 2010 to 2020, we identified nine patients with tumors encasing or extensively abutting major arterial structures for whom en bloc arterial resection and reconstruction was performed. Results Mean age was 53 ± 20 years, and 89% were females. Diagnoses were primary sarcomas (5), recurrent gynecologic carcinomas (3), and benign retroperitoneal fibrosis (1). Tumors involved the infrarenal aorta (2), iliac arteries (6), and superficial femoral artery (1). Three patients (33%) had severe perioperative morbidity (Grade III + ) with no mortality. At a median follow-up of 23 months, eight patients (89%) had primary graft patency, and five patients (56%) had no evidence of disease. Conclusions Arterial resection and reconstruction as part of the multimodality treatment of regionally advanced tumors is associated with acceptable short- and long-term outcomes, including excellent graft patency. In appropriately selected patients, involvement of major arterial structures should not be viewed as a contraindication to attempted curative surgery.

Rationale: obstructive sleep apnea (OSA) may contribute to poor outcomes in adults with Coronavirus Disease 2019 (COVID-19). Objective: to determine the effect of OSA on clinical outcomes in patients with COVID-19. Methods: the current prospective observational study was conducted in three hospitals in Istanbul, Turkey from March 10 to June 22, 2020. The participants were categorized as modified high-risk (mHR), or low-risk (mLR)-OSA according to a modified version of the Berlin questionnaire. Snoring patterns (intensity and/or frequency), breathing pauses and morning/daytime sleepiness, without taking obesity and hypertension into account, were used in the regression models. Results: the primary outcome was clinical improvement defined as a decline of 2 categories from admission on a 7-category ordinal scale. Secondary outcomes included worsening (increase of 1 category), need for hospitalization, supplemental oxygen and intensive care. In total, 320 eligible patients were enrolled. According to the modified scoring, 70 (21.9%) had mHR-OSA. Among 242 patients requiring hospitalization, clinical improvement within 2 weeks occurred in 75.4 % of the mHR-OSA group compared to 88.4 % of the modified low-risk (mLR-OSA) group (P = 0.014). In multivariate regression analyses, mHR-OSA (adjusted OR 0.42; 95% CI 0.19-0.92) predicted the delayed clinical improvement. In the entire study population (n=320), mHR-OSA was associated with clinical worsening and need for supplemental oxygen. Snoring patterns, especially louder snoring, were significantly predicted delayed clinical improvement, worsening, need for hospitalization, supplemental oxygen, and intensive care. Conclusions: adults with mHR-OSA in our Covid-19 cohort had poorer clinical outcomes than those with mLR OSA independent of age, sex and comorbidities., NA

ObjectiveThe initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days).MethodsThis is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality.ResultsIn 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (pConclusionPercutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic.Trial registration numberNCT04412655.

Neurocutaneous melanocytosis (NCM) is characterized by melanocyte deposition in the leptomeninges and brain parenchyma, primarily occurring in children with large or giant congenital melanocytic nevi (LCMN) or multiple congenital melanocytic nevi. Patients with NCM may develop hydrocephalus and increased intracranial pressure, which can be managed with ventriculoperitoneal (VP) shunting. We present the case of a 16-month-old girl who developed peritoneal carcinomatosis and malignant ascites following VP shunting for hydrocephalus secondary to NCM to increase awareness of this rare, but serious, complication of cerebrospinal fluid diversion.

Purpose While obesity is related to more severe outcomes of coronavirus disease 2019 (COVID-19), factors leading to poor prognosis still remain unclear. The present study evaluated the outcomes of COVID-19 patients who were overweight or obese and variables associated with severe disease in a large group of consecutive cases. Methods A nationwide retrospective cohort study was performed using the Turkish National Healthcare Database. Demographic characteristics, laboratory tests, comorbidities, and medications of patients registered between March 11 and May 30, 2020, were recorded. Results A total of 14, 625 patients (median age:42, IQR:26 years; female 57.4%) with normal weight (34.7%), overweight (35.6%), and obesity (29.7%) were included. Hospitalization, ICU admission, intubation/mechanical ventilation, pulmonary involvement, and mortality were significantly higher in patients who were overweight or obese. In adjusted analyses, both overweight (OR, 95% CI: 1.82, 1.04–3.21; p=0.037) and obesity (OR, 95% CI: 2.69, 1.02–1.05; p Conclusions COVID-19 patients who were overweight or obese were more likely to have adverse outcomes but only obesity was a predictor of mortality. Such patients should receive urgent medical attention and active management, especially the elderly, men, and people with chronic kidney disease.

Aim To analyze the risk factors of lymph node involvement in pure endometrioid type endometrial cancer and assess factors that necessitate lymphadenectomy. Methods Patients who had been operated on due to endometrial cancer and whose final pathology was reported as pure endometrioid carcinoma between January 2014 and January 2020 were assessed. Hysterectomy, bilateral salpingo-oophorectomy, and systematic lymphadenectomy were performed in all patients. All specimens were reported by expert gynecopathologists. Results The lymph node positivity rate was 14.4%. When the study population was classified according to the Mayo risk criteria; lymph node involvement in the low-risk and high-risk groups was 9.1% and 14.8%, respectively and there was no statistically difference (p > 0.05). The median of tumor size and the rate of deep myometrial invasion, lymphovascular space invasion, adnexal involvement, FIGO grade 3 tumor were found significantly higher in the positive lymph node group in univariate analysis. In the receiver operating characteristic curve analysis, the cut-off value of the tumor diameter was determined as 47.5 mm (sensitivity 85%, specificity 62%). Every 10 mm increase in tumor diameter increased the risk of lymph node involvement 10 times. Conclusion This study defined that the tumor diameter is an independent predictor for lymphatic dissemination. In the future, it could be shown that even with new modeling based on tumor diameter, lymphadenectomy or adjuvant radiotherapy requirements would be reevaluated.

The aim of this study was to investigate the validity and reliability of “Shriners Hospital for Children Upper Extremity Evaluation (SHUEE)” for children with rheumatic diseases. The study was carried out after obtaining the necessary permissions and retrospectively registered. The psychometric properties evaluated were reliability and concurrent validity. Reliability was determined by intra- and inter-observer agreement. Concurrent validity was performed using the Jebsen Taylor Hand Function Test (JTHFT), Abilhand-Rheumatoid Arthritis (Abilhand-RA), and Children Health Assessment Questionnaire (CHAQ). The validity and reliability of the evaluation were determined after the retest 1 week later. Twenty children with rheumatic diseases were participated in to study. Intraclass coefficients ranged from 0.82 to 0.97 and the intraobserver reliability for SHUEE total and subscales were considered “excellent.” Interobserver reliability was considered “excellent” for the SHUUE total score, spontaneous functional analysis and dynamic positional analysis, and “moderate” for grasp-release. A moderate negative correlation was determined between Spontaneous Functional Analysis and JTHFT (r = − 0.63; p = 0.003). SHUEE is a valid and reliable evaluation for children with rheumatic diseases. ClinicalTrials.org NCT04685434/21.12.2020

Background/aim: Ischemia on the colon wall negatively affects healing of anastomosis. We were aimed to evaluate the effects of carbon monoxide releasing molecule-2 (CORM-2) on the healing of anastomosis in a rat model of the ischemic colon. Materials and methods: In this prospective study a total of 60 rats were randomly divided into three groups as colon transection and end-to-end anastomosis (Group I), colon transection, and end-to-end anastomosis following the induction of ischemia (Group II), and colon transection and end-to-end anastomosis following the induction of ischemia and treated with daily intraperitoneal administration of CORM-2 (Group III). Each group was also divided into two equal subgroups as postoperative 3rd and 7th day. Postoperative healing of anastomoses was evaluated by anastomosis burst pressure (ABP), tissue biomarkers including hydroxyproline (HP), malondialdehyde (MDA), glutathione (GSH), and histopathological findings. Results: In the ischemic group treated with CORM-2, lower MDA and higher HP levels were observed in comparison to the untreated ischemic group on the 3rd day. GSH and HP levels were higher and MDA levels was lower in the ischemic rats treated with CORM-2 than in the ischemic untreated rats on the 7th day. Conclusion: In the ischemic group treated with CORM-2, the mucosal epithelial score decreased and the neoangiogenesis score increased compared to the untreated rats on the 7th day. Conclusion: In ischemic colon anastomosis, reduces cell destruction by suppressing the oxidative reaction, and strengthening the antioxidative mechanisms of the cells. It also increases collagen formation, epithelial development, and neoangiogenesis.

OBJECTIVE: In this study, we aimed to evaluate the accuracy of the original and simplified pulmonary embolism (PE) severity index (PESI) to predict all-cause mortality after 30 days of acute PE diagnosis up to five years within consecutive sub-periods. METHODS: Adult patients diagnosed with acute PE between January 1, 2003, and June 30, 2013, were retrospectively included. Data on baseline characteristics and mortality during a five-year follow-up were collected. RESULTS: The study included 414 patients (Male/Female=192/222). The median age at diagnosis was 61.5 (minimum–maximum, 18–93) years. Mortality rates were 13.3% at 30 days, 21.8% at 90 days, 32.6% at one year, and 51.0% at five years. Both stratification into risk classes according to the original PESI and low vs. high-risk classification of original and simplified PESI were significantly correlated with the 30-day, 31–90-day, 91-day-one-year, and one-five-year mortality. Significant PESI predictors for mortality were history of cancer [hazard ratio (HR): 3.31, 95% confidence interval (CI): 1.64–6.68; p=0.001] and heart failure (HR: 2.35, 95% CI: 1.04–5.32, p=0.041) at 31–90-day, history of cancer (HR: 5.45, 95% CI: 2.86–10.40, p

Objectives It was aimed to compare Alpha-1 antitrypsin (AAT), Alpha-1 acid glycoprotein (AGP), Total Immunoglobulin M (Total IgM), Total Immunoglobulin G (Total IgG), Galectin-3 (Gal3), and severe acute respiratory syndrome coronavirus 2 IgG (SARS-CoV-2 IgG) levels in patients with COVID-19 and healthy individuals. Methods The study included a total of 86 participants, 44 patients diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction (rRT-PCR) test and 42 as the control group. AAT, AGP, Total IgM, and Total IgG levels were measured using the immunoturbidimetric method. Gal3 and SARS-CoV-2 IgG levels were measured using the chemiluminescent microparticle immunoassay method. Results AAT, AGP, Total IgG, Gal3, and SARS-CoV-2 IgG levels were found to be significantly higher in the patient group compared to the control group (p Conclusions High levels of AAT, AGP, Total IgG, Gal3, and SARS-CoV-2 IgG in the patient group and correlations between variables suggest that these parameters may be involved in the pathogenesis of the disease and provide an idea about the prognosis of the disease. However, new studies on this subject are needed in order to clearly reveal the laboratory tests related to the clinical course of the disease.

To quantitatively evaluate the acute effects of pseudoephedrine on the macular microvasculature using optical coherence tomography angiography (OCTA).Randomized placebo-controlled clinical study.In this study, 60 right eyes of 60 healthy subjects were divided into 2 groups. The study group received 60 mg of pseudoephedrine and the control group received a placebo. All participants underwent OCTA at baseline and 1 h after oral intake. Superficial macular flow area, foveal avascular zone (FAZ), superficial macular vessel density, central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) were analyzed.Baseline superficial macular flow area, FAZ area, superficial macular vessel density, CFT and SFCT measurements in the study and control groups showed no significant difference (p 0.05 for all). Oral pseudoephedrine intake caused a significant reduction in superficial macular flow area, FAZ area, superficial macular vessel density and SFCT measurements when compared with baseline (p 0.05 for all). However, there was no significant difference in CFT after oral pseudoephedrine intake (p 0.05).Oral pseudoephedrine intake causes a significant decrease in superficial macular blood flow and SFCT. Impairmant of macular microcirculation can be detected noninvasively and quantitavitely by OCTA.

Introduction Coronavirus 2019 (COVID‐19) is typically spread by droplets and has had a remarkable effect on pediatric pulmonology healthcare practice. Here, we aimed to evaluate the effect of the COVID‐19 pandemic on the clinical follow‐up and hospital visits of patients followed up at a pediatric pulmonology unit at a tertiary care center. Methods This study was an observational descriptive study performed at a tertiary care center pediatric pulmonology unit between January 2019 and December 2020. We analyzed the outpatient visits, laboratory procedures which including pulmonary function tests (PFTs), diffusion capacity assessment, plethysmography, and lung clearance index (LCI), high‐speed video microscopy, gastric aspirate sampling, and Flexible fiberoptic bronchoscopy (FFB) during clinical follow‐up, and hospitalization numbers of patients with chronic lung diseases during the COVID‐19 pandemic and compared them with the previous year before the pandemic started. Results In 2020, compared with 2019, outpatient visits decreased by 42.2%; from 8324 patients to 4804 patients and other laboratory procedures decreased after the pandemic started; PFTs including spirometry by 87.2%; from 2990 to 380 tests, diffusion capacity assessment from 172 to 55 tests, plethysmography from 172 to 53 and LCI from 70 to 9 tests, also high‐speed video microscopy analyses by 64.3% from 300 to 107 patients, and gastric aspirate sampling by 75.5% from 42 to 9 patients. FFB procedures also decreased by 59.1%, from 142 to 58 patients, and only 15 were after the first reported case of COVID‐19 in our country, and they were all for urgent indications. None of these patients was positive pretesting for COVID‐19 who underwent the FFB. There was no significant decrease in patients' hospitalization due to pulmonary exacerbation in cystic fibrosis, interstitial lung disease, and primary ciliary dyskinesia.

Aims: Spleen masses, which are discovered on imaging studies, usually create difficulty in diagnosis and treatment. Except for lymphomas involving the spleen, primary and secondary neoplasms are rare and discovered by chance. This study analyses a series of splenectomies in a surgical clinic to evaluate the management of incidentally diagnosed splenic masses. Study Design: This retrospective study included patients operated for spleen masses between 2010 and 2021. Patients with a history of lymphoproliferative disease and splenectomy performed as part of a larger resection were excluded. Methodology: The patients were divided into three groups, i.e. cystic, benign and malignant, based on the results of pathological examinations. The groups were compared in terms of age, gender, tumor size, and previous history of malignancy. Results: Splenectomy was performed in 512 patients in 11 years, 62 of whom had solid and cystic lesions detected on imaging. Thirty-five patients (56,5%) were female and the median age was 40 years (range: 18-80 years). Forty-four patients (71%) had distinct symptoms. Radiological evaluations of all the patients were made. Diagnostic biopsy could not be performed in any of the patients. The final pathological examination showed cysts in 38 patients (61,3%), benign lesions in nine patients (14,5%) and malignant lesions in 15 patients (24,2%). Out of 15 patients with malignant lesions, one patient had Hodgkin’s lymphoma, four patients had diffuse large B cell lymphoma and ten patients had metastatic tumors. There was a significant difference in age between the groups and the malignant group was older (p = 0.017). The size of the lesions also significantly differed and the malignant lesions had a significantly smaller diameter (p = 0.014). A significantly higher rate of the malignant group had a previous history of cancer (p˂0,001). Conclusion: Spleen neoplasms are masses that are difficult to diagnose. Most of them are asymptomatic and are found after splenectomies by coincidence. Splenectomy can be utilized as both a diagnostic and curative method. It should be kept in mind that the lesions detected in the spleen in patients with a history of malignancy can be metastatic.

Introduction and Objectives We aimed to point out the ureteral access facility and obstruction removal efficiency of mini-URS in the use of proximal ureteral stone management in children under five-year-old. Patients We retrospectively reviewed the data of 26 children who underwent mini-URS-LL for obstructive stones in proximal ureter between January 2016 and August 2018. The effectiveness of the mini-URS-LL was assessed based on the feasibility, reliability, and success of the technique. Results Mean age was 3 ± 1.3 years, and 11 (42.3%) patients were ≤2 years old, remaining 15 (57.7%) were aged 3−5 years. Mean stone size was 9.11 ± 3.02 mm. A stone-free status was obtained at the end of 31 ureteroscopic procedure in 24 (92.3%) patients. The mean age was found significantly higher in patients who had the procedure without pre-stenting than the others who did (P = .027). No perioperative complication was experienced. Conclusion In preschool-age children, laser lithotripsy with mini-URS may be a safe technique in the hands with advanced endo-urological skills but it has low efficacy with higher rates of prestenting causing additional anesthesia sessions.

Auto-oxidized oxysterols are implicated in the pathogenesis of various chronic diseases. Their concentrations are indicators of oxidative stress in vivo and associated with atherosclerosis. Subclinical hypothyroidism is related with cardiac diseases and oxidative stress, but the exact mechanisms underlying these associations are not clear yet.To investigate the auto-oxidized oxysterols, 7-ketocholesterol (7-KC) and cholestane-3β,5α,6β-triol (chol-triol), in patients with subclinical hypothyroidism, as well as to evaluate the impact of restoring euthyroidism on oxysterol concentrations.In this prospective observational study, 64 patients with newly diagnosed autoimmune thyroiditis (41 with subclinical hypothyroidism and 23 euthyroidism), and 45 healthy controls were enrolled. Age, gender, and body mass index were matched among patient groups and healthy controls. Anthropometric measurements were obtained and fasting plasma 7-ketocholesterol and cholestane-3β,5α,6β-triol concentrations were measured by using liquid chromatography coupled with tandem mass spectrometry. Levothyroxine was then administered to all patients with subclinical-hypothyroidism. After three months, measurements of the oxysterols and serum cholesterols from the patients who have become euthyroid were repeated.Concentrations of 7-ketocholesterol and cholestane-3β,5α,6β-triol were significantly higher in patients with subclinical-hypothyroidism when compared to both euthyroid patients and healthy controls (p 0.001 for both oxysterols). After restoration of euthyroidism, concentrations of 7-ketocholesterol and cholestane-3β,5α,6β-triol decreased significantly and reached similar concentrations observed in healthy controls (p 0.001 for both oxysterols).Auto-oxidized oxysterol species are higher in patients with mild thyroid dysfunction, and supported the rationale for treating subclinical-hypothyroidism.

To evaluate surgical and refractive outcomes of a new sutured scleral fixation technique in the management of subluxated intraocular lenses (IOLs). Nineteen eyes treated with the new scleral fixation technique were included. The mean corrected distance visual acuity (CDVA), postoperative refraction error, mean endothelial cell count (ECC), and complications were recorded. All patients were evaluated immediately postoperatively, at 1 and 7 days, and then at 1, 3, and 6 months. The mean duration of follow-up of the patients was 10 months (range, 6–15 months). The mean CDVA was 0.41 ± 0.1 logMAR (logarithm of minimum angle of resolution) preoperatively and was 0.08 ± 0.07 logMAR postoperatively. The mean astigmatism was − 2.22 ± 1.86 D preoperative and was − 0.86 ± 0.58 D postoperative. The mean preoperative and postoperative ECC was 2455 ± 288 and 2352 ± 288, respectively. One patient (5.26%) experienced vitreous hemorrhage, and two (10.52%) experienced intraocular pressure elevation. IOL tilt and decentralization, conjunctival erosion, and cystoid macular edema were not observed in any eyes during follow-up. This new IOL repositioning technique can be applied in a short surgical time and provides a stable IOL centration on long-term follow-up.

Objective:This study aimed to investigate the factors associated with pancreatic fistula (PF) development after pancreaticoduodenectomy (PD) at our clinic.Methods:Patients who underwent PD for periampullary tumours between 2010 and 2019 were included in the study and categorised into Group I (with PF) and Group II (without PF). The demographic and clinical characteristics, laboratory parameters, tumour characteristics and post-operative results were compared between the groups. Risk factors for PF were analysed by univariate analysis and multivariate logistic regression analysis.Results:In total, 155 patients participated in the study (Group I: n=31; Group II: n=124). The rate of PF was 20%. The two groups were comparable with regard to sex (p=0.348) and age (64.8 vs 66.9 years, p=0.916). Compared with Group II, Group I had a higher number of metastatic lymph nodes (1.61 vs 0.87, p=0.041), a higher number of post-operative complications (58.1% vs 21.8%, p=0.000) and a longer duration of post-operative hospital stay (25.25 vs 16.43 days, p=0.000). Haemoglobin (p=0.493) and albumin (p=0.698) levels were similar between the groups. Total survival duration was shorter in Group I (23.9 vs 38.18 months, p=0.024). In multivariate analyses, being ≥65 years (p=0.040), tumour localisation (p=0.021), lymph node stage (p=0.008) and performedtumour diameter ≥2 (p=0.021) were the independent risk factors for developing pancreatic fistula.Conclusion:In our study, tumour diameter, patient age and lymph node status were associated with PF development. The development of PF reduced expected survival. We believe that identifying the preoperative, intraoperative and post-operative factors related to PF formation may help decrease its development.

Keratoconus is the most common corneal ectatic disease and the most common cause of corneal transplantation in developed countries. The etiopathogenesis of the disease remains unclear.The human bod...

The importance of a local tissue immune response in healing injured tissues such as skin and lung is well established. Little is known about whether sterile wounds elicit lymph node (LN) responses and inflammatory responses after injury of musculoskeletal tissues that are mechanically loaded during the repair response. We investigated LN and tissue immune responses in a tibial implant model of joint replacement surgery where wounded tissue is subjected to movement and mechanical loading postoperatively. Draining inguinal and iliac LNs expanded postoperatively, including increases in regulatory T cells and activation of a subset of T cells. Thus, tissue injury was actively sensed in secondary lymphoid organs, with the potential to activate adaptive immunity. Joint tissues exhibited three temporally distinct immune response components, including a novel interferon (IFN) response with activation of signal transducer and activator of transcription (STAT) and interferon regulatory factor (IRF) pathways. Fibrovascular tissue formation was not associated with a macrophage type 2 (M2) reparative immune response, but instead with delayed induction of interleukin-1 family (IL-1β, IL-33, IL-36), IL-17, and prostaglandin pathway genes concomitant with transforming growth factor (TGF)-β and growth factor signaling, fibroblast activation, and tissue formation. Tissue remodeling was associated with activity of the HOX antisense intergenic RNA (HOTAIR) pathway. These results provide insights into immune responses and regulation of tissue healing after knee arthroplasty that potentially can be used to develop therapeutic strategies to improve healing, prevent arthrofibrosis, and improve surgical outcomes. © 2021 American Society for Bone and Mineral Research (ASBMR).

One of the most important problems encountered in reconstructive surgery is partial or total flap loss, and venous congestion is the most common reason. It should be solved as early as possible. The purpose of this study is to investigate the effects of Negative pressure wound therapy (NPWT) on an ideal congested rabbit skin flap model without any open wound. The current study included 28 female, adult, New Zealand albino rabbits. Animals were divided into four groups according to the duration of NPWT to be applied. An axial pattern ideal congested skin flap was designed on the posterior surface of the ear. After surgical intervention on the right ears, we applied NPWT treatment for 2, 4, 6 and 8 days. The left ears were followed without any treatment. Samples were taken for edema, congestion and neo-angiogenesis examination. There was no significant difference between the NPWT applied group and control group in the 2nd, 4th, 6th, and 8th days for edema and neo-angiogenesis and no differences in the 2nd, 6th, and 8th days for congestion. NPWT group had a higher flap survival rate than the control group but without a significant difference. This study used an ideal congested rabbit skin flap model imitating venous congestion. Our findings illustrate that NPWT treatment does not have a significant effect on the congested skin flap model we utilized where a closed system was created maintaining a skin barrier without a bare surface of the flap. Level of Evidence: Level I, experimental study.

Spondyloepimetaphyseal dysplasia (SEMD) is a group of genetic skeletal disorders characterized by disproportionate short stature, and varying degrees of vertebral, epiphyseal, and metaphyseal involvement of the skeleton. According to the Nosology and classification of genetic skeletal disorders 2019 revision, more than 20 types of SEMD have been identified, and SEMD with immune deficiency, EXTL3 type is one of the newcomers. Affected individuals display variable skeletal abnormalities and neurodevelopmental findings. Liver and kidney cysts have also been reported frequently. Patients may exhibit varying degrees of immune deficiency as well. To date, only 14 patients from 9 unrelated families with SEMD with immune deficiency, EXTL3 type have been reported in the literature. We report a new patient who is currently 15 years old in whom cystic liver lesions were detected in the prenatal period. Disproportionate short stature, mild developmental delay and a T- NK+ B+ immunological profile were detected in the postnatal follow-up. Exome sequence analysis revealed a previously reported homozygous missense variant in exon 3 c.953C > T; p.(Pro318Leu) in EXTL3.

Purpose New coronavirus disease 2019 (COVID-19) has a worse prognosis in patients with diabetes. However, there are insufficient data about the effect of hyperglycemia on COVID-19 prognosis in non-diabetic patients. This study aimed to investigate the relationship between random blood glucose levels measured at the time of diagnosis and prognosis of COVID-19 disease in non-diabetic patients. Methods A nationwide retrospective cohort of non-diabetic patients with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. The patients were stratified into three groups according to blood glucose levels which were Results A total of 12,817 non-diabetic patients (median age [IQR]: 44 [25] years, females: 50.9%) were included. Patients in group-2 (5%) and group-3 (14%) had higher mortality rates than patients in group-1 (2.1%). The rates of hospitalization, hospital stays longer than 8 days, intensive care unit (ICU) admission, ICU stay more than 6 days, and mechanical ventilation were also significantly higher in group-3 patients. Likewise, glucose levels in the range of 140-199 mg/dL were an independent associate of mortality and composite of ICU admission and/or mechanical ventilation. ConclusionHyperglycemia at the time of COVID-19 diagnosis is associated with poor prognosis in non-diabetic patients. Clinicians should be more careful in the treatment of non-diabetic COVID-19 patients with hyperglycemia.