Olan Hastalarda Research Articles

A Rare Hernia Mimicking Implant in a Patient with Rectal Adenocarcinoma: Internal Herniation.

Internal herniation may be seen more frequently in patients with intra-abdominal surgery and malignancy history. We presented a 58-year-old male patient diagnosed with rectal adenocarcinoma seven years ago with a history of surgery and pelvic radiotherapy. When the abdominal computed tomography (CT) image was taken during routine oncology follow-up, a lesion mimicking a serosal implant on the anterior abdominal wall was detected. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging was performed the suspicion of recurrence. It was concluded that the lesion, which was evaluated as an implant in abdominal CT with 18F-FDG PET/CT imaging, was a spontaneously reducing internal herniation. 18F-FDG PET/CT imaging in cancer patients is crucial in illuminating the suspicion of recurrent lesions in these patients and sheds light on the course of the patients in oncology practice.

Hiperkapnik Solunum Yetmezliği Olan Hastalarda Karbondioksit Klirensinin Klinik Prognoza Etkisi

Aim: Hypercapnic respiratory failure is defined as a carbon dioxide (CO2) level >45 mmHg. High PaCO2 levels are related with increased mortality in acute exacerbation of COPD. In our study, we aimed to determine CO2 clearance value for predicting patients' prognosis. Material and Methods: 68 patients were included in the study. The patients were divided into two as, good and poor prognosis groups according to the outcome. The patients’ demographic information, comorbidities, vital parameters, blood gas results on admission (first measurement) and in the first sixth hour (second measurement), treatment, and outcomes were recorded in data forms. The relation between CO2 change and outcome was evaluated. Results: There was no statistically significant difference in CO2 clearance and delta pCO2 levels between the good and poor prognosis groups (11.7±12 vs. 6.2 ± 23, p=0.205 and -11.77±12.92 mmHg vs. -7.66±24.76 mmHg, p=0.281 respectively). NaHCO3 levels in the second measurement were higher than the first measurement in both good (23.89 ±5.28, 25.78±4.39, p<0.0001) and poor prognosis (23,26±6.05, 23.53 ± 5.05, p<0.0001) groups. And also, pCO2 levels in the second measurement was lower than the first measurement in the good (60.68 ± 11.89, 48.92 ± 14.02, p=0.007) and poor (68.04 ± 20.15, 61.76 ± 22.87, p=0.007) prognosis groups. There was also a significant decrease in lactate levels in the poor prognosis group between the first and the second measurements (p<0.001). Conclusion: Our study revealed that the CO2 clearance calculated in the first six hours in hypercarbic patients who came to the emergency department with shortness of breath was not useful in predicting the short-term prognosis of the patients. However, delta lactate and delta NaHCO3 levels significantly changed in the poor prognosis group.

Biosimilar Rituximab (Redditux) Added to CHOP Chemotherapy for De Novo Diffuse Large B-Cell Lymphoma Patients: Real-Life Single-Center Experience

Redditux® (RED), as a biosimilar rituximab, was approved in Turkey for all indications of the original Mabthera® (MAB) in March 2018. The aim of our study was to evaluate the efficacy and safety of RED in de novo diffuse large B-cell lymphoma. Fifty-one patients received RED combined with the CHOP regimen. The median follow-up was 31 months. The historical control group included 219 patients treated with the MAB-CHOP regimen and the median follow-up time was 38 months. We compared the response rates and survival outcomes of these RED-CHOP and MAB-CHOP cohorts. In the RED cohort, the overall response rate (ORR) at the end of the treatment protocol was 86%, with 37 (72.5%) cases of complete response (CR) and 7 (13.5%) cases of partial response (PR). In the historical MAB cohort, the ORR was 84%, with CR and PR rates of 82% and 2%, respectively. The 24-month progression-free survival (PFS) rates were 73.76% (95% confidence interval [CI]: 0.59-0.84) and 85.2% (95% CI: 0.79-0.90) for the RED and MAB cohorts, respectively (p=0.0106). The 24-month overall survival rates were 78.4% (95% CI: 0.64-0.87) and 81.4% (95% CI: 0.75-0.86) for the RED and MAB cohorts, respectively (p=0.7461). For patients with high revised International Prognostic Index scores, 24-month PFS was 45.5% (95% CI: 0.17-0.71) and 63% (95% CI: 0.37-0.80) for the RED and MAB cohorts, respectively (p=0.0711). In the RED cohort, central nervous system (CNS) relapse was significantly increased compared to the MAB cohort (10% vs. 1.83%, p=0.004). Among the RED cohort, bone involvement at the time of diagnosis was a risk factor for CNS relapse (p=0.028). Thirteen patients died in follow-up. There were no serious adverse events causing the cessation of the drugs. RED has an ORR similar to that of MAB. However, PFS rates were worse in the RED cohort. Additionally, CNS relapse ratio was a major concern for our RED cohort. Large prospective controlled studies and real-life data with longer follow-up are needed to document the non-inferiority of RED compared to MAB.

Primary Soft Tissue Hydatid Cysts

Hydatid cyst disease is a helminthic infection caused by Echinococcus granulous, which is encountered with cysts in many organs, especially the liver and lungs. Soft tissue and intramuscular hydatid cyst are rare even in endemic countries. It is challengig to distinguish subcutaneous and intramuscular hydatid cysts from soft tissue tumors. This study aimed to present the clinical features of primary soft tissue hydatid cyst cases without liver and lung hydatid cyst in the Southeast Anatolian region, where hydatid cyst disease is endemic. Patients admitted to the Şanlıurfa Training and Research Hospital General Surgery and Orthopedics and Traumatology Outpatient Clinic between September 2018 and December 2019 with complaints of pain and/or swelling under the skin and soft tissue were evaluated. After the examinations, the records of the patients who were operated on with a pre-diagnosis of hydatid cyst and whose histopathologic evaluation was reported as a hydatid cyst were reviewed retrospectively. Eight patients were included in the study. The mean age of the patients was 39.75±14.80 years. Lesions were located in neck (12.5%), left thoracic posterior area (25%), gluteus (25%), thigh (12.5%), right upper quadrant of abdominal wall (12.5%), and under the right clavicle (12.5%). When imaging methods were examined, ultrasonography was performed in 7 patients (87.5%), chest computed tomography was performed in 1 patient (12.5%), and magnetic resonance imaging was performed in 2 patients (25%). Diagnosis of hydatid cyst should be considered in the differential diagnosis of soft tissue tumors in countries of endemic regions for hydatid cyst disease such as Southeastern Anatolia Region, Turkey.

Kronik Miyofasiyal Boyun Ağrısı Olan Hastalarda Enstrüman Destekli Yumuşak Doku Mobilizasyonu ve/veya Egzersizin Ağrı, Postüral Denge, Uyku ve Yaşam Kalitesi Üzerine Etkileri: Randomize Kontrollü Bir Çalışma

Amaç: Bu çalışmanın amacı; kronik miyofasiyal boyun ağrısı (KMBA) olan hastalarda, enstrüman destekli yumuşak doku mobilizasyonu (EDYDM) ve/veya egzersizin ağrı, postüral denge, uyku ve yaşam kalitesi üzerine olan etkilerini araştırmaktı. Gereç ve Yöntemler: Çalışmaya 30-50 yaş arası KMBA olan 36'sı kadın, 36'sı erkek toplam 72 hasta dâhil edildi. Hastalar randomize EDYDM grubu, egzersiz grubu ve plasebo grubu olacak şekilde 3 gruba ayrıldı. Bireylerin demografik ve fiziksel özellikleri olgu rapor formu ile kaydedildi. EDYDM grubuna sadece EDYDM, egzersiz grubuna ev egzersiz programı, kontrol grubuna ise plasebo EDYDM uygulandı. Ağrı şiddeti, Görsel Analog Skalası [Visual Analogue Scale (VAS)] ile, denge Dört Adım Kare Testi (DAKT) ve Tek Ayak Üzerinde Durma Testi (TAÜDT) ile, uyku kalitesi Pittsburg Uyku Kalitesi İndeksi (PUKİ) ile, yaşam kalitesi SF-36 Yaşam Kalitesi Ölçeği ile değerlendirildi. Ölçümler tedavi öncesi ve sonrasında tekrarlandı. Bulgular: Çalışmada, EDYDM grubu ve egzersiz grubunda tedavi öncesi ve sonrası VAS, DAKT, TAÜDT, PUKİ ve SF-36 yaşam kalitesi ölçeklerinin alt parametrelerinde anlamlı fark vardı (p0,05). Sonuç: Çalışma sonucunda EDYDM ve egzersiz grubunda VAS, DAKT, TAÜDT, PUKİ ve SF-36 yaşam kalitesi ölçeklerinin alt parametrelerinde anlamlı gelişmeler görülürken, plasebo grubunda anlamlı bir fark yoktu.

Diabetes Mellitus Olan Hastalarda C-MAC Video Laringoskop ve Macintosh Laringoskopun Elektif Trakeal Entübasyon İçin Karşılaştırılması: Randomize Kontrollü Çalışma

Objective: C-MAC video laryngoscope and Macintosh direct laryngoscope were compared in terms of intubation conditions, during elective tracheal intubation in patients with diabetes mellitus (DM) who have a high risk for difficult airway. Material and Methods: One hundred and ten American Society of Anesthesiologist physical class II-III patients with DM undergoing elective surgery were randomized to be intubated using C-MAC video laryngoscope or Macintosh laryngoscope. Glottic view Cormack Lehane (CL) score, intubation time, intubation difficulty scale (IDS) score, and first attempt intubation success were compared. Results: Similar intubation times were detected [Macintosh laryngoscope: 39.6±30.1 seconds; C-MAC: 46.7±35.4 seconds (p=0.098). C-MAC provided significantly better CL scores]. Grade 1 CL laryngeal view was observed in 37 (68%) C-MAC vs. 26 (47.3%) Macintosh laryngoscope intubations (p=0.04). An IDS score of >5 was determined in 11 (20.4%) patients with C-MAC and in 10 (18.2%) with Macintosh laryngoscope (p=0.04), indicating an overall 20.1% moderate-to-severe intubation difficulty (p=0.536). The mean IDS score was 3.2±2.9 and 2.4±3.3 with C-MAC and Macintosh laryngoscopes, (p=0.04). First-attempt intubation success was 83.3% vs. 87.0% with C-MAC vs. Macintosh laryngoscope (p=0.786). Conclusion: In patients with DM, CMAC provided improved glottis visualization, similar intubation time and first-attempt intubation success as a first-attempt intubation device compared with the Macintosh laryngoscope. However IDS scores were higher with the C-MAC. The incidence of actual intubation difficulty was found 20.1% in this diabetic study population.

COVID-19 Enfeksiyonunun Geriatrik Kalça Kırığı Olan Hastalarda Postoperatif Erken Dönem Ağrı Üzerine Etkisi: Retrospektif Kohort Çalışma

Amaç: Kalça kırıkları; geriatrik hastalarda genellikle düşük enerjili travma sonucu oluşan, yaşlının tüm fizyolojisini ve yaşam kalitesini olumsuz etkileyerek yüksek mortalite oranları ile seyreden kendine özgü ciddi bir kırık çeşididir. Kliniği daha da komplike hâle getiren koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisinden etkilenen hastalarda ciddi ağrı oluşur ve kronik ağrı sendromuna neden olabilir. Bu çalışmanın amacı, kalça kırığı olan geriatrik hastalarda COVID-19 enfeksiyonunun ağrının nitelik ve niceliğine etkisini araştırmaktır. Gereç ve Yöntemler: Mart 2019-Mart 2020 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi İbni Sina Hastanesinde, trokanterik kırık cerrahisi uygulanan 26 geriatrik hasta retrospektif olarak değerlendirildi. Hastalar, şiddetli akut solunum sendromu-koronavirüs-2 pozitif (Grup-C) ve negatif (Grup- N) olarak 2 gruba ayrıldı. Ameliyat sonrası ağrı, kısa McGill-Melzack ağrı soru formu (K-MASF) ve Vizüel Analog Skala (VAS) ile değerlendirildi. Hastalar ilk 12 ayda mortalite açısından takip edildi. Bulgular: Grup-C'de 10 hasta ve Grup-N'de 16 hasta değerlendirildi. Grup-C'de ortalama duyusal ağrı skoru 26,3±4,5 ve Grup-N'de 20±8,1 idi (p=0,01). Emosyonel ağrı şiddeti skoru Grup-C'de 9,3±2,0 ve Grup-N'de 6,1±2,8 idi (p=0,005). VAS ile ağrı şiddeti Grup-C'de 7,5±2,2 ve Grup-N'de 5±2,4 idi (p=0,01). On iki aylık takipteki mortalite oranı %26,9'du ve bu hastalarda K-MASF ve VAS skorları daha yüksekti (p<0,05). Sonuç: COVID-19 pozitif olan hastalarda ağrı niceliği ve niteliğinin, negatif olan hastalara göre daha yüksek olduğu görüldü. Postoperatif ağrıya bağlı komplikasyonları önlemek için standart analjezik tedaviler dışında etkili tedavi yöntemleri oluşturulmalıdır.

Pterjium ve Pinguekulası Olan Hastalarda Demografik Özelliklerin ve Semptom Varlığının Değerlendirilmesi: Retrospektif Kesitsel Çalışma

Amaç: Pterjium ve pinguekulası olan hastaları; yaş, cinsiyet, semptom varlığı ve meslek grupları açısından değerlendirmek. Gereç ve Yöntemler: Çalışmaya 1.022 hastanın 2.044 gözü dâhil edildi. Hastalara tam bir oftalmolojik muayene yapıldı. Pterjium ve pinguekula varlı ğı, yaş, cinsiyet, meslek ve semptom varlığı not edildi. İstatistiksel analiz için Fisher'in kesin ki-kare testi kullanıldı. Bulgular: Hastaların yaş ortalaması 44±17,14 yıl (yaş aralığı 13-94), 455'i (%44,52) kadın, 567'si (%55,48) erkek idi. Hastaların 124'ünde (%12,13) pterjium, 898'inde (%87,87) pinguekula, gözlerin 173'ünde (%8,46) pterjium, 1.697'sinde (%83,02) pinguekula izlendi. Kadın ve erkekler arasında, sağ ve sol gözler arasında pterjium ya da pinguekula görülme sıklığı bakımından istatistiksel olarak anlamlı fark yoktu (p>0,05 hepsi için). Pterjiumu olan gözlerin 61'i (%35,26), pinguekulası olan gözlerin 478'i (%28,16) semptomatik olup aradaki fark istatistiksel olarak anlamlı değildi (p=0,290). Pterjiumu olan hastaların 49'unda (%39,51), pinguekulası olanların 799'unda (%88,97) bilateral tutulum vardı (p<0,001). Hastaların 343'ü (%33,56) çiftçi, 298'i (%29,15) ev hanımı, 201'i (%19,66) işçi, 61'i (%5,96) öğrenci, 52'si (%5,08) şoför, 44'ü (%4,30) memur, 11'i (%1,07) esnaf, 7'si (%0,68) kuaför, 3'ü (%0,29) terzi, 1'i ('0,97) ressam ve 1'i ('0,97) müzisyen idi. Sonuç: Pinguekulanı n bilateralitesi daha yüksektir. Pinguekulanın semptom oluşturma sıklığı istatistiksel olarak anlamlı olmasa da pterjiuma göre daha düşüktür Pterjiumun orta ve ileri yaşlarda sıklığı görece artmaktadır.

Geniş Maksiller Rezeksiyonu Olan Hastalarda Yeni Tedavi Yaklaşımları

Prosthetic treatment of the maxillectomy cases are difficult due to the problems to perform sufficient retention, stability and aesthetic. Separation of the oral and nasal passages, impairment of mastication, esthetic and phonetic problems are the main goals of treatment. In this study, the prosthetic treatment of the subtotal maxillectomy patient, who is diagnosed with adenoid cystic carcinoma was described. A patient-specific obturator was fabricated for problems regarding to reduced crest support stabilization and retention. The retention was obtained by certain parts of the obturator, one which is actively engaged to the defect undercuts and one which was designed for the limited opening of the patient's mouth. A latex tube was used for retention which was ligatured, using a 0.1 mm orthodontic wire, around a neighboring bulb portion which suits the defective undercut region. Due to the limitation of mouth opening, the obturator is designed to have a short bulb extension which is attached to the acrylic prosthesis base.

İmmünglobülin A Vaskülitinde Gastrointestinal Sistem Tutulumu için Belirleyici Risk Faktörleri

AMAÇ: İmmünglobulin A vasküliti (IgAV), çocukluk döneminin en sık görülen küçük damar vaskülitidir. Alt ekstremitelerde görülen palpabl purpura karakteristik özelliğidir. Aynı zamanda eklem ağrısı, artrit, gastrointestinal sistem (GİS) ve üriner sistem etkilenmesi oldukça sıktır. Özellikle hastaneye yatışın büyük kısmı GİS tutulumu nedeni ile olmaktadır. Bu çalışmada IgAV’nde GİS tutulumu için risk faktörleri belirlenmeye çalışıldı. &#x0D; GEREÇ ve YÖNTEM: Eylül 2015-Ağustos 2020 yılları arasında hastanemizin çocuk romatoloji kliniğinde IgAV tanısı ile izlenen GİS tutulumu olan ve olmayan toplam 100 hastanın dosyası retrospektif olarak incelendi. Klinik, demografik, laboratuar parametreleri ve uygulanan tedaviler kaydedildi. &#x0D; BULGULAR: 100 (49 K/51 E) hastanın yarısı GİS tutulumu olan ve diğer yarısı GİS tutulumu olmayan hastalardan seçildi. Ortanca tanı yaşı 8 (6,1-9,8) yıldı. Tüm hastalarda palpabl purpura mevcuttu. En sık görülen diğer bulgular artrit (%34) ve artralji (%52) idi. GİS tutulumu olan hastaların tamamında karın ağrısı mevcuttu. Aktif kanama GİS tutulumu olan hastaların %25’inde (n=12) vardı. GİS tutulumu olan ve olmayan hastalar arasında yaş, cinsiyet, diğer klinik bulgular, mevsimsel farklılıklar, tanı anındaki laboratuar parametreleri arasında herhangi bir ilişki saptanmadı. Ancak MEFV gen mutasyonu varlığı, ağır GİS tutulumu olan grupta daha sık tespit edildi (p=0,009). Renal tutulum hastaların %18’inde gelişti. Hastaların tamamı komplikasyonsuz iyileşti. &#x0D; SONUÇ: IgAV’nde GİS tutulumu oldukça sıktır. Bu çalışmada GİS tutulumunda yaş, cinsiyet, diğer klinik bulguların dağılımı, mevsimler gibi farklılıkların GİS tutulumu için belirleyici faktör olmadığını gösterdik. Ancak ağır GİS tutulumu olan hastalarda MEFV gen mutasyonlarının katkısı olabileceği göz önünde bulundurulmalıdır.&#x0D; Abstract &#x0D; AİM: Immunoglobulin A vasculitis (IgAV) is the most common small vessel vasculitis in childhood. It is characteristic of palpable purpura seen in the lower extremities. Also, joint pain, arthritis, gastrointestinal system (GI) and urinary system involvement are quite common. Especially most hospitalizations are due to GI involvement. In this study, it was aimed to determine the risk factors for GI involvement in IgAV.&#x0D; MATERIALS AND METHODS: The files of 100 patients with and without GI involvement who were followed up with a diagnosis of IgAV in the pediatric rheumatology department of our hospital between September 2015 and August 2020 were retrospectively analyzed. Clinical, demographic, laboratory parameters and applied treatments were recorded.&#x0D; RESULTS: Half of the 100 (49 F/51 M) patients were selected from patients with GI involvement and the other half from patients without GI involvement. The median age of diagnosis was 8 (6.1-9.8) years. All patients had palpable purpura. The other most common findings were arthritis (34%) and arthralgia (52%). All patients with GI involvement had abdominal pain. Active bleeding was present in 25% (n = 12) of the patients with GI involvement. No relationship was found between patients with and without GIS involvement, between age, gender, other clinical findings, seasonal differences, and laboratory parameters at the time of diagnosis. However, presence of MEFV gene mutation was detected more frequently in the group with severe GI involvement (p = 0.009). Renal involvement developed in 18% of the patients. All the patients recovered without any complications.&#x0D; CONCLUSION: GI involvement is very common in IgAV. In this study, we showed that differences in GI involvement such as age, gender, distribution of other clinical findings, and seasons are not determinative factors for GI involvement. However, it should be kept in mind that MEFV gene mutations may contribute to patients with severe GI involvement.&#x0D; Key words: IgA vasculitis, gastrointestinal system, risk, MEFV gene

Varikoseli Olan Hastalarda Trombosit Hacim İndekslerinin Değerlendirilmesi

Objective: Varicocele is the abnormal venous dilatation and the tortuosity of the pampiniform plexus. Varicocele has been shown to be related with systemic varicosity in some studies. Platelet volume indices have also been reported to increase in vascular disorders. In this study, we aimed to determine if complete blood count (CBC) parameters especially platelet counts and volume indices could be a practical tool in the diagnosis and follow-up of varicocele. Materials and Methods: The medical records of all patients who underwent varicocelectomy due to grade 2 or 3 clinical varicocele were reviewed. Examined parameters included patient demographic characteristics and preoperative CBC parameters [hemoglobin, white blood cell, platelet, mean platelet volume (MPV) and platelet distribution width (PDW)]. Patients without varicocele, active infection and vascular disorders constituted the control group. Results: The study population consisted of 61 patients with varicocele and 62 control subjects. The mean age of the patients was 28.6 ± 6.2 years. Mean preoperative hemoglobin, WBC, platelet, MPV and PDW were 15.5 ± 1 g/dL, 7.5±1.6 x103 /μL, (236 ± 53.4) x103 /μL, 9.3±1.1 (fL) and 15.2± 3.9 (%), respectively. There was no difference between patients with varicocele and control subjects in terms of age, mean preoperative Hb, WBC and MPV. However, mean preoperative platelet count was significantly lower and mean PDW was significantly higher in varicocele patients compared to controls (p&lt;0.05). Conclusion: We found that PDW is significantly higher in varicocele patients compared to controls. Thus, PDW might be a practical tool in the confirmation of varicocele diagnosis and also be utilized at follow-up after varicocelectomy.

Majmaah Bölgesi'nde (Suudi Arabistan Krallığı) Kardiyovasküler Hastalığı Olan Hastalarda Kardiyak Otonom Fonksiyon ile Metabolik Sendrom Arasındaki İlişki: Vaka Kontrol Gözlem Çalışması

Objective: Lacunae in literature persist regarding the mechanisms connected with the progression from metabolic syndrome (MetS) to Type 2 diabetes and cardiovascular disease (CVD). To validate heart rate variability (HRV), as a tool for progression of CVD in patients visiting cardiovascular outpatient clinic. Material and Methods: This crosssectional study involved screening of 126 patients for the presence of one or more cardiometabolic risk factors and followed with HRV measurement after categorizing them as MetS+ or control MetS-. Results: Time domain analysis showed a significant reduction between male and female of MetS- and MetS+ While frequency domain analysis in MetS+ male showed no difference, MetS+ female showed significant difference in TP and HF indices. With increasing number of metabolic components, the MetS+ males exhibited significant decrease in the time domain and increase in frequency domain indices of HRV. Body mass index (BMI), waist circumference (WC), high-density lipoprotein (HDL), and triglyceride (TG) were associated with time and frequency domain of HRV among MetS+ and MetS- males and females. Low density lipoprotein (LDL) was a significant predictor of SDNN, RRSSD, and NN50 in patients with MetS+ while HDL was a significant predictor of Standard deviation of normal-to-normal intervals (SDNN) and pNN50. BMI was significant predictor of SDNN and pNN50 in MetS- patients and NN50 in MetS+ patients. In MetS+, the significant predictor of HF was WC, TG, HDL and LDL and that of LF were TG and LDL while in MetS-, WC was significant predictor of LF and HDL of LF/HF. Conclusion: MetS+ females showed lower vagal activity and decreased sympathetic predominance as compared to MetS males suggesting greater cardiovascular risk.

Prediction of Stem Cell Mobilization Failure in Patients with Hodgkin and Non-Hodgkin Lymphoma

Objective:Autologous stem cell transplantation (ASCT) is a significant and potentially curative treatment modality for patients with relapsed/refractory lymphoma. Insufficient mobilization and harvest of peripheral stem cells can be a major obstacle for performing ASCT. The aim of this study was to evaluate the factors that might influence mobilization failure in patients with lymphoma.Materials and Methods:Eighty-seven patients diagnosed with non-Hodgkin and Hodgkin lymphoma who underwent stem cell mobilization afterwards at the Hacettepe University Medical School Bone Marrow Transplantation Center, Turkey, between the years of 2000 and 2018 were evaluated.Results:A total of 87 patients were included in this study. In 66 of 87 patients (75.9%), the first mobilization trial was successful. Adequate (≥2x106/kg) CD34+ cells were collected in the first apheresis for 66 patients (9.5±8.1). For 21 of 87 (24.1%), the first mobilization trial was unsuccessful. Therefore, a second mobilization trial was performed for these patients with plerixafor (5.5±3.3). The number of CD34+ cells was significantly higher in patients who were successful in the first mobilization (p=0.002).Conclusion:The success rate of the first mobilization trial was found to be higher in patients with high platelet counts before mobilization and patients who received chemotherapy-based mobilization protocols. In the patients who had mobilization failure in the first trial, plerixafor was used in a later mobilization, and those patients had an adequate amount of stem cells for ASCT. Parameters predicting mobilization failure would allow for preemptive, more cost-effective use of such agents during the first mobilization attempt; however, risk factors for mobilization failure are still not clear.

The association of lipid metabolism and non-alcoholic fatty liver disease in children with obesity.

Aim:Obesity, insulin resistance, and hyperlipidemia have been shown as risk factors for non-alcoholic fatty liver disease. In this study, the association between lipid and lipoprotein metabolism abnormalities and the presence of non-alcoholic fatty liver disease was investigated in patients with obesity.Material and Methods:In this study, the clinical, laboratory and imaging findings of 357 children and adolescent patients (199 girls and 158 boys) aged 2–18 years who were diagnosed as having obesity between 2013 and 2018 were retrospectively analyzed. The clinical and laboratory features of the patients who were diagnosed as having non-alcoholic fatty liver disease using ultrasonography were compared with patients who did not have non-alcoholic fatty liver disease. All lipid and lipoprotein levels were defined as hypo-, normo- and hyperlipidemic in comparison with the reference values according to age and sex.Results:The frequency of non-alcoholic fatty liver disease was 44.5% in the entire study group and was higher in males (p<0.05). The body weight, body mass index, alanine aminotransferase, glucose, insulin, non-high-density lipoprotein-cholesterol, and HOMA-IR scores were found to be higher in the patients with non-alcoholic fatty liver disease, whereas the high-density lipoprotein-cholesterol level was lower (p<0.05). There was no difference in the frequency of non-alcoholic fatty liver disease among the patients with low, normal, and high total cholesterol, triglyceride and low-density lipoprotein-cholesterol levels (p>0.05). The frequency of lipid metabolism disorder (hypolipidemia and/or hyperlipidemia) was found as 77.5% in all patients.Conclusion:Non-alcoholic liver disease and lipid metabolism disorders are common in children and adolescents with obesity. The frequency of non-alcoholic fatty liver disease in hypolipidemic, normolipidemic, and hyperlipidemic patients was not different. This finding indicated that the increase in the amount of body fatty tissue and insulin resistance were more important risk factors in the development of non-alcoholic fatty liver disease.

Miyofasial Ağrı Sendromu Olan Hastalarda Yaş Kupa Tedavisinin Etkinliğini ve Laktik Asit Seviye Değişikliğinin Değerlendirilmesi

Objective: Wet cupping therapy is used as a traditional and complementary therapy with a wide application all around the world for especially pain conditions. The aim of this study was to evaluate the effectiveness of wet cupping therapy (WCT) and to assess the changes in lactic acid (LA) levels in isolated leucocyte of the venous and cupping blood samples in patients with myofascial pain syndrome (MPS). Material and Methods: Patients aged between 18 and 65, and diagnosed with MPS were included the study. The Visual Analogue Scale (VAS) was recorded baseline, at 1st and 3rd months, Nothingham Health Profile (NHP) and Beck Depression Index (BDI) scores were recorded at baseline and 1st month follow-up in patients. The level of LA in isolated leucocyte of venous and cupping blood were also measured before and after 15 days WCT. Results: There was a significant decrease in VAS level from baseline to 1 and 3 months (p<0.001) and in BDI, NHP from baseline to 1 month (p <0.05). We found a significant decrease in the concentration of LA in isolated leucocyte of cupping blood 15 days after WCT (p<0.05). The median level of LA in isolated leucocyte of venous blood was lower than the levels before WCT but it wasn't statistically significant (p>0.05). Conclusion: In conclusion, WCT is found to be effective in clinical improvements of VAS, BDI and NHP scores in our study. This study also suggests that WCT may be eneficial for pain through reducing LA levels in cupping blood in patients with MPS.

5 Alfa Redüktaz Tip 2 Enzim Eksikliği Olan Hastalarda SRD5A2 Geni Metilasyon Değişikliklerinin Araştırılması

Amaç: 5 alfa redüktaz Tip 2 enzim eksikliği; erkek genotipli (46,XY) bireylerde cinsel gelişim bozukluğuna neden olan, otozomal resesif kalıtılan bir hastalıktır. 5 alfa redüktaz Tip 2 enzim eksikliği düşünülen hastalarda en önemli tanı yöntemi genital cilt fibroblast kültürü enzim analizidir. Ancak, pratikte kesin tanı SRD5A2 (Steroid 5 alfa redüktaz alfa polipeptid 2) geni mutasyon analizi ile konulmaktadır. Klinik bulgular 5 alfa redüktaz Tip 2 enzim eksikliğini düşündürmesine rağmen, hastaların bir kısmında dizi analizi ile mutasyon tespit edilememektedir. Bu çalışmada, 5 alfa redüktaz Tip 2 enzim eksikliği ön tanısıyla izlenen ve SRD5A2 geninde dizi analizi ile mutasyon tespit edilmeyen hastalarda metilasyon değişikliklerinin incelenmesi ve mevcut hastalıkla metilasyon değişiklikleri arasında bir ilişki olup olmadığının belirlenmesi amaçlandı. Gereç ve Yöntemler: 5AR2E ön tanısı alan, 46,XY genotipine sahip, dış genital anomalisi olan, beta insan koryonik gonadotropini uyarısına normal testosteron yanıtı veren, testosteron/dihidrotestosteron oranı 8`in üzerinde tespit edilen ve SRD5A2 geninde mutasyon saptanmayan hastalar ile değişik nedenlerle polikliniğimize başvuran 12 sağlıklı ve gönüllü birey kontrol grubu olarak çalışmaya dâhil edildi. Bulgular: Hasta grubunun SRD5A2 genindeki 6 adet CpG adacığının metilasyon oranları, kontrol grubu ile karşılaştırıldığında daha yüksek bulundu ve DNA metilasyonunun SRD5A geninin düzenlenmesinde rol oynayabileceği gösterildi. Sonuç: Değişik nedenlerle genital cilt fibroblast kültüründe enzim analizi yapılamayan ve DNA dizi analizinde mutasyon bulunmayan bu hastalarda, metilasyon değişikliklerinin de değerlendirilmesinin hastalığın genetik etiyolojisinin aydınlatılmasında yararlı olacağı düşünülmektedir.

Kronik İnme Hastalarında Üst Ekstremite Proprioseptif Eğitimin Fonksiyonel Sonuçlara Etkisi Var mıdır?

Objective:We aimed to investigate the effect of upper extremity proprioceptive training on spasticity and functional motor skills in patients with chronic hemiplegia occurring after stroke.Method:Thirty chronic hemiplegic patients (17 females, mean age: 66.47±12.55 years) admitted to the Research Center with a diagnosis of chronic hemiplegia developed after stroke were included in the study. Patients were divided into two groups. The first group received a conventional physiotherapy program (PTR) for 5 days a week and the second group additionally received a proprioceptive training program (PTR-PT) for 5 days a week. Before and 6 weeks after the treatment modified Ashworth scale (MAS), Fugl-Meyer upper extremity motor evaluation scale (FMA) and action-research-arm-test (ARAT) and motor activity log-28 scale (MAL-28) were applied. SSPS-22.0 program was used for statistical evaluation and p <0.05 was considered as the level of statistical significanceResults:There was no difference in MAS scores before and after treatment in the groups (p>0.05). There was a statistically significant improvement in both PTR (p<0.05) and PTR-PT groups (p<0.001) for the FMA, ARAT and MAL-28. scale scores. Although the results obtained in the PTR, and PT groups were more improved, there was a significant result in favor of PTR-PT only regarding the MAL-28 scale scores (p<0.05). It was determined that adding proprioception-based exercises had the greatest effect on FMA, ARAT and MAL-28 in the evaluation of the effect size (>0.3).ConclusionIt was observed that upper extremity proprioceptive training yielded better results in patients with chronic hemiplegia developed after stroke than conventional therapy in increasing the frequency and quality of movement in upper extremity. This result shows that proprioceptive training programs should be added to stroke rehabilitation methods.

Evaluation of clinical and laboratory characteristics of childhood tuberculosis.

Aim:Tuberculosis is one of the oldest and most contagious diseases of human history. One- quarter of the world’s population is infected with the tuberculosis bacillus. Childhood tuberculosis does not have a standard clinical and radiologic description. Herein, we aimed to evaluate the clinical, laboratory, and radiologic findings of childhood tuberculosis.Material and Methods:The medical records of 216 patients hospitalized and treated with a diagnosis of TB between January 2015 and July 2019 in the Division of Pediatric Infectious Diseases in our hospital, were examined retrospectively.Results:One hundred twenty-nine (59.7%) of 216 patients who were diagnosed as having TB were female and 87 (40.3%) were male. The age distribution of the patients was 12.3 (range, 0.33–18) years. One hundred sixty-nine patients (78.2%) had pulmonary, 34 (15.7%) had extrapulmonary, 13 had (6%) both pulmonary and extrapulmonary. One hundred forty-three (66.2%) patients had tuberculin skin test positivity. Acid-resistant bacteria were observed in 46 (21.3%) body fluid samples, and culture positivity was observed in 42 (19.4%) samples. The association of pulmonary tuberculosis and extrapulmonary tuberculosis was found with a higher rate in individuals who lived on minimum wage and in patients who had growth and developmental retardation (p=0.001, p<0.001). The hospitalization time was longer in these patients (p=0.027). The hemoglobin and sodium levels were significantly lower in patients who had extrapulmonary tuberculosis (p=0.044, p=0.002).Conclusion:Although the diagnosis of childhood tuberculosis is difficult due to the nonspecific signs and symptoms, it is a preventable and treatable disease.

Koroner Kronik Total Oklüzyonu Olan Hastalarda Serum Endokan Düzeyi ile Koroner Kollateral Dolaşım Arasındaki İlişki

Introduction: Endocan, a dermatan sulfate proteoglycan, is synthesized and secreted by the vascular endothelium. It is involved in the pathogenesis of vascular diseases, organ-specific inflammations, and angiogenesis. The aim of the present study was to investigate the relationship between serum endocan level and development of coronary collateral circulation (CCC) in patients with stable angina pectoris. Patients and Methods: Patients with stable angina with at least one chronic total coronary occlusion (CTO) (n= 44) and who had normal coronary artery (n= 29) were included in the study. Collateral degree was evaluated according to the Rentrop and Cohen's classification. Patients who had grade 0 or 1 collateral filling were included in the poorly developed collateral group (n= 19), and those with grade 2 or 3 collateral filling were included in the well-developed collateral group (n= 23). Results: Endocan levels were significantly higher in patients in the well CCC group than in those in the poor CCC and control groups (p< 0.001). Endocan level is higher in patients with poorly developed CCC than in the control group. Endocan was only found as an independent predictor of well CCC in regression analysis (odds ratio 1.002, 95% confidence interval (CI) 1.001-1.005, p= 0.001). Receiver operating characteristic curve analysis detected an optimal cut-off value for endocan level of 1773.9 ng/L that predicted the presence of well development of CCC with a sensitivity of 84% and specificity of 63% (area under the receiver operating characteristic (ROC) curve: 0.749, 95% CI: 0.654-0.849, p< 0.001). Conclusion: Elevated endocan level is associated with better CCC in patients with CTO. Endocan may play an important role in the development of CCC.

Ten-year follow-up of children with hydatid cysts.

Aim:Hydatid cystic disease is an endemic parasitic disease that is common in the world. We aimed to review the demographic, clinical and laboratory findings, and treatments and outcomes of children with hydatid cyst disease, and to determine the factors affecting treatment response in two pediatric pulmonology centers in the central region of Turkey.Material and Methods:The clinical records of patients aged below 18 years who were followed up between January 2006 and December 2016 because of hydatid cyst disease were reviewed retrospectively. The patients’ ages at the time of diagnosis, sexes, living areas (rural /urban), dog contact history, presence of hydatid cyst in other family members, symptoms, organs involved, dimensions of cysts, laboratory results, treatments and post treatment responses, follow-up, and outcomes were noted.Results:In a period of 10 years, 50 pediatric patients were followed up with a diagnosis of hydatid cyst. The mean age was 9.3±0.5 years and 33 (66%) of the patients were male. Fifteen patients were living in a rural area and 35 were living in an urban area. Fifteen patients had a history of contact with a dog and 10% had a positive family history. Thirty-six patients had lung involvement, 25 had liver involvement, 14 (28%) had both lung and liver involvement, and six patients had organ involvement other than lung and liver. The indirect hemagglutination test for hydatid cyst was positive in 24 of 40 patients and Echinococcus granulosus-specific IgE positivity was detected in 8 of 17 patients. Surgery was performed in 31 patients with lung involvement and PAIR was performed in 13 patients who had liver involvement. Cyst excision was performed in two patients who had isolated spinal involvement. All patients were treated with albendazole, and additional praziquantel treatment was given to seven patients. Relapse occurred in seven patients in this period. The relapse frequency was higher in patients who had organ involvement other than in the lung and liver (p<0.05), and these patients’ treatment durations were longer compared with the others (p<0.05).Conclusion:Hydatid cysts can involve different organs in children. Patients with organ involvement other than the lung and liver should be followed up carefully in terms of recurrence.