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Hepatitis-associated aplastic anemia (HAA) is a form of acquired aplastic anemia (AA) in which bone marrow failure develops after an acute attack of hepatitis. Bone marrow failure leading to AA is generally severe in cases of HAA and fatal if left untreated. This retrospective multicenter study investigated clinical and laboratory characteristics, possible causes, treatment, and outcome of HAA in children. Twenty patients from 8 centers were included in the study. Aspartate aminotransferase and alanine aminotransferase were 10×ULN in 16 patients. Acute liver failure developed in 5 (29%) patients. Pancytopenia was simultaneously present in 6 of 20 (30%) patients. Eleven of the 20 patients (55%) were alive, in remission and transfusion free. Those who were alive either had undergone hematopoietic stem cell transplantation and/or immunosuppressive treatment, except 1 patient who had received no treatment. Patients with the diagnosis of acute hepatitis should be evaluated and followed up carefully for presence of cytopenia, so that definitive treatment of AA can be initiated in a timely and appropriate manner when needed. Copyright r 2021 Wolters Kluwer Health, Inc. 34669357

This study aimed to biochemically and histopathologically investigate the effect of sunitinib on oxidative testicular damage induced by ischemia/reperfusion in rats.Experimental animals were divided into three groups of six rats each: testicular torsion-detorsion (TTD), sunitinib+testicular torsion-detorsion (STD), and sham control (SC). Sunitinib (25mg/kg) was administered orally to the STD group by gavage. Normal saline (0.9% NaCl) was administered orally to the TTD and control groups as the solvent. One hour after administration of sunitinib and 0.9% NaCl, all animal groups were done torsion-detorsion. Then, all the rats were killed by high-dose anesthesia, and their testicles were removed. Biochemical and histopathological examinations were performed on the removed testicular tissues.Malondialdehyde; it was observed that the results in the STD group were close to those of the SC group and statistically significant lower compared to the TTD group (p=0.001). The glutathione values were statistically significantly higher in the STD group compared to the TTD group (p0.001). Nuclear factor kappa B values, revealing a statistically significant difference between the TTD and STD groups (p0.001). The TNF-α levels were measured and indicating that the results of the STD group were statistically significantly lower than those of the TTD group (p0.001). Histopathologically, animal tissues given sunitinib were observed to resemble normal tissues.Sunitinib was shown to prevent histopathological changes in testicular tissue against ischemia/reperfusion damage.

Introduction The purpose of this study was to identify the relation of daily prosthesis usage time (DPUT) of individuals with amputation with quality of life (QoL) questionnaires. Methods The research was carried out on 125 individuals with amputation. Prosthetic-related parameters were searched, as well as demographic data. A generic (Nottingham Health Profile [NHP]) questionnaire and a questionnaire specific to individuals with amputation (Trinity Amputation and Prosthesis Experience Scales [TAPES]) QoL measurements were used. Results Ninety-one males and 28 females with a mean age of 42.4 ± 14.7 years participated in the study. The average DPUT was 11.1 ± 4.4 hrs/d. Study results showed that there was significant correlation between both of the QoL questionnaires (NHP and TAPES) and DPUT. High correlation was determined between DPUT and NHP total score and NHP-Pain, and very high correlation was found between DPUT and NHP-Physical Activity subscale. A moderate negative correlation was found between DPUT and NHP-Energy Level, NHP-Emotional Reaction, NHP-Social Isolation, and NHP-Sleep. A moderate negative correlation was found between DPUT and TAPES-Activity Restriction. A high correlation was found between DPUT and residual limb pain, prosthetic satisfaction, time interval after amputation, and number of prosthetic fittings. A moderate correlation was found between DPUT and walking aids, whereas a poor relationship was shown between phantom pain and DPUT. Conclusions This study showed that "the average DPUT"may be used in terms of short assessment of QoL of individuals with amputation. The outcomes of this study pointed out that especially prosthetic-related parameters affected the QoL in individuals with amputation. In problems resulting from routine assessment and questionnaires having so many items, a single-item question, "the average DPUT,"may be used effectively in a shorter period and is helpful for organizing a rehabilitation program. Clinical Relevance A single-item question, "The average daily prosthesis usage time (DPUT),"be used effectively in a shorter assessment of quality of life of individuals with amputation and is helpful for organizing a rehabilitation program. © Lippincott Williams & Wilkins.

While data on the efficacy and safety of continuous glucose monitoring (CGM) exist across a broad age spectrum, it is limited in very young children with type 1 diabetes (T1D). We aimed to assess real-world data in this high-risk population, focusing on glycemic variability and metrics beyond HbA1c. A 12-month multi-national, prospective, observational, registry-based cohort study in children with T1D aged 1-7 years compared glucose control using real-time CGM and using fingerstick blood glucose monitoring (BGM) alone. The prespecified primary endpoint was a difference in coefficient of variation (CV) between the CGM users and BGM-only cohort. Among 227 individuals using insulin pumps (42% female, age 5.3 years), 175 were CGM and 52 were BGM-only users. The median (IQR) CV was 39.1% (36.6-41.9) among CGM and 46.8% (42.3-51.2) among BGM-only users (P

Background: Metabolic or non-metabolic many bone diseases can be distinguished in sickle cell anemia. Patients with sickle cell anemia have a high risk of osteopenia and osteoporosis. The aim of this study is to reveal bone mineral density abnormalities and related factors in patients with sickle cell anemia. Methods: A total of 70 patients with sickle cell anemia were retrospectively included in our study. Complete blood count (CBC) parameters, serum creatinine, lactate dehydrogenase (LDH), total bilirubin, direct bilirubin, uric acid, calcium, phosphorus, parathormone, alkaline phosphatase, 25 (OH) vitamin D, ferritin, C reactive protein (CRP) and calculated bone mineral densitometry measurements by Dual-Energy X-ray Absorptiometry (DEXA) were assessed and recorded to the statistics program. We diagnosed osteopenia and osteoporosis according to World Health Organization (WHO) criteria. To determine the status of avascular necrosis and bone fracture, we examined x-ray and magnetic resonance imaging reports and epicrisis reports of patients from the records. Results: The average age was 30.01 ± 8.64 years. Eighteen (26.5%) of the 68 patients whose Z-score was evaluated by DEXA had bone mass below the expected age-related range according to the Z score, while 50 (73.5%) had bone mass within the expected age-related range. Of the patients whose T score was evaluated by DEXA, 46.8% were normal (n=29), 45.1% were osteopenic (n=28) and 8.1% were osteoporotic (n=5). Conclusion: Patients with sickle cell anemia are at increased risk for osteoporosis, osteopenia, and osteomalacia. Bone health should be emphasized in these patients.

Adenoid hypertrophy (AH) has been identified as a cause of otitis media with effusion (OME), which is the most common cause of childhood hearing loss. Indeed, there may be other upper airway-related predisposing factors such as, location of the adenoid, accompanying tonsillar hypertrophy (TH) and nasal septal deviation (NSD) for the development of OME. In this study, we aimed to evaluate the associations between the upper airway physicals and OME with auditory functions.Eighty-six ears of 43 children, aged 3-11 years were included in this prospective clinical study. Findings of otolaryngologic examinations were noted. Data of pure tone audiometry (PTA), traditional tympanometry (TT) and wideband tympanometry (WBT) parameters were collected. Cluster analysis was performed to the following variables: age, sex; the adenoid choana percentage (ACP), the presences of adenoid around torus tubarius (AATT), TH, NSD and OME; peak pressure (PP) values on TT, resonance frequencies (RF) on WBT, ambient pressure absorbance ratios (APAR) and PTA hearing thresholds.Two groups of ears revealed by clustering; cluster-1 (n = 46) and cluster-2 (n = 40), at the similarity level of 0.662. The presences of AH, AATT, OME and the medians of ACP, PP, RF, WBT APARs at all frequencies except 5656 Hz and 8000 Hz, all PTA thresholds were significantly different between two clusters (p0.05). The lower WBT APARs and higher PTA thresholds were associated with higher levels of ACP and higher frequencies of the presence of AATT and OME in cluster-1.There are associations between AH, AATT and OME together with decline in hearing and SEA. Whereas, TH and NSD are not related to the formation of clusters and they are insignificant factors.

Objective: to determine homocysteine, vitamin B12, and folate levels in patients with Parkinson's disease and to investigate the effect of entacapone use on homocysteine levels. Materials and methods: the records of patients who were followed up in our outpatient clinic between 2009 and 2010 were reviewed retrospectively. The demographic, clinical characteristics, and laboratory findings of the patients were recorded. The control group consisted of healthy subjects with similar demographic characteristics. The patients were divided into two groups according to the treatment they received. Results: the control group consisted of 22 healthy subjects (group 1), group 2 comprised 22 patients [entacapone (+)], and group 3 constitued 50 patients [entacapone (-)]. The homocysteine levels of the control group were significantly lower than the entacapone (-) and entacapone (+) groups. The vitamin B12 level of the control group was significantly higher than in the entacapone (-) group. The folate levels of the control group were significantly higher than those of the entacapone (-) group. There was no significant difference between the entacapone (-) and entacapone (+) groups in terms of homocysteine, vitamin B12, and folate levels. Conclusion: levodopa treatment affects homocysteine levels in patients with Parkinson's disease. The effect of levodopa + entacapone on plasma homocysteine levels should be evaluated together with basal vitamin B12 and folate levels and genetic features. / Amaç: parkinson hastalarında homosistein, vitamin B12 ve folat düzeylerinin belirlenmesi ve entakapon kullanımının homosistein düzeylerine etkisinin araştırılması amaçlanmıştır. Gereç ve yöntem: hareket bozuklukları polikliniğimizde 2009-2010 tarihleri arasında takipli olan hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik, klinik özellikleri ve laboratuvar bulguları kayıt edildi. Benzer demografik özelliklere sahip laboratuvar değerleri incelenmiş olan sağlıklı kişiler kontrol grubunu oluşturdu. Hastalar aldıkları tedaviye göre 2 gruba ayrılarak değerlendirme yapıldı. Bulgular: grup 1: Yirmi iki sağlıklı kişiden (kontrol grubu), grup 2: Yirmi iki hastadan [entakapon (+)], grup 3: Elli hastadan [entakapon (-)] oluşmaktadır. Kontrol grubunun homosistein düzeyi entakapon (-) ve entakapon (+) gruba göre anlamlı derecede düşük saptandı. Kontrol grubunun vitamin B12 düzeyi entakapon (-) grupa göre anlamlı olarak yüksek saptandı. Kontrol grubunun folat düzeyi entakapon (-) gruba göre anlamlı olarak yüksek saptandı. Entakapon (-) ve entakapon (+) gruplar arasında homosistein, vitamin B12 ve folat düzeyleri açısından anlamlı fark saptanmadı. Sonuç: Parkinson hastalarında levodopa tedavisi homosistein düzeyini etkilemektedir. Levodopa + entakapon kullanımının plazma homosistein düzeylerine etkisinin plazmanın bazal vitamin B12 ve folat düzeyleri ve genetik özelliklerle birlikte değerlendirilmesi gerektiği düşünülmüştür., NA

Background: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy. Objectives: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility. Methods: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gyne- cology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed. Results: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction. Conclusion: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in considera- tion of the invasive nature and the higher complication rate of laparoscopy. Keywords: Infertility; hysterosalpingography; laparoscopy; tubal factor.

OBJECTIVE: To determine the perinatal mortality rate in patients with HELLP syndrome in our clinic and to investigate the factors affecting perinatal mortality. It also makes recommendations to reduce perinatal mortality and contributes to the literature. STUDY DESIGN: Three-hundred-and-eighty-three patients were retrospectively evaluated in this cohort study. The patients' demographic, clinical data, laboratory results, gestational week at delivery, method of delivery, neonatal birth weight, fetal gender, 1- and 5-minute APGAR scores, place of delivery, maternal morbidity, mortality rates, and perinatal mortality rates were recorded. The relationship of these factors with perinatal mortality was investigated. RESULTS: The rate of perinatal mortality was determined as 6%. Patients with HELLP syndrome who experienced perinatal mortality showed significantly lower birth weight, gestational age at delivery, and 1- and 5-minute APGAR score values (p

Lower limb amputation causes difficulties in mobility together with motor and sensory loss. Challenging situations such as concurrent tasks cause gait parameters to deteriorate. Understanding the effect of concurrent tasks on gait is important for the rehabilitation of amputees.Are the effects of concurrent cognitive and motor tasks on gait parameters at fixed speed different in individuals with transtibial amputation, or transfemoral amputation compared to healthy individuals?The gait parameters were evaluated of 20 individuals with transtibial amputation, 13 individuals with transfemoral amputation and 20 healthy individuals while walking on a motorized treadmill under single task (ST), cognitive dual task (CDT) and motor dual task (MDT) conditions. The self-selected comfortable velocity, which was determined in the single-task gait, was used in all three walking tests.ST, CDT and MDT gait parameters of individuals with transtibial amputation, transfemoral amputation and healthy individuals were significantly different (p 0.01). Covariance of step length variability increased in amputees when walking under MDT (p 0.05). The dual task cost (DTC) for all the gait parameters was similar in all three groups (p 0.05). The motor DTC of covariance of step length was greater than cognitive DTC (p 0.05).Individuals with lower limb amputation have the capacity to walk with cognitive and motor tasks without changing velocity on the treadmill, but concurrent motor tasks cause an increase in gait variability. The results of this study suggest that there is an increase in gait variability especially with motor tasks, which may cause a higher risk of falling. Trial number: NCT04392466 (clinicaltrials.gov).

Objective: Trigeminal autonomic headaches are the primary headache group that occurs with autonomic stimulation of the cranial nerves. The most common type of this group is cluster headache (CH). This study aimed to report the clinical features and pain characteristics of patients with CH. Materials and Methods: Patients of the outpatient headache center between 2010 and 2020 were retrospectively analyzed. Inclusion criteria were diagnosis of CH and a minimum of 1-year follow-up. Records were reviewed using the International Headache Classification-3β. The sociodemographic characteristics of patients, types of pain, pain characteristics, and treatments that were used were documented. Clinical features were compared with sociodemographic characteristics and factors that could affect the pain features. Results: The mean age of 32 patients (25 male and 7 female) was 41.8 (23-68) years, and the mean age at disease onset was 31.7 (15-65) years. Lacrimation followed by conjunctival injection were the most common autonomic findings. According to gender, no statistical significance was found between pain character (p=0.166), painful side (p=0.572), month of onset (p=0.562), accompanying autonomic findings (p=0.495), pain duration (p=0.650), pain occurrence time during the day (p=0.394), and localization (Retroorbital/orbital, p=0.602; temporal, p=0.650; and forehead p=0.394). Nine patients had migraine-like features (MLF). The pain duration of patients with MLF was found to be 1.14±0.6 months and this period was longer than the results of other patients. No statistically significant difference was found between pain characteristics. Conclusion: The delay in diagnosis due to MLF that may accompany shows the importance of increasing awareness in the definition of CH.

Aim:This study was carried out to determine the effect of obstetric characteristics of pregnant women who had relatives diagnosed with SARS-COV2 (COVID-19) on depression, anxiety and stress levels. Material and Methods:This descriptive study was conducted between 17 April 2020 and 30 May 2020 with 450 pregnant women in the Obstetrician Clinic of a private hospital in Istanbul. The study data were collected face-to-face with the Introductory Information Form, State-Trait Anxiety Index (STAI), and the Depression Anxiety Stress Scale (DASS-21). Results:All pregnant women were aware of COVID-19 pandemic (100.0%), and 40.0% of them had a relative diagnosed with COVID-19. A total of 64.4% of those with no relatives diagnosed with COVID-19 had depression, 80.4% had anxiety and 81.5% had stress. A total of 100.0% of those who had relatives diagnosed with COVID-19 had depression, anxiety, and stress (DASS). Conclusions:It was found that DASS-21 scores were high in all pregnant women who had relatives diagnosed with COVID-19. Presence of chronic diseases and parity count were decisive in depression and anxiety levels in pregnant women who had relatives diagnosed with COVID-19, unlike those who did not. Clinical evaluations should be made carefully with this situation in mind..

Objective:This study aimed to determine the factors affecting the mortality of patients in critical condition with coronavirus disease-2019 (COVID-19) in the intensive care unit (ICU).Materials and Methods:We included a total of 445 patients who are admitted in the ICU due to COVID-19. Patients were divided into two groups-those who survived and those who died during the ICU follow-up-and their demographic, clinical and laboratory characteristics were compared. Factors affecting mortality were also determined.Results:Older age, high Kidney Disease: Improving Global Outcome (KDIGO) stage and Sequential Organ Failure Assessment (SOFA) scores at first admission to the ICU, high neutrophil/lymphocyte ratio, high D-dimer levels, low bicarbonate (HCO3) values and high lactate dehydrogenase (LDH) and creatinine levels were determined as independent risk factors for mortality in patients in critical condition with COVID-19 admitted in the ICU. Particularly, a substantial relationship was observed between the KDIGO stage and mortality during the ICU admission.Conclusion:Age, KDIGO stage and SOFA scores at first admission, neutrophil/lymphocyte ratio and D-dimer, HCO3, LDH and creatinine levels were independent risk factors for mortality in patients in critical condition with COVID-19 admitted in the ICU.

Aim: This study aimed to determine the incidence, predisposing factors, clinical presentation, and treatment options for portomesenteric and splenic vein thrombosis (PMSVT) in patients undergoing l...

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Background Developmental delay in infancy includes cognitive-language delay, fine motor delay, gross motor delay, and social-self help delay. Delay in one intellectual domain frequently effects the other areas of development; therefore, determining risk factors are essential. In this study, we evaluated the relationship between maternal psychiatric symptoms and developmental delay types of infants who have not a known risk factor and are expected to show healthy development but have some behavioral and developmental problems. Methods The sample consisted of 79 infant–mother (26 girls, 53 boys) dyads who had been admitted to the Department of Child and Adolescent Psychiatry at Gulhane Research and Training Hospital over a one year period. Brief Infant-Toddler Social and Emotional Assessment Scale, Brief Symptom Inventory and Ankara Developmental Screening Inventory were used. Results The most frequent developmental delay types were fine motor and social -self-help delay in this sample. For all developmentally delayed infants, maternal interpersonal sensitivity, and depression scores were higher than healthy developed ones. Logistic regression analyses revealed the risk factors: Higher maternal paranoid ideation increases the language-cognitive delay; maternal hostility and anxiety increase the gross motor delay; maternal psychoticism increases the social and self-help delay, and maternal depression increases the total development delay of infants. Conclusion Maternal depression, anxiety, psychoticism, and paranoid ideation are important risk factors for infants' developmental delay types and should be addressed while evaluating infant-mother dyads in clinical practice.

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of idiopathic inflammatory arthritis affecting children younger than 16 years of age. Tocilizumab (TCZ) is a humanized anti-interleukin 6 (IL-6) receptor antibody that was approved for systemic and polyarticular JIA patients. However, the studies regarding patients’ satisfaction while receiving TCZ therapy is scarce. Herein, we aimed to evaluate the effect of subcutaneous (SC) TCZ administration on patient satisfaction and disease control of JIA patients. All JIA patients receiving TCZ were included in the study. Clinical features, laboratory findings and JADAS71 scores were recorded at baseline and every 3 months during follow-up. Nine of the patients on intravenous (IV) TCZ treatment were switched to SC form. All patients receiving TCZ-SC were questioned by a clinical nurse specialist (CNS) to assess patient satisfaction. A total of 39 patients receiving TCZ were included in the study. Among them, treatment of nine patients (five female, four male) was switched to SC form with a median of 11.5 (8–69) months after initiation of TCZ. Patients were stable both clinically and in laboratory means at the 3rd month of TCZ-SC treatment. There was no deterioration in terms of active joint counts, physician’s VAS, patient’s VAS and JADAS71. According to patient satisfaction questionnaire, eight of the patients felt satisfied with SC administrations in terms of life quality, school success and reduced school absenteeism. However, one patient did not agree that the SC form is as effective as IV form and wanted to continue with IV form. TCZ is an effective treatment option in JIA and switching from IV to SC route when necessary is found to be an effective and acceptable alternative by the patients as well.

BACKGROUND Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs. To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation. AIM To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation. METHODS Twenty patients (22 knees) with osteochondritis dissecans (OCD) lesions involving the knee were treated with autologous tendon transplantation between 2005-2018. All lesions were International Cartilage Repair Society grade IV. All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score (KOOS); and radiologically with magnetic resonance observation and cartilage repair tissue (MOCART) and Kellgren-Lawrence (KL) classification. RESULTS A total of 20 patients (22 knees) with a mean age of 25.5± 6.8 years were included. The average defect size was 4.2 ± 2.1 cm2, and the average defect depth was 0.9 ± 0.4 cm. Total KOOS score was preoperatively 29.4 ± 5.5 and was later found to be 81.5 ± 5.9 after an average of 68.7 ± 37.7 mo follow-up. The mean MOCART score was 56.2 ± 10.7. Preoperatively, all of the patients had KL grades of 0–1; during the follow-up period, 80% of the patients showed no radiological progress of osteoarthritis. Patients with less than 4 cm2 lesion had statistically significantly better overall KOOS than patients whose more than 4 cm2 lesion, particularly in sport and quality of life subscales. CONCLUSION The autologous tendon transplantation is a single-step, safe, simple, cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes, particularly in patients with less than 4 cm2 lesion.

Aims We aimed to determine parents' levels of anxiety and fear and suspicion in relation to the COVID-19 period and the possible predictive factors for these variables in families admitted to a child and adolescent psychiatry outpatient clinic of a university hospital in Turkey. In this way, it is hoped to contribute to the identification of priority target groups in psychosocial support services. Method The research study group consisted of 600 patients aged 0-18 years and their parents who were referred to a child and adolescent psychiatry outpatient clinic of a university hospital. Parents completed the COVID-19-related psychological distress (CORPD) scale and the data recording form developed specifically for this study. All cases included in the study were examined by a child and adolescent psychiatrist for diagnostic evaluation and their current diagnoses were recorded. Results Parents of children with any psychiatric diagnosis had higher suspicion scores on the CORPD scale and parents of children with high COVID-19-related anxiety also had higher anxiety and fear scores on the same scale. Logistic regression analysis revealed that negative changes in family relationships increased the risk of higher maternal COVID-19-related suspicion. Conclusions The most important factors associated with parental high CORPD levels were negative changes in family relationships and children with high COVID-19-related anxiety. Children's high COVID-19-related anxiety levels were associated with living with a single parent or separation from parents, negative changes in family relationships, previous COVID-19 infection in the family, and changes in daily routines.

Background/Aim: It is possible to find studies in the literature evaluating the relationship among self-reported bruxism, psychological factors, and myogenous temporomandibular disorder. In addition, the relationship between these issues has not yet been clarified. The objective of this study was to evaluate the association between peripartum depression, self-reported bruxism, and myogenous temporomandibular disorders among postpartum women in Turkey. Material and Methods: This study included 220 women, who were asked about their bruxism behavior during day and during sleep. Besides, all of them assessed with Short-Form Fonseca's Anamnestic Index for myogenous temporomandibular disorder and the Edinburgh postnatal depression scale for peripartum depression. Results: The results showed that, self-reported bruxism was observed at a statistically significantly higher rate (94.3%) in peripartum depression group. 86.5% of the patients with self-reported bruxism had myogenous temporomandibular disorder (p

Objective: The onset, severity and progression of periodontal diseases are mainly related to the inflammatory host response against periodontal pathogens. The aim of this study was to evaluate salivary interleukin (IL) -1β, IL-13, IL-21 and IL-33 levels in patients with stage III grade C periodontitis and compare it with periodontally healthy individuals. Methods: A total of 58 individuals, including 28 periodontally healthy and 30 stage III grade C periodontitis patients were included in this study. Periodontal parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) were measured. Saliva samples were obtained from all patients. Salivary interleukin (IL) -1β, IL-13, IL21, IL-33 levels were assessed using enzyme-linked immunosorbent assay (ELISA). Results: All clinical parameters were significantly higher in periodontitis patients compared to healthy individuals (p

Purpose The main objective of this study is to demonstrate the diagnostic accuracy of susceptibility-weighted angiography (SWAN) in the diagnosis of slow-flow cerebral vascular malformations, especially developmental venous anomaly (DVA). We also aimed to determine the prevalence of DVAs identified by SWAN at 1.5 T. Methods We retrospectively evaluated 1,760 axial SWAN images for the diagnosis of low-flow vascular anomaly. Among them were 305 patients who underwent contrast-enhanced examination due to different indications. Postcontrast images were analyzed by different radiologists who were blinded to patients. The presence of DVA and other features such as location, length, depth, and direction of drainage vein was evaluated. Results Twenty-six patients with DVA had both SWAN and postcontrast images. There were four false-negative patients with SWAN. The sensitivity of the SWAN sequence was 84.6%. In addition, totally 77 DVA (4.36%), 2 capillary telangiectasia (0.11%), and 2 cavernous malformations (0.11%) were detected in 1,760 patients. Conclusion SWAN is an effective method for the diagnosis of developmental venous anomalies and other low-flow cerebral vascular malformations. Especially in the pediatric age, susceptibility-weighted imaging sequences are useful to limit contrast use.

INTRODUCTION: COVID-19 pandemic created concerns among patients receiving immunosuppressive therapy. Frequency of COVID-19 and impact of lockdown on treatment compliance in patients with vasculitis are largely unknown. PATIENTS AND METHOD: Patients with ANCA-associated and large vessel vasculitis that have been followed-up in our clinic were contacted by phone and a questionnaire containing home isolation status, treatment adherence and history of COVID-19 between March 1st and June 30th, 2020 was applied. RESULTS: The survey was applied to 103 patients (F/M: 59/44, mean age: 53.2±12.5). Thirty-three (32%) patients didn?t attend at least one appointment; 98(95.1%) noted that they spent 3 months in home isolation. Five patients (4.8%) received immunosuppressives irregularly and 3(2.9%) developed symptoms due to undertreatment. Four (3.9%) patients admitted to hospital with a suspicion of COVID-19, but none of them had positive PCR or suggestive findings by imaging. COVID-19 diagnosed in a patient with granulomatosis with polyangiitis during hospitalization for disease flare and she died despite treatment. DISCUSSION: Frequency of COVID-19 was low in patients with vasculitis in our single center cohort during the first months of pandemic. Although outpatient appointments were postponed in one-third of our patients, high compliance with treatment and isolation rules ensured patients with vasculitis overcome this period with minimal morbidity and mortality.

In Turkey, the seven-valent pneumococcal conjugated vaccine (PCV7) was included in the childhood national immunization programme in April 2008 and was replaced by the 13-valent pneumococcal conjugated vaccine (PCV13) in April 2011. In this retrospective, single-center study, it was aimed to determine the serotype distribution and antimicrobial resistance in Streptococcus pneumoniae isolates of pediatric patients with invasive pneumococcal disease (IPD) after the introduction of PVC7 and PVC13. Fifty pediatric patients diagnosed with meningitis and sepsis/bacteremia between October 2009 and October 2019 were included in the study. The pediatric patient group consisted of previously healthy patients diagnosed with meningitis and sepsis/bacteremia with S.pneumoniae isolated in their blood or cerebrospinal fluids. Patients with pneumonia-associated bacteremia and empyema were not included in the study. Serotyping of the isolates was performed by Quellung reaction using specific antisera (Statens Serum Institute, Denmark) and antibiotic (penicillin and ceftriaxone) susceptibility was determined by antibiotic gradient method based on Clinical Laboratory Standards Institute (CLSI) criteria. Of the children, 29 (58%) were boys and 21 (42%) were girls. The median age of the patients was 19 months (1 month-18 year). When the children under the age of five were evaluated, it was found that 30 (79%) patients were diagnosed with occult bacteremia/sepsis and 8 (21%) with meningitis. The overall annual incidence rate of IPD among the healthy children aged5 years decreased significantly from 9.35/100000 to 0.83/100000 (p0.001). Serotype identification was determined for 44 of 50 pneumococcal isolates . However, since six patients with underlying disease were not included in the evaluation, the remaining 38 isolates were found to be one of the serotypes included in PCV7 and PCV13 at a rate of 28.9% (n= 11) and 44.7% (n= 17), respectively. While the rate of PCV13 serotypes seen in the PCV7 period was 81.8%, this rate decreased to 29.6% within eight years after PCV13 administration. The rate of non-vaccine serotypes was determined as 54.5% in PCV7 period and 70.3% in PCV13 period. The rate of non-vaccine serotypes in patients under 5 years was 60% in the period of PCV7 and 75% in the period of PCV13. The proportion of non-vaccine serotypes has increased over time. However, this difference was not statistically significant (p0.05). The most common serotypes detected in isolates were 19F, 23F, 7F, 31 and 24B. According to the minimum inhibitory concentration values of the isolates recovered from patients with meningitis, penicillin and ceftriaxone resistance rates were found as 43.9% and 9.8%, respectively. In conclusion, our study showed that there was a 91.1% decrease in the incidence of IPD in healthy children aged under five years after the implementation of PCV7 and PCV13. It was determined that while the rate of serotypes in vaccine content decreased, there was an increase in non-vaccine serotypes. In addition no significant change was observed in antibiotic resistance rates over the years.

Purpose: To investigate the effect of age- and sex-related differences on macular and choroidal perfusion in healthy Turkish individuals by optical coherence tomography angiography (OCTA).Methods: Two hundred-eight eyes of 116 healthy Turkish individuals (60 females and 56 males, mean age 40.35 ± 12.64 years) were included in this study. OCTA was performed on a 3 × 3-mm region on the macula. The superficial macula wholeimage vessel density (wiVD), foveal VD and parafoveal VD vessel density, foveal avascular zone (FAZ) as well as choriocapillaris flow index (CFI) were quantified.Results: The mean vessel density was 53.1% ± 2.8% in superficial macula wiVD, 31.7% ± 6.9% in superficial foveal VD and 55.2% ± 3.4% in superficial parafoveal VD for 3 × 3-mm OCTA images. Analysis of 3 × 3-mm scan has revealed a mean value of FAZ area was 0.313 ± 0.112 mm2. The mean CFI for 3 × 3-mm scan was 1.937 ± 0.059. A significant decrease was observed in the mean values of wiVD, parafoveal VD and CFI with age (p < 0.001, p = 0.001, and p < 0.001, respectively), with average yearly reductions of 0.3%, 0.4% and 0.4%, respectively. However, there was no correlation between age and foveal VD (p > 0.05). The FAZ area has shown an age-dependent annual increment, showing an average of 1.26%. The parafoveal VD and FAZ area were significantly higher in females than males (p = 0.027 and p = 0.015, respectively) while other parameters seemed similar (p > 0.05 for all).Conclusions: Our results suggest that age- and sex-related variations were effective on macular and choroidal perfusion. These normative values obtained using OCTA may be clinically useful to the evaluation of retinal and choroidal disorders.

Background We report a nosocomial outbreak caused by Burkholderia cepacia that occurred among six patients admitted in the medical and surgical intensive care unit between 04 March 2019 and 02 April 2019 in Istanbul, Turkey. Methods The outbreak investigation was launched on 11 March 2019 five days after the detection of B. cepacia in four different patients. We defined potential reservoirs and started environmental screening. We sampled the liquid solutions used in patient care activities. Pulse-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness of environmental and patient samples. Results Burkholderia cepacia was isolated in tracheal aspiration cultures of six patients. Three out of six patients developed healthcare-associated pneumoniae due to B. cepacia. Environmental cultures in the ICUs revealed B. cepacia growth in 2% chlorhexidine-gluconate mouthwash solution that been used in the colonized patients as well as in samples obtained from the unused products. PFGE revealed the patient and a specific batch of chlorhexidine mouthwash solution samples had a 96% similarity. Conclusion Contamination of medical solutions used in critical patient care could cause outbreaks and should be detected early by infection control teams. Graphic abstract

Background/Aim: Cholesteatoma is an invasive and destructive disease, responsible for most of the complications related to chronic otitis media. The only effective treatment is surgical excision. Researching medical treatment alternatives can bring a new perspective to the treatment of this disease. This study aimed to investigate the effect of Mesna on otitis media and cholesteatoma induced by propylene glycol on an experimental animal model.Methods: The study was designed to consist of sixteen Wistar albino rats, with their right ears being the control group and the left ears being the experiment group. Fifty percent propylene glycol, gentamicin sulfate, and physiologic saltwater were administered to the right ear, and 50% propylene glycol, gentamicin sulfate, and 20% Mesna were administered to the left ear through intratympanic injections on days 1, 3, 8, 15, and 21. The rats were sacrificed 45 days after the first injection and underwent histopathological examination.Results: Cholesteatoma and fibrosis were less common in the experimental group. In the study group, the average and maximum thicknesses of the tympanic membranes (P=0.008) and the minimum thicknesses of the tympanic bulla (P=0.019) were significantly less than those of the control group.Conclusion: In the experimental cholesteatoma model created in rats, Mesna, administered intratympanically, was seen to completely prevent the formation of cholesteatoma. However, histopathological examination revealed that although present, cholesteatoma formation and fibrosis were significantly less in the experimental group.

Günümüzde kronikleşmiş cari açık, beraberinde getirdiği enflasyon, ekonominin daralması, işsizlik gibi pek çok sorun sebebiyle ülkeler için çözüm yaratma noktasında ciddi ve özellikle uzun vadeli stratejiler geliştirilmesini gerektiren önemli bir sorundur. Soruna çözüm geliştirmenin yolu ise açığın sürdürülebilir olup olmadığı ve ekonomik krize kadar varan sonuçlar doğurup doğurmayacağının analizi; bir başka ifade ile cari açığın yapısının ve nasıl finanse edildiğinin belirlenmesi ile mümkündür. Çalışmanın çıkış noktası ise Türkiye için özellikle ekonomik liberalleşme sonrası artan cari açık sorununa çözüm öneri sunma çabasıdır. Bu motivasyonla, cari açığın yapısı ve finansman yöntemleri incelenmiş ve KOBİ’lerin ihracattan aldıkları payın artırılması önerisi geliştirilmiştir. Ampirik kısımda ise bahsi geçen önerinin teorik alt yapısını oluşturmak üzere KOBİ’lerin ihracattan aldıkları pay artışının cari denge üzerinde ne derece olumlu bir etkisinin olduğu analiz edilmeye çalışılmıştır. Bu amaçla OECD ülkeleri verileri ele alınarak 2008-2018 dönemi için, KOBİ’lerin ihracat içerisinde aldıkları pay artışının, cari dengeyi istatistiki olarak anlamlı ve pozitif yönde etkileyeceği şeklindeki hipotez sabit etkili panel veri ve threshold regresyon modelleri kullanılarak test edilmektedir. Elde edilen tahmin sonuçlarına göre küçük ve orta ölçekli işletmelerin ihracatındaki artış ile cari denge arasında tüm modellerde pozitif ve istatistiksel olarak anlamlı bir korelasyonun mevcut olduğu görülmektedir. Bu çıktıya ek olarak ülkelerin yüksek teknolojili ürünlere adaptasyonunun sağlandığı ve ihracatının yapıldığı erken dönemlerde cari işlemler hesabını yüksek teknoloji ihracatının negatif yönde etkilediği ancak ileri dönemlerde üretim sürecindeki artan entegrasyon ve üretkenlikteki artışa bağlı olarak mevcut ilişkinin pozitif bir yöne evrildiği görülmektedir.

Objective: Nutrition is one of the substantial modifiable risk factors in the prevention and control of many diseases such as chronic kidney diseases. Nutrition knowledge can thus help in prevention. The objective of this study is to assess nutritional knowledge of patients on hemodialysis and determine if this differs and was linked to duration of the therapy in Finland and Turkey. Methods: The study was conducted in one university hospital dialysis center each in Finland and Turkey with hemodialysis patients with an age of ≥18 years. A questionnaire about demographic and disease characteristics and nutritional knowledge was administered face-to-face. Anthropometric measurements (body weight, edema-free dry weight, height, body mass index) were evaluated. Results: The study group consisted of 120 adults, 50 patients (14 female, 36 male) from Finland and 70 patients (21 women, 49 men) from Turkey. The mean nutritional knowledge score was 10.1 ± 3.11 for the Finnish patients and 9.2 ± 3.32 for the Turkish patients (p>0.05). There was a positive correlation between the nutritional knowledge score and body weight in Turkey and between the nutritional knowledge score and duration of dialysis in Finland (p

The significance of tumor thickness is not clear in the prognosis of basal cell carcinoma. We aimed to identify the relationship between the tumor thickness and aggressive histopathological growth pattern in BCC.We retrospectively reviewed 85 primary BCCs of 82 patients. A total of 78 (91.7%) tumor slides were available for review, 7 (8.2%) missing slides in archive could not to be re-evaluated. We recorded the histological subtype, ulceration, perineural invasion, and the tumor thickness. Tumors with infiltrative, micronodular, morpheaform and basosquamous features were classified as having an aggressive growth pattern.The aggressive growth pattern was determined in 21 (26.9%) tumors with a mean tumor thickness of 2.19 ± 0.71 mm (range, 0.9-3.40). The non-aggressive growth pattern was detected in 57 (73%) tumors and the mean tumor thickness was 1.76 ± 0.87 mm (range 0.50-4.40 mm). There was a statistically significant difference in the mean tumor thickness between the tumors with aggressive growth pattern and non-aggressive growth pattern (p = 0.033).Tumor thickness might have positive correlation with aggressive histological pattern. Measuring and reporting tumor thickness may be a more practical way to determine the pathological risk for BCC.

This study aimed to detect patients’ characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O2) requirement and daily living activities were assessed before and after rehabilitation. Eighty-five patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81 kg/m2. The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99 days, while those who needed O2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain–Barre syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities.

Objectives Coronavirus disease 2019 has caused a major epidemic worldwide, and lockdowns became necessary in all countries to prevent its spread. This study aimed to evaluate the effects of staying-at-home practices on the metabolic control of children and adolescents with type 1 diabetes during the pandemic period. Materials and Methods Eighty-nine patients younger than 18 years old who were diagnosed with type 1 diabetes at least one year before the declaration of the pandemic were included in the study. The last visit data of the patients before and after the declaration of the pandemic, and the frequency of presentation of diabetes-related emergencies from one year after diagnosis of type 1 diabetes to the declaration of the pandemic, and from the declaration of the pandemic to the last visit after the pandemic declaration were compared. Results The total number of patients was 89, and 48 (53.9%) were boys. The mean (± standard deviation [SD]) age at diagnosis was 8.4 ± 3.7 years (boys 7.9 ± 3.6 years; girls 8.9 ± 3.9 years). There was no statistically significant difference when the SD values of the anthropometric measurements, and the glycosylated hemoglobin (HbA1c) and lipid profile tests were compared. However, the frequency of admission to the emergency service related to diabetes was significantly different. Conclusions Although the pandemic did not significantly affect the metabolic and glycemic controls of the children with type 1 diabetes included in this study, an increase in the frequency of diabetes-related emergency admissions was noted.

Cardiac involvement is a common and serious problem in multisystem inflammatory syndrome in children (MIS-C). Echocardiographic evaluation of systolic and diastolic function by traditional, tissue Doppler and three-dimensional (3D) echocardiography was performed in consecutive 50 MIS-C patients during hospitalization and age-matched 40 healthy controls. On the day of worst left ventricular (LV) systolic function (echo-1), all left and right ventricular systolic function parameters were significantly lower (p

Amaç: Bu araştırma hemşirelik bölümünde okuyan kız öğrencilerin menstruasyon tutumlarının genital hijyen davranışları üzerine etkisini belirlemek amacıyla yapılmıştır. Yöntem: Kesitsel türde yapılan araştırmaya, 2019-2020 eğitim yılında olan 341 öğrenci katılmıştır. Veriler kişisel bilgi formu, Genital Hijyen Davranışları Ölçeği ve Menstruasyon Tutum Ölçeği ile toplanmıştır. Verilerin analizinde tanımlayıcı istatistikler, OneWayAnova testi, korelasyon ve regresyon analiz yöntemleri kullanılmıştır. Bulgular: Araştırmaya katılan öğrencilerin %78,9’u 20 yaş ve üstünde, %39,9’u birinci sınıfta ve %64,5’i yurtta yaşamaktadır. Öğrencilerin Menstrual Tutum Ölçeği toplam puanı 93,31±10,27, Genital Hijyen Davranışları Ölçeği toplam puanı 95,50±9,42 olarak bulunmuştur. Çalışmamızda menstruasyonun doğal bir olgu olarak görülmesi ile genital hijyen davranışları ve adet hijyeni arasında olumlu ilişki olduğu saptanmıştır. Regresyon analizi sonucunda kullanılan ped sayısının genel hijyen davranışı ve anormal bulgu farkındalığı üzerinde etkili olduğu, menstruasyon uzunluğu ve ped sayısının ise adet hijyeni üzerinde etkili olduğu bulunmuştur. Sonuç: Öğrencilerin menstruasyonu doğal bir olgu olarak görmesinin adet hijyeni davranışlarını olumlu etkilediği bulunmuştur. Bu doğrultuda ilk deneyimden itibaren menstruasyonla ilgili kazandırılacak olumlu tutumların, kadınların tüm hayat dönemlerinde genel sağlık durumunu olumlu yönde etkileyeceği düşünülmektedir.

Purpose: The purpose of the study was to compare the effect of two taping techniques and manual therapy, applied in addition to the conventional physiotherapy program, on pain and function in patient with subacromial impingement syndrome.Methods: A total of 55 patients participated in this study. Patients were divided into four groups; Kinesio taping group, McConnell taping group, manual therapy group, and control group. Conventional physiotherapy (5 days a week for four weeks) was applied to the patients in all groups. The level of pain was assessed by the Visual Analogue Scale, and the functional activity level was assessed by the Disabilities of the Arm, Shoulder, and Hand-DASH Questionnaire. The patients were assessed before treatment and after treatment.Results: There was a significant difference in terms of pain severity and functional activity levels after treatment when compared to the pre-treatment period in all groups (p0.05).Conclusions: There was a significantly greater decrease in pain intensity after all three applications than the control group. It was observed that they did not have significant superiorities over one another in terms of pain and functionality parameters.Keywords: Shoulder impingement syndrome, athletic tape, musculoskeletal manipulations

BACKGROUND Thyroid cancer is one of the most common cancers and is especially common in young patients. Therefore, effective recognition and treatment of thyroid cancer are essential for patient survival. OBJECTIVES To compare the effectiveness of standard guidelines for predicting thyroid malignancy. To do so, thyroid nodules were classified according to the categories of the American Thyroid Association (ATA) and Thyroid Imaging Reporting and Data System (TI-RADS) guidelines, and compared with fine-needle aspiration biopsy (FNAB) results. MATERIAL AND METHODS The study included 1741 thyroid nodules with a final diagnosis in 1121 consecutive patients. The FNAB was recommended for all patients according to ATA guidelines and subsequently performed. The nodules were reclassified according to TI-RADS guidelines. RESULTS Comparing nodules classified according to ATA and TI-RADS in terms of ultrasonography (US) features with the Bethesda cytological diagnosis classification System for Reporting Thyroid Cytopathology, 37.6% of the nodules classified in the high-risk category according to the ATA classification were found to be malignant cytology, 10.4% suspicious for malignancy, 4% non-diagnostic, 9.6% indeterminant cytology, and 38.4% benign. According to the TI-RADS risk category, 50% of those with high suspicion were malignant, 13.3% suspicious for malignancy cytology and 36.7% were benign. For the TI-RADS guidelines, the best cutoff value for differentiating benign and malignant nodules was found to be 4.5 (area under the curve (AUC) = 0.962, 95% CI = 0.943-0.981, p < 0.001). For the ATA guidelines, the best cutoff value for separating benign and malignant nodules was 4.5 (AUC = 0.917, 95% CI = 0.875-0.959, p < 0.001). The diagnostic performances of the TI-RADS and ATA score systems were evaluated using highly suspicious nodules. The sensitivity and specificity of highly suspicious nodules, according to both TI-RADS and ATA guidelines, were both high. Sensitivity and specificity of ATA classification were 80% and 96.3%, respectively. Sensitivity and specificity of TI-RADS classification were 76% and 97.5%, respectively, but positive predictive value was low (63.3% compared to 55.5%). CONCLUSIONS Both, the ATA and TI-RADS classifications can effectively predict malignancy risk of thyroid nodules and may thus decrease unnecessary FNAB.

Background: Inhaled antibiotics for treating bronchiectasis have been investigated in the cystic fibrosis population since 1981 and long-term clinical benefits have been reported. However, studies ...

Background: The demonstration that severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) enters the cell via the angiotensin-converting enzyme 2 receptor has raised concerns that, in hereditary angioedema (HAE), a disease characterized by bradykinin-mediated angioedema attacks, coronavirus disease 2019 (COVID-19) may trigger angioedema attacks, increase the frequency and/or severity of attacks, or cause more severe symptoms of COVID-19. Objective: The objective was to evaluate the severity of COVID-19 in patients with HAE, the course of HAE attacks, angioedema activity, and the quality-of-life scores during COVID-19 pandemic. Methods: Patients diagnosed with HAE for at least 6 months were included in the study. The 7-day Angioedema Activity Score and the Angioedema Quality of Life (AE-QoL) Questionnaire were first completed at the onset of the pandemic between March 12 and June 1, 2020, then during SARS-CoV-2 infection, and in the third month after recovering from COVID-19. Results: Ten of 67 patients with HAE (14.9%) were diagnosed with COVID-19. The median (interquartile range) age of the 10 patients diagnosed with COVID-19 was 35.5 years (28.0‐55.0 years). Six of the 10 patients (60%) were women. During COVID-19, five of the 10 patients (50%) had no angioedema attack. Two patients with severe HAE experienced a significant increase in angioedema activity during COVID-19 compared with their basal activity scores. The remaining three patients had a similar or lower attack frequency than their basal level. Four (40%) of the 10 patients had a relative increase in their attacks during the convalescence period. There was no statistically significant difference among pre-COVID-19, during COVID-19 and post-COVID-19 periods in function, mood, fear and/or shame, nutrition, and total scores of the AE-QoL Questionnaire although the fear dimension was relatively more affected (p = 0.06). Conclusion: Although the sample size was small, analysis of our data supported that the symptoms of COVID-19 were not more severe in HAE. Also, there was no significant difference in the AE-QoL Questionnaire scores, the frequency, and severity of angioedema attacks during the course of COVID-19 in the patients with HAE.

Aim: to discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitorization (IEM) following their epilepsy surgery at our centre. Material and Methods: forty-seven patients suffering from refractory epilepsy and who were evaluated by invasive EEG were included in this retrospective study at Istanbul Faculty of Medicine from 2003 to 2017. We examined the Video EEG and invasive EEG monitorization, cranial MRI, SPECT, PET and neuropsychological tests of all patients. Postoperative seizure outcome results were evaluated according to Engel classification. The factors affecting seizure outcomes were discussed. Results: twenty-six of the patients were female (55.3%), 21 were male (44.7). The average age was 32.0 (+/- 12.4). Forty-three patients had surgery and the average age of these patients was 26,6 (+/- 11.15). 38.3% of the patients had hippocampal sclerosis (HS), 23.4% had focal cortical dysplasia (FCD), 8.5% had a tumor, 14.9% had sequela lesion and 14.9% had unknown etiology. Postoperative seizure status according to the Engel classification showed that 81.6% of the patients were class I, 10.5% were class II, 2.6% were class III and 5.3% were class IV. Conclusion: a significant relation was statistically determined between structural MRI lesion and favorable seizure outcome (p0.05). We argue that IEM is an essential examination for favorable outcomes for determining the epileptogenic zone and/or the proximity of the functional structures., NA

Chronic renal failure (CRF) makes significant changes in the life of patients and their families. A good family support has a positive effect on successful patients' adaptation to the treatment and compliance with dietary regimen. This study aimed to examine the effects of nutritional knowledge of informal caregivers on depression and metabolic outcomes of hemodialysis patients. This was a cross-sectional study conducted at Baskent University Hemodialysis Center with 116 hemodialysis patients and their informal caregivers. Findings revealed that the caregivers who were the couple of the patients had the highest nutritional knowledge level than the other caregivers (p

Objectives: Conventional bronchoscopic techniques and computed tomography-guided transthoracic needle aspiration are widely used in the diagnosis of lung cancer. In some patients diagnosis can be challenging. Endobronchial ultrasound-guided transbronchial needle aspiration can be used in the diagnosis of lung cancer after procedures have failed to provide a diagnosis. We aimed to show the effectiveness of Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer in view of the literature and to share the experience from Turkey. Material and Methods: This was a retrospective study conducted between 2014 and 2019. Forty-five patients who were suspected of having lung cancer and underwent Endobronchial ultrasound because diagnosis was not confirmed using methods such as bronchoscopy, computed tomography transthoracic needle aspiration, and peripheral lymph node excision, were included in the study. Results: Three hundred sixty-eight Endobronchial ultrasound procedures were performed. Forty-five patients met the inclusion criteria and were included in the study. Using Endobronchial ultrasound, samples were taken from only mass in eight patients (17.8%), lymph nodes in 30 patients (66.7%), and mass + lymph node in seven (15.5%) patients. Minor complications were seen in five (11.1%) patients and no major complications were seen. Definitive diagnosis was obtained in 35 (77.7%) patients with Endobronchial ultrasound guided transbronchial needle aspiration. Non-small cell lung cancer was identified in 16 patients (45.7%), small cell lung cancer was seen in 15 (42.8%) patients. Seven of ten undiagnosed patients underwent surgical procedures. Conclusion: Endobronchial ultrasound, is an effective and safe method for diagnosing lung cancer after undiagnosed procedures. In selected cases, it can be the first choice for the diagnosis of lung cancer.

Epstein-Barr virus (EBV) has been associated with a plethora of neurological manifestations including polyneuropathy and polyradiculopathy. A 27-year-old man with a recent upper respiratory system infection presented with difficulty in walking. His neurological examination revealed reduced muscle strength in both proximal and distal lower limb muscles without sensory and autonomic signs. Needle electromyography showed abnormal spontaneous activity and reduced recruitment of motor units in muscles innervated by multiple lumbo-sacral roots. Cerebrospinal examination showed increased protein levels with normal cell counts. While spinal MRI was normal, whole-body CT and PET examination showed disseminated lymph node enlargement. Anti-EBV viral capsid antigen and anti-nuclear antigen IgG but not IgM was positive, whereas EBV PCR was negative in blood. Analysis of inguinal lymph node biopsy showed reactive lymphoid hyperplasia and EBV DNA. Leucine-rich glioma-inactivated protein 1 (LGI1) antibody was found in serum but not in CSF. All clinical, imaging, and electrophysiological findings improved following steroid and intravenous immunoglobulin treatment. These findings suggested the acute involvement of lumbo-sacral spinal roots and/or motor neurons. Purely motor polyradiculopathy has been reported in both EBV-positive and LGI1 antibody-positive patients, and EBV infection is known to precede different autoimmune manifestations. Whether EBV infection may trigger LGI1 autoimmunity and cause involvement of spinal motor roots and/or motor neurons needs to be further studied.

This study was conducted to investigate the effect of perceived social support on self-care agency and loneliness among elderly Muslim people. This study used a cross-sectional design and included 965 elderly individuals who met the inclusion criteria. There was a positive correlation between perceived social support and self-care agency and a negative correlation between perceived social support and loneliness in elderly muslim individuals (p < 0.05). It is recommended that psychiatric nurses should activate the social support mechanisms of elderly individuals, and necessary follow-ups to increase self-care agencies must be conducted.

Background Multisystem inflammatory syndrome in children (MIS-C) is characterized by persistent fever, abdominal pain, vomiting, diarrhea, rash, conjunctivitis, headaches, and mucocutaneous manifestations and it can cause circulatory dysfunction, resulting in hypotension, shock, and end-organ injury in the heart and other organs and possibly death. In this study, we aimed to analyze the clinical spectrum, treatment options and outcomes of children with MIS-C who were admitted to our pediatric intensive care (PICU). Materials and Methods Clinical and laboratory findings and treatment of the patients admitted to the PICU with MIS-C between April 2020 and January 2021 were recorded, and their outcomes were evaluated. Results Nineteen patients with a median age of 12.5 years (interquartile range (IQR): 5.8–14.0 years) were admitted. Eleven (57.8%) were males. The most frequent clinical and laboratory features were fever (100%), abdominal pain (94.7%), rash (63.1%), headache (68.4%), diarrhea (47.3%), seizure (10.5%), cardiac dysfunction (52.6%), acute kidney injury (26.3%), lymphopenia (84.2%), and thrombocytopenia (36.8%). However, 8 patients needed mechanical respiratory support, 11 patients needed inotropes, 2 patients needed plasma exchange, and 1 patient needed continuous renal replacement therapy. All patients received corticosteroids, 17 patients (89.2%) received intravenous immunoglobulin, 2 patients received anakinra, 10 patients received acetylsalicylic acid, and 6 patients received enoxaparin. Median PICU length of stay was 3 days (IQR: 2–5) and only one patient died. Conclusion In conclusion, MIS-C may present with a variety of clinical manifestations, and it can lead to life-threatening critical illness. Most children need intensive care and the response to immunomodulation is usually favorable.

Objectives: To determine the knowledge of hepatitis B infected patients and their behaviors regarding hepatitis B virus (HBV) infection and vaccination.

Ziel der Studie Etwa 25% der deutschen Bevolkerung raucht. Obgleich Tabakentwohnung eines der effektivsten Mittel zur Reduktion tabakassoziierter Folgen ist, findet sie nicht ihren Weg in die Regelversorgung. Auch in Hausarztpraxen wird sie nur vereinzelt angeboten. Diese Studie untersucht, wie Hausarztinnen und Hausarzte mit dem Thema Tabakentwohnung umgehen und welche Faktoren die Umsetzung von Tabakentwohnung behindern. Methodik Es wurden leitfadengestutzte Einzelinterviews mit 13 LehrarztInnen des Instituts fur Hausarztmedizin in Bonn gefuhrt. Die Interviews wurden auf Tonband aufgezeichnet und transkribiert. Anhand des Textmaterials erfolgte in MAXQDA eine inhaltlich strukturierende Inhaltsanalyse mit deduktiv-induktiver Kategorienbildung. Ergebnisse Die HausarztInnen berichten verschiedene Arten, wie sie Tabakentwohnungsmasnahmen in der Praxis umsetzen, wobei sie kombinierte Ansatze als erfahrungsgemas effektiv beschreiben. Nikotinersatztherapie und verschreibungspflichtige Mittel behalten sie starken Rauchern mit erfolglosen Entwohnungsversuchen vor. Ihrer Erfahrung nach ist der Wirkstoff Vareniclin sehr wirksam und gut vertraglich. Dennoch berichten die HausarztInnen einen zuruckhaltenden Einsatz, da sie infolge der Warnhinweise fur den Wirkstoff Bupropion auch Nebenwirkungen bei Vareniclin befurchten. Als zentrale Barrieren fur Tabakentwohnung sehen sie praxisseitigen Zeitmangel, fehlende Patientenmotivation und Kosten fur medikamentose Ansatze. Schlussfolgerung Die befragten HausarztInnen mochten gerade ihren motivierten PatientInnen zum Rauchstopp verhelfen. Jedoch fehlt eine strukturierte Behandlung der Tabakabhangigkeit. Dadurch ist die Anzahl an Raucherinterventionen gering und wirksame Therapien werden zu selten eingesetzt. Der Aufwand einer strukturierten Behandlung musste jedoch finanziell entlohnt werden. Zudem konnten die HausarztInnen durch den Ausbau von externen Angeboten zur Tabakentwohnung zeitlich entlastet werden. Purpose About 25% of the German population suffers from smoking. Although smoking cessation is one of the most effective approaches to reduce tobacco-related consequences, it is not well implemented in basic health care. Also, in GP practices it is only offered in a handful of cases. This study examines how GPs deal with the topic of smoking cessation and which factors hamper the implementation of smoking cessation. Methods Guided individual interviews were conducted with 13 GPs from teaching practices of the Institute of Family Medicine in Bonn. The interviews were audio-recorded and transcribed. Facilitated by MAXQDA the text document was analysed using thematic qualitative text analysis with deductive-inductive coding. Results GPs report different ways in which they implement smoking cessation in practice, describing combined interventions as most effective in practice. Nicotine replacement therapy and drug prescribing are reserved for heavy smokers with unsuccessful attempts to quit. In their experience, varenicline is effective and well tolerated. However, GPs report that they are cautious about using varenicline as they are afraid of side effects due to the warnings for the other cessation drug bupropion. According to the GPs the main barriers for smoking cessation are a lack of time in the practice, lack of patient motivation and the costs of medication. Conclusion The interviewed GPs concentrate on their motivated patients when applying smoking cessation. However, there is no structured treatment for nicotine addiction. As a consequence, the number of smoking interventions is low and effective therapies are rarely used. As a structured treatment is associated with a higher workload, there is a need for financial reward. In addition, GPs could be supported by providing more external smoking cessation services.

Childhood attention deficit hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. To reach a consensus based on the combination of scientific data and clinical experience, a modified Delphi study was conducted with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n=4), risk of developing SUD (n=3), screening and diagnosis (n=7), psychosocial treatment (n=5), pharmacological treatment (n=11), and complementary treatments (n=7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimülants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining noconsensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimülants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.