Amaç: Yeni koronavirüs hastalýðý (COVID-19) tüm dünyada hýzlý bir þekilde yayýlarak anksiyete bozukluðuna sebep olmuþtur. Yakýn zamanlý çalýþmalar, COVID-19 salgýný sýrasýnda depresyon ve anksiyete prevalansýnda artýþ olduðunu göstermiþtir. Biz bu çalýþmamýzda primer hipertansif hastalarda, pandemi sýrasýnda anksiyete ve depresyon düzeylerini deðerlendirmeyi ve pandemiye baðlý stresin kan basýncý kontrolü üzerindeki etkisini belirlemeyi amaçladýk.
Yöntem: Pandemi öncesinde ve sýrasýnda ayný antihipertansif ilaçlarý kullanmaya devam eden toplam 142 primer hipertansiyon hastasý çalýþmaya dahil edildi. Bu hastalara 24 saatlik Ambulatuar Kan Basýncý Monitorizasyonu (AKBM) yapýldý ve Hastane Anksiyete ve Depresyon Ölçeði (HADS) anketi uygulandý. Pandemiden önceki son 1 yýl için ayný hastalarýn 24 saatlik AKBM kayýtlarýný geriye dönük olarak incelendi.
Bulgular: Gündüz, gece ve 24 saat sistolik kan basýncý ile gündüz, gece ve 24 saat diyastolik kan basýncý, COVID-19 salgýný sýrasýnda pandemi öncesi döneme kýyasla önemli ölçüde yükseldi (p<0.001). Daha yüksek HADS-A skorlarý (HADS-A 7), daha düþük HADS-A skoruna sahip hastalara kýyasla kan basýncýnda çok daha fazla artýþla anlamlý þekilde iliþkilendirildi.
Sonuç: COVID-19 salgýnýna baðlý psikolojik stres, antihipertansif tedavileri deðiþmeyen kontrollü hipertansif hastalarda kan basýncý regülasyonun bozulmasýna sebep olmuþtur.

Objective: The new coronavirus disease (COVID-19) has spread rapidly all over the world and caused anxiety disorders. Recent studies have also shown that the prevalence of depression and anxiety increased during the COVID-19 outbreak. We aimed to evaluate the anxiety and depression levels during the pandemic and identify the effect of pandemic-related stress on blood pressure (BP) control in primary hypertensive patients.
Method: A total of 142 patients with primary hypertension (HT) who continued to use the same antihypertensive drugs before and during the pandemic were included in the study. Twenty-four -hour Ambulatory Blood Pressure Monitoring (ABPM) and the Hospital Anxiety and Depression Scale (HADS) questionnaire were applied to patients. We retrospectively reviewed 24-h ABPM records of the same patients for the year before the pandemic.
Results: Daytime, nighttime and 24 -hour-systolic blood pressure (SBP) levels as well as daytime, nighttime, and 24- hour-diastolic blood pressure (DBP) levels, were significantly elevated during the COVID-19 outbreak compared to the pre-pandemic period (p<0.001). Higher HADS-A scores (HADS-A ≥7) were significantly associated with much greater increase in BP compared to the patients with lower HADS-A scores.
Conclusion: Psychological stress due to the COVID-19 outbreak led to worsening of the regulation of BP in controlled hypertensive patients whose antihypertensive treatments did not change.

Abstract | Full Text PDF

Objective: In the present study, cardiac autonomic functions in CSA patients were evaluated before and after percutaneous coronary intervention (PCI) using heart rate variability (HRV).
Methods: Thirty patients with CSA were recruited from cardiology outpatient clinics of VMMC and Safdarjung hospital, New Delhi, India. For each patient HRV parameters (LF, HF, LF: HF ratio, SDNN, RMSSD, total power, and pNN50) were gathered before and after PCI. Data were compiled and analyzed using licensed statistical software: SPSS version 21.0.
Results: Out of 30 subjects, SDNN (61.47±22.27 vs. 32.24±16.50ms, p<0.0001), RMSSD (53.86±31.41 vs. 28.81±23.80ms, p=0.001) and pNN50 (46.24±34.36 vs. 5.20±6.63, p<0.0001) in post-PCI were significantly higher as compared to the pre-PCI values. There were significant increases in both LF (1193ms2±302.04ms2vs. 1054.60ms2±208 ms2, p<0.001) and HF (991.57±872.40ms2vs. 466.72ms2±257.93ms2, p<0.0001), also in total power (3548.37ms2±807.73ms2vs. 2428 ms2±867.07 ms2, p<0.0001) in post-PCI as compared to pre-PCI. The LF: HF ratio in pre-PCI was higher as compared to post-PCI (1.467±1.639 vs. 1.143±0.852, p=0.805), but the difference was not statistically significant.
Conclusion: In this preliminary study, it is concluded that there is significant improvement in resting cardiovascular parameters, resting autonomic tone as measured by HRV which shows increase in both parasympathetic as well as sympathetic reactivity following revascularization by PCI in CSA patients. Hence, we also suggest that the use of noninvasive tests such as HRV should be done to stratify further risk of disease progression.

Abstract | Full Text PDF

Amaç: Spontan abortus, erken gebeliðin en sýk görülen komplikasyonudur ve tanýnan gebeliklerin % 20’sini etkilemektedir. Kisspeptin, plasental sinsitiyotrofoblastlar tarafýndan salýnmakta olup rahim matrislerine plasental invazyonu düzenlemektedir. Biz bu çalýþmada ilk trimesterin erken gebelik evresindeki gebelik sonuçlarý ile serum kisspeptin düzeyleri arasýnda bir iliþki kurmayý amaçladýk.
Yöntem: Bu prospektif çalýþmada, 7-8 6/7 hafta gebelikleri olan doksan gebe toplam üç gruba ayrýldý: (i) saðlýklý gebelerden oluþan kontrol grubu (n=30), (ii) düþük tehdidi grubu (n=30) ve (iii) spontan düþük grubu (n=30). Maternal serum örnekleri, tam kan sayýmý parametreleri ve kisspeptin seviyeleri analiz edildi.
Bulgular: Vücut kütle indeksi ve gebelik yaþý açýsýndan istatistiksel olarak fark yoktu (p=0.370). Gravida, parite, kürtaj ve yaþayan çocuklar, sosyo-ekonomik düzey ve istihdam dahil olmak üzere ayrýntýlý obstetrik durumlarla ilgili olarak çalýþma gruplarý arasýnda fark yoktu (p>0.05). Nötrofil, lenfosit ve trombosit sayýlarýnýn yaný sýra nötrofil-lenfosit oraný (NLR) ve trombosit-lenfosit oraný (PLR) dahil olmak üzere tam kan sayýmýnýn biyokimyasal parametreleri açýsýndan önemli bir iliþki bulunmadý (p>0.05). Çalýþma gruplarý arasýnda medyan serum kisspeptin seviyeleri anlamlý farklýlýk göstermedi (p=0.153). Korelasyon analiz testi tüm çalýþma gruplarýnda kisspeptin ile diðer çalýþma parametreleri arasýnda bir korelasyonun olmadýðýný gösterdi (p>0.05).
Sonuç: Bulgularýmýz, birinci trimesterin erken gebelik evresinde serum kisspeptin konsantrasyonu ile gebelik sonuçlarý arasýnda herhangi bir iliþkinin olmadýðýný ve serum kisspeptin konsantrasyonunun düþük durumunu canlý gebeliklerden ayýrt etmek için güvenilir bir belirteç olmadýðýný göstermiþtir.

Objective: Spontaneous abortion is the most common complication of early pregnancy, affecting up to 20% of recognized pregnancies. Kisspeptin is predominantly released by placental syncytiotrophoblasts, and regulates their placental invasion into the uterine matrices. We aimed to establish an association of serum kisspeptin levels with pregnancy outcomes during the early gestational stage of the first trimester.
Method: In this prospective study, 90 pregnant women in their 7 to 8 6/7 gestational weeks were classified into three groups: (i) The control group, consisting of healthy pregnant women (n=30), (ii) the threatened abortion group (n=30), and (iii) the spontaneous abortion group (n=30). The maternal serum samples were analyzed for complete blood count parameters and kisspeptin levels.
Results: There was no statistical difference regarding body mass index (BMI) and gestational age (p=0.370). Regarding detailed obstetric notations, including gravida, parity, abortion, and living children, socioeconomic levels, and employment rates, all study groups were comparable (p>0.05, for all). No significant association was found regarding the biochemical parameters of complete blood count, including neutrophil, lymphocyte, and platelet concentrations, as well as neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratios (PLR) (p>0.05, for all). The median serum kisspeptin levels of the study groups did not differ between the groups (p=0.153). Correlation analysis revealed no significant relationship between serum kisspeptin levels and other study parameters in any study groups (p>0.05, for all)
Conclusions: We found no statistically significant relationship between serum kisspeptin concentrations and pregnancy outcomes in the early gestational stage of the first trimester, and serum kisspeptin concentrations did not seem to be a reliable marker to distinguish abortion status from viable pregnancy

Abstract | Full Text PDF

Amaç: Nokturnal hipoventilasyonu (NH) tahmin etmek için arteriyel kan gazý analizinde parsiyel arteriyel karbondioksit basýncý (PaCO2) ile invaziv olmayan bir yöntem olan oksikapnografi ile elde edilen nokturnal end-tidal CO2 (PetCO2) ölçümünün birbiriyle uyumlu olup olmadýðýný araþtýrmak.
Yöntem: Doðrulanmýþ NMD tanýsý olan 6-18 yaþlarý arasýnda 21 hasta kaydedildi. Her hasta, PetCO2, oksijen satürasyonu (SpO2), nabýz sayýsý ve solunum hýzýný kaydetmek için bir orinasal prob ve bir nabýz oksimetre parmak probu kullanýlarak bir nokturnal oksikapnografi çalýþmasýna tabi tutuldu. PaCO2 seviyelerini kaydetmek için gece üç kez (23: 00 pm, 03: 00 am, 07: 00 am) arteriyel kan gazý analizi yapýldý.
Bulgular: Üç kan gazý analizinin ortalama gecelik PaCO2 seviyesi (ortalama PaCO2noct) 41,78±4,69 mmHg idi. Ortalama PaCO2 23: 00 ve PaCO2 07: 00 seviyeleri arasýnda anlamlý bir deðiþiklik gözlendi (p=0,032). NMD grubunda PaCO2, PetCO2 ve SpO2 seviyeleri arasýnda anlamlý bir fark yoktu. PaCO2 07: 00 ve PetCO2 sonuçlarý arasýndaki sýnýflar arasý korelasyon katsayýsý 0,791 (%95 CI: 0,533-0,923); Gecelik ortalama PaCO2 ve PetCO2 arasýndaki sýnýflar arasý korelasyon katsayýsý 0,811 (%95 CI: 0,533-0,923) idi.
Sonuç: Çalýþmamýz, nokturnal PetCO2 ve PaCO2 düzeylerinin istatistiksel olarak karþýlaþtýrýlabilir olduðunu, ancak NMD’de NH’nin erken teþhisi için tek baþýna PaCO2 kullanýmýnýn yeterli olmadýðýný göstermektedir. NH için daha kýsýtlayýcý tanýmlar yapmaya, hipoventilasyonun en iyi tanýmý üzerinde bir anlaþmaya varmak için daha geniþ çalýþma popülasyonlarý ile çalýþmalar yürütmeye ve kýlavuzlarý güncellemeye ihtiyaç vardýr.

Objective: To investigate whether partial arterial carbon dioxide pressure (PaCO2) level in arterial blood gas analysis that was used to predict nocturnal hypoventilation (NH) is concordant with nocturnal end-tidal CO2 (PetCO2) measurement obtained by a noninvasive method of oxycapnography in children with neuromuscular disease (NMD).
Methods: Twenty-one patients aged 6-18 years with a confirmed diagnosis of NMD were enrolled. Each patient underwent a nocturnal oxycapnography study using an orinasal probe and a pulse oximetry finger probe to record PetCO2, oxygen saturation (SpO2), pulse rate, and respiratory rate. Arterial blood gas analysis was performed to record PaCO2 levels on three occasions at night (23: 00 pm, 03: 00 am, 07: 00 am).
Results: The mean overnight PaCO2 level of the three blood gas analyses (mean PaCO2noct) was 41.78±4.69 mmHg. A significant change was observed between mean PaCO2 23: 00 and PaCO2 07: 00 levels (p=0.032). There was no significant difference between PaCO2, PetCO2, and SpO2 levels in the NMD group. The interclass correlation coefficient between PaCO2 07: 00 and PetCO2 levels was 0.791 (95% CI: 0.533-0.923); the interclass correlation coefficient between overnight mean PaCO2 and PetCO2 levels was 0.811 (95% CI: 0.533-0.923).
Conclusion: Our study indicates that nocturnal PetCO2 and PaCO2 levels were statistically comparable but the use of PaCO2 alone is not adequate to make an early diagnosis of NH in NMD. There is a need for making more restrictive definitions for NH, and conducting studies with larger study populations to reach an agreement on the best definition of hypoventilation, and updating consensus guidelines.

Abstract | Full Text PDF

Amaç: Günümüzde sýklýðý hýzla artmakta olan diabetes mellitusun (DM) en sýk komorbiditelerinden biri obezitedir. Aþýrý ve dengesiz beslenmenin yol açtýðý obezite, sýklýkla diyabete eþlik etse de; malnütrisyon da diyabetin bir diðer komplikasyonu olarak karþýmýza çýkmaktadýr. Bu çalýþma diyabetli bireylerdeki malnütrisyon riski sýklýðýnýn incelenmesi amacýyla yapýlmýþtýr.
Yöntem: Bu çalýþma kesitsel bir çalýþmadýr. Þubat 2018 - Mart 2018 tarihleri arasýnda bir üniversite hastanesinin diyabet polikliniðinde takip edilen tip 2 diyabetli hastalar çalýþmaya dahil edildi.Hastalarýn antropometrik ölçümleri ve “Nutritional Risk Screening-2002” (NRS-2002) skorlarý kayýt altýna alýnmýþtýr.
Bulgular: Çalýþmaya 222 (Kadýn: 132, %59,4) hasta alýndý. NRS skoru yüksek (NRS≥3) olan ve (NRS<3) olan iki grup karþýlaþtýrýldýðýnda, yaþ, bel çevresi ve HbA1c açýsýndan iki grup arasýnda da anlamlý bir fark yoktu. Malnütrisyon riski olan grupta sadece BKÝ daha düþük bulundu (p=0.030). Hastalar diyabet tedavileri ve malnütrisyon riski açýsýndan deðerlendirildiðinde tedavi ve malnütrisyon riski açýsýndan fark saptanmadý (p=0.847).
Sonuç: Yapýlan çalýþmada diyabet polikliniðinde takip edilmekte olan ve beden kütle indeksi yüksek olan her yedi diyabetliden birinde malnütrisyon riskinin mevcut olduðu görülmüþtür.

Objective: Obesity is one of the most common comorbidities of diabetes mellitus (DM) whose frequency is rapidly increasing nowadays. Although obesity caused by excessive and unbalanced nutrition often accompanies diabetes; malnutrition is another complication of diabetes. This study was conducted to investigate the frequency of malnutrition in individuals with diabetes.
Method: This study is a cross-sectional study. The patients with type 2 diabetes followed up in the diabetes outpatient clinic of a university hospital between February and March 2018 were included in the study. Anthropometric measurements of the patients and “Nutritional Risk Screening-2002” (NRS-2002) scores were recorded.
Results: A total of 222 (F: 132 59.4%) patients were included in the study. When two groups with higher NRS (≥3) and lower NRS (<3) scores less than 3 were compared, any significant difference was not detected between two groups in terms of age, waist circumference and HbA1c values. Only BMI was found to be lower in the group with malnutrition risk (p: 0.030). When the patients were evaluated in terms of diabetes treatments and risk of malnutrition, any significant intergroup difference was not found (p: 0.847).
Conclusion: It was found that there is a risk of malnutrition in one of every seven diabetics with a high body mass index who were being followed up in the diabetes outpatient clinic.

Abstract | Full Text PDF

Amaç: Difteri-dýþý Corynebacterium suþlarý, mikrobiyolojik sýnýflandýrmalarý ve klinik önemi ile onlarca yýllýk kafa karýþýklýðýnýn ardýndan önemli patojenler olarak kabul edilmiþtir. Bu çalýþmanýn amacý, difteri-dýþý Corynebacterium suþlarýnýn tür tayinin yapýlmasý, biyofilm oluþumu ve antimikrobiyal direnç prevalansýný araþtýrmaktýr.
Yöntem: Ocak 2015-Ocak 2020 tarihleri arasýnda hastanemizde yatarak tedavi gören bakteriyemili hastalarýn kan kültürlerinden difteri olmayan 126 Corynebacterium suþu izole edildi. Kan kültürleri Bactec-9120 sistemi ile analiz edildi. Suþlarýn tanýmlanmasý MALDI-TOF MS (Bruker Daltonics, Almanya) kullanýlarak yapýldý. Antimikrobiyal duyarlýlýklar Mueller-Hinton agarda Kirby-Bauer disk difüzyon yöntemiyle belirlendi ve EUCAST standartlarýna göre deðerlendirildi. Biyofilm oluþumu Congo Red Agar yöntemi ile deðerlendirildi.
Bulgular: Difteri-dýþý Corynebacterium suþlarý arasýnda Corynebacterium striatum ve Corynebacterium matruchotii sýrasýyla 29 ve 26 izolatla en yaygýn suþlardý. Biyofilm üretimi C. striatum suþlarýnda %62,06 (18/29), C. matruchotii suþlarýnda %53,8 (14/26), Corynebacterium afermentans suþlarýnda %50 (9/18), Corynebacterium amycolatum suþlarýnda %50 (6/12) ve Corynebacterium jeikeium suþlarýnda %46 (7/15) olarak tespit edilmiþtir. Çalýþmanýn en sýk izole edilen ilk beþ suþunda, %54 gibi yüksek bir biyofilm oraný bulduk. Penisilin, klindamisin, siprofloksasin, rifampisin, tetrasiklin ve gentamisine direnç oranlarý sýrasýyla %91,2, %87,3, %79,3, %56,3, %45,2 ve %39,6 olarak tespit edildi. 126 suþun tamamý vankomisin ve linezolide duyarlýydý.
Sonuç: Bu sonuçlar, hastanede yatan bakteriyemili hastalarýn kan kültürlerinden izole edilen Corynebacterium suþlarýnýn biyofilm oluþturma yeteneðiyle birlikte çoklu-ilaç direnci gösterdiklerini ve kontaminasyon olarak göz ardý edilmemesi için, tür tayini ve antibiyotik duyarlýlýðýnýn belirlenmesinin önemini vurgulamaktadýr.

Objective: Non-diphtheriae Corynebacterium strains have been recognized as important pathogens after decades of confusion regarding their microbiological classification and clinical significance. The aim of this study was to identify non-diphtheriae Corynebacterium strains and the prevalence of biofilm formation and antimicrobial resistance.
Method: In total, 126 non-diphtheriae Corynebacterium strains were isolated from blood cultures of inpatients with bacteremia in our hospital between January 2015 and January 2020. Blood cultures were analyzed with the Bactec-9120 system. Strains were identified using MALDI-TOF MS (Bruker Daltonics, Germany). Antimicrobial susceptibilities were determined using the Kirby-Bauer disk diffusion method on a Mueller-Hinton agar and evaluated according to EUCAST standards. Biofilm formation was assessed with the Congo Red Agar method.
Results: Corynebacterium striatum and Corynebacterium matruchotii were the most prevalent with 29 and 26 isolates, respectively. Biofilm production was detected in 62.06% (18/29) of C. striatum, in 53.8% (14/26) of C. matruchotii, in 50% (9/18) of Corynebacterium afermentans, 50% (6/12) of Corynebacterium amycolatum, and in 46% (7/15) of Corynebacterium jeikeium strains. Among the five most prevalent strains, we found a high biofilm rate of 54%. The resistance rates to penicillin, clindamycin, ciprofloxacin, rifampicin, tetracycline, and gentamicin were 91.2%, 87.3%, 79.3%, 56.3%, 45.2%, and 39.6%, respectively. All 126 strains were susceptible to vancomycin and linezolid.
Conclusion: Non-diphtheriae Corynebacterium strains isolated from blood cultures of hospitalized patients with bacteremia may have multidrug resistance and the ability to produce biofilm. These results emphasize the importance of identifying strains and determining their antimicrobial susceptibility and biofilm production potential.

Abstract | Full Text PDF

Amaç: Bu çalýþmada, yoðun bakýma pnömoni tanýsý ile yatýrýlmýþ hastalarda hesaplanan Nötrofil/Lenfosit Oraný (NLO) ve Trombosit/Lenfosit Oraný (TLO)’nun; diðer prognostik skorlarla karþýlaþtýrýldýðýnda mortaliteyi belirleme düzeyini ortaya koymak amaçlanmýþtýr.
Yöntem: Ocak 2015 ile Ocak 2018 arasýnda yoðun bakým ünitesine kabul edilen ve çalýþmamýza dahil olma kriterlerini saðlayan toplam 112 hastanýn hastane kayýtlarý retrospektif olarak incelendi. Demografik veriler kaydedildi; NLO, TLO, APACHE II (Akut Fizyoloji ve Saðlýk Deðerlendirmesi Skoru II) ve SOFA (Ardýþýk Organ Yetmezliði Deðerlendirme Skoru) skorlarý kayýtlardan hesaplandý.
Bulgular: Ýncelenen 112 hastanýn 70’i erkekti. Bakýlan risk analizinde erkek cinsiyetin 2,7 kat daha fazla mortalite riskine sahip olduðu anlaþýldý. NLO, TLO, APACHE II ve SOFA’nýn mortaliteyi belirlemede istatistiksel olarak anlamlý olduðu tespit edildi (p<0,001). Risk oranlarýna bakýldýðýnda her 1 birim NLO’nýn %5, SOFA’nýn ise %13 mortalite riskini artýrdýðý belirlendi (p<0,05). Yapýlan ROC (Alýcý iþletim karakteristiði) analizinde ise NLO en güçlü, en spesifik ve sensitif test olarak bulundu. Cut-off deðerleri; NLO’nun 11,3, APACHE II’nin 29,8, TLO’nun 227 ve SOFA’nýn ise 5,5 olarak belirlendi.
Sonuç: NLO ve TLO’nun iyi bir mortalite belirleyicisi olmakla birlikte, basit, ucuz, hýzlý ve baðýmsýz bir gösterge olduðunu düþünmekteyiz.

Objective: In this study, we aimed to reveal the level of predicting mortality of the Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (TLR) calculated in patients hospitalized with the diagnosis of pneumonia in the intensive care unit when compared with other prognostic scores.
Method: The hospital records of 112 patients who were admitted to the intensive care unit between January 2015 and January 2018 and met the inclusion criteria were retrospectively reviewed. The patients’ demographic data, the NLR and PLR levels, and the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores were calculated from the patient files.
Results: Of the 112 patients examined, 70 were males. The risk analysis showed that the male gender had 2.7 times higher risk of mortality. The NLR, PLR, APACHE II, and SOFA values were found statistically significant in predicting mortality (p<0.001). An evaluation of the risk ratios demonstrated that each one point increase in the NLR increased the mortality risk by 5%, and each one point increase in the SOFA score increased the mortality risk by 13% (p<0.05). In the ROC (receiver operating characteristic) analysis, the NLR assessment proved to be the most powerful, most specific, and sensitive test. The cut-off values were 11.3 for the NLR, 227 for the PLR, 29.8 for the APACHE II scores, and 5.5 for the SOFA scores.
Conclusion: We believe that NLR and PLR are strong and independent predictors of mortality that can be easily and cost-effectively tested.

Abstract | Full Text PDF

Amaç: Bu çalýþmada biyopsi iþlemlerini azaltmak amacý ile Manyetik Rezonans Görüntülemenin (MRG) parotis gland tümörlerinin (PGT) malign-benign ayrýmýndaki etkinliði deðerlendirilmiþtir ve operasyon öncesi biyopsi iþleminin azaltýlmasý amaçlanmýþtýr.
Yöntem: 42 hastaya (24 kadýn, 18 erkek, ortalama yaþ; 51,4±15,9) ait 54 parotis gland lezyonu çalýþmaya dahil edildi. Tüm hastalarýn MR görüntüleri ve histopatolojik sonuçlarý retrospektif olarak tarandý. PGT’lerin T1, T2 aðýrlýklý sekanslarda ve kontrast verimi sonrasýnda sinyal intensiteleri ve ortalama ADC deðerleri ölçüldü. Diðer yandan lezyonlarýn kontrastlanma paterni (homojen, heterojen, periferik veya kontrastlanmayan), sýnýrlarý (iyi veya kötü sýnýrlý), boyutlarý, lokalizasyonlarý (yüzeyel lob/derin lob/ her ikisi), perinöral yayýlým, lenfadenopati varlýðý ve komþu dokulara ekstansiyon deðerlendirildi.
Bulgular: PGT’lerin daðýlýmý; 13 malign ve 41 benign lezyon olmak üzere 21 pleomorfik adenom, 18 Warthin tümörü, 3 lenf nodu, 2 mukoepidermoid karsinom, 5 adenoid kistik karsinom, 1 bazal hücreli karsinom, 2 metastaz ve 2 lenfoma þeklindeydi. Morfolojik parametrelerden kötü sýnýr, perinöral yayýlým, lenfadenopati varlýðý ve çevre doku uzaným malign lezyonlarla anlamlý olarak iliþkili bulundu (p<0.01). Malign lezyonlarýn ADC deðerleri benignlere göre anlamlý olarak düþük bulundu ( p<0.05). Ayrýca Warthin tümörlerinde ADC deðerleri ve T2 sinyal intensitesi, pleomorfik adenomlardan istatistiksel olarak anlamlý þekilde daha düþüktü ( p<0.05).
Sonuç: Morfolojik özelliklerle birlikte ortalama ADC deðerleri malign tümörleri benignlerden, ADC deðerleri ve T2 sinyalleri ise pleomorfik adenomlarý Warthin tümörlerinden ayýrmaya yardýmcý olarak biyopsi sayýlarýný dolayýsýyla komplikasyonlarýný azaltabilir.

Objective: This study investigated the effectivity of Magnetic Resonance Imaging (MRI) findings and Apparent Diffusion Coefficient (ADC) value in evaluating parotid gland tumors (PGTs), and aimed to reduce the biopsy procedure before surgery.
Methods: This retrospective study included 54 PGTs of 42 patients’ (24 female, 18 male, mean age; 51.4±15.9). All of the patients had an MRI, and histopathologic diagnosis. The signal intensity [T1 and T2 Weighted (W), T1W after intravenous contrast agent injection] and mean ADC values of the PGTs were measured. Also contrast enhancement pattern (homogenous, heterogeneous, peripheral or none), margin features (well or ill-defined), sizes, location (superficial lobe/deeplobe/both), perineural spread, presence of lymphadenopathy, and extension to adjacent structures were noted.
Results: The distribution of PGTs was; 21 pleomorphic adenomas, 18 Warthin tumors, 2 lymph nodes, 2 mucoepidermoid carcinomas, 5 adenoid cystic carcinoma, 1 basal cell carcinoma,2 metastases and 2 lymphomas; (13 malignant and 41 benign lesions). Morphologic parameters; ill-defined margin, perineural spread, lymphadenopathy, and extension to adjacent structures were found to be significantly associated with malign lesions (p<0.01). There was a significant difference between ADC values of malignant and benign PGTs (p<0.05). Also ADC values and T2 signal intensity was significantly lower in Warthin tumors rather than pleomorphic adenomas (p<0.05).
Conclusions: Mean ADC values when considered with morphological features may be accessible methods to distinguish benign and malignant PGTs, also ADC values and T2 signal intensity may be useful for differentiating pleomorphic adenomas from Warthin tumors, thereby reducing the number of biopsies and thus complications.

Abstract | Full Text PDF

Amaç: Hipokolesterolemi kronik hastalýklar ve malignitelerde görülebilen bir lipid metabolizma bozukluðudur. Eriþkin ve çocuk hematolojik malignitelerinde deðiþik dislipidemi profilleri gösterilmiþtir. Bu çalýþmada hematolojik malignite tanýsý olan hastalarda saðlýklý kontrol grubuna göre lipid profilinin özelliklerini deðerlendirilmesi amaçlandý.
Yöntem: Hematolojik malignite tanýsý almýþ 1213 hasta içerisinden tedavi öncesi lipid profili bakýlmýþ 98 hastanýn verileri geriye dönük tarandý. Kontrol grubu olarak 40 saðlýklý birey alýndý. Hasta ve kontrol grubunda total kolesterol, trigliserid (TG), düþük yoðunluklu lipoprotein (LDL) ve yüksek yoðunluklu lipoprotein (HDL) düzeyleri karþýlaþtýrýldý.
Bulgular: Hematolojik maligniteli hastalarda kontrol grubuna göre TG düzeyleri daha yüksek (p=0.02) saptanýrken, total kolesterol, LDL ve HDL daha düþük saptandý. Ürik asit düzeyi artýþýna paralel olarak, TG düzeyinin yüksek (p=0.013), HDL düzeylerinin ise düþük (p=0.022) olduðu görüldü. Hodgkin dýþý lenfoma tanýsý olanlarda Ýnternasyonel Prognostik Ýndex (IPI) skoru ile TG düzeyleri arasýnda iliþki saptandý (p=0.003). Sýnýrlý ve ileri evre lenfomalarda TG, total kolesterol ve LDL deðerleri arasýnda iliþki saptanmaz iken, HDL arasýnda negatif korelasyon gösterildi (p=0.027).
Sonuç: Hematolojik malignitelerde hipertrigliseridemi, LDL ve HDL düþüklüðü olabileceði görülmektedir. Ýnsidental saptanan hipokolesterolemi ve hipertrigliseridemi etyolojisinde kronik hastalýk ve malinitelerin olabileceði deðerlendirilmelidir. Dislipideminin hastalýk patogenezi ve prognozunda etkisinin belirlenmesi için bu konuda çalýþmalara ihtiyaç vardýr.

Objective: Hypocholesterolemia is a metabolism disorder that may be seen in chronic diseases and malignancies. Various dyslipidemia profiles have been shown in adult and pediatric hematological malignancies. We aimed to evaluate the lipid profile properties in patients diagnosed with a hematological malignancy compared to a healthy control group.
Method: Out of 1213 patients diagnosed with hematologic malignancy, the data of 98 patients whose pretreatment lipid profiles had already been studied, were reviewed. Forty healthy individuals were selected as the control group. The levels of total cholesterol, triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were compared.
Results: Triglyceride values were significantly higher (p=0.02), and the total cholesterol, LDL and HDL levels were lower in the study group compared to the control group. Triglyceride values were higher (p=0.013), and HDL levels were lower (p=0.022) in parallel with increases in uric acid levels. There was a significant correlation between the International Prognostic Index (IPI) score and TG (p=0.003) in those diagnosed with non-Hodgkin lymphoma (NHL). Whereas no significant correlation was found between TG, total cholesterol, and LDL values in the limited (early) and advanced stage NHL, while a significant negative correlation was found with HDL (p=0.027).
Conclusion: Hypertriglyceridemia, as well as low LDL and HDL values may be seen in hematological malignancies. It should be kept in mind that there may be chronic diseases and malignancies in the etiology of incidental hypocholesterolemia and hypertriglyceridemia. Further studies are needed on this subject to determine the effects of dyslipidemia on the pathogenesis and prognosis of the disease in hematological malignancies.

Abstract | Full Text PDF

Çocuklar ve bebekler, çoðunun nadir olduðu çeþitli akut ve kronik hastalýklardan etkilenebilirler. Çocuklar için ilaç geliþtirmek, tabletleri veya sert oral katý dozaj formlarýný alamadýklarý için çok zordur. Bunun dýþýnda çocuklar için reçete edilen ilaçlarýn çoðu ruhsatsýzdýr. Klinisyenlerin çözmesi gereken en büyük sorun, çocuklarda dozlamanýn yetiþkinlerde olduðu gibi aðýrlýk veya yüzey alanýna baðlý olmamasý, ilaç emilimi, daðýlýmý, metabolizmasý ve eliminasyonundaki yaþ varyasyonlarý ile ilgili olmasýdýr. Bu nedenle, pediyatrik hastalar için sývý dozajlar, esnek kapsüller, süt bazlý olan ürünler gibi uygun formülasyonlar geliþtirmek için çeþitli terapötik yaklaþýmlar önerilmiþtir. Ayrýca, mevcut týbbi ürünlerin çocuklara uygulanmasý, yetiþkinlerde ortaya çýkabilecek ancak daha yüksek risk taþýyan bazý yan etkilere neden olabilir. Özellikle bebeklerin yetiþkinler için kullanýlan ilaçlarý alarak zehirlenme riski yüksektir. Dahasý, çocuklar bazý ilaç araçlarýnýn tadýna ve kokusuna karþý çok hassastýrlar ve bu durum ebeveynleri tatsýz ve kokusuz ilaçlar aramaya yöneltmektedir. Bu çalýþmada, çocuk hastalarda kullanýlmasý amaçlanan çeþitli kronik ve akut çocukluk hastalýklarý için güncel formülasyonlar özetlenmiþtir. Yazarlar, bu incelemenin, pediyatrik formülasyonlarla çalýþmak isteyen profesyonellerin daha verimli ve çocuða uygun ilaç taþýyýcý sistemlerin tasarlamalarýna yardýmcý olabileceðine inanýyor.

Infants and other children can be affected by various acute, chronic and many of them rare illnesses. Developing drugs for children is very challenging since they cannot intake tablets or hard oral solid dosage forms. Besides, most of the prescribed pediatric medications are unlicensed. The biggest issue that clinicians have to solve is that dosing in children is not based on weight or surface area of the body, as it happened in adults but is related to age variations in drug absorption, distribution, metabolism, and elimination. Thus, for pediatric patients, various therapeutic approaches have been proposed so as to develop suitable formulations such as liquid dosage forms, flexible capsules, milk-based products, etc. In addition, the administration of current pharmaceutical products to children might lead to some serious side effects which can also happen in adults but with a lower risk. Especially, infants are at high risk of getting poisoned by taking drugs used for adults. Moreover, children are very sensitive to the taste and smell of some pharmaceutical vehicles and can resist to intake them and this situation leads parents to search for tasteless and odorless medications. In this study, the current formulations for various diseases intended to be used in pediatric patients as well as various chronic and acute diseases of childhood are summarized. Authors believe that this review can help professionals who want to work with pediatric formulations to design more efficient and child-friendly drug delivery systems.

Abstract | Full Text PDF

Pneumatosis cystoides-like pattern is a group of histopathological features occasionally found in ovarian teratomas. This is a case of laparoscopic ovarian cystectomy performed for incomplete adnexal torsion where histology reported mature ovarian teratoma with “pneumatosis cystoides-like appearance”. This term is used to describe the presence of multiple cystic spaces within the tumor wall. It has been reported also in other organs, such as gastrointestinal tract, urinary bladder and the vagina. It may be secondary to mechanical, bacterial or ischemic causes, with the pathogenesis remaining unclear. It is benign and may exist more often than reported.

Abstract | Full Text PDF

Glioblastoma, also known as glioblastoma multiforme, is an aggressive type of cancer that is made up of abnormal astrocytic cells, but also contain a mixture of different cell types (including blood vessels) and areas of necrosis. It is often seen in the brain and spinal cord, but glioblastomas are rarely found in the third ventricle. In this case, it was diagnosed in a 22-year-old male patient and we intended to draw

Abstract | Full Text PDF

Nasopharyngeal tuberculosis is a rare occurrence, and primarily involves the proximal part of the Eustachian tube. Mechanical obstruction of the Eustachian tube will affect the pressure discrepancy between the middle ear and the external atmosphere, leading to aural fullness, unilateral hearing disturbance, and otitis media. These conditions can be overlooked or mistakenly diagnosed as ear pathology. We report a case of unilateral hearing loss and tinnitus in a 31-year-old healthy woman that was later confirmed to be tuberculosis of the Eustachian tube. In cases with indicators suggesting a high index of suspicion, a thorough examination of the head and neck regions is especially very important. Once it has been diagnosed, Eustachian tuberculosis can be successfully treated with anti-tuberculosis medications.

Abstract | Full Text PDF

Kronik lenfositik lösemi (KLL) yavaþ seyirli, indolen bir hastalýktýr ve seyrinde tümör lizis sendromu (TLS) görülmesi nadirdir. Ibrutinib, KLL tedavisinde giderek daha fazla kullanýlan yeni bir Bruton kinaz (BTK) inhibitörüdür. Ibrutinib tedavisinin atriyal fibrilasyon, kanama, ishal ve enfeksiyon gibi önemli yan etkileri vardýr. Bununla birlikte, ibrutinib tedavisi ile TLS nadiren bildirilmektedir. Bu olguda KLL nüksünden sonra ibrutinib monoterapisi uygulanan ve grade 4 TLS geliþtiren 69 yaþýndaki bir kadýn sunulmaktadýr. Ibrutinib tedavisinin 3. gününde TLS geliþen hastanýn ibrutinib tedavisi kesilerek, hemodiyaliz ile destekleyici tedavi uygulandý. Ibrutinib tedavisi, yedi günlük bir ara verildikten sonra 140 mg dozunda yeniden baþlatýldý ve ek yan etki görülmedi. Ibrutinibe baðlý tümör lizis sendromu artan sayýlarda rapor edilmektedir. Ibrutinibe baðlý TLS yan etkisinin yönetimi hakkýnda bilgi yoktur. Bu hastada ibrutinib tedavisi sonlandýrýlmadý ve kýsa bir aradan sonra tekrar baþlandý. Tümör lizis sendromunun Ibrutinibe baðlý nadiren görülebileceði ve yaþamý tehdit edebileceði unutulmamalýdýr. Ibrutinib tedavisine bu yan etki göz önünde bulundurularak baþlanmalýdýr ve TLS komplikasyonunda ibrutinib tedavisinin sonlandýrýlmasý gerekmeyebilir.

Chronic lymphocytic leukemia (CLL) is a progressive disease with an indolent course, and tumor lysis syndrome (TLS) is rarely seen in CLL. Ibrutinib is a novel bruton kinase (BTK) inhibitor increasingly used in CLL treatment. Ibrutinib has significant side effects such as atrial fibrillation, bleeding, diarrhea, and infections. However, TLS is reported rarely with ibrutinib treatment. This report focuses on a 69-year-old female patient diagnosed with relapsed CLL who developed grade 4 TLS after ibrutinib monotherapy. The patient developed TLS on the third day of ibrutinib treatment necessitating discontinuation of the treatment and initiation of hemodialysis and supportive care. Ibrutinib treatment was re-initiated at a daily dose of 140 mg therapy after an interval of seven days, and then any additional side effect was not seen. Tumor lysis syndrome secondary to ibrutinib has been reported in an increasing number of cases. There is currently no information on managing adverse effects of TLS attributed to ibrutinib. Consequently, ibrutinib treatment of this patient was not terminated, and restarted after a short interval. It must not be forgotten that TLS secondary to ibrutinib treatment may be rarely seen, and can be life-threatening. Treatment with ibrutinib should be initiated in consideration of this side effect, and the development of complication of TLS may not necessitate discontinuation of ibrutinib treatment.

Abstract | Full Text PDF

SARS-CoV-2 enfeksiyonu geçirdikten haftalar hatta aylar sonra, COVID-19 ile iliþkili birden çok sistemi etkileyen enflamatuvar bir sendrom olarak düþünülen ve klinik olarak daha aðýr vakalar bildirilmektedir. Bu durum ilk önce (Mart 2020) çocuklarda COVID-19 ile iliþkili (MIS-C) olarak bildirilmiþtir. Haziran 2020’den beri benzer þekilde, eriþkin olgularda multisistemik inflamatuvar sendrom (MIS-E) farkedilmiþtir. Burada, hafif klinik þiddette COVID-19 enfeksiyonu geçirdikten 47 gün sonra karýn aðrýsý ile baþvuran ve sonrasýnda þiddetli öksürük ve hemen arkasýndan geliþen subkonjonktival kanama, perikardiyal efüzyon, plevral efüzyon, batýn içi mayi gibi multisistemik olarak deðerlendirdiðimiz akut klinik bulgularýn görüldüðü 24 yaþýnda genç eriþkin bir kadýn olgu bildirdik. COVID-19 sürecinde gecikmiþ immün yanýtla birlikte multisistemik enflamatuvar bir sendronumun yanlýzca çocuklarda deðil genç eriþkinlerde de görülebileceði ve þiddetli görünen klinik ve laboratuvar bulgularýn, enflamatuvar sürecin kontrol edilmesi ile düzelebileceði akýlda tutulmalýdýr.

Weeks and even months after recovering from the SARS-CoV-2 infection, clinically more severe cases are being reported, which are suggestive of COVID-19- related multisystemic inflammatory syndromes (MIS). Firstly on March 2020, this condition was reported to be COVID-19 related to children (MIS-C). Since June 2020, a syndrome similar to multisystem inflammatory syndrome in adults (MIS-A) came to be noticed in adults as well. We reported here a case of 24-year-old young woman who had gone to a hospital with abdominal pain and later developed a severe cough, followed by development of subconjunctival bleeding, pericardial effusion, pleural effusion, and intra-abdominal fluid that we deemed them to be acute multisystemic clinical symptoms, 47 days after she had undergone a COVID-19 infection of mild clinical severity. It should be kept in mind that a multisystemic inflammatory syndrome along with a delayed immune response during COVID-19 disease can be seen not only in children but also in young adults, and seemingly severe clinical and laboratory findings can improve by controlling the inflammatory process.

Abstract | Full Text PDF