1. | Frontmatters Pages I - V |
REVIEW ARTICLE | |
2. | Pharmacotherapy of Painful Diabetic Neuropathy: A Clinical Update Cornelius Fernandez James, Shiva Tripathi, Kyriaki Karampatou, Divya V Gladstone, Joseph M Pappachan PMID: 35515975 PMCID: PMC9040305 doi: 10.14744/SEMB.2021.54670 Pages 1 - 20 The rising prevalence of diabetes mellitus (DM) leads on to an increase in chronic diabetic complications. Diabetic peripheral neuropathies (DPNs) are common chronic complications of diabetes. Distal symmetric polyneuropathy is the most prevalent form. Most patients with DPN will remain pain-free; however, painful DPN (PDPN) occurs in 6–34% of all DM patients and is associated with reduced health-related-quality-of-life and substantial economic burden. Symptomatic treatment of PDPN and diabetic autonomic neuropathy is the key treatment goals. Using certain patient related characteristics, subjects with PDPN can be stratified and assigned targeted therapies to produce better pain outcomes. The aim of this review is to discuss the various pathogenetic mechanisms of DPN with special reference to the mechanisms leading to PDPN and the various pharmacological and non-pharmacological therapies available for its management. Recommended pharmacological therapies include anticonvulsants, antidepressants, opioid analgesics, and topical medications. (SETB-2021-12-376) |
3. | Non-Toxic Multinodular Goiter: From Etiopathogenesis to Treatment Mehmet Taner Unlu, Mehmet Kostek, Nurcihan Aygun, Adnan Isgor, Mehmet Uludag PMID: 35515961 PMCID: PMC9040296 doi: 10.14744/SEMB.2022.56514 Pages 21 - 40 Goiter term is generally used for defining the enlargement of thyroid gland. Thyroid nodules are very common and some of these nodules may harbor malignancy. Multinodular goiter (MNG) disease without thyroid dysfunction is defined as non-toxic MNG. There are many factors in etiology for development of MNG. They can be classified as iodine dependent and non-iodine dependent factors basically. Beyond this basic classification, the effect of many environmental and acquired factors is also effective on the development of goiter. Many methods have described for diagnosis and treatment for non-toxic MNG. Biochemical tests, imagining methods, invasive and non-invasive methods have been used for diagnosis for many years. Each method has advantages and disadvantages, separately. Although the best method for diagnosis is still debatable, distinguishing malignant nodules from benign nodules is the first and most important step for MNG. Biochemical tests such as serum thyroid stimulating hormone (TSH) measurement, thyroid hormone measurement; and thyroid ultrasonography are used for diagnosis of MNG, traditionally. Nowadays, there are some new techniques were developed like ultrasound-elastography. Furthermore, thyroid scintigraphy may be used if there is abnormal TSH measurement. Fine-needle aspiration biopsy and some cross-sectional imaging methods (computed tomography, magnetic resonance imaging, and positron emission tomography) could be used, too. After a certain diagnosis is made, treatment options should be evaluated. Many treatment methods have been used for goiter from ancient times upon today. From non-invasive methods such as medical follow-up to invasive methods such as lobectomy or thyroidectomy are options for treatment. Patients with compression symptoms due to an enlarged thyroid gland are usually candidates for surgery. In this study, it is aimed to determine the most appropriate treatment for the patient by discussing the advantages and disadvantages of all these methods. The present review discusses definition of goiter term, etiology, epidemiology, pathogenesis, diagnostic methods, and treatment methods for nontoxic MNG. |
ORIGINAL RESEARCH | |
4. | Relationship Between ABO Blood Types and Coronavirus Disease 2019 Severity Mufide Arzu Ozkarafakili, Nesrin Gareayaghi, Zeynep Mine Yalcinkaya Kara PMID: 35515967 PMCID: PMC9040303 doi: 10.14744/SEMB.2021.15045 Pages 41 - 48 Objectives: Severe Acute Respiratory Syndrome Coronavirus-2 infection spreads rapidly around the world. The blood groups are recognized to influence susceptibility to certain viruses. The aim of this research was to determine any potential role of the patients’ ABO and Rh blood groups in both the acquisition and severity of coronavirus disease 2019 (COVID-19). As a growing global health problem, to find any marker for COVID-19 may help to identify high-risk individuals and ease the strain on health system. Methods: The patients who were hospitalized between March and August 2020 with a diagnosis of COVID-19 and had a documented ABO blood type in medical database were examined retrospectively. Patients were grouped as survivors (followed up in pandemic wards /or intensive care unit [ICU]) and non-survivors. Their ABO blood types were correlated with general population’s blood types. The labaratory findings of patients were evaluated according to the blood types. Results: A total of 492 patients included, 233 (47.4%) were male. The mean age was 58.9±17.5. Data of ABO blood groups of 51966 individuals in general population was used as a control group; the number of the patients in Rh (-) blood type 0, were significantly lower than the control group (p=0.008). Among the whole patient group (survivors and non-survivors), Blood type A 210 (42%) was the most common and type AB 52 (10%) was the least common. However, no statistically significant difference was noted between survivors (pandemic wards/ICU) and non-survivors unlike the previous studies (p=0.514). No correlation was found between laboratory findings (Hemoglobin, red cell distribution width, platelet, white blood cell, lymphocyte, D-Dimer, C-reactive protein, ferritin) and ABO blood groups of COVID-19 patients (p>0.05). Conclusion: There was no association found between the ABO blood type and COVID-19 infection rate or disease severity. No evidence was noted to support the use of ABO blood type as a marker for COVID-19. Further efforts are warranted to better predict outcomes of hospitalized COVID-19 patients. |
5. | The Impact of COVID-19 Pandemic on Urological Emergencies, 8 Months Results of a Multicenter Retrospective Study From Turkey Okan Alkis, Aykut Baser, Mustafa Serdar Caglayan, Kerem Teke, Ibrahim Erkut Avci, Adem Yasar, Ercument Keskin, Mustafa Yuksekkaya, Sinan Celen, Yusuf Ozlulerden, Mahmut Taha Olcucu, Murat Ucar, Ahmet Guzel, Mehmet Kazim Asutay, Tuncer Bahceci, Halil Ferat Oncel PMID: 35515971 PMCID: PMC9040294 doi: 10.14744/SEMB.2021.59852 Pages 49 - 54 Objectives: We aimed to reveal the change of urological emergencies during the COVID-19 pandemic compared to the same period of the previous year. Methods: The number of admissions to the emergency department (ED), admissions to the urology outpatient clinic, emergency urological consultations, and urological and emergency urological surgeries during the periods April-November-2019 and April-November-2020 were recorded. The data of the COVID-19 period were compared with the previous year. Results: While the number of admissions to the urological outpatient clinic was 160,447 during the COVID period, it was 351,809 during the non-COVID period. The number of admissions to the ED decreased from 3.2 million to 2.4. The number of admissions to the urology outpatient clinic significantly decreased by 54% during the pandemic (p=0.001). Percutaneous cystostomy performed due to acute urinary obstruction decreased by 27.96%, double J stent, nephrostomy decreased by 16.61%, and ureterorenoscopy decreased by 12.26%. Urogenital trauma also decreased. On the contrary, surgical procedures performed due to penile fracture, gross hematuria, Fournier gangrene, and testicular torsion increased. Conclusion: During the COVID-19 pandemic, a significant decrease was observed in non-COVID patients’ admissions to the emergency and urology department, and in urologic surgeries. |
6. | Comparison of Clinical Characteristics of COVID-19-Related and Unrelated Acute Stroke Patients During the COVID-19 Pandemic in Turkey Derya Selcuk Demirelli, Gencer Genc, Celal Ilker Basarir, Serpil Bulut PMID: 35515970 PMCID: PMC9040310 doi: 10.14744/SEMB.2021.65785 Pages 55 - 61 Objectives: Data on the co-occurrence of stroke and coronavirus disease 2019 (COVID-19) infection are limited and need to be improved. In our study, we aimed to evaluate the clinical and laboratory characteristics of COVID-19-related patients admitted to our center with acute stroke and compare them with acute stroke patients without COVID-19 infection during the same period. Methods: One hundred and eighty-four patients admitted with acute stroke from March 11, 2020, to May 11, 2020, were included in the study. Demographic and clinical characteristics, work-up studies, and clinical scales including National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) scores were examined retrospectively. All patients diagnosed with acute stroke who were also evaluated for COVID-19 before hospitalization were divided into two groups: COVID-19-related and unrelated cases. Results: COVID-19-related and unrelated acute stroke patients had similar characteristics in terms of age, gender, and stroke risk factors. The admission NIHSS (mean NIHSS: 9.8 vs. 5.9) scores and the discharge mRS values (mean mRS: 3.9 vs. 2.4) were significantly higher in the COVID-19-related stroke group (p=0.002 and p=0.001, respectively). The prognosis of the COVID-19-related stroke group was significantly worse (69.6% vs. 39.8%) and the mortality rate (39.1% vs. 6.2%) was significantly higher than the COVID-19-unrelated stroke group (p=0.007 vs. p=0.000, respectively). The proportion of patients with large infarcts in the COVID-19-related acute ischemic stroke group was significantly higher than the one in the COVID-19-unrelated acute ischemic stroke group (57.9% vs. 21.9%, p=0.003). Conclusion: This is the first comparative study to evaluate the clinical presentation and outcome of COVID-19-related acute ischemic and hemorrhagic stroke patients in Turkey. Our results suggest that COVID-19-related acute stroke is associated with more severe clinical presentation and worse outcome. This seems to be linked to the coagulation abnormalities induced by COVID-19 infection. |
7. | Pediatric Patients with COVID-19: A Retrospective Single-Center Experience Ayse Sahin, Nazan Dalgic, Mesut Sancar, Emel Celebi Congur, Mehmet Kemal Kanik, Sibel Degim Ilgar, Banu Bayraktar, Haci Mustafa Ozdemir PMID: 35515968 PMCID: PMC9040293 doi: 10.14744/SEMB.2021.85595 Pages 62 - 69 Objectives: The pandemic of coronavirus disease 2019 (COVID-19) is still effective all over the world. Compared to adults, data on pediatric patients are limited. In this study, we aimed to retrospectively examine the demographic, clinical, and laboratory characteristics of pediatric patients who were followed up with the diagnosis of COVID-19 in the first 3 months of the pandemic in our hospital. Methods: A total of 190 patients, aged 1 month–18 years, who were followed up with a definite/probable diagnosis of COVID-19, who were treated in the Pediatric Infection Clinic, were included in the study. The demographic features, clinical characteristics, and laboratory findings of the patients were retrospectively analyzed from their electronic medical records. Results: Eighty (42.1%) of the patients were laboratory confirmed (Polymerase chain reaction positive in nasopharyngeal swab). Mean age was 72 (2–216 months) and 102 (53.7%) patients were female. Family contact history was present in 115 (60.5%) patients. The patients were classified as asymptomatic (5.8%), mild (73.2%), moderate (18.4%), and severe/critical (2.6%) according to the severity of the disease. The most common symptoms were cough (71.1%) and fever (51.1%). Hydroxychloroquine alone or in combination was the most commonly used agent. Conclusion: In our study, in which we examined the pediatric COVID-19 patients, most of the patients had a mild clinical course, but there were applications with different clinical pictures such as acute appendicitis. Therefore, COVID-19 infection, which is still very unknown, will continue to surprise us with both changing treatment protocols and clinical presentations such as multisystem inflammatory syndrome in children. |
8. | Pre-Operative Parameters Predicting Hemoglobin Decline Related to Percutaneous Nephrolithotomy Mithat Eksi, Deniz Noyan Ozlu, Taner Kargi, Abdullah Hizir Yavuzsan, Ahmet Haciislamoglu, Serdar Karadag, Selcuk Sahin, Ali Ihsan Tasci PMID: 35515974 PMCID: PMC9040304 doi: 10.14744/SEMB.2021.21284 Pages 70 - 76 Objectives: Percutaneous nephrolithotomy (PNL) for upper urinary tract stones is a minimally invasive, effective treatment modality. Despite its high success rates, its potential complications pose a risk. In this study, we aimed to determine the risk factors associated with bleeding which is one of PNL’s most important complications. Methods: The data of patients who underwent PNL between January 2017 and December 2018 were retrospectively analyzed. The median reduction in post-operative hemoglobin levels compared to preoperative levels was found to be 1.6 g/dl, which was accepted as the threshold value. The patients with hemoglobin decrease above the threshold were assigned as Group 1, and below the threshold as Group 2. Pre-operative, perioperative data, and stone characteristics of the patients were recorded. Results: 169 patients, 85 patients in Group 1 and 84 patients in Group 2 were included in the study. The mean age of Group 1 was significantly higher (47.4±7.9 and 32±9.4 years, respectively, p=0.001) Sixteen in Group 1 (18.8%) and six in Group 2 (7, 1%) had a diagnosis of hypertension (HT) and a significant difference was found (p=0.038). The average stone burden was 2733±1121.3 mm3 in Group 1, and 2326.5±975.6 mm3 in Group 2. It was observed that there was a significantly higher stone burden in Group 1 (p=0.001). There was a significant difference between the groups in terms of mean operation time (84.4±7 and 76.2±9.9 min, respectively, p<0.001). When the complication rates were analyzed, complications were observed in 25 (29.4%) patients in Group 1 and 12 (14.2%) patients in Group 2, and a significant difference was found between both groups (p=0.019). Age and HT were found to be significant independent risk factors associated with hemoglobin decline in multivariate analyzes (p<0.001 and p<0.027, respectively). Conclusion: In this study; advanced age, presence of HT, and high stone burden were found to be predictive of reductions in hemoglobin levels. Furthermore, a correlation of decreased hemoglobin levels was detected with operative times and occurrence of complications. |
9. | Lymphocyte to Monocyte Ratio and C-Reactive Protein Combination as the Best Simple Predictor of Treatment Response in Cirrhotic Patients with Culture Negative Neutrocytic Ascites Sezgin Barutcu, Abdullah Emre Yildirim, Ahmet Sahin, Murat Taner Gulsen PMID: 35515960 PMCID: PMC9040302 doi: 10.14744/SEMB.2021.58219 Pages 77 - 83 Objectives: The aim of this study was to evaluate the most ideal inflammatory markers for treatment response and to determine a cutoff value that could predict response to treatment for culture negative neutrocytic ascite (CNNA) patients. Methods: This is a retrospective cross-sectional case-controlled study. Patients with CNNA were evaluated by taking ascites fluid sampling at the beginning and on the 5th day of treatment. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-monocyte ratio were calculated. Results: Of the 123 cases with cirrhotic ascites disease, 59 were CCNA and 64 were the control group without ascite-fluid infection. There were statistically significant differences for blood monocyte count, NLR (p<0.01), LMR, and C-reactive protein (CRP) (p<0.001) between two groups. Patients in the CNNA group were compared before and after treatment among themselves for the treatment response. There was statistically significant difference in mean platelet volume, monocyte, LMR, and CRP (p<0.05) between two groups. After receiver operator characteristics curve analysis, the best cutoff value for monocyte was <0.64 × 10³/µL (sensitivity 49.2%, specificity 74.6%, positive predictive value [PPV] 65.9%, and negative predictive value [NPV] 59.5%) (p<0.01), for LMR was ≥1.7 (sensitivity 76.3%, specificity 78%, PPV 77.6%, and NPV 76.7%), and for CRP was ≤18 mg/L (sensitivity 91.5% specificity 57.6%, PPV 68.4%, and NPV 87.2%) (p<0.001). When LMR and CRP were used together, sensitivity (86.5%), specificity (83.1%), PPV (83.6%), and NPV (86%) were found to be statistically significantly higher (p<0.001). Conclusion: Our results showed that in cirrhotic patients with CNNA, combined LMR + CRP can be used as a novel, low cost and non-invasive test to predict treatment response. |
10. | Factors Affecting Metabolic Bone Disease of Prematurity: Is Hypothyroxinemia Included? Mesut Dursun, Bahar Ozcabi, Mehmet Sariaydın PMID: 35515963 PMCID: PMC9040307 doi: 10.14744/SEMB.2021.99076 Pages 84 - 90 Objectives: The association between transient hypothyroxinemia of prematurity (THOP) and metabolic bone disease of prematurity (MBD) is not clearly known. We aimed to evaluate the effects of THOP and other risk factors on MBD in very low birth weight infants. Methods: This study included infants born at <30 weeks gestational age and <1500 g birth weight who were hospitalized between July 2016 and December 2019. The following information was obtained from medical records: Demographic characteristics; clinical follow-up data; morbidities; initial thyroid function tests; and calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP) levels at postnatal 4–6 weeks. Newborns with an ALP level >500 IU/L were diagnosed with MBD. Patients without MBD were defined as Group 1 and patients with MBD were defined as Group 2. Results: Our study enrolled 145 infants who met the inclusion criteria. The incidences of MBD and THOP were 16.5% and 56.5%, respectively. Gestational age and birth weight were significantly lower in Group 2 than in Group 1. It was observed that these infants received total parenteral nutrition for a longer period of time and had a longer transition period to full enteral feeding. In addition, duration of non-invasive mechanical ventilation, duration of oxygen treatment, frequencies of moderate-severe bronchopulmonary dysplasia, and postnatal steroid use were found to be significantly higher in babies in Group 2 compared to babies in Group 1. There was no significant difference between the groups in terms of THOP. However, multivariate logistic regression analysis revealed no risk factors for the development of MBD. The presence of MBD and Ca, P, and ALP levels did not differ significantly between patients with and without THOP. Conclusion: Our study reveals that MBD is a multifactorial disease and THOP is not a risk factor for the development of MBD. |
11. | Is the Frequency of Seborrheic Dermatitis Related to Climate Parameters? Tugba Ozkok Akbulut, Hulya Suslu, Tugba Atci PMID: 35515978 PMCID: PMC9040311 doi: 10.14744/SEMB.2021.67503 Pages 91 - 95 Objectives: The aim of this study was to determine the frequency of seborrheic dermatitis (SD) by months and seasons in Istanbul, Turkey, and to examine the relationships between SD frequency and meteorological data, such as average temperature (°C), average humidity (%), average sunshine duration, and solar radiation per months. Methods: The study was conducted at Dermatology Department of Haseki Training and Research Hospital. The data of all adult patients who applied to the dermatology outpatient clinic between June 2018 and May 2020 were obtained. Monthly average climate data values of Istanbul between the same period were requested from the Turkish Ministry of Agriculture and Forestry, General Directorate of Meteorology. Results: During the study period, SD was diagnosed in 5316 patients (5.9% of the outpatient clinic). Among these, 2721 (51.2%) were male, 2595 (48.8%) were female, and mean age was 35.9±15.1 years-old. With respect to monthly distributions, SD frequency was 7.3% in December, 7.1% in February, 6.7% in November, and 6.6% in January; whereas June (3.8%) and July (3.9%) represented the lowest proportion of patients. Frequency of SD was similar in the autumn and winter seasons, despite considerable difference in average temperature. The frequency of SD was found to be strongly and inversely correlated with temperature values (r=–0,646, p<0.001) and monthly maximum humidity value (r=–0.609, p=0.001), while it was also moderately correlated with solar radiation levels (r=–0.442, p=0.027). Minimum or average humidity values and sunshine durations (daily and monthly) were not associated with frequency of SD. Spearman’s Rho correlation was calculated to assess the directional relationships between continuous variables. Conclusion: Our study shows that environmental factors such as low temperature, low ultraviolet index, and low humidity are critical factors that increase the likelihood of SD development. These data support previous studies in terms of indicating that SD frequency might be increased in climate conditions favoring the growth of Malassezia species. |
12. | Evaluation of Temperament and Character Traits and Their Subscale Dimensions Associated with Major Depressive Disorder Abdullah Burak Uygur, Ece Ozdemir Oktem, Selime Celik PMID: 35515976 PMCID: PMC9040292 doi: 10.14744/SEMB.2021.75031 Pages 96 - 106 Objectives: The relationship between major depressive disorder (MDD) and, especially harm avoidance, self-directedness, and cooperativeness has been determined based on Cloninger’s psychobiological personality model; there are not enough studies in the literature on the role of the subdimensions. Therefore, the aim of this study was to compare the patients with MDD and healthy controls in terms of temperament and character traits and especially subdimensions and thus to determine the role and predictive value of temperament and character subdimensions in major depression patients. Methods: The sample of this cross-sectional study consisted of 105 participants, 65 of whom were MDD patients, and 40 healthy controls, who voluntarily agreed to participate in the study. Sociodemographic data form, temperament and character inventory, and Hamilton depression rating scale were administered to the participants. Results: Compared with healthy controls, patients with MDD had lower self-directedness (p<0.001), cooperativeness (p=0.017), persistence (p<0.001), self-transcendence (p=0.001), and higher harm avoidance (p<0.001) scores. While there was no significant difference in novelty seeking (p=0.774); it was determined that MDD patients got higher scores in “Impulsiveness” (p=0.013) and lower scores in “Exploratory excitability” (p=0.001) subscales. Reward dependence has been identified as the only personality trait that there was no significant difference between major depression patients and healthy controls (p=0.511). As a result of the logistic regression analysis performed to determine the predictors of temperament and character subdimensions in major depression patients, only three temperament and character traits “Fatigability, Purposefulness, and Spiritual Acceptance” were determined as significant predictors (p<0.001). Fatigability was determined to be a serious risk factor, increasing the probability of MDD 3.6 times (p<0.001); purposefulness and spiritual acceptance were found to be protective personality traits that together reduced the probability of MDD by 0.8 times (p<0.001). Conclusion: This study shows that the risk of developing MDD is increased in individuals with low self-directedness, cooperativeness, persistence, and self-transcendence profiles, and whereas with prominent Harm avoidance personality traits. Therapeutic interventions, especially considering the temperament and character traits of “Fatigability, Purposefulness, and Spiritual Acceptance” determined in our study, may contribute positively to MDD treatment. |
13. | Comparison of Optical Coherence Angiography Measurements in Patients with Neovascular and Non-Neovascular Age-Related Macular Degeneration Mehmet Demir, Cetin Akpolat, Turgay Ucak, Zeynep Yilmaz, Emine Betul Akbas Ozyurek PMID: 35515966 PMCID: PMC9040298 doi: 10.14744/SEMB.2021.41017 Pages 107 - 112 Objectives: The purpose of the study was to determine the differences of optical coherence tomography angiography (OCTA) measurements between the patients with neovascular age-related macular degeneration (AMD) and non-neovascular early AMD. Methods: This retrospectively designed study included patients with neovascular AMD (N-AMD group) and non-neovascular early AMD (NN-AMD group). The patients had a completed ocular examination including best-corrected visual acuity (BCVA, in decimal), intraocular pressure (IOP, mmHg), and OCTA measurements such as choroidal blood flow (au) and retinal vessel density (VD, %). Results: The N-AMD group (1.46±0.28 au) showed a lower mean choroidal flow measurement than the NN-AMD group (1.73±0.32 au), (p<0.001). The patients in the N-AMD group had reduced VD measurements in all superficial and deep retinal layers compared with the NN-AMD group. However, significant differences in VD measurements were observed only in total superficial parafovea and in the superior and inferior quadrants of superficial parafovea while comparing the N-AMD and NN-AMD groups (p<0.05 for all). Almost all deep retinal VD measurements (p<0.05 for them) were significantly different in the N-AMD group except the overall and foveal zones (p=0.144 and p=0.433, respectively). Conclusion: Retinal VD is reduced in patients with N-AMD when compared to NN-AMD. This outcome offered a retinal vessel contribution to AMD pathogenesis. |
14. | The Efficiency of Fractional Anisotropy, Apparent Diffusion Coefficient, and Contrast Enhancement Index in Liver Fibrosis Staging Umut Perçem Orhan Soylemez, Deniz Turkyilmaz Mut, Canan Alkim, Huseyin Alkim, Banu Yılmaz Ozguven, Salih Boga, Muzaffer Basak, Sukru Mehmet Erturk PMID: 35515969 PMCID: PMC9040295 doi: 10.14744/SEMB.2021.33396 Pages 113 - 118 Objectives: Even though magnetic resonance imaging has been described as the most effective imaging method for the diagnosis of liver fibrosis, an accepted magnetic resonance ımaging (MRI) technique is yet to be defined. The aim of this study is to determine the efficiency of MRI in the staging of liver fibrosis. Methods: Patients with chronic hepatitis B infection and had upper abdominal MRI with hepatocyte specific contrast agent were evaluated. Twenty-nine patients that had undergone liver biopsy were included in the study. ADC, FA, and signal intensity values of liver parenchyma were measured by two observers and contrast enhancement index (CEI) was calculated as well. Patients were grouped as early (A) and late fibrosis(B) according to Ishak grading system and then the correlations between the stage and MRI findings were analysed. The intraclass correlation coefficient was used to analyze the inter-rater agreements. ADC, FA, and CEI were compared with Student t-test between early and late fibrosis groups. Pearson’s correlation was used to assess the correlation between ADC and FA values. Spearman correlation was used to evaluate the relationship between pathologic fibrosis grade and MRI parameters that were measured. Results: Twenty-two patients were staged as 1 and 2 (group A), seven patients were staged as 3 and above fibrosis(group B). Statistically, there was a strong, negative correlation between the FA values and the degree of fibrosis (r=−0.582, p=0.001). There was no correlation between the CEI and hepatocyte activity index (r=−0.88, p=0.655) and degree of fibrosis (r=0.0001, p=0.997). In terms of FA values, there was a statistically significant difference between two groups (group A=0.429 ± 0.06, group B=0.349 ± 0.06) (p=0.004). Conclusion: Correlation of FA values with fibrosis stage and significant difference in FA values between early-late stage fibrosis patients shows that diffusion tensor imaging can be a promising technique in the staging and follow-up of liver fibrosis. |
15. | The Relationship Between Mammographic Density and Factors Affecting Breast Cancer Risk Belma Kocer, Ebru Menekse, Umit Turan, Ozan Namdaroglu, Ayse Nurdan Barca, Levent Araz, Buket Altun Özdemir, Betul Bozkurt PMID: 35515977 PMCID: PMC9040300 doi: 10.14744/SEMB.2021.30771 Pages 119 - 125 Objectives: Although the relationship between breast cancer (BC) risk factors and mammographic density (MD) patterns is not clear, high MD is well known as an independent risk factor for BC. Thus, the aim of this study was to examine the association between MD and BC risk factors in BC patients and find a correlation between MD and tumor characteristics in BC patients. Methods: Our data included 242 patients with BC. Furthermore, the MD (type I - <25%; type II - 25–50%; type III - 51–75%; and type IV - >75%) was categorized according to percentile density, and the various types of MD were compared using risk factors for BC and tumor characteristics of patients. Results: The results of this study indicated that younger age, pre-menopausal status, younger menarche age, nulliparity, low body mass index, and smoking significantly increase the percentage of MD (p<0.001, p<0.001, p=0.04, p<0.001, p=0.003, and p=0.01, respectively). Moreover, the distribution of MD patterns showed significant differences according to tumor subtypes. Type 4 mammographic pattern was higher in patients with human epidermal growth factor receptor 2 (Her2) type of tumor (p=0.01). Conclusion: Higher MD is related to reproductive risk factors and tumor subtypes, especially Her2 type, in BC patients. Further studies are needed to identify the factors related to breast density. |
16. | Relationship Between Thyroid-Stimulating Hormone Level and Aggressive Pathological Features of Papillary Thyroid Cancer Zeynep Gul Demircioglu, Mahmut Kaan Demircioglu, Nurcihan Aygun, Ismail Ethem Akgun, Mehmet Taner Unlu, Mehmet Kostek, Banu Yılmaz Ozguven, Mehmet Uludag PMID: 35515965 PMCID: PMC9040308 doi: 10.14744/SEMB.2022.14554 Pages 126 - 131 Objectives: Thyroid-stimulating hormones (TSHs) are associated with the risk of differentiated thyroid cancer. The relationship between pre-operative TSH levels and aggressive features is unclear. We aimed to evaluate the relationship between pathological features of papillary thyroid carcinoma (PTC) and high TSH levels. Methods: Patients who were operated between 2012 and 2017 and who were found to have PTC in their pathology were included in the study. The relationship between TSH and the features of tumor aggressiveness was evaluated in the patients. Results: Of the 132 patients, TSH level was significantly higher in those with lymphovascular invasion than those without (p=0.048), in those with central metastases than in those without (p=0.014), and in those with extrathyroidal spread than in those without (p=0.003). When patients were categorized into four 25% quartiles according to TSH (mUI/mL) level; the rate of extrathyroidal invasion increased as the TSH level increased, and the level was significantly higher in quartile 1 than the others, with significant difference (p=0.030). Conclusion: Pre-operative increase in TSH level is associated with an increased risk of extrathyroidal spread and central lymph node metastasis. TSH level may be a pre-operative valuable predictive factor for patients’ risk of central metastasis. |
17. | Low Vitamin D Status is Not Associated with the Aggressive Pathological Features of Papillary Thyroid Cancer Zeynep Gul Demircioglu, Nurcihan Aygun, Mahmut Kaan Demircioglu, Banu Yilmaz Ozguven, Mehmet Uludag PMID: 35515959 PMCID: PMC9040301 doi: 10.14744/SEMB.2022.36048 Pages 132 - 136 Objectives: In the present study, we investigated the effects of Vitamin D (vit D) deficiency on aggressiveness of papillary thyroid cancer (PTC). Methods: Patients with PTC confirmed with pathological examination, whom were operated by a single surgeon between 2012 and 2017, were included in the study. The data of the patients were analyzed retrospectively. Cancers other than PTC, patients with hyperthyroidism and/or using antithyroid drugs were excluded from the study. The patients were classified as four quartiles according to serum Vit D levels; category 1 (<7.1 ng/mL), category 2 (7.2–11.8 ng/mL), category 3 (11.9–23.4 ng/mL) and category 4 (>23.5 ng/mL). Results: A total of 133 patients (103 female, 30 male) with mean age of 46.4±13.6 (17–82) years were included in the study. There was no significant difference between the categories in terms of preoperative Vit D values according to the evaluated tumor aggressiveness characteristics. It was determined that the presence of tumor with a size above 1 cm and T3/4 tumor were not affected by Vit D level. There was no significant difference between Vit D categories regarding the characteristics of aggressiveness such as multicentricity, lymphovascular invasion, central, and lateral metastases. Conclusion: According to our results, serum Vit D levels are not associated with the aggressive tumor characteristics of PTC. |
18. | External Validation of a Nomogram Developed for Predicting Overall Survival in Gastric Cancer Patients with Insufficient Number of Examined Lymph Nodes Mehmet Kubat, Mustafa Omer Yazicioglu, Bahadır Bozkirli, Riza Haldun Gundogdu PMID: 35515973 PMCID: PMC9040297 doi: 10.14744/SEMB.2021.47587 Pages 137 - 144 Objectives: Nomograms and scoring systems in gastric cancers have been mainly developed based on adequate lymph node (lN) dissections. This study aimed to perform external validation of a nomogram developed for predicting overall survival (OS) in gastric cancer patients with insufficient number of examined LNs (eLNs) and to evaluate its usability as compared with the 8th American Joint Committee on Cancer (AJCC)’s Tumor-Node-Metastasis staging system. Methods: Medical records of 262 patients undergoing complete surgical resection for gastric cancers and having pathologically confirmed diagnosis were retrospectively reviewed. The study included 104 (39.7%) patients (82 males, median age, 60.3 years) with insufficient number of eLNs (<16). The 5-year OS rate was calculated using the nomogram and according to the AJCC system. Results: The median follow-up period was 37.4 months (range: 0.9–122.9). Of the patients, 69 (66.3%) died and 35 (33.7%) achieved 5-year survival within the follow-up period. The nomogram and the AJCC system predicted OS were significantly lower in patients who died than in those who achieved 5-year survival (p<0.001 for both). According to the receiver operative characteristics-curve, the area under the curve for the nomogram (0.801; 95% CI, 0.715–0.887; p<0.001) was larger than that for the AJCC system (0.754; 95% CI, 0.659–0.849; p<0.001). Conclusion: The nomogram developed for gastric cancer patients with insufficient number of eLNs (<16) was effective in predicting 5-year OS in our cohort and was superior to the AJCC system. |
19. | Evaluation of the Cricothyroid Muscle Innervation Pattern Through Intraoperative Electromyography Nurcihan Aygun, Mehmet Mihmanlı, Adnan İsgor, Mehmet Uludag PMID: 35515964 PMCID: PMC9040299 doi: 10.14744/SEMB.2022.25874 Pages 145 - 153 Objectives: We observed significant contractions in the cricothyroid muscle (CTM) after recurrent laryngeal nerve (RLN) stimulation in some patients. We aimed to evaluate whether these contractions resulted from the laryngeal-muscle movement due to the contraction of other intrinsic muscles or actual CTM contraction, with objective real-time intraoperative electromyography (EMG) recordings. Methods: This study was performed prospectively in 106 consecutive patients who underwent intraoperative neural monitoring-guided primary thyroid surgery due to various thyroid diseases between February-2015 and February-2016. After completion of the thyroidectomy procedure; the RLN, vagus nerve (VN), external branch of the superior laryngeal nerve (EBSLN), plexus pharyngeus (PP), and contralateral EBSLN (CEBSLN) were stimulated and the responses from the CTM and CPM were recorded and evaluated by EMG through needle electrodes. Results: 182 CTMs of 106 patients, with the mean age of 45, were evaluated regarding their innervation patterns. Positive EMG waveforms were achieved from 181 CTMs with EBSLN stimulation. A total of 132 (74%) positive EMG responses were recorded after the stimulation of 179 RLNs. The mean amplitude obtained with CTM EMG with RLN stimulation was 5.5% of that with EBSLN stimulation. The CTM amplitude was 39% of the vocal cord amplitude with RLN stimulation. Positive EMG responses of 96 CTMs (55%) with VN stimulation were recorded. The mean amplitude through CTM EMG with VN stimulation was 6% of that with EBSLN stimulation. Positive EMG responses were achieved from 10 (0.6%) CTMs with the stimulation of 170 PPs. The mean amplitude obtained from CTMs with PP stimulation was 4.3% of that with EBSLN stimulation. Positive EMG amplitudes of 35 (67%) CTMs were obtained with stimulation of 52 CEBSLN. Temporary vocal cord paralysis was detected in six patients (5% of patients and 3.3% of the nerves) postoperatively. Conclusion: The RLN contributes significantly to the innervation of the CTM. Despite the findings associated with the contribution of the PP and CEBSLN to the CTM innervation, further studies are needed. We are of the opinion that these are among the significant factors that contribute to the differences in clinical findings between patients with EBSLN injuries. |
20. | Curcumin Enhanced the Neomucosa Formation by Mediating the Antioxidation Mechanism in Rats Nadir Adnan Hacim, Ahmet Akbas, Osman Bilgin Gulcicek, Serhat Meric, Ali Solmaz, Erkan Yavuz, Hakan Yigitbas, Yigit Ulgen, Gulcin Ercan, Aysegul Kirankaya, Atilla Celik PMID: 35515962 PMCID: PMC9040306 doi: 10.14744/SEMB.2021.01878 Pages 154 - 160 Objectives: The purpose of the study was to examine the possible effects of curcumin on the formation of neomucosa in parietal peritoneum which was applied as a patch for terminal ileal defect in rats. Methods: Sixteen male Wistar Hannover rats were split into two groups. The control group was injected with saline and curcumin (2 mL/kg/day, by gavage) was given to the experimental group. In both groups, amounts of 8-hydroxy-2’-deoxyguanosine (8-OHdG) and malondialdehyde (MDA), the activities of glutathione peroxidase and superoxide dismutase were determined in serum. The development of neomucosa formation was examined morphologically. Results: Serum antioxidant levels and glutathione peroxidase activity in rats given curcumin were significantly higher than those of the control group (p<0.05). The levels of oxidative markers (MDA and 8-OHdG) in rats given curcumin were significantly lower than those of the control group (p<0.05). In the histopathological examination, 62.5% of rats in the curcumin group showed formation of neomucosa while 37.5% of control rats showed neomucosa. Conclusion: The use of curcumin in rats with terminal ileal defect enhanced the formation of neomucosa by decreasing the oxidation level and increasing the antioxidation level. Curcumin may be used in the patients with short bowel syndrome to increase the absorption surface area. |
CASE REPORT | |
21. | A Neonatal Case of Infantile Malignant Osteopetrosis Presenting with Thrombocytopenia and Hypotonicity: A Novel Mutation in Chloride Voltage-Gated Channel 7 Gene Isik Odaman Al, Yesim Oymak, Filiz Hazan, Semra Gursoy, Tulay Ozturk, Ozlem Bag, Salih Gozmen, Nurgul Karakaya, Tuba Hilkay Karapinar PMID: 35515972 PMCID: PMC9040309 doi: 10.14744/SEMB.2021.88964 Pages 161 - 165 Autosomal recessive osteopetrosis is also known as infantile malignant osteopetrosis (IMO). The clinical course is often serious and if left untreated, it is fatal in the 1st year of life. Diagnosis is challenging and often delayed or misdiagnosed. Herein, we present an infant girl who was diagnosed with IMO during evaluations for her hypotonicity and thrombocytopenia. A novel mutation of the chloride voltage-gated channel 7 (CLCN7) gene was also reported. A 10-day-old female patient was referred to our hospital for evaluation of hypotonicity. Her physical examination was normal, other than hypotonicity. Laboratory analysis revealed thrombocytopenia and hypocalcemia. In the progress, while she was followed in outpatient clinic, hepatosplenomegaly was detected at the age of 3 months. IMO was suspected with the findings of hepatosplenomegaly, cytopenia, hypocalcemia, difficulty of obtaining bone marrow, peripheral smear findings, and hearing loss. The X-ray of the bones was consistent with IMO. A novel pathogenic homozygous c.1504>T (p.Arg502Trp) mutation in CLCN7 gene was revealed. IMO is a rare disorder and it is important to differentiate this entity for better clinical outcome. The presence of neurological and hematological findings, organomegaly, hearing loss, and vision disorders must attract attention to IMO. |