ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 43 (2)
Volume: 43  Issue: 2 - 2021
EDITORIAL COMMENTS
1.COVID-19: Infection Control and Treatment Strategy in Pediatric Age Group in Turkey
Hasan Tezer, Melis Deniz
doi: 10.14744/etd.2020.84565  Pages 107 - 109
Abstract | Full Text PDF

REVIEW
2.Thorax CT Findings in Novel Coronavirus Disease 2019 (COVID-19)
Mehmet Atalar, Halil Çaylak, Dilara Atasoy, Nazım Çetinkaya, Ömer Tamer Doğan, Enes Gül
doi: 10.14744/etd.2020.25993  Pages 110 - 115
Novel coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has high mortality rates. It has become a severe pandemic worldwide. Real-time PCR testing is still the gold standard test method for the definitive diagnosis of COVID-19 despite the possibility of false negatives. Radiological imaging methods, especially computed tomography (CT), are important assistant methods in the diagnosis and management of the disease. This review presents the role of CT in COVID-19 pneumonia, its diagnostic accuracy, thorax CT findings of the disease and differential diagnosis.

3.COVID-19 Disease and Interferon-γ: Has it a Protective Impact on Mortality?
Abbas Ali Husseini, Anton Abdulbasah Kamil, Mohammad Reza Aloudal
doi: 10.14744/etd.2020.40326  Pages 116 - 121
The complex coincidence of several immunopathological, socio-cultural, and health infrastructure factors may affect the COVID-19 related mortality among different populations. The impact of the age on disease progression has been confirmed in several studies. Recently limited ecological and clinical studies have sparked controversy among researchers about the protective impact of the non-specific effect of routinely used Bacille Calmette-Guerin (BCG), Hepatitis A virus (HAV), and influenza (Flu) vaccines or their natural infections against COVID-19. In the present study, variables, including BCG vaccination coverage, HAV prevalence, and population age distributions, from 59 countries were analyzed to examine their potential association with COVID-19 infection and related mortality rate. Concerning COVID-19 cases/million population (1MP) and mortality, there are significant differences between countries with and without BCG vaccination programs (p-value <0.001). A significant negative correlation between both BCG coverage and HAV prevalence with COVID-19 related mortality was also found (r (59)=-0.4, p-value <0.05), (r (59) =-0.3, p-value <0.01). Based on the results of the present study, previous ecological analyses and available epidemiological evidence, along with knowledge of the immune response to BCG, HAV and influenza vaccination, as well as COVID-19 infection progression, the current study suggest a hypothesis that IFN-γ induced immune response which could be triggered by BCG, HAV, and flu vaccination or natural infections may have a protective effect against COVID-19 related mortality.

ORIGINAL ARTICLE
4.Epidermal Growth Factor-Like Repeats and Discoidin I-Like Domains 3 is a Novel Regulator of Epithelial-Mesenchymal Transition in Clear Cell Renal Cell Carcinoma: In Silico Analysis
Rahşan Ilıkçı Sağkan, Dilara Fatma Akın Balı
doi: 10.14744/etd.2020.47827  Pages 122 - 129
Objective: Epithelial-mesenchymal transition (EMT) contributes to cancer metastasis and recurrence, which are major obstacles in changing the course of cancer. However, studies on the mutational and gene expression profiles of epidermal growth factor-like repeats and discoidin I-like domains 3 (EDIL3) that reveal the relationship between clear cell renal cell carcinoma (ccRCC) and EMT markers are limited. The aim of our study was to reveal the correlation between tumor and EMT markers (E-cadherin and vimentin) and EDIL3 expression. Additionally, we evaluated target gene expression levels and mutational profiles in kidney cancer tissue and normal tissue.
Materials and Methods: We investigated the mutational profile and mRNA expression of EDIL3 and compared them with that of VIM and CDH1 in 523 patients with ccRCC using validated bioinformatics analysis. Additionally, Polymorphism Phenotyping v2 (PolyPhen-2), Screening for NonAcceptable Polymorphisms (SNAP) were used to predict and confirm the pathogenicity of the mutations detected. Studies were performed in silico using bioinformatics tools.
Results: EDIL3 and VIM expression was statistically significantly higher in the healthy group and exhibited a positive correlation in patients with ccRCC. Patients with elevated VIM and CDH1 expression and low EDIL3 expression had prolonged survival time. In addition, 7 mutations were detected in the evaluated genes, 6 of which had potential pathogenic features.
Conclusion: Our study provides insights for further experimental studies. EDIL3 can be used as a diagnostic or prognostic indicator of cancer development to help cure renal clear cell cancer.

5.Did COVID-19 Pandemic Changed Parents’ Approach to Vaccination?
Nimet Pınar Yılmazbaş, Özlem Terzi, Deniz Özçeker
doi: 10.14744/etd.2020.85451  Pages 130 - 134
Objective: Vaccine hesitancy is driven by many factors and varies across time. People with vaccine hesitancy may change their decision in the case of COVID-19 pandemic. Our study aimed to evaluate parents’ pandemic related perceived stress levels and its effects on vaccine hesitation, also their willingness towards the COVID-19 vaccine.
Materials and Methods: This cross-sectional study was practiced with an open-access online survey program through social networks. Parents aged between 18 and 49 years, who had at least one child and agreed to participate in this study constituted the population (n=440). The questionnaire consisted of 14 questions about socio-demographic characteristics of parents, their attitudes and behaviors about childhood vaccines and the Perceived Stress Scale (PSS).
Results: Four hundred forty parents participated in this study, 377 (85.7%) of them stated that they thought positively towards the vaccines, 55 (12.5%) were hesitant. After the pandemic, 22 (40.0%) of 55 participants who had hesitations stated that now they believe vaccines are necessary. Of all participants, 43.4% stated they would definitely, 30.5% would probably have the COVID-19 vaccine administered. Participants who had high-stress levels perceived more vaccine hesitation.
Conclusion: Pandemia may change people’s opinions about vaccine hesitancy. Even if an effective vaccine is developed in case of a pandemic, people need to be told correctly, to create a demand for vaccination.

6.Knowledge Level of Nursing Students on Nosocomial Infection
Ece Davran, Anita Karaca
doi: 10.14744/etd.2019.19615  Pages 135 - 141
Objective: This study was carried out to evaluate the knowledge level of student nurses on nosocomial infection.
Materials and Methods: The sample of this descriptive study consisted of a total of 208 nursing students in the 2nd, 3rd, and 4th year of a foundation university between February and March 2019. Study data were collected through “Student Information Form” and “Nosocomial Infection Information Form of Nursing Students” prepared in accordance with the literature.
Results: The mean age of the student nurses was 21.78±2.21 years. Moreover, 27.4% of the students graduated from a vocational school of health services and 20.7% of them were already employed while continuing their education. Further, 72.1% of the student nurses stated that they received training on nosocomial infections, 90.4% needed training on nosocomial infections, and 76.9% required training, most importantly, on the measures related to the route of transmission. The item in which most of the student nurses provided an incorrect answer (92.3%) was “The intravenous catheters attached to the patient should be changed every 48–72 h at the latest.”
Conclusion: The total mean score of student nurses’ knowledge level of nosocomial infection was above the moderate level. To meet the educational needs of the student nurses about nosocomial infections, provisions of more comprehensive trainings on this issue and of updated information in line with the recently published guidelines through continuing education programs after graduation are necessary.

7.The Relationship Between Blood Groups and COVID-19 Patients
Mustafa Çakır
doi: 10.14744/etd.2020.27790  Pages 142 - 145
Objective: The present research aims to evaluate the relationship between blood groups and COVID-19 patients.
Materials and Methods: This is a descriptive study, and data of 256 patients with COVID-19 positive were evaluated. In the analysis, the level of statistical significance was accepted as p<0.05.
Results: In this research, 62.1% of the patients examined were male, 75.4% were married; 34.8% were in the 30–39 age group, 23.8% were in the 40–49 age group, and the mean age was 37.0±12.2. 33.3% of the patients were high school graduates, 32.9% were primary school graduates, 44.1% had blood group A Rh+, and 21.5% had blood group 0 Rh+. In this research, the findings showed that 85.9% of the patients had symptoms, 49.6% had malaise, 48.0% had joint pain, 32.0% had a history of a positive family member or a positive relative before themselves, and 42.2% had a history of positive case at the workplace before themselves.
Conclusion: In this research, the frequency of the blood group A Rh+ was high and the frequency of the blood group 0 Rh+ was low in COVID-19 patients. The mean age of the patients was 37, and number of the patients who needed intensive care was low. There was no difference between the symptom states, according to blood groups. It is recommended that people with blood type A behave more sensitively in terms of following the protection measures.

8.The Association Between Refeeding Hypophosphatemia and Serum Appetite-Regulating Hormone Levels in Critically Ill Patients: A Prospective, Observational, Single-Center Pilot Study
Ender Doğan, Kürşat Gündoğan, Şahin Temel, Serap Şahin, Nurhayat Tuğra Özer, Gülşah Güneş Şahin, Sabahattin Muhtaroğlu, Murat Sungur, Muhammet Güven
doi: 10.14744/etd.2020.94580  Pages 146 - 151
Objective: Refeeding hypophosphatemia (RH) is common in critically ill patients and is associated with high morbidity and mortality, but the influence on appetite-regulating hormones is unknown. This study aimed to determine the association between serum levels of phosphorus and specific appetite-regulating hormones in critically ill patients.
Materials and Methods: This study was performed prospectively in patients admitted to the intensive care unit (ICU). The study included patients aged ≥18 years who were admitted to the ICU and feeding at least 72 hours (h). Serum was obtained at baseline, 24 h, and 72 h later for concentrations of leptin, adiponectin, ghrelin, resistin, insulin-like growth factor 1 (IGF-1), and glucagon-like peptide 1 (GLP-1). Phosphorus levels were accepted at ≤2.4 mg/dL for RH.
Results: Of the 26 cases, 17 (65%) were male. The baseline phosphorus levels at baseline, 24 h, and 72 h were 3.58±0.94 mg/dL, 2.61±1.05 mg/dL, and 2.91±0.76 mg/dL, respectively. RH rate was developed 24 h, 72 h, and over time in 38%, 15%, and 42% patients, respectively. Adiponectin levels at 24 h were significantly different between patients who developed RH and those who did not develop RH. A positive correlation was observed between 24 h serum adiponectin level and 24 h phosphorus level. A positive correlation was found between baseline serum ghrelin level and baseline phosphorus level. No significant difference was found between RH and insulin, leptin, ghrelin, resistin, IGF-1, and GLP-1 at baseline, 24 h, and 72 h.
Conclusion: RH was found to be of high ratio in critically ill patients. Adiponectin level was found to be high at 24 h in patients with RH.

9.Factors Affecting Mortality in Hematology Patients Accepted to the Intensive Care Unit
Leyla Talan, Neriman Altıntaş
doi: 10.14744/etd.2020.14477  Pages 152 - 155
Objective: Patients with hematologic diseases can have increased life expectancy with newly developed chemotherapeutic agents, hematopoietic stem-cell transplantation, and further supportive therapy. However, intensive therapies lead to more life-threatening complications that require intensive care unit (ICU) admission. Therefore, understanding the factors affecting mortality is important when accepting these patients to the ICU. This study was conducted to explore the factors affecting the mortality of patients admitted to medical ICUs with a diagnosis of hematologic disease.
Materials and Methods: The medical records of patients with diagnoses of hematologic diseases hospitalized in the medical ICU between March 2013 and March 2019 were retrospectively reviewed. Age, gender, subgroup of hematologic disease, APACHE II scores, admission diagnoses, mechanical ventilation requirement, renal replacement therapy, vasopressor therapy, and ICU and hospital outcomes were recorded. The factors affecting mortality were evaluated.
Results: Patients with acute leukemia [29 (30%)], multiple myeloma [20 (21%)], lymphoma [22 (23%)], chronic leukemia [8 (9%)], and other hematologic diseases [15 (16%)] were identified and included during the 6-year study period. The median age of patients was 60 (27.5) years, and 50 (53%) patients were women. Bone marrow transplantation was performed in 20% of patients, and 75 (79%) patients required invasive mechanical ventilation. Vasopressor treatment was required in 49 (52%) of patients. The mortality rate was 55%. APACHE II scores were higher in nonsurvivors. Moreover, they required more mechanical ventilation, vasopressor treatment, and renal replacement therapy. According to regression analysis, high APACHE II scores, vasopressor therapy requirement, and presence of respiratory failure were the risk factors for mortality.
Conclusion: High APACHE II scores, need for vasopressor therapy, and respiratory failure were identified as independent risk factors for mortality in patients with hematologic diseases admitted to the medical ICU.

10.Parents’ Postoperative Pain Measure: Turkish Validity and Reliability
Müge Seval, Aylin Kurt
doi: 10.14744/etd.2020.59260  Pages 156 - 160
Objective: This study aimed to test the reliability and validity of the Turkish version of the Parents’ Postoperative Pain Measure.
Materials and Methods: The permission was obtained via email from the creator of the measure, Christine T. Chambers. A sample of 150 children aged 7–12 years (48.7% girls, 51.3% boys) was recruited for this methodological study. The instrument consisted of 15 items. A “Sociodemographic Questionnaire,” the “Parents’ Postoperative Pain Measure,” and the “Wong–Baker Faces Pain Rating Scale” were utilized as data collection instruments. The study consisted of language and content validity testing (the technique of translation-back translation, Lawshe’s technique), construct validity (exploratory and confirmatory factor analyses), and reliability testing (Kuder–Richardson 20 test, Pearson product moment correlation between parallel forms). Measurements were taken on postoperative days 1, 2, and 3.
Results: The results of the factor analysis for validity demonstrated acceptable levels. The factor analysis produced a single factor with a total variance of 69%. The Parents’ Postoperative Pain Measure and the Wong–Baker Faces Pain Rating Scale exhibited positive correlations on postop days 1, 2, and 3 (r=0.67/p<0.01, r=0.74/p<0.05, r=0.79/p<0.05). The internal consistency coefficient (Kuder–Richardson 20) was 0.851.
Conclusion: The Parents’ Postoperative Pain Measure, originally developed by Chambers et al. in the English language, is a valid and reliable instrument that is suitable for use in Turkish and the Turkish culture.

11.Protective Effect of Indole-3-Carbinol on Sperm Morphometric Alteration in a High-Fat Diet-Induced Obese Rat Model
Nur Hande Tüfek, Ahmad Yahyazadeh
doi: 10.14744/etd.2020.62443  Pages 161 - 165
Objective: This study aimed to investigate the deleterious effect of obesity induced by high-fat diet on rat testes. Another objective was to survey the possible efficacy of indole-3-carbinol (I3C) on testicular change in obese rats.
Materials and Methods: Twenty-four rats were randomly assigned into 4 groups as follows: control, obese, indole-3-carbinol (I3C), and obese+I3C groups. Morphometric and histopathological examination was performed on sperm smears to determine the type and percentage of abnormalities in sperm morphology.
Results: We found a significant decrease in the percentage of sperms with normal morphology in the obese group in comparison with the control group. Moreover, the percentage of abnormal sperm head, neck, and tail was significantly increased in the obese group compared with that in the control group. In the obese+I3C group, the percentage of normal sperm morphology was significantly higher than that in the obese group, but the percentage of abnormal sperm heads, necks, and tails decreased. Morphological examination also exhibited various types of abnormalities in the sperm heads, necks, and tails.
Conclusion: Our finding showed an increased abnormal morphology in sperms due to the detrimental effect of obesity. Also, the administration of I3C may have improved such sperm abnormalities and, thus, infertility in obese rats.

12.Chromosomal Evaluation Results for Transgender Individuals and Questioning the Necessity of Karyotyping
Tufan Çankaya, Duygu Onur Cura, Hande Özkalaycı, Ayfer Ulgenalp
doi: 10.14744/etd.2020.67915  Pages 166 - 169
Objective: Gender dysphoria is a condition where an individual is discontent with their assigned gender. Karyotyping is a part of the transition period before hormone therapy to detect the biological gender for most professionals in many countries. Thus, we discussed the requirements for chromosomal analysis of individuals with gender dysphoria considering clinical and genetic findings.
Materials and Methods: Karyotype analyses were used to evaluate 67 unrelated individuals.
Results: Five individuals transitioned from male to female, and the rest transitioned from female to male. No chromosomal abnormalities and/or chromosomal rearrangements were observed, except for an individual who had mosaic Turner syndrome.
Conclusion: This study evaluates the results of chromosomal analysis of individuals with gender dysphoria. From the findings of this study and the literature, we suggest that chromosomal analysis is unnecessary unless evidence for another disorder of sex development is found alongside clinical, laboratory, and radiological findings.

13.Evidence of a Sharp Increase in Scientific Productivity on COVID-19 by Comparing Publications of the First Quarter with the First Half of 2020
Koray Baş, Fulya Yılmaz
doi: 10.14744/etd.2020.06882  Pages 170 - 174
Objective: Coronavirus disease 19 (COVID-19) is a highly contagious disease characterized by severe respiratory infection by SARS-CoV-2 virus. COVID-19 was first appeared in Wuhan, China, in December 2019 and then rapidly became a global pandemic from a local outbreak. The present study aims to present the rapid increase of scientific productivity on COVID-19 by comparing publications of the first quarter with the first half of 2020.
Materials and Methods: Web of Science (WoS) software was used for the search and the analysis. To compare scientific productivity of two periods as the first quarter and the first half of the pandemic era, all scientific papers published about COVID-19 included in Science Citation Index Expanded (SCI-E) from January 1st to April 5th and from January 1st to July 9th of 2020 were searched using the following terms: “COVID-19”,“2019-n-CoV”,“SARS-CoV-2”,“Coronavirus disease 19” and “2019 novel coronavirus” as nomenclatures of COVID-19.
Results: Overall, 337 and 11.704 scientific papers related to COVID-19, indexed by SCI-E, were found in the first quarter and the first half of 2020, respectively. While the biggest contribution for publications was from People’s Republic of China (PRC) in the first quarter and was from the USA in the first half of 2020 for COVID-19.
Conclusion: We found a close correlation between the rapid acceleration of scientific papers and turning the disease from a local outbreak to a global pandemic. Since sharing experiences is as important as struggling with these kinds of novel diseases, we believe that encouraging researchers to make scientific publications for others is more important than ever in the circumstances like this.

14.Analysis of Risk Factors for Ultrasonographic Graf Type IIa (−) Hips in Developmental Dysplasia: A Hospital-Based Case-Control Study with Follow-Up Outcomes
Bahtiyar Haberal, Orçun Şahin, Ismail Cengiz Tuncay
doi: 10.14744/etd.2020.90232  Pages 175 - 179
Objective: To examine the association of Graf type IIa(-) hips with maternal and infant risk factors in newborns and to evaluate the follow-up outcomes.
Materials and Methods: Two different risk analyses were performed. In the first analysis, Graf type I hips were grouped as “controls,” and Graf type II were grouped as “cases.” In the second analysis, all the Graf type I and Type IIa(+) hips were grouped as “controls,” and all Graf type IIa (-) hips were considered as “cases.” Maternal age, presence of consanguinity, pregnancy, and smoking were considered as maternal risk factors. Sex, birth weight, gestational age, associated congenital anomalies, and family history were considered as infant risk factors. Further, we determined the risk factors for Graf type IIa and type IIa (-) hips.
Results: The study population included 73 cases (11.4%) and 569 controls (88.6%), including 322 (50.2%) male and 320 (49.8%) female infants. Graf type IIa hips revealed significant differences for gestational age (>42 wk), birthweight (>3500 g), and maternal age (≤20 y). At follow-up, all Graf type IIa(+) hips became Graf type I mature hips. In contrast, three Graf type IIa(−) hips (3/12, 25%) required additional treatment.
Conclusion: Significant risk factors for Graf type IIa(-) hips were female sex, gestational age of >42 wk, and birthweight of >3500 g. Almost one-quarter of Graf type IIa (-) hips may require additional treatment. Thus, significant risk factors for Graf type IIa(-)should be remembered in clinical practice.

15.ABCDEF Bundle: An Undiscovered Golden Approach for Acute Care Patients in Turkey
Gülseren Elay, İsmail Hakkı Akbudak, Ilhan Bahar
doi: 10.14744/etd.2020.39225  Pages 180 - 183
Objective: The ABCDEF (Assess, prevent, and manage Pain, Both spontaneous awakening trials and spontaneous breathing trials, Choice of analgesia and sedation, Delirium: assess, prevent, and manage, Early mobility and Exercise, and Family engagement and empowerment) bundle is a path for optimal resource utilization. This study aimed to investigate the knowledge level and views of physicians working at the intensive care units (ICUs) in Turkey, a developing country, on the use of ABCDEF bundle.
Materials and Methods: A cross-sectional online survey was administered to ICU physicians in Turkey, using Supplemental Digital Content 1, on June 20, 2018. The survey was terminated and deactivated on September 30, 2018.
Results: A multidisciplinary team oriented for compliance with the ABCDEF bundle was not found to be present in any of the responding ICUs in Turkey. Of 461 participants, 161 (35.1%) were knowledgeable about the bundle. The bundle could not be used due to lack of a team and shortage of trained personnel.
Conclusion: The rates of using scales proposed by the ABCDEF bundle were remarkably low although most participants acknowledged that the use of protocols and scales leads to decreased morbidity and mortality rates.

16.The effect of Blood Urea Nitrogen/Albumin Ratio in the Short-Term Prognosis of Chronic Obstructive Pulmonary Disease
Ayşe Demir Baha, Türkan Zeynep Işıkdoğan Fendoğlu, Nurdan Köktürk, Hatice Kılıç, Hatice Canan Hasanoğlu, Sertaç Arslan, Meral Gülhan, Nalan Ogan, Evrim Eylem Akpınar, Aslıhan Alhan
doi: 10.14744/etd.2020.13914  Pages 184 - 188
Objective: There is no definite laboratory parameter in predicting short-term prognosis in patients with chronic obstructive pulmonary disease (COPD). Our aim was to evaluate the prognostic effect of serum blood urea nitrogen (BUN)/albumin ratio in COPD patients.
Materials and Methods: A retrospective study comprising of 264 COPD patients who were in exacerbation period and selected from 4 centers was carried out. Data on demographic characteristics, disease characteristics, comorbid conditions and short-term prognosis of patients were obtained. and analyzed.
Results: The BUN/Albumin ratio was higher in patients with oxygen saturation <90% (p=0.004). There was no difference between global obstructive lung disease (GOLD) stages means of BUN/Albumin ratio but this rate was higher in those with infective exacerbations (p=0.019). The BUN/albumin ratio of patients who were discharged (5.3±2.2) was significantly higher than the patients who were transferred to the intensive care unit [ICU] (11.7±6.0) (p<0.0001). The cut-off level of BUN/albumin ratio in prediction of the need for ICU was7.2 (sensitivity 80%, specificity 85.4%) and the area under the receiver operating characteristic (ROC) curve was 0.911 (95% CI: 0.861–0.961) (p<0.001). The cut-off level of BUN/albumin ratio in prediction of mortality was 8.1 (sensitivity 88.2%, specificity 85.4%) and the area under the ROC curve was 0.963 (95% CI: 0.930–0.995) (p<0.001).
Conclusion: BUN/albumin ratio can be used as an affordable, inexpensive and practical method for determining the short-term prognosis in hospitalized COPD patients. Prospective studies involving more patients are needed.

17.The Effects of Arginine and Glutamine Used Before Laparoscopic Cholecystectomy on Postoperative Stress Hormones
Yavuz Pirhan, Volkan Taşova
doi: 10.14744/etd.2020.88120  Pages 189 - 193
Objective: Enteral nutrition products containing amino acids of glutamine and arginine were administered to patients to be operated under general anesthesia and the response of stress hormones after surgery was evaluated after surgery. The aim of this study is to examine the effect of enteral nutrition, which is provided 3 days before the surgery and includes glutamine and arginine amino acids, on the stress hormones of the patients.
Materials and Methods: In this study, a total of 60 patients were included and randomly assigned to three different groups (n = 20): glutamine group, arginine group, and control group. The patients who were above 18, were classified as ASA 1–2, and were not pregnant were recruited in this study. All groups except the control group were administered with glutamine (3*2) and arginine (2*1) 3 days before the study was conducted. Cortisol, insulin, insulin resistance, and glucose levels were measured at the 3rd and 24th hour before and after the surgery. All of the participants underwent laparoscopic cholecystectomy in the general surgery clinic department.
Results: Although significant results were obtained regarding the insulin and insulin drain groups in the glutamine and arginine groups compared with the control group, no significant results were found between the glutamine and arginine groups. Among the three groups, significant results were obtained from the arginine group. When all groups were compared, the hospital stay of the patients in the arginine group was shorter than the others. Moreover, the insulin resistance and cortisol levels in the arginine group were slightly increased.
Conclusion: Overall, it was observed that arginine and glutamine amino acids administered before surgery can reduce the surgical stress levels of patients.

18.Correlation between androgen levels and dry eye parameters in males with chronic obstructive pulmonary disease
Duygu Gülmez Sevim, Koray Gumus, inci Gülmez, Metin Unlu
doi: 10.14744/etd.2020.36363  Pages 194 - 200
Objective: To investigate the effects of chronic obstructive pulmonary disease (COPD) in dry eye status in males and whether the hypoandrogenic status has any concomitant impact.
Methods: Eighty patients with stable COPD and individually matched healthy volunteers on the basis of body mass index (BMI), age, and sex were enrolled. Ocular surface testing included ocular surface disease index (OSDI) questionnaire, evaluation of meibomian gland dysfunction (MGD), tear fluorescein break-up time (TF-BUT), ocular surface staining with lissamine green (LG), Schirmer test with topical anesthesia and Sirius meibographic analysis of meibomian gland area (MGA) loss. Bioavailable testosterone and free testosterone (fT) were measured through the measured total testosterone (TT), albumin, and sex hormone binding globulin (SHBG) concentrations.
Results: Patients with COPD had lower levels of circulating androgens, decreased TF-BUT and Schirmer score and increased LG staining score, MGD grade and MG area loss compared to healthy controls (p<0.01). Forced expiratory volume in 1-second (FEV1), FEV1/forced expiratory vital capacity (FVC) and circulating androgen levels were inversely correlated to OSDI score, LG staining, MGD grade and MGA loss and showed positive correlation with TF-BUT and Schirmer score in patients with COPD (p<0.01). However, when adjusted for androgen levels, FEV1 and FEV1/FVC ratio showed a negative correlation with Schirmer score (p<0.05).
Conclusion: Males with COPD had worse tear film parameters, and this finding was more notable in patients with lower androgen levels. Hypoandrogenic status in patients with COPD attributes to dry eye status of the patients independent of their FEV1 and FEV1/FVC status.

CASE REPORT
19.Type 2B Von Willebrand Disease Mimicking Autoimmune Thrombocytopenia in the Neonatal Period
Veysel Gök, Esra Işık, Ebru Yılmaz, Firdevs Aydın, Alper Özcan, Ekrem Ünal, Musa Karakükçü, Tahir Atik, Türkan Patıroğlu
doi: 10.14744/etd.2020.81557  Pages 201 - 203
Background: Type 2B von Willebrand disease (VWD) is a hereditary bleeding disorder caused by changes in the von Willebrand factor (VWF), which increases the binding of VWF to platelets. Type 2B VWD may present with thrombocytopenia.
Case Report: A four-day-old newborn was brought to the neonatal intensive care unit presenting with bleeding and severe thrombocytopenia. The platelet level was 10,000/mm3, and coagulation tests were normal. There were no clinical evidence of sepsis; therefore, alloimmune or autoimmune thrombocytopenia was suspected. When we found out that her mother and relatives had intermittent thrombocytopenia, advanced tests were performed. Ristocetin cofactor activity was low; type 2 VWD was considered. Using low-dose ristocetin, we increased platelet aggregation. Heterozygous c.3946G > A (p.Val1316Met) mutation was detected, and type 2B VWD was diagnosed.
Conclusion: Type 2B VWD may cause a diagnostic problem in the differential diagnosis of neonatal thrombocytopenia including neonatal autoimmune thrombocytopenia.

20.Endovascular Embolization of a Pancreatic Pseudoaneurysm in an Adolescent Girl with Chronic Pancreatitis
Zehra Filiz Karaman, Güven Kahriman, Derya Altay, Muhammed Şamil Aydın, Aytaç Doğan
doi: 10.14744/etd.2020.67355  Pages 204 - 206
Background: Pancreatic pseudoaneurysm (PSA) is a rare, potentially fatal complication of pancreatitis that is commonly associated with a pseudocyst. There is no clear information on the incidence of PSA in children. Surgery and endovascular techniques are the primary treatment options for PSA.
Case Report: We describe the case of a 16-year-old girl with a pancreatic pesudoaneurysm in association with chronic pancreatitis. The diagnosis was made using ultrasonography and magnetic resonance imaging findings. The pseudoaneurysm was successfully treated by endovascular transcatheter embolization without intra- or post-procedural complications.
Conclusion: Early diagnosis and appropriate management are essential to prevent fatal outcomes because the timing of rupture is unpredictable. Endovascular transcatheter embolization of PSA is an invasive, safe, and effective procedure and should be the first choice in the management of PSA.

IMAGE
21.Lemierre’s Syndrome: An Unfortunate Sequela
Athierah Muhammad, Geng Ju Tuang, Tan Ek Guan
doi: 10.14744/etd.2020.24571  Pages 207 - 208
Abstract | Full Text PDF

LETTER TO THE EDITOR
22.Double Disaster: Pandemic and Earthquake
Perihan Şimşek, Abdülkadir Gündüz
doi: 10.14744/etd.2020.03342  Pages 209 - 210
Abstract | Full Text PDF

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