ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 44 (3)
Volume: 44  Issue: 3 - 2022
INVITED REVIEW
1.Immunotherapies for Myelodysplastic Syndromes: Current State and Future Developments
Nikolaos Papadantonakis, George Deeb
doi: 10.14744/etd.2021.39205  Pages 245 - 251
Myelodysplastic syndromes (MDS) encompass a heterogeneous set of myeloid neoplasms characterized by ineffective hema-topoiesis. Treatment remains challenging, especially for patients with unfavorable disease features. Hypomethylating agents have remained the standard of care for higher-risk MDS for almost 2 decades. A plethora of clinical trials utilizing different approaches ranging from small molecule inhibitors to antibodies are underway. In this mini review, we describe recent developments in treatment approaches that incorporate antibodies in the therapeutic context of MDS apart from immune checkpoint inhibitors.

ORIGINAL ARTICLE
2.An Assessment of the Adequacy of Endobronchial Ultrasound to Assess Mediastinal Lymph Nodes Accompanying Extrathoracic Malignancies
Hülya Dirol, Ruşen Uzun, Olgun Keskin
doi: 10.14744/etd.2021.72929  Pages 252 - 256
Objective: Correct sampling with a targeted diagnosis of pathological mediastinal lymph nodes (LNs) accompanying extra-thoracic malignancies (ETMs) is necessary to grade tumors and evaluate the treatment response. However, debate continues about the adequacy of endobronchial ultrasound (EBUS) assessment. This study was designed to determine the efficiency and reliability of EBUS in the diagnosis of mediastinal LNs in patients with ETMs.
Materials and Methods: A retrospective analysis was conducted of patients with suspicious mediastinal LNs accompanying ETM observed at diagnosis or in follow-up who underwent EBUS. The data assessed were age, gender, ETM, LN diameter observed in both computed tomography (CT) and EBUS, LN metabolic activity recorded with positron emission tomography (PET)-CT, the histopathological diagnosis of LNs sampled using EBUS, and the actual LN diagnosis based on mediastino-scopic LN sampling or radiological stability.
Results: Samples were taken from a total of 78 LN stations from 50 patients with a mean age of 61.28±10.92 years. Of 22 LNs with actual malignancy, 16 were identified with EBUS. The mean LN diameter determined with CT and EBUS, and the mean PET-CT maximum standard uptake (SUVmax) value was 17.36±7.90 mm, 22.90±9.87 mm, and 8.17±5.44, respec-tively. The malignant LN diameter measured using both CT and EBUS was significantly higher than that of benign LNs (re-spectively p=0.001, p=0.026). There was no significant difference between the SUVmax values of malignant and benign LNs.
Conclusion: As some of the LNs found to be reactive with EBUS were malignant, we recommend confirming the diagnosis with mediastinoscopy sampling or radiological follow-up.

3.Effects of Music Intervention During Cesarean Section on the Level of the Mother’s Anxiety: A Randomized Controlled Study
Jule Eriç Horasanlı, Nur Demirbaş
doi: 10.14744/etd.2021.64188  Pages 257 - 262
Objective: Anxiety felt before and during childbirth can have negative effects on maternal and infant health. Music interven-tions during labor have been shown to mitigate the effects of anxiety in a variety of populations. It is a low-cost and easily accessible technique that also has a high level of acceptability. The aim of this study was to examine the effect of listening to music on the vital signs of women during a cesarean section (C-section) and their level of anxiety.
Materials and Methods: This was a single-center, controlled, randomized study. The pregnant women in the intervention group listened to Sufi music via earphones during the operation. The control group received standard treatment without music. The C-section was performed under regional anesthesia in all cases. The State-Trait Anxiety Inventory (STAI) was administered to the patients before and after the procedure.
Results: There was no significant difference in the vital sign parameters of the music group and the control group (p>0.05). The preoperative STAI anxiety score was similar in the music (45.58±4.60) and control (43.82±4.33) groups (p=0.183). However, after the operation, the anxiety score of the music group (35.88±5.39) was statistically significantly lower than that of the anxiety score of the control group (42.14±3.75) (p<0.001).
Conclusion: The women who listened to Sufi music during a C-section reported less anxiety. Slow, rhythmic music can distract the patient, help them relax, and reduce their anxiety.

4.Factors Affecting Fear, Obsession, and Anxiety Associated with COVID-19: A Cross-Sectional Study in Patients Admitted to University Hospital Outpatient Clinics
Raziye Şavkın, Mücahit Öztop, Gökhan Bayrak, Nihal Büker
doi: 10.14744/etd.2021.57527  Pages 263 - 269
Objective: During the coronavirus disease 2019 (COVID-19) pandemic, there has been a significant decrease in outpatient visits and hospital admissions. The increased risk of transmission, especially in environments with high contamination such as hospitals, may increase fear, obsession, and anxiety in patients. This study aims to investigate the factors affecting fear, obsession, and anxiety associated with COVID-19 in patients who are admitted to university hospital outpatient clinics.
Materials and Methods: This study was conducted from January 2021 to February 2021 at Pamukkale University Hos-pitals outpatient clinics. Demographic information (age, education, sex, marital status, house sharing, employment, and work schedule) and questions related to COVID-19 (visiting a doctor regularly before the pandemic, positive test results, isolation due to contact, losing a friend/family member because of the disease, and delay/avoidance of medical care because of COVID-19-related concerns) were questioned. Fear of COVID-19 Scale, Obsession with COVID-19 Scale, Coronavirus Anxiety Scale, and Short Form-12 were filled.
Results: A total of 535 patients (291 females and 244 males; mean age, 45.59±16.08 years) participated. The Fear of COVID-19 Scale score was 16.74±6.60, that of Obsession with COVID-19 Scale was 2.22±2.74, and that of Coronavirus Anxiety Scale was 0.77±2.32. Female sex, working from home or flexibly, admission to internal medical sciences, and losing a loved one due to the disease increased COVID-19 fear, obsession, and anxiety (p<0.001). Fear, obsession, and anxiety associated with COVID-19 have negatively affected SF-12 physical and mental scores (p<0.001).
Conclusion: The present study suggested that to ensure that treatments can be continued uninterruptedly in patient groups who are at risk in terms of increasing COVID-19 fear, obsession, and anxiety, remote health consultations can be performed.

5.Demographic and Clinical Characteristics of Patients with Nutcracker Esophagus
Ömer Öztürk, Mustafa Kaplan, İlyas Tenlik, Volkan Gökbulut, Ferhat Bacaksız, Derya Arı, Yasemin Ozin
doi: 10.14744/etd.2021.45380  Pages 270 - 273
bjective: This retrospective study was designed to investigate the demographic and clinical characteristics of 77 patients diagnosed with nutcracker esophagus (NE).
Materials and Methods: The medical records of patients with NE who were followed up at a single center between 2000 and 2020 were collected and analyzed.
Results: The average age of the patients was 52.5±15.7 years; 43 (55.8%) were male and 34 (44.2%) were female. Dyspha-gia was the primary symptom in 49 patients (63.6%) and noncardiac chest pain (NCCP) symptoms were prominent in 28 patients (36.4%). Esophageal manometry results according to the presenting symptom indicated that the median amplitude was 210 mmHg (min–max: 190–270 mmHg) in those with prominent NCCP and 215 mmHg (min–max: 190–310 mmHg) in those with prominent dysphagia, with no statistically significant difference between the groups (p=0.19). The mean lower esophageal sphincter pressure (LESP) of the patients was 25 mmHg (min–max: 10–80 mmHg). While the pressure was normal in 55 patients (71%), was elevated in 22 patients (29%). Comparison of the LESP results revealed that the distal esophageal amplitude (DEA) median was 220 mmHg (min–max: 190–310 mmHg) in patients with normal LESP and 210 mmHg (min–max: 190–250 mmHg) in those with a high LESP. Normal or high LESP was not associated with high DEA (p=0.57).
Conclusion: Patients with NE may present with a variety of symptoms. The presence of reflux should be investigated and symptomatic treatment should be applied.

6.Evaluation of Monocyte to High-Density Lipoprotein Cholesterol and Neutrophil to High-Density Lipoprotein Cholesterol Ratios as Indicators of Inflammation in Patients with Celiac Disease
Tolga Duzenli, Derya Köseoğlu, Hüseyin Köseoğlu
doi: 10.14744/etd.2021.99975  Pages 274 - 278
Objective: Celiac disease (CD) is an autoimmune disease with multisystemic manifestations that may be consequences of autoimmunity, inflammation, or malabsorption. The monocyte to high-density lipoprotein cholesterol ratio (MHR) and the neutrophil to high-density lipoprotein cholesterol ratio (NHR) are recent markers of inflammation. The aim of the present study was to analyze the relationship between the MHR, NHR, and CD and to examine whether these measures might be used as inflammatory markers in CD.
Materials and Methods: This cross-sectional, retrospective study included 153 participants. The data of 50 patients with CD and 103 healthy individuals enrolled as a control group were evaluated. Receiver operating characteristic (ROC) analysis and the corresponding area under the curve (AUC) calculation were performed to assess the discriminatory ability of the MHR and the NHR.
Results: The MHR and the NHR were both high in the study participants with CD (p<0.001). ROC analysis revealed an AUC value of 0.725 (95% confidence interval [CI]: 0.639–0.811) for the MHR and 0.695 (95% CI: 0.598–0.792) for the NHR (p<0.001). The cut-off value for MHR was 9.312 (sensitivity: 76.7%, specificity: 65%) and 77.79 for NHR (sensitivity: 67.4%, specificity: 65%). No statistically significant correlation was seen between the MHR and NHR values and the modified Marsh scores of the patients with CD.
Conclusion: The current study is believed to be the first in the literature to explore and demonstrate that the MHR and the NHR may be indicators in patients with CD. The MHR and the NHR may be promising diagnostic markers for CD.

7.Potential Genotoxic Effects of Butylparaben (Butyl 4-Hydroxybenzoate) in Lymphocytes and Liver Samples of Pubertal Male Rats
Burcu Çömezoğlu, Nurhayat Barlas
doi: 10.14744/etd.2021.70750  Pages 279 - 285
Objective: The aim of this study was to investigate potential genotoxic effects in blood and liver samples of male rats of pubertal age following the administration of butylparaben (BP).
Materials and Methods: A total of 48 6-week-old male rats were divided randomly into 8 equal groups. Three groups received 200, 400, or 800 mg/kg/day BP for 14 days; 3 groups received 100, 200, or 400 mg/kg/day for 28 days; and 2 control groups received corn oil or methyl methanesulfonate. Blood and liver samples were analyzed to determine any genotoxic effect using comet assay parameters of tail moment, tail length, and tail intensity.
Results: Significant differences were observed between the control and treatment groups: liver sample analysis revealed that the tail length of the 28-day dose groups was lower than that of the 14-day dose groups and some tail moment and the tail intensity values were high in the BP treatment groups. The measurements of tail length in the 200 and 400 mg/kg/day BP groups was higher than that of the control groups, while in the 800 mg/kg/day group, it was lower than that of the control group. The lymphocyte values in the 14-day high-dose groups were higher than the 28-day low-dose data.
Conclusion: The results indicated that BP had genotoxic potential in the blood and liver cells of young male rats.

8.Adaptation, Validity, and Reliability of the Turkish version of Misophonia Assessment Questionnaire
Büşra Altın, Songül Aksoy
doi: 10.14744/etd.2021.78545  Pages 286 - 292
Objective: Misophonia is a disorder in which certain specific patterns of sound provoke a strong negative reaction. This extreme sensitivity to typically ordinary sounds can cause significant disruption to daily life. The aim of this study was to investigate the validity and reliability of the Turkish version of the Misophonia Assessment Questionnaire (MAQ). This will be a useful tool to accurately assess the severity and frequency of misophonia in the Turkish population.
Materials and Methods: A total of 210 patients who presented with complaints of misophonia were enrolled in the study. The mean age of the participants was 27.85±9.49 years (range: 18–57 years). The construct validity of the MAQ was de-termined using exploratory factor analysis (EFA) and the internal consistency was evaluated using the Cronbach alpha value. The concurrent validity of the MAQ was determined based on the directionality of its relationship with a visual analog scale (VAS) and the strength and of the correlation using Pearson’s correlation coefficient.
Results: The mean MAQ total score was 24.33±13.28. The EFA results revealed a 4-factor structure. The reliability of the instrument was extremely high: the Cronbach alpha for the total scale was 0.94 and subscale values ranged from 0.76 to 0.93. In a test-retest reliability assessment, the intraclass correlation coefficient was 0.970. A significant correlation between the MAQ and VAS scores was demonstrated (r=0.811, p<0.001).
Conclusion: The Turkish version of MAQ is reliable and provides a valid scale to measure the impact and severity of miso-phonia symptoms.

9.Association Between Carotid Artery Disease and ABO Blood Group
Özden Kutlay, Zafer Yalım, Arzu Keskin-Aktan, Tülay Koca
doi: 10.14744/etd.2021.70670  Pages 293 - 298
Objective: Carotid artery disease (CAD) is a type of cardiovascular disease typically caused by the formation of atheroscle-rotic plaques in the carotid arteries. Diabetes mellitus, hereditary features, hyperlipidemia, and hypertension are significant risk factors for CAD. There is strong evidence of a relationship between these major risk factors and the ABO blood groups. The aim of this retrospective study was to examine a potential relationship between the ABO blood groups and CAD.
Materials and Methods: The study group comprised 230 consecutive patients diagnosed with CAD using carotid an-giography between January 2012 and November 2019 and 136 consecutive subjects without CAD as controls. The data analyzed were collected from patient files: details of demographic characteristics, lipid profiles (total cholesterol, low-density lipoprotein, high-density lipoprotein, very-low-density lipoprotein, and triglyceride levels), and hematological indices (leuko-cyte, platelet, hemoglobin, mean platelet volume, neutrophil, lymphocyte, monocyte values).
Results: Chi-squared test analysis indicated that there was a statistically significant difference between the distribution of the blood groups in the patient and control groups (p=0.017). Multiple logistic regression analysis demonstrated that the risk of developing CAD was 1.92 times higher in the non-O blood groups than in the O blood group (p=0.032).
Conclusion: A non-O blood group may be another risk factor for CAD. However, the blood group must be evaluated along-side established risk factors to fully understand the risk of developing CAD.

10.Molecular Karyotyping in Anorectal Malformations: Could DGCR6 Gene Haploinsufficiency Cause Anal Atresia in 22q11 Deletion Syndrome?
Pelin Özyavuz Çubuk, Gülsüm Kayhan, Ferda Emriye Perçin
doi: 10.14744/etd.2021.58701  Pages 299 - 305
Objective: Anorectal malformations (ARM) are classified as a multifactorial disease. The etiology of ARM is still not clear due to the complexity of the pathological anomalies.
Materials and Methods: The microarray-based comparative genomic hybridization (array CGH) results of 10 patients with ARM not associated with a specific syndrome were analyzed using the 8x60K ISCA Agilent microarray platform (Human Genome CGH Microarray; Agilent Technologies, Inc., Santa Clara, CA, USA). Pathogenic copy number variants were fur-ther confirmed using fluorescence in situ hybridization or quantitative real-time polymerase chain reaction testing.
Results: Chromosome 22q11.2 deletion was detected in 2 patients. One of these patients had anal stenosis, minor cardiac abnormalities, and a small 0.89-Mb deletion. The second patient had anal atresia, immune deficiency, inguinal hernia, and a 2.7-Mb cryptic deletion. The overlapping genes in the deletion regions of the 2 patients were the DGCR5, DGCR6, and PRODH genes.
Conclusion: DGCR6 alters the expression of important genes such as TBX1 and affects neural crest migration. Given that ARM are caused by abnormalities in neural crest cell migration, it may be that these genes play a role in the etiology. To our knowledge, this is one of the smallest interstitial deletions in the chromosome 22q11.2 region to be published to date. Further research on the DGCR6 gene, which may be a candidate gene responsible for anal atresia, will clarify this point.

11.Assessment of Hand Hygiene Compliance in the Context of COVID-19 Among Paediatric Nurses in a Nigerian Federal University Teaching Hospital
Chioma Oko, Azlina Yusuf, Fahisham Taib
doi: 10.14744/etd.2021.48716  Pages 306 - 311
Objective: The aim of this study was to assess hand hygiene (HH) facilities and to measure HH compliance during the COVID-19 pandemic among pediatric nurses in a single Nigerian federal university teaching hospital.
Materials and Methods: This is a cross-sectional study utilizing the WHO HH observational design. Compliance data were collected by a trained observer using the WHO “my five moments for HH” checklist, while HH facilities were assessed using the infection and control assessment form. The data were analysed using SPSS software version 26.0. A Chi-square test was employed to determine the compliance across units, shifts, and “my five moments for HH”.
Results: Most HH facilities in the study were non-functional and inadequate. The overall compliance rate was 38.1%, based on the 561 HH opportunities recorded. The compliance rate was similar across the unit and shift, but varied according to “my five moments for HH” (p<0.001). HH compliance was found to be decreased in the moments before the contact with childt (5.6%) and before an aseptic procedure (1.1%). Better compliance was observed after body fluid exposure (100%), after the contact with child (61.2%), and after the contact with the child’s environment (61.4%).
Conclusion: The study found inadequate HH facilities, possibly contributing to poor HH compliance. Local facilities need to be restructured to ensure adequate access to resources which would indirectly increase HH practice and compliance, especially in the pediatric settings where HH is very crucial.

12.The Effectiveness of Denosumab in the Treatment of Postmenopausal Osteoporosis
Berke Aras, Ömer Kuzu
doi: 10.14744/etd.2021.79803  Pages 312 - 317
Objective: The purpose of this study was to examine the effectiveness of denosumab to treat postmenopausal os-teoporosis, and the impact of prior osteoporosis drug use and the duration of denosumab use on the success of the treatment.
Materials and Methods: In all, 116 patients who had been diagnosed with postmenopausal osteoporosis and were treated with denosumab were enrolled in the study. The primary study groups were those who had used oral bisphosphonates before denosumab treatment (n=88) and those who had not (n=28). The outcome measures were the L1-L4 lumbar vertebra, total femur, and femoral neck T-scores, and bone mineral density (BMD) values. All of the patients were evaluated pre-treatment and again at 1 and 2 years after denosumab treatment.
Results: Significant improvements were seen in the total vertebral BMD and T-scores, total femur, and femoral neck BMD and T-scores in both patient groups 1 year after treatment. The total lumbar vertebra BMD and T-scores were statistically significantly higher in the group that had not used oral bisphosphonates compared with those of the group that had used oral bisphosphonates. The total femur and femoral neck BMD and T-scores were also significantly higher after 2 years of use of denosumab in comparison with the results at 1 year of use.
Conclusion: The results indicated that denosumab is an effective treatment for postmenopausal osteoporosis; however, additional randomized controlled studies are needed to further examine the effectiveness of long-term denosumab treatment and prior bisphosphonate use.

13.Distribution of Colon Lesions in the Elderly
Oktay Bulur, Şebnem Gürsoy, Kemal Deniz, Ömer Özbakır, Kadri Güven, Alper Yurci, Gülten Can Sezgin, Mustafa Özel, Burcu Bozkurt Burgucu, Yavuz Özden, Vusal Abdurahmanov, Mihriban Yıldırım
doi: 10.14744/etd.2021.45087  Pages 318 - 323
Objective: Screening and surveillance for colon lesions is very important, particularly given the increased incidence of be-nign and malign colon diseases with age. The aim of this study was to determine the frequency and characteristics of colon lesions in an elderly population in Turkey.
Materials and Methods: This retrospective study was conducted in the gastroenterology clinic of the Erciyes University Faculty of Medicine Hospital. The histopathological results and demographic characteristics of 1004 elderly patients who underwent a colonoscopy with a biopsy between 2015 and 2019 were retrospectively analyzed.
Results: A total of 1004 elderly patients were included in the study. The findings revealed that 592 (58.9%) of the patients had polyps, 121 (12.05%) had colitis, 23 (2.3%) had ileitis, 88 (8.7%) had colon carcinoma, 2 (0.2%) had amyloidosis, 34 (3.4%) had other histopathological diagnoses (in order of frequency, melanosis coli, lipoma, solitary rectal ulcer, neuroendo-crine tumor, leiomyoma, mantle cell lymphoma, marginal zone lymphoma and 1ow grade dysplasia), and 22 patients had multiple synchronous pathologies.
Conclusion: Colon pathology types and frequencies differ with advanced age. Appropriate colonoscopy screening pro-grams and multiple histopathological sampling methods from each colon segment during colonoscopy offer early recognition of both benign and malignant colon lesions.

14.Leptin Prevents U46619- and Angiotensin II-Elicited Contraction in Isolated Human Umbilical Vessels
İpek Duman, Burak Soner, Salim Yalçın İnan, Ayşe Saide Şahin
doi: 10.14744/etd.2021.64249  Pages 324 - 329
Objective: This study investigated the vasoactive responses of quiescent and pre-contracted isolated human umbilical veins and arteries to cumulative leptin.
Materials and Methods: The vasoactive response of umbilical vessels pre-contracted with U46619 (10-10M) and angioten-sin II (10-6M) to cumulative leptin (10-11-10-7M) were recorded in vitro.
Results: Leptin did not affect the artery or vein basal tonus (p=1). The leptin-elicited relaxation in U46619-contracted vessels was greater in veins than in arteries (p<0.001). Incubation with N (omega)-nitro-L-arginine methyl ester (L-NAME) (10-4M) prevented the leptin-induced relaxation of the U46619 contraction response in the artery. The Emax and pD2 values of the L-NAME-incubated veins were lower than those of the non-incubated veins (p<0.001 and p=0.001, respectively). The relaxation in angiotensin II-contracted veins was greater than that of the arteries (p<0.001). Incubation with L-NAME prevented leptin-induced relaxation in angiotensin II-contracted arteries. The Emax of leptin-induced relaxation of L-NAME-in-cubated veins was significantly lower than that of non-incubated veins (p=0.027); the pD2 was similar.
Conclusion: Leptin did not alter the resting tension of isolated umbilical vessels; however, the results indicated that leptin caused concentration-dependent relaxation in umbilical vessels pre-contracted with U46619 or angiotensin II. The maximum relaxation was greater in veins compared with arteries. Incubation with L-NAME completely inhibited leptin-induced relax-ation in arteries and resulted in a significant inhibition in veins.

15.Effect of ABO Blood Groups on Patent Ductus Arteriosus Closure
Burak Ceran, Ufuk Çakır, Ali Ulaş Tuğcu, Cüneyt Tayman
doi: 10.14744/etd.2021.23855  Pages 330 - 333
Objective: Although some ABO blood groups are known to be associated with risk in adult diseases, the data related to neonatal diseases remain insufficient. The aim of this study was to identify blood groups that may confer a risk of patent ductus arteriosus (PDA) in very low birth weight (VLBW; <1500 g) preterm infants.
Materials and Methods: The records of preterm infants admitted to our unit who weighed <1500 g at birth were reviewed ret-rospectively. The prevalence of PDA and the demographic and clinical characteristics were compared according to blood group.
Results: The study included a total of 497 infants: 155 (31.2%) in blood group O, 227 (45.7%) in blood group A, 83 (16.7%) in blood group B, and 32 (6.4%) in blood group AB. There were no significant differences in PDA, demographic characteristics, or clinical parameters according to blood group (p>0.05).
Conclusion: The results of this study did not suggest a relationship between PDA and blood group in VLBW infants. These findings represent a valuable first contribution to the literature on the role of blood group in premature infants.

16.Which Parameter is the Most Effective Predictor of Poor Outcomes in Sepsis: C-reactive Protein, Albumin, or C-reactive Protein/Albumin Ratio?
Esra Çakır, Işıl Özkoçak Turan
doi: 10.14744/etd.2021.20737  Pages 334 - 338
Objective: Albumin and C-reactive protein (CRP) values can be indicators of adverse clinical outcomes in sepsis. The pur-pose of this study was to investigate the diagnostic value of the CRP/albumin ratio in patients with sepsis in an intensive care unit (ICU).
Materials and Methods: This retrospective study examined the records of patients admitted to an ICU for sepsis. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, sex, age, CRP and albumin levels, white blood cell count, and Sepsis-Related Organ Failure Assessment (SOFA) score at ICU admission, duration of mechanical ventilation (MV), ICU stay, presence of bacteremia, and mortality data of the patients were analyzed.
Results: A total of 849 patients diagnosed with sepsis were enrolled in the study. The in-ICU mortality rate was 55% (467/849). The mortality group had notably higher APACHE II scores, duration of MV, ICU stay, SOFA scores, CRP values, and CRP/albumin ratios and lower albumin levels (p<0.05). Receiver operating characteristic analysis for mortality prediction yielded area under the curve and cut-off values of 0.820 and >95 mg/L, respectively, for CRP, 0.813 and ≤2.6 g/dL for albumin, and 0.843 and >53.7 for the CRP/albumin ratio.
Conclusion: The results indicated that the CRP/albumin ratio was a more effective parameter than either the CRP or albu-min value alone as a predictor of mortality in sepsis patients.

CASE REPORT
17.Human Herpesvirus 7-Associated Acute Longitudinal Myelitis in an Immunocompetent Patient: A Case Report
Müge Kuzu Kumcu, Zehra Yavuz, Ebru Us, Hüseyin Özden Şener
doi: 10.14744/etd.2021.17802  Pages 339 - 343
Background: Human herpesvirus 7 (HHV-7) can cause a central nervous system infection in both immunodeficient and immunocompetent patients. This report describes a case of longitudinal myelitis due to HHV-7.
Case Report: A 56-year-old male presented with lower extremity weakness and the inability to walk, difficulty urinating, and numbness in lower chest region. Thoracic magnetic resonance imaging showed hyperintensity in the spinal cord below the T4 level in a T2 sequence. Polymerase chain reaction (PCR) analysis of the cerebrospinal fluid (CSF) revealed HHV-7. The clinical diagnosis was longitudinal myelitis and a positive PCR test confirmed acute viral longitudinal myelitis due to HHV-7. Treatment with intravenous immunoglobulin and ganciclovir was initiated. After a program of rehabilitation therapy, the patient demonstrated partial recovery at a 9-month follow-up assessment.
Conclusion: Acute transverse myelitis due HHV-7 has been reported, but clinicians should be aware that, while rare, longi-tudinal myelitis can also occur, even in an immunocompetent patient.

18.Unusual Nerve Compression Secondary to Intermuscular Lipoma: A Case Report
Eren Öğüt, Fatoş Belgin Yıldırım, Umut Özsoy, Aydın Yıldırım
doi: 10.14744/etd.2021.86143  Pages 344 - 346
Background: This report presents the case of a 68-year-old male patient with a 3-month history of progressive weakness of the left hand accompanied by symptoms of pain and dysesthesia radiating to the dorsal aspect of the forearm.
Case Report: Complete compression of the radial nerve and partial entrapment of the ulnar nerve secondary to the inter-muscular lipoma were detected. Electromyography findings revealed prolonged motor and sensory latency of the radial nerve and reduced sensory conduction velocity in the distribution of the ulnar nerve. The pathological findings revealed nuclear atypia with no increased mitosis, hyperchromasia, pleomorphism, or multinucleation of fat cells. Total surgical excision of the intermuscular lipoma was performed with an anterior surgical approach. Optimal functional improvement in hand extension had been achieved at a 1-year follow-up evaluation.
Conclusion: Clinicians should be aware of the possibility of the entrapment of adjacent peripheral nerves by an intermus-cular lipoma and its clinical and pathological manifestations.

19.Pituitary Insufficiency Diagnosed After Coronavirus Disease-19: A Case Report
Mina Gülfem Kaya, Cem Ertürk, Muhammet Güven
doi: 10.14744/etd.2021.30676  Pages 347 - 349
Background: Severe acute respiratory syndrome-coronavirus (SARS-CoV) and SARS-CoV-2 might affect the hypothalam-ic-pituitary-adrenal axis. This paper presents a rare case of pituitary insufficiency diagnosed after CoV disease (COVID)-19.
Case Report: On December 7, 2020, a 67-year-old male patient presented to the Endocrinology Department of Lokman Hekim University with weakness, weight loss, and abdominal pain lasting for 3 weeks. In his medical history, he had a positive real-time polymerase chain reaction test result for SARS-CoV-2 based on the nasopharyngeal swab analyzed on September 30. Central hypothyroidism, secondary adrenal insufficiency, hypogonadotropic hypogonadism, and a low dehy-droepiandrosterone-sulfate level were detected in the laboratory examinations. Steroid therapy was initiated.
Conclusion: Non-specific adrenal insufficiency symptoms such as fatigue and weakness, and psychosomatic symptoms can be seen during the course of COVID-19 or the post-COVID-19 period. Physicians should be aware about the systemic effects of SARS-CoV-2 infection and follow-up patients with a history of COVID-19 accordingly.

IMAGE
20.Neurofibromatosis
Satvinder Singh Bakshi
doi: 10.14744/etd.2021.04903  Page 350
Abstract | Full Text PDF

LETTER TO THE EDITOR
21.The mRNA COVID-19 Vaccination and the Mortality of Pediatric Vaccine Recipients, any Association?
Won Sriwijitalai, Viroj Wiwanitkit
doi: 10.14744/etd.2021.26780  Pages 351 - 352
Abstract | Full Text PDF

22.SARS CoV2 Variant Delta and Delta Plus, Molecular Change and Expected Impact of Response to COVID-19 Vaccine
Sora Yasri, Viroj Wiwanitkit
doi: 10.14744/etd.2022.51196  Pages 353 - 354
Abstract | Full Text PDF

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