ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 44 (6)
Volume: 44  Issue: 6 - 2022
INVITED REVIEW
1.An Overview of Imaging in Pediatric Spinal Infections
Merve Yazol, E. Turgut Tali
doi: 10.14744/etd.2022.49465  Pages 535 - 539
Despite being rare than in adults, pediatric spinal infections (SIs) are important diseases that commonly lead to poor neurological prognosis morbidity and hospitalization. The etiology, location, and management are different for different ages. The majority of patients present with subtle and non-specific clinical symptoms that are difficult to diagnose. Therefore, imaging continues to be crucial for the diagnosis, localization, management, and follow-up of SI. In this review, we will discuss and highlight the imaging features of SI and complications according to affected locations.

REVIEW
2.Update on COVID-19 Co-infection
Elif Şeker, Öner Özdemir
doi: 10.14744/etd.2022.77864  Pages 540 - 543
World Health Organization data indicate that as of April 2022, 6.2 million deaths have been reported worldwide due to coronavirus disease 2019 (COVID-19). In Türkiye, official statistics indicate some 15 million cases and a death toll of 98,660. It is important that clinicians consider the possibility of the co-occurrence of other respiratory microorganisms with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the virus that causes COVID-19, when managing treatment, particularly severe COVID-19 patients. The burden and effect of a secondary infection may be significant, especially in patients with chronic disease and advanced age. Proper attention to potential co-infections can prevent COVID-19 progression and the development of complications.

ORIGINAL ARTICLE
3.Prediction of COVID-19 Based on Genomic Biomarkers of Metagenomic Next-Generation Sequencing Data Using Artificial Intelligence Technology
Sami Akbulut, Fatma Hilal Yağın, Cemil Çolak
doi: 10.14744/etd.2022.00868  Pages 544 - 548
Objective: The primary aim of this study was to use metagenomic next-generation sequencing (mNGS) data to identify coronavirus 2019 (COVID-19)-related biomarker genes and to construct a machine learning model that could successfully differentiate patients with COVID-19 from healthy controls.
Materials and Methods: The mNGS dataset used in the study demonstrated expression of 15,979 genes in the upper air-way in 234 patients who were COVID-19 negative and COVID-19 positive. The Boruta method was used to select qualitative biomarker genes associated with COVID-19. Random forest (RF), gradient boosting tree (GBT), and multi-layer perceptron (MLP) models were used to predict COVID-19 based on the selected biomarker genes.
Results: The MLP (0.936) model outperformed the GBT (0.851), and RF (0.809) models in predicting COVID-19. The three most important biomarker candidate genes associated with COVID-19 were IFI27, TPTI, and FAM83A.
Conclusion: The proposed model (MLP) was able to predict COVID-19 successfully. The results showed that the generated model and selected biomarker candidate genes can be used as diagnostic models for clinical testing or potential therapeutic targets and vaccine design.

4.The Relationship Between Nasal Obstruction Symptom Evaluation (NOSE) Scores and the Size and Location of Nasal Septal Perforations
Mert Cemal Gökgöz, Hamdi Taşlı
doi: 10.14744/etd.2022.06777  Pages 549 - 554
Objective: Nasal septum perforation (NSP) is defined as a communication between the nasal passages due to a full layer defect of the septum. The condition has a broad spectrum of potential symptoms, such as scabbing inside the nose, dryness, epistaxis, and breathing difficulty. The aim of this study was to evaluate the symptomatology of NSP and the relationship between the subcomponents of the Nasal Obstruction Symptom Evaluation (NOSE) scale assessment of quality of life and the size and localization of NSP.
Materials and Methods: This prospective study included patients who presented at the otolaryngology policlinics of 2 hospitals and were diagnosed with NSP. The NSPs were grouped according to the length of the long axis, that is, small: 1–10 mm, medium: 11–20 mm, or large: 21–30 mm, and the localization was categorized as anterior, middle, or posterior. A Turkish version of the NOSE scale has been validated as a reliable tool.
Results: A total of 61 patients, 31 (50.8%) females and 30 (49.2%) males, were evaluated. The mean NOSE score was 59.50±20.58. No significant difference was seen in the NOSE score based on the size of the perforation; however analysis of variance revealed a significant difference according to the localization of the perforation in the scale items of NOSE-2 (p=0.007), NOSE-3 (p=0.048), NOSE-4 (p=0.011), and the total NOSE score (p=0.015) (p<0.05).
Conclusion: The results of the NOSE scale analysis indicated that the NSP patients experienced a high level of symptoms, regardless the size and localization of the perforation. The NOSE scale is easy to administer and provides useful information, particularly when the subcomponents are evaluated.

5.The Overlap of Sarcopenia and Frailty: When Two Major Geriatric Syndromes Coincide
Esma Nur Kolbaşı, Filiz Demirdağ, Gözde Balkaya, Özlem Pehlivan, Sema Basat
doi: 10.14744/etd.2022.96777  Pages 555 - 559
Objective: The aim of this study was to investigate the prevalence of the co-occurrence of sarcopenia and frailty and to determine any associations between these syndromes and physical activity, nutrition, and psychological well-being in Turkish older adults.
Materials and Methods: All of the participants were aged ≥65 years. Sarcopenia was diagnosed using the SARC-CalF scale with a previously determined national calf diameter cut-off value of 33 cm. Frailty was evaluated with the FRAIL scale. The Rapid Assessment of Physical Activity (RAPA) was administered to measure physical activity, the Mini-Nutritional Assessment (MNA) to evaluate nutritional status, and the Geriatric Depression Scale (GDS) to assess depression.
Results: A total of 566 individuals were included in the study. The prevalence rate of pre-frailty, sarcopenia, frailty, and sarcopenia+frailty was 42.4%, 6.89%, 6.89%, and 2.47%, respectively. A multinomial logistic regression model consisting of the RAPA (p<0.0001), MNA (p<0.0001), and GDS (p<0.0001) revealed that each was associated with all of the subgroups (pseudo R2=0.322; goodness-of-fit= 0.753; p=0.481). The association became stronger with progression from pre-frailty to sarcopenia+frailty, with the exception of the RAPA score recorded in the sarcopenia subgroup.
Conclusion: The concurrent prevalence rate of sarcopenia and frailty was 2.47% in community-dwelling older adults. The likelihood of being physically inactive, malnourished, and depressed became more pronounced with deterioration in physical condition. This is the first known study to report the prevalence rate of the overlap of frailty and sarcopenia in Türkiye and the association between these syndromes and physical inactivity, malnutrition, and depression. The study has been registered with the US National Institutes of Health (National Clinical Trial number: NCT04146844).

6.Comparison of Emergency Department Patient Visits One Year Before and After the Start of the COVID-19 Pandemic
Kadir Küçükceran, Mustafa Kürşat Ayrancı, Abdullah Sadik Girisgin, Sedat Koçak, Zerrin Defne Dündar
doi: 10.14744/etd.2022.88655  Pages 560 - 568
Objective: Planning for emergency department (ED) services based on epidemiological data is essential. This study retrospectively examined ED patient presentations at a tertiary hospital 1 year before and 1 year after the start of the coronavirus 2019 (COVID-2019) pandemic to assist with planning efforts.
Materials and Methods: The study period was March 1, 2019 to February 28, 2021. The patient cases were separated into 2 groups using a reference date of March 2020. The period between March 1, 2019 and February 29, 2020 was de-fined as the pre-COVID period, or ordinary circumstances, and the period between March 1, 2020 and February 28, 2021 was defined as the period following the COVID-19 outbreak, which reflected extraordinary conditions. The primary outcome was the difference in the number of patients and the mortality rate between groups.
Results: A total of 74,063 (62%) people presented at the ED in the pre-COVID period, and there were 45,397 (38%) ED visits in the post-COVID period. The median daily number of patients seen in the pre-COVID period was significantly higher than that of the post-COVID period (200.5 [181–219.25] vs. 123 [108.5–139], respectively [p<0.001]). The in-hospital mortality rate and the hospitalization rate in the post-COVID period were significantly higher than in the pre-COVID period (in-hospital mortality rate: 1105 [2.4%], 852 [1.2%], [p<0.001]; hospitalization rate: 9404 [20.7%], 9019 [12.2%], [p<0.001]).
Conclusion: Although the number of patients presenting at the ED decreased in the period after the outbreak of COVID-19, the number of those who died increased. While the number of hospitalized patients was similar between the 2 groups, the hospitalization rate was greater in the post-COVID period. This information and additional detailed study may prove useful to ED planning efforts.

7.A New Chest Radiography Clue to Predict Saphenous Vein Graft Failure
Ertan Akbay, Ali Çoner, Sinan Akıncı, Adem Adar, Ali Rıza Demir, Begum Uygur, Tonguç Saba, Ali Baran Budak, İbrahim Haldun Müderrisoğlu
doi: 10.14744/etd.2022.84484  Pages 569 - 575
Objective: Saphenous vein graft failure (VGF) is a measure of the short- and long-term success of coronary artery bypass graft surgery (CABG). Aortic arch calcification (AAC) is a long-term finding of atherosclerosis in large vessels. The aim of this study was to evaluate the relationship between AAC and VGF.
Materials and Methods: Patients who underwent CABG surgery and subsequent coronary angiography in a single hospital between January 2010 and January 2021 were included in the study. The presence and stage of AAC was evaluated using preoperative chest X-rays. VGF was defined as ≥75% stenosis and/or total occlusion in the saphenous vein graft. In addition, the effect of AAC on VGF was evaluated based on the time elapsed since the CABG procedure.
Results: Of the 594 patients who underwent CABG during the study period, 91 patients (mean age 63.6±10.0; 71 [78.0%] male) were included in the study. VGF was observed in 49 (53.8%) patients. AAC was found to be an independent predictor of VGF (odds ratio [OR]: 2.788, 95% confidence interval [CI]: 1.068–7.278). The results indicated no association between AAC and VGF in patients whose coronaries were screened within 1 year (OR: 1.143, 95% CI: 0.279–4.683), while there was a strong association between AAC and VGF in patients who were screened 1 year after the surgery (OR: 5.355, 95% CI: 1.618–17.720).
Conclusion: AAC evaluation may be a valuable diagnostic method to predict VGF after CABG, and particularly late VGF.

8.Factors Affecting Lipid Profile in Pediatric Palliative Care
Nilgün Harputluoğlu, Ünsal Yılmaz, Tanju Çelik, Yiğithan Güzin
doi: 10.14744/etd.2022.47527  Pages 576 - 580
Objective: Hyperlipidemia can develop as a consequence of a sedentary life or becoming bedridden, malnutrition, and the use of drugs such as carbamazepine, and is associated with a greater risk of morbidity and mortality. The most common diagnoses in pediatric palliative care (PPC) patients are neurological diseases, metabolic diseases, and genetic and congenital conditions. This is the first study to collect and analyze data of the lipid levels of children receiving palliative care support in Türkiye.
Materials and Methods: Hospital records of PPC patients were used to gather the data used in this retrospective study. Hyperlipidemia was defined by a triglyceride (TG) value of >75 mg/dL for patients aged 0–9 years and >90 mg/dL for those aged 10–19 years of age, along with a total cholesterol (TC) level of >170 mg/dL, a low-density lipoprotein (LDL) level of >110 mg/dL, and a high-density lipoprotein (HDL) level of ≤45 mg/dL.
Results: A total of 89 cases were included. The mean age of the participants was 6.2±4.8 years (range: 0.1–17 years), and 53.9% (n=48) were female. Lipid level examination revealed a mean TC level of 147.65±38.22 mg/dL, TG level of 141.76±111.61 mg/dL, HDL level of 38.98±11.43 mg/dL, and LDL level of 85.29±47.14 mg/dL. A correlation was found between the alkaline phosphatase, phosphorus, vitamin B12, hemoglobin, mean corpuscular volume, albumin, and lipid levels.
Conclusion: PPC patients may have particularly high TG levels and low HDL levels. It is important to meet the nutritional needs of those in PPC, to keep the albumin, hemoglobin, and phosphorus levels high, and to monitor vitamin B12 and mean corpuscular volume. Larger and multicentered studies are needed to more fully identify and address PPC needs.

9.Causes of Isolated Mediastinal Lymphadenopathy: Analysis of 348 Cervical Mediastinoscopy Patients
Yunus Aksoy, Volkan Erdoğu, Necati Çıtak, Ece Yasemin Demirkol, Celal Bugra Sezen, Atilla Pekçolaklar, Ozkan Saydam, Muzaffer Metin
doi: 10.14744/etd.2022.15146  Pages 581 - 586
Objective: This study was designed to investigate the causes of isolated mediastinal lymphadenopathy, the role of cervical mediastinoscopy (CM) in the diagnosis, and the accuracy of computed tomography (CT) to predict malign and benign pathology in patients with isolated mediastinal lymphadenopathy.
Materials and Methods: The records of 348 patients who underwent CM for isolated mediastinal lymphadenopathy between 2006 and 2018 were analyzed. The group comprised 189 males and 159 females. The cases were evaluated in terms of age, distribution of lymph node stations in which lymphadenopathy was detected and sampled, mortality, morbidity, and histopathological diagnostic parameters.
Results: The median age of the patients was 48 years (min–max: 18–79 years). The median lymph node diameter was 2 cm (min–max: 1–6 cm). Lymphadenopathy was found in a total of 724 lymph node stations. The median lymph node diameter was 3.7 cm in patients with malignant disease and 2 cm in cases of benign disease. The reliability of CT to predict malignancy was 76.8% specificity and 71.1% sensitivity when the lymph node diameter was >2.5 cm (area under the curve: 0.820; 95% confidence interval: 0.774–0.860; p<0.001). Complications occurred in 2 cases, however, no mortality was observed. The histopathological results were sarcoidosis (43.1%), tuberculosis (TB) (20.7%), reactive hyperplasia (14.7%), carcinoma metastasis (8.6%), lymphoma (6%), and other (6.8%).
Conclusion: Although sarcoidosis is the most common cause of isolated mediastinal lymphadenopathy, TB is still prevalent in Türkiye. The sensitivity of CT imaging to identify malignancy increased with a larger lymph node diameter. CM is a safe and effective diagnostic procedure for patients with mediastinal lymphadenopathy.

10.Downregulation of glutaminase 1 (GLS1) Inhibits Proliferation, Clonogenicity, and Migration of Aggressive MDA-MB-231 Breast Cancer Cells by Increasing p21 and Decreasing Integrin-β1 Expression
Sakine Akar, Hamiyet Dönmez Altuntaş, Zuhal Hamurcu
doi: 10.14744/etd.2022.88123  Pages 587 - 593
Objective: Glutamine metabolism is an important pathway in cell proliferation and tumor progression. The first enzyme to be converted in the process of glutamine metabolism, glutaminase 1 (GLS1), exhibits increased expression in many types of cancer, including breast cancer. Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with high glutamine metabolic activity. The aim of this research was to examine the effects on glutamine metabolism and carcinogenic properties following small interfering RNA (siRNA)-mediated inhibition of GLS1 in glutamine-dependent TNBC.
Materials and Methods: The effects on cell proliferation, migration, apoptosis, colony formation, and the cell cycle of MDA-MB-231 cells using different siRNAs targeting GLS1 were analyzed using an MTS assay, a wound-healing assay, clonogenic analysis, and annexin V and propidium iodide staining methods. The protein expression of GLS1, integrin beta 1 (β1), caspase-3, and p21 were examined using western blot analysis and flow cytometry.
Results: The findings revealed that cell viability, migration, and colony formation were significantly suppressed in MDA-MB-231 cells transfected with 2 different GLS1 siRNAs. Furthermore, the results of flow cytometry and western blot analysis demonstrated that knockdown of GLS1 induced arrest in the G0/G1 phase of the cell cycle through the p21 signaling pathway, but did not induce apoptosis.
Conclusion: GLS1 is needed for cell proliferation and promotes tumor progression and growth of MDA-MB 231 cells. siRNAs may provide a means to downregulate GLS1 and offer a promising target for breast cancer therapy.

11.The Effect of Sex-Specific Genetic Factors on the Host Immune Response to COVID-19: A Pilot Study
Dilara Fatma Akın, Tuğba Arslan Gülen, Esma Özmen, Zeynep Türe Yüce, Orhan Yildiz, Tuba Turunç, Uner Kayabaş
doi: 10.14744/etd.2022.32955  Pages 594 - 602
Objective: The aim of this study was to investigate the impact of sex-specific genetic factors in the pathogenesis and prog-nosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-induced macrophage activation syndrome (MAS), independent of age and comorbidity presence.
Materials and Methods: Patients aged 18-50 years who had been diagnosed with coronavirus 2019 (COVID-19), the disease caused by the SARS-CoV2 virus, were enrolled in a prospective, case-control, multi-center study. Genetic alterations and messenger RNA (m-RNA) expression levels of the TLR7, TLR8, ACE2, CD40L, CXCR3, and TASL genes were determined using DNA sequencing analysis, and gene expression was determined using quantitative reverse transcriptase polymerase chain reaction testing. PolyPhen-2 (Polymorphism Phenotyping v2; Adzhubei et al., 2010) and SNAP2 (Rostlab, Munich, Germany) genetic analysis tools were used to define the pathogenic effects of detected mutations by sequencing the selected genes in hotspot regions.
Results: The study group consisted of 80 patients diagnosed with COVID-19 and was divided into groups based on sex and MAS status. Twenty-nine mutations were detected in 6 genes. Among the alterations, 15 were identified in this study for the first time and 9 were pathogenic. Pathogenic missense mutations in the TLR7, TLR8, ACE2, and TASL genes were detected in the MAS (+) group. In males, decreased TLR7, TLR8, and CXCR3 expression was statistically significant in the MAS (+) group (p<0.050). CXCR3 expression was lower in the female and male MAS (+) groups compared with the MAS (-) groups (p<0.050).
Conclusion: In the absence of major risk factors for COVID-19, the TLR7/8, ACE2, and CXCR3 variants and decreased m-RNA expression levels associated with genetic susceptibility may be independent prognostic risk factors for COVID-19.

12.Evaluation of Subclinical Inflammation in Children with Premature Adrenarche
Gözde Köylü, Nurullah Çelik, Halef Okan Doğan
doi: 10.14744/etd.2022.39699  Pages 603 - 607
Objective: The objectives of this study were to compare the serum inflammatory markers, interleukin-6 (IL-6), highly sensi-tive C-reactive protein (hs-CRP), and fetuin-A, in patients with premature adrenarche (PA) and the control group.
Materials and Methods: This single-center cross-sectional study included 85 non-obese and pre-pubertal children. After 8–12 h of fasting, blood glucose, HDL, LDL, triglyceride, cholesterol, insulin, dehydroepiandrosterone sulfate, total testosterone, 17-OH PG, IL-6, hs-CRP, and Fetuin-A levels were measured and compared in a convenience sample of PA (n=35) and a healthy volunteers of control (n=50) group.
Results: The mean age (7.34±0.62 years vs. 7.09±0.77 years, respectively) and sex (82% girl vs. 80% girl, respectively) of the PA and control groups were similar (p>0.05). Fasting insulin levels (10.9±6.21 Uu/mL vs. 7.4±5.9 Uu/mL; p<0.001), HOMA-IR (2.06±0.63 vs. 1.36±1.00; p=0.017), FGIR (11.31±5.60 vs. 16.46±8.52; p=0.004), and QUICKI (0.35±0.02 vs. 0.37±0.03; p<0.001) levels were different in PA and control groups. IL-6 level higher in PA group than controls [2.7 (3.30) pg/mL vs. 3.02 (1.31) pg/mL, p=0.035], while plasma Fetuin-A [522.02 (715.86) mg/L; 519.4 (945.97) mg/L, p=0.434] and hs-CRP [0.73 (1.02) mg/dL; 1.0 (1.12) mg/dL, p=0.439] levels were similar. IL-6 cutoff value for PA was calculated as 2.06 with 72.7% sensitivity and 48.8% specificity for all study groups (AUC=0.641, p=0.036).
Conclusion: The high IL-6 levels may be an indicator of chronic subclinical inflammation in PA cases. These children should be followed closely in terms of metabolic disorders.

BRIEF REPORT
13.Paranasal Sinus Osteomas: Evaluation of Surgical Management with 13 Cases
İrfan Kara, Alperen Vural, Metin Ünlü, Kerem Kökoğlu
doi: 10.14744/etd.2022.27243  Pages 608 - 611
Abstract | Full Text PDF

CASE REPORT
14.Complex Syndrome of Posterior Microphthalmos–Retinitis Pigmentosa–Foveoschisis–Optic Disc Drusen in a 13-year-old Boy
Banafsheh Kharrazi Ghadim, Mohammad Hosein Ahoor, Mohamad Reza Niyousha
doi: 10.14744/etd.2021.64614  Pages 612 - 614
Background: Microphthalmos is an embryonic developmental anomaly that may rarely accompany other congenital ocular disorders.
Case Report: A rare, complex syndrome was observed in a 13-year-old boy with a chief complaint of progressive blurred vision without any known trigger and no familial history of relevant ocular disease. The prominent ophthalmic finding was progressive hyperopia, steep corneas, and a short axial length. Slit-lamp examination revealed optic disc drusen, which were confirmed with echography. The ocular images also indicated the presence of foveoschisis and a macular fold.
Conclusion: Given the multiple structural anomalies and non-consanguineous parents, this appeared to be a very rare ocular syndrome.

15.A Rare Complication of Acute Phlegmonous Gastritis: Right Gastroepiploic Artery Aneurysm and Abdominal Hemorrhage
Furkan Ufuk, Mustafa Çelik
doi: 10.14744/etd.2021.42889  Pages 615 - 617
Background: Acute phlegmonous gastritis (APG) is an unusual disorder characterized by a diffuse suppurative infection of the stomach. Although the clinical features of APG are non-specific, it is a serious condition that may lead to life-threatening complications. Therefore, early diagnosis and treatment are crucial.
Case Report: A 67-year-old female presented with severe acute abdominal pain, high fever, vomiting, and clouding of consciousness. She had a history of diabetes mellitus for 18 years and was using insulin therapy. A physical examination revealed diffuse abdominal guarding. An abdominal computed tomography (CT) examination showed diffuse wall thickening affecting the entire stomach, which was suspicious for malignancy. Moreover, the CT revealed a gastroepiploic artery aneurysm and abdominal free fluid with high attenuation, suggesting abdominal hemorrhage. An urgent upper gastrointestinal endoscopy revealed dark-colored and thickened gastric mucosa with several ulcerations, consistent with acute phlegmonous gastritis (APG).
Conclusion: APG is a life-threatening condition. Early diagnosis and appropriate treatment are vital. APG should be kept in mind in the differential diagnosis of an acute abdomen, especially in diabetic or elderly patients.

16.A Critically Ill Patient with Aspergillus Fumigatus Sepsis-Related Ischemic Colitis
Türkay Akbaş, Gökhan Coşkun, Serkan Torun, Gül Akın, Ömer Önbaş
doi: 10.14744/etd.2021.58812  Pages 618 - 620
Background: Invasive aspergillosis (IA) is an opportunistic infection generally encountered in patients with hematological malignancies. However, IA is increasingly recognized in non-neutropenic and critically ill patients in the absence of classic risk factors.
Case Report: An 81-year-old man with diabetes mellitus (DM), chronic renal failure (CRF), and heart failure, who had had 1-week complaints of diarrhea, nausea, and vomiting, was admitted to the intensive care unit with septic shock, acute respiratory failure, and acute kidney injury. Chest computed tomography showed cavitary lung lesions and colonoscopy revealed ischemic ulcers in the descending colon. Other causes of cavitary lung lesions were excluded and all cultures were negative, except for bronchoalveolar lavage yielding Aspergillus fumigatus. Thus, Aspergillus fumigatus sepsis with multiorgan failures was diagnosed.
Conclusion: Inhaled Aspergillus conidia are kept under control by alveolar macrophage. DM, CRF, and aging are the conditions that disrupt phagocytic activity of macrophages and predispose to IA.

17.Severe Form of Scarlet Fever in a Child: A Case Report
Imdat Efendiyev, Anargul Mansurova
doi: 10.14744/etd.2022.36034  Pages 621 - 623
Background: Scarlet fever is a bacterial illness characterized by a high fever and skin rash that can develop with acute onset, is typically accompanied by pharyngitis, and has the possibility of severe complications.
Case Report: An 11-year-old boy was referred to a children’s infectious diseases hospital with a fever, rash, and sore throat. The child had significant signs of erythrogenic intoxication, as well as punctate exanthem against a hyperemic background, a hemorrhagic rash on the lower extremities, and purulent plaques in the lacunae of the tonsils. Blood tests revealed hy-perleukocytosis, neutrophilia, and an elevated erythrocyte sedimentation rate. Urine analysis revealed profuse erythrocytes. Hypocoagulability was determined in coagulation tests. Following antibiotic therapy, desensitization, and detoxification, the child was discharged on the 11th day with clinical and laboratory improvement.
Conclusion: Scarlet fever often occurs in a mild or moderate form; however, a severe and complicated course may also occur. Knowledge of appropriate treatment can be life-saving.

LETTER TO THE EDITOR
18.Is Omicron Bringing the End of the Pandemic?
Mehmet Reşat Nas, Kemal Nas, Mehmet Faruk Geyik
doi: 10.14744/etd.2022.42243  Page 624
Abstract | Full Text PDF

OTHER
19.Reviewer Index

Pages 625 - 626
Abstract | Full Text PDF

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