Sadi Konuk Training Research Articles

Evaluation of Hospitalized Pediatric Patients in Terms of Anemia: Single-Center Experience

Introduction: Anemia, characterized by reduced hemoglobin and hematocrit levels, affects roughly one-third of the global population and is associated with increased morbidity and mortality. Iron deficiency anemia (IDA) is the most common form, particularly prevalent during childhood, a period of rapid growth. This study aimed to assess the frequency of anemia in pediatric patients hospitalized for various reasons. Material and methods: This study was conducted at SBU Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatrics, from September 1 to November 30,2021. The records of pediatric patients treated during this period were retrospectively reviewed. Patients with hematologic diseases were excluded from the study. Demographic data and laboratory results were recorded, and patients were grouped by age (0-2, 2-6, 6-12, 12-17 years) to compare laboratory values across these groups. Results: The study included 100 children, with an equal distribution of 50 girls (50%) and 50 boys (50%), hospitalized between September 1 and November 30, 2021, at SBÜ Bakırköy Dr. Sadi Konuk Training and Research Hospital. The patients' ages ranged from 1 month to 16.2 years, with a mean age of 3.34±3.90 years. The majority (59%) of patients were in the 0-2 age group, followed by 19% in the 2-6 age group, 19% in the 6-12 age group, and 3% in the 12-17 age group. It was observed that 31% of patients had chronic diseases. Hemoglobin levels were measured at 11.11±1.84 g/dL, hematocrit at 33.71±4.85%, mean corpuscular volume (MCV) at 81.35±8.48 fL, red cell distribution width (RDW) at 15.08±2.67%, iron (Fe) at 64.70±38.89 g/dL, ferritin at 228.50±200.04 μg/L, vitamin B12 at 554.83±389.46 ng/L, and folate at 11.34±6.23 ng/L. Conclusions: Anemia is a prevalent issue during childhood in our country and should be carefully considered in hospitalized pediatric patients. Upon detection, a cause-specific treatment plan must be developed to address this condition effectively.

Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair Under Combined Spinal Epidural Anesthesia Versus General Anesthesia

Background: Inguinal hernia repair is one of the most frequently used elective surgical operations in the world. General anesthesia (GA) has risks and routine postoperative complications, such as nausea, vomiting, throat irritation, and postoperative pain. Regional anesthesia (RA) has many advantages over GA, such as faster recovery, less postoperative pain, nausea, and vomiting, and less hemodynamic compromise. We aimed to investigate the efficacy and safety of combined spinal and epidural anesthesia (CSEA) in preventing shoulder pain in patients undergoing totally extraperitoneal herniorrhaphy (TEP). Materials and Methods: The files of patients who had undergone the TEP method under GA and CSEA due to inguinal hernia between April 2020 and November 2021 at the Bakirköy Dr. Sadi Konuk Training and Research Hospital were reviewed retrospectively. Results: A total of 81 patients were included in the study. The number of patients operated on GA (group 1) was 40, and the number of patients operated under CSEA (group 2) was 41. There was no significant difference in the demographic characteristics of the patients. The surgical time was 42.9 and 42.5 minutes in groups 1 and 2, respectively (P=0.970). The mean operative time was recorded as 60.1 and 80.2 minutes in groups 1 and 2, respectively, and it was statistically significantly shorter in group 1 (P<0.001). A peritoneal tear was seen in 18 patients (43.90%) in the GA group and 16 patients (40%) in the CSEA group, but no significant difference was found between the groups (P=0.823). Mild shoulder pain that did not require intervention was observed in 1 patient (2.5%) in the CSEA group. In group 2, the VAS scores at all times and the need for postoperative analgesia were statistically significantly lower (P<0.001). In terms of anesthesia complications, headache was not observed in group 1, while it was seen in 6 (15%) patients in group 2 (P=0.012) Conclusions: In laparoscopic TEP surgeries, CSEA may be an alternative anesthesia method to GA anesthesia due to the low VAS score, less need for analgesia, and fewer postoperative pulmonary complications.

Comparison of the Anaemia and Transfusion Rates of Pregnant Women Treated with Intravenous versus Oral Iron in the Third Trimester.

To evaluate and compare the blood transfusion requirements during delivery in third-trimester pregnant women with iron deficiency anaemia (IDA) who were treated with intravenous (IV) ferric carboxymaltose (FCM) versus those treated with oral iron supplementation. Comparative study. Place and Duration of the Study: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkiye, from January 2017 to December 2022. Pregnant women with haemoglobin (Hb) levels <10 g/dL in their third trimester were included. One group (n = 50) received IV FCM, while the other group (n = 96) received oral iron therapy. Key outcome measures included Hb levels at delivery and the need for a postpartum blood transfusion. Inclusion criteria were third-trimester pregnancy with IDA, and exclusion criteria included haematological or chronic systemic diseases and high-risk pregnancies. The mean initial Hb levels in the third trimester of pregnancy in the FCM group and oral iron group were 8.31 ± 0.96 g/dL and 9.29 ± 1.20 g/dL, respectively (p <0.001). The mean Hb levels in the delivery room were 11.09 ± 1.38 and 9.44 ± 1.16 g/dL, respectively (p <0.001). The rates of postpartum erythrocyte transfusion requirement were 6% (n = 3) and 18.75% (n = 18), respectively (p = 0.037). IV FCM administration to pregnant patients with IDA during the third trimester was found to be more effective than oral iron treatment in reducing blood transfusion rates. Anaemia, Ferric carboxymaltose, Pregnancy, Iron deficiency, Intravenous iron.

Diagnostic Value of Pericholedochal Hypointense Ring Sign in MRI T2W Images in Cases of Pancreatic Ductal Adenocarcinoma.

To determine the value of hypointense pericholedocal ring sign in magnetic resonance imaging (MRI) T2W sequence images in the diagnosis of pancreatic ductal adenocarcinoma (PDA). Retrospective observational study. Place and Duration of the Study: Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkiye, from January 2016 and March 2022. Retrospective analysis of MRI scans was performed on 70 patients with postoperative histopathological confirmation of a diagnosis of periampullary cancer. The patients' demographic information, the results of their histopathological examinations, and the findings of their MRIs were recorded. The results of the MRI were statistically analysed and compared between the PDA and the non-PDA groups. The study included 43 (61.4%) male and 27 (38.5%) female patients, with a mean age of 62.2 ± 8.4 years. The means of Wirsung diameter and tumour diameter were significantly higher in PDA group (p = 0.034, p = 0.010, respectively). A progressive contrast enhancement pattern of 95.3% was observed in PDA group, while 40.7% rapid contrast enhancement pattern was observed in the non-PDA group. Hypointense pericholedochal ring sign, observed in T2W sequences, was detected in 74.2% (n = 32) of the PDA group and 11.1% (n = 3) of the non-PDA group, and the findings were statistically significant (p <0.001). Hypointense pericholedochal ring sign in axial T2W sequences in periampullary tumours is a complementary MRI finding in the distinction between the PDA and the non-PDA groups. Magnetic resonance imaging, Pancreatic ductal adenocarcinoma, Periampullary tumours, Pericholedochal ring sign.

All-cause mortality and related factors in patients with varying degrees of peripheral blood eosinophilia.

The aim of this study was to investigate all-cause mortality rates and related factors in patients with different levels of eosinophilia. This retrospective cohort study was conducted between January 2020 and December 2022 in the Internal Medicine Department of Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkiye. A total of 161 patients with eosinophilia (at least 3 times) were included and divided into groups with absolute eosinophil counts of 500-999/µL (mild), 1000-1500/µL (moderate), and >1500/µL (severe). The mean age of patients was 65.67 ± 16.64 years at the time of admission, and 45 patients (57.8%) were male. The rates of mortality, oncological disease, and organ involvement were significantly higher in the severe group (P < .05). Increased serum total immunoglobulin E and vitamin B12, hematocrit value, eosinophil-to-lymphocyte ratio, and leukocyte were observed in eosinophilic patients. Decreased lymphocyte count, hemoglobin and hematocrit values were higher in deceased patients than in survivors (P < .05). Increased eosinophil-to-lymphocyte ratio, C-reactive protein, vitamin B12, and lactate dehydrogenase (LDH) activity were observed in participants who died compared to those who survived (P < .05). Multivariable logistic regression revealed that advanced age and higher LDH activity were independently associated with greater mortality risk while receiving non-steroid anti-inflammatory drugs or proton-pump inhibitors were associated with reduced mortality risk (P < .05). Advanced age and increased LDH activity were independently associated with greater risk for mortality, whereas absolute eosinophil counts was not. Considering the literature on this topic, our results show the need for further clinical and fundamental research to understand the role of eosinophils in human disease.

Is it possible to identify COVID-19 infection-related biomarkers during pregnancy?: A prospective study in Turkish population.

The coronavirus disease 2019 (COVID-19) has raised concerns about the potential complications it may cause in pregnant women. Therefore, biomarkers that can predict the course of COVID-19 in pregnant women may be of great benefit as they would provide valuable insights into the prognosis and, thus, the management of the disease. In this context, the objective of this study is to identify the biomarkers that can predict COVID-19 progression in pregnant women, focusing on composite hemogram parameters and systemic inflammatory and spike markers. The population of this single-center prospective case-control study consisted of all consecutive pregnant women with single healthy fetuses who tested positive for COVID-19 and who were admitted to Bakirköy Dr Sadi Konuk Training and Research Hospital in Istanbul, Turkey, a COVID-19 referral hospital, between April 2020 and March 2021, with an obstetric indication, during their second or third trimester. The control group consisted of consecutive pregnant women with a single healthy fetus who were admitted to the same hospital within the same date range, had demographic and obstetric characteristics matching the patient group, but tested negative for COVID-19. The patient and control groups were compared in terms of platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), and neutrophil-to-lymphocyte ratio (NLR), and systemic inflammatory and spike markers, including C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), cluster of differentiation 26 (CD26), and B7 homolog 4 (B7H4). There were 45 (51.1%) and 43 (48.8%) pregnant women in the patient and control groups, respectively. There was no significant difference between the groups in demographic and obstetric characteristics (P > .05). The PNR, PLR, and CRP values were significantly higher in the patient group than in the control group (P < .05). On the other hand, there was no significant difference between the groups in IL-6, IL-10, CD26, and B7H4 levels (P > .05). The findings of our study showed that specific inflammatory markers, such as CRP, PLR, and PNR, can potentially predict the course of COVID-19 in pregnant women. However, more comprehensive, well-controlled studies are needed to corroborate our study's findings and investigate other potential inflammatory markers.

Single Center Data of Kahramanmaraş Earthquake: Bakırköy Dr. Sadi Konuk Training and Research Hospital, Nephrology Department Experience

Single Center Data of Kahramanmaraş Earthquake: Bakırköy Dr. Sadi Konuk Training and Research Hospital, Nephrology Department Experience

Adaptation of the professionalism mini-evaluation exercise instrument into Turkish: a validity and reliability study

BackgroundThere is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version.MethodsA total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach’s alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument.ResultsA total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach’s alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX.ConclusionThe findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education.Trial registration2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.

Does Ultrasound Really Good Enough to Evaluate the Pneumothorax in the Emergency Department

Thorax computed tomography in patients with thoracic trauma is undeniably a highly beneficial method. However, it also has disadvantages such as difficulties in transferring critical patients to computed tomography, delays in diagnosis, the risk of radiation exposure, and higher costs. On the other hand, ultrasonography can be rapidly performed at the bedside and is a non-invasive technique that poses no risk of radiation exposure. These advantages make it a valuable method in the early diagnosis of thoracic trauma. Therefore, this study aimed to provide insights into the sensitivity and accuracy of bedside ultrasonography in diagnosing pneumothorax in patients presenting with thorax trauma in an emergency department. The study sample comprised 132 patients over 18 years of age who were transferred with thorax trauma to the Emergency Clinic of Bakırköy Dr. Sadi Konuk Training and Research Hospital between January 30, 2015, and June 30, 2015. Ultrasonographic examinations were performed before thoracic computed tomography in all patients for whom a thorax computed tomography was indicated based on the clinical examination by the emergency room physician. The thoracic computed tomography reports, interpreted by a radiologist who was blinded to the ultrasonographic and clinical findings of the patients, were accepted as the gold standard. All 132 patients included in the study underwent Thorax ultrasonography. The average age of the patients was 76.5%, with the youngest patient being 18 years old and the oldest one being 90 years old. Of the patients, 45.38% (n = 101) were men. The results of Thorax ultrasonography showed that 19 patients had pneumothorax. These findings were then compared with the Thorax computed tomography results accepted as the gold standard. The results revealed that Thorax ultrasonography had a sensitivity of 56.2% and a specificity of 99% in detecting pneumothorax. According to the grading on CT, our observation revealed that the sensitivity of ultrasonography to detect pneumothorax increased proportionally with the severity of pneumothorax detected on thoracic computed tomography. The sensitivity of ultrasonography in patients with a grade 2 pneumothorax and those with a grade 3 pneumothorax, according to Thorax computed tomography, was found to be 70% and 100%, respectively. Thorax ultrasonography is a useful technique with high specificity in diagnosing pneumothorax, but its sensitivity decreases significantly when the size is below 1 cm.

Metilen mavisi retroperitonoskopi tekniği: renal akses sağlanamayan perkütan nefrolitotomi vakalarında alternatif

Objective: To present our ‘methylene blue-guided retroperitoneoscopy technique’ that we apply in cases where extravasation develops for various reasons and is complicated as a result in Percutaneous Nephrolithotomy surgery (PNL). Material and Methods: A total of 36 patients, who underwent PNL with the ‘methylene blue technique’ at Bakirkoy Dr. Sadi Konuk Training and Research Hospital between 2014 and 2020, were retrospectively evaluated. The study included only cases in which the ‘methylene blue-guided retroperitoneoscopy technique’ was used due to the inability to advance the Amplatz sheath to the targeted calyx due to renal scarring or a staghorn stone filling the targeted calyx, Amplatz sheath was withdrawn from the kidney with the guidewire due to the inattention of the assistant surgical team or contrast material extravasation. The patients’ demographic, preoperative, perioperative, and postoperative data were recorded, and stone-free and complication rates were noted. Results: The mean age of the patients was 45.1 (36-55) years, the mean body mass index was 27.8±4 kg/m2, the mean stone size was 3.4±0.7 cm, and the mean stone volume was 22.3±10.2 cm3. The mean operation time was calculated as 95.8±30.3 minutes. The stone-free rate was 68% on the postoperative first day and 75% on the third month. Eight patients (22.2%) underwent a secondary procedure (extracorporeal shock wave lithotripsy or flexible ureterorenoscopy). Conclusion: The ‘methylene blue-guided retroperitoneoscopy technique’ we apply under retroperitoneoscopic direct vision is a safe and practical option for re-accessing the kidney by locating the calyx, which is first partially or completely dilated. Keywords: methylene blue, retroperitoneoscopy, renal access failure, percutaneous nephrolithotomy

MO376: Can the Urinary Albumin-Creatinine Ratio Be Calculated Over the Urinary Protein-Creatinine Ratio in Chronic Kidney Disease?

Abstract BACKGROUND AND AIMS Urine albumin-to-creatinine ratio (ACR) and protein-to-creatinine ratio (PCR) are used to measure urine protein. Recent guidelines recommend the use of the ACR, and equations have been developed incorporating ACR to predict risk of kidney failure. Where ACR cannot be measured, whether due to cost issues, laboratory inefficiencies, or other reasons, it is helpful to have a method for estimating ACR from PCR as accurately as possible. In this study, we investigated the usability of the formula developed by Keiichi Sumida et al.[1]. METHOD The formula for calculating the estimated ACR developed by Keiichi Sumida et al. includes urinary PCR, gender, diabetes, and hypertension variables. Between 2020 and 2021, eGFR, PCR, ACR and creatinine tests were requested from 644 patients who met the requirements for the formula and applied to Bakırköy Dr Sadi Konuk Training and Research Hospital Nephrology outpatient clinic. Estimated ACR value was calculated using the formula over PCR. With PCR and ACR measurement performed on the same day and from the same sample, intra-day and inter-day variation in excretion variability was minimized. eGFR values were evaluated in five subgroups as &amp;gt;90, between 60 and 89, between 30 and 59, 15 and 29 and &amp;lt;15, and the concordance between ACR and estimated ACR was examined for each group. PCR and ACR were analyzed by dye binding and immunoturbidimetric methods., and the relationship between estimated ACR and measured ACR was examined using the logarithmic-exponential function formula. NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) program was used for statistical analysis. Descriptive statistical methods (mean, standard deviation, median, first quartile, third quartile, frequency, percentage, minimum and maximum) were used while evaluating the study data. Kruskal–Wallis test and Dunn–Bonferroni test were used for comparisons between groups of more than two quantitative variables that did not show normal distribution. Spearman correlation analysis was used to evaluate the relationships between quantitative variables. Statistical significance was accepted as P &amp;lt; 0.05. RESULTS It was conducted with a total of 644 cases, 49.2% (n = 317) male and 50.8% (n = 327) female. Of the subjects participating in the study, 44.4% had a diagnosis of hypertension and 28.7% had diabetes. PCR measurement values of the cases ranged from 7.5 to 5000 mg/g; the mean measurement value is 1048.29 ± 1166.77 mg/g. ACR measurement values of the subjects participating in the study ranged from 0.64 to 4799 mg/g; mean measurement value is 689.05 ± 891.20 mg/g. The estimated ACR measurement values of the cases ranged from 2 to 2843 mg/g; the mean measurement value is 487.87 ± 620.30 mg/g. When Intraclass Correlation Coefficient (ICC) levels were examined between estimated ACR and ACR measurements, the agreement at the level of 0.846 was found to be excellent (ICC = 0.846; P = 0.001; P &amp;lt; 0.01). In the groups with eGFR ≥90, 60–89, 30–59, 15–29 and &amp;lt;15; The agreement between estimated ACR and ACR measurements was excellent. (ICC = 0.793, 0.799,0.881,0.849, 0.883 P = 0.001; P &amp;lt; 0.01). CONCLUSION Urine ACR is the preferred measure of albuminuria; however, if ACR is not available or cannot be measured, ACR estimated from PCR can be helpful in CKD screening, staging, and prognosis.

Investigation of SARS-CoV-2 in tear and conjunctival secretions of hospitalized patients with clinically-confirmed COVID-19 pneumonia

BackgroundThe aim of this study was to demonstrate the presence of the virus in tear and conjunctival secretions of clinically-confirmed COVID-19 pneumonia patients.MethodsThis prospective study was conducted at Bakirkoy Dr. Sadi Konuk Training and Research Hospital (2020/190). Nasopharyngeal and ocular samples were obtained by swab technique and investigated by RT-PCR.ResultsA total of 83 patients were included. The mean age was 61.88 ± 16.04 years. 28.92% of the patients had mild, 65.06% moderate and 6.02% severe pneumonia radiologically. RT-PCR was positive in 31 (37.35%) patients in the first nasopharyngeal swabs and in 19 (22.89%) in the second swabs. 17 of 19 patients had positive both first and second nasopharyngeal swabs; only the second swabs of two patients were positive. The first conjunctival swabs RT-PCR were positive in 5 out of 83 clinically-confirmed patients or 33 laboratory-confirmed patients (rates: 6.02% and 15.15%). There were no positives detected in the second conjunctival swabs.ConclusionsSARS-CoV-2 can be detected in the conjunctival swabs of patients with COVID-19 pneumonia.

Validity and reliability of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS) in Turkish: prospective study.

Using pain scales helps nurses in making early diagnoses and in assessing and managing pain symptoms and findings when developing a nursing care plan. To determine the validity and reliability of the Turkish form of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). Prospective study conducted in Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. 145 newborns in the 26th to 42nd gestational weeks that were receiving treatment and care in the neonatal intensive care unit were included in this study. A total of 1740 pain assessments were made by two independent observers on these 145 newborns. The research data was collected using a newborn description form, NIAPAS and the Neonatal Infant Pain Scale (NIPS). The scope validity index of NIAPAS was found to be between 0.90 and 1.00 and its Cronbach's alpha coefficient was 0.914. Correlations between characteristics and total scores (r = 0.20-0.82) were found to be sufficiently high. In an assessment on concurrency validity, there was a strong positive relationship between NIAPAS and NIPS scores (r = 0.73-0.82; P < 0.000). From kappa analysis (0.73-0.99) and intraclass correlation (r = 0.75-0.96), it was determined that there was concordance between the observers. NIAPAS was found to be a valid and reliable scale for evaluating acute pain in newborns.

Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period?

Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9±11.6years and 24.4±2.9kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P=.002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P=.003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

Crizotinib for c-MET-amplified advanced NSCLC: a single-center experience.

Lung cancer is the most common cause of cancer-related death in the world. Changes in the treatment of metastatic lung cancer in recent years have made targetable mutations gain importance. MET alteration is one of these driver mutations and crizotinib is a tyrosine kinase inhibitor used in therapy. In our study, data of patients with c-MET amplification who received crizotinib treatment between July 2017 and November 2020 in the Medical Oncology Clinic of Bakırköy Dr. Sadi Konuk Training and Research Hospital were retrospectively analyzed. c-MET scanning was performed by the fluorescent in situ hybridization method by using Cytotest MET/CCP7 probe kit by evaluating 100 tumor cells and the threshold value for positivity was accepted as above 20%. Eight of 28 patients who received crizotinib treatment had c-MET amplification. Seven of these patients were male and one was female. Progression-free survival and overall survival in these eight patients were 9.4 and 10.9 months, respectively, and objective response rate was 50%. Grade 4 nausea was observed in only one patient; there was no grade 4-5 toxicity and no patient discontinued the drug due to toxicity. Crizotinib is an effective treatment option other than cytotoxic chemotherapy in the limited number of patients with MET amplification in the stage 4 lung adenocarcinoma subgroup. It is important to investigate this amplification, which can be detected especially in smoking patients in the appropriate patient group, and to use appropriate tyrosine kinase inhibitors in treatment.

Sex estimation in a Turkish population using Purkait’s triangle: a virtual approach by 3-dimensional computed tomography (3D-CT)

Sex estimation is considered one of the first steps in the forensic identification process. Morphological and morphometrical differences between males and females have been used as means for morphoscopic and metric methods on both cranial and postcranial skeletal elements. When dry skeletal elements are not available, virtual data can be used as a substitute. The present research explores 3-dimensional (3D) scans from a Turkish population to test a sex estimation method developed by Purkait (2005). Overall, 296 individuals were used in this study (158 males and 138 females). Purkait’s triangle parameters were measured on computed tomography (CT) scans obtained from both right and left femora of each patient at the Bakirkoy Dr. Sadi Konuk Training Research Hospital (Istanbul, Turkey). Intra- and inter-observer errors were assessed for all variables through technical error of measurements analysis. Bilateral asymmetry and sex differences were evaluated using parametric and non-parametric statistical approaches. Univariate and multivariate discriminant function analyses were then conducted. Observer errors demonstrated an overall agreement within and between experts, as indicated by technical error of measurement (TEM) results. No bilateral asymmetries were reported, and all parameters demonstrated a statistically significant difference between males and females. Fourteen discriminant models were generated by applying single and combined parameters, producing a total correct sex classification ranging from 78.4% to 92.6%. In addition, over 67% of the total sample was accurately classified, with 95% or greater posterior probabilities. Our study demonstrates the feasibility of 3D sex estimation using Purkait’s triangle on a Turkish population, with accuracy rates comparable to those reported in other populations. This is the first attempt to apply this method on virtual data and although further validation and standardisation are recommended for its application on dry bone, this research constitutes a significant contribution to the development of population-specific standards when only virtual data are available. Key points CT analysis using Purkait’s triangle is a suitable tool for assessment of sex in unidentified individuals. The best overall estimation rate was achieved with the F11 model, with around 92% of accuracy. The results suggested 78.4% to 92.6% correct sex identification rates. More research is needed to expand the sample set and verify the results.

Uticaj pandemije Kovid-19 na funkcionisanje hirurške klinike - iskustvo jednog centra u turskoj

Introduction: Covid-19 is a viral epidemic disease that causes serious health problems and death worldwide. The rapid expansion of Covid-19 infection led to the disruption of healthcare services and radical reorganisation of healthcare resources due to the healthcare workers' infection. Aim: This clinical study investigated the effects of Covid-19 infection on emergency and elective cases in our general surgery clinic. Material and methods: We retrospectively analysed the clinical data of 195 patients who underwent elective (Group Elective) and emergency (Group Emergency) surgery during the Covid-19 incubation period in the Bakırköy Dr. Sadi Konuk Training and Research Hospital between March 11 - May 18, 2020. Demographic features, symptoms, surgical diagnoses, surgical methods, complications, duration of surgery, length of hospital stay and mortality, the status of Covid-19 of all patients were recorded. Results: 195 patients, including emergency and elective surgery cases, were operated on (104 and 91, respectively). The incidence of Covid-19 infection was 5.49% in patients scheduled for elective surgery and 4.8% in patients operated urgently, and all developed in the postoperative period. Two patients with emergency surgery died of respiratory failure, their mean age was 51 years. Two of 104 emergency-operated patients were positive from Covid-19 (1.92%) at the time of admission. Eighteen medical staff and nurses got Covid-19 infections. Conclusions: Due to the rapid spread of Covid-19 infection, early precautions must be taken in surgical clinics to guarantee the safety of patients all healthcare providers, and personnel.

Yoğun Bakımda Akut Böbrek Hasarı Takibinde NGAL, Kreatinin ve Renal Kan Akımının Monitörizasyonu

Objectıve: Acute Kidney Injury (AKI) and subsequent renal failure are the leading causes of morbidity and mortality in the intensive care unit (ICU). In this study, it was planned to compare Neutrophil Gelatinase-associated Lipocalin (NGAL) and creatinine values in patients diagnosed with AKI and to determine the effect of renal dose dopamine use on renal blood flow, development of chronic renal failure (CRF) and mortality. Materıals and methods: This prospective study was planned with 35 patients developed AKI in the ICU of Bakırköy Dr. Sadi Konuk Training and Research Hospital. The patients were randomized into 2 groups as 18 patients who received dopamine treatment with the recommendation of the cardiology clinic and 17 patients who did not receive dopamine treatment. Urea, creatinine and NGAL plasma levels were compared between groups. Results: There was no difference between the groups in terms of age, gender and AKI stage. The 0th, 24th hour results and 24-hour changes of urea, creatinine and NGAL values of dopamine patient, who took dopamine, were found to be similar to those of patients who did not take dopamine. A significant positive correlation was found between the 24-hour change in creatinine value and the 24-hour change in NGAL (r=0.374; p&lt;0.05). There was no significant change in the diameter and flow of renal arteries between measurements in patients who received dopamine. The rates of patients who regain normal kidney functions, develop CRF or develop mortality between the two groups were found to be similar. Conclusıon: Treatment results of AKI developing in ICU are not satisfactory. Low-dose dopamine treatment has no effect on patient outcomes in these patients. NGAL is a biomarker that has the ability to show renal damage at an early stage. Serial measurement of NGAL concentration during ICU stay may benefit the clinician in early diagnosis and follow-up of AKI.

Vitamin and mineral levels in children with autism spectrum disorder

The aim of this study was to compare the vitamin and mineral values of the patients followed up in the Child Psychiatry Outpatient Clinic with the diagnosis of autism spectrum disorder to healthy controls in the same age group and to investigate whether vitamin-mineral values were related to autism weight (CARS score).Between September 2017 and September 2018, we worked at Bak?rköy Dr. Sadi Konuk Training and Research Hospital Children and Adolescent Mental Health and Diseases outpatient clinic with autism spectrum disorder patients with childhood autism assessment scale (CARS) was weighted. Age, gender, height, weight, blood Iron, Vitamin B12, Folate and 25 (OH) Vitamin D levels of all patients included in the study were recorded. Mann-Whitney U, Pearson chi-square and Fisher's exact test were used to evaluate the data. In this study, 108 patients with ASD were compared with 115 normal cases. There was no statistically significant decrease in Vitamin B12, Folate, Iron and Vitamin D levels in patients with ASD compared to normal patients. According to CARS score, there was no statistically significant difference in vitamin B12, Folate, Iron and Vitamin D levels in children with mild and severe ASD. In our study, it was concluded that vitamin B12, Folate, Iron and Vitamin D levels in children with ASD were not lower than healthy children, and there was no difference between mild and severe cases according to CARS score.

Atypical response patterns in metastatic melanoma and renal cell carcinoma patients treated with nivolumab: A single center experience.

The response patterns of immune checkpoint inhibitors (ICIs) have been recognized to differ from those seen in standard cytotoxic and targeted therapy. Pseudoprogression and hyperprogression are new clinical phenomena specific to the field of immuno-oncology. In this study, we aimed to assess the frequency of hyperprogression and pseudoprogression in metastatic RCC and melanoma patients treated in our institution with the programmed cell death protein-1 inhibitor nivolumab. The medical records of all metastatic melanoma and renal cell carcinoma patients that were treated with nivolumab (n = 54) in Bakirkoy Dr. Sadi Konuk Training and Research Hospital (Istanbul-Turkey), Medical Oncology Clinic between June 2017 and December 2019 were retrospectively analyzed. Hyperprogression and pseudoprogression rates were 12% and 9%, respectively and that is consistent with published data. Pseudoprogression and hyperprogression are new radiologic response patterns with immunotherapy agents. It is critical to be aware of these two phenomena in order to make the right decisions for patients.