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Erciyes Med J: 41 (1)

Volume: 41  Issue: 1 - 2019

EDITORIAL COMMENTS
1.Osteoporosis: Unawareness or Ignorance?
Kürşad Ünlühızarcı
doi: 10.14744/etd.2019.19005  Pages 1 - 2
Abstract | Full Text PDF

2.Acute and Long-term Effects of Organophosphate Poisoning
Selim Kurtoğlu
doi: 10.14744/etd.2019.36043  Pages 3 - 4
Abstract | Full Text PDF

INVITED REVIEW
3.Current Antiretroviral Therapies and Future Trends in Management of Human Immunodeficiency Virus-1 Infection
Naomi S Bulteel, Clifford Leen
doi: 10.14744/etd.2019.19210  Pages 5 - 11
Earlier initiation of antiretroviral therapy (ART) for human immunodeficiency virus (HIV)-1 infection is associated with reduced HIV-related morbidity and mortality, improved immune recovery, and reduced risk of HIV-1 transmission. Consequently, international guidelines now recommend ART for all HIV-1-infected adults, regardless of CD4 cell count. The shift in guidance has led to concern regarding long-term ART toxicity, and new strategies to limit ART exposure have been proposed. In this review, we will discuss current recommendations for ART and future trends in management including mono- and dual-therapy, new ART formulations, and novel antiretroviral agents.

4.New Way in Cancer Therapy: PD-1 Inhibitors and Hematologic Diseases
Gülşah Akyol, Leylagül Kaynar, Mustafa Çetin
doi: 10.14744/etd.2019.19001  Pages 12 - 17
Programed death-1 (PD-1) is an immune checkpoint pathway used by cancer cells to evade the anti-cancer activity of T cells. If this pathway is active, inhibitory signals create an unresponsive state, bringing about the tumor growth. Nowadays, the PD-1/PD-L1, L2 inhibitor therapy shows a new way of treatment to clinicians who are working with hemato-oncologic cancers. Some diseases, such as classic Hodgkin lymphoma (cHL) and primary mediastinal large-B-cell lymphoma, that express large amounts of programed death-ligand 1(PD-L1), may be a good target of such a therapy. In hematology, the anti-PD-1 therapy is used successfully and safely in cHL. Other studies are limited, or the results are not available yet. Although most of the diseases, except chronic lymphocytic leukemia and multiple myeloma, show meaningful responses, when using these drugs, we must carefully monitor autoimmune and rare, but serious side effects. In this paper, we emphasize the use of PD-1 inhibitors in hematology.

ORIGINAL ARTICLE
5.Characteristics of Mesenchymal Stem Cells Derived From the Apical Papilla of a Supernumerary Tooth Compared to Stem Cells Derived From the Dental Pulp
Zeynep Burçin Gönen, Selami Demirci, Ayşegül Doğan, Ayşegül Sardoğan, Abdullah Ekizer, Alper Alkan, Fikrettin Şahin
doi: 10.14744/etd.2019.62592  Pages 18 - 24
Objective: There are several comparative studies that were conducted to explain the specific properties of oral tissue derived mesenchymal stem cells (MSC). However, apical papilla stem cells derived from supernumerary teeth (ST-APSCs) have not been characterized for their MSC properties yet.
Materials and Methods: In the present study, ST-APSCs were isolated and characterized from a nonsyndromic male patient to evaluate the MSC characteristics. Dental pulp stem cells (DPSCs) and ST-APSCs were isolated and characterized for mesenchymal surface markers. Cells were differentiated into osteo-, chondro-, and adipogenic cell types.
Results: Both cell types expressed the MSC surface markers. When DPSCs and ST-APSCs were cultured in differentiation media promoting transformation to osteo-, chondro-, and adipo-genic lineages, both showed calcium mineralization, chondrogenic mass formation, and lipid accumulation. However, DPSCs derived from a wisdom tooth demonstrated more differentiation potential to osteo- and chondro-genic cell types compared to ST-APSCs.
Conclusion: Overall, ST-APSCs were characterized by their MSC properties and were able to differentiate into three cell lineages. However, they were less potent for osteo- and chondro-genic cell lineage specification compared to DPSCs derived from a wisdom tooth.

6.Point Prevalence Survey of Antimicrobial Prescription and Infection in Pediatric and Neonatal Wards of Two Iranian Teaching Hospitals
Jafar Soltani, Gholamreza Pouladfar, Ann Versporten, Mike Sharland, Herman Goossens, Zahra Jafarpour, Naseh Soleimani
doi: 10.5152/etd.2018.18191  Pages 25 - 32
Objective: Point Prevalence Surveys (PPSs) provide useful data on the patterns of in-hospital antimicrobial prescription. Aiming to identify targets for quality improvement, we evaluated prescribing patterns of antimicrobials in the pediatric and neonatal wards of two tertiary referral centers in Iran.
Materials and Methods: Two PPSs on antimicrobial use in children and neonates hospitalized in the Nemazee teaching hospital in Shiraz (south of Iran) and Besat teaching hospital in Sanandaj (west of Iran) were performed for two consecutive years. We used a validated and standardized method based on the Antibiotic Resistance and Prescribing in European Children project.
Results: Out of a total of 266 and 129 admissions in pediatric and neonatal wards, respectively, 61% of pediatric inpatients and 71% of neonates received at least one antimicrobial. The most frequently prescribed antibiotics in pediatric wards were ceftriaxone (29.2%) and vancomycin (15%), and in neonatal wards, ampicillin (34.7%) and cefotaxime (14.7%). Antimicrobial combination therapies and the parenteral route of administration in pediatric wards were 40% and 91.3%, and in neonatal wards, 63% and 100%, respectively. Empirical antibiotic therapies in pediatric and neonatal wards were 93.6% and 96%, respectively.
Conclusion: The high percentage of antimicrobial use, combination therapies, and empirical therapies could be the targets for quality improvement in our hospitals.

7.Effects of Organophosphate Poisoning on the Endocrine System in the Long Term: A Pilot Study
Zuhal Özer Şimşek, Mustafa Sevim, Yasin Şimşek, Murat Sungur, Kürşat Gündoğan, Muhammet Güven
doi: 10.14744/etd.2019.19122  Pages 33 - 36
Objective: Organophosphates (OPs) are widely used for pest control worldwide, leading to increased risk for human exposure. The acute hormonal effects of OP include deficiencies in the thyroid-stimulating hormone (TSH), adrenocorticotropic hormone, and insulin-like growth factor 1 hormone correlated with the levels of cholinesterase. Most patients with OP-related hormone deficiency recover at 3 months of follow-up. However, the chronic effects of these chemicals are not clear. The aim of the present study was to determine the chronic influences of OP on pituitary functions in patients who had OP poisoning.
Materials and Methods: This prospective study was performed in Erciyes University Medical School. All of the patients who had OP poisoning were followed up in the medical intensive care unit (MICU). They were evaluated after discharge from the MICU after at least 6 months with regard to pituitary functions. In all patients, data were extracted from the MICU records. Baseline hormone levels were assessed, and dynamic tests (insulin tolerance test and glucagon stress test) were performed.
Results: Twenty-nine adult patients (13 women and 16 men) with OP poisoning were included in the study. The mean age of the patients was 41.9±16.7 years. The mean time from hospitalization to assessment of pituitary functions was 43.9±15.8 months in patients with OP poisoning. All patients had normal prolactin, TSH, follicle-stimulating hormone, and luteinizing hormone levels. Women had normal estrogen levels, and men had normal total testosterone levels. Cortisol deficiency was detected in only 1 (3.4%) patient, and growth hormone (GH) insufficiency was found in 3 (10.3%) patients.
Conclusion: GH and cortisol axis may be affected by OP poisoning in the long term. Thus, pituitary hormone levels should be tested following an acute period in patients with OP.

8.Does the Diameter of the Prosthesis Affect the Outcome of Stapedotomy?
Mehmet İlhan Şahin, Deniz Avcı, Furkan Şan, İbrahim Ketenci, Yaşar Ünlü
doi: 10.14744/etd.2019.19199  Pages 37 - 40
Objective: To compare the outcomes of the stapedotomies performed using Teflon prostheses with 0.4 mm and 0.6 mm diameters.
Materials and Methods: Pre- and postoperative audiograms of 52 participants, who had undergone stapedotomy, were evaluated retrospectively. Participants were divided into two groups according to the diameter of the prosthesis used for their surgery: Group 1 (0.4 mm) and Group 2 (0.6 mm). Air conduction (AC) pure tone thresholds at 250, 500, 1000, 2000, 4000, and 6000 Hz and air–bone gaps (ABGs) at 500, 1000, 2000, and 4000 Hz, as well as pure tone averages (PTAs), were compared within and between groups.
Results: Hearing gain, with regard to AC thresholds and ABGs, was statistically significant within both groups for each frequency (p<0.05). Pre- and postoperative PTAs and ABGs were similar between the groups (p>0.05). Whereas the preoperative AC thresholds were similar between the groups at all frequencies, postoperative AC thresholds of the 0.6 mm group were better than those of the 0.4 mm group at 2000 Hz (p<0.05). However, postoperative AC thresholds were similar between the groups at all frequencies other than 2000 Hz (p>0.05).
Conclusion: The outcomes of the stapedotomies with 0.4 and 0.6 mm Teflon prostheses were similar to each other with regard to postoperative hearing gain, PTA, and ABG. However, only at 2000 Hz, AC thresholds were found to be better in patients with a 0.6 mm prosthesis than in those with a 0.4 mm prosthesis.

9.Postpartum Comfort and Breastfeeding Behavior of Primipara Obese and Non-obese Mothers
Nuray Egelioğlu Cetişli, Feyza Ertop, Ekin Dila Topaloğlu Ören
doi: 10.14744/etd.2018.18162  Pages 41 - 45
Objective: Maternal obesity negatively affects the health of the mother and the newborn during pregnancy and in the postpartum period. This study was carried out to determine if there was any difference with regard to breastfeeding behavior and postpartum comfort between obese and non-obese mothers.
Materials and Methods: This prospective case-control study included 104 mothers, of whom 54 were obese, in the Obstetrics Clinic Department of a university hospital in Turkey. Data were collected using the Individual Information Form, Postpartum Comfort Questionnaire (PPCQ), and LATCH breastfeeding assessment tool.
Results: The LATCH and PPCQ total scores in obese mothers were lower compared to non-obese mothers, and the difference was statistically significant. For obese women, there was a statistically significant positive correlation between the LATCH score and the PPCQ total score, and the physical, psycho-spiritual, and sociocultural comfort subscale scores. For non-obese mothers, a positive correlation with the LATCH score was found only for the physical comfort subscale score.
Conclusion: Obesity affects the postpartum comfort and breastfeeding negatively, so mothers who are obese require more support than mothers who are not obese.

10.Comparison of the Performance of Second (Fast TSH) and Third (HYPERsensitive TSH) Generation Automated TSH Immunoassays in Healthy Euthyroid Subjects
Esin Çalcı, Halef Okan Doğan, Fatma Sağlam, Turan Turhan, Dilek Berker
doi: 10.14744/etd.2018.18127  Pages 46 - 49
Objective: We aimed to compare the performances of HYPERsensitive and Fast thyroid-stimulating hormone (TSH) methods in euthyroid subjects.
Materials and Methods: The study included 500 euthyroid subjects. We measured the TSH levels of study subjects using HYPERsensitive and Fast TSH methods. We compared the performances of the two methods. Moreover, free triiodothyronine and thyroxine, anti-thyroglobulin, and anti-thyroperoxidase levels were determined in study subjects.
Results: Mean serum TSH levels were determined as 1.76±1.06 and 1.85±1.12 µIU/mL using Fast and HYPERsensitive TSH methods, respectively. Differences were statistically significant (p<0.05). We found a positive correlation between Fast and HYPERsensitive TSH methods (r=0.960, p<0.001).
Conclusion: Although the sensitivity and precision of HYPERsensitive TSH method is better than that of Fast TSH method, the Fast TSH method needs lower sample volume, and the reaction time is shorter than that in HYPERsensitive TSH method. Thus, clinical biochemistry laboratories should select an appropriate method according to their requirements.

11.Hormonal Contraceptives: What if Exposed During Pregnancy?
Duygun Altıntaş Aykan, Yusuf Ergün
doi: 10.14744/etd.2018.18176  Pages 50 - 55
Objective: Hormonal contraceptives are contraindicated in pregnancy. However, some women may become pregnant while using contraceptives to prevent pregnancy. In addition, these hormones may be used for abnormal uterine bleeding or secondary amenorrhea. In the present study, we evaluated the fetal outcomes of pregnant women who were inadvertently exposed to hormonal contraceptives during anytime in pregnancy. The aim of the present study was to expand the data about contraceptives with regard to their potential teratogenic effects.
Materials and Methods: We collected data of pregnant women who were admitted to the Teratology Information Service (TIS) between 2014 and 2018 with hormonal contraception exposure during pregnancy. Data about medications, exposure to other agents, and comorbidities were documented. We analyzed the exposed drugs with respect to their potential teratogenic effects. Follow-up was conducted with women after delivery to determine whether any major or minor congenital malformations or adverse neurodevelopmental effects occurred in infants.
Results: A total of 25 pregnant women who were admitted to the TIS for inadvertent use of hormonal contraception during pregnancy were included in the study. After delivery, we found that one female baby, who was exposed to medroxyprogesterone acetate in utero, had exitus postnatally in the first week of life. Three infants with maternal exposure to medroxyprogesterone acetate, dydrogesterone, estradiol valerate+norgestrel, and ethinyl estradiol+gestodene were born preterm. Among the three infants, two with maternal exposure to medroxyprogesterone acetate and ethinyl estradiol+gestodene had low birth weight. On the other hand, we found that 75% of the infants delivered were female.
Conclusion: Contraceptive hormones presented no major teratogenic effects. However, avoidance of hormonal exposure and discontinuation whenever possible during pregnancy are suggested.

12.Which Frailty Scale Predicts 4-Year Mortality in Community-Dwelling Turkish Elderly Better: The FRAIL Scale or the Fried Frailty Index?
Sibel Akın, Firuzan Fırat Özer, Gözde Ertürk, Şemsinur Göçer, Mustafa Mümtaz Mazıcıoğlu, Elif Deniz Şafak, Salime Mucuk
doi: 10.14744/etd.2018.18167  Pages 56 - 61
Objective: Frailty is a prevalent geriatric syndrome that can indicate mortality in the elderly. The aim of this study was to determine if there was an association between frailty and 4-year mortality in the community-dwelling Turkish older people.
Materials and Methods: The Fried Frailty Index (FFI) and FRAIL scale data from the Kayseri Elderly Health Study were used. Univariate and multivariate analyses were conducted to determine the association between frailty and mortality, as assessed by the FFI and FRAIL scales.
Results: The 4-year mortality frequency was found at 7.2% (n=65/905).The gender-specific mortality was 2.4% (n=22) in females and 4.8% (n=43) in males. The frequency of mortality in the elderly aged ≥75 years was 12.8% (n=34/265), and in those aged 60–74 years, it was 4.8% (n=31/640). The frequency of mortality in the frail, pre-frail, and non-frail older people was 57.4%, 25.9%, and 16.7%, respectively, for the FFI. The corresponding frequency of mortality for the FRAIL scale was 20.6%, 54.0%, and 25.4%, respectively. In a multivariate analysis, male gender (OR 2.67, 95% confidence interval [CI] 1.43–4.96) and being frail (OR 5.34, 95%CI 2.45–11.67) were significantly associated with 4-year mortality according to the FFI.
Conclusion: Both the FFI and FRAIL scales may be significant predictors of 4-year mortality in the sample. However, the FFI may be considered as the strongest predictor for 4-year mortality, primarily in male gender.

13.Colorectal Cancer in Patients Aged ≤30 Years: 17 Years of Experience
Şükrü Özaydın, Erman Ataş, Mustafa Tanrıseven, Muhammet A. Kaplan, Patrick Hartendorp, Aytekin Ünlü, Patrizio Petrone, Nuri Karadurmuş, Fikret Arpacı
doi: 10.14744/etd.2018.18109  Pages 62 - 68
Objective: Although its incidence has been increasing, colorectal cancer is rare in young patients. There are conflicting reports on its prognosis in young patients with colorectal cancers. The goal of this study is to investigate the prognostic factors in young patients with colorectal cancer. An observational, population-based, retrospective study.
Materials and Methods: The clinicopathological characteristics, treatment approaches, and survival data of patients with colorectal cancers aged 30 years and younger were retrospectively analyzed.
Results: A total of 32 patients were identified. Hematochezia and abdominal pain were the major signs of colorectal cancer. Left-sided tumors (rectum 53.1%, and left colon 25%) were found to be more common than right-sided (18.8%) and transverse colon tumors (3.1%). Curative surgery was performed in 81.3% of patients. Histologically, 43.8% of cancers found were poorly differentiated. According to the subtype, 21.9% were signet ring cell, and 25% were mucinous (colloid) tumors. Patients were evaluated as Stage III in 46.9% and Stage IV in 31.3% of cases. The 3-year progression-free survival (PFS) was 38.7%, and the 3-year overall survival (OS) was 53.2%. Stage IV disease and disease without curative surgery were poor prognostic factors, both for the OS and PFS.
Conclusion: Prognosis was poor in young patients with colorectal cancer. In this institutional study, an advanced stage, left-sided localization, and poor histological feature were frequently detected. The stage and complete surgery were predictive factors for the long-term survival. In this respect, it is important for physicians to heighten their awareness of the increased incidence of colon cancer in younger patients.

14.Job Satisfaction, Quality of Life Levels, and Other Factors Affecting Physicians Working in Primary Health Care Institutions (Sivas)
İrem Akova, Öznur Hasdemir
doi: 10.14744/etd.2018.18148  Pages 69 - 76
Objective: The aim of this study was to evaluate job satisfaction and quality of life levels of physicians working in primary health care institutions in Sivas, as well as other factors affecting them.
Materials and Methods: This cross-sectional study included 135 (100%) physicians working in the Provincial Health Directorate (PHD), Community Health Center (CHC), and 29 Family Health Centers (FHC) between June 2018 and August 2018. The sociodemographic data form was prepared using the literature, and the Minnesota Job Satisfaction Scale (MJSS) and the World Health Organization Quality of Life Scale (WHOQOL-8) were applied. Student’s t-test, analysis of variance, Pearson’s chi-squared test, Fisher’s exact test, and Pearson’s correlation analysis were used in the analysis of the study data. A p-value <0.05 was accepted as statistically significant.
Results: Most physicians (73.3%) expressed the medium level of job satisfaction, and their quality of life was good (63%). There was no difference between the FHC physicians’ and CHC/PHD physicians’ job satisfaction and quality of life levels (p>0.05). While job satisfaction and quality of life were lower in those who frequently thought about quitting their job and those who experienced violence within the past year (p<0.05), it was higher in those who would be physicians if they were to choose their profession again and who were satisfied with the family medicine system (p<0.05). As the job satisfaction of physicians increased, the quality of life also increased (p<0.05).
Conclusion: Health policies should be developed and implemented to correct the factors affecting physicians’ job satisfaction negatively, especially with regard to violence against physicians.

15.Efficacy of Quadratus Lumborum Block in Children with Laparoscopic-Assisted Pyeloplasty
Gözen Öksüz, Ahmet Burak Doğan
doi: 10.14744/etd.2018.18158  Pages 77 - 79
Objective: The quadratus lumborum block (QLB) is a new and effective truncal block used for postoperative analgesia in patients undergoing upper and lower abdominal surgeries. We aimed to evaluate and compare the efficacy of QLB and wound infiltration (WI) using postoperative Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores and total 24-h analgesic consumption in pediatric patients who underwent laparoscopic-assisted pyeloplasty (LAP).
Materials and Methods: Patients who underwent LAP between May 2016 and June 2017 were retrospectively examined and were divided into two groups: QLB group and WI group. Patients’ FLACC scores at 1, 6, 12, and 24 h; postoperative analgesic doses; and complications were evaluated from patient’s records.
Results: A total of 31 patients who underwent LAP were identified from the records. Of them, 14 had QLB and 17 had WI. Demographic characteristics of patients and operation duration were similar between the two groups. FLACC scores at 1, 6, 12, and 24 h and postoperative total 24-h paracetamol consumption were significantly lower in the QLB group. No complications were seen in both groups.
Conclusion: According to the present study results, QLB provides a longer and more effective postoperative analgesia than WI in pediatric patients who have undergone LAP.

16.Effect of Maternal Depression and Environmental Factors on Infantile Colic
Şükrü Güngör, Serkan Kırık, Mehmet Yaşar Özkars, Ali Korulmaz
doi: 10.14744/etd.2018.18185  Pages 80 - 84
Objective: Infantile colic, a condition with unclear etiology that typically occurs in the evening in the first 3 months of life among healthy infants, occurs less frequently after 3 months. The intensity and continuous nature of the act of crying is utterly saddening and wearing for parents. The aim of the present study was to investigate the effect of maternal depression and other environmental factors on infantile colic.
Materials and Methods: The mothers of 100 patients diagnosed with infantile colic according to the Rome 4 criteria and 50 healthy control subjects were asked to complete a questionnaire examining environmental factors and demographic properties.
Results: In the comparison of the patients’ Patient Health Questionnaire (PHQ) 2 and PHQ9 test scores, PHQ2 test scores were 1.42±1.40102 (0–5) in the control group and 4.09±1.61492 (0–6) in the infantile colic group (p≤0.001) according to the PHQ9 test. Mothers in the control group attained 6.28±4.915578 (1–21) points, whereas those in the infantile colic group had 16.47±6.95070 (3–26) points (p≤0.001).
Conclusion: In conclusion, in addition to the importance of using breast milk alone in the first 6 months and avoiding unnecessary antibiotherapy to eliminate the risk factors for infantile colic, examining maternal depression for solving problems of infants with frequent crying attacks is also of importance for family and public health.

17.Ectopic and Eutopic Located Parathyroid Lesions: Do They Behave Differently? How Can We Monitor Them? What Should We Look for?
Ülkü Korkmaz, Ali Sarıkaya
doi: 10.5152/etd.2018.18147  Pages 85 - 90
Objective: Hyperparathyroidism (HPT) is a frequent endocrine disorder that progresses with an increase in the parathormone (PTH) synthesis and secretion from the chief cells in one or more glands. The common methods used in the imaging of parathyroid adenomas are the ultrasonography and Tc-99m sestamibi scintigraphy (MIBI) scintigraphy. We aimed to investigate the determining characteristics and availability of the MIBI scintigraphy technique in detecting eutopic and ectopic localized parathyroid adenomas.
Materials and Methods: This is a retrospective study. A total of 59 patients diagnosed with primary HPT between 2002 and 2010 using parathyroid scintigraphy with Tc99m MIBI imaging and dual-phase dual-isotope technique, which was reported as parathyroid adenoma, were enrolled into this study. To determine the radiopharmaceutic retention, an early parathyroid-to-thyroid ratio (early PT/T), late parathyroid-to-thyroid ratio (late PT/T), early-to-late ratio (E/L), and the retention index (RI) were calculated.
Results: The lesions were divided into two groups: ectopic (n=28) and eutopic (n=37). When biochemical parameters were compared, there was not any statistically significant difference in the physiological parameters excluding the PTH levels. We determined that the level of PTH is the only biochemical parameter that is directly associated with the positivity of MIBI. Moreover, our findings revealed that the E/L ratio is negatively correlated with Ca+2 and P, while the RI ratio exhibited a positive association with Ca+2 and P in the ectopic group.
Conclusion: We concluded that the MIBI is currently the best imaging method to diagnose parathyroid adenomas. The ideal imaging protocol should include a combination of a single photon emission computerized tomography study that is not prolonged over 1 h with an early and late planar (15 min and 2 h, respectively) imaging.

18.Evaluation of suPAR Levels in Attention Deficit Hyperactivity Disorder Etiopathogenesis
Ayşe Irmak, Sevgi Özmen, Zeynep Şan, Esra Demirci
doi: 10.14744/etd.2018.18188  Pages 91 - 95
Objective: Although a strong inflammatory basis has been demonstrated, the pathophysiology of attention deficit hyperactivity disorder (ADHD) has not been defined clearly. The aim of the present study was to investigate whether soluble urokinase plasminogen activator receptor (suPAR), one of the inflammatory disruptors, plays a role in the etiology of ADHD.
Materials and Methods: The study population comprised 50 patients aged 7–13 years, diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, without any chronic or other psychiatric disease, and 25 healthy controls. Parents of the children in the study group completed the Conners’ Parent Rating Scale—Revised Short, and teachers completed the Conners’ Teacher Rating Scale—Revised Short. Enzyme-linked immunosorbent assay kits were used to measure suPAR levels in plasma samples.
Results: The mean plasma suPAR level of patients with ADHD was 2.92±1.74 ng/ml, the suPAR level of the controls was 2.54±1.05 ng/ml, and there was no significant difference in suPAR levels between ADHD and controls (Z=0.084, p=0.933). No correlation was found between plasma suPAR levels and ADHD severity as assessed by Conners’ parent and teacher scales.
Conclusion: The role of inflammatory systems and mediators in ADHD was emphasized in many studies, and many important data on ADHD etiopathology were obtained. However, we found no significant relationship between ADHD and suPAR levels. Further research is needed with large samples.

BRIEF REPORT
19.The Usefulness of Papanicolaou Test in the Cytomorphological Evaluation of Squamous Cell Abnormalities of the Cervix
Lepa Bogdanovska, Nevenka Velickova
doi: 10.14744/etd.2018.18168  Pages 96 - 98
Objective: Papanicolaou test as a screening method is suitable method in prevention of cervical cancer. The aims of study was to detecting the prevalence of various cervical cytology results in the squamous epithelial tissue of endocervix and endometrium in women, aged 18-70 years, according to Bethesda system (2014).
Methods: This was a hospital based cross-sectional study conducted on 16790 Pap smears prepared from women aged 18-70 years between January and December, 2017.
Results: The evaluation of the results is hospital based not the whole country. Diagnosis of atypical squamous cells of undetermined significance (ASC-US) was made in 72 (12%) cases. Atypical squamous cells as a HSIL (ASC-H) was seen in 36 cases (6%), HPV infection was in 26 cases (4%), Low-grade squamous intraepithelial lesion (LGSIL or LSIL) as a CIN 1, 27 cases (5%) and as a CIN 2 13 cases or 2%. High-grade squamous intraepithelial lesion (HGSIL or HSIL) or CIN 3 in 5 cases (1%). The prevalence of various epithelial abnormalities as a AGC (glandular epithelial cell abnormalities) was determined in 20% of women (119 cases) and other abnormalities even to 50% (298 cases).
Conclusions: According to these results (high prevalence of epithelial cell abnormalities in cervical smears due to I-XII) Pap test as a screening methods should begin at 18 years. This screening test can detect abnormal cervical cells before they turn into malignant neoplasm or can be used as a good screening method to detect the earliest signs of carcinogenesis.

20.Febuxostat Mitigates Genotoxicity Induced by Ionizing Radiation in Human Normal Lymphocytes
Shiva Asemi, Arash Ghasemi, Seyed Jalal Hosseinimehr
doi: 10.14744/etd.2019.35762  Pages 99 - 101
Febuxostat (BF) is a xanthine oxidase inhibitor that has been usedto treat chronic gout. FBexhibits anti-inflammatory effect. In this study, the radioprotective effect of BF was investigated against genotoxicity induced by ionizing radiation (IR) in human healthy lymphocytes.Peripheral blood samples were treated with BF at various concentrations for three hours. Then, the whole blood samples were exposed to IR at a dose of 1.5 Gy. Lymphocytes were cultured for determining the frequency of micronuclei in binucleated lymphocytes.The frequency of micronuclei was significantly decreased in human lymphocytes which were exposed to IR and treated with BF as compared to irradiated lymphocytes without BF treatment. The maximum radioprotection as decreasing in the frequency of micronuclei was observed at 100 μM of BF treatment (43% decrease). The anti-inflammatory property is probably involved in the mechanism of FB exerting radioprotective effect in human lymphocytes.

21.Effects of Platelet-rich Plasma Injection on Adhesive Capsulitis: An Interventional Case Series
Havva Talay Çalış, Çağlar Karabaş, Emel Güler
doi: 10.14744/etd.2019.16362  Pages 102 - 104
This case series aims to present effectiveness of PRP on pain, range of motion and functionality in patients with frozen shoulder and chronic shoulder pain
The study included 9 patients (aged 18-75 years) who had shoulder pain for at least 3 months with 50% limited range of motion in at least one direction and VAS score>5. Under sonography guidance, PRP injection was performed into glenohumeral joint at baseline and on the week 2. Concurrently, PNF stretching and Codman exercises were given to all patients.
Significant improvements were detected in VAS scores on week 2, 6, and 12 when compared to baseline(p<0.05) and SPADI scores in all time points when compared to baseline(p<0.05). There was significant improvement in active and passive ROM on weeks 2, 6 and 12 when compared to baseline(p<0.05).
Treatment of adhesive capsulitis with PRP may be an alternative treatment method for patients.

CASE REPORT
22.Clinical Outcome of Leptospirosis: A Fatal Case Report
Kate Nikolaevna Bukharina, Gulnar Nuralinova, Saule Maukayeva
doi: 10.14744/etd.2018.18186  Pages 105 - 107
Leptospirosis is a widespread zoonotic disease that is commonly seen in temperate and tropical areas. Here, we have presented a case report of fatal leptospirosis with thrombocytopenia and renal failure. A 22-year-old male soldier was referred to the infectious diseases clinic with complaints of fever, headache, dizziness, sore throat, and weakness. He had a history of staying in a village and tick removal from his head. An extended polymorphic rash on the whole body, congestion on the sclera, hyperemic pharynx, and hepatomegaly were observed. Laboratory examination revealed leukocytosis and impaired liver and kidney function tests. Antibiotic therapy with penicillin G and gentamicin was started with the pre-diagnosis of leptospirosis. The main diagnosis was confirmed by passive hemagglutination test positivity. On day 5 of treatment, bleeding continued, and hemodialysis was performed. The patient died on day 6 of treatment. The physicians should be aware about the clinical presentations of Leptospira infections in endemic areas.

23.An Extremely Rare Cause of Wolff-Parkinson-White Syndrome: Rhabdomyoma in Association With Tuberous Sclerosis
Özlem Elkıran, Cemşit Karakurt, Damla İnce
doi: 10.14744/etd.2018.18165  Pages 108 - 110
Rhabdomyomas are the most common primary cardiac tumors in infants and children. They are usually associated with tuberous sclerosis (TS). As the tumors tend to regress spontaneously, surgical intervention is not usually performed unless they become obstructive or cause incessant arrhythmias. We report an extremely rare case of rhabdomyoma serving as a substrate for Wolff-Parkinson-White (WPW) syndrome and intractable supraventricular tachycardia accompanied by TS. Our case is particularly interesting because it was diagnosed prenatally. The signs of WPW syndrome disappeared from the electrocardiogram with the regression of the tumor.

24.Treacher Collins Syndrome with a Novel Deletion in the TCOF1 Gene
Büşra Eser Çavdartepe, Nadir Koçak, Nafiz Yaşa, Tülin Çora
doi: 10.14744/etd.2019.62144  Pages 111 - 113
Treacher Collins syndrome (TCS) is a rare autosomal dominant congenital disorder characterized by various craniofacial malformations. The estimated incidence is 1 in 50000 live births. Bilaterally symmetric anomalies of the structure are present within the first and second branchial arches. Characteristic facial findings includes bilateral hypoplasia of the malar bones and mandible. This syndrome most commonly results from mutations in the TCOF1 gene. Here we present a five-year-old female patient with syndromic appearance and hearing loss. The patient had various facial dysmorphic features and malformed bilateral pinnae and left ear microtia. According to the clinical features, we suspected TCS and sequence analysis of TCOF1 gene was performed. A heterozygous new mutation c.1722_1731delCATCCTCCAG in exon 12 of the TCOF1 gene was detected. It has been determined that this mutation is pathogenic according to the in silico prediction tools. The current study further expands the TCOF1 mutation spectrum.

25.Lung Adenocarcinoma Presented with Extensive Pulmonary Calcification
Alaa Omar Shalaby, Khaled Mahmoud Kamel, Ahmed Al Halfawy, Hassan Amin, Sabah Ahmed Hussein, Hassan Gamal Yamamah, Mohamed Shaaban Mousa
doi: 10.14744/etd.2019.49002  Pages 114 - 116
Calcification in lung lesions includes many differential diagnoses and usually indicates a benign course. However, its interpretation is challenging due to many etiologies. Radiological visualization of extensive calcification in bronchogenic carcinoma is not familiar and may cause confusion and misdiagnosis; however, it may be rarely seen and has also been rarely reported. We documented a case of lung adenocarcinoma with extensive calcification in computed tomography (CT) of chest and diagnosed as mucinous adenocarcinoma of the lung by bronchoscopic lung biopsy.

IMAGE
26.Primary Duodenal Adenocarcinoma
Daniel Kostov, Vasil Kostov
doi: 10.5152/etd.2018.18154  Pages 117 - 118
Abstract | Full Text PDF

27.Severe Varicella Pneumonia in an Immunocompetent Adult
Tuğba Güğül Demirel, Zeynep Türe, Ilhami Çelik
doi: 10.14744/etd.2018.18173  Pages 119 - 120
Abstract | Full Text PDF

HISTORY OF MEDICINE
28.Prof. Dr. Fuat Sezgin (1924–2018) and His Contributions to the History of Medical Sciences
Halil Tekiner
doi: 10.14744/etd.2019.27443  Pages 121 - 124
Prof. Dr. Fuat Sezgin (1924–2018), a renowned Turkish orientalist and historian of science, was the founder and long-term director of the Institute of the History of the Arab-Islamic Sciences at J.W. Goethe University in Frankfurt, Germany since 1982. With respect to medical sciences, he outlined the historical development of medical literature in Islamic civilizations by introducing the works and contributions of many medical authors of the Islamic Golden Age. Among them, the third (1970) and fourth (1971) volumes of his voluminous work Geschichte des arabischen Schrifttums (History of Arabic Writings), a systematically organized bio-bibliographical reference on the history of science and technology in the Islamic world, are of particular importance. He also established Frankfurt’s (1983) and Istanbul’s (2008) Museum for the History of Science and Technology in Islam, bringing together nearly 800 ingenious replicas of historical scientific instruments and medical tools.

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