ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 44 (1)
Volume: 44  Issue: 1 - 2022
EDITORIAL COMMENTS
1.Drug Patents: A Historical Look at a Controversial Subject
Bruno Guy Bonnemain
doi: 10.14744/etd.2021.78370  Pages 1 - 2
Abstract | Full Text PDF

INVITED REVIEW
2.Coronavirus Disease Mortality: Understanding Regional Differences
Daniele Rigamonti, Roberto Leonardi, Jaffar Al-Tawfiq
doi: 10.14744/etd.2021.42949  Pages 3 - 7
Since the emergence of the coronavirus disease (COVID-19) pandemic, the world has struggled to contain it and deal with the in-creasing number of deaths. There have been reported variations in the incidence, prevalence, and fatality rates. These variations were thought to be multifactorial rather than due solely to unique characteristics or interventions. This work reviews data publicly available regarding COVID-19 and discusses the possible reasons for the regional variabilities of prevalence and mortality.

REVIEW
3.Serum Adropin: Pathogenesis and Clinical Research in Cardiovascular Disease
Lütfü Aşkın, Hüsna Şengül Aşkın, Okan Tanrıverdi, Yusuf Hoşoğlu
doi: 10.14744/etd.2021.23571  Pages 8 - 11
Adropin is a peptide hormone that acts as a stabilizing factor in body energy metabolism and may be a marker for cardio-vascular disease (CVD). The serum adropin level has been shown to be positively correlated with the nitrite/nitrate level and adropin appears to provide a protective endothelial function. Adropin has been reported to play a protective role in heart failure and hypertension. The underlying mechanism may help to reduce obesity and insulin resistance, improve endothelial dysfunction, and modulate the activity of the nervous system. Adropin regulates the cardiac energy cycle through a series of reactions, such as insulin signaling, glucose, and fat oxidation. This regulation of the energy circuit may represent a source of an alternative therapy for obese diabetes. The objective of this review was to contribute to the literature by examining research of the expression, processing, biological function, and role of adropin in the prevention of CVD.

ORIGINAL ARTICLE
4.Computed Tomography Features of Pulmonary Hydatid Cysts: Factors Related to Cyst Rupture and Clinical and Therapeutic Issues
Mehmet Tahtabaşı, Tuğrul Hoşbul
doi: 10.14744/etd.2021.41524  Pages 12 - 19
Objective: The aim of this study was to present computed tomography (CT) findings associated with the rupture of a pulmonary hydatid cyst (HC) and to assess related factors. HC rupture is a serious and potentially life-threatening complication of hydatid disease, also known as echinococcosis.
Materials and Methods: The case records of 125 patients with a confirmed pulmonary HC and who underwent CT evaluation were included and studied retrospectively. The CT images were analyzed for radiologic findings and signs of rupture, and the cysts were classified based on a manifestation of rupture and size (giant cyst).
Results: In the group, 52% of the patients were female. It was determined that 60.8% (n=76) of the cysts were solitary, and most were located in the right lung (n=71, 54.4%), lower lobes (n=83, 66.4%), or periphery (n=92, 73.6%). There were 64 (51.2%) ruptured cysts. The most common finding in cases of contained rupture cases was the air bubble sign (n=16, 12.8%), and the water lily sign (n=13, 10.4%) was most frequent in complete rupture cases. The rates of airway compression, consolidation, pleural effusion, cysto-bronchial fistula, and lung resection were significantly higher in cases of ruptured cysts, in addition to the length of hospitalization (p<0.05). The prevalence of giant cysts was 12.8% (n=6), and these cases demonstrated a significantly higher incidence of a central location, airway compression, consolidation, rupture, and elevated C-reactive protein level (p<0.05).
Conclusion: The majority of the pulmonary HCs reviewed were solitary and located in the lower lobes and periphery. The results revealed that the morbidity and lung resection rates, as well as length of hospitalization, were higher in cases of ruptured cysts as a result of airway compression, consolidation, and bronchial fistulas. Pulmonary HC should be evaluated with CT early and treated surgically to avoid further complications.

5.The Role of Matrix Metalloproteinase-1 (-1607 1G/2G) Gene Variation in Ischemic Stroke Development
Nevra Alkanlı, Arzu Ay, Sezgin Kehaya
doi: 10.14744/etd.2021.87012  Pages 20 - 25
Objective: The matrix metalloproteinase (MMP) family is a potential genetic risk factor for the development of cerebrovascular disease, including ischemic stroke. MMP-1 (-1607 1G/2G) gene variation can lead to excessive MMP-1 protein production and MMP-1 enzyme activity. MMPs have an important role in the pathophysiology ischemic stroke pathophysiology and clinical outcome. Thus, the sensitivity to ischemic stroke may vary according to genetic characteristics. The objective of this study was to investigate the effect of MMP-1 (-1607 1G/2G) gene variation in the development of ischemic stroke disease in the population of Thrace, Turkey.
Materials and Methods: In all, 87 ischemic stroke patients and 80 healthy controls were enrolled in the study. Polymerase chain reaction and restriction fragment length polymorphism methods were used to determine the genotype distribution of MMP-1 (-1607 1G/2G) gene variations.
Results: There were more 1G/1G genotype (56.9%) and 1G/2G genotypes (55.1%) of MMP-1 (-1607 1G/2G) gene variations in the patient group than in the control group. However, no significant difference was determined between the groups in the distribution of MMP-1 (-1607 1G/2G) gene variation genotypes (p=0.127). The allele frequency of MMP-1 (-1607 1G/2G) gene variation in the ischemic stroke patient and healthy control groups was not significantly different from the Hardy-Weinberg distribution (p=0.6556 and p=0.0501, respectively).
Conclusion: The 1G/1G and 1G/2G genotypes of MMP-1 (-1607 1G/2G) gene variation were observed more frequently in the ischemic stroke group compared with the healthy control group. However, the MMP-1 (-1607 1G/2G) gene variation was not determined to be a genetic risk factor for the development of ischemic stroke in the population of Thrace region of Turkey.

6.The Effect of the Coronavirus Disease-19 Pandemic Process on Midwifery and Nursing Students’ Tendency to Violence
Zümrüt Yılar Erkek, Tülay Yılmaz Bingöl, Serap Öztürk Altınayak
doi: 10.14744/etd.2021.94715  Pages 26 - 32
Objective: This study was carried out to determine the effect of the coronavirus disease-19 pandemic process on midwifery and nursing students’ tendency toward violence.
Materials and Methods: The study, which used a cross-sectional descriptive design, was carried out with 549 university students studying midwifery and nursing. Data were collected using “Socio-Demographic Data Form” and “Violence Tenden-cy Scale.” Research data were collected between March 23, 2020 and September 15, 2020. The study was implemented online. The questionnaires were uploaded to https: //docs.google.com/forms/ and the link to the questionnaires was sent to the students through e-mail and WhatsApp.
Results: The pre-pandemic and while-pandemic median values of the violence tendency scale of the students were found to be 35 (min: 20–max: 86) and 34 (min: 20–max: 71), respectively, and the difference between the two was statistically significant (p=0.004). The tendency of students to violence who were male was studying nursing, was 2nd and 3rd-year stu-dents, graduated from a health vocational high school, had inadequate income, had a nuclear family, and were placed in their departments with low scores, statistically significantly decreased during the pandemic process (p<005).
Conclusion: In conclusion, it was determined that the tendency of nursing and midwifery undergraduate students toward violence was low before and during the pandemic process and that their tendency toward violence decreased during the pandemic process. We recommend that topics about violence should be integrated into the curriculum of future midwives and nurses and that training programs raising awareness and informing students should be organized especially during the pandemic process when the rate of violence is on the increase.

7.Exon-2 Genotypes May Explain Typical Clinical Features of Familial Mediterranean Fever with Milder Disease Activity
Serkan Türkuçar, Hatice Adıgüzel Dündar, Ceren Yılmaz Uzman, Erbil Ünsal
doi: 10.14744/etd.2021.15579  Pages 33 - 38
Objective: Familial Mediterranean fever (FMF) is the most prevalent monogenic autoinflammatory disease worldwide. The diagnosis is primarily clinical, based on severity of the disease, and confirmed by mutations of the MEFV gene. The aim of this study was to evaluate the effect of exon-2 genotypic variants on clinical signs and symptoms and the severity of FMF in children in comparison with those with an exon-10 genotypic variant.
Materials and Methods: The demographic, clinical, and laboratory data of 164 pediatric FMF patients were evaluated. The patients were classified into 3 groups according to MEFV mutations: patients with a variation in only the exon-2 genotype, both the exon-2 and exon-10 genotypes, and only the exon-10 genotype.
Results: There was no statistically significant difference between the 3 groups in terms of the sex or age at diagnosis, medical history of recurrent tonsillitis, history of appendectomy, or anthropometric features (p>0.05, for both parameters). However, the median age at the first attack was significantly lower in patients with only an exon-10 genotypic variant (median: 4.16 years [interquartile range: 2.5-5.5 years]) (p=0.038). Evaluation of the clinical features of all of the groups revealed that the frequency of attack and attack-free period symptoms were similar (p>0.05). However, the median disease severity score was lower in patients with only exon-2 genotypic variants than patients with exon-10 and compound heterozygous genotype variants (p=0.017).
Conclusion: FMF should be carefully evaluated according to the genotypic and phenotypic characteristics; all potential MEFV gene mutations should be considered. Variants of exon-2 appear to result in milder clinical symptoms in comparison with exon-10 variants.

8.Cesarean Rate and Indications at a Tertiary Center
Ayça Nazlı Bulut, Venhar Ceyhan
doi: 10.14744/etd.2021.64022  Pages 39 - 43
Objective: The aim of this study was to assess the change in the frequency of cesarean delivery and indications for a cesarean section procedure over a 2-year time period at a tertiary center.
Materials and Methods: A retrospective examination of all births that occurred at the Kayseri Training and Research Hospital between May 2018 and April 2020 was conducted. The data of patients who had a cesarean delivery were recorded and compared by year. The Robson Ten Group Classification System of perinatal events and outcomes was used to categorize the deliveries.
Results: A total of 18,576 patients gave birth in the hospital during the study period. The rate of vaginal delivery was 65.11% and the cesarean delivery rate was 34.89%. During the period May 2018-April 2019, 32.64% of deliveries were by cesarean section, and the rate was 36.87% in May 2019-April 2020. The most common indication for a cesarean procedure was a history of cesarean delivery, followed by fetal distress.
Conclusion: The 2-year rate of cesarean deliveries in the hospital was 34.89%, which is well below the mean rate for Turkey. As seen in the literature, the most common indication for a cesarean delivery was a history of a previous cesarean procedure, and the most common indication for a primary cesarean was fetal distress.

9.One-Year Outcome Comparison of Polyetheretherketone Cage and Disc Prosthesis in Cervical Disc Replacement Surgery
Ayşegül Irmak, Burçak Söylemez
doi: 10.14744/etd.2021.96493  Pages 44 - 50
Objective: Anterior cervical microdiscectomy (ACD) is an established surgical method to treat cervical disc disease. Since ACD changes the natural distribution of biomechanical forces, grafts are often used. The most commonly used grafts are a polyetheretherketone (PEEK) cage or a cervical disc prothesis (CDP). This study is a comparison of the early period results of single-level ACD performed using a PEEK cage or a CDP.
Materials and Methods: A total of 80 patients with a single-level cervical disc herniation who underwent ACD with PEEK cage (n=40) or CDP (n=40) implantation between 2015–2018 at a single center were retrospectively evaluated. The Cobb angle, T1-slope angle, segmental fusion angle, cervical-tilt angle, and disc height at the operated level were measured using cervical lateral radiographs and magnetic resonance images obtained preoperatively and at 1 day, 1 month, and 12 months postoperative. Neck pain was also evaluated pre- and postoperatively.
Results: No statistically significant difference was seen between the groups in the parameters measured at the first and 12th months (p=0.481). In both groups, the preoperative and 12th-month measurements were found to be statistically significant (p=0.001). The development of adjacent segment disease (ASD) was not statistically different between groups.
Conclusion: Although a CDP has some advantages in short-term outcomes, there is still insufficient evidence regarding long-term outcomes, particularly regarding the prevention of ASD. CDP implantation offers an earlier return to work and no requirement for an external cervical orthosis, but due to the high cost and some specific complications, such as implant dis-location, heterotopic ossification, and fusion, CPD is still far from a gold-standard treatment option, even for selected cases.

10.Surgical Experience: Wrist Ganglion Cyst Treatment and Outcomes
Mehmet Cenk Turgut, Serdar Toy
doi: 10.14744/etd.2021.38739  Pages 51 - 55
Objective: Ganglion cysts, the most common benign soft tissue tumors, are most often located in the wrist. This study describes successful surgical outcomes of wrist ganglion cyst treatment, and provides guidance related to an adequate excision.
Materials and Methods: A total of 74 patients (46 females and 28 males, aged 18–46 years) treated operatively for a wrist ganglion cyst between January 2018 and January 2020 were included in the study. The surgical results were evaluated after a minimum 12-month follow-up period. Details of patient sex, age, affected limb, preoperative symptoms, cyst location and complications, the severity of pain, and postsurgical recurrence rate were recorded. The pain, recurrence rate, and localiza-tion data were analyzed statistically.
Results: The mean patient age was 26.15±6.61 years and the mean length of follow-up was 22.55±7.97 months. The cysts studied were located in the dorsal (n=53, 71.6%), volar (n=19, 25.7%), or ulnar aspect of the wrist (n=2, 2.7%). The 12-month postoperative follow-up visits revealed that 70 (94.6%) patients had developed no symptoms. The preoperative and postoperative mean visual analog scale score was 6.07±1.07 and 2.03±0.89, respectively.
Conclusion: Operative treatment is a widely recognized method of management for wrist ganglion cysts. The results of this study indicated that a careful and appropriate capsule excision reduced the rate of persistent symptoms and recurrence in ganglion cyst surgery.

11.Comparison of the Effectiveness of Rapamycin and Gabapentin Treatment in Rats with Induced Sciatic Nerve Injury
Mehmet Canpolat, Halis Ali Çolpak, Dilek Günay Canpolat, Gözde Özge Önder, Mehmet Fatih Yetkin, Arzu Hanım Yay, Gözde Ertürk Zararsız, Sefer Kumandaş
doi: 10.14744/etd.2021.87405  Pages 56 - 62
Objective: The purpose of this study was to compare the therapeutic effects of gabapentin (GBP) and different doses of rapamycin (RAPA) in an induced sciatic nerve (SN)-injury rat model.
Materials and Methods: The study consisted of 7 groups: Control, Sham, High-dose rapamycin (RAPA-H), Low-dose rapamycin (RAPA-L), GBP, DMSO and DMSO+nerve injury (DMSO+NI). Medical treatment was administered intraperitoneally for 30 days after the induction of SN injury.
Results: Significant differences (p<0.001 for all) were found in comparisons between the groups in terms of axon diameter, axon number, and neurofilament (NF) and S100 immunointensity. Among the treatment groups, the highest mean axon diameter value, close to that of the Control group, was seen in the RAPA-L group. In terms of axon number, the value closest to that of the Control group was measured in the GBP group. The NF and S100 immunodensity in the RAPA-L group was similar to that of the GBP group. The S100 immunodensity in the RAPA-L group was closest to that of the Control group. The highest conduction velocity and distal latency values were recorded in the RAPA-L group.
Conclusion: The histological and electrophysiological findings observed in this study suggest that RAPA-L treatment is a promising alternative to GBP.

12.Analysis of HIV Infection in Cyprus Using a Mathematical Model
Nazife Sultanoğlu, Farouk Saad, Tamer Şanlıdağ, Evren Hıncal, Murat Sayan, Bilgen Kaymakamzade, Kaya Süer
doi: 10.14744/etd.2021.32855  Pages 63 - 67
Objective: The Mediterranean island of Cyprus has a high rate of human transit as a result of tourism, human trafficking, and migration, which could contribute to the rate of HIV infection. The island is divided into 2 states – the northern portion is mainly populated by Turkish-Cypriots, and the southern portion is populated by Greek-Cypriots. The aim of this study was to assess the dynamics of HIV infection in both segments of Cyprus using a mathematical model.
Materials and Methods: Data of HIV-positive individuals diagnosed during the period 1997–2018 in northern Cyprus were obtained from the Turkish Republic of Northern Cyprus Ministry of Health database, yielding a total of 129 cases, and data for the southern region, the Republic of Cyprus, were retrieved from a European Centre for Disease Prevention and Control (ECDC) 2013 report and ECDC/World Health Organization 2017 data. The total number of reported HIV infections was 1057. A mathematical model was used to evaluate the current and future HIV infection rate.
Results: Stability analysis of the equilibrium point – disease-free or endemic – was conducted using the Lyapunov function. The basic reproduction number, represented as R0, is a measure of the potential for disease spread and serves as a threshold for stability. The R0 value was 0.83 in northern Cyprus and 0.040 in southern Cyprus. An R0 indicated a disease-free equilibrium.
Conclusion: The calculations suggest that there is no current HIV epidemic on either part of the island; however, the model predicted a significant increase in the near future.

13.Comparison of Nursing Home-acquired Pneumonia and Community-acquired Pneumonia and Evaluation of Factors Predicting Mortality
Halil Ilker Yencilek, Alp Şener, Ayhan Özhasenekler, Mehmet Ergin, Gül Pamukçu Günaydın, Servan Gökhan, Özcan Erel, Salim Neşelioğlu
doi: 10.14744/etd.2021.20502  Pages 68 - 76
Objective: The number of admissions to the emergency department (ED) of elderly patients who reside in nursing homes with a diagnosis of pneumonia continues to grow. This study was designed to assess factors that predicted mortality in the patient group defined as those with nursing home-acquired pneumonia (NHAP).
Materials and Methods: This was a prospective, observational study conducted in a hospital ED. The data of nursing home patients admitted to the ED with a pneumonia presentation (NHAP) were compared with those of patients with community-acquired pneumonia (CAP). Factors that predicted mortality in the NHAP group were analyzed. SPSS for Windows, Version 16.0 software (SPSS Inc., Chicago, IL, USA) was used to perform the statistical analysis.
Results: A total of 98 patients >18 years of age, 36 of whom were NHAP patients, were included in the research. The risk level and rates of intensive care admission and mortality were significantly higher in the NHAP group (p<0.05), and the thiol level, an antioxidant parameter, was lower in the NHAP group than that of the CAP group (p<0.001). Evaluation of the NHAP group alone revealed a higher mortality rate in patients with congestive heart failure, those hospitalized in intensive care, and those with high risk scores (p<0.05). The shock index (SI) value was found to be an independent predictor of mortality in the NHAP group. The study results indicated that each 0.1 unit increase in the SI increased mortality 3.637 times (95% confidence interval: 1.024-12.921) (p=0.046).
Conclusion: The findings suggest that the SI could serve as a valuable marker for predicting mortality in NHAP patients.

14.Tracheostomy in Covid-19 Patients: A Retrospective Observational Study
Hayriye Cankar Dal, Sema Turan
doi: 10.14744/etd.2021.07266  Pages 77 - 81
Objective: During the COVID-19 pandemic, many patients require intensive care unit (ICU) hospitalization with mechanical ventilation (MV). There is still no clear information about the timing and indications of tracheostomy in COVID-19 cases. We aimed to evaluate the relationship between the timing of tracheostomy and outcomes of critical COVID-19 cases.
Materials and Methods: This single-center, retrospective, observational study included patients with COVID-19 who were intubated in the ICU between November 1, 2020 and February 1, 2021, and underwent percutaneous tracheostomy. Demographic data of all patients, the day each patient underwent a percutaneous tracheostomy, the complications related to the procedure, laboratory data, mortality, MV duration, and ICU length of stay (LOS) were recorded.
Results: The study included 33 critically ill patients with COVID-19 undergoing tracheostomy. Among these cases, 18 (54.5%) patients who underwent tracheostomy within 14 days after intubation comprised the early group; 15 (45.5%) patients who underwent tracheostomy after 14 days comprised the late tracheostomy group. There was no difference between the two groups in mortality. The median ICU LOS was 33.0 (25.0–37.0) days, and it was longer in late group [35.0 (30.0–37.0) vs. 29.5 (18.8–34.5), p=0.046]. The median duration of MV was 27.0 (18.0–33.5) days, which was longer in late group [29 (25.0–37.0) vs. 19 (12.8–29.0), p=0.004].
Conclusion: In critical COVID-19 cases, there was no difference between groups in terms of mortality. In the early tracheostomy group, ICU LOS and the MV duration were significantly shorter.

15.Do Current Scoring Systems Predict the Length of Hospital Stay in Cases of Fournier’s Gangrene?
Serdar Kırmızı, Emil Hüseyinoğlu
doi: 10.14744/etd.2021.06253  Pages 82 - 87
Objective: The aim of this study was to investigate the reliability of scoring systems to predict the length of hospital stay in cases of Fournier’s gangrene (FG), and to contribute to the potential development of new scoring systems to more accurately predict the length of hospital stay of FG patients.
Materials and Methods: This retrospective study examined the data of FG patients treated between January 2016 and April 2021. The length of hospital stay was evaluated using demographic characteristics, laboratory values, vital signs, and Fournier’s Gangrene Severity Index (FGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and Combined Urology and Plastics Index (CUPI) scores.
Results: A total of 28 patients were treated for FG during the study period. The mean length of hospital stay was 13.7±5.4 days. The median FGSI, LRINEC, and CUPI score was 2 (min–max: 0–11), 4 (min–max: 0–10), and 5.5 (min–max: 1–9), respectively. The analysis indicated that the CUPI score had a statistical correlation with the length of hospital stay; the FGSI and LRINEC were not found to have a significant predictive ability of the length of hospitalization.
Conclusion: The findings indicated that the FGSI and LRINEC disease severity scores were not sufficient to predict the length of hospital stay. The CUPI scoring system was more useful but was judged to be a weak model. Improvement or a new scoring instrument based on additional research is needed.

16.Is Umbilical Cord Arterial Lactate a Predictive Indicator for Assessment of in-Term Neonates Well-being?
Filiz Tubaş, Ayşe Şener Taplak
doi: 10.14744/etd.2021.56659  Pages 88 - 94
Objective: This study was conducted as a medical records-based retrospective design to determine whether lactate is a predictive indicator for predicting well-being and the severe conditions of neonates.
Methods: The sampling of the study consists of 81 term neonates whose gestation age is 37 weeks and above, and monitored in the neonate intense care unit, whose cord arterial blood gas was taken during the birth and had respiratory distress. The data were retrospectively collected from the neonates’ file records.
Results: Umbilical cord arterial lactate value was found associated with pH and Apgar score for assessment of the well-being of neonates and suggested it predict the low Apgar score. (p<0.05). The lactate value was significantly higher at birth in neonates with Meconium Aspiration Syndrome (MAS) and Premature Rupture of Membranes (PROM) according to pH and other cord gas parameters. ROC curve analysis was used to determine whether lactate and pH were predictive indicators of the first-minute Apgar score and lactate was found more distinguishing than pH. Additionally, it was determined that as the lactate level increased, the duration of hospitalization increased.
Conclusion: Cord lactate is at least as predictive as Apgar scores and pH for determining severe conditions. Lactate might be useful for clinicians at first-level hospitals for decision- making to refer the patient to the secondary or tertiary level neonatal intensive care unit before the clinical situation is worsened.

BRIEF REPORT
17.Glomus Tumors of the Foot and Ankle: Case Series
Hüseyin Bilgehan Çevik, Sibel Kayahan, Seyit Ali Gümüştaş, Engin Eceviz
doi: 10.14744/etd.2021.93892  Pages 95 - 97
Abstract | Full Text PDF

18.COVID-19 in Pregnancy: A Single-center Experience in Kazakhstan
Saule Maukayeva, Dariya Shabdarbaeva, Saya Karimova
doi: 10.14744/etd.2021.25747  Pages 98 - 101
Abstract | Full Text PDF

CASE REPORT
19.Management of Acute Kidney Injury in a Patient with Diabetic Ketoacidosis and Multiple Autoimmune Diseases
Emre Sarıkaya, Gül Direk, Serkan Özsoylu, Ismail Dursun, Nihal Hatipoğlu
doi: 10.14744/etd.2021.92489  Pages 102 - 105
Background: Type 1 diabetes mellitus (DM) is an autoimmune disease caused by the failure of pancreatic beta cells to secrete sufficient insulin. Several other autoimmune diseases that involve the endocrine glands may accompany type 1 DM. Prerenal acute kidney injury due to dehydration occurring during diabetic ketoacidosis (DKA) is a common condition that usually im-proves with appropriate fluid therapy management.
Case Report: A 9-year-old child presented with DKA and renal failure that was resistant to treatment. Other autoimmune conditions potentially accompanying the DM were investigated and it was determined that the patient had severe hypothy-roidism due to Hashimoto’s thyroiditis. The hypothyroidism was the cause of the treatment-resistant renal failure, which regressed within days of starting levothyroxine treatment.
Conclusion: In addition to classic causes of renal failure in patients with diabetes, it is important to remember the potential effects of other underlying autoimmune events, such as hypothyroidism.

20.An Unusual Complication of Internal Jugular Vein Catheterization: Chylothorax
Sümeyra Koyuncu, Ali Gündoğdu, Eray Eroğlu, Nevzat Herdem, Ismail Koçyiğit, Murat Hayri Sipahioğlu, Bülent Tokgöz, Oktay Oymak
doi: 10.14744/etd.2021.39024  Pages 106 - 108
Background: Infection and vascular occlusion are common catheter-related complications in patients with central venous catheters.
Case Report: A hemodialysis patient presented at the emergency department with frequent shortness of breath. Diffuse pleural fluid was observed on the right side in a computerized tomography image of the chest. Thoracentesis was performed, a chest tube was inserted to treat chylothorax, and a triglyceride diet was administered. On the 13th day of hospitalization, the chest tube was removed and video-assisted thoracoscopic surgery was performed with successful results.
Conclusion: Chylothorax should be kept in mind in the differential diagnosis of hemodialysis patients with hypervolemia symptoms. Thoracentesis can aid in the diagnosis.

21.Coronavirus Disease-Induced Acute Myocarditis: Two Clinical Presentations with Different Electrocardiographic Findings
Tufan Çınar, Vedat Çiçek, Şahhan Kılıç, Süha Asal, Murat Selçuk, Muhammed Keskin, Nurgül Keser, Ahmet L. Orhan
doi: 10.14744/etd.2021.39924  Pages 109 - 111
Background: In this report, we present two cases of coronavirus disease (COVID-19)-related acute myocarditis (AM) with different clinical presentations and electrocardiographic (ECG) findings.
Case Report: The first case was a 33-year-old male patient who presented with chest pain to the emergency department (ED). The ECG result suggested an acute coronary syndrome (ACS). However, coronary angiography (CAG) results showed normal coronary arteries, and the cardiac magnetic resonance imaging findings were compatible with COVID-19-induced AM. The ECG revealed a normalization of the T-wave negativity in the anterolateral precordial leads. The second case was a 41-year-old female patient who presented with ST-elevation myocardial infarction (STEMI) to the ED. CAG revealed normal coronary arteries, and the reverse-transcription polymerase chain reaction test result for COVID-19 was positive. The patient was diagnosed as having COVID-19-induced AM.
Conclusion: Our cases demonstrate that clinicians should be aware that some patients with COVID-19-induced AM can present with ECG findings mimicking ACS, including STEMI.

IMAGE
22.Testicular Cyst Detected Incidentally in a Patient with Fournier’s Gangrene
Recep Bedir, Muhammet Ayazoğlu, Yusuf Önder Özsağır
doi: 10.14744/etd.2021.39455  Pages 112 - 113
Abstract | Full Text PDF

LETTER TO THE EDITOR
23.Chloroquine, Malaria Prophylaxis, and COVID-19: An Observation From Endemic Area
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
doi: 10.14744/etd.2021.37085  Pages 114 - 115
Abstract | Full Text PDF

HISTORY OF MEDICINE - REVIEW
24.A Recent History of Ultrasound Contrast Media and Nuclear Medicine Tracers
Bruno Bonnemain
doi: 10.14744/etd.2021.38387  Pages 116 - 120
The recent developmental history of contrast media and nuclear medicine tracers has been crucial in facilitating the inno-vation of radiology equipment. Modern ultrasound has provided an opportunity for developing gas-encapsulated contrast products. In addition, scintigraphy has also evolved with “technetium cows,” especially in cardiology. However, the revolution in nuclear medicine arrived with the use of positron emission tomography with Fluorine-18 fluorodeoxyglucose (18F-FDG) in this field, followed by new and numerous other products and radioelements such as gallium-68 and the corresponding generators. To highlight the lesser known history of ultrasound contrast media and nuclear medicine tracers, this review indicates the success of its progress over the last decades, at least at the university level. It has enabled radiological practic-es to evolve and accompany the technological innovations in imaging equipment. In all fields, patients have been able to benefit from the knowledge acquired for improving the diagnosis and therapeutic management of their pathologies. As for other imaging techniques, however, a significant slowdown in innovation was observed because of the difficulties associated with applications for the marketing authorization of diagnostic imaging products and the low return on investment for the concerned manufacturers.

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