ISSN: 2149-2247 | E-ISSN: 2149-2549
Volume: 45  Issue: 2 - 2023
1.An Update on Granulomatous Lobular Mastitis: It is Time to Tell the Untold
Oktay irkorucu, Ali Ibrahim Shorbagi, Dima Alwardat, Alper Parlakgumus, Burcak Cakir Pekoz, Zeynel Abidin Taş, Mode Al Ojaimi
doi: 10.14744/etd.2023.53929  Pages 115 - 122
Objective: Granulomatous mastitis is an infrequent, benign, inflammatory disease of the breast that mostly affects young women of reproductive age. The main objective of this review was to clarify the latest terminology and to provide an update on the diagnosis and management.
Materials and Methods: A total of 792 granulomatous mastitis-related articles published in the English literature from 1965 to 2022 were reviewed.
Results: The management of this benign but daunting condition remains controversial, and there is no worldwide consensus regarding the best systematic treatment protocol. Good judgment is required to ensure optimal diagnosis and treatment.
Conclusion: This narrative review deals with the latest developments in the diagnosis, etiopathogenesis, and modern treat-ment of the disease.

2.Adult Pyogenic Spinal Infections
Seda Akyol
doi: 10.14744/etd.2023.27981  Pages 123 - 130
Pyogenic spinal infections are potentially life-threatening diseases that can impair the patient’s neurological status, physical abilities, and quality of life. They can be considered a single disease or group of diseases and include spondylitis, discitis, facet arthritis, epidural phlegmon/abscesses, peri/paraspinal soft tissue infection/abscesses, pachymeningitis and/or leptomeningitis, and myelitis/spinal cord abscess. This group of diseases is distinct from degenerative diseases, metabolic and inflammatory disorders, and neoplasms and mimickers. Delays in the diagnosis and treatment can cause significant morbidity and mor-tality. Imaging is important in preparing diagnoses, planning minimally invasive treatment, and monitoring patient progress. This review explains the adult spinal infections’ radiological imaging features and their values in differential diagnoses.

3.The Effects of Genistein as Supplement to Oral/Enteral Nutrition on Inflammatory Cytokines in Septic ICU patients: A Prospective, Single-center, Randomized Controlled Pilot Study
Gülseren Elay, Kürşat Gündoğan, İnayet Güntürk, Şahin Temel, Nurhayat Tuğra Özer, Hilal Sipahioğlu, Omer Kucuk, Cevat Yazıcı, Muhammet Güven, Murat Sungur
doi: 10.14744/etd.2022.55492  Pages 131 - 137
Objective: Genistein has an anti-inflammatory effect that may be beneficial in many inflammatory diseases. The aim of this study was to determine the effects of supplementation of oral/enteral nutrition (EN) with genistein on the level of inflammatory cytokines in septic patients.
Materials and Methods: This prospective, randomized controlled study included critically ill adult patients with sepsis receiving EN or oral/EN. The patients were randomly divided into a genistein or a control group. Genistein (60 mg/day) was administered as a supplement to EN in the genistein group and the control group received only EN or oral/EN. Serum interleukin 1 beta (IL-1β), interleukin 6 (IL-6), high mobility group box 1 protein (HMGB-1), tumor necrosis factor alfa (TNF-α), procalcitonin (PCT), and C-reactive protein (CRP) concentrations were serially measured at the baseline, 24th hour, and 72nd hour after admission.
Results: Thirty-two participants (genistein group: 16 patients, control group: 16 patients) were included. The mean age was 56±17 years. The serum IL-1β concentration in the genistein group was significantly higher than that of the control group in follow-up (p=0.001). The control group had a significantly lower serum IL-6 value at the 72nd hour compared with the baseline and 24th-hour values (p=0.001). The TNF-α concentration was significantly greater (p<0.001, both groups), while the PCT values were lower in follow-up measurements (genistein group: p=0.031; control group: p=0.004). The CRP level was higher in the genistein group than in the control group at the baseline (p=0.019) and significantly lower in follow-up measurements (p=0.028). At all of the study time points, the serum IL-6, TNF-α, HMGB-1, and PCT level of the genistein group was similar to that of the control group.
Conclusion: Genistein supplementation may add to the inflammation process and worsen the prognosis of sepsis patients in the acute period.

4.Evaluation of Metacarpophalangeal Joint Cartilage Thickness in Patients with Rheumatoid Arthritis: A Clinical and Ultrasonographic Study
Halil Harman, Nedim Kaban
doi: 10.14744/etd.2022.35714  Pages 138 - 144
Objective: This study aims to evaluate the relationship of ultrasonographic cartilage thickness with clinical and functional parameters in patients with rheumatoid arthritis (RA).
Materials and Methods: The study included 50 patients with RA and 20 patients with osteoarthritis (OA), together with 20 healthy subjects. Demographic and clinical characteristics of the patients and the healthy controls were recorded. The second and third metacarpophalangeal (MCP) articular cartilage surfaces were examined in both hands of RA patients. Cartilage qualities were also measured using the semiquantitative scoring system for the quality of MCP joint cartilage. Duruöz Hand Index (DHI) was used to assess the hand functions.
Results: The second and third MCP cartilage thicknesses were found to be less in RA patients than in healthy controls and controls with OA (p<0.05). No statistically significant relationship was found between continuous glucocorticoid use and MCP cartilage thickness or semiquantitative scoring (r=0.125, p=0.154; r=0.172, p=0.103; respectively). There was a statistically significant correlation between disease duration, delay time in diagnosis, DHI scores, and the second MCP and third MCP cartilage thicknesses, as well as between the second MCP and third MCP semiquantitative scores (p<0.05).
Conclusion: Thickness of the MCP joint cartilage is significantly lower in patients with RA who experienced a prolonged delay in diagnosis than that in RA patients who adhere to the management and in RA patients.

5.The Effect of Transcatheter Ventricular Septal Defect Closure on Children’s Appetite, Hormones, and Growth
Onur Tasci, Ozge Pamukcu, Nazmi Narin, Didem Barlak Keti, Suleyman Sunkak, Çağdaş Vural, Nihal Hatipoglu, Ali Baykan
doi: 10.14744/etd.2022.41848  Pages 145 - 151
Objective: Children with congenital heart disease are at risk for malnutrition. The aim of this study is to investigate the changes in appetite, nutritional hormones, and anthropometric measurements of patients before and after the transcatheter closure of ventricular septal defect.
Materials and Methods: Twenty patients whose defect was closed percutaneously and 26 children as healthy control group were included in the study. The anthropometric evaluation, symptoms, and blood tests of patient group were enrolled at initial and follow-up (1st and 6th month visit).
Results: The median age of patient and control group was 27 and 29.5 months, respectively. Lack of appetite, inadequate weight gain, and fatigue were higher in the patient group at initial visit (p=0.027, p=0.029, and p=0.033, respectively). At 1st month after closure, the rate of decrease in lack of appetite, inadequate weight gain, and fatigue were statistically significant (p=0.016, p=0.031, and p=0.031, respectively). After closure, increasing body mass index, its z score, and mid-upper arm circumference were statistically significant at 1st month (p=0.008, p=0.018, and p=0.018, respectively). Insulin-like growth factor-1, insulin-like growth factor binding protein-3, and their z scores were increased compared to the initial values at 1st month (p=0.001, p=0.033, p=0.002, and p=0.048, respectively). Ghrelin levels showed a linear decrease; leptin levels showed a linear increase for 6 months.
Conclusion: Children with ventricular septal defect are under the risk of malnutrition. One of the goals of our treatment plan for these children should be the prevention of malnutrition; therefore, the timing of interventional therapy should be before malnutrition develops

6.Detection of Novel NF1 Variants with Next-Generation DNA Sequencing Technology and Genotype–Phenotype Characteristics of Neurofibromatosis
Aslihan Kiraz, Hakan Gumus, Burhan Balta, Murat Erdogan, Ahmet Sami Guven, Ahmet Savranlar, Serkan Fazli Celik, Sefer Kumandas, Zehra Filiz Karaman, Yesim Ozdemir, Gulsum Gumus, Nurettin Bayram, Huseyin Per
doi: 10.14744/etd.2022.90023  Pages 152 - 158
Objective: Neurofibromatosis type 1 (NF1, #162200) is a common neurological disorder with de novo or inherited germline mutations of the Neurofibromin (NF1, *613113). The purpose of this study is to increase the limited knowledge of NF1 in a small population-based dataset.
Materials and Methods: This study enrolled patients with clinically suspected NF1 referred to the Kayseri Training and Research Hospital, Medical Genetics Department, between 2015 and 2017. The local ethics committee approved this study. Next-generation sequencing was performed for the genetic analysis. The genetic, demographic, and clinical features of the participants were characterized.
Results: A total of 79 cases of NF1 were included. Of these cases, 40 were male, and 39 were female. The mean age was 11.9 years, and most were younger than 18 years. The most common complaint was café au lait macules. The 61 (77.3%) patients had pathogenic variants, and 16 (26.2%) were novel. Mostly affected mutation sites were exonic regions (n=54, 88.5%). The most common mutated exon was exon 38 (n=7, 11.5%), and most of the detected mutations were nonsense mutations (31%).
Conclusion: It is one of Türkiye’s largest NF1 study groups, where all exons of the NF1 gene were analyzed. This study contributes novel variants to the literature. There was no mutational hotspot region, and no significant relationship between genotype and phenotype was observed. Further studies and large sample sizes are required to better understand the relationship between NF and genetic changes.

7.Effect of an Active Distraction Method for Pediatric Venipuncture-Related Pain and Anxiety
Emel Isiyel, Melahat Yurttas, Ezgi Perktas, Elif Nursel Ozmert, Ozlem Teksam
doi: 10.14744/etd.2022.13707  Pages 159 - 164
Objective: Children can experience less pain and anxiety by being informed and distracted. Our goal was to assess the effectiveness of providing information and using an active distraction technique to treat pediatric venipuncture-related pain and anxiety in children.
Materials and Methods: One hundred forty-two children between the ages of 3 and 8 years were randomized into three groups: the informed, the informed and distracted, and the control. In the informed group, information was provided to the parents and children in written and verbal forms; in the informed and distracted group, information was also provided to the parents and children while allowing the children to play a puzzle game on the tablet; and in the control group, the routine injection procedure was performed. Parents and an independent observer completed two separate forms to rate the pain and terror of the children.
Results: According to the parents/caregivers, fear and pain experience were found to be significantly lower in the informed and distracted group (p=0.001 for pain; p=0.005 for fear) than in the control and the informed groups. Moreover, according to the independent observer, fear and pain experience were similarly found to be significantly lower in the informed and distracted group (p=0.002 for pain; p<0.001 for fear) than in the other two groups. According to the independent observer, the anxiety of the parents was significantly found to be lower in the informed and distracted group (p=0.007) than in the other two groups.
Conclusion: Children and their families experience stress as a result of painful procedures. It may be possible to lessen the pain and anxiety that children experience during invasive operations by informing, preparing, and distracting them.

8.The Effect of Mutations Determined by Liquid Biopsy on the Progress of the Disease in Advanced Lung Adenocancer
Mehmet Ergin, Metin Özkan, Meral Ilgaz Ergin, Ahu Cephe
doi: 10.14744/etd.2022.09514  Pages 165 - 171
Aim: In this study, it was aimed to examine the mutation panel studied with liquid biopsy in diagnosed lung adenocancer patients and to investigate its relationship with survival.
Material and Methods: Twenty-four diagnosed lung adenocarcinoma patients between the ages of 18-80, metastatic and who had not received chemotherapy yet were included in the study. The cfDNAs (cell-free DNA) isolated from the patient's blood were analyzed using the next generation sequencing commercial kit 56G Oncology Panel. SOPHiA DDM® (Saint-Sulpice, Switzerland) bioinformatics program was used for the classification of detected genetic variants. The patients were followed for 3 years in terms of survival. R Version 4.1.3 (https: // and TURCOSA Analytical (https: // software was used for the statistical analysis.
Results: Mutation was found in liquid biopsy in 16 (66.7%) of the patients. In 7 (29.1%) patients, more than one mutation was detected in liquid biopsy. When the relationship between the variables and mortality was examined in the cases included in the study, there was a significant relationship between age and mortality (p=0.029) and mortality was increasing with aging. In the survival analysis, no statistically significant relationship was found between gender, smoking status, mutation status and survival according to Kaplan-Meier graphs and log-rank tests.
Conclusion: As a result, driver mutation was detected in 66.7% of the patients included in our study. Driver mutations are targets for treatments, and liquid biopsy may play a crucial role in the course of lung adenocancer to detect the driver mutations.

9.Duration of Oral Antioxidant Therapy in Male Infertility with Increased DNA Damage: 3 Months Versus 6 Months
Eray Hasırcı, Mehmet Resit Gören, Cevahir Özer
doi: 10.14744/etd.2022.49404  Pages 172 - 176
Objective: Oral antioxidants are one of the options for treating male patients with idiopathic infertility associated with increased sperm DNA fragmentation. The aim of this study is to assess the contribution of antioxidant treatment duration to treatment success in this patient group.
Materials and Methods: In this cross-sectional study (between 2014 and 2019), 637 patients who received antioxidant therapy for male infertility were retrospectively analyzed. The results of patients with 30% or more sperm DNA damage and who did not meet the exclusion criteria and who had at least 6 months of follow-up were evaluated. DNA damage, semen parameters, and laboratory results of the patients receiving antioxidant therapy were evaluated before the treatment and at the third and sixth months of treatment.
Results: A total of 53 patients with follow-up data met the study criteria. Significant decreases were observed in sperm DNA fragmentation index (DFI) values in the third and sixth months of the treatment. The sperm DFI was a median of 44% (interquartile range, 13.7%) before the treatment and 33.3% (IQR, 20.9%) after the 3 months and 18% (IQR, 13.4%) after the 6 months. Additionally, during the antioxidant treatment, a statistically significant decrease was observed between the third and sixth month DFI values.
Conclusion: In idiopathic infertility cases, antioxidant treatment may have positive effects on sperm DFI values, and the pro-longation of the treatment period may make an additional contribution to treatment success for infertile men with increased sperm DNA fragmentation (SDF). Nevertheless, possible side effects cost of treatment, patient compliance, and the condition of the partner should be considered while planning the duration of treatment.

10.Differences between Chronological Age and Height Age in Goiter Interpretation
Serkan Bilge Koca, Turgut Seber, Ahu Paketçi, Kürşad Özdemir
doi: 10.14744/etd.2022.56687  Pages 177 - 181
Objective: Some factors (age, weight, height, body mass index, body surface area, puberty stage, and iodine nutrition status) may affect thyroid volume (TV). We aimed to investigate the differences between chronological age and height age in interpreting goiter.
Materials and Methods: The thyroid ultrasonography records of 420 children aged 1–18 years were evaluated. We searched the difference between the interpretations of goiter by recalculating the TV standard deviation score (SDS) in terms of both chronological ages and corrected for height age. We also evaluated those with negative thyroid autoantibodies and normal thyroid hormone levels by subgroup analysis. The evaluation of TV according to chronological age and height age and the change of goiter interpretation were compared with the McNemar test.
Results: A total of 180 children who had euthyroid and negative thyroid autoantibodies were analyzed. A weak correlation was detected between TV and age (r=0.29, p<0.001), body weight (r=0.35, p<0.001), height (r=0.32, p<0.001), height age (r=0.32, p<0.001), body weight SDS (r=0.20, p=0.008) and height SDS (r=0.21, p=0.005). When the changes of goiter interpretation were compared, a statistically significant difference was determined in the whole group (p=0.029); however, there was no significant difference in children who were both euthyroid and found to have negative thyroid auto-antibodies (p=0.375).
Conclusion: We observed that the interpretation of goiter changed according to chronological age and height age if thyroid hormone level and/or thyroid autoantibody positivity were included.

11.Diagnostic Accuracy of Fine-Needle Aspiration Cytology of Thyroid Nodules and Seven Years of Experience
Selma Erdoğan Düzcü, Nur Tunç Karabekiroğlu, Hesna Müzeyyen Astarcı, Seyit Ali Kayıs
doi: 10.14744/etd.2023.57267  Pages 182 - 189
Objective: Thyroid fine-needle aspiration cytology is a dependable, effective method of detecting thyroid nodules. This study aims to assess the diagnostic distribution of thyroid fine-needle aspiration cytology, compare it to postoperative histological tissue diagnoses, and explore its diagnostic compatibility with published data.
Materials and Methods: This single-center retrospective descriptive study included 172 cases diagnosed histopathologically out of the 1675 thyroid fine-needle aspiration cytology procedures performed in the Bolu Abant İzzet Baysal University Fac-ulty of Medicine, Department of Medical Pathology, between 2014 and 2020. The study examined the correlation between cytological and histopathological diagnoses.
Results: Of the 172 cases, 132 were female (76.74%), and 40 were male (23.26%). The participants ranged in age from 14 to 79, with a mean age of 49.23±11.83. Fine-needle aspiration cytology results were compared to tissue diagnoses. The method’s sensitivity was 61.29%, its specificity was 96.00%, its negative predictive value was 80.00%, its positive predictive value was 90.48%, and its diagnostic efficiency was 82.72%.
Conclusion: In our study, the sensitivity and specificity values of cytology were high. Fine-needle aspiration cytology had limited diagnostic contributions in diagnosing papillary microcarcinoma and follicular lesions. In addition to increasing cy-topathology experience to improve diagnostic compliance, we believe evaluating patients with clinical and radiological find-ings will better benefit patient treatment.

12.Determining the Body Composition of Patients with Acromegaly as a Cardiovascular Risk
Yasemin Aydoğan Ünsal, Özen Öz Gül, Şeyma Esenbuğa, Coşkun Ateş, Ensar Aydemir, Soner Cander, Canan Ersoy, Erdinç Ertürk
doi: 10.14744/etd.2023.83809  Pages 190 - 196
Objective: This report aimed to examine changes in constituents of body composition that correlate to cardiovascular morbidity and mortality in patients with acromegaly using bioelectrical impedance analysis (BIA).
Materials and Methods: This prospective study included 62 patients who were followed up after their acromegaly diagnosis and 40 healthy volunteers. All patients’ body compositions were evaluated using a body composition analyzer (TANITA MC-780-Black) with the BIA method. The laboratory and anthropometric measurements and body composition parameters were compared between the patients with acromegaly and the controls. Moreover, these parameters were examined according to the disease activity.
Results: This study showed that patients with acromegaly have higher plasma glucose levels than the control group (p=0.001). The homeostasis model assessment-insulin resistance index of patients with acromegaly was significantly higher than that of the controls (p=0.02). The compartments of intracellular water (ICW) and extracellular water (ECW) in the patients with acromegaly were larger than that in the controls (respectively; p=0.02 and p=0.001). The lean mass of the patients with acromegaly in the trunk and extremities was significantly higher than the controls (respectively; p=0.002 and p=0.001). The compartment of muscle was significantly larger than that in the controls (p=0.001). The basal metabolism in patients with acromegaly was significantly higher than that in the controls (p=0.002).
Conclusion: Determining the body composition using the BIA method can provide important information about the cardiovascular risks in patients with acromegaly. With the BIA method, cardiovascular risk can be estimated and reduced with effective strategies.

13.A Comparison of Prenatal, Natal, and Postnatal Histories in Children with Cerebral Palsy with and without Swallowing Disorder
Nezehat Özgül Ünlüer, Selen Serel Arslan
doi: 10.14744/etd.2023.94763  Pages 197 - 202
Objective: In children with suspected cerebral palsy (CP) after birth who are followed up, the possibility of swallowing disorder should also be considered from the early stages and should be evaluated on a regular basis. The aim of the study was to compare the prenatal, natal, and postnatal histories in children with CP with and without swallowing disorder.
Materials and Methods: Children with CP who were between 2 and 16 years old and who were currently subjected to oral feeding were evaluated. The demographic characteristics and natal histories of the children were noted by asking their caregivers. The 3-ounce water swallow test was used in swallowing evaluation.
Results: On the basis of the results of the water swallow test, 46 children were divided into two groups: those who had no swallowing disorder (n=15) and those who had swallowing disorder (n=31). The groups were similar in terms of histories between the prenatal period and natal period (p>0.05). Postnatal histories, including gagging after sucking, weight loss, chewing problem, and head control, were different between groups (p=0.024, p=0.001, p=0.001, and p=0.047, respectively).
Conclusion: It is important to evaluate the postnatal symptoms and motor development of children with CP who have swallowing disorders during follow-up.

14.Monitoring of SARS-CoV-2 RNA in Public Areas: An Investigation of Environmental Surface Contamination
Doruk Kaynarca, Toner Korkmazhan, Makbule Naz Oktay, Tamer Sanlidag, Buket Baddal
doi: 10.14744/etd.2022.94468  Pages 203 - 206
Abstract |Full Text PDF

15.A Fatal Case of Familial Hemophagocytic Lymphohistiocytosis Associated with Fusarium Infection and Rare Mutation
Mehmet Akif Dündar, Filiz Orak, Can Acıpayam, Kübra Aslan, Veysel Gök, Benhur Şirvan Çetin, Ekrem Ünal, Christoph Klein, Basak Nur Akyıldız
doi: 10.14744/etd.2022.33866  Pages 207 - 210
Background: Hemophagocytic lymphohistiocytosis (HLH) is classified as primary or secondary. While primary (familial) HLH is caused by genetic mutations, secondary (acquired, reactive) HLH is the type that has an underlying cause and is not associated with genetic mutations.
Case Report: We report a two-year-old female patient with a fatal course of Fusarium sepsis who was diagnosed with primary HLH. A homozygous variant of PRF1 (c.445G > A, p.Gly149Ser) was detected. Hyphal growth was detected on Sabouraud dextrose agar and Fusarium multiplied in blood cultures. The patient’s clinical course was fulminant, and she died of septic shock 4 days after admission to the hospital. Fusarium, a rare infection in HLH, was found in this case.
Conclusion: We discovered the rare PRF1 (c.445G>A, p.Gly149Ser) mutation in HLH and the high morbidity and mortal-ity associated with Fusarium infection.

16.Coexistence of Behçet Disease and Sarcoidosis in a Young Man with Femoral Artery Aneurysm: An Uncommon Case
Ümit Arslan, Ferhat Borulu, Sevilay Özmen
doi: 10.14744/etd.2022.42375  Pages 211 - 214
Background: Behçet disease may be confused with sarcoidosis because they are both multisystem inflammatory disorders presenting with uveitis, polyarthritis, cardiovascular disease, erythema nodosum, and other cutaneous lesions. The coexistence of Behçet disease and sarcoidosis is extremely rare but not impossible. Vascular involvement is a significant pathological finding in Behçet disease, and arterial aneurysm formation is more common than occlusion. However, large-vessel vasculitis associated with sarcoidosis is extremely rare.
Case Report: A 23-year-old man was admitted to the hospital because of swelling and pain in the right groin. The patient, who had predominant Behçet disease, was also diagnosed with sarcoidosis during the examination. He had inguinal disten-tion associated with femoral artery aneurysm and underwent successful surgery without complication.
Conclusion: Assessment of the coexistence of Behçet disease and sarcoidosis is critical because of their potentially fatal effects by triggering systemic inflammation. Furthermore, arterial diseases, especially those developing at young ages, can be a sign of immunoinflammatory disease.

17.Detecting Emphysematous Cholecystitis Using Plain Radiograph
Toshimasa Yamaguchi
doi: 10.14744/etd.2022.99897  Pages 215 - 216
Abstract |Full Text PDF

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