Amaç: Bu çalýþma, koronavirüs hastalýðý 2019 (COVID-19) hastalarýnda hastane içi mortaliteyi öngörmede 3. gün hastanede ölçülen D-dimer deðeri ile baþvuru D-dimer düzeyini karþýlaþtýrmayý amaçlamaktadýr.
Yöntem: Toplamda, COVID-19’lu 231 hasta çalýþmaya dâhil edildi. D-dimer seviyeleri, 0-500 μq/mL normal aralýðý ile immünoturbidimetrik test kullanýlarak ölçüldü. Mevcut araþtýrmada, birincil sonlaným hastane içi tüm nedenlere baðlý mortaliteydi.
Bulgular: Mevcut araþtýrmada, 39 (%16,8) COVID-19 vakasý hastanede yatarken öldü. Çok deðiþkenli analizde; yaþ, D-dimer (3.üncü gün) (OR: 1.00, %95 CI: 1.00-1.00, p<0.001), beyaz küre sayýsý ve kreatinin, COVID-19 vakalarý için hastane içi ölümün baðýmsýz prediktörleri idi. Hastaneye yatýþýn 3’üncü gününde bakýlan D-dimer seviyesi %83,2 duyarlýlýk ve %83,6 özgüllük ile ideal deðeri 774 μq/mL’di (eðri altýndaki alan (AUC): 0.903,%95 GA: 0,836-0.968; p<0.01). Hastaneye yatýþýn 3’üncü günündeki D-dimer düzeyinin, baþvurdaki D-dimer düzeyinden daha yüksek duyarlýlýða (sýrasýyla %83,2’ye karþý %67,6) ve AUC deðerine (sýrasýyla 0,903’e karþý 0,799) sahip olduðu saptandý.
Sonuç: Bu araþtýrmadaki temel bulgu, COVID-19 hastalarýnda hastaneye yatýþýnýn 3’üncü günündeki D-dimer yükselmesinin, hastaneye baþvuru sýrasýndaki D-dimer seviyesine göre hastane içi mortalitenin daha duyarlý bir prediktörü olmasýdýr. COVID-19 hastalýðý olan hastalarda D-dimer düzeyi açýsýndan kesin prognozu tahmin etmek için daha fazla araþtýrmaya ihtiyaç duyulsa da, 3. gün yatýþtaki D-dimer düzeyinin rutinde prognostik bir belirteç olarak kullanýlma potansiyeline sahip olduðunu düþünmekteyiz.

Objective: The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases.
Method: In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0-500 μg/mL. In the current research, the primary outcome was the in-hospital mortality.
Results: In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00-1.00, p<0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836-0.968; p<0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively).
Conclusion: The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice.

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Amaç: Ýntrakanaliküler vestibüler schwannomlu (ICVS) olgularda Gamma Knife Radyocerrahisi (GKR) sonrasý beyin sapý subkortikal iþitsel yollarda DTG (Difüzyon Tensör Görüntüleme) parametrelerinde deðiþiklik olup olmadýðýný araþtýrmak ve tümör hacmi ile ADC (görünür difüzyon katsayýsý) ve FA (görünür difüzyon katsayýsý) deðerleri arasýndaki iliþkiyi analiz etmek
Yöntem: ICVS’li 17 hasta radyocerrahi öncesi ve sonrasý deðerlendirildi. Lateral lemniscus (LL) ve inferior kollikulus (IC) ADC ve FA deðerleri ve tümör hacmi hesaplandý. Radyocerrahi tedavisine yanýt verenler Grup 1, yeterli yanýt vermeyenler ise Grup 2 olarak sýnýflandýrýldý. ADC ve FA deðerleri ile tümor hacim deðiþiklikleri arasýndaki iliþki analiz edildi.
Bulgular: Radyocerrahi sonrasý tümör hacmi belirgin azalmýþtý. GKR sonrasý tümörden elde edilen ADC deðerleri arttý (p: 0,002). GKR öncesi ve sonrasý LL ve IC’de FA ve ADC deðerleri (n: 17) açýsýndan anlamlý farklýlýk saptanmadý. Tedaviye yanýt ile GKR sonrasý kontralateral LL ADC deðerleri arasýnda pozitif korelasyon mevcuttu (p=0,005, r: 0,652). GKR sonrasý kontralateral IC FA deðerleri ile tedaviye yanýt arasýnda negatif korelasyon saptandý (p=0,017, r: -0,568). Grup 1 ile Grup 2 arasýnda kontralateral LL ADC (p=0,03) ve IC FA deðerleri (p=0,017) açýsýndan anlamlý fark vardý.
Sonuç: Kohlear sinir ve subkortikal iþitme yolaklarýn düþük rejenerasyon potansiyeli sahip olmasý nedeniyle LL ve IC’deki ADC ve FA deðiþiklikleri mevcut olan intrakanaliküler tümör varlýðý ile açýklanabilir. Radyocerrahi, beyin sapý düzeyinde subkortikal iþitme yollarýna ek hasar vermediðinden dolayý GKR’nin ICVS’li hastalarda güvenle kullanýlabilecek noninvaziv bir tedavi yöntemi olduðunu düþünüyoruz.

Objective: To investigate changes in DTI (Diffusion Tensor Imaging) parameters in brainstem subcortical auditory pathways after Gamma Knife Radiosurgery (GKR) in patients with intracanalicular vestibular schwannoma (ICVS) and to analyze the relationship between tumor volume and ADC (apparent diffusion coefficient) and FA (fractional anisotropy) values.
Method: Seventeen patients with ICVS were evaluated before and after GKR. ADC and FA values of the lateral lemniscus (LL) and inferior colliculus (IC) and tumor volume were calculated. Patients who responded to GKR were classified as Group 1 and those who did not respond adequately as Group 2. The relationship between ADC and FA values and changes in tumor volume were analyzed.
Results: Tumor volume significantly decreased after GKR. ADC values obtained from the tumor increased after GKR (p: 0.002). There was no significant difference in LL and IC before and after GKR in terms of FA and ADC values (n: 17). There was a positive correlation between response to treatment and contralateral LL ADC values after GKR (p=0.005, r: 0.652). There was a negative correlation between contralateral IC FA values after GKR and response to treatment (p=0.017, r: -0.568). There was a significant difference between Groups 1 and 2 in regards to contralateral LL ADC (p=0.03) and IC FA values (p=0.017).
Conclusion: Since the cochlear nerve and subcortical auditory pathways have low regeneration potential after nerve damage, ADC and FA changes in LL and IC may be explained with the presence of intracanalicular tumors prior to GKR. Since GKR does not cause additional damage to the subcortical auditory pathways at the brainstem level, we think that GKR is a noninvasive treatment method that can be used safely in patients with ICVS.

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Objective: To detect factors related with loss to follow-up (LTF) in neonatal hearing screening (NHS) program of one institution in a developing country.
Methods: A prospective study was planned based on the data collected in a pilot study conducted a year before in the same institution. In this pilot study, hearing screening was performed before hospital discharge for every infant (1217 newborns) in six months period. Total referral rate was 19.1% (223/1217). Loss to follow-up (LTF) was 38.1% (85/223). Telephonic interviews were done with 50 parents who had not come with their child to the second hearing test. For these telephonic interviews the questionnaire with four sections (socio-demographic information; information about pregnancy, birth, and present health condition of the child; caregiver knowledge of neonatal hearing screening, and reasons for default on follow-up) was created.
Results: The mothers participated in this study were 29.1 years (±5.2 SD) of age in average. Place of residence was mostly rural (64%; n=32) with 39.4 Km (±24.8 SD) away from from the rescreen referral center. Their knowledge on neonatal hearing screening, hearing impairment incidence or treatment opportunities was at a very low level. Caregivers’ perceptions that follow-up was unnecessary (50%; n=25), was most frequently given reason for follow-up default, followed by newborns bad health condition (12%; n=6) and forgetting about the follow-up visits (8%; n=6).
Conclusion: The main reason for default in follow-up in our study was caregiver’s poor knowledge about this topic.

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Amaç: Malign otitis eksterna esas olarak yaþlý diyabetik hastalarý etkileyen ve ölümle sonuçlanabilen ciddi bir hastalýktýr. Hastalýðýn ilerleyiþi arasýnda tedavi yanýtlarý ile klinik ve radyolojik parametreler arasýndaki iliþkinin deðerlendirilmesi amaçlandý. Ýkincil amaç, malign otitis eksterna tedavisinde klinik sonuçlarýmýzý sunmaktý.
Yöntem: Retrospektif olarak tek merkezde yapýldý. Ýncelenen veriler arasýnda þikayet öyküsü, semptomlarýn süresi, hiperbarik oksijen tedavisi eklenmesi, cerrahi giriþim varlýðý, patolojik bulgular, kültür pozitifliði ve mikroorganizma, laboratuvar bulgularý, sintigrafi, görüntüleme yöntemleri ve hastalýðýn sonucu yer aldý.
Bulgular: Çalýþmamýza 17 kadýn (%65,4) ve 9 erkek (%34,6) olmak üzere toplam 26 malign eksternal otitisli hasta dahil edildi. Tedaviye baþlamadan önce semptom süresi, Hiperbarik oksijen tedavisi sonucu olumlu etkilemedi. Enflamatuar belirteçler ve Peleg evreleme, tedavi yanýtýný önemli ölçüde yansýtýyordu.
Sonuç: Enflamatuar parametrelerin yakýndan izlenmesi prognoz tahmininde anahtar noktadýr. Yönetimin planlanmasý ve sonuçlarýn tahmin edilmesi, hastalýðýn derecesinin uygun radyolojik ve klinik deðerlendirmesine dayanýr. MOE deðerlendirmesinde, verilerin karþýlaþtýrýlabilir bir þekilde havuzlanmasý için evrensel puanlama sistemleri tercih edilmelidir.

Objective: Malignant otitis externa (MOE) is a serious disease affecting mainly the elderly diabetic patients that may result in mortality. It was aimed to evaluate the relationship between treatment responses and clinical and radiologic parameters among progress of the disease. Secondary aim was to present our clinical outcomes in the treatment of malignant otitis externa.
Method: This study was retrospectively conducted in a single center. Reviewed data included history of complaints, duration of symptoms, addition of hyperbaric oxygen treatment, presence of surgical intervention, pathological findings, culture positivity and microorganism, laboratory findings, scintigraphy, imaging modalities and outcome of disease.
Result: A total of 26 cases with malignant external otitis including 17 females (65.4%) and nine males (34.6%) patients were included in our study. Duration of symptoms before the initiation of treatment, and hyperbaric oxygen treatment did not positively influence the outcome. Inflammatory markers and Peleg staging significantly reflected the treatment response.
Conclusion: Close monitoring of inflammatory parameters is the key point in the prediction of prognosis. Planning the management and predicting the outcomes rely on proper radiological and clinical assessment of the extent of disease. In the assessment of MOE, universal scoring systems should be preferred for pooling the data in comparable manner.

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Amaç: Bu çalýþma, kanseri olan ve olmayan yüksek riskli olmayan pulmoner emboli (PE) hastalarýnda pulmoner bilgisayarlý tomografik anjiyografide (PBTA) PE lokalizasyonu, trombüs yükü, sað ventrikül disfonksiyonu (SVD), serum D-dimer, serum kardiyak troponin I (kTnI) ve alt ekstremite derin ven trombozu (DVT) varlýðýnýn karþýlaþtýrýlmasýný amaçlamýþtýr.
Yöntem: Her hasta için trombüs yükü Miller Skoru ile hesaplandý. PE yeri PTBA’da deðerlendirildi. Serum D-dimer, kTnI düzeyleri ölçüldü. Hastalara SVD için ekokardiyografi ve DVT için alt ekstremite renkli mod doppler ultrasonografi yapýldý.
Bulgular: PE tanýlý yetmiþ bir hasta çalýþmaya alýndý. Hastalar kanser varlýðýna göre iki gruba ayrýldý. Ýki grup arasýnda D-dimer düzeyleri (p=0,15), PE yeri (p=0,67), trombüs yükü (p=0,34), SVD (p=0,28) ve DVT (p=0,33) yönünden istatistiki anlamlý bir fark saptanmadý. Kanseri olan ve PE tanýsý konulan hastalar, kanser tanýsý olmayanlara göre istatistiksel olarak anlamlý derecede daha yüksek kTnI düzeylerine sahipti (p=0,03).
Sonuç: Kanseri olan ve olmayan PE tanýsý konulan hastalar arasýnda D-dimer, trombüs yükü, emboli yerleþimi, SVD ve DVT varlýðý açýsýndan fark saptanmadý. Kanseri olan yüksek riskli olmayan PE hastalarýnda kTnI düzeyleri, kanseri olmayan yüksek riskli olmayan PE hastalarýndan daha yüksekti.

Objective: This study aimed to compare the pulmonary embolism (PE) location and clot burden on computed tomography pulmonary angiography (CTPA), the degree of right ventricular dysfunction (RVD), D-dimer, and cardiac troponin I (cTnI) levels, and the presence of a lower extremity deep venous thrombosis (DVT) in patients with and without cancer diagnosed with a non high risk pulmonary embolism (PE).
Method: We calculated Miller score for each patient for clot burden. The location of PE was also evaluated at CTPA. D-dimer and cardiac cTnI levels were measured. Patients had echocardiography for RVD and lower extremity color flow Doppler ultrasonography for DVT.
Results: The study included 71 patients with PE. The patients were divided into two groups according to the presence of cancer. There was no statistically significant difference for D-dimer levels (P=0.15), PE location (p=0.67), clot burden (P=0.34), RVD (P=0.28) and DVT (P=0.33) between groups (P=0.15). Cancer patients diagnosed as PE had statistically significantly higher levels of cTnI than those who were diagnosed as PE without cancer (P=0.03).
Conclusion: There was no significant difference between patients diagnosed as PE with and without cancer in terms of D-dimer levels, clot burden and emboli location, RVD and DVT. cTnI levels were higher in non-high risk PE patients with cancer than these patients without cancer.cancer.

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Objective: To assess the influence of benign mass lesions in the superficial lobe of parotid on the known anatomic landmarks for identifying the facial nerve trunk.
Method: Patients with unilateral biopsy-proven benign mass lesions in the superficial parotid were selected for this observational study. During superficial/partial superficial parotidectomy, distance of the facial nerve trunk from each landmark was assessed using spring calliper and correlated with the lesion’s volume (measured from the pre-operative imaging). At least two identifiers among tragal pointer (TP), posterior belly of digastric muscle (PBDM) and tympanomastoid suture (TMS) were considered.
Results: The study involved 32 patients. The lesions mostly involved the parotid tail (50%) and pretragal region (34.3%), and constituted of pleomorphic adenoma (~66%) and Warthin’s tumor (~9%), the rest being various cysts and hamartomas. TP was universally uncovered, while PBDM and TMS were exposed in 26 and 25 patients, respectively. Average distances between the facial nerve trunk and TP, PBDM and TMS were 12.79 mm (SD=2.33), 9.78 mm (SD=1.21) and 7.58 mm (SD=1.33), respectively. Correlation coefficients between the lesion’s volume and the distance of facial nerve from a given landmark were -0.11, 0.04 and -0.16 for TP, PBDM and TMS, respectively.
Conclusions: TP was the most easily available landmark on surgical dissection, while PBDM was the most consistent and the least variable when volumetric data of the benign mass lesions in the superficial lobe of parotid were considered as a factor influencing the distance from the facial nerve trunk.

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Objective: To provide relevant insight into the current degree of usage of the research potential of students of biomedical sciences in Bosnia and Herzegovina.
Method: The chosen data collection method was online surveying via Google search engine. The target group were students of biomedical sciences in Bosnia and Herzegovina. The surveying was conducted in July 2019, and responses were subjected to descriptive statistics.
Results: Although the majority of participants claimed that they were familiar with the seminar and scientific papers writing methodology and that the related course is available in their faculty’s curriculum, the quality of such courses may be questioned as the majority of study participants self-reported that they do not possess or did not posses necessary knowledge for writing and publishing a scientific paper. Also, the majority of respondents reported that they have never participated in any scientific research, which questions the involvement of students in scientific research in our country as well. More than half of respondents were actively reading scientific papers, but a third of them did not have that habit. Two-thirds of students reported that they have never attended any scientific event where they could learn more about the scientific research methods. Inadequate awareness of the importance of research, lack of students’ interest in making a research, and lack of knowledge were characterized as main obstacles in conducting scientific research according to survey responses.
Conclusion: Information obtained through research indicate that the student potential in scientific research in Bosnia and Herzegovina has not been used in its maximal capacity, requiring several steps to be taken towards its improvement.

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Amaç: Sistemik amiloidoz birçok organý etkileyebilir ve adrenal yetmezlikle sonuçlanabilecek endokrinolojik problemlere sebep olabilir. Renal tutulumlu amiloidoz hastalarýnda ise adrenokortikal rezervi deðerlendirmek zordur. Biz bu çalýþmada farklý kortizol ölçüm yöntemleri ile renal tutulumlu amiloidoz hastalarýnda gizli adrenal problemlerini tespit etmeyi planladýk.
Yöntem: Bu kesitsel çalýþmada renal tutulumu olan amilodoz hastalarýný ve saðlýklý kontrol grubunu adrenal yetmezlik testleri açýsýndan deðerlendirdik. Bazal kortizol ve kortizol baðlayýcý globulin (KBG) ölçüldü. Serum serbest kortizol düzeyi hesaplandý. 250 mcg ACTH stimulasyon testi sonrasý kortizol yanýt testleri deðerlendirildi ve serbest kortizol indeksi (SKI) hesaplandý.
Bulgular: Çalýþmaya 20 amilodoz hastasý ve 25 saðlýklý kontrol grubu dahil edildi. Bazal serum kortizol düzeyleri hasta ve kontrol grubunda benzerdi [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)]. Ancak amiloidoz grubunda ACTH stimulasyon testi sonrasý 60. dk. kortizol yanýtý daha düþüktü [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. 20 hastanýn 8’inde (40%) bu deðer <500 nmol/L olarak bulundu. Ancak sadece bu sekiz hastanýn üçünde (15%) SKI <12 nmol/mg olarak bulundu. Bu üç hasta klinik olarak da adrenal yetmezlikle uyumlu olabilecek bulgular taþýyordu.
Sonuç: Aðýr proteinürisi olan renal tutulumlu amiloidoz hastalarýnda, adrenal yetmezlik araþtýrýlýrken sadece ACTH stimulasyon testinin kullanýlmasý yanlýþ pozitifliklere sebep olabilir. Bu grup hastalarý SKI gibi hesaplanmýþ ölçümlerle birlikte deðerlendirmek daha uygun olacaktýr.

Objective: Systemic amyloidosis may affect many organs, and may cause endocrinologic problems which may result in adrenal insufficiency. However, assessment of adrenocortical reserve is challenging in amyloidosis patients with renal involvement. We aimed to evaluate adrenocortical reserve with various methods of cortisol measurement to determine any occult clinical condition.
Methods: Patients with renal amyloidosis and healthy subjects were evaluated in this cross-sectional study. Basal cortisol, corticosteroid-binding globulin (CBG), and albumin levels were measured. Serum free cortisol (cFC) level was calculated. Cortisol response tests performed after ACTH stimulation test (250 μg, intravenously) were evaluated, and free cortisol index (FCI) was calculated.
Results: Twenty renal amyloidosis patients, and 25 healthy control subjects were included in the study. Patients and control subjects had similar median serum baseline cortisol levels [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)] whereas patients’ stimulated cortisol levels at the 60th minute were lower [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. The 60th-minute total cortisol levels of 8 of the 20 (40%) amyloidosis patients were <500 nmol/L, but only three of these 8 patients had stimulated FCI <12 nmol/mg suggesting an adrenal insufficiency (15%).
Conclusion: ACTH stimulation test and cortisol measurements should be considered in renal amyloidosis patients with severe proteinuria to avoid false positive results if only ACTH stimulation test is used. It will be appropriate to evaluate this group of patients together with estimated measurements as FCI.

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Lemierre Sendromu, özellikle Fusobacterium necrophorum gibi enfeksiyöz ajanlarla iliþkili internal juguler ven tromboflebiti ile karakterize bir hastalýktýr. Hem orofarenks, hem de gastrointestinal sistemde bulunan Fusobacterium necrophorum hepatik abselerle sonuçlanabilen ve ciddi bir durum olan pilefilebite neden olabilmektedir. Bu tabloya Lemierre sendromunun abdominal varyantý da denmektedir. Gastrointestinal malignitesi bulunan hastalar, özellikle cerrahi geçirenler, Lemierre sendromu abdominal varyantýna daha duyarlý olmaktadýr. Bu hastalýðýn hayatý tehdit eden komplikasyonlarýnýn önüne geçmek için zamanýnda taný gerekmektedir. Malignite hastalarýnda karaciðer metastazlarýyla ayrýmýnda, difüzyon aðýrlýklý manyetik rezonans görüntüleme (MRG) fayda saðlamaktadýr. Erken tedavi hayat kurtarýcý olduðu için radyologlar ve klinisyenler yanlýþ tanýnýn önüne geçmek adýna bu zorlayýcý tanýyý da akýllarýnda bulundurmalýlar.

Lemierre’s syndrome is an illness characterized by internal jugular vein thrombophlebitis related to infectious agents, primarily Fusobacterium necrophorum. These bacteria, residing in both the oropharynx and the gastrointestinal tract, may lead to pylephlebitis, a serious condition that could result in the development of hepatic abscesses. This manifestation of the disease is regarded as the abdominal variant of Lemierre’s syndrome. Patients with gastrointestinal malignancies, especially those who undergo surgeries, are susceptible to the abdominal variant of Lemierre’s syndrome. Timely diagnosis is required to avoid the life-threatening complications of the abdominal variant of Lemierre’s syndrome. Diffusion-weighted magnetic resonance imaging (MRI) might be very useful in differentiating this disease from liver metastasis in patients with malignancies. Radiologists and clinicians need to be aware of this challenging condition to prevent misdiagnosis, since prompt treatment is often lifesaving.

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Non-obstrüktif Koroner Arterlerle birlikte Miyokart Ýnfarktüsü (MINOCA), miyokard infarktüsü teþhisi konulan bir hastada koroner anjiyografide darlýðýn %50’den az olmasý veya dar olmamasý olarak tanýmlanýr.
COVID-19’daki büyük trombojenik yatkýnlýðý nedeniyle, elektrokardiyogram’da ST-elevasyonlu miyokard infarktüsü görülen hastalarda MINOCA sendromu tanýsý nadiren düþünülür. Bu vaka sunumunda, yoðun bakým ünitesi’nde, COVID-19 viral pnömonisine baðlý solunum yetmezliði ile takip eden MINOCA tanýsý almýþ 47 yaþýnda bir erkek hastayý tartýþýyoruz. Hastanýn 12-derivasyonlu elektrokardiyografisinde “inferiyor STEMI” vardý. Acil koroner anjiyografide de sol ön inen arter orta kýsmýnda %30-40 darlýk gösterildi. Bilgisayarlý tomografik pulmoner anjiyografisi normal olan hasta iyileþerek evine taburcu edildi.
MINOCA, COVID-19’a baðlý olarak hiperinflamasyon veya çeþitli süreçlerle tetiklenebilir. MINOCA sendromuyla iliþkili bu süreçleri açýklamak için daha fazla klinik denemeye ihtiyaç vardýr.

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as having a stenosis of less than 50% or no stenosis in coronary angiography in a patient diagnosed with myocardial infarction.
Because of its thrombogenic predisposition in COVID-19, the diagnosis of MINOCA syndrome is rarely thought in the patients with ST-segment elevation myocardial Infarction on electrocardiogram. In this case report, we discuss a 47-year-old male patient diagnosed with MINOCA who was followed up with respiratory failure due to COVID-19 viral pneumonia in intensive care unit. His 12-lead electrocardiogram showed “inferior STEMI”. A 30-40% stenosis was also shown in the midportion of left anterior descending artery in emergency coronary angiography. The patient had a normal computed tomographic pulmonary angiography and was discharged with a full recovery.
MINOCA may be triggered by hyperinflammation or various processes due to COVID-19. To explain these processes associated with MINOCA syndrome, further clinical trials are needed.

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Pheochromocytoma is a catecholamine-secreting adrenal tumor and also a rare cause of secondary hypertension in pregnancy. Its low prevalence, nonspecific clinical presentation, and symptoms similar to preeclampsia generate a diagnostic challenge during pregnancy. A 23-year-old hypertensive pregnant woman at 36th gestational week of her first pregnancy was admitted with severe hypertension (210/150 mmHg), headache and proteinuria that made us presume the case as severe preeclampsia. In spite of starting with maximum doses of antihypertensive medications like IV labetolol,and oral nifedipine, loading dose of an anticonvulsant drug, and IV magnesium sulphate, her symptoms persisted. Keeping in view the risks involved to mother and fetus, we delivered the baby by emergency cesarean section. In the postoperative period, along with severe uncontrolled hypertension, she developed tremors, palpitation, and sweating that all led us to further diagnostic workup for secondary causes of hypertension. Eventually, a diagnosis of pheochromocytoma was confirmed by abdominopelvic contrast- enhanced computed tomography and by increased 24-hour urine metanephrine, normetanephrine, and vanillylmandelic acid levels. Subsequently, adrenal suppression was achieved by a multidisciplinary approach, and then she underwent laparoscopic adrenalectomy. This case highlights the importance of maintaining a high index of suspicion and multidisciplinary approach while investigating secondary causes of hypertension in young women, thereby differentiating it from preeclampsia.

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Retropharyngeal calcific tendonitis (RCT) is an aseptic inflammatory process of the superior oblique tendons of the longus colli muscle caused by the deposition of calcium hydroxyapatite crystals. We reported a 23-year-old woman who presented with a sudden onset of neck pain with odynophagia after waking up from sleep. Physical examination showed paracervical point tenderness with limited neck movement in all directions. Prior to surgery, further imaging was requested to aid in diagnosis, which in turn revealed RCT. It is important to be aware that RCT presentation may mimic other severe conditions such as retropharyngeal space abscess or meningitis.

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