Search

We investigated the effects on kidney tissue of 900 megahertz (MHz) EMF applied during the prenatal period. Pregnant rats were exposed to 900 MHz EMF, 1 h/day, on days 13-21 of pregnancy; no procedure was performed on control group pregnant rats or on mothers or newborns after birth. On postnatal day 21, kidney tissues of male rat pups from both groups were examined by light and electron microscopy. Malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and glutathione levels also were investigated. Light microscopy revealed some degenerative changes in the tubule epithelium, small cystic formations in the primitive tubules and large cysts in the cortico-medullary or medullary regions in the experimental group. Electron microscopy revealed a loss of peritubular capillaries and atypical parietal layer epithelial cells in the experimental group. Biochemical analysis showed significantly increased MDA levels in the experimental group and decreased SOD and CAT levels. EMF applied during the prenatal period can caused pathological changes in kidney tissue in 21-day-old male rats owing to oxidative stress and decreased antioxidant enzyme levels. [ABSTRACT FROM AUTHOR]

Myeloid sarcoma of urinary bladder is a rare disorder. We report a 71-year old man with hematuria. He was also under follow up for unclassified myeloproliferative/ myelodysplastic disorder, diagnosed 2 months ago. Abdominal ultrasonography and computed tomography findings were normal. Diagnostic cystoscopy revealed patchy areas of mucosal swelling with hyperemia. Histopathological examination of biopsies demonstrated a neoplasm composed of blasts showing myeloperoxidease positivity by immunohistochemistry. To our knowledge, current case is the first case of myeloid sarcoma without evidence of a mass lesion in the urinary bladder with a concurrent diagnosis of myelodysplastic /myeloproliferative disease, unclassifiable. [ABSTRACT FROM AUTHOR]

Background: The prevalence of malignancies is higher among kidney transplant recipients (KTR) than general population. Although the incidence of renal cell cancer (RCC) after KTR was reported as 0.6 % with a high mortality rate of 13.9 %, none of the guidelines except the European Best Practice Guideline (EBPG) recommends RCC screening based on cost-effectiveness and lack of solid evidence. The EBPG recommends RCC screening in native kidneys (not the allograft) by ultrasonography (USG) every 1-3 years. Case description: A 55-year-old male patient who had a kidney transplant from a living donor 14 years before, presented with sudden onset uncontrolled hypertension (180/110 mmHg) and rapid deterioration in graft functions (increase in serum creatinine to two-times baseline). Evaluations revealed RCC in the allograft. Abdominal pain, hematuria, fever, weight loss, flu-like syndrome, recurrent urinary tract infections, weakness, hypertension, and allograft dysfunction are reported as the main complaints and signs of RCC in KTR patients. Our patient's findings were hypertension and allograft dysfunction. Conclusion: It is essential to follow EBPG for KTR and not to forget the annual USG for screening of RCC both in native kidneys and allograft. [ABSTRACT FROM AUTHOR]

Background: Even though complement 1q nephropathy (C1qN) was first introduced in 1985, this entity is still unknown and recognized by clinicians due to its rare prevalence (0.2 - 2.5 %) and insufficient emphasis. Description of the case: A 50-year-old woman was incidentally found to have non-nephrotic proteinuria with a normal glomerular filtration rate. Renal biopsy revealed C1qN with severe fibrosis. The presence of consanguinity and kidney diseases in family members of the patient led to genetic research, and homogenous mutation of c.991G>T (p.G331C) in the WD-repeat domain 19 (WDR19) gene was found. The same homozygous and heterozygous mutations in the WDR gene were found in the relatives of our patient with kidney diseases. One year of follow-up with methylprednisolone and mycophenolate mofetil treatment resulted in partial remission of the kidney disease. Conclusion: Renal biopsy for patients with non-nephrotic proteinuria without delay is suggested as it might be a surrogate marker of severe injury. Genetic mutations in the WDR19 gene should be searched for C1qN pathogenesis. This is the first adult case report on C1qN from Turkey. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 46 year old man with congenital adrenal hyperplasia who was first treated according to the symptoms of nausea. He had a medical history of using methylprednisolone and after applying bilateral adrenalectomy he was diagnosed with bilateral adrenal myelolipoma, he was advised to continue methylprednisolone.

Introduction Osmophobia is hypersensitivity to certain odors. Although osmophobia is a symptom related to migraine, it is also reported in tension-type headache (TTH). Osmophobia is recommended for inclusion in the migraine diagnostic criteria because it increases sensitivity and shows absolute specificity. However, there is no evidence of the association between TTH and osmophobia. This study aimed to evaluate the prevalence and clinical characteristics of osmophobia in a cohort of migraine and TTH patients. Methods For the current analysis, patients who met the inclusion criteria among patients diagnosed with migraine and TTH according to the International Classification of Headache Disorders III criteria in the neurology outpatient clinics of Ankara City Hospital and Akyazı State Hospital were selected retrospectively. A total of 214 patients (129 with migraine and 85 with TTH) were included in the study. Patients' characteristics, visual analog scale (VAS) pain scores, and Migraine Disability Assessment Scale (MIDAS) scores were recorded. Osmophobia characteristics in migraine and TTH patients were compared along with clinical parameters between the groups and within the groups. Results Osmophobia was found in 68% of migraine patients. The most common type of smell that migraine patients experienced was the scent of perfume. A total of 31.3% of the patients with TTH had osmophobia. While the most irritating odorant in migraine patients was perfume (32%), in TTH patients, it was the smell of food (10.5%). There were no significant differences between osmophobia, and age, education level, disease duration, pain frequency, attack duration, or VAS score in both migraine patients and TTH patients. There was also no significant difference between migraine patients with (2.42) and without (2.33) osmophobia in terms of the MIDAS score. Discussion Our study indicates that osmophobia observed in migraine is valuable in differential diagnosis. However, it can be significantly identified in TTH patients. It should be used together with other supporting criteria in differential diagnosis. It would also be useful to question the characteristics of osmophobia in more detail in the anamnesis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ankara City Hospital Medical Research Scientific and Ethical Evaluation Board issued approval 2-24-51. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Çiçekli et al.)

Background Microsatellite instability (MSI) is a genetic condition caused by errors in DNA repair genes that cause colorectal cancer (CRC). The literature contradicts the frequency of MSI in sporadic CRCs and its effect on prognosis. This study investigated the distribution of clinicopathologic features and the relationship between MSI and survival outcomes. Methodology This is a retrospective study of 101 consecutive cases of CRC and immunohistochemical studies. All cases were retrospectively reviewed and reevaluated by histological grade, lymphovascular invasion, perineural invasion, tumor borders, dirty necrosis, tumor-infiltrating lymphocytes (TILs), Crohn's-like lymphoid reaction, mucinous and medullary differentiation, and tumoral budding from pathological slides. An immunohistochemical study was performed in appropriate blocks for using MLH-1, MSH-2, MSH-6, and PMS-2. We collected the clinical stage, pathological tumor stage, lymph node metastasis, age, sex, tumor diameter, distant metastasis, localization, and survival information from patients' clinical data. Results There was no statistically significant difference between the two groups regarding age, gender, tumor diameter, histological grade, tumor border, dirty necrosis, TILs, N and M stage, perineural and lymphovascular invasion, mucinous differentiation, medullary differentiation, and tumor budding characteristics of the patients. The MSI-H group was more frequently located in the right colon and transverse colon (p < 0.001), and the T stage was higher among them than in the MSI-L group (p = 0.014). Upon multivariate regression analysis, MSI status had no significant effect on survival time. Age and stage N and M were independent prognostic factors for colon cancer prognosis. Conclusions Our study presented the distribution of clinicopathological features and their relationship with MSI for 101 regional CRC patients. MSI status was detected by immunohistochemistry. Identifying MSI in CRCs may help personalize therapy planning. As the distribution of the features may vary from population to population, further investigations are needed on this topic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Cesmecioglu Karavin et al.)

Purpose: This study aimed to evaluate the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI) in the differentiation of renal cell carcinoma (RCC) subtypes., Methods: This is a retrospective diagnostic performance study, in which the diagnostic performances of mpMRI features were evaluated to differentiate clear cell RCC (ccRCC) from non-clear cell RCC (non-ccRCC). Adult patients who were evaluated using a 3-Tesla dynamic contrast-enhanced mpMRI before undergoing partial or radical nephrectomy for possible malignant renal tumors were included in the study. Signal intensity change percentages (SICP) between contrast-enhanced phases and pre-administration period for both the tumor and normal renal cortex, and tumor-to-cortex enhancement index (TCEI); tumor apparent diffusion coefficient (ADC) values; tumor-to-cortex ADC ratio; and a scale which was developed according to the tumor signal intensities on the axial fat-suppressed T2-weighted Half-Fourier Acquisition Single-shot Turbo spin Echo (HASTE) images were used in ROC analysis to estimate the presence of ccRCC in the patients. The reference test positivity was the histopathologic examination of the surgical specimens., Results: Ninety-eight tumors from 91 patients were included in the study, and 59 of them were ccRCC, 29 were pRCC, and 10 were chRCC. The mpMRI features that had the three highest sensitivity rates were excretory phase SICP, T2-weighted HASTE scale score, and corticomedullary phase TCEI (93.2%, 91.5%, and 86.4%, respectively). However, those with the three highest specificity rates were nephrographic phase TCEI, excretory phase TCEI, and tumor ADC value (94.9%, 94.9%, and 89.7%, respectively)., Conclusion: Several parameters on mpMRI showed an acceptable performance to differentiate ccRCC from non-ccRCC., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study aimed to assess the possible association between cognitive impairment and two important biochemical biomarkers of oxidative stress, thiol-disulfide homeostasis (TDH), and ischemia-modified albumin (IMA) in patients with multiple sclerosis (MS). This study included 85 patients with MS (38 treatment-naïve relapsing-remitting MS (RRMS), 31 RRMS on fingolimod therapy, and 16 secondary progressive MS (SPMS)) and 33 healthy controls. Cognitive evaluation was carried out by applying the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) test battery and the scores were adjusted for age and years of education. Plasma TDH was assessed using an automated method and plasma IMA levels were determined using the cobalt-albumin binding assay. Plasma native thiol and total thiol levels were significantly decreased in patients with SPMS when compared with the naïve patients and healthy controls. Cognitive impairment was detected in 47.4% of naïve patients, 64.5% of patients on fingolimod therapy, and 80% of patients with SPMS. Naïve patients or patients on fingolimod therapy who were cognitively impaired had significantly decreased levels of native thiol and total thiol compared to the cognitively normal patients. Logistic regression analysis revealed total thiol and native thiol to be significantly associated with cognitive impairment in naïve patients and patients on fingolimod therapy. Significant correlations were determined between BICAMS scores, TDH, IMA, clinical indices of disease severity (EDSS and MSSS), and magnetic resonance imaging parameters. This study has shown for the first time that plasma TDH parameters are associated with cognitive impairment in MS., (© 2023 Wiley Periodicals LLC.)

Introduction: Fingolimod is the first oral immunomodulatory treatment used as secondary care therapy in the treatment of multiple sclerosis for the last 10 years. The objective of our study is to reveal the experiences of the first generic fingolimod active ingredient treatment in different centers across Turkey., Method: The first generic fingolimod efficacy and safety data of patients followed-up in 29 different clinical multiple sclerosis units in Turkey were analyzed retrospectively. Data regarding efficacy and safety of the patients were transferred to the data system both before the treatment and on the 6th, 12 th and 24 th month following the treatment. The data were analyzed using the IBM SPSS 20.00. P value of <0.05 was considered to be statistically significant., Results: A total of 508 multiple sclerosis patients, 331 of whom were women, were included in the study. Upon comparing the Expanded Disability Status values before and after the treatment, a significant decrease was observed, especially at month 6 and thereafter. Since bradycardia occurred in 11 of the patients (2.3%), the first dose had to be longer than 6 hours. During the observation of the first dose, no issues that could prevent the use of the drug occured. Side effects were seen in 49 (10.3%) patients during the course of fingolimod treatment. Respectively, the most frequent side effects were bradycardia, hypotension, headache, dizziness and tachycardia., Conclusion: The observed results regarding efficacy and safety were similar to clinical trial data in the literature and real life data in terms of the first equivalent with fingolimod active ingredient., Competing Interests: Conflict of Interest: The authors declared that there is no conflict of interest., (Copyright: © 2023 Turkish Neuropsychiatric Society.)

Introduction: There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings., Methods: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings., Results: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p &lt; 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172)., Conclusion: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury., (© 2023 S. Karger AG, Basel.)

Background: This study aimed to explore the possible association of single nucleotide polymorphisms (SNPs) in the upstream (rs9402373) and downstream regions (rs9399005 and rs12526196) of the gene encoding connective tissue growth factor (CTGF/CCN2) with relapsing-remitting multiple sclerosis (RRMS) risk and clinical parameters including disability scores and rate of disability progression., Materials and Methods: In total, 200 patients with RRMS and 305 controls were genotyped using real-time PCR (rs1252696 C/T and rs9402373 G/C) or PCR-RFLP (rs9399005 C/T) methods. Furthermore, the association between these genotypes and clinical parameters including Expanded Disability Status Scale (EDSS) score, Multiple Sclerosis Severity Score (MSSS), age at onset, duration of disease, duration of treatment, and presence of contrast-enhancing lesions was analyzed., Results: rs9399005 genotypes TT and CT in the dominant model were significant predictors of RRMS vs. control status by logistic regression analysis (OR = 1.45, 95% CI = 1.01-2.08, P = .04). Moreover, these genotypes for rs9399005 were associated with a MSSS ≥ 2.4 (OR = 3.54, 95% CI = 1.56-8.05, P = .003). In addition, MSSS was lower in patients who had at least one rs12526196C allele than in the corresponding patients with the TT genotype (P = .02)., Conclusion: To our knowledge, this is the first evidence of the involvement of variants around the CTGF gene in MS risk and disability progression., (© 2021. Fondazione Società Italiana di Neurologia.)

Background: COVID-19 is a multisystemic infection with variables consequences depending on individual and comorbid conditions. The course and outcomes of COVID-19 during neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) are not clearly known., Objective/methods: The aim of this study was to examine the features and outcomes of COVID-19 infection in NMOSD and MOGAD patients. The patients' demographic and clinical factors, disease modifying treatment (DMT) used and disease information of COVID-19 infection were recorded. Conditions leading to hospitalization and severe exposure to COVID-19 infection were also analyzed., Results: The study included 63 patients from 25 centers. Thirty-two patients (50.8%) belong to AQP-4 seropositive group, 13 (20.6%) and 18 (28.6%) were in MOG-positive and double-seronegative groups, respectively. Risk factors for severe COVID-19 infection and hospitalization were advanced age, high disability level and the presence of comorbid disease. Disease severity was found to be high in double-seronegative NMOSD and low in MOGAD patients. No statistically significant effect of DMTs on disease severity and hospitalization was found., Conclusion: In NMOSD and MOGAD patients, advanced age, high disability and presence of comorbid disease pose risks for severe COVID-19 infection. There was no direct significant effect of DMTs for COVID-19 infection., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Multiple sclerosis (MS) is an autoimmune neurodegenerative disease of the central nervous system. Sarcopenia, which is characterized by the loss of physical performance and poor outcomes, has recently become the focus of research. However, the relationship between sarcopenia and MS has not yet been investigated. This study aims to determine the prevalence of sarcopenia in MS patients and investigate the factors associated with sarcopenia., Methods: One hundred and one MS patients who can walk without assistance and 55 healthy controls were included. Handgrip strength (HGS) and gait speed tests were applied to all participants. Additionally, anterior thigh muscle thickness (anterior TMT) and skeletal muscle mass index (SSMI) were estimated by ultrasound and bioelectrical impedance analysis (BIA), respectively. According to these tests, MS patients were grouped as either sarcopenic or non-sarcopenic. The groups were compared using clinical and laboratory data, handgrip strength and performance test, Modified Fatigue Impact Scale (MFIS), and the Godin leisure-time exercise questionnaire (GLTEQ)., Results: HGS, gait speed, fat free mass (FFM), SMMI, anterior TMT, and sonographic thigh adjustment ratio (STAR) values in patients with MS were significantly lower than healthy controls for both sexes (for female, p:0.001, p:0.001, p:0.010, p:0.049, p:0.001, and p:0.101, respectively; for male, all p:0.001). Compared with healthy controls, MS patients had a significantly lower GLTEQ score (p:0.001), while the MFIS score (p:0.001) was higher. According to STAR, HGS, and gait speed, sarcopenia was diagnosed in 12 (17.64%) female and 7 (21.21%) male patients with MS. Whole-body sarcopenia was diagnosed in only 11 (10.9%) of the patients by BIA. HGS, gait speed, FFM, anterior TMT, and STAR values in sarcopenic MS patients were significantly lower than in non-sarcopenic for females (p:0.001, p:0.001, p:0.004, p:0.001, and p:0.001, respectively) and males (p:0.001, p:0.001, p:0.011, p:0.003, and p:0.001, respectively). MFIS score was significantly higher in sarcopenic patients than non-sarcopenic for both females (p:0.001) and males (p:0.036), but only the physical fatigue subscale was significantly higher. While the physical fatigue score was negatively correlated with GLTEQ in MS patients (r:-0.276, p:0.005), it was positively correlated with the expanded disability status scale (r:0.409, p:0.001)., Conclusion: We detected that approximately one-fifth of MS patients have sarcopenia. Regional sarcopenia was more prevalent than whole body sarcopenia. We found a high degree of fatigue and lack of exercise in sarcopenic MS patients., (Copyright © 2021. Published by Elsevier B.V.)

Purpose: The aim of this study was to analyze neurocognitive function in patients who underwent continuous flow left ventricular assist device (LVAD) implantation., Material and Method: This cross-sectional study included three groups: LVAD ( n  = 31), heart failure patients ( n  = 26), and healthy volunteers ( n  = 27). The Rey Auditory-Verbal Learning Test (RAVLT), Judgement of Line Orientation Test (JLOT), Trail Making Test (TMT), Stroop Color-Word Interference Test (SCWIT), Verbal Fluency Test (VFT), Symbol-Digit Modality Test (SDMT) were used to assess the neurocognitive functions. Data were analyzed at a median 12 (3-47) months after LVAD implantation. The LVAD patients were also divided by aortic valve opening (AVO) into three subgroups as "closed" ( n  = 9), "1-6" ( n  = 8) and "7-10" ( n  = 14) opening per ten beats and data were re-analyzed accordingly., Results: There was no significant difference among the groups according to SCWIT, JLOT, SDMT, TMT, and VFT scores. Post-hoc analyzes of RAVLT scores showed significant differences between the LVAD and the other two groups in favor of the LVAD group. Also, the patients with AVO "7-10" the response times were longer and learning scores were found to be lower than those without AVO., Conclusion: With continuous-flow LVAD, neurocognitive functions were not impaired. The learning performance was better in cases where there was no AVO and flow was completely device dependent. We may speculate that neurocognitive functions are not worsening with continuous cerebral blood flow and even it may improve learning performance.

Testicular torsion is an emergency, and unless there is an urgent intervention, irreversible ischaemic damage and gonad loss occur in the testicle. We aimed to investigate myricetin's antioxidant properties as well as its protective effect against ischaemia-reperfusion (I/R) damage in the testicular torsion model. A total of 18 rats were divided into three equal groups. Group 1 was the sham group. Group 2: testicular torsion was performed, and orchiectomy was done 2 hr after detorsion. Group 3: received torsion and 1 mg/kg intraperitoneal myricetin was given 30 min before detorsion, and orchiectomy was applied 2 hr after detorsion. We evaluated tissue malondialdehyde, superoxide dismutase, and catalase levels and Johnsen Testicular Biopsy Score to show its histopathological effect. There was a statistically significant decrease in MDA values in myricetin group compared to Group 2 (p < .017). There was no significant difference in the statistical analysis of SOD and CAT values (p = .337 and p = .025). There was a statistically significant difference in testicular I/R damage in the myricetin group compared to Group 1 and Group 2 (p < .017). Myricetin treatment significantly decreased testicular tissue damage compared to the torsion group but did not reach the values close to the control group., (© 2020 Wiley-VCH GmbH.)

Continuous-flow left ventricular assist devices (LVADs) reduce peak systolic flow, increase diastolic flow, and eliminate pulsatility of circulation. Altered blood flow may lead to a change in end-organ perfusion. Analysis of the flow dynamics of the arteries of end organs, such as the brain, may indicate whether an organ is perfused sufficiently. The aim of this study is to evaluate and identify the flow pattern changes of carotid (CA) and middle cerebral arteries (MCA) in LVAD patients and to compare with heart failure patients and healthy volunteers. Eighty-nine individuals were included in this cross-sectional study. Participants were divided into three groups: LVAD patients (n = 31), heart failure patients (n = 26), and healthy volunteers (n = 27). Carotid and transcranial Doppler ultrasonography were performed for all study groups for peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility (PI), and resistive (RI) indices of CA and MCA. Flow dynamics were compared between the groups. Doppler ultrasonographic data were analyzed at a median 12 (3-47) months after LVAD implantation. CA-PSV was lower in LVAD group compared with the other two groups (P < .001), MCA-PSV of LVAD and heart failure groups were similar and lower than healthy volunteers (P < .05). The highest values for CA-EDV were found in the LVAD group (P < .05). MCA-EDV values were found to be lowest in heart failure group (P < .05). For PI and RI, in all CA and MCA, the LVAD group had lower indices compared with the other two groups (P < .001). In addition, MCA flow analysis in patients with LVADs was identified for the first time with this study., (© 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Systemic amyloidosis is a clinical manifestation of the accumulation of amyloid fibrils in tissues because of persistent acute phase elevation and chronic inflammation. Its most common causes are inflammatory diseases and malignancies. Here, we present a 12-year-old girl diagnosed with systemic amyloidosis and Hodgkin lymphoma (HL) who was also previously diagnosed with familial Mediterranean fever (FMF). Despite colchicine treatment for FMF, the patient had a persistent elevation of acute phase reactants and AA-type amyloid deposits were observed in a kidney biopsy. Anakinra, an interleukin-1 antagonist, was added to the treatment. Shortly after the diagnosis of amyloidosis, mediastinal lymphadenopathy was recognized, and she was also diagnosed with HL. A chemotherapy protocol of doxorubicin, bleomycin, vinblastine, and dacarbazine was initiated. After 6 cycles of the chemotherapy and 8 months of the anakinra treatment, no recurrence or residual malignancy was observed and proteinuria was decreased. To the authors' knowledge, this is the first reported case of systemic amyloidosis in the literature associated with both FMF and HL.

Background/aim: This study aimed to evaluate the diagnostic value of vascular indices obtained using 3D power Doppler ultrasound (3D PDUS) in differentiation of benign and malignant thyroid nodules., Materials and Methods: Sixty-seven patients (56 female, 11 male, mean age 44.6) with 81 thyroid nodules exhibiting mixed (peripheral and central) vascularization patterns, with the largest diameter between 10 and 30 mm, were prospectively evaluated using 3D PDUS. Nodule volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated using the Virtual Organ Computer-aided Analysis (VOCAL) software, and these indices were then compared with regard to the cytohistopathology-based diagnosis. The optimum cutoff values for the differentiation of benign and malignant nodules were identified, and diagnostic efficacy was calculated using receiver operating characteristic (ROC) analysis., Results: Fifty-six of the 81 nodules included in this study were diagnosed as benign and 25 as malignant. Vascular indices in malignant nodules were significantly higher than those in benign nodules (P < 0.05). In benign nodules, the mean VI was 11.61 ± 6.88, mean FI was 39.75 ± 3.93, and mean VFI was 4.82 ± 2.94, compared to 18.64 ± 12.81, 41.82 ± 4.43, and 8.17 ± 6.37, respectively, in malignant nodules. The area under the curves (AUCs) was calculated as 0.68, 0.61, and 0.67 for VI, FI, and VFI, respectively. At optimal cutoff values of 10.2 for VI, 40.8 for FI, and 5.5 for VFI, the sensitivity and specificity were 72%/55.4%, 68%/57.1%, and 68%/67.9%, respectively., Conclusion: 3D PDUS can be useful in the characterization of thyroid nodules., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: Nitric oxide synthase (NOS) is present in the brain and cerebral arteries and it enables the synthesis of nitric oxide (NO), which plays a critical role in brain perfusion. Asymmetrical dimethylarginine (ADMA) is an endogenous NOS inhibitor., Objectives: The aim of this study was to evaluate serum ADMA levels, which are an indicator of endothelial dysfunction of the renal functions in patients with acute ischemic stroke, and to determine whether there is a possible correlation between ADMA and NO levels and the l-arginine-to-ADMA ratio., Material and Methods: Fifty-two patients (22 male and 30 female; mean age: 75.2 ±10.1 years) with a diagnosis of acute ischemic stroke in the first 24 h post-stroke and 48 healthy individuals (controls; 13 male and 35 female; mean age: 60.1 ±7.92 years) were included in this study. The risk factors recorded and evaluated were age and gender of the patients, serum lipid levels, serum ADMA levels, nitrate-to-nitrite ratios, l-arginine, l-arginine-to-ADMA ratios, sedimentation rate, C-reactive protein (CRP), urea and creatinine levels, and glomerular filtration ratio (eGFR)., Results: The mean serum ADMA level was 0.48 ±0.23 μM for the patients and 0.36 ±0.18 μM for the controls. The mean NO level was 2.78 ±0.59 μM for the patient group and 4.49 ±2.84 μM for the controls. The ADMA levels for the patient group were significantly higher than for the control group (p = 0.011); the NO levels for the patients were significantly lower than for the controls (p < 0.001). The logistic regression method demonstrated that ADMA and NO levels may be independent risk factors for the patient group, and the receiver operating characteristic (ROC) curve analysis showed that both of these variables were discriminative risk factors., Conclusions: An increased serum level of the NOS inhibitor ADMA was found to be a possible independent risk factor for ischemic stroke.

We aimed to analyze the effects of progressive myelin loss and neurodegeneration seen in patients with multiple sclerosis (MS) on visual tract with electrophysiological and structural tests. Fifty-one patients diagnosed with MS in the Neurology Department were followed up in neuro-ophthalmology outpatient clinic irrespective of their visual symptoms, and were included in our study. The patients were classified as the ones with the history of optic neuritis (group II) and ones without the history (group I) of optic neuritis. The data, including clinical presentation, retinal nerve fiber layer thickness (RNFLT) measurements, pattern visual evoked potential (pVEP) and flash electro retino grams (ERG) test results, were recorded. In our study, comparison of pVEP test latencies of groups I and II with each other, and with those of healthy subjects revealed statistically significant differences (p < 0.05). The analysis of rod functions on ERG did not show any significant changes (p > 0.05). However, both groups showed significantly decreased cone b-wave amplitudes, elongation of latencies, and decreased flicker amplitudes on cone and flicker potentials obtained after light adaptation (p < 0.05). There was significant thinning in RNFLT of the both groups when compared to the normal standards. The difference between two groups was statistically significant (p < 0.05). Axon loss is seen in the optic nerve with subclinical or acute optic neuritis in patients with MS. RNFLT analysis and electrophysiological tests are of great importance in diagnosis of MS, as well as to determine progression and to direct neuroprotective therapy in patients diagnosed with MS. Objective analysis methods gain more importance in the diagnosis and follow-up of MS patients, parallel to technological advancements.

Purpose: To investigate the possible relationship between the nuclear morphometric characteristics (nuclear perimeter, roundness, nuclear area, and nuclear shape) and BRAF mutation status in papillary thyroid carcinoma cases with a prior diagnosis of undetermined cytology., Materials and Methods: Total thyroidectomy specimens obtained from 48 patients with papillary thyroid carcinoma with a prior diagnosis of undetermined cytology were included. Morphometric analysis under light microscopy included measurements of the perimeter, shape factor, nuclear area, and roundness of thyrocyte nuclei from the cytological smear preparations. Mutational analysis, including immunohistochemistry and polymerase chain reaction, was performed in formalin fixed paraffin embedded tissue blocks., Results: BRAF V600E mutation was detected in 7 of 48 cases (14.5%). The nuclear perimeter and nuclear area in mutated cases were significantly higher than the wild type (p = 0.005). Shape factor (p = 0.681) and roundness (p = 0.752) values did not significantly differ between the wild-type and mutant groups. No significant relationship was evident between BRAF expression and BRAF point mutation., Conclusion: In cases with positivity for BRAF mutation, the nuclear perimeter and nuclear area were significantly increased. These findings suggest that morphometric variables are predictive markers for papillary thyroid carcinoma cases with positivity for BRAF mutation. However, further trials on larger series are warranted to understand the significance and predictive value of nuclear morphometric analysis in these circumstances.

Objective: The aim of this study is to evaluate the effects of an intratympanic gentamicin-dexamethasone combination on the inner ear., Materials and Methods: Twenty-six Wistar albino rats were divided into four groups: Group I (Control), group II (Intratympanic dexamethasone; ITD), group III (Intratympanic gentamicin; ITG), and group IV (Intratympanic gentamicin and dexamethasone; ITGD). On the first day after basal auditory brainstem response (ABR) measurements, the ITG group received 0.03 mL of intratympanic gentamicin (26.7 mg/mL). Intratympanic injection of 0.06 mL of a solution containing 13.35 mg/mL gentamicin and 2 mg/mL dexamethasone was performed in the ITGD group. 0.03 mL of physiological intratympanic serum and dexamethasone (4 mg/mL) was applied in control and ITD groups, respectively. On the 7th day, ABR measurements were repeated and vestibular functions were evaluated. On the 21th day, ABR and vestibular tests were repeated, and the animals were sacrificed for histopathological investigation., Results: The ITG group's hearing thresholds deteriorated in all frequencies. The ITGD group's hearing thresholds were significantly better than the ITG group, except at 8 kHz on the 7th day and in all frequencies at the 21th day measurements. The vestibular function scores of the ITG and ITGD groups were higher than the controls. Apoptotic changes were seen in cochlea, spiral ganglion, and vestibule of the ITG group. Cochlear and vestibular structures were well preserved in the ITGD group, similar to the controls., Conclusion: The ITGD combination led to a significant hearing preservation. Although in subjective vestibular tests, it seemed that vestibulotoxicity was present in both ITG and ITGD groups the histopathological investigations revealed no signs of vestibulotoxicity in the ITGD group in contrast to the ITG group. Further studies using a combination of different concentrations of gentamicin and dexamethasone are needed.