Onset Of Complaints Research Articles

041. A Case of Cholangiocarcinoma in A Young Adolescent

Background: Cholangiocarcinoma usually occurs in 50-70 years age group. Recent study showed an increased incidence in younger age group. We describe a case of Cholangiocarcinoma in an adolescent girl in order to understand its natural history. Case: A 16 year old girl presented with 2 months history of jaundice, itchyness, right upper quadrant abdominal pain, pale stool and dark urine. Initial investigation showed : Total Bilirubin 8.87, (Direct 3.53, Indirect 12.40), SGOT 75, SGPT 56, ALP 240, GGT 59, Hepatitis B and C negative, AFP 1.96, CA19-9 3.1, and CEA 5.1. Imaging showed dilated hepatic duct with 1.5cm mass in mid-Common Bile Duct (CBD). Due to unforeseen personal circumstances, surgery was done 16 months from onset of complaints. Tumor was found at junction of cystic duct + CBD. The CBD and Gallbladder was resected (with frozen section), lymph node dissected along hepatic artery, Roux-en-Y hepaticojejunostomy anastomosis and Jejuno-Jejunostomy anastomosis was performed. Histopathology showed Cholangiocarcinoma grade 2 with perineural + lymphovascular invasion, and malignant cells’ perineural invasion at proximal margin. She underwent adjuvant chemotherapy (Gemcitabine + Cisplatin). CT scan 6 months post Chemotherapy showed 3cm lesion in CBD. After a further 2 months of chemotherapy, CT evaluation showed no residual mass left. Conclusion: This highlight that despite significant time lapse from onset of symptoms, surgery with curative intent may still be considered. Secondly, chemotherapy is an extremely important part of the treatment, especially in presence of malignant cells at resection margin.

A single center experience on PI3K/AKT/MTOR signaling defects: Towards pathogenicity assessment for four novel defects.

Phosphoinositide 3 kinases (PI3K) are lipid kinases expressed in lymphocytes/myeloid cells. PI3K/AKT/mTOR signaling defects present with recurrent infections, autoimmunity, lymphoproliferation, and agammaglobulinemia. To characterize the PI3K/AKT/mTOR pathway defects and perform pathway analyses to assess novel variant pathogenicity. We included 12 patients (heterozygous PIK3CD (n = 9) and PIK3R1 (n = 1) (activated PI3K delta syndrome (APDS) with gain-of-function mutations) and homozygous PIK3R1 variant (n = 2)), performed clinical/laboratory/genetic evaluation, and flow cytometric PI3K/AKT/mTOR pathway analyses. Median age at onset of complaints was 17.5 months (3 months to 12 years) and at diagnosis was 15.7 years (2.5-37) in APDS. Median diagnostic delay was 12.9 years (1.6-27). Recurrent respiratory tract infections (90%), lymphoproliferation (70%), autoimmune/inflammatory findings (60%), and allergy (40%) were common in APDS. Recurrent viral infections were present in 4/10 and malignancy (non-Hodgkin lymphoma and testicular yolk sac tumor) was present in 2/10 in APDS. Low CD4+ T cells(5/8) with increased CD4+ effector memory (8/8) and CD4+ TEMRA cells (6/8) were present in the given number of APDS patients. We diagnosed tubulointerstitial nephritis, Langerhans cell histiocytosis, and late-onset congenital adrenal hyperplasia in APDS. Allergic findings, lymphoproliferation/malignancy, and high IgM were present in the APDS but not in PIK3R1 deficiency. Low IgM/IgG/CD19+ B cell counts were characteristic in patients with PIK3R1 homozygous loss-of function mutations. Differential diagnosis with combined immunodeficiency and diseases of immune dysregulation make molecular genetic analysis crucial for diagnosing mTOR pathway defects. It is easy to differentiate APDS and homozygous PIK3R1 defects with specific laboratory features. Additionally, mTOR pathway functional analysis is a definitive diagnostic and pathogenicity assessment tool for novel APDS mutations.

Factors Associated with Therapeutic Outcomes in the Treatment of Nontraumatic Acute Upper Limb Ischemia at a Tertiary Care Center in South India: A Prospective Analysis

Abstract Background: The outcomes of acute upper extremity ischemia (AUEI) demonstrated lower rates of limb loss (0%–3.1%) and mortality (~6%) compared to acute lower extremity ischemia. However, AUEI still is a challenge for a vascular surgeon as delays in diagnosis and treatment are likely to result in severe functional disability, even in the absence of overt tissue loss. Objectives: The objectives of this study are to determine the association of factors affecting the clinical outcomes of acute upper limb ischemia treatment. Methodology: A single-center prospective observational study was done between July 2021 and July 2023 on patients with AUEI who came to our emergency medicine department at a tertiary care center in South India. The demography, risk factors, duration of ischemia, time from onset of complaints, and primary intervention chosen were recorded. Functional improvement on subsequent follow-up intervals was analyzed to describe the surgical outcome. Results: Of 53 patients with AUEI, 31 (58.5%) had atrial fibrillation. In 81.1% of patients, thrombosis was the primary cause of acute limb ischemia. Most patients belonged to the 2A Rutherford classification (47.2%), followed by 2B (26.4%). Regardless of the severity of ischemia, the patients (n = 10) who arrived after 36 h had a higher rate of amputation (5; 50%). Lower levels of preoperative serum lactate dehydrogenase and serum glutamic-oxaloacetic transaminase were associated with better postoperative outcomes (P = 0.007) and lesser amputation rates (P = 0.017). Lower grades of ischemia, prompt intervention, and early consultation were all linked to better postoperative functional outcomes (P = 0.026). Conclusion: At our facility, AUEI due to cardiac or noncardiac emboli, thrombosis, or both was a significant cause of inhospital morbidity. An important risk factor for worse outcomes was hypertension. The availability of appropriate interventional care, and the timing of presentation after the onset of symptoms are thus significant modifiable factors in lowering the rates of amputation.

Analysis of patients with adhesive capsulitis after COVID-19 vaccination: An observational study.

This study aimed to increase the awareness of clinicians about shoulder injury related to vaccine administration (SIRVA) by analyzing 21 patients with adhesive capsulitis that developed after COVID-19 (coronavirus disease 2019) vaccination. In this observational study, 21 patients (11 males, 10 females; mean age: 60.7±7.3 years; range, 45 to 70 years) with incipient shoulder pain and limitation diagnosed with adhesive capsulitis due to SIRVA were evaluated between June 2021 and December 2022. Demographic and clinical data of the patients were recorded. Pain was evaluated with the Visual Analog Scale (VAS). The passive range of motion (ROM) of the affected shoulder was measured by a goniometer. The applied treatment methods (medical treatment, physical therapy, intraarticular steroid injection, hydrodilatation, and suprascapular nerve block) were recorded. The patients were called in for control two months later. Visual Analog Scale scores and passive shoulder ROMs were reevaluated. Symptoms started after the second dose in nine (42.9%) patients. The mean time between vaccination and onset of complaints was 8.0±6.4 days. Sinovac vaccine was administered to eight patients, BioNTech vaccine was administered to five patients, and Sinovac+BioNTech vaccine was administered to eight patients. Baseline to control ROM angle changes were 128.8±30.4º to 155.0±20.6° for flexion, 117.1±37.8° to 147.1±26.4° for abduction, 45.9±17.8° to 61.9±12.6° for internal rotation, and 43.4±21.9° to 56.3±18.3° for external rotation, respectively. The mean VAS scores were 7.0±1.2 (5-9) at baseline and 2.7±1.0 (1-5) at the control. There was a statistically significant difference between the baseline and control (two months after treatment) in terms of VAS scores and ROM angles (p<0.001). Clinicians should be aware of adhesive capsulitis following vaccine administration since a significant improvement can be obtained by proper treatment for SIRVA.

The etiologies and management of spinal cord compression in childhood cancers: Are we aware of the emergency of cord compression?

The spinal cord compression causes irreversible long-term permanent neurological sequelae. This study aims to increase awareness of childhood cancers that cause cord compression by comparing histopathological diagnosis, treatments, and survival rates to the literature. Seventy-three patients (38 male, 35 female) with spinal cord compression, among 1085 patients diagnosed with solid tumors at Gazi University Department of Pediatric Oncology between 1991 and 2021 were retrospectively evaluated. The mean time between the onset of complaints and diagnosis was 27.5± 24.9 (2-150) days. The first three most common tumors that caused cord compression; were central nervous system tumors in 22 (30%), neuroblastoma in 17 (23%), and malignant germ cell tumors in 8 (10%) cases. Of the patients, 46 (63%) had compression due to extradural masses, and 27 (37%) patients had an intradural compression. The most common symptoms were pain in 60 (82%), weakness in 57 (78%), and pins and needles in 28 (38%) patients, respectively. The clinical physical neurological examination findings were motor deficit in 62 (84%), and deep tendon reflex changes in 54 patients (73.9%). Compression findings were detected in 58 (79.5%) patients at diagnosis, and in 15 (20.5%) of them during follow-up. The most common level of compression was seen in the thoracolumbar region in 19 (26%) cases. In 65 (89%) patients with cord compression, corticosteroids were given as anti-edema treatment. Surgical excision was performed in 39 (53%) patients. Spinal radiotherapy was given to 35 patients (48%) with radiosensitive tumors. Chemotherapy protocols were started in 52 (71.2%) cases according to their diagnoses. Complete neurological recovery was achieved in 33 (45%) patients. The 5-year overall survival rates for solid tumors with extradural compression and intradural compression were 62% and 22%, respectively (p=0.002). Neurological sequela-free recovery is possible with early diagnosis and urgent treatment. Spinal compression must be detected by detailed systemic and neurological examination and imaging methods. Patients should be rapidly transferred to pediatric oncology units after starting anti-edema treatment.

Evaluation of the impact of the COVID-19 Pandemic on Nonhospital Cardiac Arrest Rates

Objective: This study aimed to investigate whether the coronavirus disease 2019 (COVID-19) pandemic resulted in delayed access to acute medical conditions and an increase in nonhospital cardiac arrests. Material and Methods: In this retrospective cross-sectional study, emergency department admissions of nonhospital cardiac arrest patients during the pre-pandemic period (11/03/2019-31/01/2020) and the pandemic period (11/03/2020-31/01/2021) were examined. Demographic data, comorbidities, pre-arrest complaints and onset of complaints, return of spontaneous circulation, and duration of stay in the emergency department were compared. Results: Although there was a 49% decrease in general hospital admissions and a 28% decrease in emergency department admissions between the two defined periods, there was a 38% increase in out-of-hospital cardiac arrests during the pandemic period. There was no statistically significant difference between the patients who underwent cardiopulmonary resuscitation in both periods in terms of gender (p=0.06), age (p=0.15), and comorbidity (p=0.14). Pre-arrest chest pain and dyspnea were more common in the pandemic period than in the pre-pandemic period (p=0.02). Patients who achieved spontaneous return during the pandemic period had longer intensive care unit waiting times (p&lt;0.001). Conclusions: Limitations such as the risk of transmission of the COVID-19 disease, the desire to protect social distance, and curfews caused people with chronic diseases to delay their follow-up and avoid the need to seek emergency health care in case of acute exacerbations.

The Efficacy of Chest X-Ray for the Diagnosis and Follow-up in Young Adult COVID-19 Patients with Mild Dyspnea No Comorbid Diseases

We investigated whether Chest X-Ray (CXR) could replace computed tomography (CT) modality in the diagnosis and during the treatment of young adult COVID-19 patients with mild dyspnea with no comorbid diseases. This retrospective study involved an examination of the records of a total of 956 patients hospitalized between March 1, 2020, and May 15, 2020. The study included a total of sixty-four COVID-19 patients who underwent a CXR at admission and CT imaging within 24 hours, aged 21-60 years with mild dyspnea with no comorbid diseases. The diagnosis of infection was confirmed by the polymerase chain reaction test in all cases. The first CXR and CT images at the time of admission were evaluated in terms of lesions and localization. The clinical-radiological course of the disease was also statistically evaluated. CT was normal in 18/64 (28.1%) patients, all of whom also had normal CXR. The rest of the patients 46/64 (71.9%) with an abnormal CT, the CXR was normal in 18/46 (39.1%) and abnormal in 28/46 (60.9%). The time between the onset of complaints and admission to the hospital in patients with abnormal and normal CXR was 3.5±2.3 days and 2.1±1.1 days respectively and this difference was statistically significant (p=0.004). The hospital stay durations of the patients with abnormal and normal CXR was 9.6±3.5 and 9.5±3.4 days (p=0.928), respectively, and was not statistically significant. In conclusion, in the case of early admission to the hospital, there is not a significant difference between using CXR or CT in the management of young adult COVID 19 patients with mild dyspnea no comorbid disease. Therefore, the use of CXR in these patient groups will reduce the burden of CT units in pandemic conditions with limited resources.

2009-2019 Yılları Arasında Sivas Cumhuriyet Üniversitesi Tıp Fakültesi Çocuk Kliniği’nde Bruselloz Saptanan Çocuk Hastaların Demografik, Klinik, Laboratuvar Bulguları ve Tedavilerinin Değerlendirilmesi

Purpose: The purpose of the present study is to evaluate the demographical and clinical characteristics, laboratory findings, all symptoms, treatments received, durations of hospital stay and prognosis after treatment of the pediatric patients with brucellosis diagnosis followed-up in the Pediatrics Department of the Research and Application Hospital of Sivas Cumhuriyet University. Materials and Methods: In this study, 51 patients within the age group 0 and 18, who were diagnosed with brucellosis and who presented to the Pediatrics Department of Research and Application Hospital of Sivas Cumhuriyet University between January 1st, 2009 and December 31st, 2019, were included. The files of the patients were analyzed retrospectively. The diagnosis was made in all patients with the presence of history, clinical symptoms and findings by the positivity (≥1/160) of the Standard Tube Agglutination Test (STA) and/or by the growth of Brucella species in the blood culture. The time the patients who were included in the study presented to the hospital, their ages, gender, place of residence, intake of raw milk and dairy products, contact history with farm animals, time elapsed until diagnosis, Brucella history in the other members of the family, the properties of their houses, the number of people living in the house, social insurance, physical examination findings, laboratory findings, all symptoms of the patient, treatments received, duration of hospital stay, complications and prognosis after treatment were examined and recorded. Findings: 41 of the patients (80.4%) were males and 10 of them (19.6%) were females. The ages of the patients were between 2 and 17, and the average age was 10.9±4.10. The time it took between the patients’ onset of complaints and the diagnosis of brucellosis varied between 1 and 30 days, and the average number of days was 10. The most frequent complaint was fever which was seen in 39 (76.5 %) patients. The second most frequent complaint was joint pain observed in 34 (66.7 %) patients. 15 (29.4 %) of the patients presented with fever and 12 (23.5 %) patients had joint swelling. Statistically significant difference was observed between the Erythrocyte Sedimentation Rates (ESH), C-Reactive Protein (CRP) values before and after the treatment (p=0.001, p=0.002). Before the treatment, Platelets (PLT), Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) were significantly high (p=0.010, p=0.000, p=0.000). Conclusion: Because Turkey is an endemic zone for Brucellosis, Brucellosis must be considered for every child with complaints of long-lasting fever, perspiration and joint pain. Both clinical and serological evaluations of the family members of the patient with brucellosis diagnosis might be needed. This would enable the early diagnosis and treatments of probable cases. Diagnosis and treatment of the disease in the early stage, awareness-raising in public against consuming raw milk and/or dairy products in places where animal breeding is prevalent, especially in the rural areas, training of the public and the health personnel on the causes of Brucellosis transmission and the methods of protection from Brucellosis would be the precautions to be protected from this infection and would lead to a reduction in the development of complications.

Normal Pressure Hydrocephalus Overshadowed by Traumatic and Degenerative Spinal Diseases: A New Assessment Proposal.

Normal pressure hydrocephalus (NPH) is a rare disorder among the elderly, characterized by gait disorder, dementia, and urinary incontinence. Considering the rareness of NPH and a lot of other pathologies, such as Parkinson's disease, lumbar spinal stenosis, and even aging cause similar symptoms, NPH is an underdiagnosed entity. However, the percentage of misdiagnosis is not given in the literature. In this study, patients diagnosed with NPH were retrospectively screened between 2015 and May 2019 in our clinical database and Ste-P formula was applied. Example cases showed that some of the patients receive inaccurate medical and surgical treatments before being diagnosed with NPH. As a result of the study was seen that a few out of 29 patients confused dizziness with trunkal ataxia or imbalance due to gait abnormality. As the time between onset of complaints and diagnosis increased, the value approached "zero", and diagnosis became difficult. Every unnecessary operation carries serious risks that may threaten the life of the patient and decrease the quality of life. These surgeries and instrumentation materials used may also result to additional financial cost. Similarly, long-term use of Parkinson's and dementia medications has a serious economical burden on the insurance systems and is detrimental to the patient's health. Considering all these diagnoses and physiological conditions that can be easily confused with each other, we recommend in this article a new formula to reduce the possibility of misdiagnosis and treatment in patients with walking disorder.

A case report of relapse of minimal change disease after the first dose of Pfizer-BioNTech Covid-19 vaccine in King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia

Background: Documented cases of de novo glomerular disease or relapse of pre-existing glomerular disease was acquired shortly after administration of COVID-19 messenger RNA (mRNA) vaccinations. Objectives: to present a case of a 64-year-old female who received the Pfizer-BioNTech COVID-19 vaccination as a first dose and then experienced a relapse of minimal change disease (MCD) presenting with nephrotic syndrome. Case presentation: The presenting symptom was ankle swelling and frothy urine which started 9 days after the first dose of vaccine. Albumin level was 24 g/L, urine albumin/creatinine ratio was 668 mg/mmol, Creatinine had risen to 1.3 mg/dl, urine analysis showed 3+ protein. light microscopy showed 17 patent glomeruli, one of which was globally sclerosed. There was mild focal increase in mesangial matrix with occasional atrophic tubules with minor interstitial scarring affecting less than 5% of cortical area. There was moderate fibrointimal thickening. In electron microscopy, 100% of podocyte foot process were effaced with microvillation and marked cytoplasmic vacuolation. The findings were consistent with minimal change disease (MCD) with mild chronic renal parenchymal damage. The patient started furosemide 80 mg daily for 21 days after the onset of complaints. prednisolone 1 mg/kg was initiated 1 week and patient`s symptoms improved. The patient achieved a complete remission 4 weeks after initiation of prednisolone. Conclusion: For the best management of MCD as a potential side effect following COVID-19 vaccination, more knowledge is required. Keywords: case, relapse, MCD, Pfizer-BioNTech, Covid-19, Taif

CASE STUDY: MAJOR DUODENAL PAPILLA CANCER COMPLICATED BY ACUTE PARACANCROTIC NECROTIZING PANCREATITIS

The given paper describes a case of treating adenocarcinoma of the papilla of Vater diagnosed as the cause after an episode of acute pancreatitis. The etiology of aсute pancreatitis was considered idiopathic until the onset of complaints caused by tumor growth. The volume of radical surgery has changed intraoperatively due to the detection of infected limited necrotic clusters, didn’t diagnosed both laboratory and instrumentally. Pathomorphological conclusion: considering clinical data, low-grade (G3) adenocarcinoma of the major duodenal papilla, which developed from pre-existing tubular villous adenoma of the duodenum or intraampullary papillary neoplasia (IAPN). Predicting the early detection of MNPs after AP episode requires further research by improving imaging techniques, introducing new non-invasive techniques and investigating circulating biomarkers. The scope of surgery for patients with clinically significant complications of tumor growth and identified competing diagnosis at the target site should be individually decided and weighed. Infected pancreatitis in the late stages requires careful diagnosis.

Central Retinal Artery Occlusion as a Complication in Invasive Aesthetic Cosmetology: a Clinical Case

Central retinal artery occlusion (CRAO) is a relatively rare form of acute retinal arterial ischemia that results in unilateral vision loss. The incidence of transient vision loss is estimated at approximately 14 cases per 100,000 people per year, while the incidence of CRAO is approximately 1–2 cases per 100,000 people. In the foreign literature, there are more and more publications about the development of iatrogenic vision loss after dermal cosmetic injections. We would like to present a clinical case that should be interesting for both practicing ophthalmologists and specialists of related specialties, especially for cosmetologists. Patient M., 42 years old, came to us with complaints of a sharp loss of vision to light perception in the right eye. From the anamnesis, it is known that two hours earlier, the patient was injected into the temporal region (plasma, anesthetic, epinephrine) in the cosmetology office. Lightning-fast deterioration of vision occurred at the time of the drug administration. The patient arrived at the clinic 2 hours after the onset of complaints. We conducted an ophthalmological examination of the patient, the diagnosis was made: occlusion of the central artery of the retina of the right eye, and immediately performed standard emergency therapy. After a course of conservative treatment in an ophthalmological hospital, a persistent decrease in visual functions and a violation of arterial blood circulation in the central retinal artery basin remained. The progressive increase in the number of minimally invasive cosmetic procedures in recent years, in particular, injections of dermal fillers, is associated with rare, but often fatal complications. This clinical situation should attract the attention of practicing ophthalmologists and cosmetologists to these types of complications, and improve the quality and speed of emergency medical care.

COVID-19 Pandemisi Çocuklarda Apandisit Tanısının Konulmasında Gecikmelere Neden Oluyor mu?

Objective: We aimed to investigate whether there is an increase in the number of complicated appendicitis during pandemic period. Material and Methods: Data of patients were evaluated retrospectively. Patients were divided into two-groups as pre-pandemic and pandemic. Age, gender, duration after the onset of complaints until visiting hospital, WBC count, days after presentation to hospital until surgery, surgical method, whether the appendix was complicated, duration of hospitalization, whether any complications developed, and results of PCR tests were evaluated. The data of the groups were compared and it was investigated whether there was any difference between them. Statistical analysis was done with the SPSS (Statistical Package for Social Sciences) version 21. P < 0.05 was considered significant. Results: Appendectomy was performed in 327 patients during pandemic and in 295 during pre-pandemic period. Although the ratio of complicated appendicitis increased during pandemic compared to pre-pandemic period (47.1% versus 40.7%), there was no difference between groups. However, duration between onset of symptoms and arrival at hospital (p=0.003), time elapsed before surgery (p=0.021), length-of-stay in hospital (p=0.009), and developed complications (p=0.01) were higher in pandemic group. Conclusion: Comparing prepandemic, although there was no statistically significant difference during the pandemic period, there was an increase in complicated appendicitis and related complications. It was attributed to late arrival at hospitals due to curfews, parental fear of disease transmission, and prolonged duration of screening tests in the emergency departments.

Çocuklarda Periyodik Ateş, Aftöz Stomatit, Farenjit ve Adenit (PFAPA) Sendromu: 82 Hastanın Retrospektif Olarak Değerlendirilmesi

Amaç: Periyodik ateş, aftöz stomatit, farenjit ve adenit (PFAPA) sendromu ani yükselen ateş, stomatit, farenjit ve adenit ile karakterize olup çocukluk çağında en yaygın görülen tekrarlayan ateş sendromudur. Bu çalışmada, bu hastalığa dair farkındalığı artırmak amacıyla PFAPA sendromu tanısı almış olan çocuklara dair klinik veriler değerlendirilmiştir. Gereç ve Yöntemler: Bu retrospektif çalışma 1 Ekim 2017—30 Haziran 2019 döneminde Diyarbakır Çocuk Hastalıkları Hastanesi Çocuk Enfeksiyon Polikliniği’nde PFAPA tanısıyla izlenmiş olan 82 hastayı kapsamıştır. Hastaların demografik özellikleri, klinik ve laboratuvar bulguları, gördüğü tedaviler ve tedaviye yanıtları ile ilgili veriler tıbbi kayıtlardan elde edilmiştir. Bulgular: Hastaların 52’si erkek, 30’u kızdı. Medyan şikayet başlangıç yaşı 18 (1–120) ay, medyan tanı yaşı 53 (12–172) aydı. Seksen iki hastanın hepsinde ateş ve farenjit, 56’sında lenfadenit, 48’inde kriptik tonsilit, 28’inde stomatit mevcuttu. Laboratuvar tetkiklerinde lökositoz (%46,38), nötrofili (%59,7) ve lenfopeni (%4,47) tespit edildi. C-reaktif protein hastaların %86,56’sında pozitif olup medyan değer 69,9 (6,19–279) mg/dl idi. Eritrosit sedimantasyon hızı medyan değeri 36 (7–101) ml/saat idi. Otuz dört (%41,46) hastada ateş nedeniyle en az bir kez hastaneye yatırılma hikayesi vardı. Elli sekiz (%71) hastanın birinci derece akrabalarında sık tonsilit atakları mevcuttu ve bunlardan 21’i (%25,6) tonsilektomi geçirmişti. Tüm hastalarda metilprednisolon tedavisine dramatik yanıt alınmıştı. Tartışma ve Sonuç: PFAPA sendromunda erken tanı gereksiz tetkik, tedavi ve hastaneye yatışları önlemek için önemlidir. Beş yaşından küçük olan ve yineleyen ateş ve tonsilit atakları ile getirilen, özellikle de ailesinde sık tonsilit geçirme veya tonsilektomi hikayesi olan çocuklarda ayırıcı tanıda PFAPA sendromu göz önünde bulundurulmalıdır.

Factors affecting length of stay in Fournier's gangrene: a retrospective analysis of 10 years' data.

We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene. A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated. Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ± 2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality. Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.

Relationship Between Pathogenetic Mechanisms of NSAID-gastropathy Development in Elderly Patients with Concomitant Ischemic Heart Disease

The objective: to study the relationship between risk factors and mechanisms of NSAID gastropathy development with concomitant ischemic heart disease.Materials and methods. The study included 125 patients who underwent general clinical examination, upper endoscopy with biopsy of the gastric mucosa (GM), followed by histological examination of biopsies, assessment of mucosal function of GM (content of N-acetylneuraminic acid (NANA) and fucoproteins in the blood), oxidative stress (concentration of TBA-active products and catalase activity in the blood serum), endothelial dysfunction (nitrite concentration and endothelial NO-synthase (eNOS), inducible NOS (iNOS) activity), severity of erosive-ulcerative lesions according to modified Lanzascore scale with assessment of histological changes.Results. In most patients of both groups, the onset of complaints was provoked by taking ASA and/or NSAIDs and had a direct correlation with the number of anti-inflammatory drugs (r=0.72; r=0.63; p=0.025), and also depended on the duration of NSAIDs treatment (r=0.52; r=0.67; p=0.031). There is a strong direct relationship between the concentration of NANA in the blood serum and the amount of NSAIDs (r=0.69; p=0.03), the duration of drugs (r=0.50; p=0.024), the content of TBA reactants in the blood serum (r=0.59; p=0.015), the severity of erosive-ulcerative lesions according to Lanzascore scale (r=0.71; p=0.017) on the background of inverse correlation with eNOS activity (r=–0,65; р=0,024). Correlation analysis showed a direct relationship between iNOS activity and H. pylori infection (r=0.63; p=0.030), the severity of erosive-ulcerative lesions according to Lanzascore scale (r=0.50; p=0.047), the GM infiltration by polymorphonuclear leukocytes (r=0.72; p=0.027) against the background of inverse correlation with the catalase activity (r=–0.41; р=0.030).Conclusion. The degree of GM injury depends on the amount and duration of NSAIDs and/or ASA, the presence of comorbid pathology, H.pylori infection, oxidative stress activity, endothelial dysfunction.

Increased Diagnosis of Eosinophilic Esophagitis in Young Children

Objective: To investigate the patients with eosinophilic esophagitis that is diagnosed with an increasing frequency despite the still unknown etiology. Materials and Methods: The data of patients diagnosed as eosinophilic esophagitis between 2012 and 2019 in our hospital were retrospectively reviewed from the medical records. Results: A total of 21 patients (12 male) with eosinophilic esophagitis were included in this study. There was a significant increase in the number of patients in the last two years. The mean age at the onset of complaints was 3.42 + 2.47 years, and the mean age at diagnosis was 5.83 + 3.18 years. Vomiting, food impaction and food rejection were the most common presenting symptoms. The prick test was positive in 24% and the patch test was positive in 33% of the patients. Milk and egg were the most common positive food allergens in the patch test. Forty eight percent of the patients responded positively to proton pump inhibitor treatment. Forty eight percent of the patients had concomitant atopic disease, and 67% had a positive family history for atopic disease. Almost all of the cases were breastfed for more than six months and used antibiotics in the first year of life. Clinical remission was achieved in 8.33 + 5.61 (mean±SD) months. No side effects were observed related to topical steroids in any of the patients. Conclusion: Eosinophilic esophagitis should be considered in the differential diagnosis of every patient with esophageal complaints. Endoscopic evaluation should be performed without delay, especially in young children with vomiting.

Two-year clinical follow-up from the onset of complaints is predictive for the early diagnosis of hip osteoarthritis

Purpose: The aim of this study was to assess whether the course of signs and symptoms over the first two years after consulting with hip complaints for the first time in primary care is predictive for clinically relevant hip osteoarthritis (OA) 5 to 10 years later.

Misophony treated with cognitive behavioral therapy in a 10-year old child: A case report

ABSTRACT Objective: Misophonia is a recently described condition characterized by autonomic arousal and unpleasant emotional experiences against some specific voices. There are studies showing that the individual can negatively affect the quality of life when the mizofoni is not treated. Misophonia is not yet included in psychiatric classification systems. Experience in this area is limited to case reports. In this study, a 10-year-old girl with misophonia complaints was described. Method: Cognitive behavioral therapy method was applied to the girl who came with misophonia complaints at the age of 10 years. Results: In our study, the girl case benefited from CBT. The short time between the onset of complaints and the initiation of the diagnosis and treatment application resulted in a rapid response to CBT. Conclusion: CBT would be successfully applied in the child age group with misophonia.

Male Breast Cancer: Clinicopathological, Immunohistochemical and Radiological Study.

To evaluate the pathological and radiological features, immunohistochemical profile and treatment methods of primary male breast carcinoma cases diagnosed at our center. The pathology archive between 2006 and 2019 was reviewed and the data of 27 male patients diagnosed as primary breast cancer were retrospectively evaluated. The age of the patients ranged between 40-86 years. The left breast was involved in 17 patients. The mean tumor diameter was 2.35 ± 1.09 cm. Of the 27 cases, 8 were dead and 19 were alive. The mean follow-up duration was 37.45 ± 24.84 months. The mean estimated life expectancy was 65±14.7 months. The most common complaint was a swelling in the breast. The time interval between the onset of complaints and admittance to hospital ranged from three months to two years. The most common histopathological diagnosis was invasive carcinoma - no special type. The most common surgical procedure was mastectomy with lymph node dissection. Nine patients had metastatic lymph nodes. In terms of the hormone profiles, 24 were Estrogen receptor positive, 21 were Progesterone receptor positive and six were Her2/neu positive. Three patients had triple-negative tumors. Male breast carcinoma is a rare disease but its frequency has been increasing recently. As breast cancer is more commonly attributed to women, the diagnosis is usually delayed until later stages in males. Public awareness should therefore be increased and breast cancer should be considered in the differential diagnosis especially in the presence of breast swelling and complaints related to the breast skin so that the appropriate biopsy can be obtained without delay.