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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)

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Guatr terimi genellikle tiroid bezinin büyümesini tanýmlamak için kullanýlýr. Tiroid nodülleri çok yaygýndýr ve bu nodüllerin bazýlarý malignite barýndýrabilir. Tiroid fonksiyon bozukluðu olmayan multinodüler guatr hastalýðý ise nontoksik multinodüler guatr olarak tanýmlanýr.
Multinodüler guatr geliþiminde etiyolojide bir çok faktör bulunmaktadýr. Temel olarak iyot baðýmlý ve iyot baðýmlý olmayan faktörler olarak sýnýflandýrýlabilirler. Guatr geliþiminde bu temel sýnýflandýrmanýn ötesinde çevresel ve edinsel bir çok faktörün de etkisi vardýr.
Toksik olmayan multinodüler guatrýn taný ve tedavisi için birçok yöntem tanýmlanmýþtýr. Biyokimyasal testler, görüntüleme yöntemleri, invaziv ve non-invaziv yöntemler uzun yýllardýr taný için kullanýlmaktadýr. Her yöntemin ayrý ayrý avantajlarý ve dezavantajlarý vardýr. Taný için en iyi yöntem hala tartýþmalý olsa da, malign nodülleri benign nodüllerden ayýrt etmek multinodüler guatr için ilk ve en önemli adýmdýr.
Serum tiroid uyarýcý hormon ölçümü, tiroid hormonu ölçümü gibi biyokimyasal testler ve tiroid ultrasonografisi geleneksel olarak multinodüler guatr tanýsýnda kullanýlmaktadýr. Günümüzde ultrason-elastografi gibi geliþtirilmiþ bazý yeni teknikler vardýr. Ayrýca anormal tiroid uyarýcý hormon ölçümü varsa tiroid sintigrafisi kullanýlabilir. Ýnce iðne aspirasyon biyopsisi ve bazý kesitsel görüntüleme yöntemleri de (bilgisayarlý tomografi, manyetik rezonans görüntüleme, pozitron emisyon tomografi) kullanýlabilir.
Kesin bir teþhis konulduktan sonra tedavi seçenekleri deðerlendirilmelidir. Antik çaðlardan günümüze guatr için birçok tedavi yöntemi kullanýlmýþtýr. Týbbi takip gibi non-invaziv yöntemlerden lobektomi veya tiroidektomi gibi invaziv yöntemlere kadar tedavi seçenekleri vardýr. Tiroid bezi büyümesine baðlý kompresyon semptomlarý olan hastalar genellikle cerrahi için adaydýr. Bu çalýþmada tüm bu yöntemlerin avantaj ve dezavantajlarý tartýþýlarak hasta için en uygun tedavinin belirlenmesi amaçlanmýþtýr.
Bu derleme, toksik olmayan multinodüler guatr için guatr teriminin tanýmýný, etiyolojisini, epidemiyolojisini, patogenezini, taný yöntemleri ve tedavi yöntemlerini tartýþmaktadýr. (SETB-2022-03-070)

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.

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Amaç: SARS-CoV2 infeksiyonu tüm dünyada etkisini göstermektedir.Bazý kan gruplarýnýn viral infeksiyonlara duyarlýlýðý artýrdýðý bilinmektedir. Bu çalýþmanýn amacý, ABO kan gruplarýnýn COVID-19 a yakalanma ve hastalýðýn þiddeti üzerindeki potansiyel rolünü araþtýrmaktý. Giderek büyüyen bir halk saðlýðý problemi olan COVID-19 için bulunacak bir belirteç riskli hastalarýn belirlenmesini saðlayabilir ve saðlýk sistemi üzerindeki yükü azaltmakta da yardýmcý olabilecektir.
Material Metod: Çalýþmamýzda, Mart-Aðustos 2020 tarihleri arasýnda, hastanemizde yatarak tedavi görmüþ ve hastane bilgi sisteminde kan grubu kaydý olan COVID-19 tanýlý 492 hastanýn dosyalarý retrospektif olarak incelendi. Son 3 yýlda kan bankasýna baþvurmuþ 51966 hastanýn kan gruplarý kontrol grubu olarak alýndý, hasta kan gruplarý ile korele edildi. Hastalar sað kalanlar (pandemi servisi/ yoðun bakým ünitesi) ve ölenler olarak iki gruba ayrýldý. Hastalarýn labaratuvar bulgularý ABO kan gruplarýna göre ve hastalarýn klinik durumlarýna göre incelendi.
Bulgular: 492 hastanýn 233 ü (% 47.4) erkekti. Ortalama yaþ 58.9±17.5 bulundu. Kontrol grubu ile karþýlaþtýrýldýðýnda, hasta grubunda 0 Rh (-) kan grubu anlamlý olarak düþüktü (p=0.08). COVID-19 hasta grubunda en az hasta AB kan grubu 52 (%10), en çok hasta A 210 (%42) kan grubunda bulunurken, kan gruplarýna göre daðýlýmda istatistiksel olarak anlamlý fark saptanmadý. Sað kalanlar ve ölenler arasýnda da ABO kan gruplarýna göre anlamlý fark bulunmadý. Hastalarýn hemoglobin, RDW, platelet, WBC, lenfosit, D-DIMER, CRP, ferritin gibi labaratuvar bulgularý, ABO kan gruplarýna göre deðerlendirildiðinde, anlamlý fark bulunmadý (p>0.05).
Sonuç: Çalýþmamýzda ABO kan gruplarý ile COVID-19 infeksiyonuna yakalanma ve hastalýðýn þiddeti arasýnda iliþki saptayamadýk. Yatarak takip edilen COVID-19 hastalarýnda klinik sonlanýmý öngörebilmek için daha farklý çalýþmalara ihtiyaç vardýr. (SETB-2021-05-163)

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.

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Amaç: Çalýþmamýzda Covid-19 salgýný sýrasýnda ürolojik acillerin geçen yýlýn ayný dönemine göre deðiþimini ortaya çýkarmayý hedefledik.
Yöntem: Nisan-Kasým-2019 ve Nisan-Kasým-2020 dönemlerinde acil servise (ED) baþvuru, üroloji polikliniðine baþvuru, acil ürolojik konsültasyonlar, ürolojik ve acil ürolojik ameliyat sayýlarý kaydedildi. Covid-19 dönemine ait veriler bir önceki yýlla karþýlaþtýrýldý.
Bulgular: Covid döneminde üroloji polikliniðine baþvuru sayýsý 160447 iken non-Covid dönemde 351809 idi. Acil servise kabul sayýsý 3,2 milyondan 2,4 milyona düþtü. Pandemi sýrasýnda üroloji polikliniðine baþvuru sayýsý % 54 oranýnda istatiksel anlamlý olarak azaldý (p=0,001). Akut üriner retansiyon nedeniyle yapýlan perkütan sistostomi % 27,96, double J stent, nefrostomi % 16,61 ve üreterorenoskopi % 12,26 azaldý. Ürogenital travma da azaldý. Aksine penil fraktür, gros hematüri, Fournier gangreni ve testis torsiyonu nedeniyle yapýlan cerrahi iþlemler arttý.
Sonuç: Covid-19 salgýný sýrasýnda Covid dýþý hastalarýn acil ve üroloji polikliniðine baþvurularý ile ürolojik ameliyatlarda önemli düþüþ gözlendi. (SETB-2021-03-068)

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.

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Amaç: Ýnme ve Coronavirus hastalýðý 2019 (COVID-19) enfeksiyonunun birlikte görülmesine iliþkin sýnýrlý sayýda veri bulunmaktadýr. Çalýþmamýzda, merkezimize akut inme ile baþvuran COVID-19 iliþkili hastalarýn klinik ve laboratuvar özelliklerinin deðerlendirilmesi ve ayný dönem içerisinde COVID-19 enfeksiyonu olmayan akut inme hastalarý ile kýyaslanmasý amaçlanmýþtýr.
Gereç ve Yöntemler: Merkezimize 11 Mart 2020 ile 11 Mayýs 2020 tarihleri arasýnda akut inme ile baþvuran 184 hasta çalýþmaya dahil edildi. Olgularýn demografik ve klinik özellikleri, tanýya ve etiyolojiye yönelik yapýlmýþ olan tetkikleri ile NIHSS (National Institutes of Health Stroke Scale), mRS (modified Rankin scale) skorlarý retrospektif olarak incelendi. Yatýþ öncesi COVID-19 açýsýndan deðerlendirilen tüm akut inme tanýlý hastalar, COVID-19 iliþkili olan ve olmayan olgular olmak üzere iki gruba ayrýldý.
Bulgular: COVID-19 iliþkili olan ve olmayan hastalar yaþ, cinsiyet ve inme risk faktörleri açýsýndan karþýlaþtýrýldýðýnda her iki grup benzer özelliklere sahipti. COVID-19 iliþkili akut inme grubunda giriþ NIHSS ve çýkýþ mRS skorlarý COVID-19 iliþkisiz inme grubundan anlamlý olarak daha yüksekti (sýrasýyla 9,8 vs 5,9; p=0,002 ve 3,9 vs 2,4; p=0,001). COVID-19 iliþkili inme grubunun prognozu COVID-19 iliþkisiz inme grubundan anlamlý derecede daha kötü ve mortalite oraný da anlamlý derecede daha yüksekti (sýrasýyla %69.6 vs %39.8; p=0,007 ve %39,1 vs %6,2; p=0,000). COVID-19 iliþkili akut iskemik inme grubunda büyük enfarktý olan hastalarýn oraný, COVID-19 iliþkisiz akut iskemik inme grubundan anlamlý derecede daha yüksekti (%57,9 vs %21,9 p=0,003).
Sonuç: Çalýþmamýz, Türkiye'de COVID-19 ile iliþkili akut iskemik ve hemorajik inme hastalarýnýn klinik prezantasyonunu ve sonuçlarýný deðerlendiren ilk çalýþmadýr. Bulgularýmýz COVID-19 iliþkili akut inmenin daha aðýr klinik prezentasyon ve daha kötü sonlaným ile iliþkili olduðunu düþündürmektedir. Bu durum COVID-19 enfeksiyonunun arttýrdýðý koagülasyon anormallikleri ile baðlantýlý görünmektedir. (SETB-2021-05-127)

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.

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Amaç: Coronavirus disease 2019 (COVID-19) pandemisi, halen tüm dünyada etkisini sürdürmektedir. Eriþkinlere kýyasla çocuk hastalarla ilgili veriler sýnýrlýdýr. Bu çalýþmada, hastanemizde pandeminin ilk üç ayýnda COVID-19 tanýsý ile takip edilen çocuk hastalarýn demografik, klinik, laboratuvar özelliklerinin retrospektif olarak incelenmesi amaçlanmýþtýr.
Yöntem: Çocuk Enfeksiyon Kliniðinde ayaktan/yatarak tedavi gören kesin/olasý COVID-19 tanýsý ile takip edilen 1 ay-18 yaþ arasý 190 hasta çalýþmaya dahil edildi. Hastalarýn, demografik yapýlarý, klinik özellikleri ve laboratuvar bulgularý elektronik týbbi kayýtlarýndan retrospektif olarak incelendi.
Bulgular: Hastalarýn 80 (% 42.1)’i laboratuvar ile (nazofarengeal sürüntüde PCR pozitif) doðrulanmýþtý. Ortalama yaþ 72 ( 2-216 ay), 102 (% 53.7) hasta kýz idi. Aile içi temas öyküsü, 115 (%60.5) hastada mevcuttu. Hastalar hastalýðýn þiddetine göre asemptomatik (%5.8), hafif (%73.2), orta (%18.4) ve aðýr/kritik (%2.6) olarak sýnýflandýrýldý. En sýk görülen semptom, öksürük (%71.1) ve ateþ (% 51.1) idi. Hydroxychloroquine tek ya da kombine olarak en sýk kullanýlan ajandý.
Sonuç: Çocuk yaþ grubu COVID-19 hastalarýný incelediðimiz çalýþmamýzda, hastalarýn büyük kýsmý hafif klinik seyir göstermekteydi ancak akut appandisit gibi farklý klinik tablo ile baþvurularda mevcuttu. Bu nedenle halen çok bilinmezi olan COVID-19 enfeksiyonu gerek deðiþen tedavi protokolleri gerekse MIS-C gibi klinik prezentasyonlarý ile bizi þaþýrtmaya devam edecektir. (SETB-2021-06-197)

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.

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Amaç: Perkütan nefrolitotomi (PNL), üst sistem kalküllerinde minimal invaziv, efektif bir tedavi modalitesidir. Yüksek baþarý oranlarýna raðmen, potansiyel komplikasyonlarý risk teþkil etmektedir. Biz bu çalýþmamýzda, en önemli komplikasyonlarýndan biri olan PNL sonrasý kanamayla iliþkili risk faktörlerini belirlemeyi amaçladýk.
Materyal-Method: Ocak 2017- Aralýk 2018 tarihleri arasýnda PNL uygulanan hastalarýn verileri retrospektif olarak incelendi. Preoperatif düzeylere göre postoperatif hemoglobin düzeylerindeki medyan düþüþ 1,6 g/dl hesaplanarak eþik deðer olarak alýndý. Eþiðin üzerinde hemoglobin düþüþü gerçekleþen hastalar Grup 1, altýnda düþüþ gerçekleþenler Grup 2 olarak belirlendi. Hastalarýn preoperatif, perioperatif verileri ve taþ karakteristiðine ait veriler kaydedildi.
Bulgular: Grup 1’de 85 ve Grup 2’de 84 hasta olmak üzere 169 hasta dahil edildi. Grup 1’in yaþ ortalamasýnýn anlamlý olarak yüksek olduðu belirlendi (sýrasýyla 47,4 ± 7,9 ve 32 ± 9,4 yýl, p= 0,001) Grup 1’de 16 (18,8%) Grup 2’de 6 (7,1%) hastada hipertansiyon (HT) tanýsý mevcuttu ve anlamlý bir fark saptandý (p=0,038). Grup 1’de ortalama taþ yükü 2733 ± 1121,3 mm3, Grup 2’de 2326,5 ± 975,6 mm3 bulundu. Grup 1’de anlamlý olarak daha yüksek taþ yükü olduðu görüldü (p=0,001). Gruplar arasýnda ortalama operasyon süresi açýsýndan anlamlý fark tespit edildi (sýrasýyla 84,4 ± 7 ve 76,2 ± 9,9 dakika, p<0,001). Komplikasyon oranlarý incelendiðinde, Grup 1’de 25 (29,4%), Grup 2’de 12 (14,2%) hastada komplikasyon izlendi ve her iki grup arasýnda anlamlý fark saptandý (p=0,019). Multivaryant analizlerde yaþ ve HT, hemoglobin düþüþü ile iliþkili anlamlý birer baðýmsýz risk faktörü olarak bulunmuþtur (sýrasýyla p<0,001, p<0,027).
Sonuç: Bu çalýþmada ileri yaþ, HT varlýðý ve taþ yükünün fazlalýðýnýn hemoglobin düþüþünü predikte eden deðerler olduðu bulunmuþtur. Ayrýca hemoglobin düþüþü ile operasyon süresi ve komplikasyon geliþmesi arasýnda korelasyon olduðu tespit edilmiþtir. (SETB-2021-03-078)

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.

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Amaç: Bu çalýþmanýn amacý, kültür negatif nötrositik asitli (KNNA) siroz hastalarýnda tedavi yanýtý için en ideal inflamatuar belirteçleri deðerlendirmek ve tedaviye yanýtý öngörebilecek bir kesme deðeri belirlemekti.
Metod: Bu çalýþma, retrospektif, kesitsel, vaka kontrollü bir çalýþmadýr. KNNA olan hastalar tedavinin baþlangýcýnda ve 5. gününde asit sývý örneði alýnarak deðerlendirildi. Nötrofil-lenfosit oraný (NLR), lenfosit-monosit oraný (LMR) ve nötrofil-monosit oraný hesaplandý.
Bulgular: Sirotik asit hastalýðý olan 123 vakanýn 59'u KNNA, 64'ü asit-sývý enfeksiyonu olmayan kontrol grubuydu. Ýki grup arasýnda kan monosit sayýsý, NLR (p <0,01), LMR ve C-reaktif protein (CRP) (p <0,001) açýsýndan istatistiksel olarak anlamlý fark vardý. KNNA grubundaki hastalar tedavi yanýtý için tedavi öncesi ve sonrasý kendi aralarýnda karþýlaþtýrýldý. Ýki grup arasýnda ortalama trombosit hacmi (MPV), monosit, LMR ve CRP (p <0.05) açýsýndan istatistiksel olarak anlamlý fark vardý. ROC eðrisi analizinden sonra, monosit için en iyi kesme deðeri <0,64 10³ / µL idi (duyarlýlýk%49,2, özgüllük%74,6, PPV %65,9, NPV %59,5) (p <0,01) LMR için ≥1,7 (duyarlýlýk %76,3, özgüllük %78, PPV %77,6, NPV %76,7) ve CRP için 18 mg / L (duyarlýlýk %91,5 özgüllük 57,6 %, PPV %68,4, NPV %87,2) (p<0,001). Hem LMR hem de CRP birlikte birleþtirildiðinde duyarlýlýk (%86,5), özgüllük (%83,1), PPV (%83,6) ve NPV (%86) istatistiksel olarak anlamlý derecede yüksek bulundu (p <0,001).
Sonuç: Sonuçlarýmýz, KNNA'li sirotik hastalarda, kombine LMR + CRP'nin tedavi yanýtýný tahmin etmek için yeni, düþük maliyetli ve invazif olmayan bir test olarak kullanýlabileceðini gösterdi. (SETB-2021-02-050)

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.

Abstract | English Full Text

Amaç: Prematürenin geçici hipotiroksinemisi (THOP) ile prematürenin metabolik kemik hastalýðý (MBD) arasýndaki iliþki net olarak bilinmemektedir. Çalýþmadaki amacýmýz çok düþük doðum aðýrlýklý (ÇDDA) bebeklerde THOP’nin ve diðer risk faktörlerinin, MBD üzerine olan etkisini incelemektir.
Yöntemler: Temmuz 2016 - Aralýk 2019 tarihleri arasýnda ünitemizde yatan <30. gebelik haftasýndan önce doðan ve doðum aðýrlýðý < 1500 g olan bebekler çalýþmaya dahil edildi. Bebeklerin demografik özellikleri, klinik seyirleri, morbiditeleri, ilk tiroid fonksiyon testi sonuçlarý, postnatal 4-6. haftalardaki kalsiyum, fosfor ve alkalen fosfataz düzeyleri hasta dosyalarý geriye yönelik taranarak kaydedildi. Metabolik kemik hastalýðý tanýsý postnatal 4-6. haftalar arasýnda çalýþýlan ALP düzeyinin >500 IU/L olmasý ile kondu. Hastalar, MBD olmayanlar (grup-1) ve olanlar (grup-2) olarak gruplandýrýldý.
Bulgular: Çalýþmamýza, dahil edilme kriterlerini karþýlayan 145 bebek alýndý. Metabolik kemik hastalýðý görülme oraný %16,5, THOP sýklýðý %56,5 olarak saptandý. Grup 2’deki bebeklerin gebelik haftasý ve doðum aðýrlýðý grup 1’deki bebeklere göre anlamlý olarak daha düþüktü. Bu bebeklerin daha uzun süre TPN aldýklarý ve tam enteral beslenmeye geçiþ sürelerinin daha uzun olduðu gözlendi. Ayrýca grup 2’deki bebeklerde noninvaziv mekanik ventilasyon süresi, oksijen tedavi süresi, orta-aðýr bronkopulmoner displazi varlýðý ve postnatal steroid kullaným sýklýðýnýn grup 1’deki bebeklere göre anlamlý olarak daha fazla olduðu saptandý. Gruplar arasýnda THOP açýsýndan anlamlý farklýlýk bulunmadý. Metabolik kemik hastalýðý geliþimi üzerinde etkisi olabilecek risk faktörlerini içeren multivariate lojistik regresyon analizinde önemini sürdüren risk faktörü saptanmadý. Hastalar THOP varlýðýna göre gruplandýrýldýðýnda, gruplar arasýnda MBD varlýðý ile serum Ca, P ve ALP düzeyleri açýsýndan fark olmadýðý saptandý.
Sonuç: Çalýþmamýz, MBD’nin çok etmenli bir hastalýk olduðunu ve THOP’nin MBD geliþimi için bir risk faktörü olmadýðýný göstermektedir. (SETB-2021-09-270)

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.

Abstract | English Full Text

Amaç: Bu çalýþmanýn amacý, Ýstanbul, Türkiye'de seboreik dermatit (SD) sýklýðýnýn aylara ve mevsimlere göre deðiþimini belirlemek ve SD sýklýðý ile ortalama sýcaklýk (°C), ortalama nem (%), ortalama güneþ ýþýðý süresi ve aylýk güneþ radyasyonu gibi meteorolojik veriler arasýndaki iliþkileri incelemektir.
Yöntemler: Çalýþma Haseki Eðitim ve Araþtýrma Hastanesi Dermatoloji Bölümü'nde gerçekleþtirildi. Haziran 2018 - Mayýs 2020 tarihleri arasýnda dermatoloji polikliniðine baþvuran tüm yetiþkin hastalarýn verileri incelendi. Ayný döneme ait Ýstanbul için aylýk ortalama iklim veri deðerleri TC Tarým ve Orman Bakanlýðý Meteoroloji Genel Müdürlüðü'nden talep edildi.
Bulgular: Çalýþma süresi boyunca, 5316 hastaya SD tanýsý kondu (toplam poliklinik hastalarýnýn%5,9'u). Bunlarýn 2721'i (%51,2) erkek, 2595'i (%48,8) kadýn ve ortalama yaþ 35,9 ± 15,1 yýldý. Aylýk daðýlýmlara göre SD sýklýðý Aralýk'ta %7,3, Þubat’ta %7,1, Kasým'da %6,7, ve Ocak'ta %6,6 iken; Haziran’da %3,8 ve Temmuz’da %3,9 sýklýkta saptanarak tüm aylar içinde en düþük oraný temsil ediyordu. SD sýklýðý ortalama sýcaklýk deðerlerindeki önemli farklýlýða raðmen sonbahar ve kýþ mevsimlerinde benzerdi. SD sýklýðýnýn, sýcaklýk deðerleri ve aylýk maksimum nem deðeri ile güçlü ve ters orantýlý olduðu ve ayný zamanda güneþ radyasyon seviyeleri ile orta derecede korelasyon gösterdiði bulunmuþtur. En düþük veya ortalama nem deðerleri ve güneþ ýþýðý süreleri (günlük ve aylýk), SD sýklýðý ile iliþkili deðildi.
Sonuç: Çalýþmamýz, düþük sýcaklýk, düþük UV indeksi ve düþük nem gibi çevresel faktörlerin SD geliþme olasýlýðýný artýran kritik faktörler olduðunu göstermektedir. Bu veriler, Malassezia türlerinin büyümesini destekleyen iklim koþullarýnda SD sýklýðýnýn artabileceðini göstermesi açýsýndan önceki çalýþmalarý desteklemektedir. (SETB-2021-03-083)

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.

Abstract | English Full Text

Amaç: Cloninger'in psikobiyolojik kiþilik modeline dayalý olarak majör depresif bozukluk (MDB) ile özellikle zarardan kaçýnma, kendini yönetme ve iþ birliði yapma arasýndaki iliþki belirlenmiþ olmakla birlikte, alt boyutlarýn rolü ile ilgili literatürde yeterli çalýþma bulunmamaktadýr. Bu çalýþmanýn amacý MDB'li hastalarla saðlýklý kontrolleri mizaç ve karakter özellikleri ve özellikle alt boyutlarý açýsýndan karþýlaþtýrmak ve böylece Majör Depresyon hastalarýnda mizaç ve karakter alt boyutlarýnýn rolünü ve yordayýcý deðerini belirlemektir.
Yöntem: Kesitsel tipteki bu çalýþmanýn örneklemini araþtýrmaya katýlmayý gönüllü olarak kabul eden 65'i MDB hastasý ve 40'ý saðlýklý kontrol olmak üzere toplam 105 katýlýmcý oluþturmuþtur. Katýlýmcýlara Sosyodemografik Veri Formu, Mizaç ve Karakter Envanteri ve Hamilton Depresyon Derecelendirme Ölçeði uygulanmýþtýr.
Bulgular: MDB hastalarýnda saðlýklý kontrollere kýyasla, daha düþük kendini yönetme (p < 0.001), iþ birliði yapma (p = 0.017), sebat etme (p < 0.001), kendini aþma (p = 0.001), ve daha yüksek zarardan kaçýnma (p < 0.001) puanlarý saptanmýþtýr. Yenilik arayýþý mizaç boyutu ile MDB arasýnda iliþki belirlenmemekle birlikte (p = 0.774), alt ölçek boyutlarýnda deðerlendirildiðinde; Majör Depresyon hastalarýnýn saðlýklý kontrollere kýyasla, "Dürtüsellik" alt ölçek boyutunda daha yüksek (p = 0.013), "Keþfetmekten heyecan duyma" alt ölçek boyutundaysa daha düþük puanlar aldýklarý belirlenmiþtir (p = 0.001). Ödül Baðýmlýlýðý, MDB ile alt ölçek boyutlarý dahil, iliþki kurulamayan tek kiþilik özelliði olarak belirlenmiþtir (p = 0.511). Majör depresyon hastalarýnda mizaç ve karakter alt ölçek boyutlarýnýn yordayýcýlýðýný belirlemek için gerçekleþtirilen lojistik regresyon analizi sonucunda, sadece üç mizaç ve karakter özelliði: "Çabuk Yorulma, Amaçlýlýk ve Manevi Kabullenme" anlamlý yordayýcýlar olarak belirlenmiþtir (p < 0.001). "Çabuk Yorulma", MDB olma olasýlýðýný 3,6 kat arttýran ciddi bir risk faktörü olarak belirlenirken; "Amaçlýlýk ve Manevi Kabullenme" ise birlikte, MDB olma olasýlýðýný 0.8 kat azaltan koruyucu kiþilik özellikleri olarak belirlenmiþtir.
Sonuç: Bu çalýþma, kendini yönetme, iþ birliði yapma, sebat etme ve kendini aþma kiþilik özellikleri düþük profil gösteren, buna karþýn zarardan kaçýnma kiþilik özelliði belirgin olan bireylerde MDB geliþme riskinin arttýðýný göstermektedir. Özellikle çalýþmamýzda belirlenen "Çabuk Yorulma, Amaçlýlýk ve Manevi Kabullenme" mizaç ve karakter özellikleri dikkate alýnarak yapýlacak terapötik müdahaleler, MDB tedavi sonuçlarýna olumlu katkýda bulunabilir. (SETB-2021-09-273)

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.

Abstract | English Full Text

Amaç: Neovasküler ve erken non-neovasküler tip yaþa baðlý makula dejenerasyonu (YBMD) olan hastalarda optik koherens tomografi anjiyografi (OKTA) ölçümlerinin farklýlýklarýný belirlemek.
Yöntemler: Bu retrospektif olarak tasarlanmýþ çalýþma, neovasküler (N-YBMD grubu) ve non-neovasküler erken YBMD (NN-YBMD grubu) olan hastalarý içermekteydi. Hastalarýn en iyi düzeltilmiþ görme keskinliði (EÝDGK, ondalýk olarak), göz içi basýncý (GÝB, mmHg), koroidal kan akýmý (au) ve retina damar yoðunluðu (VD, %) gibi OKTA ölçümlerini içeren tam bir göz muayenesi yapýldý.
Bulgular: N-YBMD grubu (1.46±0.28 au) NN-YBMD grubuna (1.73±0.32 au) göre daha düþük ortalama koroidal akým ölçümüne sahipti (p<0.001). N-YBMD grubundaki hastalar, NN-YBMD grubuna kýyasla tüm yüzeysel ve derin retina katmanlarýnda azalmýþ VD ölçümlerine sahipti. Ancak, N-YBMD ve NN-YBMD gruplarý karþýlaþtýrýldýðýnda, VD ölçümlerinde sadece toplam yüzeysel parafoveada ve yüzeysel parafoveanýn üst ve alt kadranlarýnda önemli farklýlýklar gözlendi (tümü için p<0.05). Hemen hemen tüm derin retinal VD ölçümleri (bunlar için p<0.05), toplam ve foveal zonlar dýþýnda N-YBMD grubunda önemli ölçüde farklýydý (sýrasýyla p=0.144 ve p=0.433).
Sonuç: NN-YBMD ile karþýlaþtýrýldýðýnda N-YBMD’li hastalarda retinal VD azaldý, ancak VD anti-VEGF tedavisinden etkilenmedi, bu da YBMD patogenezinde retinal damarlarýn etkisini öne sunar. (SETB-2021-07-230)

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.

Abstract | English Full Text

Amaç: Manyetik Rezonans görüntüleme (MRG), karaciðer fibrozisi tanýsýnda en etkili görüntüleme yöntemi olarak tanýmlansa da, bunun için kabul görmüþ bir MR tekniði henüz tanýmlanmamýþtýr. Bu çalýþmanýn amacý, karaciðer fibrozisinin evrelemesinde MRG'nin etkinliðini belirlemektir.
Gereç ve Yöntem: Kronik hepatit B enfeksiyonu nedeni ile takipli olan hastalar arasýndan hastane veri tabanýnda hepatosit spesifik kontrast madde ile çekilmiþ üst batýn MRG'si olan hastalar seçildi. Bunlarýn arasýndan karaciðer biyopsisi yapýlmýþ olan 29 hasta çalýþmaya dahil edildi. Karaciðer parankiminin görünür difüzyon katsayýsý (ADC), fraksiyonel anizotropi (FA) ve sinyal intensite deðerleri iki gözlemci tarafýndan ölçüldü ve kontrastlanma indeksi hesaplandý. Hastalar histopatolojik Ishak derecelendirme sistemine göre erken (A) ve geç evre fibrozis (B) olarak gruplandýrýldý ve daha sonra fibrozis evresi ile MR parametreleri arasýndaki korelasyon analiz edildi. Gözlemciler arasý uyumu analiz etmek için intraklas korelasyon katsayýsý kullanýldý. ADC, FA ve kontrastlanma indeksi erken ve geç fibrozis gruplarý arasýnda Student-t testi ile karþýlaþtýrýldý. ADC ve FA deðerleri arasýndaki korelasyonu deðerlendirmek için Pearson, patolojik fibrozis evresi ile ölçülen MR parametreleri arasýndaki iliþkiyi deðerlendirmek için ise Spearman korelasyonu kullanýldý.

Bulgular: 22 hasta evre 1 ve 2 (grup A), 7 hasta evre 3 ve üzeri fibrozis (grup B) olarak evrelendirildi. Ýstatistiksel olarak, FA deðerleri ile fibroz derecesi arasýnda güçlü, negatif bir korelasyon vardý (r = -0.582, p = 0.001). Kontrastlanma indeksi ile hepatosit aktivite indeksi (r = -0.88, p = 0.655) ve fibrozis derecesi (r = 0.0001, p = 0.997) arasýnda korelasyon yoktu. FA deðerleri açýsýndan erken ve geç evre fibrozis gruplarý arasýnda istatistiksel olarak anlamlý fark vardý (grup A = 0.429 ± 0.06, grup B = 0.349 ± 0.06)(p = 0.004).
Sonuçlar: FA deðerlerinin fibrozis evresi ile korelasyonu ve erken-geç evre fibrozis hastalarý arasýnda FA deðerleri açýsýndan anlamlý fark bulunmasý; difüzyon tensör görüntülemenin karaciðer fibrozisinin evreleme ve takibinde umut verici bir teknik olabileceðini göstermektedir. (SETB-2021-08-246)

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 ýmaging (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.

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Amaç: Meme kanser (MK) risk faktörleri ve mammografik dansite (MD) paterni arasýndaki iliþki açýk olmamasýna raðmen, yüksek MD’nin MK için baðýmsýz bir risk faktörü olduðu bilinmektedir. Bu çalýþmanýn amacý, MK hastalarýnda MD ile MK risk faktörleri ve tümör özellikleri arasýndaki iliþkiyi araþtýrmaktýr.
Gereç ve Yöntem: Çalýþmya 242 MK’li hasta dahil edildi. MD dansite yüzdelerine göre (tip I—<25%; tip II—25%–50%; tip III—51%–75%; tip IV—>75%) kategorize edildi, ve MD’ye ait bu gruplar arasýnda meme kanseri için kullanýlan risk faktörleri ve hastalarýn tümör özellikleri karþýlaþtýrýldý.
Bulgular: Bu çalýþmanýn sonucunda, meme kanseri hastalarýnda artmýþ MD yüzdeleri ile genç yaþ, premenapozal durum, erken menarþ yaþý, doðum yapmamýþ olmak, düþük vücut kitle indeksi ve sigara kullanýmý arasýndaki iliþki anlamlý bulunmuþtur (p<0.001, p<0.001, p=0.04, p<0.001, p=0.003, p=0.01, respectively). Ayrýca, tümör subtiplerine göre MD yüzdelerinin daðýlýmý da anlamlý olarak farklýlýk göstermektedir. Tip 4 mammografik dansite de Her 2 tip tümör görülme sýklýðý anlamlý olarak yüksektir (p=0.01).
Sonuç: Yüksek MD, meme kanseri hastalarýnda reprodüktif risk faktörleri ve özellikle Her2 tip tümörle iliþkilidir. Meme kanseri hastalarýnda, MD ile iliþkili faktörleri saptamak için daha kapsamlý çalýþmalar gerekmektedir. (SETB-2020-12-249)

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.

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Amaç: Tiroid uyarýcý hormon (TSH), diferansiye tiroid kanseri riski ile iliþkilidir. Preoperatif TSH seviyeleri ile agresif özellikler arasýndaki iliþki ise henüz belirsizdir. Bu çalýþmamýzda papiller tiroid karsinomunun (PTC) patolojik özellikleri ile yüksek TSH düzeyleri arasýndaki iliþkiyi deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: 2012-2017 yýllarý arasýnda opere edilen ve patolojisinde PTK saptanan hastalar çalýþmaya dahil edildi. Hastalarda TSH ile tümörün agresif patolojik özellikleri arasýndaki iliþki deðerlendirildi.
Bulgular: 132 hastadan; TSH düzeyi lenfovasküler invazyonu olanlarda olmayanlara göre (p=0.048), santral metastazý olanlarda olmayanlara göre (p=0.014) ve ekstratiroidal yayýlýmý olanlarda olmayanlara göre (p=0.003) anlamlý olarak yüksekti. Hastalar TSH (mUI/mL) düzeyine göre %25'lik dört kartile ayrýldýðýnda; TSH düzeyi arttýkça ekstratiroidal invazyon oraný arttý ve TSH düzeyi diðer gruplarda 1. kartilden anlamlý olarak daha yüksekti (p=0.030).
Sonuç: TSH düzeyindeki preoperatif artýþ, artmýþ ekstratiroidal yayýlma ve santral lenf nodu metastazý riski ile iliþkilidir. TSH düzeyi, hastalarýn santral metastaz riski için preoperatif deðerli bir prediktif faktör olabilir. (SETB-2021-12-381)

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.

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Amaç: Bu çalýþmada, D vitamini (vit D) eksikliðinin papiller tiroid kanserinin (PTC) agresifliði üzerindeki etkilerini araþtýrdýk.
Gereç ve Yöntem: 2012-2017 yýllarý arasýnda tek cerrah tarafýndan opere edilen patolojik inceleme ile PTK saptanan hastalar çalýþmaya dahil edildi. Hastalarýn verileri retrospektif olarak incelendi. PTC dýþýndaki kanserler, hipertiroidi olan ve/veya antitiroid ilaç kullanan hastalar çalýþma dýþý býrakýldý. Hastalar serum vit D düzeylerine göre dört çeyrek; kategori 1 (<7.1 ng/mL), kategori 2 (7.2-11.8 ng/mL), kategori 3 (11.9-23.4 ng/mL) ve kategori 4 (> 23.5 ng/mL).
Bulgular: Çalýþmaya yaþ ortalamasý 46.4+13.6 (17-82) yýl olan toplam 133 hasta (103 kadýn, 30 erkek) dahil edildi. Deðerlendirilen tümör agresiflik özelliklerine göre ameliyat öncesi vit D deðerleri açýsýndan kategoriler arasýnda anlamlý fark yoktu. 1 cm'den büyük tümör ve T3/4 tümör varlýðýnýn vit D düzeyinden etkilenmediði belirlendi. Çok merkezlilik, lenfovasküler invazyon, santral ve lateral metastazlar gibi agresiflik özellikleri açýsýndan vit D kategorileri arasýnda anlamlý bir fark yoktu.
Sonuç: Sonuçlarýmýza göre serum vit D düzeyleri PTC'nin agresif tümör özellikleri ile iliþkili deðildir. (SETB-2022-01-022)

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.

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AMAÇ: Mide kanserlerinde nomogramlar ve skorlama sistemleri temel olarak yeterli lenf nodu diseksiyonu yapýlmasýna dayalý olarak geliþtirilmiþtir. Bu çalýþma, yetersiz sayýda incelenen lenf nodu (eLN) olan mide kanseri hastalarýnda genel saðkalýmý (OS) tahmin etmek için geliþtirilmiþ bir nomogramýn harici doðrulamasýný gerçekleþtirmeyi ve 8. Amerikan Ortak Kanser Komitesi (AJCC)’nin Tümör-Lenf Nodu-Metastaz (TNM) evreleme sistemi ile karþýlaþtýrarak kullanýlabilirliðini deðerlendirmeyi amaçladý.
YÖNTEMLER: Mide kanseri nedeniyle tam cerrahi rezeksiyon uygulanan ve tanýsý patolojik olarak doðrulanmýþ 262 hastanýn týbbi kayýtlarý geriye dönük olarak incelendi. Çalýþmaya yetersiz sayýda eLN (<16) olan 104 hasta (%39.7) (82 erkek, medyan yaþ, 60,3 yýl) dahil edildi. 5 yýllýk OS oraný, nomogram kullanýlarak ve AJCC sistemine göre hesaplandý.
BULGULAR: Medyan takip süresi 37.4 aydý (0.9-122.9). Takip süresi içinde hastalarýn 69'u (%66,3) öldü ve 35'i (%33,7) 5 yýllýk sað kalým saðladý. Nomogram ve AJCC sistemi tarafýndan öngörülen OS, ölen hastalarda 5 yýllýk saðkalýma ulaþanlara göre anlamlý derecede daha düþüktü (her ikisi için p<0,001). ROC eðrisine göre, nomogram (0.801; %95 GA, 0.715-0.887; p<0.001) için eðri altýnda kalan alan (AUC) AJCC sistemine göre daha yüksekti (0.754; %95 GA, 0.659- 0.849; p<0.001).
SONUÇ: Yetersiz sayýda eLN (<16) olan mide kanseri hastalarý için geliþtirilen nomogram, kohortumuzda 5 yýllýk OS'yi öngörmede etkiliydi ve AJCC sisteminden daha üstündü. (SETB-2021-08-243)

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.

Abstract | English Full Text

SETB-2022-03-071

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.

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Amaç: Bu çalýþmanýn amacý, sýçanlarda terminal ileal defekt için yama olarak kullanýlan parietal peritonda neomukoza oluþumu üzerine curcumin’in potansiyel etkilerini araþtýrmaktý.
Metod: On altý erkek Wistar-Hanover sýçaný 2 gruba ayrýldý. Kontrol grubu salin ile deney grubu curcumin (2 mL/kg/gün, gavaj yoluyla) ile tedavi edildi. Her iki grupta da serumda 8-hidroksi-2'-deoksiguanozin (8-OHdG) ve malondialdehit (MDA) miktarlarý, süperoksit dismutaz ve glutatyon peroksidaz enzim aktiviteleri belirlendi. Neomukoza oluþumunun geliþimi morfolojik olarak incelendi.
Bulgular: Curcumin verilen sýçanlarda serum antioksidan düzeyleri ve glutatyon peroksidaz aktivitesi, kontrol grubuna göre anlamlý derecede yüksekti (p<0,05). Curcumin verilen sýçanlarda oluþan oksidatif hasarýn (MDA ve 8-OHdG), kontrol grubuna göre anlamlý derecede düþük olduðu gözlendi (p<0,05). Histopatolojik incelemede curcumin verilen grupta sýçanlarýn %62,5’inde ve control sýçanlarýnýn ise %37,5’inde neomukoza oluþumu görüldü.
Tartýþma: Terminal ileal defekti olan ratlarda curcumin kullanýmý oksidasyon seviyesini azaltarak ve antioksidasyon seviyesini artýrarak neomukoza oluþumunu arttýrmaktadýr. Kýsa barsak sendromlu hastalarda emilim yüzey alanýný arttýrmak için curcumin kullanýlabilir. (SETB-2021-11-334)

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.

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Otozomal resesif osteopetrozis, infantil malign osteopetrozis (IMO) olarak da bilinir. Genellikle aðýr bir klinik gidiþ gösterir ve tedavi edilmezse hayatýn ilk yýllarýnda ölümle sonuçlanýr. Taný koymak zordur ve genellikle yanlýþ taný konulur ya da taný konulmasý gecikir. Burada hipotonisite ve trombositopeni nedeni ile tetkik edilirken IMO tanýsý konulan ve CLCN7 geninde yeni bir mutasyon saptanan olguyu sunmak istiyoruz. On günlük kýz hasta hipotonisite nedeni ile tetkik amaçlý hastanemize gönderildi. Fizik muayenesi hipotonisite dýþýnda normaldi. Tetkiklerinde trombositopeni ve hipokalsemi saptandý. Klinik izleminde 3 aylýkken hepatosplenomegalisi fark edildi. Direk kemik grafileri IMO ile uyumluydu. Moleküler incelemede CLCN7 geninde yeni bir homozigot c.1504>T (p.Arg502Trp) mutasyonu saptandý. IMO nadir görülen bir hastalýktýr ve daha iyi klinik sonuçlar elde etmek için hastalýðýn farkýna varýp erken taný konulmasý önemlidir. Nörolojik ve hematolojik bulgular, organomegali, iþitme kaybý ve görme bozukluklarý IMO’yu düþündürmelidir. (SETB-2021-03-093)

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.

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