Selçuk Tıp Dergisi Arşiv

Aim: Pediatric age period has a dynamic structure for nevogenesis. In this paper, it was aimed to contribute to recognition of banal and atypical nevi through examining dermoscopic pattern and pigment network structures of acquired melanocytic nevi in pediatric age group. 
Patients and Methods: One hundred and fifty pediatric volunteers who were not predisposed to nevogenesis were included in the study. Children were divided into two groups as 7 and under, and 8 and over. 
Results: It was observed that the mean number of nevus was higher in the older age group (9.72) than in the younger age group (3.44). It was observed that the predominant pattern structure was globular pattern in both groups, and nevi with reticular patter in the age group of 8 and above were more than the age group 7 and below (p = 0.03). In both groups, nevi with globular pattern were found to be denser in the trunk and nevi with reticular patter in the extremities (p = 0.001). When the pigment network structures of nevi were examined, it was observed that the most frequently observed pigment network was uniform, but nevi with central pigmentation changes were observed more frequently in the age group of 8 years and older (p = 0.001).
Conclusion: Although acquired melanocytic nevi in the pediatric age group often have a globular pattern and uniform pigment network, the number of nevi with reticular pattern and central pigmentation changes increases with increasing age. 

Aim

The decision to start treatment in sarcoidosis is made based on clinical and radiological findings and changes in pulmonary function test findings during follow-up, and more useful tools are needed in treatment management. F-18 fluorodeoxyglucose (18F-FDG) positron required important tomography / computed tomography (PET/CT) contains important information about the extent of sarcoidosis. On the other hand, the neutrophil/lymphocyte ratio (NLR) opens as a good prognostic marker for tissue-related inflammation. This study evaluated the relationship between the 18F-FDG PET/CT findings of sarcoidosis and NLR and other clinical findings.

Material and methods

The data of the patient who was diagnosed with sarcoidosis after 18F-FDG PET/CT examination in our clinic were retrospectively reviewed. Patients' age, gender, NLR values, smoking status, extrathoracic involvement and symptoms, and 18F-FDG PET/CT findings were compared.

Results

This study consisted of 41 patients. There was a strong correlation between NLR and whole body total lesion glycolysis (TLG), and moderate correlation between  MAIA and NLR (r values: 0.852, 0.660, both of them p value: <0.001, respectively). There was a significant difference between the groups showing only thoracic involvement and additional extrathoracic involvement with MAIA, TLG and NLR values (p values,: 0.002, 0.001 and, 0.003, respectively). In the classification made according to the symptoms of the patients, there was no significant difference between the groups with SUVmax, MAIA, TLG and NLR values. Median values were found to be significantly higher in the elderly group (p values: 0.037 and 0.040, respectively). In the classification made according to gender; there was no significant difference in both PET/CT parameters and NLR values.

Conclusion

The close relationship between the NLR value, which is accepted as a prognostic indicator in sarcoidosis, and the 18F-FDG PET / CT findings which show the involvement of the disease in the whole body, may provide the clinician with significant benefits in treatment management.

Objective: The present study aimed to investigate the predictive value of (F/T)/PSAD and Free PSA/PSAD in PCa detection in Turkish males.

Material-Methods: A retrospective analysis of patients’ files, from January 2007 to December 2017, with prostate-specific antigen (PSA) values between 4-10 ng/dl was conducted. According to the prostate biopsy outcomes, data were collected from patients and divided into prostate cancer (PCa) and/or benign prostatic hyperplasia (BPH) groups. Among the groups, prostate volume (PV), Free PSA (FPSA), Total PSA (TPSA), free-to-total PSA ratio (F/T), PSA Density (PSAD), (F/T)/PSAD, and FPSA/PSAD values were evaluated and compared. The utilization of these values in PCa detection was examined. We compared our results statistically with the ROC curve and calculated the sensitivity, specificity, PPV, and NPV values.

Results: The present study participants were 131 PCa and 196 BPH patients, 327 in total. Sensitivity and specificity values of (F/T)/PSAD and FPSA/PSAD were better than PSAD, PSA, F/T. According to the optimal cut-off value, the sensitivity of (F/T)/PSAD and FPSA/PSAD was similar. Likewise, NPV of F/T, (F/T)/PSAD, and FPSA/PSAD were also similar. The logistic regression model using a combination of age, PV, FPSA/PSAD, and (F/T)/PSAD displayed a higher AUC than each of these values per se.

Conclusion: FPSA/PSAD and (F/T)/PSAD, the relatively new parameters, have similar predictive accuracy in PCa detection. They have higher sensitivity and specificity than F/T PSA and PSAD alone. However, more research is needed to evaluate the efficiency of predictive value of these parameters.

Introduction: Our aim is to evaluate the cardiac involvement of Neurofibromatosis type 1  patients in our region and to compare them with other clinical findings. In this study, we wanted to show the frequency and variety of cardiac involvement.

Material and Methods: Patients diagnosed with Neurofibromatosis type 1  in Hatay Mustafa Kemal University Medical Faculty Pediatric Neurology Clinic between 01/09/2019 and 01/09/2020 were included in the study. The patients included in the study were examined by a Pediatric Cardiology Specialist, and echocardiography and electrocardiography were taken. Demographic information, examination findings, brain magnetic resonance images were collected from the files of the patients. Electrocardiography and echocardiography were examined and recorded by the Pediatric Cardiology Specialist.

Results: We accepted 17 patients from our center to the study. Six patients (35.3%) were diagnosed with sporadic Neurofibromatosis type 1, while 11 patients (64.7%) had familial Neurofibromatosis type 1. All of our patients had cafe au late spots on the skin. In addition, 10 (58.8%) patients also had axillary and / or inguinal freckles. We detected optic glioma in 3 of our patients with ocular involvement, and lish nodules in 3 of them with papillary edema. When we looked at central nervous system involvement, we encountered various involvements in brain MRIs of 8 (47%) patients. In our cardiac examination, we found QT length in 1 patient’s electrocardiography. In the echocardiography we performed for the detection of cardiac structural pathologies, we detected nodular appearance compatible with subendocardial neurofibroma in 3 patients, mitral insufficiency in 3 patients, patent foramen ovale in 1 patient, atrial septal defect in 1 patient, and bicuspid aorta in 1 patient.

Discussion: In our study, unlike the literature, subendocardial nodular hyperechogenic appearance was present in 3 patients. Although these findings are quite rare, subendocardial nodular hyperechogenic images in 3 of our 17 patients suggest that this pathology may be more common. In addition, one of our patients had a long QT. As far as we know, this is the first case of Neurofibromatosis type 1 and Long QT syndrome. In conclussion; Cardiac involvement in patients with Neurofibromatosis type 1 could more common than mentioned in the literature.

Objective: Familial hypercholesterolemia (FH) is an autosomal dominant inherited genetic disorder that causes a significant increase in low-density lipoprotein (LDL) cholesterol levels and leads to early coronary heart disease and cardiac mortality. Although this disease has a heterozygous (HeFH) and homozygous (HoFH) form, the incidence of HeFH is reported to be 1: 500, while HoFH is reported to be 1: 1 000 000. This disease is often caused by LDL receptor (most common), apolipoprotein B (Apo B), Proprotein Convertase Subtilisin/Kexin 9 (PCSK9), and LDL receptor adaptor protein (LDLRAP) gene mutations. Patients with FH do not respond well to lipid-lowering therapies such as a statin, and so lipoprotein apheresis is the treatment of choice.

Material and Methods: We compared the results of lipoprotein apheresis in a 20-year-old female patient diagnosed with HoFH with two different methods [double-filtration plasmapheresis (DFPP) and dextran sulfate column (DSC) methods]. 40 lipoprotein apheresis procedures including 20 sessions of DFPP and 20 sessions of DSC were evaluated.

Results: When the two methods were compared the changes in high-density lipoprotein, white blood cells, platelets, potassium, calcium, prothrombin time (INR) and activated partial thromboplastin time values were statistically significant.

Conclusions: In conclusion, our study suggests that it would be more appropriate to choose the apheresis method according to the clinical and laboratory findings of the patient since it shows that two different methods have different effects on serum electrolyte values, hemostasis criteria and leukocyte and platelet counts.

Objective: Epistaxis is a common condition in the childhood age group. However, it is important to diagnose the underlying bleeding disorders in children presenting with this complaint. Simple methods to be used in primary health care are needed to determine whether patients have bleeding disorders.

This study aims to evaluate patients presenting with epistaxis with the bleeding questionnaire and determine the diagnostic value of patients with symptomatic but normal hemostatic tests.

Methods: Seventy-seven children with epistaxis were included in the study group and 20 healthy children in the control group. Pediatric Bleeding Questionnaire (PBQ) was used for evaluation.

Results: In our study, 19.4% (n = 15) of the patients were diagnosed with bleeding diathesis (vWh: 10, rare factor deficiency: 5). The mean age at presentation was 8.99 ± 3.42 (3-17) years. Thirty-seven (48%) were girls and 40 were boys. In terms of PBQ epistaxis score, there was no statistically significant difference between those with and without bleeding diathesis. However, the overall score was not statistically different; it was higher in the group with bleeding diathesis. The cutaneous bleeding score was higher in the group with bleeding diathesis and there was a statistically significant difference.

 Conclusions: This study showed that bleeding scores can be used in patients with epistaxis who apply to primary health care institutions and patients with high overall scores and cutaneous bleeding scores should be directed to the hematologist for further research.Keywords: Epistaxis, bleeding diathesis, bleeding score

Introduction and Objective

Brucellosis is a zoonotic infection seen as an endemic in Turkey and is a public health problem at the same time. The objective of this study was to evaluate demographic/epidemiologic, clinic, laboratory features, complications and treatments in brucellosis patients followed-up in our clinic.

Material & Methods

In this study, features of patients followed-up between 01/01/2010 and 31/12/2018 in our clinic were retrospectively evaluated. Descriptive data were expressed as number and percentage. Categorical variables were analyzed with Chi-square test and numerical variables with Student’s t test.

Results

Of the total of 365 brucellosis patients, 159 (43.56%) were female and 206 (56.44%) were male. The mean age of the patients was 45.9±14.51 (18-82) years. The most common time of presentation was summer season with 137 (37.5%) patients. The most common transmission route of the disease was a history of animal husbandry with 252 (69%) patients. Of all cases 168 (46%) were acute, 96 (26.3%) were subacute, and 101 (27.7%) were chronic brucellosis. The most common complaint of the patients was fatigue in 302 (82.7%) patients with being higher in acute brucellosis (p=0.0015). Anemia was found in 53 (33.3%) male and 114 (55.3%) female patients with being significantly higher in female patients (p=0.0283). Leukopenia was found in 7.9%, leukocytosis in 16.2%, thrombocytopenia in 9.6%, neutropenia in 4.1%, neutrophilia in 9% and lymphomonocytosis in 12% of the patients. Wright agglutination test was performed in 26 (7.1%) and brucella immunocapture agglutination test in 361 (98.9%) patients and all results were positive. Of all patients, 172 (47.1%) developed complications with spondylodiscitis being the most commonly found in 58 (15.9%) patients. Sixty-one (31.8%) of patients developed relapse.

Conclusion: Since brucellosis is endemic in our country, it should be considered in presumed diagnosis of patients presenting with complaints such as fatigue, articular pain and fever.

Aim: Diabetes, which has turned into a pandemic in the twenty-first century, concerns all branches of medicine. This study aims to investigate the prevalence of diabetes unawareness by checking HbA1c in patients hospitalized in clinics other than internal medicine and evaluate the factors associated with them.

Patients and Methods: The study included 630 patients hospitalized outside internal medicine services at or over the age of 18 whose anthropometric measurements could be made. The sociodemographic properties and comorbidities of the patients were recorded. Their anthropometric measurements, fasting blood glucose and HbA1c measurements were made. Those without a known diabetes diagnosis but with an HbA1c value of ≥6.5% were grouped as diabetes unaware. The differences among known diabetes, diabetes unaware and no diabetes  groups  were examined.

Results: The study was conducted between 01.03.2017 and 31.12.2017. The mean age of the patients was 58.04±18.56, while 54.6% (n=344) were male. The number of the patients with known diabetes was 190 (30.2%), 396 (62.9%) did not have diabetes, and unknown diabetes was detected in 44 (7%). Among the 234 patients with diabetes, 18.8% (n:44) had diabetes unawareness. The rate of those under the age of 45 in the diabetes unaware group (11.4%) was higher than that in the known diabetes group (3.7%) (p<0.01). Again, the rate of the male sex was also higher among the same individuals (68% vs 47.9%, p:0.15). The rate of overweight in the diabetes unaware group (56.8%) was higher than those in the known diabetes (37.9%) and no diabetes (39.1%) groups (respectively, p:0.36, p<0.01). There was no significant difference among the three groups in terms of educational levels. The rate of comorbidity presence was higher in the known diabetics (89.5%) than the diabetes unaware group (75%) (p:0.01). All patients with diabetes were evaluated by logistic regression analysis. The male sex, age<45 years, being overweight and absence of a comorbidity were associated with diabetes unawareness.

Conclusion: Undiagnosed diabetes was detected in 7% of the patients. Among all diabetic patients, 18.8% had diabetes unawareness. Conducting diabetes screening with HbA1c in inpatients and paying special attention to those under 45, males, overweight patients and those without comorbidities may help detect unknown diabetes.

This study was retrospectively registered at the Protocol Registration and Results System (Clinicaltrials.gov PRS)  with the registration number NCT04694326.

Aim: It was aimed to compare with healthy volunteers the changes in heat shock protein (HSP) 90 alpha and vitamin levels during exacerbation and remission periods in our patients with familial Mediterranean fever (FMF), to research whether these molecules will benefit in control of FMF exacerbation and prevention of amyloid accumulation, and also to investigate the relationship of these molecules with FMF gene mutations.

Patients and Methods: HSP 90 alpha, vitamin A, vitamin B 12, vitamin D, vitamin E and folic acid levels were studied in 30 patients with AAA diagnosed in our hospital's pediatric nephrology department during the exacerbation and remission periods and 30 healthy volunteers. The results were compared statistically.

Results: In our series, 19 (63.3%) of the patients were male, 11 (36.7%) were female, with a mean age of 11 years. The most common presenting complaint was abdominal pain (n=19; 63.3%) after fever and only high fever was found to be present in five (16.7%) patients. The most common genetic mutation was M694V (n=14; 46.7%), whereas no mutation was detected in five (16.7%) patients. Although HSP 90 alpha was the highest in the exacerbation group and the lowest in the remission group, there was no significant difference between the groups. Vitamin B12 was significantly different between the groups and the highest value was in the control group. Vitamin D was significantly different between the exacerbation and the remission groups and the highest value was in the exacerbation group. In addition, vitamin D levels were significantly higher in boys. There was no significant difference between vitamin A, vitamin E and folic acid levels. FMF gene mutations did not affect HSP 90 alpha and vitamin levels.

Conclusion: Our findings showed that serum HSP 90 alpha, vitamin D, vitamin E and folic acid levels were normal in AAA, but vitamin B12 and vitamin A levels were low during exacerbation and remission. However, we think that prospective studies including larger series should be performed about the subject.

Aim: In the present study, the aim is to determine whether centromere protein H (CENPH) gene expression levels change in prostate carcinoma (PCa).
Materials and Methods: Prostate tissue sample of 40 patients with primary prostate cancer was used in the study. Hence, transcriptional analysis of the CENPH gene was conducted in the total paraffin embedded prostate tissues extracted from patients diagnosed with prostate cancer. The expression analyses were obtained from the comparison of the expressions within the tumoral and non-tumoral areas in the prostate tissue of the same patient.
Results: Separate RNA isolation was performed. Subsequent qRT-PCR analyzes were repeated three times and quality controls of the Ct values were performed on the obtained data. The Ct values of the expression of the housekeeping gene GAPDH and the target gene CENPH gene were compared in tissue (tumor and normal) and technical repeat groups. There was no statistically significant difference in CENPH gene expression between tumor and normal tissue specimens in prostate cancer. Moreover, on investigating the causes of death, in none of the patients PCa related death was determined. 
Conclusion: In our study, we could not find any relationship with prostate cancer tumorogenesis in CENPH gene expression anomalies. However, some cancers (non-small cell lung cancer, colon cancer, etc) with high CENPH gene expression are associated with tumor aggressiveness, poor prognosis and drugresistance. More studies are needed on CENPH gene expression and its effect on prostate cancer.

Aim: Ginkgo biloba is used in traditional Chinese medicine for the treatment of various illnesses, including asthma, cough, and enuresis. Standardized Ginkgo biloba extract, EGb-761 contains flavonoids and terpenoids, which induce vasorelaxation in animal vessels. Little information is present on the effects of EGb–761 on human umbilical circulation. This in vitro study assesses the vascular effects of EGb-761 on the isolated human umbilical artery and the role of nitric oxide (NO) and prostaglandins in these effects.

Materials and methods: Isolated human umbilical artery strips were suspended in organ baths containing Krebs-Henseleit solution, continuously gassed with 95% O2-5% CO2. After a resting period, the isometric vasoactive changes to the applied agents were recorded. The following experimental procedures were conducted in different groups of strips (n=9); 1) Effect of cumulative EGb-761 (50-500 µg/ml) on the basal tonus of the artery strips. 2) The relaxant effect of cumulative EGb-761 on contraction elicited by 10-6 M 5-HT. 3) Effect of L-NAME incubation on the relaxant effect of cumulative EGb-761 on contraction elicited by 5-HT. 4) Effect of indomethacin incubation on the relaxant effect of cumulative EGb-761 on contraction elicited by 5-HT. 5) Combined effect of L-NAME and indomethacin incubation on the relaxant effect of cumulative EGb-761 on contraction elicited by 5-HT. Mixed effect models were used for Statistical analysis of the data. p<0.05 was considered significant.

Results:

The application of cumulative EGb-761 (50-500 µg/ml) did not alter the basal tone of the artery strips (p>0.05). Cumulative EGb-761 (50-500 µg/ml) generated concentration-dependent relaxation in 5-HT induced contraction (p<0.05). L-NAME significantly reduced the relaxation responses at all concentrations of EGb-761 (50-500 µg/ml) on 5-HT induced contractions (p<0.05). L-NAME completely inhibited relaxation responses of low concentrations (50-100 µg/ml) of EGb-76. Indomethacin significantly inhibited these responses at higher concentrations of EGb-761 (200-500 µg/ml) (p<0.05). L-NAME + indomethacin resulted in significant inhibition of relaxation responses with all concentrations of EGb-761 (50-500 µg/ml) (p<0.05). In addition, the co-administration of L-NAME and indomethacin resulted in a stronger inhibition in these relaxation responses at certain concentrations of EGb-761 than L-NAME and indomethacin alone.

Conclusions: EGb-761 does not affect the basal tone of the human umbilical artery. Cumulative application of EGb-761 in human umbilical artery strips precontracted with 5-HT generates significant concentration-dependent relaxation. NO and prostaglandins are involved in the mechanism of vasodilatation with varying potentials depending on the EGb-761 concentration. Prostaglandins also create synergy with NO in these responses.

ABSTRACT

Objective: Endometrial cancer is the most common malignancy of the female genital tract and the fourth leading cancer among women. Our aim is to share the surgical treatment and results of endometrial cancer cases in our gynecological oncology clinic.

Material and Methods: In this study, the records of 164 endometrial cancer patients operated by the same surgical team between 2009-2019 were reviewed retrospectively. The clinical, surgical and histopathological features of the patients are presented here. Four patients who had sarcoma as a result of pathology, 7 patients who underwent complementary surgery and 1 patient with a second primary tumor were not included in the study.

Results: The mean age of the patients included in our study was 61.3 and the mean body mass index was 25.8. According to the postoperative pathology results; mean tumor size was 3.4 cm and mean number of collected lymph nodes was 28.8. Lymph node metastasis was observed in 19 patients and all of the metastases were in pelvic lymph nodes. Endometrioid type adenocarcinoma was seen in 81% of the patients. Myometrial invasion > 50% in 81 patients (49.4%). Twenty patients (12.2%) had cervical involvement, 11 patients (6.7%) had adnexal involvement and 28 patients (17.1%) had lymphovascular area invasion. 76 patients (46.3%) were grade 1, 61 patients (37.2%) were grade 2, 19 patients (11.6%) were grade 3. When the patients were staging according to the FIGO system in 2009, 70 (42.7%) stage 1A, 58 (35.4%) stage 1B, 12 (7.3%) stage 2, 3 (1.8%) stage 3A 17 patients (10.4%) were stage 3C1 and 4 patients (2.4%) were stage 4.

Conclusion: Endometrial cancer is the most common gynecological cancer, and it is usually diagnosed at an early stage as a result of early signs. Tumor size, depth of myometrial invasion and histopathologic grade are used to evaluate the risk of the disease, but studies with a higher number of high stage patients will be more useful in determining the risk.

Scientific experiments are needed to see the natural course of the disease in living (human or animal) individuals and to develop treatment for this. For centuries, human beings have been studying human-like organisms and have been using an animal experiments in order to advance in science and health. Researchers who work in in the field of physiotherapy that is the main philosophy of which is to plan and apply the appropriate program by the teamwork into each patient under the clinical and experimental knowledge, must have knowledge of the design, methodology, analysis and interpretation of the study in order to be able to effectively evaluate the results of research on animal experiments. This paper aims to introduce the basic principles of experimental animal studies used in the field of physiotherapy and to give the necessary information to choose the appropriate experimental model.

Anaphylaxis is a multi-systemic disease, which develops associated with the sudden expression of mast cell mediators into the systemic circulation, and can be life-threatening. The majority of cases are reactions to food, drugs, or insect stings, mediated by immunoglobulin E (IgE), and may cause a process resulting in degranulation of mast cells. Severe asthma, mastocytosis, cardiovascular disease, elevated basal serum triptase, the use of beta blockers or ACE inhibitors, exercise, acute infections and emotional stress are some of the reasons increasing the risk of anaphylaxis. As cardiac functions and respiration can halt within minutes during an anaphylaxis attack, treatment must be applied rapidly immediately after diagnosis. Adrenalin is the first and most important drug which should be given in treatment. In this review, the diagnosis and treatment of anaphylaxis are summarised in the light of current literature.

HaNDL syndrome is a rare syndrome mimicking migraine and stroke with lymphocytosis in the CSF, migraine-like moderate or severe headaches and transient neurological deficit. In this article, we present a 26-year-old male patient with headache, transient neurological deficit and CSF lymphocytosis who was diagnosed as HaNDL Syndrome.

Since it is the most abundant bacteria in the flora, resistance to E. coli, especially the development of carbapenemase-producing strains, is one of the undesired situations. In our hospital, E. coli isolates with OXA-48 resistance gene were isolated from the clinical samples of two patients. That it would be beneficial to report these cases in order to report the isolation of E. coli isolates with OXA-48 resistance gene and to prevent the spread of this resistance gene in these microorganisms.