ISSN : 1302-7123 | E-ISSN : 1308-5123
The Medical Bulletin of Sisli Etfal Hospital - Med Bull Sisli Etfal Hosp: 58 (1)
Volume: 58  Issue: 1 - 2024
EDITORIAL
1. Front Matter

Pages I - IX

REVIEW ARTICLE
2. Impact of Living Donor Liver Transplantation on the Improvement of Hepatocellular Carcinoma Treatment
Yucel Yankol, Oswaldo Aguirre, Luis A. Fernandez
PMID: 38808046  PMCID: PMC11128703  doi: 10.14744/SEMB.2024.87864  Pages 1 - 9
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths, with increasing incidence. There are different treatment options, but only 30%-40% of HCC cases are diagnosed at an early stage for curative treatment. With the implementation of Milan Criteria for liver transplantation (LT) in HCC cases and its use for organ allocation with successful outcomes, LT has become an optimal treatment. Seeking new criteria for LT and developing updated algorithms for HCC treatment has become a hot topic nowadays. With the experience in living donor liver transplantation (LDLT), especially in Asian countries, LDLT was established and adopted with different criteria for HCC treatment, especially including criteria beyond Milan's size and number of tumors. Living donor grafts are uniquely different than deceased donor grafts as they are not considered a public resource. A living donor graft is rather a private gift intended for a specific recipient. Living donor livers are not limited by organ allocation systems, and this significant advantage of LDLT has opened new frontiers in the treatment of HCC. Improvements in LDLT have had remark-able parallel effects in the successful treatment of HCC as supported by a growing body of literature in the past decade.

ORIGINAL RESEARCH
3. Comparison of Surgical Results of Modified Stoppa and Ilioinguinal Approach in Patients with Acetabular Fractures Involving Quadrilateral Surface Fractures
Sezgin Bahadir Tekin, Burcin Karsli, Erman Ogumsogutlu, Bahri Bozgeyik, Cagri Karabulut
PMID: 38808040  PMCID: PMC11128694  doi: 10.14744/SEMB.2023.64280  Pages 10 - 16
Objectives: The aim of this study was to evaluate the results of surgical treatment in patients with acetabular fractures with a fractured quadrilateral surface treated using two different approaches.
Methods: The study included 106 patients who were operated on with ilioinguinal (group A) or modified Stoppa (group B) technique for acetabular fracture with a fractured quadrilateral surface between 2011 and 2020 in our clinic. The quality of reduction was evaluated according to Matta criteria and postoperative pelvic (anteroposterior, external oblique, iliac oblique) radiographs. Evaluation of hip function was recorded using the Merle d'aubigne and Postel Score and Harris Hip Score.
Results: Among the patients included in the study, there were 45 patients in group A and 61 patients in group B. When the group data were compared, it was seen that the modified Stoppa approach was superior in terms of intraoperative reduction quality, radiological data, Harris hip score, Merle d'aubigne and PostelScore. (Respectively p=0.40, p=0.49, p=0.040, p=0.028). Conclusion: Modified Stoppa approach has successful clinical and radiological outcomes and better reduction quality and hip scores than ilioinguinal approaches in acetabular fractures involving quadrilateral plates.

4. Factors Affecting Success Rates in Endoscopic Repair of CSF Rhinorrhea
Senem Kurt Dizdar, Egehan Salepci, Alican Coktur, Nurullah Seyhun, Bilge Turk, Suat Turgut
PMID: 38808048  PMCID: PMC11128705  doi: 10.14744/SEMB.2023.35589  Pages 17 - 22
Objectives: Our aim in this study is to assess the effect of factors such as age, etiology, defect size, application of lumbar drainage and surgical technique on Cerebrospinal Fluid (CSF) fistula repair success rates.
Methods: The Electronic Medical Records (EMR) system of our clinic was retrospectively reviewed for cases that were operated between 2006 and 2020 for CSF fistula originating from anterior skull base with endoscopic transnasal technique. A total of 35 patients were included in the study. Patients were grouped according to the number of layers used in repair (two, three or four-layered reconstruction) and defect size (smaller than 5 mm, 5 to 10 mm and larger than 10mm), etiology, location of the defect and application of lumbar drainage as LD (+) and LD (-). Complications and CSF leak recurrence were compared between groups. Results: Recurrence rates in patients who had 2 layered reconstructions were significantly higher compared to patients who had 3 or 4 layered reconstructions (p=0.049). The recurrence rate in LD (+) group (41.7%) was significantly lower compared to LD (-) group (4.3%) (p=0.012). There were no significant difference in recurrence rates between groups in terms of age, defect size, defect location and etiology.
Conclusion: In endoscopic transnasal repair of anterior skull base-derived bos fistulas, planning the reconstruction at least 3 times and applying lumbar CSF drainage increases the success rates.

5. Comparison of the Early Results of Supra-Annular and Intra-Annular Aortic Valve Replacement in Isolated Aortic Valve Replacement
Osman Fehmi Beyazal, Tanzer Tokatlioglu, Veysel Basar, Ahmet Zengin, Mehmed Yanartas
PMID: 38808047  PMCID: PMC11128707  doi: 10.14744/SEMB.2024.39112  Pages 23 - 29
Objectives: This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.
Methods: Between 2013 and 2019, 113 patients (77 males; mean age 57.8±16.36 years) who underwent isolated AVR were evaluated. The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR. The most commonly used valves in surgeries St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%).
Results: The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR. However, there was no significant difference between the two groups in terms of postoperative adverse events. There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings.
Conclusion: When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions. Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features. However, this issue needs to be investigated in future prospective studies with more patients.

6. Comparative Analysis of FSE T2 Weighted, Chemical Shift and Dynamic Contrast-Enhanced MR Imaging in the Characterization of Adrenal Masses Based on Qualitative and Quantitative Parameters
Ahmet Mesrur Halefoglu, Bade Von Bodelschwingh, Yuksel Altuntas, Bahar Memis
PMID: 38808044  PMCID: PMC11128695  doi: 10.14744/SEMB.2023.02328  Pages 30 - 44
Objectives: The purpose of our study was to investigate the role of different magnetic resonance imaging (MRI) parameters in the characterization of adrenal masses.
Methods: A total of 150 patients who presented with 186 adrenal tumors were retrospectively evaluated in this study. Final patient cohort consisted of 17 pheochromocytomas, 3 adrenocortical carcinomas, 24 metastases, 31 lipid-poor adenomas and 111 lipid-rich adenomas. We carried out a visual assessment on FSE (Fast spin echo)T2 weighted images and also calculated T2 signal intensity ratio of all adrenal masses and also performed a qualitative assessment on chemical shift imaging (CSI) together with quantitative calculation using Adrenal to spleen signal intensity (si) ratio and Adrenal si index formulas. On dynamic contrast-enhanced sequences, visual assessment based on enhancement patterns on late-arterial phase images was performed and also mean signal intensity measurements were carried out. All examinations were interpreted by two abdominal radiologists in consensus who were blinded to the clinical and pathological findings. Statistical analysis was performed.
Results: On FSE T2 weighted imaging, isointense to liver and slightly hyperintense than liver was found higher in benign cases, however, in malignant cases moderately and strikingly hyperintense than liver was higher than in benign cases (p=0.001, p<0.01). There was a statistically significant difference between the T2 signal intensity ratio values of adrenal tumor groups (p=0.001, p<0.01). In lipid-rich and lipid-poor adenoma groups, T2 signal intensity ratio values was significantly lower than in pheochromo-cytoma and metastasis cases. In malignant group, T2 signal intensity ratio values were found statistically significantly higher than in the benign group (p=0.001, p<0.01). There was a statistically significant difference between CSI visual assessment of adrenal tumor groups (p=0.001, p<0.01). Although moderate and significant signal intensity loss was usually detected in lipid-rich adenoma group, never detected in other tumor groups. There was also a statistically significant difference between benign and malignant adrenal tumor groups (p=0.001, p<0.01). In the malignant group, Adrenal to spleen si ratio values were found significantly higher whereas, Adrenal si index values were significantly lower compared to benign tumors (p=0.001, p<0.01). Based on malignancy, there was a statistically significant difference between adrenal tumor groups (p=0.001, p<0.01). Although capillary blush and homogenous type enhancement were more common in benign cases than in malignant ones, peripheral-patchy and strikingly capillary blush type enhancement was more frequent in malignant tumors. Based on malignancy, mean arterial signal intensity values of malignant tumors were statistically higher than benign tumors (p=0.001; p<0.01).
Conclusion: Dynamic contrast-enhanced MRI protocol including CSI aids in the characterization of indeterminate adrenal masses. Herein, the combined use of qualitative and quantitative parameters enables more tumors to be recognized that otherwise would be indeterminate.

7. Vestibulo-Ocular Reflex in the Aging Population
Basak Mutlu, Sidika Cesur, Ahmet Mutlu, Mahmut Tayyar Kalcioglu
PMID: 38808050  PMCID: PMC11128693  doi: 10.14744/SEMB.2023.31967  Pages 45 - 54
Objectives: The aim of this study was to evaluate vestibulo-ocular reflex (VOR) of individuals over 60 years of age who have not been diagnosed with a specific vestibular pathology.
Methods: Bilateral six-semicircular canal video head impulse test (vHIT), Dizziness Handicap Inventory and European Evaluation of Vertigo scales were applied to participants.
Results: In total, 103 participants were included in the study (75 male, 28 female), and the mean age was 69.35 ± 7.41 years. The mean age of 7th decade group was 64.32±3.12 (59 participants; 38 male, 21 female), and the mean age of 8th decade and older group was 76.11±5.93 (44 participants; 37 male, 7 female). No significant differences were found between the VOR gains of the lateral or vertical semicircular canals between the 7th decade and 8th decade and older groups (p>0.05). In the 8th decade and older group, the presence of right lateral semicircular canal corrective saccade and left posterior semicircular canal corrective saccade showed a positively moderate correlation with VOR gains of the same semicircular canals (r=0.455, p=0.002, and r=0.518, p=0.001, respectively). No significant correlation was found between age and VOR gain in the 7th decade group, however, there was a negatively weak correlation between age and left lateral semicircular canal VOR gain (r=-0.366, p=0.017) in the 8th decade and older group.
Conclusion: While assessing the age-related changes in VOR using vHIT, it must be considered that the changes related to aging of the vestibular system begin to emerge in the population over 70 years of age, and corrective saccade findings may be more informative than VOR gains in revealing these changes.

8. Predictive Value of Nutrition and Inflammation-Related Indices on Prognosis in Type 2 Diabetes Mellitus Patients with Coronavirus Disease-2019
Adnan Batman, Mustafa Ekici, Tugba Sanalp Menekse, Rafiye Ciftciler, Dilek Yazici
PMID: 38808055  PMCID: PMC11128691  doi: 10.14744/SEMB.2023.36699  Pages 55 - 61
Objectives: This study aimed to demonstrate how the prognostic nutritional index (PNI) and systemic immune-inflammatory index (SII) help predict the severity and prognosis of patients with type 2 diabetes (T2DM) and coronavirus disease (COVID-19). Methods: This retrospective cohort study included 501 T2DM patients (male, 42.1%; female, 57.9%) who were hospitalized due to COVID-19 between April 2020 and December 2020. The patients were divided into survivors and non-survivors. After comparing demographic and laboratory data between the groups, the correlation of PNI and SII with clinical and laboratory data was evaluated. Results: The median (interquartile) ages of the non-survivor and survivor groups were 74 (15) and 69 (14) years, respectively, and the difference was significant (p<0.001). The PNI was significantly lower in the non-survivor group than in the survivor group (p<0.001). The SII was significantly higher in the non-survivor group than in the survivor group (p<0.001). PNI was negatively correlated with glucose levels (r=-0.115, p=0.011). If the cut-off PNI value of 29.1 was used, it had a sensitivity and specificity of 76.2% and 76.3%, respectively, in predicting the severity of the illness and the risk of death in T2DM patients.
Conclusion: Consequently, the PNI and SII levels are effective in predicting survival and disease severity in patients with COVID-19 and T2DM.

9. Turkish Validity and Reliability of Comprehensive Diabetes Self-Management Scale
Cigdem Cindoglu, Burcu Beyazgul, Merve Tatligun
PMID: 38808051  PMCID: PMC11128708  doi: 10.14744/SEMB.2023.70033  Pages 62 - 67
Objectives: A self-care approach is very important in diabetes management. In this study, it was aimed to make the Turkish validity and reliability of the Comprehensive Diabetes Self-Management Scale (CDSMS), which examines the behaviors of diabetes patients. Methods: The study is of methodological type. CDSMS, which was translated into Turkish from its original version and tested for language validity, was first included in the pilot application and then in the main study. The validity of the scale was evaluated by the Cronbach's alpha coefficient. Then, a Receiver Operating Characteristic (ROC) analysis was performed to determine the cut off score. Results: The mean age of the study participants was 57.10 ± 11.20 years and the mean disease duration was 9.96 ± 7.79 years. The internal consistency of CDSMS was 0.73, which was measured using Cronbach's alpha. After the ROC analysis, the optimal cut-point score of CDSMS to predict good glycemic control was determined as 21.17 points.
Conclusion: With this study, it was found that the Turkish version of CDSMS is valid and reliable for use in the Turkish population. It is thought that CDSMS will be beneficial to physicians working in the clinic in terms of showing the disease management skills of diabetic patients.

10. The Impact of Combination of Aerobic and Resistive Exercise on Activities of Daily Living and Risk of Fall in Osteosarcopenic Patients
Selda Ciftci Inceoglu, Aylin Ayyildiz, Tulay Sahin, Figen Yilmaz, Kudret Keskin, Banu Dede, Fatma Cici, Banu Kuran
PMID: 38808053  PMCID: PMC11128704  doi: 10.14744/SEMB.2024.56898  Pages 68 - 74
Objectives: It is aimed to explain the impact of the combination of aerobic and resistive exercise on activities of daily living and the risk of falls in osteosarcopenic patients.
Methods: Female and male patients over 70 years of age followed up from the osteoporosis outpatient clinic were screened. Appropriate patients were evaluated for sarcopenia gait speed, grip strength and skeletal muscle mass. Patients with sarcopenia who did not have the exclusion criteria were included in the 3-month aerobic and resistive exercise program. Changes in skeletal muscle mass measurements, physical performance and balance tests were evaluated at 1 month and 3 months.
Results: Sarcopenia was screened in 91 patients with osteoporosis and osteopenia. Sarcopenia was detected in 27 patients and 23 completed the 3-month study. The mean age of the patients was 78.4±5.7 years and the number of female patients was 16 (69.6%). There was no significant change in skeletal muscle mass measurements and Katz Activities of Daily Living Scale performed at 1 and 3 months (p>0.05). Short Physical Performance Battery (SPPB), Timed Up and Go Test (TUGT) and Berg Balance Test (BBT) were found to improve significantly in the first month, and it continued to develop in the third month (p<0.05).
Conclusion: Although the combination of aerobic and resistive exercise in osteosarcopenic patients did not lead to a significant increase in skeletal muscle mass, It has a significant effect on physical performance and balance. It can be foreseen that this will increase the independence of the person while reducing the risk of falling.

11. A Novel Score for an Old Enemy: Atherogenic Plasma Index Predicts In-Stent Restenosis among Stable Angina Pectoris Patients
Ozgur Selim Ser, Serhat Sigirci, Kudret Keskin, Gokhan Cetinkal, Betul Balaban Kocas, Hakan Kilci, Yalcin Dalgic, Erol Kalender, Kadriye Kilickesmez
PMID: 38808058  PMCID: PMC11128699  doi: 10.14744/SEMB.2024.40336  Pages 75 - 81
Objectives: Although the association of Atherogenic index of plasma (AIP) with coronary artery disease (CAD) and atherosclerosis is known, the relationship between AIP and in-stent restenosis (ISR) remains unclear. We aimed to investigate the relationship between AIP and ISR in patients with stable angina pectoris (SAP) treated with drug-eluting stent (DES).
Methods: Patients with a history of DES implantation following stable angina were evaluated between January 2015 and November 2019 in this observational and retrospective study. 608 eligible patients were dichotomized into ISR+ (n=241) and ISR- (n=367). ISR was defined as the presence of 50% or greater stenosis. AIP was defined as log [TG/HDL-C].
Results: AIP levels were significantly higher in patients who developed ISR compared with those who did not (0.33 [0.15-0.52] vs 0.06 [-0.08-0.21] respectively, p<0.001). The AUC value of AIP levels for predicting ISR was 0.746 (p<0.001). Multivariate logistic regression analysis revealed that AIP, diabetes mellitus, higher LDL-C levels and lower LVEF values were independently associated with ISR. Conclusion: Multivariate analysis revealed that AIP was strongly independently associated with ISR. Using this novel inexpensive and easily calculable index may provide early recognition of ISR in patients with SAP who were treated with DES.

12. One Virus, Two Diseases: Evaluation of Clinical and Immunological Differences in Covid-19 and Multisystem Inflammatory Syndrome Cases
Sefika Ilknur Kokcu Karadag, Emine Hafize Erdeniz, Esra Ozkan, Alisan Yildiran
PMID: 38808056  PMCID: PMC11128702  doi: 10.14744/SEMB.2023.23316  Pages 82 - 90
Objectives: This study aims to uncover early detection markers through the immunological analysis of children diagnosed with multisystem inflammatory syndrome (MIS-C) and coronavirus disease-2019 (COVID-19).
Methods: We retrospectively analyzed immunological data from thirty-three MIS-C patients and an equivalent number of patients under the age of 18 with a positive polymerase chain reaction (PCR) test for COVID-19. These individuals were admitted to Ondokuz Mayis University between November 2020 and February 2021. In total, the study group consisted of 66 patients and an additional 10 healthy controls.
Results: Lymphopenia, thrombocytopenia, anemia, and neutrophilia, along with elevated levels of ferritin, D-dimer, and C-reactive protein, were more pronounced in MIS-C patients (p<0.001). No significant disparities were found in serum IgG, A, M, and E concen-trations. Notably, there was an increased proportion of B cells (p<0.001), an inversion of the CD4/CD8 ratio, and a marked presence of CD3+CD38+HLA-DR+active T cells (p=0.009) in the MIS-C cohort.
Conclusion: In the early diagnosis of MIS-C, lymphopenia, increase in B cells, reversal of CD4/CD8 ratio, and demonstration of CD3+CD38+HLA-DR+active T cells may be helpful.

13. The Effect of Frequency of Sexual Intercourse on Symptoms in Women with Fibromyalgia
Savas Karpuz, Ramazan Yilmaz, Emine Akdere, Behiye Aksanyar, Ismail Hakki Tuncez, Halim Yilmaz
PMID: 38808045  PMCID: PMC11128690  doi: 10.14744/SEMB.2023.97254  Pages 91 - 96
Objectives: Fibromyalgia is known to affect sexual function, but the effect of frequency of sexual intercourse on fibromyalgia symptom severity is unclear. This study investigated how frequently women with fibromyalgia engaged in sexual activity affected how severe the disease was.
Methods: The depression status of the participants was evaluated with the Beck Depression Inventory (BDI) and the mean monthly frequency of sexual intercourse in the last 3 months was noted. Pain levels of fibromyalgia patients were evaluated with Visual Analog Scale (VAS), pain prevalence Widespread Pain Index (WPI), symptom level Symptom Severity Scale (SSS), and fibromyalgia exposure status with Fibromyalgia Impact Questionnaire (FIQ).
Results: A hundred women with fibromyalgia with a mean age of 37.11±6.2 years and 100 healthy female controls with a mean age of 36.53 ± 5.85 years participated in the study. Female patients with fibromyalgia had higher BDI and VAS scores and lower frequency of sexual intercourse (p<0.001). While no significant relationship was observed between the frequency of sexual intercourse and VAS, FIQ, SSS and WPI scores, it was found that BDI was lower in those with an average monthly frequency of 8 or more sexual intercourses (p=0.02).
Conclusion: This study revealed that the frequency of sexual intercourse is low in female patients with FM and that depression is less common in women with FM who have a higher frequency of sexual intercourse.

14. Evaluation of Etiological Causes and Factors Affect Length of Hospitalization in Neonates Hospitalized with Lower Respiratory Tract Infection
Duygu Besnili Acar, Hasan Avsar, Ali Bulbul
PMID: 38808041  PMCID: PMC11128701  doi: 10.14744/SEMB.2023.77674  Pages 97 - 101
Objectives: This study aims to determine the risk factors by examining the sociodemographic characteristics of infants hospitalized in the neonatal intensive care unit (NICU) due to lower respiratory tract infection (LRTI), to determine the factors that affect the duration of hospitalization, and to determine the underlying microbial factors and evaluate them in the light of the literature. Methods: This study evaluated the data of newborns hospitalized with LTRI between 01 October 2022 and 31 March 2023. Demographic characteristics of the patients detected viral agents, duration of hospitalization and risk factors were recorded in the study form. Babies divided viral LRTI and non-viral LRTI, and then compared with each other. Additionally, the facts that might affect the duration of hospitalization were investigated.
Results: The study included 57 babies. Viral agent was detected in 50.9% of the babies, the most frequently viral agent was respiratory syncytial virus (RSV) (48.2%). Other viral factors, in order of frequency; Adenovirus, SARS-CoV-2, Influenza A and B. There is no demographic difference between the viral agent positive and negative groups. The patients were evaluated according to length of hospitalization, it was seen that the hospital stay was longer in babies who were found to be viral positive and needed oxygen therapy (p=0.02, p=0.03, respectively). The male gender ratio was higher in the group with longer hospital stays, but this difference was not statistically significant. Although the rate of exclusive breastfeeding was higher in the group with a short hospitalization period, this difference was not statistically significant (p>0.05).
Conclusion: RSV is currently the most frequently detected viral agent in lower respiratory tract infections in newborns. The hospital stay of babies diagnosed with RSV is longer than those with non-RSV viral agents. So struggling with RSV is important in preventing lower respiratory tract infections in newborns. It is necessary to develop a vaccine or immunoglobulin application against RSV infection not only for preterm babies but also for all newborn babies.

15. Evaluation of the Clinical, Laboratory and Radiology Findings and Treatment Methods of Children with Acute Bronchiolitis: Experience of a Tertiary Center
Cuneyt Ugur, Elif Somuncu, Taha Demirci
PMID: 38808052  PMCID: PMC11128706  doi: 10.14744/SEMB.2023.95605  Pages 102 - 108
Objectives: The aim of this study is to determine the factors affecting the duration of hospitalization and causing the initiation of antibiotics in children with acute bronchiolitis.
Methods: This study was conducted retrospectively in Konya Training and Research Hospital. Demographic data, clinical features, laboratory and radiological findings, treatment methods and duration of hospitalization of 102 patients followed up in the pediatric service between September 2017 and April 2019 (in autumn, winter and spring seasons) were recorded from patient files. Results: 67 (65.7%) of 102 patients were male, and 35 (34.3%) were female. Median age was 6.5 (11.0) months. According to Wang bronchiolitis clinical scoring, 36 (35.3%) of the patients were mild, 51 (50.0%) were moderate, 15 (14.7%) were severe bronchiolitis The most common agents in polymerase chain reaction (PCR) were respiratory syncytial virus 60 (58.8%), influenza virus 20 (19.6%), rhinovirus 15 (14.7%), bocavirus 15 (14.7%) and parainfluenza virus 12 (11.7%). The median duration of hospitalization was 7.0 (4.0) days. Forty-two (41.2%) of the patients were hospitalized for ≤5 days, and 60 (58.8%) were hospitalized for >5 days. Duration of hospitalization was significantly and positively correlated with crepitant crackles, leukocytosis, neutrophilia, and coinfection with influenza virus (p=0.036, p=0.034, p=0.028, p=0.036, respectively). Duration of hospitalization was significantly and negatively correlated with pH and increased aeration (p=0.002, p=0.003, respectively) Antibiotic initiation was significantly and positively correlated with wheezing, crepitant crackles, leukocytosis, and neutrophilia (p=0.033, p=0.013, p=0.028, p=0.002, respectively). Conclusion: A significant relationship was found between crepitant crackles in physical examination, respiratory acidosis in laboratory, co-infection with influenza virus detected by PCR and hospitalization for more than 5 days. A significant relationship was determined between wheezing or crepitant crackles in physical examination, leukocytosis or neutrophilia in laboratory and the initiation of antibiotic.

16. Retrospective Evaluation of Patients Admitted to the Pediatric Neurology Outpatient Clinic with Headache: Experience of a Tertiary Hospital
İlhan Abidin, Cuneyt Ugur, Mirac Yildirim
PMID: 38808054  PMCID: PMC11128692  doi: 10.14744/SEMB.2023.86244  Pages 109 - 115
Objectives: It was aimed to determine the etiological and clinical features of pediatric patients with headache complaints. Methods: The files of patients who were admitted to the pediatric neurology outpatient clinic with headache were reviewed retrospectively. Patients' age, gender, features of headache, symptoms accompanying headache, available blood tests, brain magnetic resonance (MR) and electroencephalography (EEG) results were recorded.
Results: Of the total 470 patients, aged between 3 and 17 years, 291 (61.9%) were female and 179 (39.1%) were male. The mean age of the patients was 12.38±3.45 years. According to age groups, there were 16 (3.4%) patients under the age of 5, 159 (33.8%) between the ages of 6-11, and 295 (62.8%) patients aged 12-17 years. While 289 (61.5%) patients were diagnosed with primary headache, 122 (26.0%) patients were diagnosed with secondary headache, and headaches of 59 (12.5%) patients could not be classified. The most common primary headaches were tension-type headache (TTN) (n=177, 37.7%) and migraine (n=111, 23.6%). The 86 (70.5%) of the patients with secondary headache were diagnosed with sinusitis. Abnormal neurological examination finding was determined in 8 (1.7%) patients. Brain MR was performed in 439 (93.4%) of all patients and abnormal brain MR findings were detected in 52 (11.8%) patients. EEG was performed in 205 (43.6%) of all patients and abnormal EEG findings were detected in 24 (11.7%) patients.
Conclusion: According to age groups, headache was most common in the 12-17 age group. The most common causes of headache were TTN and migraine, respectively. The most common secondary headache cause was sinusitis. We think that physical and neurological examination still maintains its priority in determining the causes of headache.

17. Knowledge, Attitudes and Practices of Pediatricians About COVID-19 Vaccination to Children
Gizem Kara Elitok, Aybike Koc, Sebnem Apaydin, Busra Tetik Dincer, Ali Bulbul
PMID: 38808043  PMCID: PMC11128709  doi: 10.14744/SEMB.2023.46690  Pages 116 - 123
Objectives: Achieving high vaccination rates is very important in the prevention of the coronavirus disease 2019 (COVID-19) as in other infectious diseases. This study aimed to evaluate pediatricians' knowledge, attitudes and behaviours about COVID-19 vaccination of children.
Methods: Our single-center, descriptive, cross-sectional, prospective study was conducted between September 20, 2022 and November 30, 2022. The sample consisted of 350 physicians who agreed to fill out the questionnaire voluntarily. Participants were asked 21 questions about their sociodemographic data, knowledge about COVID-19 vaccination of children, attitudes and behaviours via Google Forms.
Results: A total of 350 pediatricians, 72.6% of whom were women, participated in our study. 51.4% of the participants were working in a Training and Research Hospital, and 99.1% had received COVID-19 vaccination themselves. While 65.7% (n=230) of pediatricians recommended COVID-19 vaccination for all children, 27.7% (n=97) recommended it only for children in the risk group, and 6.6% (n=23) did not recommend COVID-19 vaccination for children. The most common reasons why pediatricians did not recommend the vaccine to all children were; 56.7% lack of sufficient clinical research on vaccination in children, 50% concerns about the long-term effects of the vaccine, 27.5% vaccine-related side effects. The most risk groups for which participants recommended vaccination were asthma (chronic lung disease) 84.6%, diabetes mellitus 72%, and immunodeficiency 69.7%. 68.9% of pediatricians knew that COVID-19 vaccine was used for children aged 12 years and older in Türkiye, and 60.9% thought that COVID-19 vaccine was safe for children. Those who thought that COVID-19 vaccine was safe for children were more likely to recommend the vaccine to children (p<0.001). When the answers given to the knowledge questions were analyzed, it was found that the knowledge level of those who did not recommend vaccination to children was lower than the others (p<0.001).
Conclusion: In the present study, pediatricians mostly recommend COVID-19 vaccine to children. The vaccine safety and the level of knowledge about COVID-19 vaccine are effective factors in recommending the vaccine. Therefore, we conclude that trainings to be organized for pediatricians about COVID-19 vaccine will increase the rate of recommending COVID-19 vaccine to children.

CASE REPORT
18. A Pediatric Case of Granulomatous Appendicitis Operated Due to Recurrent Abdominal Pain
Hasan Madenci, Cuneyt Ugur, Sabit Dere, Muhammed Burhan Tekin, Meryem Ilkay Eren Karanis
PMID: 38808059  PMCID: PMC11128700  doi: 10.14744/SEMB.2023.03780  Pages 124 - 126
Granulomatous appendicitis (GA) is granulomatous inflammation of the appendix wall. It is generally idiopathic; however, it may also be associated with many diseases such as Crohn’s disease, parasitic infections, tuberculosis, or foreign bodies. An 11-year-old male patient, with a 3-month history of abdominal pain and bilious vomiting, had right lower quadrant abdominal tenderness. His white blood cell count was 8.6 x103/µL. An abdomen ultrasound was considered to show plastron appendicitis and an appendectomy was performed. Microscopically, thickening of the appendix wall with edema, fibrosis and lymphoid infiltration was observed. The patient was evaluated as idiopathic GA since no disease was detected that caused GA. When the appendix has a firm consistency and is difficult to separate from the surrounding tissues, GA should be considered before malignancy, particularly in the pediatric age group. An appendectomy should be performed before deciding on radical surgery.

19. A Rare Presentation of Anthrax: A Pediatric Patient with Palpebral Anthrax
Selime Teleke Kaymaz, Fatma Tugba Cetin, Ozlem Ozgur Gundeslioglu, Fuat Kaplan, Burak Ulas, Altan Atakan Ozcan
PMID: 38808049  PMCID: PMC11128698  doi: 10.14744/SEMB.2023.51261  Pages 127 - 130
Anthrax is a rare zoonotic disease in humans caused by Bacillus anthracis. The most common form of this disease is cutaneous anthrax. Rarely, eye involvement may occur.
In this case, a nine-year-old male patient with anthrax on his left eyelids is presented. From the patient's history, it was learned that a slight papular reaction occurred on the left side of the eye, then the lesion enlarged within three days, and edema developed around the eye. On the fifth day of the patient's preseptal cellulitis diagnosis, progress in eye lesions and necrosis and eschar formation around the eyes were detected, while Bacillus anthracis polymerase chain reaction (PCR) positivity was detected on the fifth day of the patient's complaints. The patient was treated with ciprofloxacin and clindamycin and a clinical response was achieved. Anthrax should be kept in mind in the differential diagnosis of preseptal and orbital cellulitis, especially in patients who have close contact with animals. If palpebral anthrax is not treated effectively on time, it can leave scars on the eyelids and cause permanent deformities and loss of function. Early diagnosis and initiation of antibiotic therapy significantly reduce the occurrence of complications. In this case report, a pediatric case with eyelid anthrax, which is rarely seen in anthrax disease, is presented.

20. Abducens Nerve Palsy in a Patient with COVID-19: A Case Report
Gulten Tata, Sahin Isik, Husrev Diktas, Gencer Genc, Serpil Bulut
PMID: 38808042  PMCID: PMC11128696  doi: 10.14744/SEMB.2023.55491  Pages 131 - 134
Numerous neurological manifestations associated with COVID-19 have been reported. However, abducens nerve palsy (ANP) associated with COVID-19 is very rare and mostly related to accompanying respiratory symptoms. Here we present a 29-year-old woman with unilateral ANP manifesting with diplopia and positive SARS-CoV-2 S antibodies, which were checked later. On admission, she had signs of viral pneumonia in thorax CT without any respiratory symptoms. Her cranial neuroimaging revealed no abnormality. Following treatment with favipiravir 2x1600 mg loading dose and then 2x600mg daily maintenance, dexamethasone 8 mg/day and enoxaparin 6000 IU/day, her CT findings recovered completely whereas her ANP only partially resolved. One week after the end of COVID-19 treatment, she also developed Herpes simplex keratitis which was successfully treated with valacyclovir. It should be kept in mind that isolated abducens nerve palsy may be the only finding of COVID-19 cases without any respiratory symptoms.

21. Endovascular Pipeline Shield Treatment of Iatrogenic Internal Carotid Artery Pseudoaneurysm and Carotid-Cavernous Fistula
Eyup Camurcuoglu, Umut Erdem, Ender Uysal
PMID: 38808057  PMCID: PMC11128697  doi: 10.14744/SEMB.2024.84479  Pages 135 - 137
Pseudoaneurysm (PA) and carotid cavernous fistula (CCF) of the internal carotid artery (ICA) is an uncommon complication of endoscopic endonasal surgery that occurs in 1% of cases. We report on the successful placement of flow-diverting stents (FDS) to ICA pseudoaneurysm and caroticocavernous fistula caused by iatrogenic ICA injury for a pituitary adenoma in a 37-year-old female. After placement of the pipeline shield given a certain time, dual antiplatelet agents (DAPT) and follow-up angiogram verified complete aneurysm obliteration and effective endoluminal reconstruction of the injured vessel. In managing ICA pseudoaneurysms, the placement of flow-diverting stents is a viable vessel-sparing technique.

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