ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 45 (1)
Volume: 45  Issue: 1 - 2023
INVITED REVIEW
1.Effectiveness of COVID-19 Vaccines and Antiviral Therapies in the Era of SARS-CoV-2 Variants
Gamze Kalin Unuvar, Jordi Rello, Emine Alp
doi: 10.14744/etd.2022.99441  Pages 1 - 7
Since December 2019, the respiratory infection coronavirus disease 2019 (COVID-19) has been responsible for a major pandemic. Several mutations and variants have emerged and been seen throughout the pandemic. They eventually spread to various continents and nations. The most effective method of preventing illnesses from the past till the present has been vaccination. As a result of the advancement of vaccinations, numerous nations have begun immunizing global target groups. From the start of COVID-19 to the present, there aren’t many possibilities for therapy. Data indicate that the rapid evolution and transmission of SARS-CoV-2 variants poses a danger to the effectiveness of currently available medications. As a result, the COVID-19 pandemic brought to light a serious public health issue that had an impact on everyone in the world. Along with the pandemic’s rapid speed, new targeted vaccinations and medical therapies have reduced fears to some extent. Clinical phase studies are still being conducted in various areas because it is evident that the initial antiviral medications approved for use in the treatment of COVID-19 are ineffective in severe cases. Anti-vaccination, however, is one of the most serious barriers to vaccination, which is thought to be vital in the prevention of illnesses. Lack of information, incorrect information, and misguided religious beliefs can all contribute to anti-vaccination. With the advent of SARS-CoV-2 variants, we review the literature to provide an up-to-date overview of the features and efficacy of antiviral therapy and vaccines.

SYSTEMATIC REVIEW
2.Review of the Effects of Probiotics and Their Metabolites in the Treatment of Liver Cancer: An Update on Probiotics as a New Treatment
Sheyda Bouzari, Ronak Bakhtiari, Hatef Ajoudanifar, Seyed Ataollah Sadat Shandiz
doi: 10.14744/etd.2022.25477  Pages 8 - 18
Objective: Concerns are growing about the prevalence of liver cancer as one of the most common health-threatening cancers due to the numerous risk factors for this type of cancer such as hepatitis, obesity, diabetes and fatty liver. This review article was done to investigate the protective role of probiotics and their metabolites against liver cancer, where probiotics showed various useful effects for treatment of disease especially cancer.
Materials and Methods: For this study, searches were carried out using keywords including probiotic, Bacteria, Lactobacillus, Bifidobacterium, Liver Cancer and Hepatocellular Carcinoma from reliable databases such as Google Scholar, PubMed, Science Direct, and Wiley.
Results: This review revealed that, where products of probiotic bacteria had also therapeutic effects such as OK-432, Nisin, Bovicin HC5 (as important products), probiotic bacteria of the genus Lactobacillus and Bifidobacterium such as Lactobacillus plantarum, Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus rhamnosus strains were the most useful probiotic bacteira against liver cancer.
Conclusion: The use of probiotics due to their natural source and their secretory metabolites can be a good way to develop new therapies for various diseasesm with this systematic review showing that probiotics have shown therapeutic effects on liver cancer by having a wide range of properties such as anti-inflammatory and anti-apoptotic properties.

ORIGINAL ARTICLE
3.Comparison of the Dosimetric Planning Efficiency of Dynamic Conformal Arc and Volumetric Modulated Arc Therapy Techniques for Stereotactic Body Radiotherapy of Lung Cancer Using Internal Target Volume
Yucel Saglam
doi: 10.14744/etd.2022.96572  Pages 19 - 24
Objective: This retrospective study constitutes a feasibility assessment of dynamic conformal arc (DCA) therapy as an alternative to volumetric-modulated arc therapy (VMAT) for stereotactic body radiation therapy (SBRT) of lung cancer (LC) with the free breathing technique using internal target volume. DCA is to create a more efficient treatment reducing beam-on time (BOT) and monitor unit (MU) without interplay errors except for complex tumor geometries when compared to volumetric modulated arc therapy (VMAT).
Materials and Methods: CT images and plans of forty patients treated with 50 Gy prescription in four fractions using VMAT technique for SBRT treatment of LC selected. Plans were re-planned with using DCA technique. VMAT and DCA plans compared via The Radiation Therapy Oncology Group (RTOG) Protocol 0915 for conformity and efficient having pass rate of gamma index in quality assurance (QA), MU and BOT.
Results: The study included 40 patients. The mean value of QA pass rate 99.10±1.49 in DCA and 92.34±1.96 in VMAT. The rate was higher in DCA (p<0.001 and t=8.98). The values of BOT and MU were 4.68 min and 3296 in the VMAT technique and they were 3.58 min and 2395 in DCA. These values were significantly improved with DCA (p<0.001 and p<0.001).
Conclusion: DCA can potentially minimize multi-leaf collimator errors from respiratory motion and small-field dosimetry. It delivery similar doses of treatment quality to tumor while providing faster treatment by significantly reducing MU and BOT compared to VMAT and moreover offers sameday SBRT treatments without the need for specific QA.

4.Assessment of CD63 and CD203c Basophil Activation Tests in Patients with Immediate Drug Hypersensitivity Reaction to Rocuronium
Fatma Dogruel, Dilek Günay Canpolat, Sevil Özsoy, Tuğba Rıhtım, Mustafa Yavuz Koker, Insu Yilmaz
doi: 10.14744/etd.2022.80633  Pages 25 - 31
Objective: Neuromuscular blocking agents (NMBA) are commonly used in general anesthetic applications, and are responsible for more than half of all anaphylactic reactions during general anesthesia. The aim of this study is to investigate the contribution of BasophilActivation Test (BAT) to the diagnosis in patients who developed an immediate drug hypersensitivity reaction due to rocuronium.
Materials and Methods: The study included 10 patients who developed urticaria and/or angioedema following rocuronium administration during anesthesia. Hypersensitivity to rocuronium was assesed with BAT including CD63 and CD203c expression analysis of blood samples by flow cytometry at least one month after the reactions.
Results: All patients were found positive for CD63 expression at the drug dilutions of 0.01 and 0.1 mg/ml, while nine (90%) patients were positive at the drug dose of 1 mg/ml. When assessing the CD203% expression at different drug dilutions, seven (70%) patients were found to be positive at the drug dilutions of 0.01 and 0.1 mg/ml, while eight (80%) were positive at the drug dose of 1 mg/ml.
Conclusion: This study has demonstrated that BAT can be used for diagnostic purposes in immediate drug hypersensitivity reactions to NMBA like rocuronium. The present study, to the best of our knowledge, is the first to assess the diagnostic significance of BAT in immediate drug hypersensitivity reactions caused by rocuronium in our country.

5.Exosomes’ Profile in Ankylosing Spondylitis: A Preliminary Study
Emel Karakaya, Rabia Deniz, Kerem Yiğit Abacar, Mehmet Pamir Atagündüz, Can Erzik
doi: 10.14744/etd.2022.54614  Pages 32 - 40
Objective: Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that leads to structural and functional impairments and reduced quality of life, with heterogeneous manifestations. The origin and possible role of extracellular vesicles represented by exosomes (EVexo) in the pathogenesis of AS were examined in this study.
Materials and Methods: Extracellular vesicles (EVs) were isolated from serum from ten AS patients and ten healthy controls through Izon qEV2/35 nm columns. After assessing the isolate purity by bicinchoninic acid assay (BCA) and Enzyme-Linked ImmunoSorbent Assay (ELISA), the relationship between EVexo concentration and AS was tested by the BCA method. The EVexo surface markers were analyzed by flow cytometry (FC) to verify EVexo presence and reveal its origin.
Results: In FC analysis, CD86+TSG101+ and CD3+TSG101+ exosome percentages of AS group were significantly higher than the control group (p<0.05). A significant difference was found between the AS and control groups in terms of CD3+IL17+ and CD3+IFNg+ and CD86+TNFα+ and CD86+IL12(p35)+ exosome percentages (p<0.01).
Conclusion: The exosomes whose ratio increased in the AS process were derived from T cells expressing increased levels of IL-17A and IFNg in their membranes, and macrophages expressing increased levels of TNFα and IL-12(p35) in their membranes. The EVexo profile did not change according to the AS course.

6.In vitro Activity of Boric Acid Against Biofilm Formation and Biofilm Viability in Medically Important Microorganisms
Gizem İnce, Aylin Üsküdar Güçlü, Sezin Ünlü, Ahmet Başustaoğlu
doi: 10.14744/etd.2022.78910  Pages 41 - 45
Objective: Boric acid (BA), a weak acid of boron, is used in many areas and one of the most important boron reserves is located in Türkiye. This study, in addition to investigating how biofilm formation is affected by BA in a dose-dependent manner, aimed to evaluate the minimum inhibitory concentrations (MICs), minimum fungicidal concentrations (MFCs), minimum bactericidal concentration (MBCs) and, anti-biofilm activity of BA against the medically important bacteria and yeast species.
Materials and Methods: In total 19 medically important bacteria and yeast reference strains are chosen where the MICs, MFCs and MBCs values are calculated with broth microdilution method as indicated in Clinical and Laboratory Standards Institute (CLSI) criteria. In addition to the viable microorganisms in biofilm being enumerated, the rates of biofilm inhibition are evaluated with the modified Crystal violet staining method.
Results: MICs values for the bacteria ranged between 61.83–1.93 mg/ml. The lowest MIC value (0.97 mg/ml) and the high rates of biofilm inhibition (93.39%) of fungi strain belong to C. albicans ATCC 10231. In addition, it was observed that all dilutions of BA provided significant reductions in viable microorganisms in the biofilm structure.
Conclusion: Antimicrobial and anti-biofilm activity of BA against bacterial and fungal strains with medical importance may indicate that BA may be a promising alternative against medically important pathogens.

7.Assessment of Patient Safety Attitude Levels Among Healthcare Professionals Working in the Operating Room
Murat Tamer, Sami Akbulut, İpek Balıkçı Çiçek, Hasan Sarıtaş, Mehmet Serdar Akbulut, Ali Özer, Cemil Çolak
doi: 10.14744/etd.2022.52722  Pages 46 - 54
Objective: This study aims to determine the factors affecting the perception levels of operating room (OR) nurses and nurse anesthetists working in the OR regarding patient safety attitudes.
Materials and Methods: This study was conducted using face-to-face interviews with 117 healthcare professionals working as OR nurses (n=60) and nurse anesthetists (n=57). The patient safety attitude questionnaire (SAQ), where the reliability analysis was also performed for the SAQ scale. and sociodemographic characteristics were used for this study. Qualitative variables were given as numbers and percentages (%), and the dataset belonging to quantitative variables that met the normal distribution criteria was given as mean (standard deviation), and data of quantitative variables that did not comply with normality were given as median, IQR, and 95% CI of the median.
Results: There were significant differences between OR nurses and nurse anesthetists regarding job satisfaction (p=0.015) and total SAQ score (p=0.040). Significant differences were detected between men and women participants regarding smoking (p=0.020) and stress recognition (p=0.040). The reliability analysis of the scale was as follows: total (α: 0.791), job satisfaction (α: 0.883), teamwork climate (α: 0.856), safety climate (α: 0.864), perceptions of management (α: 0.881), stress recognition (α: 0.791), and working conditions (α: 0.530).
Conclusion: It was shown that the patient safety attitudes of the healthcare professionals participating in this study are above average, although it is still insufficient, where the stress identification score of the female participant was higher, and it was also found that the nurses’ job satisfaction and SAQ score were higher.

8.Prevalence of Potentially Inappropriate Medication and Frailty: A Comparison of Three Criteria in Older Turkish Adults
Nurdan Şentürk Durmuş, Sibel Akın, Dincer Goksuluk
doi: 10.14744/etd.2022.23697  Pages 55 - 61
Objective: The aim of this study is to determine the prevalence of potentially inappropriate medication (PIM) use in older Turkish adults on the basis of three criteria as well as to investigate its relationship with frailty.
Materials and Methods: This cross-sectional study was conducted in an outpatient clinic. The Turkish Inappropriate Medication Use in the Elderly (TIME), Beers 2019, and Screening Tool of Older Person’s Prescriptions Version 2 (STOPPv2) criteria were used to detect PIM. Frailty was determined using the Fried Frailty Index categorized as 0 points, non-frail; 1, pre-frail; and ≥2, frail.
Results: Of the 382 patients, 179 (46.9%) were identified with at least one PIM according to the three sets of criteria. The prevalence rates of PIM based on the TIME, Beers 2019, and STOPPv2 criteria were 46.1%, 30.6%, and 26.2%, respectively. No association was found between PIM and frailty (p=0.593 for the TIME criteria, 0.562 for the Beers 2019 criteria, and 0.524 for the STOPPv2 criteria). The risk of PIM presence was higher when the TIME criteria were applied than when the other criteria were used (odds ratio [OR]: Beers 2019 vs. TIME, 0.5231 and STOPPv2 vs. TIME, 0.4072; p<0.001 for all). The number of prescribed medications and older age were associated with the use of any PIM (ORs, 1.3143 and 1.0301, respectively).
Conclusion: The TIME criteria showed the highest PIM frequency in older Turkish adults and had moderate-to-significant concordance with non-country-specific criteria. Further studies are needed to evaluate the relationship between frailty and PIM.

9.Determinants of Frailty and Gait Speed in People Over 65 Years of Age
Mehmet Arslan, Meryem Çakır, Esra Meltem Koç, Kaan Sozmen
doi: 10.14744/etd.2022.33396  Pages 62 - 68
Objective: Several factors in our life process may directly contribute to frailty or are associated with diseases that can lead to frailty. In this study, we aimed to determine the factors and life events that contribute to frailty and affect gait speed using several tests.
Materials and Methods: This cross-sectional study included patients aged 65 and above. The Tilburg Frailty Indicator (TFI), the timed up and go (TUG) test, and the gait speed (GS) test were used. Independent determinants for different types of frailty and TUG and GS scores were examined using multivariate logistic and linear regression models.
Results: There were 263 individuals included in this study. The mean age of the individuals was 72.53±5.83 years old, and 46% of the individuals (n=121) were frailty. The total frailty score of the participants was 4.59±3.10, the mean TUG score was 10.28±3.11 s, and the GS score was 0.80±0.30 m/s. Female sex (adjusted odds ratio [aOR]=5.3), middle and bad health perception (aOR=6.8, aOR=58.3), poor living environment satisfaction (aOR=14.3), and TUG test score (aOR=1.6) were significantly associated with an increase in risk for frailty.
Conclusion: In this study, as we have found that factors such as sex, health perception, and gait speed affect frailty and factors such as age, polypharmacy, and frailty affect gait speed; the quality of life of the elderly can be improved with suitable intervention for these factors.

10.Relationship Between Heart Rate Recovery and Mean Platelet Volume in Healthy Individuals
Halil Aktaş, Murat Gül, Sinan İnci, Oğuz Yıldırım
doi: 10.14744/etd.2022.32585  Pages 69 - 73
Objective: Heart rate recovery index (HRRI) and mean platelet volume (MPV) are two cardiovascular prognostic markers. Low HRRI and high MPV values have been observed in several diseases and conditions. However, the relationship between these two markers is unclear. In this study, the relationship between HRRI and MPV in healthy individuals is examined.
Materials and Methods: The exercise tests performed between January and December 2020 were evaluated, and 120 individuals who met the study criteria were included in the present study. An abnormal HRRI was defined as a decrease in heart rate of 12 beats or more until one minute after the peak of exercise. Those with abnormal HRRI were defined as the study group (n=60), and those with normal HRRI as the control group (n=60).
Results: A total of 120 healthy individuals were included in the study (54% female; mean age 40.14±7.90 years). Higher MPV values were detected in the study group when compared to the control group (10.27±0.10 fl vs. 9.44±0.12 fl; p<0.001). This significance continued in the logistic regression analysis (odds ratio=3.78, p<0.001). In addition, a moderate negative correlation was found between HRRI and MPV (r=-0.404, p<0.001). The MPV value of 10.25 fl was identified as an effective cutoff point for the prediction of abnormal HRRI (area under the curve [AUC]: 0.758; 95% confidence interval [CI]: 0.674–0.843).
Conclusion: Healthy individuals with abnormal HRRI have elevated MPV levels. Additionally, a negative correlation between MPV and HRRI in healthy subjects indicates a causal relation between MPV and autonomic dysfunction.

11.The Relationship Between Premature Coronary Atherosclerosis and Helicobacter pylori Infection
Gökay Taylan, Melik Demir, Çağlar Kaya, İdris Kurt, Kenan Yalta
doi: 10.14744/etd.2022.54069  Pages 74 - 78
Objective: Helicobacter pylori infection (HPI) might potentially lead to chronic infection and cancer development in the gastric mucosa. However, previous studies have shown that coronary artery disease might also be associated with this infection. On the other hand, this causal association has not been previously documented in the context of premature coronary atherosclerosis (PCA). In our study, we aimed to investigate the potential relationship between HPI and PCA.
Materials and Methods: All consecutive patients (≤40 years of age) (between the years 2009 and 2018) undergoing coronary angiography and gastroduodenoscopy were included in the study (n=199). Patients were divided into two groups (PCA and control). The statistically considered significant p value is <0.05.
Results: One hundred ninety nine patients included those with PCA [n=61 (30%)] (51% male, average age 35 years old). HPI was detected in 70% of patients with PCA (n: 43). Statistically significant independent relationship between HPI and PCA was observed in the logistics regression analysis (p<0.001).
Conclusion: HPI may be an independent risk factor for PCA.

12.Static Postural Control Data Analysis in Patients with Ankylosing Spondylitis
Menekşe Karahan, Muhammed Parlak, Ayşe Zeynep Yılmazer Kayatekin, Enis Uluçam, Nurettin Taştekin
doi: 10.14744/etd.2022.16363  Pages 79 - 83
Objective: The goal of our study was to determine how ankylosing spondylitis, a chronic inflammatory disease, affected patient’s balance.
Materials and Methods: Thirty-one healthy volunteers and thirty-five patients with ankylosing spondylitis and no comorbidities affecting their balance participated in the study. Bipedal balance analysis was performed with the subjects’ eyes open and closed in each group. The position of the center of pressure during the measurement was evaluated.
Results: The mediolateral deviation of the center of pressure (p=0.035) and the total path length (p=0.042) were significantly higher in the patient group when measured with eyes open. PL was significantly longer in the patient group when measured with eyes closed (p=0.002).
Conclusion: We observed that ankylosing spondylitis negatively affected the balance in patients. Since this disease usually occurs in the young population, it should be taken into consideration that balance impairment can complicate daily life, especially in the professional world. Therefore, it can be useful to consider the balance disorder in the treatment, and the patients should be monitored for an extended period.

13.Experience of Noninfectious Disease Doctors Redeployed to COVID-19 Duties in a Tertiary Center
Jeyasakthy Saniasiaya, Jeyanthi Kulasegarah, Narayanan Prepageran, Tengku Ahmad Shahrizal Tengku Omar
doi: 10.14744/etd.2022.90008  Pages 84 - 89
Objective: The global healthcare system was severely impacted by the coronavirus disease 2019 (COVID-19). Healthcare professionals, especially doctors, faced a tremendous amount of responsibility irrespective of the specialty and levels of experience. The majority of nations saw physicians from all medical specialties relocate to COVID-19 wards. Working outside of one’s comfort zone would have a significant psychosocial impact, especially in a crisis like the pandemic. To describe the experience of noninfectious disease physicians redeployed to COVID-19 duties.
Materials and Methods: All noninfectious disease physicians who were redeployed to COVID-19 duties received a Google form with 25 questions. Using the Pearson chi-squared test and the Fisher exact test, the relationship between survey responses and working experience and department was investigated. Statistical threshold was set at p<0.05.
Results: Out of 180 respondents, 114 completed the survey in total. Most of the participants were female (64.9%) aged between 31–40 years old (86.8%) with 64.9% having 5–10 years of working experience. During the redeployment, 57% of respondents reported experiencing psychological effects, and 73.7% felt underprepared. However, 71.1% said their assignment to COVID-19 wards was beneficial, and 38.4% were willing to receive redeployment.
Conclusion: The results of the survey indicate that COVID-19 ward redeployment was successful because participants believed their participation was important and the lead team in the COVID-19 wards offered enough direction and assistance. Doctors are prepared to safely treat COVID-19 patients, thanks to the intensive crash course and their fundamental medical knowledge.

14.Key to the Success of a Pedicled Latissimus Dorsi Musculocutaneous Flap in Patients with Soft Tissue Defects Around the Elbow Complicated by Trauma
Kaan Gürbüz, Yakup Ekinci
doi: 10.14744/etd.2022.38479  Pages 90 - 97
Objective: The purpose of this investigation was to evaluate the effectiveness of a pedicled latissimus dorsi musculocutaneous flap (PLDMF) applied to trauma-complicated large soft tissue defects in the upper extremity up to the elbow area.
Materials and Methods: Six patients who received a PLDMF at our clinic for a traumatic soft tissue defect around the elbow between 2014 and 2019 were included in this prospective follow-up, retrospective cohort-type analysis. In addition to the extent of the soft tissue defect, the length of postoperative hospitalization, follow-up, complications, and time to return to work, the patient’s demographic information was also noted. The Q-DASH questionnaire was used to assess elbow and shoulder joint range of motion (ROM) 9 months after surgery.
Results: Six male patients with an average age of 39.8±13.07 years had defects with a mean size of 272 cm2. In a patient who underwent amputation at the elbow level, a flap was used to treat an antecubital deformity after replantation in the same session. Three patients experienced hematoma in the donor location, superficial necrosis distal to the flap, and superficial infection. They were released after 14–29 days. The flaps survived in all patients, and both the Q-DASH questionnaire and shoulder and elbow joint ROM outcomes were satisfactory.
Conclusion: In complex soft tissue problems around the elbow joint that may need extensive therapy and would probably result in disability, a PLDMF can be used safely. Intraoperative Doppler ultrasonography helps prevent the most typical consequence, distal necrosis.

CASE REPORT
15.Familial Hypokalemic Periodic Paralysis with Mutation in a Voltage-Gated Calcium Channel
Esma Altınel Acoğlu, Bilge Akkaya, Burcu Sarıgül, Saliha Senel
doi: 10.14744/etd.2021.66066  Pages 98 - 100
Background: Familial hypokalemic periodic paralysis (FHPP) is an autosomal dominant disease presented by the presence of painless weakness attacks accompanied by a low level of serum potassium. Mutations in genes encoding ion channels Calcium voltage-gated channel subunit alpha 1S, SCN4, and KCNJ2 have been recognized in this disorder.
Case Report: A 15-year-old male patient was admitted to our hospital with a complaint of muscle weakness, which started about 4 years ago, recurring almost twice a week. Especially when he ate carb-rich meals or stayed after a long time in the cold, he described a feeling of numbness and weakness. FHPP was diagnosed due to CACNA1S gene mutation from the family in which six members are affected in three generations.
Conclusion: FHPP, which is an uncommon cause in cases presenting with sudden muscle weakness, is an important neu-romuscular emergency, which should be kept in mind and may cause mortal results when not treated.

16.Response and Tolerability of Palbociclib Plus Fulvestrant in Breast Cancer Patient with Bone Marrow Metastasis and Cytopenia: A Case Report
Emel Mutlu, Metin Özkan, Sedat Tarık Fırat, Ramazan Coşar
doi: 10.14744/etd.2022.21043  Pages 101 - 103
Background: Palbociclib is a potent cyclin-dependent kinase (CDK) 4/6 inhibitor that impairs cell cycle progression. It has recently been approved for patients with hormone receptor positive metastatic breast cancer.
Case Report: We report the response achieved palbociclib plus fulvestrant therapy in a 68-year-old female breast cancer patient with bone marrow metastasis. She treated with paclitaxel weekly chemotherapy, but no response was obtained. Then, with dose reduction palbociclib 75 mg/day, plus fulvestrant treatment was administered. After 6 cycles, thrombocyto-penia resolved and the palbociclib dose was increased to 125 mg/day. Cytopenia completely resolved after the eight cycle treatments. She is still going on treatment without progression and side effects.
Conclusion: The efficacy and safety of CDK 4/6 inhibitors in patients with bone marrow metastases have not been clarified. However, palbociclib treatment can be given with close follow-up and dose reduction in breast cancer patients with bone marrow metastasis.

17.A Rare COVID-19 Presentation; Relapse of Nephrotic Syndrome in a Pediatric Patient
Kübra Çelegen, Mehmet Çeleğen, Ayşegül Bükülmez
doi: 10.14744/etd.2022.47701  Pages 104 - 105
Background: In early 2020, severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) pandemics caused previously unheard of health, social, and economic problems worldwide. The disease can affect different organs such as the lungs, heart, pancreas, kidney, and unusual symptoms can be seen. Information on the clinical impact of SARS-CoV-2 infection on renal function among pediatric age groups is scarce.
Case Report: In this report, we presented a 13-year-old boy who was admitted to our hospital with the relapse of nephrotic syndrome caused by COVID-19. The patient had mild upper respiratory tract symptoms, eyelid edema and progressive swelling of the lower extremities. Clinical remission was achieved with oral prednisolone therapy without the use of any antiviral drugs.
Conclusion: Patients with nephrotic syndrome presenting with relapse should be evaluated for potential COVID-19 infec-tion during the pandemic. The use of routine doses of prednisolone appears to be safe in mild disease.

18.A Giant Pelvic Schwannoma Resected Without Blood Transfusion Following Endovascular Embolization
Fatih Uzunkaya, Murat Derebey, Serkan Burc Deşer, Kadir Önem, Ayşegül Idil Soylu, Demet Küçük
doi: 10.14744/etd.2022.38093  Pages 106 - 110
Background: Sporadic tumors called pelvic schwannomas are typically not diagnosed until they are large enough to squeeze nearby organs. Since the radiological findings are vague, a histopathological examination is necessary for the final diagnosis. The basis of treatment for these tumors is surgical resection, which is difficult due to their large size and retroperitoneal origin.
Case Report: In this article, a case study of a 25-year-old male who underwent two-stage management for an incidental 15 cm pelvic mass is given. The lump was first endovascularly embolized in the patient before being completely removed without any complications. The patient did not need a blood transfusion, and the postoperative phase went smoothly. Additionally, at 4 months following surgery, the control CT scan revealed no signs of recurrence.
Conclusion: Patients with hypervascular pelvic tumors benefit from preoperative embolization, which enables a less bloody surgical resection.

IMAGE
19.Trismus Secondary to Acute Calcific Retropharyngeal Tendinitis
Toshimasa Yamaguchi
doi: 10.14744/etd.2022.72540  Pages 111 - 112
Abstract |Full Text PDF

20.Keratosis Obturans
Satvinder Bakshi
doi: 10.14744/etd.2022.60862  Pages 113 - 114
Abstract |Full Text PDF

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