yok

Abstract

Aim: Respiratory infections caused by PIV are related to major morbidity and hospitalization rates in infants and young children. The aim of the present retrospective study is to investigate the rate and seasonal distribution of PIV infections in pediatric patients with lower respiratory tract infections.

Patients and Methods: Nasopharyngeal swab specimens of pediatric in- and outpatients with the diagnosis of lower respiratory infection were collected from various pediatric clinics between January 2014 and December 2016. PIV types 1, 2, 3 and 4 were identified by multiplex real time PCR method.

Results: One of the four PIV types was identified in 224 of 1983 nasopharyngeal swab specimens of patients aged less than 18 years (11.3%). PIV-3 was the most common agent among the subtypes (75%) followed by PIV- 4 (15.2%). The rate of PIV-1 and PIV-2 were 5.8% and 4%, respectively. Of all pediatric patients, 75.9% were under 5 years of age. When the seasonal distribution was examined, it was determined that PIV-3 was frequently observed in summer (53.6%), whereas PIV-1 and PIV-2 were observed in autumn and winter months.

Conclusion: PIV-3 was the most common subtype. Prompt identification of PIV by multiplex real time PCR method would be very helpful for clinicians in the treatment and prevention of the respiratory infections caused by viral pathogens.

\r\n Purpose: Mesh erosions that necessitates excision can develop in Trans Obturator Tape (TOT) surgeries which are widely used in the treatment of stress urinary incontinence.

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\r\n In our study, we described a method of vaginal flap placed under suburethral sling to prevent urethral mesh erosion related with TOT surgery and evaluated the patients for postoperative complications.

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\r\n Materials and methods: In our study, 22 patients who had TOT and cystocele operations simultaneously and to whom flaps composed of vaginal tissue were placed in front of the urethra under the mesh between December 2014 and May 2018 were evaluated retrospectively. Patients were evaluated for urethral mesh erosion, vaginal mesh erosion, complaints of urgency and dyspareunia, urinary retention, and need for secondary surgery.

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\r\n Results: The mean postoperative follow-up of the patients were 8,95±8,45 months. 20 patients had simultaneous TOT and cystocele operations (%90,9), 2 patient had vaginal hysterectomy, TOT and cystocele operations simultaneously (%9,1). Urethral mesh erosion developed in none of the patients during the follow-up period. Vaginal mesh erosion and dyspareunia was observed in only one menopausal patient. Urinary retention and overflow incontinence developed in another patient. Vaginal hysterectomy, TOT and cystocele operations were made simultaneously in this patient. Mesh of this patient was cut later on.

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\r\n Coclusion: The surgical technique we used in our cases kept urgency and vaginal mesh erosion in a minimal level besides totally preventing urethral mesh erosion in a mean short-term follow-up period of 9 months.

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AIM: Kaposi sarcoma (KS) is a vascular proliferative disease associated with human herpesvirus-8 (HHV-8). The studies about the epidemiology of KS in Turkey are limited. We aimed to evaluate the clinical, pathological, and immunohistochemical features a total of 78 KS patients, presenting them along with the available information in the literature.

MATERIALS AND METHODS: We retrospectively evaluated the clinical and histopathological characteristics of a total of 78 patients with KS.

RESULTS: The age of the patients ranged from 46 to 93 years and the mean age was 74.06 years. Of the patients, 59 were males and 19 were females. The lesions were most commonly found on the lower extremities. In the study patients, KS was found both at earlier stages with patches or plaques in 54 of the patients and at the nodular stage in 24 patients. A punch biopsy or an excisional biopsy was performed in 23 and 55 patients, respectively. In the excisional biopsies, the smallest tumor diameter was 0.35 cm and the largest one was 2.8 cm with a mean diameter of 0.98 cm.

DISCUSSION: This retrospective study demonstrated that; in Konya, KS developed in older people and it was most commonly seen in males. It was observed that the demographic features and histopathological types of KS in the study patients were similar to the reports in the literature.

Aim

This study aims to determine the prevalence of falls and associated risk factors among elderly living in Sinop, Turkey.

Materials and methods

The universe of this cross-sectional study consists of 32506 people older than 65 years old whom are registered to the family physicians’ information system and live in Sinop. After stratification for sex and age (65-74, 75 and over) a sample size of 2463 and 92.1% were reached. Data about some of the socio-demographic characteristics, falling status, daily living activity functionalities, depression status and awareness about falls of the participants were collected via a structuralized questionnaire. Relations between falls and associated risk factors were assessed by four different logistic regression models.

Results

The mean of falling prevalence after age 65 among elderly was 36.4%. Not being graduated from any school, having low scores for current health conditions, using more than one drug daily, not being able to walk without support and being positive for depression are found to be risk factors for falling among both sex and age groups. Having a chronic disease, living alone, having fear of falling, having low awareness about falls, being dependent in daily living activities and having inadequate knowledge about prevention from falls are found to be risk factors for at least two of the sex and age groups. There were no statistically significant relations between falling risk and previous or current employment status.

Conclusion

Falls are important public health concerns among elderly and the variability of risk factors depending on determinants such as age and sex should be considered while planning further implementations targeting fall prevention and control of risk factors for elderly.

ABSTRACT

Objective: The aim of this study was to investigate the effects of kinesiological banding on symptoms in carpal tunnel syndrome associated with pregnancy.

Materials and Methods: Patients who were admitted to the Physical Therapy and Rehabilitation Clinic due to carpal tunnel syndrome and who were diagnosed with carpal tunnel syndrome by electromyography and who were able to reach the visuel analog score, Short Form-36, Boston Carpal Tunnel Questionnaire and Pittsburgh Sleep Quality Index values were included in the study.

Results: In both groups, there was a significantly difference between the first visuel analog score day-night and the last visuel analog score day-night and first and last Pittsburgh Sleep Quality Index (p<0,05). While there was a significantly improvement in the Boston Symptom Severity Scale, there was no significantly difference in Boston Functional Capacity Scale. In the comparison between the groups, visuel analog score day, Short Form-36 pain parameter and decrease in Boston Symptom Severity Scale were found statistically significant.

Conclusions: In our study, although the superiority of kinesiological banding on hand-wrist rest splint could not be clearly shown, decreased pain and symptoms and an increase in sleep quality were observed.The kinesiological banding should be in mind in patients who have no response to resting splint because of low treatment options during pregnancy.

Backround: Myocardial infarction with coronary artery disease (MICAD) is the leading cause of myocardial injury. Myocardial injury non-related to atherosclerotic plaque disruption (non-MICAD) is a rare and heterogeneous diagnosis. Although MICAD is well studied, non-MICAD was not thoroughly identified in young patient population. We aimed to investigate the frequency, main etiologies, and five-year mortality of patients with non-MICAD younger than 40 years.

Methods: We retrospectively enrolled 292 patients with acute myocardial injury younger than 40 years between January 2010 and December 2014. Clinical, demographic, laboratory, angiographic features, and five-year all-cause mortality were compared between patients with non-MICAD (n=78) and MICAD (n=214).

Results: Median age of patients was 36. Non-MICAD group was younger than MICAD group [32 (28-37) vs 37 (34-39)]. The frequency of female patients with non-MICAD was higher than those with MICAD (24.4% vs 10.3%). Most of the patients with MICAD presented with STEMI (77.1%), while most of the patients with non-MICAD presented with non-STEMI (89.7%). Most common etiologies of non-MICAD in were myocarditis (32%) and vasospasm (9%). Age, female sex, no smoking and, absence of dyslipidemia were independent predictors for non-MICAD. Five-year all-cause mortality in non-MICAD group was significantly lower than MICAD group (2.6% vs 10.3%) (log-rank test p=0.04).

Conclusion: Non-MICAD represents a heterogeneous group of patients who had varying etiologies at different ages. Despite the lower mortality rate of non-MICAD group, different diagnostic and treatment strategies are required for management of patients with non-MICAD.

Aim: Atrial fibrillation is a common disorder and is an important cause of thromboembolic events. Recently, direct oral anticoagulant drugs (DOACs) are being used to reduce the frequency of thromboembolic events among these patients. DOACs have several advantages over oral vitamin K antagonists, such as fixed dosage and fewer side effects. However, since the drugs and their affects cannot be monitored directly, difficulties are encountered in assessing drug efficacy and side effects. For this purpose, platelet indices and their relationship with DOACs may be utilized for the prediction of thromboembolic and hemorrhagic events.

Patients and Methods: 301 patients with atrial fibrillation who were using DOACs were included in the study. Platelet indices such as platelet count, platelet distribution volume, plateletcrit, platelet-large cell ratio were evaluated at the first and sixth months. The effect of DOACs on these indices and relationships with bleeding events were investigated.

Results: All groups were similar in regard to baseline platelet indices, except for lower P-LCR value among recipients of rivaroxaban. When post-treatment results were compared, all groups were found to have similar values in all parameters. However, time-bound comparisons revealed that apixaban and dabigatran significantly reduced P-LCR value after 6 months of use.

Conclusion: This study showed that apixaban, rivoraxaban and dabigatran had no effect on platelet count, MPV, PDW, PCT values in whole blood count of patients with non-valvular AF. All characteristics of those with and without hemorrhagic events were also similar of patients with non-valvular AF.

Abstract

Aim: Since clinical and prognostic heterogeneity is observed in diffuse large B-cell lymphoma (‎DLBCL) patients, it is vital to determine its prognostic and predictive factors. The frequency of these factors varies geographically and ethnically. We aimed to reevaluate and discuss the prognostic and predictive ‎factors of DLBCL patients who have been treated with R-CHOP in our ‎center based on the WHO 2017 revised 4^th edition.‎ We also investigated the incidence of EBV in DLBCL-NOS.

Patients and Methods: Patients with DLBCL-NOS diagnosed previously in our hospital between 2007-2017 and treated with ‎R-CHOP were included in the study. We evaluated the expressions of CD10, CD5, CD30, BCL-2, BCL-6, MUM-1, MYC, LMP-1, EBNA-2, Ki-67, and p53, by immunohistochemistry, and EBV encoded RNA by in situ hybridization in 104 cases of DLBCL-NOS. The Revised International Prognostic Index (R-IPI) score and the overall survival time ‎was ‎calculated.

Results: The study included 56 men (53.8%) and 48 women (46.2%). The median age was 64.5 years. In 59.6% of the patients, the disease had a nodal beginning, whereas in 40.4% of the patients it had an ‎extranodal presentation. High ‎stage (III-IV) was present in 26.5% of the GCB subtype and 43.6% of non-GCB subtype (p=0.049). A high ‎R-IPI score was observed in 40% of GCB subtype and 54.5% of non-GCB subtype (p=0.028). Survival was significantly lower in the non-GCB subtype (log-rank test p=0.003).‎ The EBV frequency was about 3% as it is reported in Western populations. The frequency of DEL status was 8.7%, indicating that it was associated with inferior survival (p=0.045). De novo CD5⁺ DLBCL ratio as 13% and it was also associated with inferior survival (p=0.013).  We also found CD30⁺ DLBCL ratio as 11.5%, but we could not establish a significant relationship with prognosis.

Conclusion: DLBCL-NOS requires detailed subtyping and elaboration of prognostic factors. ‎The frequency of DEL status and De novo CD5⁺ DLBCL indicated that it was associated with inferior survival. However, we could not establish ‎a meaningful relationship of CD30⁺ DLBCL with prognosis.‎ Three EBV positive cases were identified and two of them were classified as ‘EBV positive large B cell lymphoma’ according to the WHO 2017 revised 4^th edition.

Keywords: Diffuse Large-Cell Lymphoma; Prognostic Factors; Survival

Today health related quality of life with its ever increasing importance has become an inherent part of treatment and follow up in all departments of medicine including diagnosis and treatment. In neuro-intensive care unit, the severest patients with the most intensive diagnosis and treatment period are followed up. Neurologic disorders with neurointensive care requirement include so many parameters potentially affecting the quality of life in acute and severe stages besides in chronic term. Apart from the effects of these diseases on life quality, there are many other important parameters related to quality of life. It is possible to list chief parameters as malnutrition in intensive care unit, agitation, pain, disruption of skin integrity, musculoskeletal system involvement, cardiovascular and autonomous involvement, side effect of drugs and multidrug interactions. In this review, the relationship between nutrition and health related quality of life in neurointensive care unit will be reviewed.

Iron is a medication that is used more in iron deficiency anemia. The use of iron in high doses can cause a multisystemic effect. The toxicity of iron depends upon the amount of elemental iron ingested. The minimum toxic dose and the lethal doses of iron are not firmly established. However, side effects that may be life-threatening are seen on the heart and liver. This paper presents a 16-year-old patient who used 720 mg; 12mg / kg / dose preparation of iron for suicide purposes. The control blood tests performed while planning the discharge of the patient, who had no complaints but were followed up clinically, continued to be followed up because of the increase in the value of troponin. The patient who has no record of physical examination, electrocardiogram (ECG), echocardiography (ECO) and indication for iron chelation and in whose troponin level a decrease was diagnosed in the monitoring was discharged with recommendations. Due to the rare occurrence of cardiac involvement and being the first case reported in our country, the effects of the drug on toxicity were discussed in the light of the literature.

Chronic mesenteric ischemia is a rare disease caused by intestinal perfusion disorder. Increased abdominal pain after meals, loss of appetite, weight loss, such as the symptoms of the course. The patient was presented with intestinal ischemia, arterial dorsalis pedis obstruction, celiac artery and superior mesenteric artery involvement. The coexistence of all these lesions in a 35-year-old female patient was interesting because of its rarity. In this study, we wanted to share the surgical treatment of a young patient who was not suitable for endovascular treatment and underwent saphenous vein and aorta-hepatic bypass due to multiple lesions.

Endometriosis is theplacement of theendometrialtissue in anotherpart of the body. Most commonly involved in peritoneum, ovaries, douglas and rectovaginal septum. It can be placed in many parts of the body. Our case was evaluated at 26 years of age after failed perianal abscess and fistula surgery. The patient has pain, swelling and discharge in the perianal region. The stiffness in the perianal region was seen during surgery. The stiffness was totally excised. Histopathological examination revealed endometriosis. It should be kept in mind that endometriosis may occur in different regions from the usual localization.

Myotonic dystrophy is the most common muscular dystrophy of adulthood. Neurological manifestation of the disease is typical, however diagnosis could be challenge in patients presentig with predominant cardiac or systemic symptoms. 46 year old male was suffering from presyncope attacks for 16 years, and first examined by a cardiologist. Because of the recent complaints including walking difficulty, he was referred to neurology department. Following a detailed neurological examination and electrodiagnostic workup, he was finally diagnosed myotonic dystrophy type 1. The case highlights the necessitiy of neurological consultation in patients who present with conduction defects, arythmias or cardiomyopathies of unknown origin, accompanied by overt or subtle neurological symptoms. In such patients, neuromuscular disorders should be considered in the differential diagnosis; and in order to provide thorough diagnostic evaluation, multidisciplinary approach is essential.