Search

Introduction: Evaluation of parameters that will predict prognosis in COVID19 disease ensures correct determination of treatment strategy. In this study, it was aimed to determine the clinical, radiological and laboratory parameters affecting mortality and to evaluate the risk factors., Materials and Methods: Patients hospitalized with the diagnosis of COVID-19 in September 2020 were included in the study. Clinical features, laboratory parameters, and radiological findings at admission were recorded. The relationship of these parameters with 30-day mortality was evaluated. Statistical analysis was performed with SPSS for Windows 16.0 Package Program., Result: Three hundred and sixty patients (female/male, n= 228/132) hospitalized in the specified period were included in the study. 30-day mortality rate was 14.4% in all patients. In multiple logistic regression analysis, age, presence of heart failure, admission oxygen saturation, body temperature higher than 38.2 and high ferritin levels were evaluated as independent risk factors for 30-day mortality., Conclusions: The relationship between clinical and laboratory markers and mortality is very important for the correct orientation of healthcare services and the correct determination of treatment strategy during the COVID-19 pandemic.

Background/aim: Radiofrequency catheter ablation (RFA) is the most effective method of supraventricular tachycardia therapy. Recurrent supraventricular tachycardia causes systolic dysfunction and dilated cardiomyopathy. The aim of this study was to evaluate the long-term alterations of atrial and ventricular functions after RFAof typical atrioventricular nodal reentrant tachycardia (AVNRT)., Materials and Methods: This cross-sectional study included 55 consecutive patients with symptomatic drug-resistant AVNRT who had had an invasive electrophysiology study and RFA. Speckle-tracking–based echocardiographic assessment was performed shortly before and 1 year after the operation. Left ventricle (LV) and right ventricle (RV) peak systolic strain (PSS) and atrial strain measurements were performed., Results: RFA successfully eliminatedtachyarrhythmia in all patients. LV apical 4-chamber PSS –20.8% (–24.7 to –16.0) vs. –22.8% (–26.6 to –17.0, P < 0.001), LV apical 2-chamber PSS –21.5% (–26.8 to –10.1) vs. –22.0% (–27.8 to –13.7, P < 0.001), LV global PSS –20.4% (–26.4 to –14.4) vs. –23.0% (–27.1 to –2.3, P < 0.001), RV global PSS –26.0% (–30.0 to –18.0) vs. –26.5% (–32.1 to –19.7, P < 0.001), and peak left atrial longitudinal strain 41.0% (19.0–71.8) vs. 54.0% (25.6–82.0, P < 0.001) were significantly improved 1 year after RFA., Conclusion: RFA of AVNRT not only provides relief of palpitations but also improves cardiac functions., Competing Interests: There is no conflict of interest. There is no relationship with the industry to be declared. This study did not get any grant support., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

The corrosion inhibition behavior of sodium nitrite (NaNO 2 ) towards pure copper (99.95%) in simulated cooling water (SCW) was investigated by means of electrochemical impedance spectroscopy (EIS) and dynamic electrochemical impedance spectroscopy (DEIS). NaNO 2 interferes with metal dissolution and reduce the corrosion rate through the formation or maintenance of inhibitive film on the metal surface. Surface morphologies illustrated that the surface homogeneity increased on adding sodium nitrite. Sodium nitrite's adsorption on copper surface followed the modified form of Langmuir, Freundlich and Frumkin isotherms. Physiosorption mode was involved in the corrosion protection. Electrochemical results revealed an corrosion resistance of copper increases on increasing the inhibitor concentration. The DEIS results indicated that copper corrosion mechanism could be hindered by 50% even after interval of 24 h by optimum concentration of sodium nitrite. The maximum inhibition was achieved with 2000 ppm of NaNO 2 . With this concentration, inhibition efficiency of up to 61.8% was achievable.

Aim: To compare childhood-onset (c-TAK) versus adult-onset Takayasu arteritis (a-TAK) patients for vascular involvement, disease activity, damage, and treatment., Methods: Patient charts from two tertiary-care centers of a pediatric and adult rheumatology clinic were reviewed. Adult patients diagnosed before the age of 18 years were included in the childhood-onset group. The activity was assessed with the physician's global assessment (PGA) and Indian Takayasu Clinical Activity Score (ITAS). The damage was evaluated with Takayasu Arteritis Damage Score (TADS) and Vasculitis Damage Index (VDI)., Results: Twenty-four c-TAK (follow-up duration: 53 months) and 117 a-TAK patients (follow-up duration: 68 months) were analyzed. Aorta involvement was more prevalent (79% vs. 33%), and the median PGA score was higher in the c-TAK group (9 vs. 7), whereas the mean Indian Takayasu Arteritis Score was similar (14 vs. 13) among both groups. Median VDI score was lower for c-TAK patients (4 vs. 5), whereas TADS was similar for children and adults (8 vs. 8). Higher incidence of glucocorticoid related side-effects, a longer time to diagnosis and upper extremity claudication seemed to account for higher VDI scores in adults., Conclusion: Aorta involvement was more common among children with TAK, whereas upper extremities were relatively spared. Biologic agents were used more commonly among children which may be explained by higher rates of aortic involvement. However, c-TAK patients did not have greater cumulative damage., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Cysteine (Cys) is incorporated into several compounds which are involved in detoxification of heavy metals. It is evident from recent studies that Cys is effective in alleviating the toxicity of heavy metals. Nevertheless, little is known about the Cys-mediated alleviation of chromium (Cr) toxicity. In our study, the impacts of exogenous Cys on Cr-stressed maize (Zea mays L.) were examined by using physiological and proteomic analyses. The results showed that Cr (100 µM) increased the accumulation of hydrogen peroxide, decreased cell viability, enhanced lipid peroxidation and consequently inhibited plant growth. The application of Cys (500 µM) attenuated the adverse effects of Cr on seedling growth. Cys supplementation to Cr treated plants decreased Cr accumulation in the shoots and increased Cr accumulation in roots. Cys treatment also modulated the activities of antioxidant enzymes and increased endogenous Cys content. Sixty proteins in root tissue were significantly affected by exogenous Cys under Cr stress using two-dimensional electrophoresis. Forty-six differentially expressed proteins were successfully identified by MALDI-TOF/TOF mass spectrometry. These differentially expressed proteins were involved in various biological pathways such as stress response (41.3%), energy and carbohydrate metabolism (21.7%), protein metabolism (6.5%), amino acid metabolism (6.5%), and others of unknown functions. The defense response-related proteins including glutathione peroxidase, glutathione S-transferases, pathogenesis-related proteins, glyoxalases and superoxide dismutase were differently regulated by Cys suggesting their roles in the Cys-mediated Cr tolerance., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

This study aimed to investigate the relationship between intercultural sensitivity and religious orientation among nurses. This study utilized a cross-sectional model. It was conducted in a public hospital in a city located in the eastern part of Turkey between July and September 2018. The participants were 105 nurses who volunteered to participate in the study. Data were collected using the Socio-Demographic Characteristics Form, the Intercultural Sensitivity Scale, and the Religious Orientation Scale. The Intercultural Sensitivity Scale mean score of the participating nurses was found 82.55 ± 9.82, and the total mean score for the Religious Orientation Scale was 53.34 ± 7.56. A significant, positive relationship was found between the Intercultural Sensitivity Scale and the Religious Orientation Scale mean scores (p < .01). It is recommended that the study should be conducted with the participation of nurses from different cultures and religion, in larger groups and in a comparative manner.

Objective: The optimal treatment modality for left main coronary artery (LMCA) disease is still controversial. The aim of this study was to investigate long-term prognostic determinants of percutaneous coronary intervention (PCI) for LMCA disease and the role of coronary artery disease (CAD) severity in this population., Methods: A total of 60 consecutive patients who underwent LMCA PCI were enrolled in this study. Baseline demographic and clinical variables were recorded, as well as the SYNTAX score (SS), SS II, and residual SS (rSS). The primary endpoints of the study were all-cause death, non procedural myocardial infarction (MI), and stroke. The patients were then divided into 2 groups: patients without a composite endpoint (Group 1) and those with a composite endpoint (Group 2)., Results: Of the 60 patients, 15 (25%) were female and the mean age was 59.8±14.7 years. The median follow-up time was 25 months (range: 12-33 months). A primary composite endpoint was observed in 16 patients (26.7%): mortality occurred in 10 patients (16.7%), 4 (6.6%) experienced MI, and stroke was seen in 2 patients (3.3%). Target vessel revascularization was performed in 3 patients (5%). The mean SYNTAX score (Group 1: 19.9±9.8; Group 2: 26.8±12.2; p=0.029), SS II PCI (Group 1: 27.7 [range: 17.7-36.8]; Group 2: 34.2 [range: 27.9-55.2]; p=0.030) and rSS (Group 1: 0 [range: 0-5]; Group 2: 12.5 [range: 3.5-22.5]; p=0.001) were higher in patients with a composite endpoint. Additionally, creatinine (odds ratio [OR]: 13.098; 95% confidence interval [CI]: 1.471-116.620; p=0.021), non-postdilatation (OR: 8.340; 95% CI: 1.230-56.570; p=0.030), and rSS (OR: 1.157; 95% CI: 1.024-1.307; p=0.019) were independent predictors of a primary composite endpoint., Conclusion: CAD severity has prognostic value for mortality, MI, and stroke in patients who undergo unprotected LMCA PCI. An increased initial SS and post-procedural rSS were related to adverse cardiovascular outcomes. The rSS was also an independent predictor of major adverse cardiac and cerebrovascular events and mortality.

Humanity has recently gained a novel foe named coronavirus disease 2019. Although data so far mostly suggest that children are more likely to have a favorable disease course, new concerns have been raised because of recently reported pediatric cases with hyperinflammatory conditions resembling Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome/hemophagocytic lymphohistiocytosis. Because the increasing evidence suggests that this recent hyperinflammatory condition emerged in the coronavirus disease 2019 era is a distinct clinical picture, the Centers for Disease Control and Prevention named this novel disease multisystem inflammatory syndrome in children. Even if this novel disease is rare, it seems to be highly fatal. Therefore, it is urgent to understand the pathogenesis of the disease to be able to establish the appropriate treatment regimes. Concerns regarding the diagnostic process and the management of the disease have been raised even among pediatricians. Therefore, we aimed to clarify this newly occurring enigma based on the current literature and our clinical insights., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright © 2021 Turkish Pediatric Association.)

Background/aim: Thermopsisturcica is a perennial species endemic to Turkey and different extracts of T. turcica have an antiproliferative effect on cancer cells, but there has not been any report on HeLa (human cervical cancer) cells., Materials and Methods: To get a better understanding of the molecular mechanism of anticancer activity of methanolic extracts of leaves (LE) and flowers (FE) of T. turcica, we employed 2-DE-based proteomics to explore the proteins involved in anticancer activity in HeLa cells., Results: T. turcica extracts showed a potent cytotoxic effect on HeLa cells with the IC50 values of 1.75 mg/mL for LE and 3.25 mg/mL for FE. The induction of apoptosis by LE and FE was also consistent with increased expression of caspase mRNAs and DNA fragmentation. In terms of the proteomic approach, 27 differentially expressed proteins were detected and identified through MALDI-TOF/TOF mass spectrometry. These altered proteins were involved in cytoskeleton organization and movement, protein folding, proteolysis and translation, cell cycle and proliferation, signal transduction, cell redox homeostasis, and metabolism., Conclusion: Up-regulation of protein disulfide isomerases and down-regulation of Rho GDP-dissociation inhibitor, heterogeneous nuclear ribonucleoproteins, and heat shock proteins may contribute to the induction of apoptosis and arresting of the cell cycle in HeLa cells., Competing Interests: none declared, (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background/aim: Pneumonia is the most serious clinical presentation of COVID-19. This study aimed to determine the demographic, clinical, and laboratory findings that can properly predict COVID-19 pneumonia., Materials and Methods: This study was conducted in the Gazi University hospital. All hospitalized patients with confirmed and suspected SARS-CoV-2 infection between 16 March 2020 and 30 April 2020 were analyzed retrospectively. COVID-19 patients were separated into two groups, pneumonia and nonpneumonia, and then compared to determine predicting factors for COVID-19 pneumonia. Variables that had a P-value of less than 0.20 and were not correlated with each other were included in the logistic regression model., Results: Of the 247 patients included in the study 58% were female, and the median age was 40. COVID-19 was confirmed in 70.9% of these patients. Among the confirmed COVID-19 cases, 21.4% had pneumonia. In the multivariate analysis male sex (P = 0.028), hypertension (P = 0.022), and shortness of breath on hospital admission (P = 0.025) were significant factors predicting COVID-19 pneumonia., Conclusion: Shortness of breath, male sex, and hypertension were significant for predicting COVID-19 pneumonia on admission. Patients with these factors should be evaluated more carefully for diagnostic procedures, such as thorax CT., Competing Interests: None to declare., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Context: Biallelic mutations in the PTF1A enhancer are the commonest cause of isolated pancreatic agenesis. These patients do not have severe neurological features associated with loss-of-function PTF1A mutations. Their clinical phenotype and disease progression have not been well characterized., Objective: To evaluate phenotype and genotype characteristics and long-term follow-up of patients with PTF1A enhancer mutations., Setting: Twelve tertiary pediatric endocrine referral centers., Patients: Thirty patients with diabetes caused by PTF1A enhancer mutations. Median follow-up duration was 4 years., Main Outcome Measures: Presenting and follow-up clinical (birthweight, gestational age, symptoms, auxology) and biochemical (pancreatic endocrine and exocrine functions, liver function, glycated hemoglobin) characteristics, pancreas imaging, and genetic analysis., Results: Five different homozygous mutations affecting conserved nucleotides in the PTF1A distal enhancer were identified. The commonest was the Chr10:g.23508437A>G mutation (n = 18). Two patients were homozygous for the novel Chr10:g.23508336A>G mutation. Birthweight was often low (median SDS = -3.4). The majority of patients presented with diabetes soon after birth (median age of diagnosis: 5 days). Only 2/30 presented after 6 months of age. All patients had exocrine pancreatic insufficiency. Five had developmental delay (4 mild) on long-term follow-up. Previously undescribed common features in our cohort were transiently elevated ferritin level (n = 12/12 tested), anemia (19/25), and cholestasis (14/24). Postnatal growth was impaired (median height SDS: -2.35, median BMI SDS: -0.52 SDS) with 20/29 (69%) cases having growth retardation., Conclusion: We report the largest series of patients with diabetes caused by PTF1A enhancer mutations. Our results expand the disease phenotype, identifying recurrent extrapancreatic features which likely reflect long-term intestinal malabsorption., (© Endocrine Society 2020.)

Background: Hypoglycemia is the most common and severe complication of insulin treatment during the management of type 1 diabetes mellitus (T1DM). Despite its importance, there is a lack of data about the efficacy and superiority of the carbohydrate sources used in hypoglycemia management in children and adolescents., Objective: We aimed to compare the effectiveness of honey, fruit juice, and sugar cubes as simple carbohydrates used in the primary treatment of hypoglycemia in children and adolescents with T1DM, who attended a diabetes summer camp., Methods: A prospective randomized study was performed in a 5-days-long diabetes summer camp. Three different types of simple carbohydrates; sugar cubes, honey, or fruit juice were randomly given for the treatment of hypoglycemia and the recovery results in the three groups were compared., Results: About 32 patients (53.1% male, mean age 12.9 ± 1.9 years) were included and 158 mild hypoglycemic episodes were observed. Sugar cubes, honey, and fruit juice were given in 46 (29.1%), 60 (37.9%), and 52 (33%) events, respectively. We found that honey and fruit juice had similar efficiency in recovering hypoglycemia in 15 minutes with a rate of 95% and 98%, respectively. However, sugar cubes had a significantly lower impact on treatment of hypoglycemia than the others, with a recovery rate of 84.7% at 15 minutes., Conclusions: This study showed, for the first time, that honey and fruit juice were more effective in treating hypoglycemia than sugar cubes, and can be preferred in treating hypoglycemic events in children and adolescents with T1DM., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: In this study, we aimed to investigate whether Ga-68 prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) scanning is adequate to predict intermediate risk, high risk, or oligometastatic prostate cancer (PCa) as an initial staging modality., Methods: The Ga-68 PSMA PET/CT scan images of 50 PCa patients pathologically proven by transrectal ultrasound guided biopsy were evaluated retrospectively. The association of standard uptake value maximum (SUV max ) value of the area with the highest PSMA expression within the primary tumor with the risk groups and metastatic burden is investigated., Results: The SUV max value was 6.18 in oligometastatic patients where it was measured as 10.93 in patients with higher metastatic burden (p=0.037). The cut-off SUV max value for multiple metastases was 7.96 (p=0.047). According to the regression model, SUV max value has a positive influence [odds ratio (OR)=1.42], which was statistically significant (p=0.038). SUV max values for intermediate and high risk patients were 6.91 and 11.44, respectively (p=0.014). The cut-off SUV max value for the high risk group was 10.55 (p=0.006). In the regression model, SUV max value has a positive influence (OR=1.198), which was statistically significant (p=0.021)., Conclusion: In this paper, we demonstrated the association between SUV max value of primary tumor and Gleason score. Our results also allowed us to suggest that primary tumor SUV max is a sufficiently accurate predictor of D'Amico risk groups in newly diagnosed PCa cases. Additionally, Ga-68 PSMA PET/CT turns out to be a useful tool in determining oligometastatic PCa, which requires a different treatment approach.

The study was conducted to evaluate effects of different dietary oils on egg quality and reproductive performance in rainbow trout. Broodfish (≈ 870 g) were fed four iso-nitrogenous and iso-lipidic diets differing in lipid sources: fish oil (FO), linseed oil (LO) and sesame oil (SO) as well as a commercial trout diet (CD) for about 5 months prior to spawning. Growth performance did not differ among the trout in the treatment groups. Mean diameter, volume and weight of eggs did not differ among the dietary treatments. Absolute fecundity, relative fecundity and gonadosomatic index were not affected by dietary treatment. A sub-set of eggs from females fed the experimental diets were fertilized to assess the reproductive performance of broodfish. When diets were fed, devoid of fish oil, fertilization rates were 89.2 ± 5.8 and 92.1 ± 4.9 %, eyeing rates were 87.3 ± 5.3 and 84.1 ± 4.4 % and hatching rates were 81.2 ± 4.3 and 78.3 ± 3.4 % in LO and SO fed fish, respectively. Fatty acid content of the eggs from broodstocks with a different nutritional history was affected by the dietary lipid sources. Eicosapentaenoic acid (EPA), arachidonic acid (ARA), and docosahexaenoic acid (DHA) concentrations in females fed vegetable oil based diets were greater than the dietary concentrations. Overall, results from the present study indicate there can be inclusion of LO or SO as dietary lipid sources without compromising egg quality and reproductive performance. Furthermore, there is efficient bioconversion of 18C fatty acids to 20-22 C fatty acids in rainbow trout., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Infectious diseases are the significant global health problem because of drug resistance to most classes of antimicrobials. Interest is growing in the development of new antimicrobials in pharmaceutical discovery. For that reason, the urgency for scientists to find and/or develop new important molecules is needed. Many natural active molecules that exhibit various biological activities have been isolated from the nature. For the present research, a new selected set of aminobenzoquinones, denoted as plastoquinone analogs (PQ1-24), was employed for their in vitro antimicrobial potential in a panel of seven bacterial strains (three Gram-positive and four Gram-negative bacteria) and three fungi. The results revealed PQ analogs with specific activity against bacteria including Staphylococcus epidermidis and pathogenic fungi, including Candida albicans. PQ8 containing methoxy group at the ortho position on the phenylamino moiety exhibited the highest growth inhibition against S. epidermidis with a minimum inhibitory concentration of 9.76 μg/mL. The antifungal profile of all PQ analogs indicated that five analogs (while PQ1, PQ8, PQ9, PQ11, and PQ18 were effective against Candida albicans, PQ1 and PQ18 were effective against Candida tropicalis) have potent antifungal activity. Selected analogs, PQ1 and PQ18, were studied for biofilm evaluation and time-kill kinetic study for better understanding.

Increased intestinal permeability (IIP) precedes several autoimmune disorders. Although Hashimoto’s thyroiditis (HT) is the most common autoimmune disorder, the role of IIP in its pathogenesis had received little attention. Zonulin plays a critical role in IIP by modulating intracellular tight junctions. Rise of serum zonulin levels were shown to indicate IIP in human subjects. In this case-control study, we examined the hypothesis that patients with HT have IIP. We studied 30 children and adolescents with HT, and 30 patients with congenital hypothyroidism (CH) matched for age, gender and body mass index (BMI). Serum zonulin levels, free thyroxine (fT4), thyroid stimulating hormone (TSH), anti-thyroglobulin antibody and anti-thyroid peroxidase antibody were measured. Zonulin levels were significantly higher in patients with HT than patients with CH (59.1±22.9 ng/mL vs. 43.3±32.9 ng/mL, p=0.035). In patients with HT, zonulin levels were positively correlated with weight (r=0.406, p=0.03), BMI (r=0.486, p=0.006) and levothyroxine dose (r=0.463, p=0.02). In patients with CH, zonulin levels were positively correlated with age (r=0.475, p=0.008), weight (r=0.707, p<0.001), BMI (r=0.872, p<0.001) and levothyroxine dose (r=0.485, p=0.007). After adjusting for age, weight, TSH and fT4 levels, serum zonulin was only associated with levothyroxine dose in patients with HT (R 2 =0.36, p=0.05). In patients with CH, only weight was associated with zonulin levels (R 2 =0.62, p<0.001). In conclusion, higher zonulin levels in children and adolescents with HT suggested IIP in these patients. Additionally, the association between zonulin levels and levothyroxine dose might imply a relationship between serum zonulin and disease severity.

Objectives: Clinical and laboratory investigations have revealed that Epstein-Barr virus (EBV) is involved in altered immunological response of systemic lupus erythematosus (SLE). Higher seroprevalence rates of anti-EBV antibodies and increased viral load are demonstrated in adult SLE patients. The prevalence of BK polyomavirus (BKV) reactivation is also suggested to be higher in SLE. Herein, we aimed to evaluate the immune response of children with SLE to EBV antigens in addition to EBV and BKV DNA. We also tried to evaluate whether these serological results differ from another connective tissue disease - juvenile systemic sclerosis (jSS) - and healthy individuals., Methods: Serum levels of EBV early antigen diffuse (EA-D) IgG, EBV nuclear antigen-1 IgG, EBV viral capsid antigen (VCA), cytomegalovirus (CMV) IgG, EBV DNA, CMV DNA and urinary BKV DNA were evaluated in healthy controls and in patients with a diagnosis of juvenile SLE (jSLE) and jSS., Results: A total of 70 jSLE patients, 14 jSS patients and 44 sex-matched healthy individuals were involved in the study. EBV VCA was positive in 84.2% of jSLE patients, 85.7% of jSS patients and 36.3% of healthy controls. EBV EA-D IgG positivity was significantly higher in jSLE patients compared to jSS patients and healthy controls (20% vs. 7.1% and 0%, p  = 0.005). EBV VCA positivity was associated with malar rash and immunological disorder, but there was no statistical significance in other antibody positivity in terms of clinical and haemogram findings and autoantibody positivity. CMV DNA positivity was present in only 2.8% of jSLE patients. None of the jSS patients or the healthy controls had CMV DNA positivity. EBV DNA and BKV DNA were also negative in all three groups., Conclusion: The results of our study assume a relationship between SLE and EBV, but we could not demonstrate an association between CMV and BKV. The negative DNA results in contrast to serological positivity can be interpreted as an altered and impaired immune system and increased viral susceptibility. These results suggest that EBV contributes to disease continuity, even if it does not directly cause development.

Objectives We aim to delineate clinical characteristics that place individuals with type 1 diabetes (T1DM) at risk of developing eating problems by using Turkish version of diabetes eating problem survey-revised (DEPS-R). Methods The patients aged 9-18 years with T1DM who came to the pediatric endocrine outpatient clinic for control between February and December 2019 completed Turkish version of DEPS-R. Clinical and laboratory findings were obtained from patient files. Cases with a questionnaire score ≥20 were considered to be at risk for eating disorders (ED). Parents were informed when the results of the screening were positive, and were offered to child psychiatrist. Results The median scores obtained with the Turkish version of DEPS-R for the total sample, for females and males were 15, 16, and 13 respectively. The score was significantly higher among females compared to males (p<0.001). DEPS-R score positive group had higher age (mean [SD]=14.6 [2.7], p=0.009), BMI (mean [SD]=21.4 [3.2], p<0.001), HbA1c % (mean [SD]=9.37[2.3], p<0.001) and year of diabetes duration (mean [SD]=5.5 [3.6], p<0.001) compared to the negative group. Conclusions Early recognition and adequate treatment of ED in T1DM is essential. DEPS-R is sensitive in identifying young people with ED.

Autoinflammatory diseases are characterized by recurrent fevers and clinical findings of impaired natural immunity and can involve various organ systems. The concept of autoinflammatory disease emerged after the definition of familial Mediterranean fever and tumor necrosis factor receptor-associated periodic syndrome. This new disease group was considered to differ from the standard concept of autoimmune diseases, which is relatively better known in terms of basic features, such as defects in innate immunity and the absence of antibodies. A better understanding has been achieved regarding the genetic and pathogenetic mechanisms of this relatively new disease group over the past 20 years since they were first diagnosed, which have led to some changes in the concept of autoinflammatory diseases. The recent definition classifies autoinflammatory disease to be a wide range of diseases with different clinical features, mainly accompanied by changes in innate immune and rarely in humoral immunity. The spectrum of autoinflammatory diseases is rapidly expanding owing to recent developments in molecular sciences and genetics. This review article discusses the clinical features, classification criteria, treatment options, and long-term prognosis of periodic fever, aphthous stomatitis, pharyngitis, adenitis syndrome, and other common autoinflammatory diseases in the light of current literature.

Objective: The aim of this study was to investigate the serum renin levels of patients with idiopathic sudden sensorineural hearing loss (ISSNHL)., Material and Methods: Twenty-four patients with ISSNHL and 24 asymptomatic healthy volunteers were included in the study. Subjects underwent pure-tone audiometry and serum renin levels were measured., Results: There were 14 women (mean age:42.35 ± 9.53) and 10 men (mean age:43.8 ± 6.87) in the patient group. There were 14 women (mean age:42.4 ± 4.7) and 10 men (mean age:41.4 ± 4.59) in the control group. ISSNHL was detected on the right side in 13 patients and on the left side in 11 patients. Serum renin levels of the patients and controls were 788.01 ± 327.8 and 282.37 ± 107.73 pg/mL, respectively. The serum renin levels were found to be significantly higher in the patient group compared to the control group ( P  ≤ .001). There was a statistically significant strong positive correlation between serum renin level and the severity of hearing loss ( r  = 0.77; P  = .001)., Conclusion: Serum renin levels of patients with ISSNHL were higher than controls. There was a statistically significant strong positive correlation between serum renin level and the severity of hearing loss.

We present a case with cardiac metastasis of the great saphenous vein leiomyosarcoma (LMS) that presented to the emergency department with dyspnea and palpitations 2 months ago. In this patient, hemodynamic instability was caused by an extensive right ventricular cavity and outflow tract invasion of the LMS. Treatment of the patient included incomplete mass resection, adjuvant chemotherapy, and permanent pacemaker implantation (due to postoperative complete atrio-ventricular block)., (© 2020 Wiley Periodicals LLC.)

Introduction: While a number of studies have found an association between stressful life events and adolescent suicidality, underlying mechanisms linking the two continue to be inadequately understood. Drawing upon the stress process, general strain, and support deterioration theories, this study examined the relationship between stressful life events and suicidality in U.S. adolescents, focusing on the mediating roles of depression, substance use, and perceived social support., Methods: The data came from the first two waves of the National Longitudinal Study of Adolescent to Adult Health (N = 12,801; M age = 15 at Wave I; 50.2% female). Mediation analyses were performed using the Karlson-Holm-Breen (KHB) method developed for nonlinear probability models., Results: Depression, substance use, and perceived social support accounted for a substantial part of the effect of stressful life events on suicidal ideation (57%) and attempts (43%). All mediating effects were statistically significant. Depression was a relatively stronger mediator for both suicidal outcomes. Significant relationships among stressful life events and suicidal outcomes persisted even after adjusting for the proposed mediators., Conclusion: Stressful life events increase suicidality in adolescents, partly by increasing psychological distress and eroding perceived social support. Findings underscore the necessity of continued emphasis on stress management and support programs in reducing suicidality among vulnerable adolescents exposed to these types of occurrences., Competing Interests: Declarations of competing interest None., (Copyright © 2020 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

As it is known, we are all in a pandemic situation due to a novel coronavirus, officially named “Severe Acute Respiratory Syndrome Coronavirus 2” and the disease caused by the virus named “Coronavirus disease-2019”. The virus seems to has propensity to infect older male individuals with underlying disease. The clinical features were on a large scale that varies from being an asymptomatic carrier to acute respiratory distress syndrome and multiorgan dysfunction. Fever, dry cough and fatigue are the most common symptoms. Not only, the disease seems to be rare and have a milder course in pediatric age but also respiratory failure, multiorgan dysfunction, and death are extremely rare. Although several comorbidities such as hypertension, diabetes and cardiovascular diseases are defined as a risk factor for developing the acute respiratory syndrome and need for intensive care; immune-compromised situations such as rheumatic disease which require immunosuppressive treatment strikingly are not found to be a risk factor for more severe disease course. However, there is a lack of data regarding the effects of “Coronavirus disease-2019” on pediatric patients with rheumatic diseases. Additionally, there are three controversial circumstances that patients with rheumatic diseases are believed to be more likely to have viral infections like “Severe Acute Respiratory Syndrome Coronavirus 2”, on the other hand, antirheumatic drugs may have a protective and therapeutic role in Coronavirus disease-2019 and children are more unlikely to have serious disease course. Therefore, we aimed to have a contributor role for explaining this conundrum and present a bird’s eye view regarding this equivocal issue in this review.

Objective: The prognostic nutritional index (PNI), based on serum albumin and lymphocyte concentration, is an inflammation-based nutritional score that has been shown to be a prognostic determinant in several populations. The aim of this study was to investigate the impact of PNI on mortality in patients with infective endocarditis (IE)., Methods: A total of 131 patients with IE were enrolled in this retrospective study. The patients were divided into 2 groups based on in-hospital mortality. The PNI value of the patients was evaluated, as well as baseline clinical and demographical variables., Results: Among the study group, 29 patients died in-hospital during the median follow-up of 37 days. The PNI was found to be lower in cases of mortality (35.90±6.96; 31.09±5.88; p=0.001). ROC curve analysis also demonstrated that the PNI had a good predictive value for in-hospital mortality with a cut-off value of 35.6 (Area under the curve: 0.691; 95% confidence interval [CI]: 0.589-0.794; p=0.002). In multivariate logistic regression analysis, advanced age (Odds ratio [OR]: 1.078; 95% CI: 1.017-1.143; p=0.012), PNI (OR: 0.911; 95% CI: 0.835-0.993; p=0.034), and leaflet perforation (OR: 5.557; 95% CI: 1.357-22.765; p=0.017) were found to be independent predictors of mortality. Kaplan-Meier survival analysis revealed that long-term survival was found to be significantly decreased in patients with a lower PNI (Log rank: p=0.008)., Conclusion: The PNI result was associated with an increased in-hospital mortality rate in patients with IE. The PNI value, advanced age, and cardiac valve perforation as a complication of IE were found to be independent predictors of mortality.

Introduction  Despite much advancement in medicine, endocrine and metabolic diseases remain an important cause of morbidity and even mortality in children. Objective  The present study was planned to investigate the evaluation of hearing that also includes high frequencies, and the presence and degree of vertigo and tinnitus symptoms in pediatric patients diagnosed with endocrine diseases such as type 1 diabetes mellitus (DM), growth hormone deficiency (GHD), obesity, idiopathic short stature, and precocious puberty Methods  The present study included a patient group of 207 children patients diagnosed with endocrine disease (95 males, 112 females; mean age 9.71 years old [range 6-16 years old]) and a control group including 55 healthy children who do not have any kind of chronic disease (26 males, 29 females; mean age 9.33 years old [range 6-16 years old]). The subjects underwent a hearing test with frequencies between 250 and 20,000 Hz. The vestibular and tinnitus symptoms were evaluated with the Pediatric Vestibular Symptom Questionnaire. Results  Out of 207 patients in the patient group, 5 (2.4%) had hearing loss in pure tones, 10 (4.8%) had it in high frequencies, 40 (19.3%) had tinnitus symptoms, and 18 (8.7%) had vertigo symptoms. A total of 4 out of 207 patients in the study group (1.9%), 2 out of 59 with type 1 DM patients (3.4%), 1 out of 46 with GHD (2.2%), and 1 out of 43 obesity patients (2.3%) had hearing loss, vertigo, and tinnitus symptoms. Conclusions  Our results suggest that some childhood endocrine diseases can cause some changes in the inner ear, although the exact cause is unknown. Perhaps, a detailed hearing and balance examination should be a routine in a child diagnosed with an endocrine disease. We think it is necessary to work on more comprehensive patient groups and tests in the future., Competing Interests: Conflicts of Interests The authors have no conflicts of interests to declare.

This paper presents a soft passive gripper consisting of six fluidic soft bending actuators arranged in a star-shaped manner. The actuators are oriented such that, upon pressurization, they bend against gravity. Gripping is realized by a commercial tape with mushroom-shaped adhesive structures that is glued to the bottom patches of the gripper. In this way, the object is released by peeling away the actuators from the object's surface. In contrast to active grippers, which require continuous pressurization during gripping and holding, the presented passive gripper only requires energy for the release process. However, due to its working principle, the gripper is restricted to only flat objects or objects with at least one flat surface.

Herein, we report the synthesis and cytotoxic effects of novel chlorinated plastoquinone analogs (ABQ1-17) against different leukemic cells. Compounds ABQ3, ABQ11, and ABQ12 demonstrated a pronounced antiproliferative effect against chronic myelogenous leukemia (CML) K562 cell line with IC 50 values of 0.82 ± 0.07, 0.28 ± 0.03, and 0.98 ± 0.22 μM, respectively. Among them, ABQ11 showed approximately three times higher selectivity than imatinib on CML. ABQ11-treated CML cells induced significant apoptosis at low concentration. Inhibitory effect of ABQ11 against eight different tyrosine kinases, including ABL1, was investigated. ABQ11 inhibited ABL1 with IC 50 value of 13.12 ± 1.71 μM, indicating that the moderate inhibition of ABL1 kinase is just an in-part mechanism of its outstanding cellular activity. Molecular docking of ABQ11 into ABL1 kinase ATP-binding pocket revealed the formation of some key interactions. Furthermore, DNA cleavage assay showed that ABQ11 strongly disintegrated DNA at 1 μM concentration in the presence of iron (II) complex system, assuming that the major mechanism for the anticancer effects of ABQ11 is DNA cleavage. In silico ADMET prediction revealed that ABQ11 is a drug-like small molecule with a favorable safety profile. Taken together, ABQ11 is a potential antiproliferative hit compound that exhibits unique cytotoxic activity distinct from imatinib., (© 2019 John Wiley & Sons A/S.)

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS ( n  = 40) and CMPL ( n  = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study.Median follow-up time was 25 (6-30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively ( p  = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group ( p  = .011 and p  < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia.Impact statement What is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction. What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar. What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.

Behçet's Disease was first described by a Turkish dermatologist, Hulusi Behçet, in 1937 as a triple symptom complex; aphthous stomatitis, genital ulcers, and uveitis. Today, in light of current trials and experiments, we know that the disease may have a wider involvement with a multisystemic recurrent course, causing significant morbidity and mortality. However, there are still unanswered questions, particularly about Pediatric Behçet's Disease. Although several immunological and genetic associations have been demonstrated, the real etiologic mechanism of the disease is unclear. The diagnosis is difficult due to its rarity in childhood, the lack of validation of the diagnostic criteria obtained from adult studies, and the inadequacy of large case-controlled studies. Also, the management is challenging and controversial due to the various geographic distribution of clinical spectrum. New therapeutic options under development in light of pathogenetic hypothesis seem to be promising.

Objectives: This study aims to evaluate traditional open surgery results of osteoid osteomas (OOs) in atypical localizations and explore whether open surgery can be a safe alternative in localizations where radiofrequency ablation (RFA) may not be suitable., Patients and Methods: A total of 26 patients (20 males, 6 females; mean age 23.3±14.2 years; range, 4 to 65 years) having OO in atypical localizations between January 2008 and January 2017 were retrospectively evaluated. All patients underwent traditional open surgery under anesthesia. All patients were followed-up, and their clinical success and complications were evaluated. The pain intensity was assessed using the visual analog scale (VAS)., Results: The postoperative first year VAS score was 0.2±0.5 (range, 0-2) (p<0.005). None of the patients showed any complications. No recurrences were reported at the end of the first year. All patients were relieved from pain due to OO in atypical localizations., Conclusion: Although RFA has been accepted as the preferred treatment for OO, traditional open surgery may still be used for OO in atypical localizations yielding perfect clinical results with fewer complications. It is a safe alternative for localizations such as carpal bones, distal ulna, hand and foot where RFA complications can be seen more frequently. In these localizations, traditional open surgery can be recommended as the first treatment choice.

The periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is an auto-inflammatory condition characterized by recurrent episodes of fever accompanied by aphthosis, cervical adenitis, and pharyngitis. Diagnosis of PFAPA could be challenging due to clinic overlap with familial Mediterranean fever (FMF). An international consensus has been established recently, to define a new set of classification criteria for PFAPA syndrome. We aimed to evaluate the performance of recently proposed PFAPA criteria, to assess their utility in FMF regions. Patients diagnosed with PFAPA syndrome, FMF, and juvenile idiopathic arthritis (JIA) were included. Two investigators blindly evaluated all of patients for the newly proposed PFAPA criteria. A total of 542 patients (322 with PFAPA syndrome, 118 FMF and 102 JIA) were evaluated. Mean age of patients was 6.6 ± 2.81, 12.75 ± 3.9, and 12.42 ± 4.8 years for PFAPA, FMF, and JIA, respectively. We found quite high sensitivity (89.7%) but insufficient specificity of newly proposed PFAPA criteria (69.5%). When applied to control patients separately, specificity was found to be 61% and 79.4% for FMF and JIA patients, respectively. Positive predictive value was 81%, while negative predictive value was 82%. Recently proposed PFAPA criteria have satisfactory sensitivity, but its specificity is still under expectation. There is a need for a distinctive criterion between PFAPA syndrome and FMF, in FMF endemic regions, e.g., cryptic tonsillitis rapidly responsive to single dose of glucocorticoids. Further studies with higher patients' number in different regions are needed.

This study aims to identify the relationship between religious orientation and death anxiety in elderly individuals aged 65 and over. This study is cross sectional in nature. It was conducted with the participation of 250 individuals aged 65 and over who were registered in Family Health Centers in the city center located in the eastern part of Turkey between February and June, 2018. The participants' Religious Orientation Scale mean score was found to be 53.03 ± 9.91, and Religious Orientation Scale mean score was found to be significantly higher in married people, in graduates of high school, in those who had social security, and in those who lived with their spouse (p < 0.01). Death Anxiety Scale mean score was found to be 7.73 ± 2.28, and Death Anxiety Scale mean score was significantly higher in those who lived with their children (p < 0.05). No statistically significant relationship was found between Death Anxiety and Religious Orientation. Elderly individuals were found to have high religious orientation and death anxiety. It is recommended that the factors that increase death anxiety should be identified, interventions should be provided to decrease these factors, and elderly people should be provided with social services for their religious needs.

Objective: The aim of this study is to conduct a case management model on a group of individuals with severe mental illness (SMI) and to evaluate the outcomes during a 24-month follow up., Method: A total of 34 patients diagnosed with schizophrenia or schizoaffective disorder with at least one exacerbation over the last year, poor treatment compliance, who were unemployed and unable to live independently and who gave consent to participate were included to the study. Case management was conducted by a medical professional in the house, schizophrenia association, hospital, and workplace of the patients by interviewing the patients, family members, and the employers of the patients, at intervals arranged according to the need of each patient. Patients were assessed at baseline stage, the sixth, 12th and the 24th month regarding functionality, clinical condition, treatment compliance and family burden., Results: The study was completed in 24 months with 30 patients with a mean age was 36, mean education level of 11 years, and a mean illness duration of 13 years. The majority consisted of unmarried males living with their parents. During the follow up, every patient participated in the recommended rehabilitation programs with, improvement in treatment adherence and functionality. A significant decrement was detected in the number of hospitalizations when compared to the history before the start of the study. Family burden decreased. Ten patients got employed and 3 patients left work., Conclusion: It can be concluded that case management hypothesized to be beneficial for people with SMI with positive outcomes on clinical recovery, improved social and vocational functionality and reduced incidences of hospital stay should be included as a routine psychosocial rehabilitation service.

Two series of amino-1,4-benzoquinones (AQ1-18) based on the structural analogs of plastoquinones were synthesized and the structure-activity relationship against chronic myelogenous leukemia activity was examined. All of the synthesized compounds were tested for their cytotoxic effects on different leukemic cell lines. Of interest, AQ15 exhibited a better selectivity than the reference drug imatinib on cancer cells. Owing to this, AQ15 was selected for a further apoptosis/necrosis evaluation where AQ15-treated K562 cells demonstrated similar apoptotic effects like imatinib-treated cells at their IC 50 values. The inhibitory effects of AQ15 and the other three compounds with various activities against eight tyrosine kinases, including ABL1, were investigated. AQ15 showed weak activity against ABL1, and a correlation was observed between the anti-K562 and anti-ABL1 activities. The binding mode of AQ15 into the ATP binding pocket of ABL1 kinase was predicted in silico, showing the formation of some key interactions. In addition, AQ15 was shown to suppress the downstream signaling of BCR-ABL in K562 cells. Finally, AQ15 obviously cleaved DNA in the presence of an iron(II) complex system, indicating that this can be the major mechanism of its antiproliferative action, whereas the mild inhibition of ABL kinase is just in-part mechanism of its overall outstanding cellular activity., (© 2019 Deutsche Pharmazeutische Gesellschaft.)

A series of aminobenzoquinones, denoted as PQ analogs (PQ1-13), were synthesized by employing a green methodology approach using water as solvent developed by Tandon et al. Subsequently, in vitro antimicrobial potential of all PQ analogs was evaluated in a panel of seven bacterial strains (three gram positive and four gram negative bacteria) and three fungi. The antifungal profile of all PQ analogs indicated that four analogs (while PQ2, PQ9, and PQ10 were effective against Candida tropicalis, PQ11 is effective against Candida albicans) have potent antifungal activity. The results revealed that PQ9 showed similar antibacterial activity against Staphylococcus epidermidis compared clinically prevalent antibacterial drugs cefuroxime. PQ11 exhibited the highest antibacterial activity against S. epidermidis, which was about fourfold better than that of cefuroxime. Owing to their outstanding activities, PQ9 and PQ11 were chosen for a further investigation for biofilm and cytotoxicity evaluation. Based on the tests performed, there was a significant positive correlation between inhibition of the biofilm attachment and time. In addition, PQ9 and PQ11 showed cytotoxic effects at high concentrations on Balb/3T3, HaCaT, HUVEC, and NRK-52E cells (>24 and >18 μg/mL, respectively). Thus, two analogs (PQ9 and PQ11) were identified as the hits with the strong antibacterial efficiency against the S. epidermidis with low MIC values., (© 2019 Wiley Periodicals, Inc.)

Objective: Symptomatic remission have substantial effects in long-term schizophrenia outcome, but exact determinants of the employment. In this study, the relationship between employment and symptomatic remission in chronic schizophrenia patients and other factors related to employment were investigated., Methods: 100 patients interviewed were evaluated by the Positive and Negative Syndrome Scale (PANSS), Functional Recovery Scale in Schizophrenia (FROGS), Global Assessment of Functioning (GAF), Quality of Life Scale (QoL) and Subjective Recovery Assessment Scale (SubRAS). Sociodemographic variables, clinical features, antipsychotic dose and past working history obtained from patient interviews were investigated., Results: The patients of 40% who participate in the study were symptomatic remission, but only 53.5% of these patients weren't employed. Young age, especially, -regardless of the onset of illness- working a job in the past, low and moderate use CPED (equivalent doses according to chlorpromazine), shorter disease duration, symptomatic remission was found to be closely related to employment. While QoL, FROGS, GAF, and SubRAS total scores of employment group were higher than the unemployment group, PANSS total scores in the unemployment group were higher than that of the employment group. There was a high correlation between the scales and employment status., Conclusion: Employment status was closely related with the remission status. This study supports that symptomatic remission alone is not decisive for employment. It was found that younger age, past working history (before or after the disease), low and intermediate CPED antipsychotic use and shorter duration of disease were closely related to employment with symptomatic remission.

In this paper, based on Plastoquinone (PQ) analogs possessing substituted aniline containing alkoxy group(s), new 2,3-dimethyl-5-amino-1,4-benzoquinones (PQ1-15) were designed and synthesized in either two steps or one-pot reaction. Specifically, the substituted amino moiety containing mono or poly alkoxy group(s) with various positions and groups were mainly explored to understand the structure-activity relationships for the cytotoxic activity against three human cancer cell lines (K562, Jurkat, and MT-2) and human peripheral blood mononuclear cells (PBMC). PQ2 was found to be most effective anticancer compound on K562 and Jurkat cell lines with IC 50 values of 6.40 ± 1.73 μM and 7.72 ± 1.49 μM, respectively. Interestingly, the compound was non-cytotoxic to normal PBMC and also MT-2 cancer cells. PQ2 which showed significant selectivity in MTT assay was chosen for apoptotic/necrotic evaluation and results exhibited that it induced apoptosis in K562 cell line after 6 h of treatment. PQ2 showed anti-Abelson kinase 1 (Abl1) activity with different inhibitory profile than Imatinib in the panel of eight kinases. The binding mode of PQ2 into Abl ATP binding pocket was predicted in silico showing the formation of some key interactions. In addition, PQ2 induced Bcr-Abl1 mediated ERK pathway in human chronic myelogenous leukemia (CML) cells. Furthermore, DNA-cleaving capability of PQ2 was clearly enhanced by iron (II) complex system. Afterward, a further in silico ADMET prediction revealed that PQ2 possesses desirable drug-like properties and favorable safety profile. These results indicated that PQ2 has multiple mechanism of action and two of them are anti-Bcr-Abl1 and DNA-cleaving activity. This study suggests that Plastoquinone analogs could be potential candidates for multi-target anticancer therapy., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background/aims: Gastroenteropancreatic neuroendocrine tumors are rarely seen and have heterogeneous clinical outcomes. Mostly half of the patients had metastatic disease at presentation. Palliative resection of primary site in metastatic disease is still controversial. The aim of this study was to find out the influence of resection of primary tumor site on progression-free survival and overall survival in metastatic non-functioning gastroenteropancreatic neuroendocrine tumors. The secondary end point is to determine the prognostic factors influencing the survivals., Materials and Methods: This study was conducted at a single medical oncology center, Antalya Education and Research Hospital. Patients who had non-functioning metastatic gastroenteropancreatic neuroendocrine tumors with primary site resected or unresected were compared retrospectively. Resection of metastases was excluded., Results: Fifty-three patients were included in the study and 29 patients had primary tumor resection. The primary site resected group had favorable outcomes with the overall survival (median unreached) compared to the median overall survival of 30 months in the unresected group (p=0.001). Median progression-free survival was also better in the primary site resected group than the unresected group (60 months vs. 14 months, respectively) (p=0.013). In multivariate analysis, unresected primary site and high-grade tumors were found to be independent prognostic factors on low survivals (Hazard ratio (HR): 4.6; 95% CI: 1.21-17.47 and HR: 10.1; 95% CI: 1.15-88.84, respectively). Age (p=0.131), gender (p=0.051), chromogranin A level (p=0.104), Ki-67 index (p=0.550), tumor size (p=0.623), and primary tumor area (p=0.154) did not influence the overall survival., Conclusion: Gastroenteropancreatic neuroendocrine tumors with primary site resected had improved survivals when compared to the unresected group.

We report the synthesis and applications of a novel N-doped graphene quantum dots (GQDs) using hydrothermal reaction between citric acid and p-aminophenol. The synthesized N-doped GQDs have been characterized physico-chemically and evaluated its antioxidant, antimicrobial, DNA binding and cleavage activities. siRNA loading studies were performed and their effects on cells were evaluated. Obtained results indicate that monodisperse solution of N-doped GQDs has been obtained with particles size ca. ∼10.9 ± 1.3 nm. UV-Vis spectroscopy studies of the interactions between the N-doped GQDs and calf thymus DNA (CT-DNA) showed that the compound interact with CT-DNA via both intercalative and electrostatic binding. The DNA cleavage study showed that the N-doped GQDs cleaved DNA without any external agents. The antioxidant activity of N-doped GQDS was very active when compared to BHT. As the concentration of the compound increased, the antioxidant activity also increased. Cell viability assay demonstrated that the Ndoped GQDs showed cell viability (70%) when the concentration reached 200 μg/mL for A549 and also MDA-MB-231, 150 μg/mL for NIH-3T3 cell lines at 24 h incubation. N-doped GQDs were coated with Eudragit RS 100 and EphA2-siRNA was loaded. As a result of the studies on these formulations, it was concluded that there may be significant effects on A549 cells. The microscopy results revealed that N-doped GQDs was quickly internalized into the cell. Our novel N-doped-GQDs with siRNA are candidate for in situ tumor suppression via DNA and mRNA breakage., Competing Interests: The author reports no conflict of interest.

The present study was conducted to investigate the antioxidant, histomorphometric, histochemical, immunohistochemical, biochemical, and cytological effects of coenzyme Q10 (CoQ10) against bisphenol-A (BPA)-induced testicular toxicity in rats. A total of 40 adult male Wistar rats were divided into five equal groups. The control group remained untreated. The vehicle control group was administered corn oil (2 ml/kg/day), the BPA group was given BPA (100 mg/kg/day), the CoQ10 group was supplemented with CoQ10 (10 mg/kg/day), and the rats in the CoQ10-BPA group received CoQ10 (10 mg/kg/day) followed by BPA (100 mg/kg/day) 1 h later. The treatments were administered by oral gavage for 14 days. Results showed that the seminiferous tubule diameters (STDs) and seminiferous epithelium heights (SEHs) at stages VII-VIII and XII-XIV, number of undifferentiated embryonic cell transcription factor-1 (UTF-1) positive cells per tubule, UTF-1 positive tubules (%), plasma glutathione (GSH), and serum superoxide dismutase activities, testicular GSH activity and sperm viability (%) decreased whereas the number of terminal dUTP nick end labeling (TUNEL) positive cells per tubule, TUNEL positive tubules (%), testicular and serum malondialdehyde (MDA) levels, and the rate of mid-piece sperm abnormality increased in the BPA administered group. However, while the STDs at stages VII-VIII and XII-XIV, SEHs at stages VII-VIII, plasma GSH, and serum SOD activities increased, serum MDA level decreased in the CoQ10-BPA group. In conclusion, these results suggest a protective effect of CoQ10 against BPA-induced testicular toxicity in rats.

Objective: To determine the demographic and biochemical features of childhood and juvenile thyrotoxicosis and treatment outcome., Methods: We reviewed the records of children from 22 centers in Turkey who were diagnosed with thyrotoxicosis between 2007 to 2017., Results: A total of 503 children had been diagnosed with thyrotoxicosis at the centers during the study period. Of these, 375 (74.6%) had been diagnosed with Graves’ disease (GD), 75 (14.9%) with hashitoxicosis and 53 (10.5%) with other less common causes of thyrotoxicosis. The most common presenting features in children with GD or hashitoxicosis were tachycardia and/or palpitations, weight loss and excessive sweating. The cumulative remission rate was 17.6% in 370 patients with GD who had received anti-thyroid drugs (ATDs) for initial treatment. The median (range) treatment period was 22.8 (0.3-127) months. No variables predictive of achieving remission were identified. Twenty-seven received second-line treatment because of poor disease control and/or adverse events associated with ATDs. Total thyroidectomy was performed in 17 patients with no recurrence of thyrotoxicosis and all became hypothyroid. Ten patients received radioiodine and six became hypothyroid, one remained hyperthyroid and restarted ATDs and one patient achieved remission. Two patients were lost to follow up., Conclusion: This study has demonstrated that using ATDs is the generally accepted first-line approach and there seems to be low remission rate with ATDs in pediatric GD patients in Turkey.

Objective: Histopathological changes in the kidney in type 1 diabetes mellitus (T1DM) begin before detection of microalbuminuria. Therefore, there is interest in finding a better biomarker for the early detection of diabetic kidney injury. The aim of this present study was to determine whether urinary indicators of fibrosis are detectable early in the development of T1DM in children and if they may predict progressive renal injury., Methods: Urinary matrix metalloproteinase 2 and 9 (MMP2 and MMP9), tissue inhibitor of metalloproteinase 1 and 2 (TIMP1 and TIMP2) and transforming growth factor-β1 (TGF-β1) were assessed in 33 patients with T1DM with normal renal functions and in 24 healthy controls. Microalbuminuria was not present in the patient group with the exception of three patients. The results were adjusted to urine creatinine (Cr) and the differences between patients and controls were evaluated. These measurements were repeated after one year and the results were compared with the first year results., Results: Urine MMP2/Cr, MMP9/Cr, TIMP1/Cr, TIMP2/Cr, TGF-β1/Cr were not different between the patient and control groups (p>0.05). There were also no significant differences between the first and second year results for these biomarkers (p>0.05). None of these parameters were correlated with hemoglobin A1c, body mass index and duration of T1DM. Interestingly, all parameters were negatively correlated to age of onset of T1DM (p<0.05)., Conclusion: Our findings suggest that urinary biomarkers of fibrosis do not show an increase in diabetic children without microalbuminuria. The results also indicate that the risk of early fibrosis may increase as age of onset of T1DM decreases.

Objective: Increased risk of unfavorable cardiovascular risk factors has been recognised in ageing patients with haemophilia (PwH), but needs further studies in younger patients. The purpose of this study was to assess obesity, hypertension (HT), metabolic variables, insulin resistance and metabolic syndrome in young PwH., Methods: Forty-eight haemophilia A and B patients and 35 age and sex matched healthy controls were included in the study. Anthropometric measurements, blood pressure (BP), fasting glucose and insulin levels, serum lipids and diet were evaluated. The metabolic syndrome was defined according to the criteria of the International Diabetes Federation for pediatric and adult age groups., Results: The mean age of PwH was 21±9 years (range, 6-40 years). Of those ≥18 years, 46% were were obese/overweight while there were no obese/overweight cases in the <18 year-old patients. Obesity was more prevalent in PwH with arthropathy (p=0.017). Seven percent of the PwH between 10 and 18 years-old and 25% of those ≥18 years had metabolic syndrome. There was no difference in metabolic syndrome frequency between PwH and controls >10 years-old (19.5% vs 10% respectively, p=0.34). Fifty percent of the PwH ≥18 years-old had elevated BP or HT. Fasting blood glucose levels of PwH were significantly higher compared to controls (p=0.02)., Conclusion: Our study showed that obesity, HT and metabolic syndrome are frequent problems, especially in PwH with arthropathy. Early prevention and management of overweight, obesity and their sequelae must be addressed in clinical practice in order to maximize the overall health of the haemophilia population.

Objective: We aimed to report the characteristics at admission, diagnosis, treatment, and follow-up of cases of pediatric hyperprolactinemia in a large multicenter study., Methods: We reviewed the records of 233 hyperprolactinemic patients, under 18 years of age, who were followed by different centers. The patients were divided as having microadenomas, macroadenomas, drug-induced hyperprolactinemia and idiopathic hyperprolactinemia. Complaints of the patients, their mode of treatment (medication and/or surgery) and outcomes were evaluated in detail., Results: The mean age of the patients with hyperprolactinemia was 14.5 years, and 88.4% were females. In terms of etiology, microadenomas were observed in 32.6%, macroadenomas in 27%, idiopathic hyperprolactinemia in 22.7% and drug-induced hyperprolactinemia in 6.4%. Other causes of hyperprolactinemia were defined in 11.3%. Common complaints in females (n=206) were sorted into menstrual irregularities, headaches, galactorrhea, primary or secondary amenorrhea and weight gain, whereas headache, gynecomastia, short stature and blurred vision were common in males (n=27). Median prolactin levels were 93.15 ng/mL, 241.8 ng/mL, 74.5 ng/mL, 93.2 ng/mL, and 69 ng/mL for microadenomas, macroadenomas, idiopathic hyperprolactinemia, drug-induced hyperprolactinemia, and other causes of hyperprolactinemia, respectively. Of 172 patients with hyperprolactinemia, 77.3% were treated with cabergoline and 13.4% with bromocriptine. 20.1% of the patients with pituitary adenomas underwent pituitary surgery., Conclusion: We present the largest cohort of children and adolescents with hyperprolactinemia in the literature to date. Hyperprolactinemia is more common in females and cabergoline is highly effective and practical to use in adolescents, due to its biweekly dosing. Indications for surgery in pediatric cases need to be revised.

Although clozapine is more effective than other antipsychotics in the treatment of schizophrenia, the rate of its discontinuation is also high. The aim of this retrospective chart-review study was to investigate the causes of clozapine discontinuation in patients with treatment-resistant schizophrenia. This study included a total of 396 patients with schizophrenia, 240 still on clozapine therapy and 156 who discontinued clozapine, and compared their clinical characteristics. Those who discontinued clozapine had a longer history of illness and more hospitalizations before clozapine and tended to be older. Inadequate response was more common among clozapine discontinuers compared to continuers. The most common reason for discontinuation was the side-effects associated with clozapine (49%). Discontinuation from patient decision or by the psychiatrist due to noncompliance was the second (29.7%) and discontinuation due to lack of efficacy was the third most frequent reason (21.3%). The patients who discontinued clozapine because of cardiac side effects were younger, had shorter duration of clozapine use, and had lower maximum clozapine dose compared to the other discontinuers. Our findings point out the importance of enhancing psychiatrists' ability to handle manageable side effects to minimize discontinuations and maximize the benefits of clozapine in patients with treatment-resistant schizophrenia., (Copyright © 2019 Elsevier B.V. All rights reserved.)