ISSN: 2149-2247 | E-ISSN: 2149-2549
Volume: 43  Issue: 5 - 2021
1.Confusing Terminology in COVID-19: Signs, Symptoms, and Physical Findings
Steven H. Yale, Halil Tekiner, Joseph Mazza, Eileen Yale
doi: 10.14744/etd.2021.67434  Pages 417 - 418
Abstract | Full Text PDF

2.Impact of the Novel Coronavirus Disease 2019 (COVID-19) Pandemic on Cardiac Emergencies and Future Perspectives in Turkey
Ali Çoner, Afsin Emre Kayıpmaz, Elif Çelikel
doi: 10.14744/etd.2021.87523  Pages 419 - 422
SARS-CoV-2-associated COVID-19 pandemic has affected the daily life of people across the world in 2020. Data about the course of viral involvement continues to be accumulated. COVID-19 is a multi-systemic disease, and the clinical presentations and possible complications may vary widely in different patient groups. The cardiovascular system is a primary target of COVID-19, and direct or indirect effects of viral involvement are observed. In addition to the direct effects of viral involvement on the cardiovascular system, decrement in acute cardiac emergencies has been experienced in many cardiology clinics in Turkey during the pandemic. Moreover, there may be a possible increase in out-of-hospital cardiac arrests in the near future. In this narrative review, we aimed to discuss the cardiac manifestations of COVID-19, the possible drug interactions related to the drugs used for COVID-19 management, and the effect of the pandemic on cardiac emergencies. We believe that understanding the natural mechanism of cardiac involvement of SARS-CoV-2 and emphasizing the data about out-of-hospital arrests will help clinicians effectively deal with the preventable cardiovascular causes of death in the forthcoming waves of COVID-19.

3.We do not Know Enough About Burnout Among Medical Residents in Turkey: A Rapid Review of the Literature
Hüseyin Küçükali, Aslıhan Akgöğ
doi: 10.14744/etd.2021.25564  Pages 423 - 426
Studies worldwide have shown that 27–75% of medical residents experience burnout syndrome. There are 26,181 residents in Turkey, and the number has been increasing. In this study, we aimed to review how much Turkish medical residents are represented in the existing literature on burnout syndrome and uncover a possible knowledge gap. In this rapid review, the PubMed database was used to identify studies on burnout syndrome among Turkish medical residents up to June 2020. A search query was designed with a combination of related keywords and narrowed by city, country, and nationality. Fifteen studies were included in the review. These studies were published between 2006 and 2019. Most of them investigated residents from a single specialty (n=7), single center (n=7), or single city (n=10). Nine studies focused only on residents. The minimum, maximum, and median numbers of residents were 11, 270, and 74, respectively. The findings of this review indicate the literature gap on burnout syndrome in medical residents in Turkey. Few studies have addressed this problem, and their findings are insufficient to represent the status of the residents. The authors encourage the scientific community to conduct various studies with rigorous methodologies.

4.Assessment of Fungal Genital Infection Frequency, Antifungal Sensitivity, and the Impact of Hemoglobin A1c Levels on These Infections in Diabetic Children
Burcu Emeklioğlu, Nuri Çakır, Işıl Çakır, Mustafa Kendirci, Ayşe Nedret Koç
doi: 10.14744/etd.2021.35920  Pages 427 - 432
Objective: A positive relationship exists between high blood glucose levels and infection prevalence in patients with diabetes. Hyperglycemia may predispose to fungal infections. This study was conducted to compare the frequency of fungal infections and antifungal agent resistance of culture strains in children with type 1 diabetes mellitus (T1DM) with those in healthy controls and to assess the relationship between fungal infection and hemoglobin A1c (HbA1c) levels.
Materials and Methods: The study population included 67 girls with T1DM and 63 girls without T1DM, immunodeficiency, or chronic drug use. Blood and urine samples were collected, and genital smear sampling was performed. Samples were evaluated in a mycology laboratory, and fluconazole sensitivity of culture samples was determined.
Results: Genital complaints were more common among patients with diabetes. Fungal agents were isolated in 55.22% of patients with diabetes, where Candida glabrata was the most common strain isolated (46.0%). Meanwhile, Candida albicans was more common in the control group (40.0%). All strains were fluconazole-sensitive, as strains with native resistance were excepted. For serum HbA1c levels, a cutoff value of 8.9 was identified and was related to fungal growth with a reliability of 80%. Patients with diabetes for more than 12 months had a higher risk of fungal infection.
Conclusion: Patients with serum HbA1c levels of more than 8.9 and a diabetes duration of more than 12 months should be assessed for fungal infections, and genital smear samples should be obtained periodically during follow-up.

5.Is it Worth Using Thrombolytic Therapy in Elderly Patients with Pulmonary Embolism?
Neslihan Özçelik, Songül Özyurt, Bilge Yilmaz Kara, Dilek Karadoğan, Aziz Gümüş, Ünal Şahin
doi: 10.14744/etd.2021.01460  Pages 433 - 437
Objective: Antithrombotic treatment is avoided in geriatric population owing to its side effects. Thus, we aimed to examine complication rates related to thrombolytic treatment in geriatric patients with pulmonary thromboembolism (PTE).
Materials and Methods: The study included patients aged >65 years who received thrombolytic treatment for a diagnosis of PTE. Patient files were screened retrospectively to extract data on etiology, clinical risk scores, laboratory values, thrombolytic treatment-related complications, and early mortality development.
Results: The study included 68 patients (female: 70.6%; mean age: 77.8 years). The Simplified Pulmonary Embolism Severity Index score was high in all patients. Early mortality risk classification at admission was high, medium-high, and medium-low risk in 64.7%, 23.5%, and 11.8% patients, respectively. In-hospital mortality was 30.9%. The causes of death were secondary to PTE in 85.7% patients, respiratory failure in 9.6%, and sepsis in 4.7%. Complication-related mortality was not observed. The only independent risk factor for mortality was change in consciousness.
Conclusion: Mortality and complication rates in geriatric patients receiving thrombolytic treatment are not as high as expected.

6.Warfarin Treatment: Home Health Services Versus Outpatient Clinics
Sonay Özdemir, Pelin Ünsal
doi: 10.14744/etd.2021.24603  Pages 438 - 442
Objective: Warfarin use is difficult due to the necessity for regular international normalized ratio (INR) monitoring and drug–drug interaction. However, it is still the most widely preferred oral anticoagulant. This study aimed to assess the efficacy and reliability of warfarin use by patients attending outpatient clinics (OC) or who received home health services (HHS).
Materials and Methods: This study included 204 patients followed by OC and HHS and receiving warfarin treatment. Demographic and clinical characteristics and INR monitoring frequency were evaluated. Moreover, complications were retrospectively questioned. The interactions between warfarin use and other medications were assessed. Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol (HAS-BLED) and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) scores were calculated in the atrial fibrillation (AF) group.
Results: The patients followed by HHS were older (78 vs. 68, p<0.001). Cerebrovascular disease was more frequent in the HSS group (51% vs. 29.4%, p=0.002) while AF was more common in the OC group (65.7% vs. 43.1%, p=0.001). Patients with an INR level in the subtherapeutic range were more common in the HHS group (42.2% vs. 24.5%, p=0.025), and thromboembolic complications were also observed more frequently (14.7% versus 10.8%, p=0.013). More than half of the individuals using drugs interacted with warfarin. In AF subgroup, the HAS-BLED and ATRIA scores were higher for HHS group compared with the OC group [HAS-BLED, 2 (1–4) vs. 2 (0–5); ATRIA, 5 (1–7) vs. 2 (0–7); p=0.032 and p<0.001, respectively].
Conclusion: The current study showed that HHS and OC staff should regularly monitor patients’ INR levels and pay attention to drug–drug interactions to reduce complications.

7.Associated Factors Causing Uterine Prolapse in Nongeriatric and Geriatric Female Patient Populations and Analysis of Pathological Diagnoses
Esra Tamburaci
doi: 10.14744/etd.2021.32847  Pages 443 - 448
Objective: Many factors influence the etiology of uterine prolapse (UP). This study, therefore, analyzed factors affecting UP in nongeriatric and geriatric age groups.
Materials and Methods: The 494 patients included in the study were divided into two groups: 317 nongeriatric patients (aged <65; 64.2%) and 177 geriatric patients (aged ≥65; 38.8%). Factors affecting UP were analyzed.
Results: Multivariate logistic regression analysis indicated that in all patients, the number of births (odds ratio [OR]=1.254; 95% confidence interval [CI]=1.081–1.456; p=0.003) and menopause (OR=2.159; 95% CI=5.612–4.334; p=0.031) increased the risk of UP. Receiver operating characteristic (ROC) analysis also indicated that the cutoff point for the number of births in all patients was >3 (area under the curve [AUC]=0.553; 95% CI=0.508–0.597; p=0.037). Although the AUC value (AUC=0.635) calculated for the number of births in patients aged ≥65 was higher than those calculated for body mass index and the number of miscarriages (AUC=0.582 and AUC=0.583, respectively), this difference was not statistically significant (p>0.05).
Conclusion: UP is closely related to the number of births and the presence of menopause. Although no significant correlation was found between age at menopause and the number of births in patients aged <65, a statistically significant positive correlation was found between age at menopause and the number of births in patients aged ≥65.

8.Molecular Testing for Thalassemia: Mutation Detection According to Referral Reasons and Demographic Data
Şule Altıner, Halil Gürhan Karabulut, Sadiye Ekinci, Arzu Vicdan, Nüket Kutlay, Timur Tuncalı, Ajlan Tükün, Hatice Ilgın Ruhi
doi: 10.14744/etd.2021.95226  Pages 449 - 451
Objective: Thalassemia is the most common inherited blood disorder worldwide and an important public health problem in Mediterranean countries such as Turkey. In this study, we aimed to define mutation detection rates according to referral reasons based on molecular testing results.
Materials and Methods: The data of 315 patients tested for thalassemia using the reverse dot-blot method between 2007 and 2017 at the Department of Medical Genetics, Ankara University School of Medicine, were analyzed.
Results: The most frequent mutations were 3.7-kb deletion and IVS1.110 [G>A] for alpha (α)- and beta (β)-thalassemia, respectively. Statistical correlation was found between the samples identified after clinical indication and the mutation detection rate in α-thalassemia (Pearson chi-square two-sided p=0.006). Moroever, a statistically significant correlation was detected between the β-thalassemia mutation rate and positive family history (continuity-to-correction two-sided p=0.002).
Conclusion: Our results highlight the importance of positive family history and evaluation of hematologic parameters and consanguinity in mutation detection for thalassemias.

9.Nonmalignant Lung Pathologies Showing 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Positivity
Sevim Yenigün, Burcu Baran Ketencioğlu, Nuri Tutar, Fatma Sema Oymak, Inci Gülmez
doi: 10.14744/etd.2021.26037  Pages 452 - 457
Objective: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) not only gives information about anatomical features of lung lesions but also about their metabolic activity. This study aimed to determine the mediastinal and parenchymal pathologies of the lung with false-positive FDG involvement and characteristics that could benefit differential diagnosis.
Materials and Methods: This study retrospectively analyzed 1,924 subjects that underwent 18F-FDG PET/CT from December 2010 to January 2015. Subjects with a maximum standardized uptake value (SUVmax) value of ≥2.5 in the lung tissue, mediastinal lymph nodes with no primary lung malignancy, and a benign pathology result were included.
Results: The mean age of the 143 subjects was 61.7±11.0 years. The pathologies anthracosis, granulomatous inflammatory events, and organized pneumonia (OP) were 64 (45%), 36 (25%), and 18 (13%) cases, respectively, in order of frequency. The median SUVmax value of all lesions was 5.2 (min–max, 2.5–37.6). Moreover, mediastinal lymph node involvement was frequent (59%). The median SUVmax value of anthracotic lesions was significantly lower than the median SUVmax value of granulomatous and OP lesions (p<0.001 and p=0.007, respectively). No significant difference in the median SUVmax value was noted between granulomatous and OP lesions.
Conclusion: Anthracosis and tuberculosis should be considered as benign causes of mediastinal lymph node positivity in developing countries. 18F-FDG PET/BT is an unreliable method for the differential diagnosis of benign diseases characterized by inflammation. Thus, metabolic activity evaluation is more suitable.

10.The Relationship Between Diet Quality of Adolescents with Type 1 Diabetes and Nutritional Status and Biochemical Parameters
Gülsüm Şahin Bodur, Alev Keser, Zeynep Sıklar, Merih Berberoğlu
doi: 10.14744/etd.2021.75133  Pages 458 - 464
Objective: Studies have shown that adolescents with type 1 diabetes do not have adequate diet quality and are, therefore, at risk for macro/microcomplications and growth retardation. This study aims to determine the diet quality of adolescents with type 1 diabetes and evaluate the relationship between diet quality and nutritional status as well as biochemical parameters.
Materials and Methods: This cross-sectional study consisted of adolescents (10–19 years old) with type 1 diabetes. The questionnaire administered to the participants is composed of sociodemographic characteristics, anthropometric measurements, and biochemical data. Furthermore, the food consumption status of the participants was determined by a 3-day food consumption record. HEI-2010 score calculated and adolescents are classified according to their diet quality.
Results: The majority of the adolescents with type 1 diabetes who participated in the study were found to have needs improvement diet quality. However, very few participants were with good diet quality. A weak and negative relationship between exist diet quality scores of the male participants and their waist circumferences and HbA1c (p<0.05) values.
Conclusion: Diet quality has been thought to have an important role in the medical nutrition treatment of type 1 diabetes which is related to blood glucose control and blood lipid profile nutritional status. Therefore, the diet quality of adolescents with type 1 diabetes should be increased.

11.An Evaluation of the Effect of the Clinical Features of Patients and the Drugs Used on the False-Positive EIA Test for HIV
Filiz Orak, Adem Doğaner, Kezban Tülay Yalçınkaya, Murat Aral
doi: 10.14744/etd.2021.34682  Pages 465 - 469
Objective: Human immunodeficiency virus (HIV) false positivity is one of the common misdiagnoses in laboratories. Thus, only positive results obtained by confirmatory tests should be considered positive while other types of screening tests should instead be referred to as reactive. This study investigated false HIV positivity via the sociodemographic characteristics of the patient, clinical diagnosis, and the relationship with the drugs used.
Materials and Methods: From January 2017 to October 2018, 25,180 patients were tested for HIV with the fourth-generation antigen/antibody EIA. Reactive test results were sent to the Public Health Institution in Turkey to confirm the test results with immunoblot or polymerase chain reaction.
Results: Of the samples, 23 (0.091%) and 113 (0.44%) were found to be HIV-positive and HIV-negative. Confirmation tests were performed on 136 samples. Consequently, 113 samples were confirmed to be negative and, therefore, considered as false positives. A distributional relationship was found between HIV false positivity and patients hospitalized in clinics of infectious diseases, hematology, and orthopedics (χ2=49.048; p=0.001), and patients diagnosed with neoplasm or soft tissue infection (χ2=51.699; p=0.001). Moreover, the rate of false positivity significantly increased with the use of antibiotics, steroidal/nonsteroidal drugs, immunoglobulin preparations, and antithrombotic drugs.
Conclusion: Since HIV tests used in a low prevalence population are commonly testing low-risk individuals, the reactive tests can lead to false-positive results rather than true-positive. Thus, screening test results alone should not be relied upon for this diagnosis.

12.Prognostic Significance of Blood Parameters in COVID-19 Pneumonia
Nazlı Görmeli Kurt, Celal Güneş
doi: 10.14744/etd.2021.23080  Pages 470 - 474
Objective: We aimed to predict disease severity by studying the admission blood parameters of patients diagnosed with novel coronavirus disease 2019 (COVID-19).
Materials and Methods: We retrospectively reviewed the medical data of 217 patients diagnosed with COVID-19 infection and 86 sex-matched and age-matched healthy controls without this infection. The patient group was divided into the following two subgroups: the severe (n=93) group and the non-severe (n=124) group. We compared the demographic characteristics, admission complaints, and admission blood parameters of the patient group with those of the control group. We also compared the above-mentioned parameters of the two patient subgroups.
Results: The patient group had a significantly lower white blood cell count, lymphocyte count, monocyte count, and platelet count (p=0.002, p<0.001, p<0.001, and p<0.001, respectively) and a significantly higher C-reactive protein level (p<0.001) than the control group did. The leucocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and ferritin level were significantly higher in the severe disease subgroup than those in the non-severe subgroup (p<0.001). The lymphocyte count and lymphocyte to monocyte ratio (LMR) were significantly lower in the severe disease subgroup than those in the non-severe subgroup (p<0.001). We performed a logistic regression analysis and obtained the odds ratios (OR) of several factors. This analysis showed that NLR was positively correlated with the COVID-19 risk (adjusted OR 1.438, p=0.012). However, the association of PLR and LMR with COVID-19 risk remained unclear.
Conclusion: The ability to predict prognosis using blood parameters that are routinely assessed at admission can save considerable time and financial resources. We believe that we can predict the prognosis of COVID-19 patients using the admission NLR levels.

13.Investigation of Angiotensinogen M235T and T174M Gene Polymorphisms in Coronary Artery Disease
Bilge Eren Yamasan, Tevfik Gülyaşar, Tammam Sipahi, Nasır Sivri, Orkide Palabıyık
doi: 10.14744/etd.2021.08784  Pages 475 - 481
Objective: Coronary artery disease (CAD) is a multifactorial disorder and is caused by both environmental and genetic factors. As the alterations in angiotensinogen (AGT) gene lead to changes in angiotensin II and plasma levels of AGT, variants of this gene may play a role in CAD pathogenesis. This study aimed to investigate the relationship between CAD and polymorphisms of AGT gene at M235T and T174M regions. Moreover, the associations of potential risk factors with these gene regions and CAD were investigated.
Materials and Methods: In total, the study enrolled 214 cases with CAD and 200 controls. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) were used to detect polymorphisms at M235T and T174M. PCR products were electrophoresed on 2% agarose gel, with ethidium bromide, and were then examined under ultraviolet light. Subsequently, RFLP was used to detect gene polymorphisms. A multiple binary logistic regression model was used to investigate the association of risk factors with both CAD and AGT variants.
Results: The number of TT polymorphisms at M235T were significantly higher in the case group than in control group. However, there were no significant differences between cases and controls regarding T174M gene polymorphisms. The presence of hypertension, low high-density lipoprotein level, alcohol consumption, and family history were associated with CAD.
Conclusion: TT polymorphisms at the M235T region in AGT can be an influential factor in the development of CAD.

14.Serum Magnesium Level and Dietary Magnesium Intake in Patients with Hypertension-Related Complications
Buse Bakır, Habibe Şahin, Ali Doğan
doi: 10.14744/etd.2021.49225  Pages 482 - 486
Objective: The objective of this study is to evaluate serum magnesium levels, dietary magnesium intake, and their relationships with hypertensive complications in adults with hypertension (HT).
Materials and Methods: Patients with HT for ≥10 years were divided into two groups for evaluation. Although the case group comprised 34 patients having at least one of the hypertensive complications of atherosclerosis, heart failure, and renal failure, the control group comprised 34 patients with HT without complications. In addition to demographic information, anthropometric measurements (body weight, height, waist circumference [WC]), and medical information of the patients were collected, dietary information was acquired via a three-day food record.
Results: Dietary magnesium intake was similar in both the groups; however, both values were below the recommended daily intake. The case group had significantly lower serum magnesium level than the control group. We found no correlations between serum magnesium and dietary magnesium intake level. Low serum magnesium level was a possible risk factor for complications (OR: 9.02, 95% CI: 3.00–27.10). Serum magnesium concentration was negatively correlated with the duration of HT, WC, fasting blood glucose; however, it positively correlated with the estimated glomerular filtration rate. Although the mean body mass index levels were similar, the mean WC was higher in the case group than in the control group.
Conclusion: In conclusion, this study’s results clearly showed insufficient dietary magnesium intake and lower serum magnesium levels in patients with hypertensive complications. Serum magnesium level was also found to be correlated with some parameters closely related to the complications of HT.

15.Characterization of Cancer Immune Landscape in Primary Central Nervous System Lymphoma
Fei Fei, Kai Wang, Deniz Peker
doi: 10.14744/etd.2021.25593  Pages 487 - 493
Objective: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal variant of non-Hodgkin lymphomas with disease confined to the brain, spinal cord, leptomeninges, or orbit, without evidence of systemic involvement. PCNSL has a poor prognosis, with a median overall survival of 30–50 months. We used NanoString Technologies to characterize the cancer immune profiles in PCNSL and associated the findings with clinical outcome.
Materials and Methods: A total of 33 patients between 2005 and 2017 were included in our study, and clinical information was collected. A PanCancer IO 360 panel (NanoString Technologies) was used to assess the expression level of 770 genes related to tumor immunity in 12 samples. We also investigated the programmed death ligand 1 (PD-L1) expression and T-cell infiltrate in 25 PCNSL samples using immunohistochemistry.
Results: NanoString analysis showed that gene expressions differed between human immunodeficiency virus (HIV)-positive and HIV-negative PCNSL. We identified four genes with deregulated expressions (adjusted p<0.05) with a cluster enrichment in cytotoxicity, DNA damage repair, interferon signaling, and lymphoid compartment-related genes. Furthermore, we found that PD-L1 was expressed in 9 of 25 (36%) cases and 11 had increased CD3+ T-cell infiltrates. However, increased PD-L1 expression and CD3+ T-cell infiltrates were not correlated with the clinical outcome.
Conclusion: Our data reveals a distinct PCNSL tumor microenvironment and immune landscape. However, our study needs to be validated in a larger population.

16.The Role of the Quick Sequential Organ Failure Assessment Score (qSOFA) in the Pre-Hospitalization Prediction of Coronavirus Disease 2019 (COVID-19) Prognosis
Eren Usul, Semih Korkut
doi: 10.14744/etd.2021.78476  Pages 494 - 498
Objective: Researchers have been investigating numerous biomarkers and scoring systems to predict the prognosis of coronavirus disease 2019 (COVID-19). We aimed to determine the effectiveness of the quick sequential organ failure assessment (qSOFA) scoring system in pre-hospital emergency health care for predicting COVID-19 prognosis in terms of the intensive care unit (ICU) admission and mortality.
Materials and Methods: We enrolled 9850 patients suspected to have COVID-19 who were transferred by 112 emergency medical services (EMS) between April 1, 2020 and July 1, 2020. Demographic and clinical data of the patients were obtained from the Ankara Emergency Health Services Automation System. The qSOFA score was calculated based on the data obtained from the ambulance medical records.
Results: The 28-day mortality rate was 6.2% (n=13) and the cut-off for the qSOFA score was >1 [area under the curve (AUC)=0.955, sensitivity 84.62%, specificity 90.4%, p<0.001, 95% confidence interval (CI): 0.918–0.979)]. The cut-off for ICU admission was a qSOFA score >1 (AUC=0.942; sensitivity 97.37%; specificity 84.97%; p<0.001; 95% CI, 0.901–0.969). The mortality risk was 51.8 times more in patients with a high qSOFA score (p<0.001; 95% CI, 10.682–251.340). Moreover, patients with a high qSOFA score were 47.7 times more likely to require ICU admission (p<0.001; 95% CI, 16.735–136.039).
Conclusion: Thus, the pre-hospital qSOFA score that comprises the ambulance vital signs of the patients can be used to predict ICU admissions and mortality in patients with COVID-19.

17.A Case of Primary Hyperparathyroidism Coincident with Advanced Iliac Artery Aneurism
Savaş Volkan Kişioğlu, Yasemin Emür Günay, Selçuk Akkaya, Irfan Nuhoğlu
doi: 10.14744/etd.2020.31391  Pages 499 - 501
Background: Primary hyperparathyroidism (PHPT) is a clinical entity characterized by clinical symptoms specific to high parathyroid hormone (PTH) and hypercalcemia. Patients are generally asymptomatic, and high calcium levels are detected by biochemical tests. We present a case of a patient with a rare vascular complication of hyperparathyroidism.
Case Report: In our 58-year-old male patient, a high calcium level was attributed to PHPT. The iliac artery aneurysm detected in our patient was evaluated as a complication of an elevated PTH level. No risk factors for IAA were detected in the patient’s history. Surgery was performed for the iliac artery, followed by parathyroidectomy.
Conclusion: In this case report, a PHPT case without a risk factor for IAA is presented. This case demonstrates the relation between higher PTH levels and vascular damage. This case presented with the absence of advanced-stage iliac artery aneurism with PHPT coexistence.

18.A Rare Duplication in the PLAG1 Gene: A Case of Neonatal Diabetes
Berna Hekimoğlu, Şenol Çitli
doi: 10.14744/etd.2020.43799  Pages 502 - 504
Background: Neonatal diabetes mellitus (NDM) is a rare form of diabetes. It occurs due to several different genetic abnormalities, and two main groups have been recognized, transient and permanent. Although insulin is often used as a first-line treatment for transient types, this mode of therapy is not helpful in some cases.
Case Report: We present a newborn case treated with oral sulfonylurea diagnosed as transient type NDM in the first days of life. The chromosomal microarray analysis detected a rare de novo duplication of 3383 kb in the 6q24.1q24.2 region.
Conclusion: An oral sulfonylurea treatment is a useful treatment option in the management of neonatal diabetes cases. This report describes a rare deletion that has not been described in the literature to date. Advanced genetic evaluation is vital for early diagnosis and intervention in patients with chromosome 6q duplication.

19.Full Recovery of a Child with Fulminant Myocarditis after Levosimendan Therapy
Mustafa Argun, Işın Sönmez, Hasan Samsa, Onur Yilmaz, Mustafa Yılmaz
doi: 10.14744/etd.2020.87513  Pages 505 - 507
Background: Fulminant myocarditis is a rare, life-threatening condition. Decompensated heart failure caused by fulminant myocarditis is managed with inotropic agents, mechanical ventilation, and mechanical circulatory support. Levosimendan is a novel inotropic agent that also has vasodilatory and cardioprotective properties. However, information about levosimendan use in children is limited in the literature.
Case Report: We report the full recovery of a 3.5-year-old male patient with an inotrope-resistant heart failure treated with levosimendan therapy who was diagnosed as having fulminant myocarditis after presenting with acute decompensated heart failure and low cardiac output.
Conclusion: Levosimendan therapy may offer an effective treatment for children with acute decompensated heart failure secondary to fulminant myocarditis resistant to standard therapy.

20.Adult-Onset Cervical Cystic Lymphangioma
Geng Ju Tuang, Athierah Muhammad, Nurhayati Hamid
doi: 10.14744/etd.2020.41961  Pages 508 - 509
Abstract | Full Text PDF

21.Vulvar Fibroadenoma: An Unusual Cause of Vulvar Mass
Recep Bedir, Mehpare Suntur, Şenol Şentürk
doi: 10.14744/etd.2021.08684  Pages 510 - 511
Abstract | Full Text PDF

22.Impact of Chronic Liver Disease on COVID-19 Mortality: The Erciyes University COVID-19 Center Experience
Fabio Castellano, Rinaldo Pellicano
doi: 10.14744/etd.2020.30111  Page 512
Abstract | Full Text PDF

23.Cancer in Ottoman Surgical Books – Part I: Classical Period (1450–1730)
Ahmet Acıduman, Uygur Er, Deniz Belen
doi: 10.14744/etd.2021.14603  Pages 513 - 518
Objective: Cancer is a disease known since prehistoric times; and both Western and Eastern medical literature have many works contain its causes and treatment during the ancient and medieval times. The aim of this study is to introduce cancer and its treatment in Ottoman jarrāh-nāmes in the classical period (1450–1730) and to make a contribution to literature of Turkish history of medicine by determining the place of this information.
Materials and Methods: Surgeon Masʿūd’s Tarjamat al-Khulāṣa fī Fenn al-Jirāḥa, Sharaf al-dīn Ṣabunjıoghlı’s Jarrāhiyyat al-Khāniyya, Jarrāh-nāme of unknown author and Surgeon İbrāhīm’s ʿAlāʾim-i Jarrāḥīn were examined. However, after the comparison, ʿAlāʾim-i Jarrāḥīn and Jarrāhiyyat al-Khāniyya were excluded from this study. A brief information was given firstly about the work and its author, and then the sections regarding cancer were presented in the Results section. The information on cancer in these works evaluated in the light of the relevant literature and period in the Discussion section.
Results: Surgeon Masʿūd’s Khulāṣa contains chapters about cancers on the head, trunk, breast and heel and their treatments. Jarrāh-nāme of unknown author comprises a section in which the treatment of cancer is generally mentioned without specifying the place of occurrence.
Conclusion: Although it is seen that Ottoman Jarrāh-nāmes in the classical period dealt with the cancer within the scope of medical practices in the Islamic civilization in the medieval times and almost all of the works examined in this study were translations.

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