INTRODUCTION: Elderly patients may be affected by some extreme positions during surgery. Upright positions may lead to systemic hypotension, cerebral circulation and oxygenation derangements, and postoperative cognitive dysfunction (POCD). Cerebral oxygen saturation monitored by near infrared spectroscopy (NIRS) in elderly patients undergoing arthroscopic shoulder operations in beach chair position (BCP) was assessed to see if this age group showed any failure to compensate for these positional hemodynamic effects and had POCD.
METHODS: After pre-operative baseline mini mental state examination (MMSE) assessment, 105 patients were operated on in beach chair position and monitored using NIRS. Intraoperative data and postoperative cognitive functions were analyzed.
RESULTS: Ninety-seven patients were included in the final analysis. Patients were cohort according to age: After Group ≥65-years old, n=43; Group <65-years old, n=54. In the group of elderly patients, the frequency, the maximum percentage of drop in hypotensive events were higher, the duration was longer (p<0.02, p=0.018); the maximum percentage of regional cerebral oxygen saturation drop, and the duration was larger. (AUC-R, median (IQR): 30 (0.274) versus 0 (0.21); (p=0.014). Three patients had a decline in cognitive function at 24 h that persisted at the 3-month follow-ups; in another 3 patients, cognitive dysfunction was detected 3-months following surgery (p=0.016).
DISCUSSION AND CONCLUSION: Elderly patients undergoing shoulder operations in BCP are at higher risk of serious cerebral hypotension, desaturation and peri-operative cognitive dysfunction than the younger patients.

INTRODUCTION: Magnesium is an intracellular ion that has analgesic properties through calcium regulation and N-methyl-D-aspartate receptors. However, the safety of neuroaxial magnesium is not proved. The aim of this experimental study is to investigate the possible neurotoxicologic effects of epidural magnesium sulfate (MgSO4) on medulla spinalis in rabbits.
METHODS: After ethic committee’s approval, 18 male Albino New Zealand rabbits were enrolled into the study. Epidural catheter was inserted into the sacral canal under ketamine. The development of motor and sensorial block 5 min after the administration of 1 mL of 1% lidocaine verified the placement of the catheter. Group Control (n=6): 0.20 mL isotonic saline was administered through epidural catheter. Group M150 (n=6): One mL of 150 mg.mL-1 MgSO4 (~ 0.6 mmol elemental magnesium) (pH=6.20) was administered through epidural catheter, then catheter was flushed with 0.20 mL isotonic saline. Group M450 (n=6): One mL of 450 mg.mL-1 MgSO4 (~ 1.8 mmol elemental magnesium) (pH=6.10) was administered through epidural catheter then catheter was flushed with 0.20 mL isotonic saline. Catheter’s placement was localized by laminectomy. Spinal sections were taken between 5 cm rostral and caudal segments from the tip of the catheter. The sections were stained both hematoxylin-eosin and Cresyl violet. The slides were examined using a light microscope.
RESULTS: Nissl body loss, vacuolization, myelin irregularity, gliosis, and fibrosis in gray and white matter samples were assessed. There were no signs of histological tissue damage. There was no statistically significant histopathological difference between groups.
DISCUSSION AND CONCLUSION: This is the first study that investigates spinal cord injury after epidural magnesium administration to our knowledge. These results are important since epidural route is the second most common route for MgSO4. In this study, we report that, even relatively higher doses of epidural MgSO4 did not cause any spinal cord injury. Further studies need to be performed to adapt these findings to clinical practice.

INTRODUCTION: To evaluate the role of nutritional status in lung transplant candidates in post-transplant mortality and clinical outcomes.
METHODS: 59 patients with end-stage lung diseases were divided into two groups: low prognostic nutritional index (PNI) (Group 1) and high PNI (Group 2). The two groups were compared, and influence factors were analyzed.
RESULTS: PNI scores were grouped into (<43.7) Group 1 and (≥43.7) Group 2. Group 1 (n=29, 50.8%) had significantly higher post-transplant mortality within 1 year compared to Group 2 (n=30, 49.2%) (p=0.027). Post-operative mechanical ventilation day and low PNI score (<43.7) were independent predictors of mortality (OR: 2.46, 95% confidence interval [CI]: 1.71–3.54, p=0.001 and OR: 4.25; 95% CI: 1.59–11.33, p=0.004).
DISCUSSION AND CONCLUSION: Our findings revealed that pre-operative nutritional status is a useful indicator of post-transplant mortality risk. We think that the PNI score can be among the standard evaluation tests as a useful test for lung transplant candidates.

INTRODUCTION: To evaluate the normal values of vestibular-evoked myogenic potential (cVEMPs) in healthy children by the head rotation method.
METHODS: 109 children ages 6–11 years with normal hearing underwent cVEMP testing with alternating clicks at intensities of 80, 85, 90, 95, and 100 dB levels by using averaged, unrectified electromyograms recorded by a surface electrode on the sternocleidomastoid muscle ipsilateral to the stimulus. The P1 output latency, peak latencies of P1 and N1, P1-N1 peak-to-peak amplitude, and asymmetry ratio were measured.
RESULTS: There were no statistically significant differences between groups regarding interpeak amplitudes, P1 output latency, P1 latency (p>0.05). Whereas, the latency of N1 showed a statistically significant positive correlation with age (in group III, 25.04±2.34, in group II, 23.63±2.10, and in group III, 23.77±1.90, p<0.01). The amplitude asymmetry ratio also showed a statistically significant negative correlation with age (35.23±18.04, 26.26±18.21, and 19.58±14.69 I in groups, respectively, p=0.008). Furthermore, there was a statistically significant relationship between stimulus intensity and age. cVEMPs waves were obtained with higher stimulus intensity in early childhood, whereas lower stimulus intensity was sufficient to obtain cVEMPs waves in late childhood (p=0.033).
DISCUSSION AND CONCLUSION: cVEMP is an easily applicable, well-tolerated test for screening vestibular function with minimal test time and reproducible results. This is the first cVEMPs study to reveal the normative data of children by comparing latencies, amplitudes, and asymmetry ratios by the head rotation method.

INTRODUCTION: Vitamin B12 deficiency continues to be an important health problem in developing countries with a wide spectrum of neurological and other system findings. Early diagnosis and appropriate treatment are essential to prevent permanent damage. In our study, we aimed to evaluate the demographic, clinical, radiological, and electrophysiological characteristics of the cases who applied to pediatric neurology outpatient clinic and had Vitamin B12 deficiency.
METHODS: Among the patients presenting to the pediatric neurology department between January 2020 and June 2020, patients with Vitamin B12 deficiency were included in the study. Vitamin B12 deficiency was classified as subclinical deficiency (200–300 pg/mL), deficiency (160–199 pg/mL), and severe deficiency (<160 pg/mL). Demographic, clinical, radiological, and electrophysiological findings were analyzed.
RESULTS: Vitamin B12 deficiency was found in 210 (21.4%) of 978 patients. The mean age was 3.3±5.1 years (1 month–17 years). About 53.3% (n: 112) of the patients were male. The most common complaints were seizures (n: 59, 26.8%), headache (n: 41, 18.6%), and neuromotor retardation (n: 14, 6.3%). Subclinical deficiency was observed in 98 (46.7%) of the patients, deficiency in 55 (26.2%), and severe deficiency in 57 (27.1%). Nine patients (4.2%) showed improvement in symptoms after Vitamin B12 treatment, of whom the complaints were headache (n: 5, 2.3%), tremor (n: 2, 0.9%), forgetfulness (n: 1, 0.5%), and dizziness (n: 1, 0.5%).
DISCUSSION AND CONCLUSION: While Vitamin B12 deficiency was observed at a high rate, the complaints regressed with Vitamin B12 treatment in 4.2% of the cases. These complaints, which completely regressed with treatment, were headache, tremor, forgetfulness, and dizziness.

INTRODUCTION: This study aims to assess the high-sensitivity C-reactive protein (hs-CRP) levels in patients with stable coronary artery disease (CAD) after coronary stenting and evaluate the effect of different stent numbers (1, 2, and ≥3 stents) on hs-CRP levels.
METHODS: Our study included 87 patients diagnosed with stable CAD who underwent coronary angiography and had >70% stenosis in the coronary arteries and underwent percutaneous coronary intervention (PCI). The study group was divided into three based on the number of treated lesions. Patients treated for only one lesion were grouped as Group-1, those treated for 2 lesions were Group-2, and those treated for 3 or more lesions were Group-3. The change in hs-CRP was defined as the difference between pre- and post-PCI hs-CRP levels.
RESULTS: A total of 87 patients were included in the study (mean age 59±10 years and 81.6% were male). For the first group, the pre-PCI hs-CRP was 1.13 mg/dL ± 1.94 mg/dL, and the post-PCI hs-CRP was 1.68 mg/dL ±1.70 mg/dL (p<0.05). For the second group, the pre-PCI hs-CRP was 0.60 mg/dL ±0.80 mg/dL and the post-PCI hs-CRP was 1.49 mg/dL ±2.24 mg/dL (p<0.05). For the third group, the pre-PCI hs-CRP was 1.08 mg/dL ±1.31 mg/dL and the post-PCI hs-CRP was 2.35 mg/dL ±2.57 mg/dL (p<0.05). However, the differences between pre- and post-PCI hs-CRP levels among the groups were estimated as 0.55 mg/dL ±1.81 mg/dL, 0.82 mg/dL ±0.82 mg/dL, and 1.27 mg/dL ±1.86 mg/dL, but these differences were not statistically significant (p>0.05).
DISCUSSION AND CONCLUSION: In this study, we demonstrated that there was a significant increase in post-procedure hs-CRP levels. However, this was not related to the number of implanted stents.

INTRODUCTION: Gait disorders can occur in different forms in hemiplegic patients. Restoring a rapid, safe, and independent gait is the main goal of neurorehabilitation after stroke. Gait training with a treadmill became popular in rehabilitation. The treadmill allows for a large number of steps in a training session and a large amount of task-specific exercise can be performed.
METHODS: Twenty patients were enrolled in this prospective, randomized, and controlled study. The patients were divided into two groups. With computerized gait analysis, the temporospatial parameters of gait and kinematics of lower extremity joints and pelvis were evaluated. Functional evaluation was performed with a 10-m walking time (sec) and the Functional Independence Measure (FIM) - mobility and locomotion score.
RESULTS: The changes in the kinematic analyses in both groups showed that walking was more economical and functional in the treadmill group. Treadmill training stimulated functional changes on the paretic side. In the ground group, changes occurred mostly in the pelvis and leg on the healthy side, and in this way, the walking function was improved. At the same time, it was determined that the gains in the motor abilities of the paretic lower extremity, 10-m walking time, FIM mobility, and locomotion scores were higher in patients who were rehabilitated in the early period and who were given walking training on the treadmill.
DISCUSSION AND CONCLUSION: Treadmill training in stroke-related hemiplegia can develop gait speed and safety in hemiplegia. Since treadmill treatments are more reachable and cheaper, they can be preferred in the rehabilitation of the gait in stroke-related hemiplegia.

INTRODUCTION: In this study, we aimed to evaluate the prognostic value of the prognostic nutritional index (PNI) in intensive care unit (ICU) patients with coronavirus 19 (COVID-19).
METHODS: Our retrospective study included the data of 149 patients who were admitted to the COVID-19 ICU of a tertiary care center. Data of patients under 18, pregnant patients, or patients who were in the ICU for <48 h were excluded. Complete blood count, biochemistry panel, and blood gas analysis results were gathered and compiled.
RESULTS: 149 ICU patients with COVID-19 (PCR-positive) were included in the study. The patients were divided into two groups according to PNI values (PNI<37.9 vs. PNI≥37.9). The patients with lower PNI needed longer hospitalization (11.7 vs. 8.3, p=0.04) and demonstrated higher in-hospital mortality (73.6% vs. 48.3%, p=0.003). A multivariate regression analysis was performed to predict in-hospital mortality. The PNI score (OR: 0.93 [0.87–0.99]) and the APACHE II (OR: 1.09 [1.03–1.14]) score predicted in-hospital mortality.
DISCUSSION AND CONCLUSION: In this study, we showed that a PNI score at admission can predict in-hospital mortality in ICU patients diagnosed with COVID-19.

INTRODUCTION: Candida auris is currently reported as a global threat. In this study, we aimed to describe antifungal susceptibility, experiences regarding the detection of C. auris in clinical and environmental samples, and infection control measures.
METHODS: Patients infected or colonized with C. auris and all clinical and environmental screening samples between October 2022 and June 2023 were included. Data on demographics, underlying diseases, length of hospital/intensive care unit (ICU) stay, presence of bacterial/fungal co-infection, history of broad-spectrum antibiotic/antifungal use, outcomes, and antifungal susceptibility results were investigated retrospectively. Screening of contact patients and environmental samples was managed according to the instructions prepared by the infection control committee.
RESULTS: C. auris was isolated in six patients, four with candidemia and two with colonization. Two of the patients with candidemia were hospitalized in the ICU and two in the internal medicine service. All had at least one comorbid disease, pro-longed hospitalization, and a history of broad-spectrum antibiotic use. The crude mortality rate was 50%. Increased minimal inhibitory concentrations (MIC) values for fluconazole and 50% resistance to amphotericin B were detected. No resistance to voriconazole, micafungin, or caspofungin was observed. Two patients with colonization did not develop invasive infections during hospitalization. There was no growth in any of the contact-patient screenings. Growth was detected in one of the environmental samples. As a result of the precautions taken, there was no growth in subsequent environmental cultures.
DISCUSSION AND CONCLUSION: C. auris continues to be an important agent of candidemia with high mortality. Although high MIC values were found for fluconazole and amphotericin B, no echinocandin resistance was observed. C. auris infection and colonization can be controlled with effective infection control measures and contact screening. Clinicians and microbiology specialists in every health-care institution must be prepared for the possible isolation of C. auris to contribute to the reduction of spread and mortality through rapid diagnosis and timely treatment.

INTRODUCTION: Urinary tract infections (UTIs) are one of the most common community-acquired infectious diseases globally. This study was conducted to contribute to the data of our country by examining the distribution of UTI agents isolated from outpatients and their antibiotic susceptibility results.
METHODS: The positive urine cultures of 24,917 outpatients aged 18 years and older, which were sent to the Istanbul Public Hospitals Services Presidency-2 Central Laboratory between January 2016 and December 2019, and their antibiotic susceptibility results were retrospectively evaluated.
RESULTS: Of the 24,917 uropathogens, 87% were Gram-negative bacteria and 13% were Gram-positive bacteria. The most commonly isolated organisms were Escherichia coli (57%), Klebsiella pneumoniae (15%), and Enterococcus spp (12%). E. coli showed high resistance to all antibiotics tested except for aminoglycoside group, carbapenem group, nitrofurantoin, and fosfomycin, while K. pneumoniae showed high resistance to all antibiotics except for aminoglycoside group and carbapenem group. In enterococci, high-level resistance was determined only to gentamicin and ciprofloxacin.
DISCUSSION AND CONCLUSION: In our study, it was determined that most of the antibiotics used for the treatment of community-acquired UTIs had a higher resistance rate than the recommended 10–20% value for empirical treatment. We think that it is very important to follow region-specific epidemiological data, take the necessary measures, and use antibiotics rationally.

INTRODUCTION: COVID-19 has emerged as a globally serious concern in recent times. The pandemic has raised several questions about our hygiene practices, social behaviors, and attention to health conditions. Understanding and following certain behavioral and social changes is cumbersome for the children. Practicing proper hand hygiene is of immense importance for the children for their safety and to prevent the disease spread. The present study was conducted to understand the influence of several social factors and instructions to maintain and practice better hand hygiene for school children.
METHODS: The present cross-sectional survey was conducted between Nov 2019 and Mar 2020 among 3462 students. The survey was conducted using a suitable questionnaire that contained questions on the participants’ awareness of the pathogens and diseases, the importance of hygiene, and the response of the students to the instruction provided by their parents or teachers related to hand washing and hygiene maintenance. All categorical responses were scaled using the Likert scale in the range of 1–5. Analysis of the data was done using standard descriptive and inferential statistical measures.
RESULTS: The considered students were between the age of 7 and 11. The selected participants were from the 2nd, 3rd, and 4th grades. Out of the total participants, 35.6% were the single child of their parent, whereas 64.44% were having siblings. When the parents of the participants were classified into higher education, the rate of fathers was 7.07% and the rate of mothers was 12.94%, which was statistically significant.
DISCUSSION AND CONCLUSION: The outcomes, follow-ups, and observations in this study suggested that the students often follow instructions that are attractively presented. During following instructions related to hand wash, they often miss the minute details.

INTRODUCTION: The aim of this study was to evaluate the clinical outcomes of post-trabeculectomy hypotony and the effect of hypotony on the final number of glaucoma medications used.
METHODS: Data pertaining to 34 patients (34 eyes) who developed hypotony after trabeculectomy were analyzed retrospectively and compared with the data of 35 patients (35 eyes) without hypotony after trabeculectomy. We compared pre-operative, intraoperative, and post-operative data between the groups and evaluated hypotony recovery time and the effects of hypotony on visual acuity, final intraocular pressure (IOP), and number of glaucoma medications used.
RESULTS: The mean follow-up times were 30±18 and 29±18 months in the hypotony and control groups, respectively. There were no significant differences in pre-operative or intraoperative data between the groups (p>0.05). IOP values at post-operative 1 day, 1 week, 1 month, and 3 months were lower in the hypotony group compared to the control group (p<0.05), while 6-month and final IOP values were similar (p>0.05). Hypotony resolved at a mean of 4±2 (1–11) weeks. There was no difference between the groups in terms of post-operative vision loss (p>0.05). The number of glaucoma medications used postoperatively was lower in the hypotony group (p=0.009) and was significantly reduced in both groups compared to preoperatively (p<0.001). The decrease in the number of glaucoma medications used was higher in the hypotony group (p<0.05). At the last follow-up, 11.8% of patients in the hypotony group and 42.9% of the control group used glaucoma medication (p<0.001).
DISCUSSION AND CONCLUSION: According to our study, post-operative 6 month and final IOP levels were similar in eyes with and without post-trabeculectomy hypotony. Hypotony resolved within 1 month on average and had no significant effect on future vision loss. Patients with hypotony were less likely to need glaucoma medication postoperatively and used fewer glaucoma medications than patients without hypotony.

INTRODUCTION: Pacemaker implantation is routinely and widely used around the world for a variety of heart conditions. The use of venography guidance is very important for the operator at the puncture site and prevent complications such as pneumothorax. The aim of this study is to determine the effect of venography in preventing complications and to compare the rate of pneumothorax between patients operated with and without venography guidance.
METHODS: A total of 539 consecutive patients who had a pacemaker implanted in our clinic between 2012 and 2022 were included in this study. Pacemaker type according to the number of leads used, diagnosis for pacemaker implantation, patient age, gender, concomitant chronic obstructive pulmonary disease (COPD), presence of defibrillator battery and lead, venography guidance were evaluated and their contribution to the complication of pneumothorax was analyzed.
RESULTS: The incidence of pneumothorax development was found to be 1.3% in our study. Venography guidance was found to be significantly protective against pneumothorax, as the patient group that developed pneumothorax consisted of patients who did not undergo venography at a high rate. It was determined that in the patient group that developed pneumothorax, there was a high percentage of patients between the ages of 18-65, of female gender, without concomitant COPD, with 2 leads inserted and with implantable cardioverter defibrillator (ICD) implantation (single/double leads). Our study revealed that routine venography in pacemaker implantation is an effective method to protect patients from pneumothorax as well as lead fracture.
DISCUSSION AND CONCLUSION: Our study revealed that routine venography during pacemaker implantation is an effective method to protect patients from pneumothorax. Since blind puncture of venous structures increases the risk of complications, venography guidance can be used routinely in pacemaker implantation.

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects people’s communication skills and world perception. Neuroinflammation and mitochondrial dysfunction have an extensive place in the etiology. Mean platelet volume (MPV) and neutrophil-lymphocyte ratio are used as inflammatory markers in many diseases. In this study, we aimed to compare platelet parameters and neutrophil-lymphocyte ratio (Neu/lymph) of children with ASD and healthy controls.
METHODS: This is a single-center, retrospective, hospital-based, and case–control study. Patients diagnosed with ASD according to DSM5 criteria and healthy controls participated in the study. Hematocrit, platelet count, neutrophil count, MPV, and Neu/lymph data were statistically compared in both groups.
RESULTS: A total of 53 patients (%38 male) with ASD and 53 healthy controls (20% male) were included in the study. The mean age of the ASD patients was 55.3±32.77 months and there was no statistical difference between the ASD group and healthy controls in terms of age and gender healthy controls had higher Neu/lymph ratio and MPV, but when the data were analyzed statistically no statistically significant parameter associated with autism was found.
DISCUSSION AND CONCLUSION: Platelet parameters and Neu/lymph ratio are not expected to alter in the ASD group.

INTRODUCTION: Values obtained by shear wave elastography (SWE) in breast lesions were compared with Apparent Diffusion Coefficient (ADC) values. This study aimed to demonstrate the usability of SWE, which is an easy-to-apply, cost-effective, quantitative data-providing and user-independent method, to distinguish benign and malignant lesions.
METHODS: In the retrospective study, SWE measurements were made by placing the smallest region of interest (ROI) obtained in 24 lesions, in the areas where the red color was most intense on the color map. The obtained values were compared with the ADC values determined using the ROI drawn freely from the entire lesion in ADC mapping and the round ROI drawn from the darkest area.
RESULTS: A high level of correlation (p=0.001, r=0.790) was detected between the kPa values measured in SWE and the minimum ADC values measured in diffusion, and a moderate correlation (p=0.001, r=0.670) was found between the ADC values measured from the entire lesion. A significant difference was detected between SWE, minimum ADC and mean ADC values of benign and malignant lesions (p=0.001).
DISCUSSION AND CONCLUSION: There is a high correlation between ADC values obtained in diffusion-weighted imaging (DWI) and SWE values in breast lesions. SWE, which is easy to apply, cost-effective and provides quantitative data, can be used instead of ADC mapping to distinguish benign and malignant breast lesions.

INTRODUCTION: Invasive candidiasis is a significant fungal infection associated with healthcare, with Candida albicans being the most commonly isolated species. Candida auris and other resistant species have become a global concern due to their potential for multi-drug resistance and causing outbreaks in hospitals. This study aims to validate the antifungal resistance of Candida species sent to the ISLAB-2 Central Mycology Laboratory for identification and antifungal susceptibility testing (AFST) using the Vitek-2 automated system (bioMérieux, France) by conducting further tests with the Sensititre YeastOone (SYO).
METHODS: The study included 65 Candida spp. isolates that showed antifungal resistance and were sent to the ISLAB-2 Central Mycology Laboratory for identification and AFST between May 18, 2022, and August 14, 2023. Candida species with unexpected resistance profiles were further tested for antifungal susceptibility using SYO.
RESULTS: Among the species, the highest resistance was found in C. auris, with resistance rates for fluconazole, amphotericin B, anidulafungin, micafungin, and caspofungin being 97.1%, 94.3%, 17.1%, 20%, and 25.7%, respectively. Resistance rates in other species were generally lower, except for Candida parapsilosis, which had a fluconazole resistance rate of 92.6%.
DISCUSSION AND CONCLUSION: The presence of antifungal resistance, including in multidrug-resistant Candida species, complicates the treatment of invasive fungal diseases with high mortality and morbidity rates. Rapid and accurate species identification is critically important for initiating appropriate antifungal treatment in the early stages. Taking necessary precautions for colonization and infection, especially in intensive care units, can prevent the spread of multidrug-resistant Candida species.

INTRODUCTION: Burn wounds caused by monopolar or bipolar cautery, which are common in surgical practice, can lead to serious complications in the post-operative period. We observed that psalmotoxin-1 (Pctx1) induces an inflammatory response during the burn-healing process and creates an effective wound-healing process. It also triggered the development of granulation tissue. Thanks to this venom, complications that may occur can be prevented in the early period.
METHODS: In this experimental study, 18 healthy, 300–350 g weighted, adult (aged>5 months) male Wistar rats were randomly assigned to 2 groups. Group 1 (n=9) was the control group. Group 2 (n=9) was burned and treated with PCTx1 0,1cc/kg IP. Post-recovery burn areas were evaluated by immunohistochemical staining. All samples were classified in terms of tissue repair response (TRR) values (inflammation, fibrosis, neovascularization, and epithelization) and other examination criteria of bacterial colonization and bleeding.
RESULTS: PCTx1 helped the wound healing process and when the inflammation, fibrosis, epithelization values of neovascularization, and other TRR values were examined, they were found to be significantly different compared to the control group 1 (p<0.05). In addition, the bacterial colonization and bleeding values of control group 1 were found to be significantly higher than group 2 (PcTx1) (p<0.05). According to histopathological examination, more granulation tissue and neovascularization were observed in the epidermis and wound area in Group 2 than in Group 1. In Group 2 (burn group treated with PcTx1), intense healing was observed characterized by the formation of well-organized granulation tissue in the epidermis and dermis. PcTx1 was also observed to be more effective by accelerating inflammation.
DISCUSSION AND CONCLUSION: Using PcTx1 in the wound healing process of burns, completing the remodeling phase of wound healing. We observe that this venom has the potential to be considered among the treatment options for such injuries in the future.

INTRODUCTION: This study aimed to investigate the incidence and risk factors of pressure ulcers (PU) in the intensive care unit (ICU).
METHODS: Patients who developed PU in the ICU between January and June 2019 were retrospectively investigated. Patients who were treated in the ICU for longer than 72 h were included. Patient demographics, length of stay, cause of admission, risk scores at ICU admission, comorbidities, time to PU development, PU stage, Braden Scale at admission and discharge, invasive mechanical ventilation (IMV) duration, use of sedatives of vasopressors, laboratory results, and mode of discharge were recorded for patients with PU. Patient factors were compared between age groups.
RESULTS: Among the 411 patients admitted to the ICU, there were PU in 60 patients (14.5%). The median age was 72 years and the median length of ICU stay was 39.5 days for the patients with PU. 96.7% of patients with PU were under IMV, 83.3% were under sedatives, and 68.3% were administered vasopressors. The median time to PU development was 14 days. The most frequent PU stages were stage 1 and stage 2. PU were most frequently located in the sacrum and the heel. The rate of PU was higher in patients aged 65 or above.
DISCUSSION AND CONCLUSION: Multiple factors contribute to PU development. A comprehensive PU management plan is necessary for the prevention of PU in the ICU.

INTRODUCTION: Incidence of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is variable between 6% and 67%. LTF is an alternative intra-operative procedure which can be used in patients with aSAH which bleeds into ventricles. It allows the reorganization of the cerebrospinal fluid (CSF) circulation and decreases the CSF pressure and increases cerebral perfusion pressure. The aim of this study was to assess the short-term effects of LTF on hydrocephalus in patients with SAH.
METHODS: 105 patients with a diagnosis of aSAH treated in Ümraniye Research and Training Hospital which underwent surgi-cal clipping were included in our study. Some patients underwent LTF with an intraoperative decision. Our results were evaluated with regard to the presence of hydrocephalus, external ventricular drainage, and/or ventriculoperitoneal shunt need.
RESULTS: 105 patients with aSAH were included in the study. According to first CT imaging of these patients, Fisher scores were given. Thirty-one patients had scored 1, 24 scored 2, 24 scored 4, and 26 scored 4. In 25 of 55 patients with Fisher Scores 1–2, LTF was applied, and shunt-dependent hydrocephalus was observed in two of them in the long term. In 38 of 50 patients with Fisher Scores 3–4, LTF was applied, and shunt-dependent hydrocephalus was observed in 16 of them.
DISCUSSION AND CONCLUSION: Risk of hydrocephalus in LTF-applied patients was lower in Fisher Grade 1–2 patients when compared to Grade 3–4 patients. LTF is an easy and efficacious procedure that allows cerebral relaxation before surgical clipping and decreases the risk of developing hydrocephalus after clipping. Since it decreases the risk of developing hydrocephalus both in lower and higher Fisher Grade groups, although the decrease in risk is more in lower grade group, we recommend that LTF should be applied.

INTRODUCTION: Rotavirus is one of the major infectious agents of childhood acute gastroenteritis (AGE). Definitive diagnosis depends on laboratory test results. Our study aimed to compare the laboratory results, number of emergency admissions, and length of hospital stay of patients with an initial diagnosis of AGE in the pediatric emergency department according to the presence of rotavirus antigen.
METHODS: 74 patients who tested positive and 91 patients who tested negative for rotavirus antigen in fresh stool specimens admitted to the pediatric emergency service of our hospital between April 1, 2019, and May 1, 2019, were included in our study. Demographic characteristics, laboratory results, and length of hospital stay of both groups of patients were evaluated retrospectively. The Shapiro–Wilk test was used for statistical analysis, whereas the Student t-test and the Mann–Whitney U-test were used for the comparison of quantitative variables, and the Pearson Chi-square test was used for the comparison of qualitative data. A value of p<0.05 was considered statistically significant.
RESULTS: Among the patients included in the study, 54.1% of the patients who tested positive for rotavirus antigen were girls and 45.9% were boys, whereas 45.1% of the patients in the control group were girls and 54.9% were boys. The ages of the subjects participating in the study were between 1 and 107 months in the study group and 2–163 months in the control group. Patients’ length of stay was 1–47 h in the rotavirus antigen-positive group and 1–34 h in the control group. Evaluation of the number of hospital admissions revealed that recurrent admissions to the emergency department were more common in rotavirus cases, which constituted the study group.
DISCUSSION AND CONCLUSION: It was observed that patients diagnosed with AGE who tested positive for the rotavirus antigen in the emergency department were younger, their length of hospital stay was longer, and the number of admissions to the emergency department was higher. Especially in viral gastroenteritis, unnecessary use of antibiotics should be avoided, and breast milk should be supported to prevent dehydration, as well as rotavirus vaccination, which is not yet in the national vaccination calendar, especially in the infant age group.

INTRODUCTION: Testicular cancer accounts for 1% of all male neoplasms and 95% of cases are testicular germ cell tumors (TGCT). There are studies investigating the relationship between hematological inflammatory markers and testicular cancer. We aimed for the 1st time to investigate whether there is an association between Systemic Inflammation Response Index (SIRI) and clinical Stage 1 TGCT.
METHODS: A total of 60 patients who underwent radical inguinal orchiectomy because of testicular mass between June 2019 and December 2020 were included. Age, preoperative serum alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), lactate dehydrogenase (LDH) levels and whole blood cell counts, tumor stage, and tumor size of the patients were recorded. Pre-operative neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), Systemic Immune Inflammation Index, and SIRI were compared to preoperative serum AFP, hCG, and LDH levels between seminoma (n=27) and non-seminoma (n=33) TGCT groups.
RESULTS: No statistically significant difference was found between two groups in terms of tumor size, LDH level and tumor side, NLR, PLR, and Systemic Immune Inflammation Index (p>0.05). SIRI, serum AFP, and HCG levels were significantly higher in non-seminoma group (p=0.006, p=0.001, and p=0.005, respectively). In multivariate analysis, it was determined SIRI over 0.985 is associated with non-seminoma TGCT pathology (OR=5.662, 95% CI=1.284–24.966, p=0.022).
DISCUSSION AND CONCLUSION: In this pilot study, it was revealed that pre-operative SIRI is associated with non-seminoma TGCT. We believe it is important to explore the utility of SIRI in the differential diagnosis of TGCT in further studies.

INTRODUCTION: Cervical dystonia (CD) is a movement disorder characterized by cranial muscle overactivity, leading to an abnormal head posture. CD patients often experience mood disorders and sleep disorders due to the disturbing body image associated with deformities, and these symptoms can be at least as disabling as motor symptoms. This study investigated the frequency of non-motor symptoms and their relation to CD severity.
METHODS: The study comprises 26 clients with CD and 26 healthy volunteers. The clinical severity of CD was assessed by the Toronto Western Spasmodic Torticollis Rating Scale. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Standardized Mini-Mental State Examination (SMMSE), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale were used to evaluate non-motor symptoms in patients with CD and healthy controls. All dystonia patients we included were receiving botulinum toxin therapy.
RESULTS: The mean BDI and BAI scores were significantly higher in the patient group (p=0.006 and p=0.001, respectively). The mean score of SMMSE was considerably lower in the patient group than that in HCs (p=0.014). The frequency of excessive daytime sleepiness did not differ between groups. The patients with CD had worse sleep quality than HCs (p=0.001). According to the subgroup analysis of PSQI, sleep onset latency and sleep disturbance were significantly higher in the patient group (p=0.001 and p=0.012, respectively). Furthermore, sleep duration and sleep efficiency were significantly lower in the patient group (p=0.001 and p=0.001, respectively). No significant correlation was found between non-motor symptoms and disease severity, age, and duration of disease in the CD (p>0.05).
DISCUSSION AND CONCLUSION: CD causes functional impairment in many patients and leads to difficulties such as lack of self-confidence, timidity, avoidance of social movements, and depressive mood. Therefore, a comprehensive assessment of the non-motor symptoms of patients diagnosed with CD can also increase treatment success.

INTRODUCTION: The aim of this study was to determine whether erectile dysfunction (ED) patients are under the effect of anxiety and analyze their results of transrectal ultrasound-guided prostate biopsy (TRUS-PB).
METHODS: The study was conducted between April 2015 and February 2016, and the population consists of the patients clean from prostate cancer (PCa) according to the TRUS-PB results. ED or cancer patients were identified for exclusion as well as those with a history of biopsy or surgery on prostate site. The study group filled in the international index of erectile function-5 (IIEF-5) and the beck depression inventory (BDI) forms under the supervision of urologists. The timetable was like this: The two pre-biopsy forms with the 2nd or 3rd-week interval, the biopsy day following the second form, and the three post-biopsy forms in the 1st, 3rd, and 6th month.
RESULTS: When completing the study process, the case number was a total of 131 patients with no PCa according to the biopsy results (Main Age: 60.14±5.49). For IIEF-5, the pre-biopsy statistics were 23.57±2.45 points on average (105 ED patients), and the post-biopsy ones got better from the fourth forms (p<0.001). The pre-biopsy scores of BDI increased in 94 patients and again their post-biopsy ones improved in the fourth forms (p<0.001).
DISCUSSION AND CONCLUSION: The process including follow-up in prostate examination has depressive risks in the patients who applied TRUS-PB along with ED.

INTRODUCTION: The most common musculoskeletal problems associated with pregnancy are low back pain (LBP) and pelvic girdle pain. The belief that LBP is a problem that occurs during the normal course of pregnancy and it will go away after delivery impairs women’s quality of life. In this study, we aimed to determine the prevalence of LBP and the factors associated with LBP in pregnant women in Türkiye. It also aims to increase health-care professionals’ awareness of this situation.
METHODS: This cross-sectional study involved 147 pregnant women who applied to the obstetric clinic of Haydarpasa Numune Training and Research Hospital between September 2020 and December 2020 during the COVID-19 pandemic. All questionnaires were filled in by a single midwife during face-to-face interviews. Functional disability was measured by the Turkish version of the Oswestry Disability Index.
RESULTS: The prevalence of pregnancy-related low back pain (PRLBP) was 86%. The prevalence of a history of LBP is 44%. Pregnant with a history of LBP had higher PRLBP during pregnancy (94.2%, p<0.001). Age, gestational week, and weight gain during pregnancy were the risk factors related to PRLBP (p<0.05). Women with PRLBP had significantly increased Oswestry score, maternal age, gestational age, and weight gain compared to pregnant without LBP (p<0.05).
DISCUSSION AND CONCLUSION: A significant increase in the prevalence of PRLBP was observed in pregnant women during the COVID-19 pandemic period. Especially, young pregnant with excess weight gain during pregnancy and LBP history are candidates for PRLBP.

INTRODUCTION: Tuberculosis (TB) is a prevalent opportunistic infection among individuals afflicted with human immunodeficiency virus (HIV). HIV infection significantly heightens the risk of TB development, whereas TB, in turn, accelerates the progression of HIV. Among individuals living with HIV, TB remains the most frequently observed disease. Our study’s aim is the evaluation of TB tests among HIV/ acquired immunodeficiency syndrome (AIDS) cases.
METHODS: This study encompassed HIV/AIDS patients aged over 18 years. Tuberculin skin test (TST) and interferon-gamma release assay test (IGRA) results of the patients were evaluated retrospectively. Microsoft Excel and Chi-square test were used to analyze the data and the relationship between assessments.
RESULTS: 109 patients underwent TST, with twenty of them displaying reactions of ≥5 mm. Ten patients received IGRA testing and two of them tested positive. Two patients who were confirmed to have active TB during the study exhibited negative TST results, with IGRA not being evaluated in these cases. Among the 22 patients found to be TST positive, TB prophylaxis was initiated. The mean CD4+ T lymphocyte count in patients with TST positivity was 500.4/mm3, whereas in patients with IGRA positivity, it was 497/mm3. Moreover, the mean CD4 + T lymphocyte count in patients with negative TST results was 444.1/mm3, and it was 392.2/mm3 in patients with negative IGRA results. No statistically significant correlation was observed between TST results and patients’ CD4 + T lymphocyte counts and serum HIV-RNA levels.
DISCUSSION AND CONCLUSION: The evaluation of TST and IGRA data within the context of HIV-infected cases presents a crucial perspective on the management of TB in this population. Our findings, alongside relevant literature, contribute to a deeper understanding of TB diagnostics and co-infection dynamics among individuals living with HIV. TB remains the leading cause of HIV-related morbidity and mortality. Screening for TB is essential in newly diagnosed HIV-infected cases.

INTRODUCTION: In our study, it was aimed to assess clinical and epidemiological features, laboratory findings, applied treatments, and complications of patients who were referred retrospectively to Konya Training and Research Hospital Pediatric’s Infectious Disease Clinic.
METHODS: This study was conducted on 50 patients diagnosed with brucellosis who applied to the Pediatric Infectious Diseases outpatient clinic between December 2014 and July 2016.
RESULTS: In our study, 46% of the patients were female and 54% were male, and the median age was 10.3±3.2 years (min: 5-max: 18 years). It was observed that patients were referred most frequently in the spring and summer seasons. Eighty percent of the patients had a history of eating raw milk cheese, and 52% had an animal contact history. Brucellosis history in the family environment and immediate surroundings was found in 44% of the patients. According to frequency order, referral complaints of our patients were 70% arthralgia, 64% fatigue, 60% anorexia, and 50% fever. Arthralgia was the most common physical examination finding (40%). Serum agglutination titer at the rate of 88%, serum immunocapture test at the rate of 96%, enzyme-linked immunosorbent assay at the rate of %88 were found positive, and the agent culture rate of blood culture, which was taken from 34% of the patients, was found to be 35%. As complications, patients were monitored by the reason of 8% pancytopenia, 8% hepatitis, and 12% osteoarticular involvement. At the follow-up between 7 and 14 days of treatment, serum immunocapture agglutination titers decreased. There were no patients in whom drug side effects, abnormality of laboratory findings, or relapse were observed.
DISCUSSION AND CONCLUSION: Brusellosis, which is endemic for our country, should be considered in patients with fever, arthralgia/arthritis, and hepatosplenomegaly; family history, occupation with stock farming, raw milk, and milk product consumption should be questioned; and tests for this disease should be wanted.

INTRODUCTION: Malignant pleural mesothelioma (MPM) is an extremely aggressive malignant tumor of the pleura and its survival is poor. We aimed to determine possible epidemiological and histological features that may affect survival, and to form treatment models according to these features.
METHODS: We retrospectively reviewed of pathologically confirmed MPM cases followed up in the oncology outpatient clinic. The data of patient’s sociodemographic characteristics, Eastern Cooperative Oncology Group performance status, tumor cell type, lymph node involvement, disease stage, treatment modalities, chemotherapy and, response to treatment, metastasis site, comorbidities, used supportive treatments and their effects on survival were analyzed.
RESULTS: A total of 38 mesothelioma patients, 26.3% (n=10) female and 73.7% (n=28) male, with a mean age of 60.21±8.99 (38–76) years were included. Of the cases 31.6% (n=12) survived and 68.4% (n=26) died. A significant difference was found between TNM stages regarding mortality (p<0.05). When the significant findings were examined, while Stage 1A was high in the survived patients, mortality was higher in Stage IB, IIIB, and Stage IV cases. No significant correlation was found between T and N staging and mortality (p>0.05). M stage, on the other hand, showed a significant difference in terms of mortality, and mortality was high in M1. The survival of the patients who received surgery+KT+ radiation therapy (Trimodal Treatment) was longer than the others.
DISCUSSION AND CONCLUSION: According to our findings, the mean survival was longer compared to the literature, and survival was longer in the patients who received trimodal treatment. Having a family history of cancer in half of the cases was also interesting.

INTRODUCTION: Malignant pleural mesothelioma (MPM) is a rare condition with a poor survival rate. This study was designed to determine the prognostic importance of glucose transporter-1 (GLUT-1) expression in operated patients with pleural mesothelioma.
METHODS: Patients operated with a diagnosis of pleural mesothelioma between January 2005 and September 2014 were retrospectively analyzed in terms of age, gender, diagnosis method, maximum standardized uptake value in positron emission tomography, operation, pathology, GLUT-1 expression in the specimen, morbidity, and mortality.
RESULTS: One hundred and twenty-nine patients were diagnosed as MPM. 75 (54 male and 21 female) of these patients underwent therapeutic operations. The mean age was 63 (range 41–89). Extrapleural pneumonectomy was performed in 27, pleurectomy/decortication in 25, and radical pleurectomy in 23 patients. The pathological diagnosis was epithelial in 67 and biphasic in 8 patients. All the patients were referred for adjuvant chemoradiotherapy and 69% completed the intended trimodality treatment. In 61 (81.3%) of the operated patients, the parietal pleura material was positive for GLUT-1. The morbidity was seen in 16 of the operated patients. The average survival time was 23.7 months after surgery. The average survival time was 24.5 months in patients with GLUT-1 expression <10% in extent, and 15.6 months in rest of the patients (p=0.001).
DISCUSSION AND CONCLUSION: MPM has a poor prognosis even after surgery. However, lower expression of GLUT-1 was associated with significantly longer survival in our study. The survival time was found to be better if the GLUT-1 extent was <10%. Larger studies are needed to prove the prognostic significance of GLUT-1.