INTRODUCTION: Millions of people worldwide die or are disabled every year due to acute ischemic stroke. In this study, our aim was to demonstrate the neuroprotective effects of Edaravone in experimental cerebral ischemia/reperfusion injury in rats.
METHODS: Twenty-eight female Sprague Dawley rats were divided into four main groups. The ischemia group underwent bilateral carotid artery clipping and hypotension for 30 min. The Edavarone group received intraperitoneal 30 mg/kg/day Edavarone following 30-min bilateral carotid artery clipping+hypotension. Skin laceration only was applied to the control group, and anesthesia only was applied for 15 min to the anesthesia group. At the end of the 10th day, all rats were sacrificed, and blood samples and brain tissues were collected for analysis.
RESULTS: Ischemia group malondialdehyde (MDA) values were significantly higher than those of the control and Edaravone groups. Edaravone group tissue MDA values (258±13.8 nmol/g) were significantly lower than those of the ischemia group (368±36.6 nmol/g) (p<0.05). Edaravone group tissue total oxidant status (TOS) was significantly lower than in the anesthesia and ischemia groups (96.9±13.4 mmol H2O2 Eq/L (g)). A statistically significant difference was observed between the groups’ serum TOS values (p<0.05).
DISCUSSION AND CONCLUSION: This study shows that Edaravone reduced or prevented ischemic damage in rat brain tissue by causing significant changes in oxidant and antioxidant parameters.

INTRODUCTION: In this study, we aim to investigate the effects of two different preanesthetic doses of dexmedetomidine on the hemodynamic response to endotracheal intubation, intubation conditions and neuromuscular block.
METHODS: Seventy-five ASAI-II patients, aged 18-70 years, who required tracheal intubation for elective surgery were allocated for this study. Before induction, patients were randomly divided into three groups to receive either saline as placebo (20cc) (GroupC), dexmedetomidine 0.5 μg/kg (Group D0.5) or dexmedetomidine 1 μg/kg (Group D1) in a total volume of 20 cc in 10 min. Heart rate(HR) and mean arterial pressure (MAP) were recorded according to the study's measurement time. Time to achieve 90% and 100% neuromuscular block, time to recovery from neuromuscular block 25% (T25), 50% (T50), 75% (T75) and recovery index values were noted.
RESULTS: The increases in HR after laryngoscopy and immediately intubation were lower in both groups D than Group C. Values of MAP during laryngoscopy were lower in both Groups D than Group C Times to achieve 90% and 100% neuromuscular block were found significantly lower in dexmedetomidine groups than Group C. Values of T75 and recovery index in Group D 0.5, T25, T50, T75 and recovery index in Group D1 were longer than Group C. Neuromuscular block properties were similar between dexmedetomidine groups.
DISCUSSION AND CONCLUSION: We conclude that dexmedetomidine decreased hemodynamic response to endotracheal intubation, especially heart rate dose-dependently, whereas it decreased time to achieve neuromuscular block and increased time to recovery from the neuromuscular block as independent from dose.

INTRODUCTION: Childhood urinary tract infection (UTI) is one of the most important causes of renal failure in adult age. The presence of congenital urinary malformation should be investigated. In this study, by evaluating new-borns with UTI who were hospitalized in our clinic, we aimed to find clues that will help clinicians for choosing the right imaging methods.
METHODS: This research includes 137 neonates who were hospitalized with the diagnosis of UTI or diagnosed as UTI after hospitalization in Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital NICU-2 between January 2009-October 2012. All patients’ demographic characteristics and urinary tract imaging were evaluated.
RESULTS: Of the 137 neonates included in this study, 78.8% of them was male, and 21.2% of them was female. In 19% of the patients, abnormalities were detected with urinary tract ultrasonography. The most frequent abnormality was hydronephrosis and ectasia 13.9%. In 39 of the patients, three imaging technique was performed. Of the patients with abnormal urinary system ultrasound, 47.1% of them had pathologic voiding cystourethrography, and 58.8% of them had pathologic DMSA scintigraphy. Abnormal VCUG and DMSA rates were 9.1% in patients with normal urinary system ultrasonography.
DISCUSSION AND CONCLUSION: Urinary tract USG should be performed to each patient who was diagnosed as urinary tract infection in the newborn period because of this may be a signal of the urinary system abnormality. Choice of the advanced imaging modalities should be decided according to the patient's characteristics.

INTRODUCTION: Introduction: Leukocyte function-related antigen-1 (LFA-1) is αβ heterodimeric transmembrane glycoprotein and expressed on the surface of leukocytes. LFA-1 also interacts with intercellular adhesion molecules 1 (ICAM-1) which is related to cancer. Variation in LFA-1 can affect the carcinogenesis; thus, we aimed to investigate rs2230433 variation in renal cell carcinoma.
METHODS: One hundred renal cell carcinoma tissues and healthy surrounding tissue of the same kidney formed the tumor and control groups, respectively. DNA isolated from the tissues and polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) methods were employed. Statistical analysis was performed with SPSS 22.0, and p<0.05 was considered as statistically significant.
RESULTS: LFA-1 rs2230433 GC and CC genotypes were found similar between tumor and control groups (p>0.05). However, GG genotype was higher in tumors (8%) than controls (2%).
DISCUSSION AND CONCLUSION: Our results showed that normal GG genotype is higher in tumors. Thus, GG genotype can be related to tumorigenic features.

INTRODUCTION: Vitamin D deficiency and iron deficiency are the most common nutritional pandemic problems worldwide at all levels of society. In some studies, vitamin D has been shown to have an effect on erythropoiesis. The objective of this study was to investigate the relationship between serum vitamin D level, hemogram parameters, and serum iron level in preschool children.
METHODS: The study group comprised 108 children aged between 2 and 5 years who visited a single pediatric hematology polyclinic between August 2014 and August 2017and whose serum vitamin D level and iron parameters were evaluated. The patients were divided into 3 groups according to the hemoglobin value, serum ferritin level, and transferrin saturation index calculation: iron deficiency, iron deficiency anemia, and a control group. Vitamin D deficiency, insufficiency, and normal categories were also used based on assessment of the serum vitamin D level.
RESULTS: There were 41 children in the iron deficiency group, 32 classified as iron deficiency anemia, and 35 age- and sex-mated controls. The vitamin D level was statistically significant between the groups (p<0.05).
DISCUSSION AND CONCLUSION: According to our findings, vitamin D deficiency and insufficiency were prevalent, especially in children with iron deficiency anemia. It is recommended that the serum vitamin D level of children with iron deficiency anemia should be checked and vitamin D-fortified food consumption should be increased.

INTRODUCTION: This study aims to investigate the association of recurrent adenoid vegetation with cigarette exposure and allergy in long-term follow-up of patients undergoing adenoidectomy.
METHODS: We included patients who underwent only adenoidectomy in our clinic between the years 2010-2014. All of the patients were evaluated by systemic assessment and physical examination. The incidence of cigarette exposure and total IgE increase were investigated and compared in patients with recurrent adenoid vegetation.
RESULTS: In this study, among 30 cases, 18 of them were male and 12 of them were female whose age ranged from four to 17 years. The average is 9.70±3.71 years. The BMI measures ranged from 8.88 to 26.23, with an average of 17.11±4.49. 15 cases had a recurrence of adenoid vegetation. 15 cases had no recurrence. Total IgE was found high in five of the patients. 16 patients had allergic rhinitis. Three patients had asthma and two patients had atopic dermatitis. There was no statistically significant difference between recurrent and control group in terms of smoking exposure, total IgE level and the presence of allergic disease (p>0.05).
DISCUSSION AND CONCLUSION: The findings suggested that there is a significant relationship between atopy and AV in the literature. According to these findings, no significant association was found between AV recurrence and allergy. Because of the small population of this study, the results of this study were accepted as preliminary findings.

INTRODUCTION: In this study, we aimed to investigate the possible causative relationship between maternal obesity and flow patterns of ductus venosus.
METHODS: One hundred twenty three pregnant women with a body mass index of 25 or higher and 83 pregnant women with body mass index lower than 25 in gestational weeks between 11-14, were included in the present study.
RESULTS: The findings showed that there was no statistically significant difference between the two groups for a combined test, three-component antenatal tests, second-level ultrasonography. In 12% of the women, loss of a wave and/or inverse a wave was noted. In the rest of the women, there were no pathological waves. In 4.8% of women with a BMI less than 25, there was an abnormality in ductus venosus flow pattern, whereas this ratio was 17% in the other group consisted of women with BMI higher than 25; and the difference was statistically significant (p=0.008).
DISCUSSION AND CONCLUSION: We concluded that maternal hyperglycemia and high body mass index might cause abnormal flow patterns in ductus venosus in pregnancies with normal first-trimester scanning and abnormal flow patterns of ductus venosus.

INTRODUCTION: Nonspecific characteristics of abdominal tuberculosis (AT) help the disease to mimic a grade scale of intraperitoneal conditions from cancer to inflammation. A significant burden arises from the diagnostic challenge also contributes to the deterioration of the conditions, which necessitates a higher than normal level of suspicion.
METHODS: Patients with AT who had no evidence of tuberculosis on lung imaging or anamnesis were evaluated in the primary AT (Group 1) group. Patients with AT who were found to have tuberculosis in lung imaging tests, anamnesis or another organ or in another part of the body and who had AT were examined in the secondary AT (Group 2) group. These two groups were compared with various parameters.
RESULTS: Of the 14 patients, who formed the primary AT group, eight of them were female, and six of them were male. Of the 36 patients who formed the secondary AT group, 18 were female, and 18 were male. The mean age of the primary AT group was significantly lower than the secondary AT group (p=0.027). The mean hematocrit value of the primary AT group was significantly lower than the secondary AT group (p=0.015). It was observed that the distribution of the presence of ascites in CT in the secondary AT group was significantly higher than the primary AT group (p=0.019). The presence of fever in the primary AT group was observed to be significantly higher than the secondary AT group (p=0.046). Presence of cough in secondary AT group was found to be statistically significantly higher (p=0.021).
DISCUSSION AND CONCLUSION: Aging of all populations worldwide, drug resistance, increased number of immigrants and immunocompromised patients, all resulted in a minor pandemic of AT in all geographies. Although primary and secondary AT seem to share many similar characteristics, they also have statistically significant differences from each other.

INTRODUCTION: Cardiovascular diseases are major causes of mortality and morbidity in the world. D type personality is a poor prognostic factor in cardiovascular diseases. Cardiac rehabilitation is known to reduce mortality and morbidity in cardiovascular diseases. The present study aims to investigate whether type D personality inhibits the benefits of cardiac rehabilitation or not.
METHODS: A single-center, retrospective cohort study was conducted with the evaluation of all CR participants at the University Hospital of Cardiovascular and Thoracic Surgery between 01.02.2017 and 01.02.2019. Study population was the patients who were 18 years and older and completed all 30 sessions of CR program and also completed both pre- and post-tests. Type D personality was assessed with DS14. Quality of life was assessed with SF 36. Functional capacity was assessed with a 6-minute walk test (6MWT). Submaximal cycle ergometer test was performed to evaluate maximum endurance watts. A special CR program was planned for each patient based on the cycle ergometer test peak workload. The primary endpoint was the observation of changes in the Beck Depression Scale, SF-36 scores and the secondary endpoint of the study was the observation of improvement in functional capacity and endurance according to patients’ type D personality.
RESULTS: 222 patients enrolled in this study. Among the patients, 37.4% of them were positive for D type personality. Functional capacity, endurance, quality of life, depression scores were all improved after cardiac rehabilitation (p<0.01). There was no statistically significant difference between D type positive and negative patient groups about the improvements of rehabilitation (p≥0.05).

DISCUSSION AND CONCLUSION: D type personality is associated with inflammation and may increase mortality and morbidity in a cardiovascular disease. Cardiac rehabilitation may improve functional capacity, endurance, quality of life and depression scores independently from D Type personality.

INTRODUCTION: In this study, we aimed to determine the role of anticoagulants and antiagregan medications in the etiology and prognosis of the upper gastrointestinal system (GIS) bleeding in elderly patients.
METHODS: One hundred and eighty-four patients who were admitted to the emergency department with the complaints of upper GIS bleeding between January and December 2016 were evaluated retrospectively regarding the age, gender, complaints, drugs, endoscopy findings, intensive care requirement and mortality.
RESULTS: The mean age of 184 patients was 78.3±7.9 years. 112 (60.9%) of them were male and 72 (39.1%) of them were female. 128 (69.6%) of the patients applied with only melena, 32(17.4%) with only hematemesis and 24 (13%) were admitted with both hematemesis and melena. Of the patients, 139 (75.9%) were treated in the internal medicine clinic and 31 (16.8%) were treated in the intensive care unit and 12 (6.5%) were expired. The most commonly used drug was acetylsalicylic acid (ASA) (31.5%) and the most common endoscopic finding was peptic ulcer (55.4%). The mean age of the patients treated in the intensive care unit was 81±7.2years, and 18 (58.1%) of those patients were male. The most common endoscopic finding was peptic ulcer- Forrest 2A (16.2%) and ASA (35.5%) was also the most common drug in that group. The mean age of the 12 patients who were expired was 75.3±7.2 years and 8 (66.7%) of them were male. In 12 patients, the most common endoscopic finding was the peptic ulcer and the most frequent drug was warfarin (33%).
DISCUSSION AND CONCLUSION: Antiagregan, anticoagulant, NSAI drugs have significant effects on etiology and prognosis of the upper GIS bleeding in the elderly. Gastroprotective drugs should be added to the treatment of patients using these drugs.

INTRODUCTION: In recent years, increased obesity due to unfavorable changes in children's diet and lifestyle is the most important cause of the metabolic syndrome. Metabolic syndrome is a multiplex risk factor that arises from insulin resistance, and the prevalence is rapidly increasing. Our study aims to investigate the frequency of MS in obese and overweight children.
METHODS: Obese and overweight children between the ages of six and 17 years, who were referred to our pediatric clinic from June 2017 to July 2018, were included in this study. MS was evaluated according to the IDF (The International Diabetes Federation, 2006) criteria.
RESULTS: A total of 98 obese and overweight children were evaluated. According to IDF diagnostic criteria, MS prevalence was found as 25.8% (n=17) in obese children. The systolic arterial pressure averages BMI percentile and z score of obese boys were found to be statistically significantly higher than of obese girls.
DISCUSSION AND CONCLUSION: The prevention of obesity will decrease the MS frequency. A regular follow-up of all children and early intervention in the development of risk factors is one of the biggest steps in preventing MS affecting many systems.

INTRODUCTION: Although there is a consensus on the treatment of femoral shaft fractures in children aged <4 years and adolescents, the treatment method is still controversial for children between aged 4 and 10 years. Therefore, different kinds of treatment methods are described. The aim of the present study was to investigate the healing capacity of femoral shaft fractures in 4–10-year-old patients who were treated non-surgically and to compare the clinical and radiological results with the surgically treated patients in the same age group.
METHODS: A total of 59 patients between aged 4 and 10 years were included in the study. The study included 18 (31%) females and 41 (69%) males. The mean age of the patients was 6.9 (4–10) years. The mean follow-up period was 84 (38–107) months. The mean ages of the non-surgical group (n=32) and the surgical group (n=27) were 5.9 and 7.1 years, respectively. The causes of fractures were falls from height (n=29), motor vehicle accidents (n=20), child abuse (n=1), and other causes (n=9).
RESULTS: The improvement values at the angulation grades were significantly higher in anteroposterior and lateral radiographs in both groups (p<0.01). There was no significant difference between the groups in foot–thigh angle, foot progression angle, and leg length discrepancy (LLD). Fracture localization was not effective on LLD and clinical outcome success, and there was no significant difference between the two groups with regard to clinical outcomes.
DISCUSSION AND CONCLUSION: The immediate postoperative radiological reduction quality was significantly higher in the surgically treated group than in the non-surgically treated group in the early post-reduction. However, the differences of thigh–foot angles and foot progression angles between the groups were not statistically significant. In addition, there was no difference with regard to LLDs between the groups.

INTRODUCTION: Creation and subsequent patency of arteriovenous fistula (AVF) is crucial for hemodialysis patients. Early thrombosis is one of the main reasons of fistula occlusion. This study aimed to explore the effect of blood pressure and the presence of visible arteriosclerosis in the artery used for anastomosis on the patency of AVF.
METHODS: This retrospective study AVF was created in 231 consecutive patients. We used the Brecio–Cimino technique to create AVF in 50% of patients. Perioperative systolic (SBP) and diastolic (DBP) blood pressures were recorded just before declampage and during the following 24-h period for each 6-h intervals. Age, gender, presence of macroscopic arteriosclerosis in the artery used for an astomosis, and the etiologic factors of chronic renal failure parameters were all equally recorded.
RESULTS: The overall early fistula survival rate was 83%. No statistically significant immediate fistula dysfunction in terms of blood pressure differences was found. The multivariate analysis of the factors related to the AV fistula in the first 24 h patency revealed that only upper arm fistula was more likely effective (OR=1.192, p=0.003).
DISCUSSION AND CONCLUSION: The effect of age, gender, presence of arteriosclerosis, and the history of existence of central venous catheter on early AVF patency was not observed. The rate of fistula patency was higher in the upper arm compared to fistulas in the lower arm. No significant difference concerning AVF patency was observed between patients with arterial blood pressure higher or lower than 120 mmHg.

INTRODUCTION: This study aimed to evaluate the features and injury mechanisms of pediatric head trauma, demographics of the patients and factors affecting the outcome and to present the common experience of neurosurgery and pediatric intensive care unit (PICU) in light of the current literature.
METHODS: Ninety-six of 110 children under the age of 18 who had sufficient data and were treated in PICU for head trauma between 2014 and 2018 were evaluated retrospectively. The association between age, sex, mechanism of injury, neurological examination at presentation, Glasgow coma scale (GCS) score, history of cardiopulmonary resuscitation, shock, blood glucose level, hypoxia, convulsion, mean arterial pressure, heart rate per minute, body temperature, intracranial pressure (ICP) values, surgical interventions and Glasgow outcome scale (GOS) scores was investigated.
RESULTS: There were 32 patients (33.3%) in mild head trauma group, 28 patients (29.1%) in moderate head trauma group and 36 patients (37.5%) in severe head trauma group. Isolated head trauma was present in 49 patients, and multitrauma was observed in the remaining. The rate of favourable outcome was 72.9% (70 patients), and that of unfavourable outcome was 27.1% (26 patients) with the mortality rate of 15.6%. A moderate and negative correlation between presenting GCS scores and presenting blood glucose levels (rho: -0.422 p<0.001), and a moderate and positive correlation between presenting GCS scores and presenting body temperature were observed (rho: 0.422 p<0.001). A highly significant positive correlation was observed between GCS and 1-year GOS scores (rho: 0.762 p<0.001).
DISCUSSION AND CONCLUSION: Analyzing the characteristics of pediatric head trauma, knowing the prognostic factors, developing a common algorithm and standardizing the management parallel to current literature will contribute to a favourable prognosis.

INTRODUCTION: In this study, we aimed to share the characteristics, results and experiences of the patients who underwent tracheostomy in our tertiary pediatric intensive care unit and who were admitted to home monitoring program after discharge.
METHODS: The medical records of patients who underwent tracheostomy at the Pediatric Intensive Care Unit of Medeniyet University, Göztepe Training and Research Hospital between May 2015 and June 2019 and followed up at home monitoring program after family education were retrospectively analyzed.
RESULTS: A total of 47 patients 30 male (63.8%) and 17 female (36.2%) who met the criteria were included in the study. The median age on the day of tracheostomy was 33 months (range, 2-205), length of stay in the intensive care unit was median 66 days (range, 15-174), and the median follow-up after discharge was 845 days (range, 60-1520). The most common cause of tracheostomy was multiple trauma with 17 patients (36.2%). Seventeen (36.2%) of the patients were discharged with a home mechanical ventilator, while 30 (63.8%) were discharged without a home mechanical ventilator. Female sex and home discharge with home ventilator support adversely affected survival (p=0.01, p=0.019).
DISCUSSION AND CONCLUSION: Tracheostomy and home mechanical ventilation is a good option for reducing the burden of chronic care patients in our country where the number of pediatric intensive care beds is limited. It is a cost-effective method that can be implemented easily and safely by families with different social and cultural levels with good education.

INTRODUCTION: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Hypohidrosis along with some skin findings have been reported to be associated with CTS. Our aims are to detect the incidence of hypohidrosis and accompanying skin manifestations in patients with CTS and to investigate potential relationships between the severity of CTS and the accompanying skin manifestations/hypohidrosis.
METHODS: Thirty-four patients with CTS were enrolled in the study. The severity of CTS was divided into three categories: mild, moderate, and severe. The patients were examined to detect skin findings occurring due to CTS. The starch iodine test was applied to measure hypo- or hyperhidrosis.
RESULTS: Of the 34 patients, 29 (85.3%) had bilateral CTS and 63 hands with CTS were evaluated. Skin manifestations were detected in 36hands (57.1%) with CTS. The most common skin findings were contact dermatitis, painful swelling on fingers, and xerosis. Hypohidrosis was detected on 16 hands (47%) with CTS and was found to be statistically more common on the hands with moderate or severe CTS (p=0.000).
DISCUSSION AND CONCLUSION: Hypohidrosis is a common finding of CTS and is associated with severe disease. If there is presence of suspicious skin findings and hypohidrosis on hands and fingers, a differential diagnosis of CTS should be kept in mind.

INTRODUCTION: The Circle of Willis, an anastomotic vascular network at the base of the brain, forms an important collateral pathway to protect cerebral blood perfusion. This study aims to investigate the different anatomic variations of the Willis circle and their prevalence.
METHODS: The patient population for this single-centre, retrospective study consisted of patients who had brain magnetic resonance angiography. A total of 580 subjects were included in this study. The three-dimensional time-of-flight technique was used for MRA imaging to evaluate the anatomy of the circle of Willis.
RESULTS: The findings showed that the anterior part of the circle of Willis had a complete structure in 82% of the cases. The vascular structure of the posterior part was complete in 22.2% of the cases.
DISCUSSION AND CONCLUSION: Posterior segment variations are more frequent in the Circle of Willis evaluation with magnetic resonance angiography, and the most common type of variation in our study was bilateral posterior communicating artery absence.

Tetanus vaccine may cause systemic reactions, such as urticaria, anaphylaxis, and peripheral neuropathy or local reactions, such as erythema, endurance, and pain. We presented a 13-years-old patient who was administrated cyanosis, numbness, and coldness in both hands and forearms after one hour of vaccination adult-type diphtheria-tetanus from left deltoid muscle and evaluated vaccine side effects as Raynaud's phenomenon. Vaccine-induced Raynaud's phenomenon has not been reported in the literature, and this may be a side effect of the injection rather than the diphtheria-tetanus vaccine itself.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitive reaction to a fungus known as Aspergillus fumigatus. The differential diagnosis for ABPA is generally not considered before diagnosis and treatment of smear-negative pulmonary tuberculosis. In this study, we present an example case and aim to remind of ABPA. A patient with a history of asthma had increasingly developed shortness of breath and wheezing during asthma treatment. The patient was initially diagnosed with pneumonia based on pulmonary infiltration findings on PA x-ray. Antibiotherapy did not relieve the symptoms, and acid-fast bacteria (AFB) culture was negative. Upon detection of a progression of pulmonary infiltration on the second PA x-ray image, following the antibiotherapy, tree-in-bud (TIB) opacities and cavitary lesion were observed on computed tomography (CT) of the thorax and the patient was clinically and radiologically diagnosed with tuberculosis. Due to not observing any relief of symptoms after tuberculosis treatment and earlier findings, such as high level of total immunoglobulin E (IgE), presence of peripheral eosinophilia, diagnosis of central bronchiectasis on thorax CT image, positive Aspergillus skin test results and history of asthma, allergic bronchopulmonary aspergillosis (ABPA) was considered and verified by cytologic examination of specimens obtained through fiberoptic bronchoscopy (FOB).

Brucellosis is one of the most prevalent zoonotic infections in the world. The disease begins with nonspecific symptoms and may affect hematopoietic, musculoskeletal, nervous and gastrointestinal system with a wide variety of symptoms and signs. In this study, we present a six-year-old girl who was admitted with fever and arthralgia diagnosed as brucellosis after excluding malignancy in the differential diagnosis. The patient recovered completely with gentamicin and trimethoprim-sulfamethoxazole (TMP-SMZ).