INTRODUCTION: Recently, interesting adipokines have been described that affect glucose metabolism and insulin resistance. However, the relationships between these adipokines and their importance in the pathogenesis of diabetes are contradictory. The aim of the present study was to investigate the relationship between plasma adipsin, adiponectin, vaspin, visfatin, and leptin levels in diabetic rats with liver enzymes related to glucose metabolism and diabetes parameters.
METHODS: Wistar albino rats were divided into three groups: control, diabetic control, and treatment groups, each with 7 of them. One group of diabetic rats was orally treated with 200 mg/kg/day metformin, and the other diabetic group received placebo. After 6 weeks, the animals were sacrificed by cardiac puncture. Glucose, insulin, glycosylated hemoglobin (HbA1c), adipsin, adiponectin, visfatin, vaspin, and leptin levels in blood were measured by enzyme-linked immunosorbent assay (ELISA), and insulin resistance was determined. In liver homogenates, glucose-6-phosphate dehydrogenase (G6PD), glucose-6-phosphatase (G6P-ase), glucokinase, pyruvate kinase (PK), and fructose-1.6-diphosphatase (F1.6DP) activities were measured by ELISA.
RESULTS: Dietary food intake and water consumption, fasting blood glucose and HbA1c levels, and insulin resistance of diabetic rats were higher than those of the control and treatment groups. Plasma adipsin, adiponectin, vaspin, and leptin levels significantly decreased, and visfatin level increased in diabetic rats. G6PD, glucokinase, and PK activities decreased, whereas G6P-ase and F1.6DP activities increased in diabetic rats. There were a negative correlation between plasma adipsin and adiponectin levels and insulin resistance and a positive correlation between visfatin level and insulin resistance in diabetic rats. In addition, adipsin, adiponectin, and leptin levels were positively correlated with each other and with some liver enzymes.
DISCUSSION AND CONCLUSION: In the diabetic rat model, body weight, glucose metabolism enzymes, insulin sensitivity, and changes in plasma adipsin, adiponectin, vaspin, visfatin, and leptin levels indicate that these adipokines play an important role in the glucose metabolism, insulin resistance, and pathogenesis of diabetes.

INTRODUCTION: The aim of the present study was to evaluate cervical vestibular evoked myogenic potentials (cVEMPs) of patients with vertebrobasilar insufficiency (VBI).
METHODS: Patients with vestibular complaints who were referred to the vestibular center were evaluated. All patients underwent a complete neurological examination, pure tone and speech audiometry, bithermal caloric test, Doppler ultrasonography of the carotid and vertebral arteries, and bilateral cVEMP recordings. Thirty patients with VBI and 30 healthy controls were included in the study. In the cVEMP test, latency and amplitude values of 95 dB were recorded.
RESULTS: In the VBI group, the mean flow rate was 91.5±36.65 mL/min at the side of higher flow, whereas it was 74.83±34.75 mL/min at the side of lower flow. In the control group, the mean flow rate was 151.5±26.62 mL/min at the side of higher flow, whereas it was 140.5±33.69 mL/min at the side of lower flow. There was a statistically significant difference between vertebral artery flow values between the VBI and control groups (p<0.001). The right and left P13 95 dB latency values in the VBI (−) group were 13.22±0.21 ms and 13.22±0.21 ms, respectively, whereas those in the VBI (+) group were 16.15±0.11 ms and 16.23±0.14 ms, respectively. The right and left N23 95 dB latency values in the VBI (−) group were 23.09±0.14 ms and 25.39±0.88 ms, respectively, whereas those in the VBI (+) group were 23.07±0.14 ms and 25.71±0.81 ms, respectively. The right and left P13–N23 95 dB amplitude values in the VBI (−) group were 41.46±8.82 mV and 41.41±6.81 mV, respectively, whereas those in the VBI (+) group were 24.81±3.36 mV and 24.11±2.09 mV, respectively. There was a statistically significant difference between the VBI and control groups regarding latency and amplitude values at 95 dB nHL stimulation (p<0.001).
DISCUSSION AND CONCLUSION: We believe that VBI is associated with abnormal cVEMP responses. Further studies with larger groups are needed to verify our findings.

INTRODUCTION: The role of smoking in the development of lung injury is well established. Many studies have reported that the oxidative stress is increased in smokers. Previous studies have investigated the oxidant and antioxidant effects of zoledronic acid in tissues such as hepatic and oral epithelial cells, but not in lung tissue and bronchial lavage.
METHODS: The rats were divided into two groups: the first group was exposed to cigarette smoke (CS), and the second group was given subcutaneous zoledronic acid along with cigarette smoke exposure (ZCS). The lung tissue analysis of the groups included interstitial fibrosis, emphysema, and lymphocyte response at the interstitial space. In serum and bronchoalveolar lavage fluid, superoxide dismutase activity and levels of the antioxidant, lipid hydroperoxide, glutathione, H2O2, and transforming growth factor beta1 were measured.
RESULTS: The accumulation rate of fibroblasts at the interstitial space was significantly higher in the CS group. The bronchoalveolar lavage levels of H2O2 used for the assessment of oxidative stress were significantly lower in the ZCS group.
DISCUSSION AND CONCLUSION: The present study showed that zoledronic acid was effective in reducing the smoke-induced oxidative stress in the lung, especially by strongly lowering the bronchoalveolar lavage levels of H2O2, and it reduced the fibroblast proliferation in the interstitial space.

INTRODUCTION: This study aimed to evaluate the effect of breast magnetic resonance imaging (MRI) on staging and surgical planning.
METHODS: Ninety-two females with breast cancer were enrolled in the study. We prospectively evaluated the contribution of MRI compared to mammography (MMG) and ultrasonography (USG) and impact of MRI on surgical treatment and histopathological concordance.
RESULTS: Contribution of breast MRI to the workup and management of breast cancer in our institute was meaningful by upstaging the cases in 23/92 (25%) of the patients and suggesting a change in surgical plan in 21/92 (23%) of the patients. Surgical staging with breast MRI results correlated with the final pathological staging in 18/21 (85%) patients who had a change in surgical plan.
DISCUSSION AND CONCLUSION: The primary therapy modality of early breast cancer is surgery. The overall tumor size, the relationship between tumor size and breast size, tumor localization, tumor stage, and histopathological findings help to shape surgical management. MRI was better than conventional diagnostic techniques in determining correct tumor diameter and in detecting non-invasive cancer areas. Consequently preoperative breast MRI is an important adjunct to conventional imaging (USG and MMG) in the staging of breast cancer and a useful tool in treatment planning.

INTRODUCTION: To evaluate the effect of bilirubin levels on auditory screening results in newborns.
METHODS: In total, 43 newborns (24 males and 19 females) who underwent the neonatal auditory screening in our hospital were included in the present study. All newborns were evaluated before they were discharged from the hospital. They were divided into two groups according to the results of the screening. Group A consisted of newborns that cleared the screening, whereas group B consisted of the remaining cases.
RESULTS: There were 31 newborns (16 males, 15 females) in group A and 12 newborns (8 males, 4 females) in group B. In group A, mean total serum bilirubin level was 24.7±8.1 mg/dl, mean serum indirect bilirubin level was 23.3±8.0 mg/dl and mean serum direct bilirubin level was 1.1±1.6 mg/dl. In group B, these values were 28.1±6.6 mg/dL, 27.1±6.4 mg/dL, and 1.4±1.3 mg/dL, respectively. There were no statistically significant between-group differences between total serum bilirubin levels, indirect, and direct serum bilirubin levels (p-values: 0.279, 0.168, and 0.233, respectively). There was no significant difference between hematocrit, reticulocyte, leukocyte, and platelet values of the groups (all p-values >0.05).
DISCUSSION AND CONCLUSION: The results of the newborn auditory screening were not affected by serum bilirubin levels. However, the clinician should consider that the neonatal jaundice is a risk factor for hearing loss.

INTRODUCTION: Many hemodynamic parameters are affected according to selected anesthesia type in patients under general or spinal anesthesia. In recent years, brain natriuretic peptide (BNP) has been frequently used in clinical follow-up. It is released from the heart ventricles and is directly proportional to increased ventricular dilatation and pressure load, suggesting cardiac performance. We aimed to compare the cardiac effects of general and spinal anesthesia with BNP values in noncardiac small surgical operations where hypovolemia is unexpected.
METHODS: The study was conducted between January and May 2009 after obtaining the approval from the ethics committee at the Haydarpaþa Numune Training and Research Hospital. Our patient group consisted of 44 patients (15 women and 29 males), aged between 45 and 80 years, scheduled for ASA 2-3, NYHA 2-3, describing exercise dyspnea at the end of 5 min walking test, with an ejection fraction of 40%–55%, hypovolemia unexpected small surgery planned (inguinal hernia, urinary incontinence, rectocele, cystocele, etc.). Patients were randomly assigned to two groups to receive general anesthesia and spinal anesthesia. Venous blood was taken, and the BNP levels were measured 30 min before the operation, 25 min after anesthesia, and 8 h after the operation.
RESULTS: In General and Spinal Anesthesia group, there was no significant change in the 25th-min BNP level according to the preoperative BNP level (p>0.05); the increase in the 8th-hour BNP level was statistically significant (p<0.01). There was no statistically significant difference between the groups in terms of percent change in 25-min BNP level according to preop (p>0.05), while the percent change in BNP level at 8th hour according to preop of spinal anesthesia group was significantly higher than general anesthesia group (p<0.05).
DISCUSSION AND CONCLUSION: In our study, postoperative BNP increase was observed in patients who underwent both general and spinal anesthesia. This increase is statistically more significant in spinal anesthesia. This difference shows that the cardiac performance of patients in the spinal anesthesia group is more affected.

INTRODUCTION: To evaluate corneal changes in patients with aortic aneurysm.
METHODS: The study group (Group 1) included 63 eyes of 33 patients diagnosed with aortic aneurysm and the control group (Group 2) included 69 eyes of 35 healthy people who presented at the Ophthalmology Department. Complete ophthalmologic examination was performed and steepest keratometry measurements were taken via rotational Scheimpflug corneal tomography on the following parameters: sagittal curvature map (S steepest), central corneal thickness (CCT), minimum corneal thickness (CT min), corneal volume (CV), mean pachymetric progression index (PPI mean), minimum PPI (PPI min), maximum PPI (PPI max), maximum Ambrosio relational thickness (ART max), posterior corneal elevation (PE) and back difference elevation (BDE).
RESULTS: The groups were similar in terms of age and gender (p=0.082 and p=0.145, respectively). There was no statistically significant difference in visual acuity and intraocular pressure between the groups (p=0.471 and p=0.199 respectively). There was no statistically significant difference in Ks, Kf, Km, CT min, CCT, CV, I-S, S steepest, PE, PPI mean, PPI min, PP max, and ART max values between the groups (p>0.05). BDE value was significantly higher in Group 1 (p=0.04).
DISCUSSION AND CONCLUSION: The patients diagnosed with aortic aneurysm should be evaluated for keratoconus.

INTRODUCTION: Our study aimed to assess Turkish publications in Science Citation Index (SCI) and Science Citation Index Expanded (SCIE) indexed journals in the field of “toxicology”.
METHODS: We searched the journals related to “toxicology” in the SCIE database of “Thomson Reuter Web of Science”. The search engine of Institute for Scientific Information (ISI) Web of Science (WoS) was used in the advanced mode by typing “IS=ISSN number” to identify publications in the journal. We found Turkish papers on toxicology by typing “IS=ISSN number AND CU=Turkey”. If Turkish and non-Turkish authors had collaborated, the article was included in the search when the corresponding author had provided a Turkey-based address. The catalogue information and statistics were used to determine Turkish publications as the percentage of total publications and the annual mean number of Turkish publications. In WoS, “SU=toxicology” was used to determine the number, country, year, and topic distributions of publications from 1975 to date and within the last 10 years. The citation numbers and h-indices were determined based on the country for publications within the last 10 years.
RESULTS: In the area of toxicology, there were 92 journals in the SCI/SCIE index. From 1975 to the early 2000s, Turkey was 19th in the list of countries with highest number of publications on toxicology; however, in the last 10 years, Turkey moved up to 14th place. Its mean citation number has been 7.17, and it remains the lowest country pertaining to citations among the 24 countries with the most number of publications.
DISCUSSION AND CONCLUSION: Our work will also shed light on scientists who are constantly working in the field of toxicology, as well as scientists witnessing unusual toxicological events and wanting to make the academic world knowledgeable.

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. The aim of this study was to evaluate 21 patients operated for GIST.
METHODS: We retrospectively analyzed medical and surgical records of 21 patients diagnosed with GIST who were operated between 2008 and 2014 in our clinic. Gastrointestinal stromal tumors localizations, applied surgical methods, histopathological examination results, postoperative medical treatments, and follow-up results were examined.
RESULTS: The study group consisted of 21 patients (11 males and 10 females) with a mean age of 69.29 (range, 39–89 years). Sixteen tumors were located in the stomach, 3 in the small intestine, 1 in the rectum, and 1 in the mesentery of the jejunum. The symptoms were not typical, and they depended on the localization and size of the tumor. The mean tumor size was 6.8 cm (range, 1.8–20 cm). Positivity rates for CD117 and CD34 expression determined by immunohistochemical methods were 95.2%, and 66.7%, respectively. One patient underwent laparoscopic resection, and other patients were treated via open surgery. Lymph node metastasis was observed in the patient with rectal tumor. Postoperatively, imatinib therapy was administered in 5 patients with high-risk tumors. Mortality was observed in 2 patients. Four patients were excluded from the follow-up because they could not be reached by phone. The mean follow-up period was 29.59±15.4 months. No recurrences or metastases have been detected.
DISCUSSION AND CONCLUSION: Gastrointestinal stromal tumors represent 0.1%–1% of all gastrointestinal malignancies. The most common location is the stomach. The goal of surgery is complete gross resection with an intact pseudocapsule and negative microscopic margins.

INTRODUCTION: Autoimmune thyroid disease (AITD) frequently accompanies myasthenia gravis (MG). The aim of the present study was to evaluate the clinical and serological features of MG associated with AITD.
METHODS: Thirty patients diagnosed with MG between 2012 and 2016 were followed. All patients’ clinical and demographic features were analyzed, and acetylcholine receptor antibody (AChRAb) and antimicrosomal antibody were evaluated. There were 30 (21 female and nine male) patients suffering from MG. Age range was 13–78 years. Age range at disease onset was 11–75 years. Duration of disease range was 1–38 years.
RESULTS: Of the 30 patients, 17 (56.7%) were positive for AChRAb, and 7 (23%) were positive for antimicrosomal antibody. Among 17 AChRAb (+) patients, both diagnoses of generalized (14/23 (60.9%)) and ocular (3/7 (42.9%)) myasthenia were present. Of the 17 AChRAb (+) patients, 6 were also positive for antimicrosomal antibody. All seven antimicrosomal antibody (+) patients had generalized myasthenia.
DISCUSSION AND CONCLUSION: It is really important to think coexisting MG in patients with autoimmune disorders and neuromuscular weakness. The presence of AChRAb in patients with MG is associated with a frequent risk for other autoimmune diseases.

INTRODUCTION: Postpartum anemia is a significant and common public health issue. Here, the prevalence of postpartum anemia and predisposing factors in women without prepartum anemia was investigated.
METHODS: This retrospective study was conducted between February 2018 and April 2018 with 1013 patients without prepartum anemia. Sociodemographic features, delivery characteristics, and hemoglobin levels of the patients were recorded. Variables were compared between the anemic and nonanemic groups, independent predictors were determined, and risk score for postpartum anemia was calculated.
RESULTS: The rate of cesarean section and emergent cesarean, the frequency of episiotomy and perineal laceration, and the application of general anesthesia were higher, whereas mean gestational week at birth and the ratio of active management of the third stage of labor were lower in the anemic group. In regression analysis, episiotomy (odds ratio (OR) 5.45, 95% confidence interval (CI) 3.75–7.93, p<0.001), perineal laceration (OR 7.09, 95% CI 2.88–17.47, p<0.001), active management (OR 0.09, 95% CI 0.06–0.12, p<0.001), general anesthesia (OR 3.9, 95% CI 0.99–15.32, p=0.026), and emergent cesarean (OR 19.35, 95% CI 10.57–35.41, p<0.001) were found to be significant independent predictors. The formula of risk score calculated to determine patients who were under risk to develop postpartum anemia was as follows: risk score=(5×episiotomy)+(7×perineal laceration)+(3×general anesthesia)+(19×emergent cesarean)−(11×active management). Risk score >−4 was found to be a predictor for postpartum anemia with a sensitivity of 73.7% and specificity of 81.1%, and it increases the risk of postpartum anemia approximately 12 times.
DISCUSSION AND CONCLUSION: The prevalence of postpartum anemia is quite high in our clinic, and so a non-selective screening program for postpartum anemia could be applicable. However, determining patients under high risk is still important to be alert to prevent short- and long-term morbidities.

INTRODUCTION: Meningiomas are the most common brain tumors and account for 13%–26% of intracranial tumors. Approximately, 5%–7% of the meningiomas are termed as atypical meningiomas. The prognosis in patients with benign meningioma (Grade I) is generally very favorable. The outcome for patients with atypical meningioma is progression that is rapid and more invasive.
METHODS: We retrospectively analyzed 35 patients with atypical meningiomas who underwent surgery. Patients’ age at diagnosis, gender, tumor location, Simpson grade, local tumor recurrence, and treatment with radiation therapy were evaluated.
RESULTS: Patients were aged 29–54 (mean±standard deviation: 54.6±12.1) years; 18 were females and 17 males. The recurrence rate was 6/35 (17.1%). Recurrence was found two times more in females. The parasagittal location of the tumor was most common in 66.6% cases. One-half of the patients did not receive adjuvant radiotherapy (RT). Patients characterized with Simpson Grade I showed lower recurrence rate compared to Grade III.
DISCUSSION AND CONCLUSION: Atypical meningioma recurs more frequently than Grade I lesions. The current management of atypical meningioma is maximal safe resection of tumor followed by adjuvant RT. Adjuvant RT following surgical resection is recommended particularly for incompletely excised tumors or tumors located in the parasagittal area or posterior fossa. In our study, the resection grade was identified as one of the most important factors affecting the prognosis.

INTRODUCTION: Tuberous sclerosis (TSC) is a multisystem, autosomal dominant disorder with a wide clinical spectrum. The aim of the present study was to review the clinical, radiological, and laboratory findings of our TSC cases in a retrospective manner and to compare them with the current literature.
METHODS: The clinical and radiological features of 16 patients diagnosed with TSC at Sütçü Ýmam University, Faculty of Medicine, Pediatric Neurology Outpatient Clinic were retrospectively assessed.
RESULTS: A total of 16 patients with a diagnosis of TSC were included in the study. The study included 9 (56.2%) male and 7 (43.7%) female patients. Of the 16 patients, 9 (56.2%) presented with convulsions, 4 (25%) with body rash, 2 (12.5%) with cardiac rhabdomyoma diagnosed at the newborn period, and 1 (6.25%) with perinatal asphyxia. Hypopigmented skin lesions were detected in all patients (100%). The most common finding on brain magnetic resonance imaging (MRI) was periventricular subependymal nodules (SNs) (n=12, 75%). In addition to the central nervous system and skin findings, 3 (18.7%) patients had cardiac involvement, and 1 (6.2%) patient had renal involvement. Three (18.7%) patients were detected with diffuse developmental delay, and 6 (37.5%) patients were detected with mental retardation.
DISCUSSION AND CONCLUSION: In line with the current literature, convulsions, hypopigmented skin lesions, mental retardation, and SNs on brain MRI were the most common signs.

INTRODUCTION: The analysis of the epidemiology of trauma is important to determine the needs of hospitals and develop treatment strategies. This study aimed to investigate the epidemiology of trauma in a hospital sample that accepts a large number of trauma patients.
METHODS: Between 2009 and 2015, trauma patients admitted to the hospital emergency department were retrospectively screened according to the ICD-10 system. The trauma mechanisms were grouped as falls on the level/from height, injury by object, pedestrian/cyclist injuries, vehicle collisions, penetrating stab injuries, gunshot wounds, and assault. Age, gender distribution of patients, and death information were recorded. In the analysis of the data, t-test and chi-square test were used for the comparison with descriptive statistics. P<0.05 was accepted as significant.
RESULTS: In the study, 138.352 patients (mean age 25.7±19.8 years, age range 0–113, male/female ratio: 1.81) were analyzed. Falls on the level/from height was the most prominent cause of trauma (n=76.636, 55.4%). Male gender was predominant in all injury mechanisms and in all age group except over 60 years (p<0.001). The most common injury mechanisms that resulted in death were falls on the level/from height, vehicle collision, and pedestrian/cyclist injury with mortality rates of 0.09, 0.08, and 0.07, respectively (p<0.001).
DISCUSSION AND CONCLUSION: Our study found that in emergency service trauma applications, fall-crash and traffic accidents were the two most common mechanisms. The frequency of trauma mechanisms should be considered in the emergency service continuous training programs. Social measures for trauma mechanisms leading to more deaths and trainings of people based on age-gender, where trauma mechanisms are more common, will reduce the morbidity and mortality rates caused by trauma.

We report an unusual case of valacylovir-induced nephrotoxicity. The study presents the case of a 38-year-old female patient who developed acute renal injury following treatment with a single oral dose of valacyclovir (2000 mg). Although nephrotoxicity due to rapid intravenous infusion of valacyclovir at high doses is not a rare side effect, oral single doses associated acute renal injury is an uncommon complication. Valacylovir is a commonly used antiviral agent; therefore, physicians should be aware of this rare but potentially serious adverse drug reaction.

Breast carcinoma is the most common cancer after non-melanoma skin cancers. It often metastasizes to the lungs, lymph nodes, and liver and rarely spreads to the bladder. Bladder cancer usually manifests with painless clotted macroscopic hematuria. Although there are no organ-specific symptoms, in case of a malignancy, all organs must be checked for metastasis for the whole lifetime. In this case, we present a patient with late onset asymptomatic bladder metastasis with different primary tumors in each breast.

Desmoid tumors are uncommon, histologically benign tumors, originating in the facial and musculoaponeurotic tissues; however, they are locally aggressive. They are frequently observed in the abdominal zone. Nevertheless, it is rare in the chest wall. The most efficient and outstanding treatment is surgery. Here we present the case of a 66-years-old male patient who was admitted with the shortness of breath and back pain in the past 4 months, and we learned that he had bypass surgery in 2010, and a lesion mass was found in the left lung in the chest X-ray. This lesion was detected in the upper lobe of the left lung, which was 135×98×74 mm in size at the thoracic computed tomography. A left thoracotomic incision was performed, and a 25×15×6 cm (1195 gr) mass was removed. In this case, the patient had no complications and recurrence in the postoperative period.