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Objective: The purpose of this study was to examine the effects of apocynin (APC), an inhibitor of NADPH oxidase (NOX), on high-fat diet (HF)-induced testis cytotoxicity. Methods: Wistar albino rats were divided into three groups as control, HF and HF+APC groups. Rats in HF and HF+APC groups were fed using HF for 16 weeks and in the last four weeks of this period vehicle solution or APC (25 mg/kg) was administered orally five days a week, respectively. Control group was fed with standart lab chow for 16 weeks. Cholesterol, triglyceride, high-density lipoproteins, leptin, estrogen, testosterone, LH and FSH were estimated in blood serum. Sperm parameters were analysed from the epididymis. Testicular malondialdehyde, 8‐hydroxy‐2‐deoxyguanosine, glutathione, superoxide dismutase and myeloperoxidase levels were estimated biochemically. Testicular morphology, proliferative, apoptotic and NOX2-positive cells were analysed histologically. HF-induced obesity caused significant alterations in serum lipid and hormone profiles. Testicular malondialdehyde, 8‐hydroxy‐2‐deoxyguanosine, and myeloperoxidase levels increased, glutathione and superoxide dismutase levels decreased in this group. Moreover, altered sperm parameters, increased degenerated seminiferous tubules, apoptotic and NOX2- positive cells and decreased proliferative cells were observed in the HF group. All these biochemical and histological alterations improved in the HF+APC group. Conclusion: HF-induced obesity causes altreations in lipid values, sperm parameters and testicular morphology by increasing oxidative stress through NOX2 activity. Apocynin might prevent testis damage via regulating oxidant/antioxidant balance.

While pregnancy among end-stage kidney disease patients is rare, the number of females becoming pregnant has been increasing worldwide during the last decade. The frequency of conception in this patient group has been reported to be between 0.3% and 7% per year. The aim of this review is to summarize the latest guidelines and practice points for ensuring the best outcome for both the fetus and the mother.

SUMMARY OBJECTIVE: This study aimed to investigate female sexual function in patients with type 1 diabetes by comparing female sexual function index scores between women with and without type 1 diabetes. METHODS: A total of 62 women with type 1 diabetes and 69 age-matched women without diabetes but with similar backgrounds were enrolled in the patient and control groups, respectively. All participants were sexually active and had no systemic diseases other than diabetes in the patient group. RESULTS: The frequency of female sexual dysfunction was significantly higher, and the mean female sexual function index score was significantly lower in women with diabetes compared to the control group (p=0.01). There was a significant relationship between sexual dysfunction and duration of diabetes, glycosylated hemoglobin test, and body mass index (p

Introduction: Circumcision is one of the oldest and most frequently performed surgeries worldwide. The age of circumcision varies according to the country and region. We aimed to analyze the age of circumcision in our hospital. Methods: We evaluated the children who underwent circumcision at Istanbul Sultanbeyli State Hospital between February 2012 and February 2022. The following parameters were analyzed: age at operation, surgery date, and surgeon provider type. Children’s age at operation were categorized as follows: neonatal period (

Objective: The value of head-up tilt test (HUTT) for differential diagnosis of epilepsy and the autonomic nervous system functions in epileptic children using heart rate variability (HRV) are studied. Patients and Methods: The study group consisted of 16 children with idiopatic/criptogenic epilepsy and 12 controls. Heart rate, PR interval, corrected QT (QTc) interval, QT and QTc dispersion were calculated using 12-lead electrocardiogram (ECG), HRV analysis was performed using the Holter recordings obtained both during HUTT and throughout the day. Time domain parameters, standard deviation of all RR intervals (SDNN), the standard deviation of mean NN intervals in five-minutes recording (SDANN), mean standard deviation of NN intervals in five-minutes recordings (SDNNi), root mean square of successive differences (RMSSD), count divided by the total number of all NN intervals (pNN50) and frequency domain parameters low frequency (LF), high frequency (HF), lowfrequency/ high-frequency ratio (LF/HF) were calculated in both and compared between the two groups. Results: Head-up tilt test was positive in 4 epileptic children (25%), none of controls were positive. The heart rate of the patients were higher than the controls (p=0.015). LF/HF ratio in 24-hour Holter recordings, were significantly lower (1.13±0.6, 1.83±0.7 respectively, p=0.002); the SDANN during HUTT (28.7±20.2, 18.2 ± 19.9 respectively, p=0.024) were significantly higher in the patients than the controls. Conclusion: Head-up tilt test positivity is frequent in epileptic children, and cannot be used in differential diagnosis. HRV calculated both from 24 hour Holter recordings and Holter recordings under orthostatic stress were impaired in favour of parasympathetic system in epileptic children.

Objective: The objective of this study was to determine the prevalence of insufficient physical activity (IPA) and neighborhood characteristics associated with it, among school children. The impact of sociodemographic characteristics and ownership of electronic devices on physical activity (PA) were also evaluated. Materials and Methods: This was a cross-sectional study carried out among 5-7th grade students attending schools and their parents. IPA was defined as having moderate-vigorous activity for 0.05). Conclusion: The prevalence of IPA is alarmingly high among school children. The impact of neighborhood characteristics on PA might be obscured since both variables were measured subjectively. Devices related information/communication technologies increase IPA; we need to find novel ways to use these devices for PA promotion. There is also a need to increase structured PA opportunities.

Objective: We aimed to find the parameters that can change during herpes zoster infection and observe the relationship of these parameters throughout the disease. Material and Methods: We compared 40 herpes zoster patients and 2 separate control groups, who were healthy and had comorbidities similar in age and gender. Patient files were retrospectively analyzed, and laboratory parameters were compared between groups. The laboratory values of the patient group with herpes zoster were evaluated among themselves according to the duration of the symptoms. Results: Fasting glucose, creatinine, aspartate aminotransferase values, the percentage and the absolute number of monocytes, red blood cell distribution width-coefficient of variation, and C-reactive protein levels of the patients with herpes zoster were significantly higher, and the absolute number of lymphocytes, mean corpuscular volume and platelet distribution width levels were lower than the control groups. The percentage of monocytes in the first 5 days was significantly higher than in the following days, and hematocrit values were lower in the last days. Conclusion: Examining routine laboratory values during diseases may help diagnose the disease, especially in patients with faint clinical signs and zoster sine zoster. In addition, it may be useful to question patients with herpes zoster for renal dysfunction, rheumatological diseases, and malignancy., Amaç: Herpes zoster enfeksiyonu sırasında değişebilen parametreleri bulmayı ve bu parametrelerin hastalık süresi ile ilişkisini gözlemlemeyi amaçladık. Gereç ve Yöntemler: Herpes zosterli 40 hasta ile yaş ve cinsiyetleri benzer sağlıklı ve ek hastalıkları olan 2 ayrı kontrol grubu karşılaştırıldı. Hasta dosyaları geriye dönük olarak incelendi ve gruplar arasında laboratuvar parametreleri değerlendirildi. Herpes zosterli hasta grubunun laboratuvar değerleri, semptomların süresine göre kendi aralarında değerlendirildi. Bulgular: Herpes zosterli hastaların açlık glukozu, kreatinin, aspartat aminotransferaz değerleri, monosit mutlak sayısı ve yüzdesi, kırmızı kan hücresi dağılım genişliği-varyasyon katsayısı ve C-reaktif protein düzeyleri kontrol gruplarına göre anlamlı olarak yüksek; lenfosit mutlak sayısı, ortalama korpüsküler hacim ve trombosit dağılım genişliği düzeyleri ise daha düşüktü. İlk 5 gündeki monosit yüzdesi sonraki günlere göre anlamlı derecede yüksekti. Sonuç: Hastalıklar sırasında rutin laboratuvar değerlerinin incelenmesi, özellikle silik klinik bulguları olan ve zoster sine zoster olan hastalarda hastalığın teşhisine yardımcı olabilir. Ayrıca herpes zosterli hastaların böbrek fonksiyon bozukluğu, romatolojik hastalıklar ve malignite açısından sorgulanması faydalı olabilir.

© 2022 Elsevier B.V.Objective: Objective methods to monitor the sleep of preterm infants at the neonatal intensive care unit (NICU) are required to prevent potentially adverse neurodevelopmental outcomes. This study aimed to determine the concordance of actigraphy and amplitude-integrated electroencephalogram (aEEG) against gold standard direct observation (DO) in assessing sleep/wake states of typically developing preterm infants. Methods: This prospective observational study was conducted in a single center level III NICU. Sleep variables were measured using Philips Respironics Mini-Mitter® Actiwatch-2 for 24 h and compared with 8-h matched data of aEEG and DO. Sensitivity-specificity analysis, Cohen's kappa, prevalence-adjusted and bias-adjusted kappa (PABAK), and Bland Altman plots were generated. Results: Seventeen preterm infants were recruited. A total of 11252 epochs were studied. Sensitivity (86.4%), agreement rate (67.9%), and predictive value for wake (47.9%) for the actigraphy were highest at the automatic activity threshold whereas specificity (54.5%) and predictive value for sleep (75.5%) were highest at low threshold. The sensitivity of aEEG was 79.3% and the specificity was 54.3%. At all thresholds, the agreement was largely equivalent with low kappas (0.14–0.17) and PABAK coefficients (0.22–0.35) for actigraphy and DO. Moderate agreement was observed between aEEG and DO according to the PABAK coefficient (0.44). Mean differences in sleep parameters were not different between DO and aEEG as well as DO/aEEG and actigraphy at medium threshold (p > 0.05). Conclusions: Actigraphy at medium threshold can be used in depicting sleep in typically developing preterm infants at NICU. aEEG may be an alternative adjunctive method to actigraphy for the evaluation of sleep/wake states in the NICU setting. Clinical trial registration number: NCT04145362

Objective: The aim of this study was to evaluate the ameliorative effects of swimming training on renal and bladder damage caused by a highfat diet (HFD) using morphological and biochemical measurements. Methods: Sprague Dawley rats were fed either standard chow (CONT, 6% fat) or HFD (45% fat) for 18 weeks, these rats were divided into two subgroups at the last 6 weeks of the experiment. The exercise groups (CONT+EXC, HFD+EXC) were trained daily swimming sessions (1 h per day for 5 days/week) during the last 6 weeks. Kidney and bladder samples were prepared for light and electron microscopic examination at the end of experiment. Malondialdehyde, glutathione, interleukin-6, and tumor necrosis factor-α were measured by biochemically. Results: Regular morphology of the renal cortex and bladder mucosa was observed in the CONT and CONT +EXC groups. Degenerated renal corpuscles and proximal tubules in the kidney and degenerated urothelium with leaky tight junctions and mast cell increase in the bladder mucosa were observed in the HFD group. Ameliorated renal cortex and bladder mucosa were observed in the HFD+EXC group. In addition, malondialdehyde, glutathione, interleukin-6, and tumor necrosis factor-α levels were also consistent with the histological findings. Conclusion: HFD-induced renal and bladder damage may be related to increased oxidative damage. It was observed that the histological damage and altered oxidative stress parameters could be reversed by swimming training, and it is thought that moderate swimming exercise may play a role in regulating oxidative stress.

Introduction: Neoadjuvant chemotherapy (NAC) is used with increasing frequency in breast cancers. Various clinicopathological parameters predict treatment response (TR). Tumor budding (TB), which is a prognostic parameter in many cancers, can be considered the first stage of the metastatic process. In our study, the relationship between TR and clinicopathological parameters and TB in core biopsy samples of patients before NAC was investigated.

Objective There are concerns that local corticosteroid injections may increase the risk of COVID-19 infection because of the immunosuppressive effect of corticosteroids. This study aimed to examine the relationship between local corticosteroid injections and the risk of COVID-19 infection. Design The date and type of procedure as well as the dose and type of corticosteroids used in patients who underwent local corticosteroid injections within 1 yr after the first COVID-19 case in the country were examined retrospectively and recorded. Patients who did not receive corticosteroids were included in the control group. Coronavirus disease 2019 infection histories of all patients were recorded. Results There was no significant difference between the patients who received local corticosteroids and the control group in terms of the incidence of COVID-19 infections, and the number of patients who needed hospitalization or intensive care treatment. In addition, it was found that the administration of two injections, the type of procedure performed, and the dose and type of steroids were not associated with the incidence or severity of COVID-19 infections. Conclusions It has been shown that local corticosteroid injections are not associated with the incidence of COVID-19 infections and the number of patients who need hospitalization or intensive care treatment due to COVID-19.

Objective: Methotrexate (MTX) is a chemotherapeutic agent that causes testicular toxicity used in the cure of various types ofcancer. The anti-oxidant and anti-cancer effects of Panax ginseng (PxG) have been reported in both experimental and clinical studies. This study aims to examine the healing effect of PxG on testicular damage induced by MTX.Materials and Methods: Sprague Dawley male rats (8-week-olds) were used in the study. A single dose ofMTXdissolved in saline(20 mg/kg) was given to MTX and MTX+PxG groups by intraperitoneal injection. PxG dissolved in saline (100 mg/kg) was given by orogastric gavage once a day for 5 days to the MTX+PxG group. Saline was given to the control and MTX groups orally during the experiments. After decapitation, the testis sampleswere obtained. Seminiferous tubules and basement membranewere evaluated histopathologically. Seminiferous tubule diameter and germinal epithelium thickness were measured. Furthermore, oxidative stress parameters such as malondialdehyde, glutathione, superoxide dismutase, and glutathione-S-transferase were measured.Results: MTX treatment caused seminiferous tubule degeneration with a decrease in Johnsen’s score, the seminiferous tubule’sdiameter, and the germinal epithelium’s thickness. Parallel with the histopathological results increased testicular oxidative stress with an increase in malondialdehyde level and a decrease of endogenous anti-oxidant activity with a decrease in glutathione level and glutathione-S-transferase and superoxide dismutase activities. PxG treatment improved these histological and biochemical parameters in MTX-induced testis cytotoxicity.Conclusion: MTX treatment causes testicular damage via the oxidative processes. PxG treatment ameliorates MTX-inducedtesticular damage by inhibiting oxidative stress.

Objective: The frequencies of amino acids in proteins for different structural levels have been determined by many studies. However, due to the different content of data sets, findings from these studies are inconsistent for some amino acids. This study aims to eliminate the contradictions in the findings of the studies by determining the frequencies of the amino acids in all structural level of globular proteins. Methods: The frequencies of the amino acids in overall protein, in secondary structural elements (helix, sheet, coil) and in subtypes of secondary structural elements (α-, π-, and 310-helices, and first, parallel and anti-parallel strands) were calculated separately using a data set including 4.882 dissimilar globular peptides. The frequencies of the amino acids were calculated as the ratio of the total number of a specific residue in related structure to the total number of all residues in the related structure. Results: The frequencies of residues determined in this study is partially in consistent with the other studies. The differences are probably due to the data set contents of the studies. The frequencies of the amino acids in subtypes of secondary structural elements were determined for the first time in this study. Conclusions: Variations in the frequencies of PRO residue in 310-helix structure and of ILE, LEU, and VAL residues in strands of sheet structure are valuable findings for the improvement of secondary structure prediction methods, as they can be used as secondary structural elements markers.

Objective: Coagulopathy is thought to play an important role in the development of severe COVID-19. High D-dimer levels have been reported in Chinese cohort studies. However, ethnicity has significant implications for thrombotic risk. Our aim in this study is to determine the effect of D-dimer measurements on disease prognosis and mortality in Turkish patients with COVID-19. Patients and Methods: The study was designed retrospectively. Patients over the age of 18 who were admitted to our hospital were included in the study. Results: The study included 226 patients. According to the World Health Organization staging, 75(33.2%) patients, according to the staging of Siddiqi et al., 67 (29.7%) patients progressed. In the ROC analysis performed to predict mortality, AUC value for D-dimer was found to be 82.25% (95%CI 74.8%-89.71%). When the cut-off value for D-dimer was accepted as ≥3.25mg/L, specificity was 94.15%, correctly classified rate 88.5%, positive likelihood ratio as (LR):5.69, negative LR:0.71. Conclusion: As a result, similar to the Chinese cohorts, elevated D-dimer measurements increase disease progression and mortality in Turkish patients with COVID-19. D-dimer levels of 3.25 mg/L and above, strongly determine the risk of increased mortality in the Turkish Caucasian ethnic group.

Objective: Neurofibromatosis type 1 (NF1) is the most common hereditary neurocutaneous syndrome. The most crucial morbidity of NF1 is tumors that may develop. Cases with café-au-lait macules (CALMs) which is the first clinical finding of NF1, due to the anxiety of its associated morbidity, are referred to the pediatric oncology clinic. In this study, we aimed to examine the characteristics of the patients who applied to our outpatient clinic with CALMs. Patients and Methods: The data of 157 pediatric patients who applied to our institution with the diagnosis of CALMs between June 2010 and November 2020 were analyzed retrospectively. Results: There were 157 pediatric cases referred to us for CALMs. According to the National Institutes of Health (NIH) diagnostic criteria, 109 (69.4%) cases were diagnosed with NF1. The diagnosis of 22 cases with NF1 were supported by genetic examination. Optic glioma was detected in 39 (24.8%) cases. In 15 (38.4%) of cases with optic glioma, visual functions were also affected. Second diagnostic criterion did not develop during the follow-up period, except for macules, in 48 cases (30.5%). Conclusion: In cases with multiple CALMs, the probability of NF1 diagnosis is high, and close and regular follow-up is of great importance in catching the development of the second clinical criterion and minimizing its morbidity.

Objective: This study aims to evaluate the blood pressure and heart rates of the patients treated with aripiprazole once-monthly, paliperidone 1-month, and paliperidone 3-month long-acting injections. Patients and Methods: This study was a non-invasive observational study. Subjects using the same long-acting injection preparation for at least four months without skipped injections were assigned to 3 groups according to their treatments. They were screened starting from routine injection day and monthly for four months. Heart rate, systolic blood pressure, and diastolic blood pressure were recorded for each subject. Results: Systolic and diastolic blood pressure among the three treatment groups demonstrated no statistical significance. The heart rate of the paliperidone 3-month group was significantly higher than the aripiprazole once-monthly group. However, the mean heart rate was within the physiological limits. Thus, a clinical significance can hardly be attributed. Conclusion: Aripiprazole once-monthly, paliperidone 1-month, and paliperidone 3-month long-acting injections are non-inferior regarding heart rate, systolic and diastolic blood pressure during the maintenance treatment. Keywords: Long-acting antipsychotic, Hypertension tachycardia, Schizophrenia, Maintenance treatment

Introduction Obesity is a component of eating disorders grouped under several eating disturbances due to emotional problems. Eating habits are directly influenced by eating disorders. Eating disorder rates in obese patients are reported to be 15-50% in various populations. This study aimed to evaluate obesity related eating habits (OREH) in obese patients who followed in an obesity center. Methods A total of 752 (F/M: 636/116, 42.6G11.6 yrs ) obese patients (BMIO30) who applied to the Obesity Center of Marmara University Pendik Education and Research Hospital (ERH) were included in this cross-sectional study. Obesity is classified as Stage 1 (BMI 30-34.9), Stage 2 (BMI 35-39.9), and Stage 3 (BMIO 40). We evaluated graze eating, night eating, eating addiction, and binge eating in the context of OREH in accordance with the literature. Self-report tests including The Short Inventory of Grazing (SIG), Modified Yale Food Addiction Scale (mYFAS), Night Eating Questionnaire (NEQ), Emotional Eating Scale (EES), and Binge Eating Scale (BES) were given to the patients. OREH results were determined based on these test’s cut-off points. Results Mean BMI was found to be 42.1G6.6 kg/m2 . There were no statistically significant difference between both genders in respect of age and BMI (PO0.05). Mild grazing habits was observed in 136 (18%) cases, moderate grazing in 309 (41%) cases, and severe grazing in 229 (30%) cases. Modarete stage grazing was more common in women (265, 41.6%) and men (44, 47.6%). Binge eating was recorded in 337 of the total (44.8%) patients, in 287 of women (45.1%) and 50 men (43.1%). Emotional eating was present in 113 of the total patients (15%), in 103 of women (16.1%) and 10 men (8.6%). Food addiction were seen in 402 of all cases (53.4%). High stage food addiction was more common in women (169, 51.1%) and men (30, 42.2%). Night eating was found in 225 patients among all (29.9%) with 185 (29%) to be in women and 40 (34.4%) in men. Emotional eating (PZ0.032) and night eating (PZ0.025) were found to be statistically significant in regard of BMI. Conclusion In this cross-sectional study, many of obese patients had obesity related eating habits whereas 65% of all cases had more than one component of obesity related eating habits. Determining the eating disorders prior to obesity treatment are necessary for planning and treatment compliance. DOI: 10.1530/endoabs.90.EP462

Objective Neurofibromatosis type 1 is an autosomal dominant inherited neurocutaneous condition characterized with multipl cafe-au-lait spots, neurofibromas, predisposition to malignancies, and the incidence of disease is 1:3000. Patients are diagnosed according to diagnostic criteria and 97% of the patents meet the criteria before 8 years of old. Diagnosis and follow-up of patients for manifestations of neurofibromatosis is important for early diagnosis and treatment of malignancies. Case Twenty-one year old female patient admitted to neurosurgery outpatient clinic with complaint of scoliosis. She was consultated to endocrinology clinic for low bone mineral density levels and osteoporotic findings in vertebral x-ray examination. In physical examination she was short statured and she had growth retardation. She had multipl cafe-au-lait spots and scoliosis. On right lower limb, she had a brown lesion and after consultation with dermatology clinic it was considered as plexiform neurofibroma. Her bone mineral density level (BMD) in L1-L4 was 1.006, z score was -0.7, femur neck BMD was 0.669 z score was -2.1. Her osteocalcin level was 21.5 ng/ml (9-42), c-telopeptide was 0.23. Hypophysial hormones were evaluated and her IGF-1 level was found to be low according to age reference range. Insulin tolerance test was performed and her growth hormone was found to be 0.206 when her blood glucose was 36 mg/dl. In family history, her mother and brother were also learnt to have multiple cafe-au-lait spots and in physical examination her mother had cutaneous neurofibromas. Neurofibromatosis diagnosis was confirmed after genetic consultation and genetic test. Hamartomatous lesion in both basal ganglia and thalamus and in right frontal lobe were found in cranial magnetic resonaunce imaging (MRI). In abdominal MRI, neurofibromas in right coxofemoral articulation and right acetabulum were found. Her urine metabolites were examined for pheochromacytoma and found in normal levels. Follow-up visits were planned and she was concultated to relevant departments. Her mother and brother were also diagnosed as neurofibromatosis. Discussion and Conclusion Patients with neurfibromatosis have a high predisposition to develop both benign and malign tumours. Although most of the manifestations effect the nervous system, multiple organs and tissues can be affected. Patients can present with different clinical symptoms to different clinics so being aware of the different clinical manifestations of the disease is important for prompt diagnosis. DOI: 10.1530/endoabs.90.EP201

Introduction Various rates were reported regarding diabetes remission and improvement in hyperglycemia in many studies from different populations. Determinants of diabetes remission have not been definitively established so far. In this study, we aimed to evaluate the long-term glycemic status after bariatric surgery in diabetic obese patients followed by Marmara University Endocrinology Outpatient Clinic. Method The retrospective study included 233 type 2 diabetic obese patients who underwent either sleeve gastrectomy or gastric bypass between 2011-2021. Preoperative, postoperative sixth month, first year, and second year data were collected from the patient files. In the analysis of the dependent variables, patients who fulfilled whole visits were included. The glycemic status of diabetic patients at postoperative first and second year visits was classified as complete remission, partial remission, recovery, no change, and recurrence in accordance with the criteria of the American Society of Bariatric and Metabolic Surgery, 2022. Remission ratios were calculated for each visit, seperately. Logistic regression was used to analyse the factors affecting diabetes remission for the whole diabetic group. Results Postoperative BMI values were significantly lower than the preoperative level (P!0,001), additionally remained similar between the first and the second years. BMI change was found to be similar between gastric bypass and sleeve gastrectomy. Fasting blood glucose and HbA1c levels were significantly lower than the preoperative levels as well (P!0,001). 24.9% (nZ58) of the patients were on insulin preoperatively. This ratio was found to be 3.5% (nZ6) in the first year and 3.3% (nZ4) in the second year. Complete remission rate was 68.0% (nZ132) in the first year. In the second year, complete remission and recurrence rates were 59.5% (nZ72) and 8.3% (nZ10), respectively. Remission rates were similar among the two surgical procedures. To determine the factors affecting remission across the whole sample, a regression model was conducted. Duration of diabetes, preoperative insulin usage, preoperative BMI, and the type of the surgery were included in the model. Preoperative insulin use of patients was associated to diabetes remission outcomes. Patients who were not taking insulin before the surgery were more likely to experience postoperative diabetes remission (ORZ7.523, P!0.001, 95%CI 3,075-18.404 for the 1st year; ORZ 5.096, PZ0.002, 95%CI 1.781-14.577 for the 2nd year). Conclusion At the postoperative first and second year checkpoints, complete remisson rates were 68.0% and 59.5%, and recurrence rate was 8.3% in the second year. Not using insulin preoperatively made the probability of diabetes remission 5.1 times higher. DOI: 10.1530/endoabs.90.P56

Purpose or Objective Pretreatment inflammatory markers obtained from the complete blood count (CBC) can be predictive for treatment response in rectal cancer patients treated with neoadjuvant chemoradiotherapy (NACRT). The aim of this study was to determine the correlation between inflammatory markers and treatment response in rectal cancer patients treated with NACRT. Materials and Methods A total of 192 rectal cancer patients treated with NACRT were included in the study. Male/female ratio was 1.59. Clinical T stage was T2 in 13 patients, T3 in 162, and T4 in 17. Clinical N stage was N0 in 25 patients, N1 in 160, and N2 in 7. Radiation dose was 50-56 Gy to the primary tumor and 45-50.4 Gy to the regional lymph nodes. All patients received concurrent capecitabine (n=191) or 5-fluorouracil (n=1). Patients with no evidence of residual disease on DRE, MRI, and endoscopic evaluation following NACRT were determined as clinical complete responders. Patients with clinical (n=34) or pathological (n=27) complete response were classified as complete responders (CR) and the other response groups as non- complete responders (nCR) (n=131). Pretreatment absolute values of neutrophils (N), lymphocytes (L), monocytes (M), and platelets (P), plateletcrit (PCT), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to- monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) were recorded as hematological inflammatory markers. Mann– Whitney U-test was used to compare the variables between the groups. Results Median age was 60 (18-86) years. Mean N, NLR, PLR, L, and LMR are given in the Table. Pretreatment N (p=0.042), NLR (p=0.001), and PLR (p=0.002) were significantly higher, while L (p=0.015) and LMR (p=0.004) were lower in nCR group compared to CR group. Pretreatment M, P, PCT, and MPV did not have any effect on the treatment response. Table. Mean (± SD) N, L, NLR, PLR, and LMR values according to treatment response. Markers Neutrophil (103/μL) Lymphocyte (103/μL) NLR PLR LMR Conclusion CR nCR 4.65 ± 1.41 5.21 ± 1.70 2.86 ± 4.85 1.99 ± 0.71 2.27 ± 1.05 3.03 ± 1.62 P value 0.042 0.015 0.001 0.002 0.004 130.36 ± 58.51 4.71 ± 4.85 164.20 ± 77.92 3.55 ± 1.62 Rectal cancer patients with lower pretreatment N, NLR, PLR, and higher L and LMR are more likely to have complete response following NACRT. These markers may be used to predict treatment response in rectal cancer patients treated with NACRT.

GİRİŞSecukinumab ve ixekizumab interlökin (IL) -17A\"yı seçici olarak nötralize eden monoklonal antikorlardır. (1) Bell paralizisinin etiyolojisi bilinmemektedir, gizli bir virüsün otoimmün reaksiyonu tetikleyebileceği ve fasiyal sinirde demiyelinizasyona neden olabileceği öne sürülmüştür. (2) IL-17 inhibisyonu ile inflamatuar bağırsak hastalığı (IBD) gelişim mekanizması belirsizdir. (3) Secukinumab tedavisinden sonra gelişen bir fasiyal paralizi ve ixekizumab tedavisinden sonra yeni başlayan bir ülseratif kolit olgusu sunuyoruz.OLGU 110 yıldır kronik plak psoriazisi olan secukinumab tedavisi alan 31 yaş erkek hastada 5 haftalık indüksiyon aşamasını tamamladıktan birkaç gün sonra, dilde ve başının arkasında uyuşma gelişti. Secukinumab tedavisi sonlandırıldı. Hastanın bilateral karotis ve vertebral renkli doppler ultrason muayenesi normaldi. İki gün sonra yüzün sol tarafında uyuşma ile başvurdu ve muayene sırasında sol tarafta azalmış yüz hareketleri tespit edildi. Elektromiyografide, sol fasiyal sinirin amplitüdü sağdan %22 daha düşüktü. Hastanın diğer nörolojik muayenesi normaldi. Diğer infeksiyöz ve otoimmün hastalıklar tespit edilmedi ve hastanın başka bir sistemik hastalığı yoktu. Şikayetleri üç hafta içinde metilprednizolon tedavisi ile geriledi. İki aylık takipte nüks gözlenmedi.OLGU 25 yıl boyunca kronik plak tip ve şiddetli tırnak psoriazisi olan ve ixekizumab tedavisi alan 27 yaşında bir erkek hastada tedavinin 28. haftasından itibaren tekrarlayan karın ağrısı ve kanlı ishal atakları gelişti. Kolonoskopi ve intestinal biyopsinin histopatolojik bulguları ülseratif kolit ile uyumluydu. Ixekizumab tedavisi sonlandırıldı. Kolit atakları metilprednizolon, azatiyoprin ve mesalazin tedavisi ile kontrol edildi. 8 aydır psoriazis için tedavi almayan hastanın psoriatik lezyonları ve tırnak bulguları yeniden ortaya çıktı ve hasta için anti-IL23 biyolojik tedavi planlanıyor. Hastalardan yayın izni için bilgilendirilmiş onam alındı.TARTIŞMAPsoriazis ve psoriatik artrit için secukinumab kullanan 306 hastanın çalışmasında, tek bir fasiyal paralizi olgusu bildirilmiştir. (1) Şimdiye kadar, ixekizumab tedavisinden sonra 3 IBD geliştiği bildirilen 5 vaka raporu ve secukinumab ile tedaviden sonra IBD geliştiren 3 vaka serisi olmuştur. (4) Anti-IL-17 ajanlarına başlamadan önce, hastalardan IBD açısından ayrıntılı bir kişisel ve aile öyküsü alınlamalıdır. Hastalar bu ilişki hakkında bilgilendirilmeli ve gastrointestinal semptomlarını izlemeleri istenmelidir.Anahtar Kelimeler: psoriazis, biyolojikler, anti IL17A, fasiyal paralizi, ülseratif kolit

Peritoneal dialysis is a home based therapy for patients with advanced chronic kidney disease. This method provides adequate clearance of uremic toxins and removal of excess fluid when a proper dialysis prescription is combined with patient adherence. Peritonitis is the most frequent infectious complication among these patients and may render the continuity of the treatment. Training patients and their caregivers have prime importance to provide proper treatment and prevent complications including infectious ones. The training methods before the onset of treatment are relatively well established. However, patients may break the rules in the long term and tend to take shortcuts. So, retraining may be necessary during follow-up. There are no established guidelines to guide the retraining of PD patients yet. This review tends to summarize data in the literature about retraining programs and also proposes a structured program for this purpose.

Aim: COVID-19 has the potential to affect many systems and organs, resulting in serious clinical symptoms that necessitate admission to the intensive care unit. The purpose of this study was to examine the relationship between CAR, other laboratory findings, comorbidities, and mortality in patients infected with the original SARSCoV-2 or other variants.Materials and Methods: The data of 368 patients admitted to the intensive care unit with COVID-19 pneumonia between March 2020 and July 2021 were analyzed. These patients were divided into two groups. The first group included [(OC) Original SARSCoV-2 ] COVID-19 infected patients in the first period of the pandemic. The second group [(OV) Other Variants] included patients with COVID-19 infection due to other variants.Results: The mean age (Mean +/- SD) in the OC group was 69.79 +/- 11.77 years. The mean age of the patients in OC was higher than in the OV group (p=0.001). The most common comorbid disease in both groups was Hypertension (54.1%, 48.8%), followed by diabetes mellitus (DM) (30.2%, 31.6%). The mean age of the survivors in the OC and OV groups was lower (64.53 +/- 13.04, 57.85 +/- 16.78, p=0.001, p=0.001, respectively). It was observed that albumin and lymphocyte counts were lower in the deceased, while LDH, CRP, Neutrophil, procalcitonin, NLR and CAR were higher (p

Objective The aim of this study was to optimize the currently used direct spectrophotometric serum prolidase enzyme activity (SPEA) assay method and compare its diagnostic accuracy with current precipitation and direct spectrophotometric assay methods, AST-to-ALT ratio, age platelet index, AST-to-platelet ratio index, cirrhosis discriminate score, Doha score, FIB-4, FibroQ, fibrosis index, Goteborg University Cirrhosis Index , King’s score, and Pohl score for distinguishing Ishak F0 from F1–F3 in patients with chronic hepatitis B (CHB) infection. Methods Liver biopsy results from 112 patients were included in this study. Results The SPEA values were 529 (292–794) U/L, 671 (486–927) U/L, and 1077 (867–1399) U/L with the precipitation, current, and optimized direct spectrophotometric assay methods, respectively. According to multivariate logistic regression analysis optimized direct spectrophotometric SPEA was the only statistically significant parameter to predict the early stages of liver fibrosis. Conclusions Optimized direct spectrophotometric SPEA assay method could be used to distinguish early stages of liver fibrosis in patients with CHB infection instead of the currently used spectrophotometric SPEA assay methods and other evaluated liver fibrosis indexes.

The primary objective of this study was to examine the effect of gestational diabetes mellitus (GDM) on pelvic girdle pain (PGP) occurrence and symptom severity. Pregnant women who were with/without GDM, 20-40 years of age, and also in the second and third trimesters of pregnancy were included in the study. PGP provocation tests were administered to 187 pregnant women to determine the presence and severity of PGP. Based on the test results, the study subjects were divided into two groups; Group 1 (GDM+, PGP+; n:32) and Group 2 (GDM-, PGP+; n:35). Both groups were asked to fill in the Pelvic Girdle Questionnaire (PGQ). The relationship between the presence of GDM and the presence of PGP was found to be significant (p = .043). It was found the groups were similar in view of pain, and also in PGQ total/subscale scores (p > .05). Although GDM has no effect on symptom severity, it has been determined that it may relate to the development of PGP. Therefore, early interventions (nutrition, exercise, belt using, etc.) are recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with a previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. What is already known on this subject? Gestational diabetes mellitus and pelvic girdle pain are pathologies that develops secondary to pregnancy-related systemic and biomechanical changes. What do results on this study add? GDM may related the development of PGP. What are the implications of these findings for clinical practice and/or further research? Early interventions (nutrition, exercise, belt using, etc.) and strict control of pregnant women in view of PGP is recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. The evaluation of pregnant women for PGP before administering interventions, such as exercise and diet (both decrease the pro-inflammatory markers), following the diagnosis of GDM and the measurement of plasma anti- and pro-inflammatory marker values in the same time period will further reveal the relationship between GDM and PGP.

İntegraz inhibitörleri (INI), viral integrazın etkisini inhibe ederek insan immün yetmezlik virüsü tip 1 (HIV-1) enfeksiyonunu tedavi etmek için kullanılan güçlü antiretroviral ilaçlardır. İntegraz genindeki mutasyonlar, tedavi başarısızlığı, hastalığın ilerlemesi ve ölümle sonuçlanan ilaç direncine neden olabilir. Bu çalışmada, HIV-1 ile enfekte hastalarda INI\"lerle ilişkili ilaç direnci mutasyonlarının araştırılması amaçlanmıştır. İki yıllık bir dönemde (2018-2019) başvuran, viral yükü 200.000 kopya/mL\"nin üzerinde olan HIV-1 ile enfekte hastalardan alınan 50 plazma örneği çalışmaya dahil edildi. Viral RNA ekstraksiyonunu takiben, HIV-1 integraz gen bölgesinin ters transkripsiyonu, PCR amplifikasyonu ve ürünlerin DNA dizilimi gerçekleştirildi. Tespit edilen mutasyonlar, Stanford Üniversitesi HIVdb Programı kullanılarak analiz edildi. Toplam 37 örnekte ters transkripsiyon sağlandı; ancak yalnızca 18 örneğin DNA dizilemesi başarılı bir şekilde gerçekleştirildi ve analiz edildi. Tüm örneklerde integraz gen bölgesinde çeşitli mutasyonlar tespit edildi. Analiz edilen 18 örnekten 2\"sinde (%11.1) INI\"lere karşı dirence neden olan T97A ve Y143H mutasyonları saptandı. Viral integraz gen bölgesinde tespit edilen ilaç direnci mutasyonları; antiviral direnç testinin, INI sınıfı ilaçlar da dahil olmak üzere, etkili HIV tedavisinin temel bir bileşeni olduğunu göstermektedir. Integrase strand transfer inhibitors (INSTIs) are potent antiretroviral drugs used to treat human immunodeficiency virus type 1 (HIV-1) infection by inhibiting the action of the viral integrase. Mutations in integrase gene may cause drug resistance which consequently results in treatment failure, disease progression and mortality. The aim of this study was to investigate the drug resistance mutations associated with INSTIs among HIV-1-infected patients. In a 2-year period (2018-2019), 50 plasma samples from HIV-1-infected patients who had a viral load over 200.000 copies/mL were included. Viral RNA extraction was followed by reverse transcription, amplification and Sanger sequencing of the HIV-1 integrase gene region. Detected mutations were analysed by using the Stanford University HIVdb Program. A total of 37 samples were reverse-transcribed, however only 18 samples were successfully sequenced and interpreted. Several mutations were detected in integrase gene region in all samples. Of the 18 samples 2 were found positive (11.1%) for drug resistance mutations for INSTIs, including T97A and Y143H. The detected drug resistance mutations in viral integrase gene region suggest that antiviral resistance testing is an essential component of effective HIV management including INSTI class drugs.

Sacroiliac joint (SIJ) injection is recommended for both diagnosis and relief of SIJ pain. YouTube has become a widely used source for health professionals and patients to obtain information about various procedures but the quality of YouTube videos including medical content is questionable. Therefore, the aim of this study is to evaluate the quality of SIJ injection videos on YouTube. This cross-sectional study was conducted through March 2022 by searching the phrase \"sacroiliac joint injection\"on YouTube. After resetting search history top 100 videos were screened. Duration of videos, number of views, number of likes, number of comments, view ratio (number of views/d), time passed since upload date, guide used for injection, and source of videos were recorded. The DISCERN and the Global Quality Scale were used to assess the quality and reliability of the videos. Of the 100 videos screened 42 videos met the inclusion criteria. The videos (73.8%) were predominantly uploaded by physicians. Most frequently used guide for injections was ultrasound with 45.4%. According to the DISCERN classification, 35.7% of the videos were \"very poor,\"30.9% were \"poor,\"21.4% were \"fair,\"7.1% were \"good\"and 4.7% were \"excellent.\"Physicians and patients should be aware of that many of the videos about SIJ injections are categorized as \"poor\"or \"very poor,\"which means they may mislead trainees, resulting in inadequate treatments.

Hereditary hyperferritinemia-cataract syndrome (HHCS) is a rare genetic condition characterized by persistent hyperferritinemia (usually ferritin >1,000 ng/mL) without tissue iron overload, with or without early-onset slow-progressing bilateral nuclear cataract. It was first identified as a new genetic disorder in 1995, and since then genetic sequencing studies have been carried out to identify associated mutations in affected families. New mutations around the world are still being reported in the iron-responsive element (IRE) of the L-ferritin gene (FTL) to this day. Many clinicians remain unaware of this rare condition. The co-occurrence of FTL mutations and hereditary hemochromatosis (HH) mutations, especially H63D, on the HFE gene has been reported in the literature, which often leads to a diagnosis of HH, missed diagnosis of HHCS, incorrect treatment with phlebotomies and the occurrence of associated iatrogenic iron deficiency anemia. We herein report the case of a 40-year-old woman with spontaneous facial freckling, bilateral cataracts, homozygosity for HFE H63D mutation, iron deficiency anemia, and hyperferritinemia, who has been treated with phlebotomy and iron chelation therapy to no avail. Eleven years after being diagnosed and treated for HH, a reevaluation of her clinical presentation, laboratory results, medical imaging, and family history led to the recognition that her case is explained not by HH, but by an alternative diagnosis, HHCS. Our main objective in this report is to increase clinical awareness about HHCS, an often-unknown differential diagnosis of hyperferritinemia without iron overload, and to prevent adverse medical interventions in HHCS patients.

Background: The systemic inflammatory response index (SIRI), which depends on peripheral neutrophil, monocyte, and lymphocyte count, was found as an effective prognostic indicator for various malignancies. This study aims to investigate the predictive value of preoperative SIRI in the prognosis of gastric cancer patients without neoadjuvant therapy. Methods: The patients who underwent gastric cancer surgery in Marmara University Hospital\"s General Surgery Department between 2019 and 2021 were analyzed retrospectively. SIRI was calculated from preoperative peripheral blood samples\" neutrophil, lymphocyte, and monocyte count. The optimal cut-off value for SIRI was calculated by the receiver operating characteristics (ROC) curve and was found to be 1.35. The clinicopathological outcomes and overall survival (OS) were analyzed under two groups according to the SIRI values lower or higher than 1.35. Results: The number of eligible patients was 199. The median follow-up time was 25 (1-56) months. The higher SIRI was associated with male gender (p = 0.044), lower serum albumin (0.002) level, and Clavien-Dindo (CD) Grade III and higher complications (p = 0.018). However, there was no significant difference between the groups regarded pathological tumor, nodes, and metastases (TNM) stages, histological grade, and Lauren Type. In addition, OS and stage-specific OS were similar between the groups. Conclusions: SIRI may be a valuable and effective predictive indicator for postoperative morbidity. The prognostic performance of SIRI on long-term OS is still controversial. Further investigations are needed into this topic.

Sağlık sorunlarının çözümüne toplumun katkısı, sağlık sorunlarının erken tanı aşamasında çö züme ulaştırılmasını sağlar; hastalık yönetimini kolaylaştırır, sağlık hizmet sunumunun toplumun bütü nüne ulaşmasına hizmet eder. Toplumun kendi sağlık gereksinimlerinin farkında olması ve sağlık sorunlarının çözümüne katılması, bireyin ve toplumun eğitim düzeyi, sağlık okuryazarlığı ile olduğu kadar toplumda farkındalığını artırmak üzere yapılan girişimlerle de ilgilidir. Topluma dayalı araştır maların yapılması, araştırma sonuçlarının toplumla paylaşılması, sağlık kurumları ve sağlık hizmet su nucularının iş birliği yapması, sağlıkla ilgili mevzuat ve yasalarla ilgili kararların alınması toplumun sağlığın geliştirilmesine aktif katılımını sağlayacak temel girişimlerdir. Aile hekimliği ve birinci basa mak sağlık hizmet sunumu bu temel girişimlerin en etkili olarak sunulacağı hizmet basamağıdır. Ge rekli olan yet-kinlik uzmanlık eğitimi ile edinilebilir. Bu makalede toplumun aile hekimliği uygulamalarına katılımının önemi ve katılımın sağlanmasına yönelik olarak kullanılan yöntemler tartı şılmaktadır. The participation of the community in the solution of the health problems, contributes to early resolution of problems, facilitates disease management, enables the health care to reach the whole community. The awareness of the community about its own health needs and its participation in the solution of health problems are as related to the individual's and the population's education level and health literacy as the attempts to raise the awareness among community. Community based researches, sharing the results with the community, cooperation of health institutions and the health providers, decisions about health related laws and regulations are the essential attempts to reassure the active participation of the community for solving problems. Family medicine and primary health care is the care level where these essential attempts are the most effectively provided. The competencies needed can be acquired by family medicine residency program. In this article, the importance of the participation of the community to the family practice and the methods used forenabling the participation are discussed.

Avrupa aile hekimliği/genel pratisyenlik tanımında (2011), disiplinin temel özelliklerinden biri olan \"birinci basamağın yönetimi’ne göre aile hekimi bireylere açık ve sınırsız erişim sağlar, yaş, cinsiyet veya hiçbir kişinin başka özelliğine göre ayrım gözetmeksizin tüm sağlık sorunları ile ilgilenir.\" Burada bahsedilen açık ve sınırsız erişimin sağlaması için aile hekimleri fiziksel ve finansal ulaşılabilir olmakla birlikte herkesle açık, dürüst ve paylaşımcı iletişim kurmalıdır. Fiziksel olarak ulaşımın zor olduğu bölgelerde gezici sağlık hizmeti vermelidir. Yine bu yerlerde özellikle yaşlı hastalar için tele-sağlık sistemi de hastanın hekime ulaşması için bir yol olabilir. Erişilebilirlik aynı zamanda aile hekimliğinde sürekliliğin sağlanmasının da temel unsurlarındandır. Birçok ülkede mesai saatleri dışında da aile hekimine erişim mevcut olup, acil servise gitmek yerine önemli bir alternatiftir. Ülkemizde ise aile hekimlerinin ulaşılabilirliğinin yalnızca mesai saatleri ile sınırlı olması acil servislerde acil olmayan hasta başvurusundaki fazlalığın nedeni olabilir. According to the "primary care management", which is one of the basic features of the discipline, in the European definition of family medicine/general practitioner (2011) the family physician provides open and unlimited access to individuals, deals with all health problems without discrimination based on age, gender or any other characteristic of any person. In order to provide the open and unrestricted access mentioned here, family physicians should be physically and financially accessible, also should establish open, honest and sharing communication with everyone. They should provide mobile health services in areas where physical access is difficult. In these places, the tele-health system, especially for elderly patients, can be a way for the patient to reach the physician. Accessibility is also one of the basic elements of ensuring continuity in family medicine. In many countries, access to primary care is available outside of working hours, and it is an important alternative to going to the emergency room. In our country, the availability of family physicians is limited to working hours only, which may be the reason for the high number of non-emergency patient applications in emergency services.

Objectives: Opioid-free anesthesia with erector spinae plane block (ESPB) has the potential to decrease perioperative opioid need, thereby potentially reducing related complications. This study aimed to compare opioid-free anesthesia with ESPB and standard opioid-based balanced anesthesia in patients undergoing video-assisted thoracic surgery (VATS) in terms of postoperative opioid need (through patient control analgesia) as well as postoperative pain management, recovery quality, and opioid-related side effects. Methods: Seventy-four patients, ranging in age from 18 to 75 years, who underwent lobectomy with VATS were included in this randomized-controlled study. The opioid-free group had ESPB, and no opioid was used during anesthesia maintenance. The opioid group received standard anesthesia with opioid use. Postoperative morphine requirement, postoperative pain as measured by the visual analog scale (VAS), intraoperative vital parameters, recovery quality using the Quality of Recovery-40 (QoR-40) questionnaire, and opioid-related complications were compared between groups. Results: The opioid-free group received a significantly lower total dose of morphine during the first 24 postoperative hours through patient-controlled analgesia (PCA) when compared to the opioid group (7.3 +/- 3.4 vs. 21.7 +/- 7.9 mg, p

Objective: Primary care, which is often the first level of contact for patients with various communicable diseases (CDs) and noncommunicable diseases (NCDs), might exhibit patterns of injectable drug utilization different from hospitals. We aimed to examine injection prescribing to adults with CD or NCD in primary care.

Physical activity is beneficial for overall health; however, informal carers may have lower levels of physical activity than non-carers. The primary aim of this systematic review was to identify barriers and facilitators to physical activity from the perspective of carers internationally, excluding the UK. The study found that barriers to physical activity include lack of time, fatigue, lack of motivation and lack of support. Facilitators of physical activity include health and well-being as a motivator, using physical activity as a coping mechanism, and social support. Participating with the care recipient and care duties were both barriers and facilitators depending on the study or participant.

BACKGROUND: Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. METHODS: A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. RESULTS: Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). DISCUSSION: SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.

Background/aim: Disease-modifying treatments (DMT) are used to prevent future relapses and disability. High long-term adherence to treatment is important to achieve disease control. This study aims to investigate and compare adherence, adverse event (AE) profiles, and frequencies, main reasons for treatment discontinuation under Teriflunomide (TERI), Dimethyl Fumarate (DMF), and Fingolimod (FNG) for relapsing-remitting MS (RRMS) patients. This study is designed to explore patient-reported experiences in real-life settings. Materials and methods: Patients who were older than 18 years with a definite diagnosis of RRMS and no history of stem-cell transplantation were included. Outpatient clinic data files at the Neurology Department of Marmara University from June 2012 to June 2019 were examined retrospectively. Results: One hundred and ninety MS patients were enrolled. 118 FNG, 51 DMF, 44 TERI treatment cycles were recorded. Time since disease onset, time since diagnosis, and treatment duration were significantly longer for FNG (p = 0.012, p = 0.004, p < 0.001). 72.8% of all the treatment cycles were continued. There was no significant difference in treatment continuity between the 3 DMT groups. The most common reasons for treatment discontinuation in order of frequency were adverse events, the progression of the disease, and the persistence of relapses. No significant difference was found for treatment discontinuation reasons. 32% of the patients reported at least one AE. 28% FNG, 49 % DMF, and 27.3% TERI using patients reported AEs. AEs were much more frequently reported for DMF (p = 0.015). The most common adverse events for each DMT were alopecia (n = 6, 13.6%) for TERI, flushing for DMF (n = 20, 39.2%), and persistent lymphopenia for FNG (n = 9, 7.6%). No severe or life-threatening AE was reported for DMF, one patient experienced pancreatitis under TERI, and 11 (9.3%) patients using FNG had to stop treatment due to serious or life-threatening AEs including cardiac adverse events, opportunistic infections, and dysplasia. Conclusion: Overall treatment discontinuation because of AEs is as low as 10.3% in this study. However, AEs are still the main reason for treatment drop-out.