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Publication Open Access A CADASIL Case Presenting with Progressive Bulbar Palsy Caused by Acute Simultaneous Multiple Subcortical Infarcts(2019-04-01T00:00:00Z) GÖKÇAL, ELİF; KOLUKISA, MEHMET; Mustafayev, Nihat; ASİL, Talip; GÖKÇAL, ELİF; KOLUKISA, MEHMET; ASİL, TALIPCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an adult-onset inherited small vessel disease of the brain caused by NOTCH3 mutations. Clinical characteristics of CADASIL include recurrent infarctions, migraine with aura, mood disturbances and cognitive impairment. We report a 35 year-old migraine-free patient with unusual presentation with acute simultaneous multiple subcortical infarctions causing progressive bulbar palsy as the initial manifestation. Hepresented with slurred speech progressing to anarthria and bilateral palsy of lower motor cranial nerves within 24 hour. Initial acute subcortical infarcts enlarged and new infarcts developed in bilateral hemispheres. There was diffuse leukoencephalopathy involving temporal horns and the patient had positive familiy history of migraine and young stroke. CADASIL was diagnosed genetically when NOTCH3 mutationwas shown. The patient improved after treatment with liquid hydration and antiplatelet agent. We experienced with the patient that CADASIL may present with unusual progressive manifestations and bilateral simultaneous infarctions. Irrespective of clinical presentation, patients with leukoencephalopathy and positive familiy history should be tested for NOTCH3 mutation.Publication Open Access A Case of Neglected Patella Dislocation Related to Tibial Plateau Fracture(2013-12-01T00:00:00Z) Elmadag, Mehmet; Ceylan, Hasan Huseyin; BIlsel, Kerem; Acar, Mehmet Ali; ELMADAĞ, NUH MEHMET; BİLSEL, İSMAIL KEREMAcute dislocation of the patella is a common orthopaedic emergency. The dislocated patella commonly reduces spontaneously or is reduced by a physician as an emergency. Rarely, open reduction is needed. Osteochondral fragments that detach from the patella or medial femoral condyle might interfere with patellar reduction, and sometimes osteophytes can interfere with reduction. Therefore, arthroscopic or, rarely, open reduction can be necessary. We present an unusual case of a locked knee related to a tibial plateau fracture. An osteochondral fragment that originated from the tibial plateau inhibited reduction of the patella. Such a fracture related to permanent patella dislocation has not previously been reported.Publication Open Access A Novel External Fixator Designed for a More Comfortable and Secure Hip Arthroscopy(2022-01-01T00:00:00Z) Pulatkan, Anil; UÇAN, VAHDET; YILDIZ, FATİH; TUNCAY, İBRAHİM; UÇAN, VAHDET; YILDIZ, FATİH; TUNCAY, İBRAHİMObjective: To evaluate the functional results of a novel external fixator (EF) designed for joint distraction and prevention of traction table-related hip arthroscopy complications Methods: After obtaining promising results in a cadaveric study, 21 hips of 20 patients underwent EF-assisted arthroscopic hip surgeries for femoroacetabular impingement (FAI) and/or labral tear treatments. Patients were operated on a standard operating table in the supine position. A novel EF was used to distract the joint for central hip arthroscopy. The time needed for EF application and joint distraction and the amount of joint distraction were recorded. Preoperative functional scores were retrospectively compared to the postoperative 5-year follow-up results using the Harris Hip and Western Ontario and McMaster Universities Index scores. Results: All patients underwent peripheral and central arthroscopy. The mean time for EF application and joint distraction was 19 min (range: 8-21). The mean amount of joint distraction was 13.2 mm (range: 12-18). None of the arthroscopic procedures had to be converted to open surgery. Functional results of all patients were improved at the 5-year follow-up (p<0.01). Only one patient required hip arthroscopy revision due to residual FAI. No other major or minor complication was found that is related to the EF or arthroscopy itself. Conclusion: Mid-term outcomes following EF-assisted hip arthroscopy demonstrate significant improvement in the functional outcomes without traction table-related complications. EF can be used as an alternative to traction table to maintain adequate hip distraction in arthroscopic hip surgery. In addition to the rotation, a novel designed EF allows hip joint flexion during distraction contrary to traction table.Publication Open Access A Preliminary Investigation on the Chromosome Aberrations in Acute Lymphoblastic Leukaemia Using Multiprobe Fluorescence In Situ Hybridization Panel(2022-06-01T00:00:00Z) Gokkaya, Bengisu; Atasoy, Sezen; ÇIRAKOĞLU, AYŞE; ARGÜDEN, YELDA; KURU, RAHİYE DİLHAN; YILMAZ, ŞÜKRİYE; ÖNGÖREN, ŞENİZ; DEVİREN, AYHAN; ATASOY, SEZENObjective: Acute lymphoblastic leukemia (ALL) is a disease related to the overproduction of immature lymphocytes. Fin diagnosis and classification of ALL, recognizing chromosome aberrations using conventional cytogenetic analysis (CCA) is essential. However, limited ability of CCA to capture cryptical chromosomal aberrations is a major drawback. The aim of this study was to investigate recurrent aberrations in patients with ALL with normal karyorype or unsuccessful karyoryping using the fluorescence in situ hybridization (FISH) method. Methods: Ten patients with ALL were included in this study. CCA was done according to the standart protocols, and then, multiprobe FISH panel was used for analyzing different chromosomal regions located on 12p13.2/21q22.12, 9q34.11-q34.12/22q11.22-q11.23, 9p21.3, 19p13.3, 11q23.3, 8q24.21, 14q32.33, 10p11.1-q11.1, 17p11.1-q11.1 and 4q12. Results: Analyses of the specific chromosomal regions with FISH assay revealed undetected chromosome rearrangements. Among all the cases, four of them harbored chromosomal abnormalities. MYC, TCF3, IGH rearrangements, CDKN2A deletion and hyperdiploidy were detected in the study. Conclusion: Diagnostic sensitivity of FISH probes in comparison with CCA is effective in the detection of multiple chromosomal rearrangements with prognostic significance. For the improvement of the cytogenctic examination and achieving optimum results for patients with ALL , FISH panels are needed to be used combining with conventional cytogenetics routinely.Publication Open Access A Radiographic Comparison of the Root Length and Area After Class II Treatment with Two Different Functional Appliances(1.10.2020) Seker, Elif Dilara; Yagci, Ahmet; Kurt Demirsoy, Kevser; Yuzuak, Ela NurObjective: The purpose of this study was to compare the changes in root lengths and root surface areas that occur after treatment with two functional appliances the Twin Block (TWB) and Crown Herbst appliances. Methods: Forty patients (12 boys, 28 girls) were included in this study. Half of them were treated with the stainless steel Crown Herbst appliance (with crowns placed on the first molars and the first and second premolars), and the other half were treated with the TWB appliance. Panoramic and cephalometric films were obtained before treatment (T1) and after the functional treatment (T2). All upper and lower teeth except second and third molars were analysed with the ImageJ software (version 1.37, National Institutes of Health, Bethesda) on panoramic films. Root length and area values were compared using t-tests. Results: The intragroup comparison showed that root length values were significantly decreased in right and left mandibular incisors and canines in the Crown Herbst group (12 years 7 months +/- 9 months). However, significantly increased root length was observed in right and left maxillary second premolars and right maxillary first premolar in the TWB group (11 years 1 month +/- 4 months). The intergroup comparison indicated that root length values were significantly decreased in right maxillary premolars, right and left mandibular laterals and left mandibular canine in the Crown Herbst group when compared with those in the TWB group. Conclusion: It was concluded that the Crown Herbst group showed a greater tendency for decreased root length than the TWB group. In orthopaedic correction of Class II malocclusions, in the absence of any contraindications, TWB appliance may be preferred for the promotion of root development.Publication Open Access A Rare Case: Mucous Membrane Plasmacytosis in the Larynx(2014-07-01) BÜYÜKPINARBAŞILI, NUR; ÇOBAN, GANİME; GÜCİN, ZÜHAL; Meriç, Ayşenur; BÜYÜKPINARBAŞILI, NUR; ÇOBAN, GANİME; GÜCİN, ZÜHALMucous membrane plasmacytosis is a rare reactive process characterized by plasma cell infiltration of mucous membranes for unknown reasons. It may be confused with malignancy because of its exophytic structure and pavement appereances. A laryngeal polypoid lesion was sent to the pathology department, clinically called fibroma, and presented to emphasize the diagnostic and differential diagnostic criteria.Publication Open Access A Rare Confusing Nevus Variant: Meyerson Nevus(2018-01-01T00:00:00Z) YILDIZ, PELİN; KÜÇÜK, ÖZLEM SU; DİZMAN, DİDEM; Tosuner, Zeynep; ARICI, Belfin Nur; DEVECİ, Uğur; DEMİRKESEN, Cüyan; YILDIZ, PELİN; SU KÜÇÜK, ÖZLEM; TOSUNER, ZEYNEP; DİZMAN, DİDEMMeyerson nevus is a rare benign entity described by Meyerson et al in 1971 as a melanocytic nevus surrounded by inflammatory, eczematous eruption that resolves spontaneously or by topical steriod therapy (fluticasone propionate, Abdi Ibrahim Ilac San. ve Tic. A.S., Istanbul), but the nevus persists. This entity is not well known and there is limited information in the literature. Since the lesion may develop suspicion for malignancy, it is important to keep this entity in mind. In this article we present three Meyerson nevi, two of which belong to one patient.Publication Open Access A Rare Presentation of Systemic Lupus Erythematosus during Childhood: Chorea(2017-04-01T00:00:00Z) DOĞAN DEMİR, AYŞEGÜL; Kucukkoc, Mehmet; Goknar, Nilufer; UYGUR ŞAHİN, TÜRKAN; ERENBERK, UFUK; DOĞAN DEMİR, AYŞEGÜL; UYGUR ŞAHİN, TÜRKAN; ERENBERK, UFUKSystemic lupus erythematosus (SLE) is a systemic, chronic, inflammatory, autoimmune disease characterized by multi-organ and - system involvement such as the kidneys and hematologic and central nervous systems. The clinical presentation of the disease is extremely variable. Systemic findings, nephritis, neuropsychiatric disease, and cytopenia are more common in children than in adults at presentation. Chorea typically manifests with jerky, involuntary, and purposeless movements, involving the face, four limbs, and neck. In addition, patients suffer from dysarthria, gait disturbance, and neuropsychiatric symptoms. Chorea can be the first finding of SLE during childhood. Herein we reported a 13-year female patient who presented with movement and speech disorders and who was diagnosed chorea-related SLE.Publication Open Access ACE-2, TMPRSS2 and Beyond; Promising Targets and Tools for COVID-19 Prophylaxis and Treatment(2020-12-01T00:00:00Z) Gepdiremen, Ali Akçahan; Kumaş, Meltem; GEPDİREMEN, ALİ AKÇAHANSeveral repurposing drugs and ongoing vaccine researches tocombat Coronavirus Disease-19 (COVID-19) are testing clinically,worldwide. COVID-19 caused by severe acute respiratory failuresyndrome-CoV-2, uses angiotensin-converting enzyme 2 (ACE-2) as a functional receptor for entry into the cells, followed by itspriming by transmembrane protease serine 2 (TMPRSS2). Most ofthe ACE-2 expressing cells are alveolar type II pneumocytes. ViralS-glycoprotein, TMPRSS2 and ACE-2 inhibition, as extracellularmedia components, are potential targets of future therapy. ACE-2 and/or TMPRSS2 blockade is thought to be beneficial in theprevention or treating of this infection which will be the mostconvenient for pharmacoeconomics and effectiveness, regardingsimilar future pandemics. Despite substrate-based design andsynthesis of ACE-2 inhibitor compounds were presented almosttwo decades ago, data on renin angiotensin system activation orits blockers, especially ACE-2, are limited by now. Priority mustbe given to design a convenient vaccine soon, but due to the highmutation ability of such viruses mean that new vaccines may needto be developed for each outbreak. So, de novo drugs such as ACE-2or TMPRSS2 blockers need to be developed which can specificallyblock spike binding sites of the target cells and prevent virusintrusion, especially at the extracellular media, for future pandemics.Publication Open Access Actinomyces neuii subsp. neuii Isolated from Perineal Abscess; Case Report(2019-04-01T00:00:00Z) AKBAŞ, EMEL; Sumbul Gultepe, Bilge; ERSÖZ, CEVPER; CEYLAN, AYŞE NUR; DOYMAZ, Mehmet Ziya; AKBAŞ, EMEL; SÜMBÜL, BİLGE; ERSÖZ, CEVPER; CEYLAN, AYŞE NUR; DOYMAZ, MEHMET ZIYAActinomyces are gram positive bacilli which generally colonize in mouth, colon and vagina. The members of genus Actinomyces are facultative anaerobic or microaerophilic organisms and have a branching flamentous structure. They cause classical actinomycosis. Among the Actinomyces species; A. israelii, A. viscosus, A. naeslundii, A. odontolyticus, A. bovis and A. neuii are the mostly isolated organisms from clinical cases. A rarely encountered member of this group, Actinomyces neuii does not show branching and is catalase and CAMP positive and is a coryneform shaped bacillus. Although Actinomyces is mostly found as contaminating organism, in some cases it is reported as a pathogen. Actinomyces neuii has been reported in chorioamnionitis, neonatal sepsis, vertebral osteomyelitis, cervical lymphadenitis, breast abscess, fatal bacteremia and postoperative endophthalmitis. In our case, A. neuii was isolated from a perineal abcess and it was not previously reported. In our case, Actinomyces neuii was identified by commercial identification systems. For this purpose; VITEK MS and VITEK (R) 2 Compact (both by bioMerieux, France) were used in the clinical microbiology laboratory and then this identification was confirmed as the Actinomyces neuii subsp. neuii by the 16S rRNA sequencing. Also, the positivity of CAMP was demonstrated in the laboratory. As in the cases of other actinomycosis, the treatment of the abcess caused by the Actinomyces neuii is through the surgical debridement. The antimicrobial susceptibility testing is not performed since the organism is reported to be susceptibile to common antibiotics. Beta lactam antibiotics are acknowledged as the proper selection for antibiotic treatment.Publication Open Access An Iron Deficiency Anemia Case That Came with Raw Rice Consumption(2015-02-01) ÇAMLI, AHMET ADİL; KARATOPRAK, CUMALİ; ÇETİN, GÜVEN; ZORLU, MEHMET; ALAY, MURAT; ÇAMLI, AHMET ADİL; KARATOPRAK, CUMALİ; ÇETİN, GÜVEN; ZORLU, MEHMETPica is the chronic consumption of edible or nonedible materials that is thought to be caused by mental problems, pregnancy, or anemia. We wanted to report this case, which we have not seen in the literature before, of a pica patient who consumed raw rice due to iron deficiency anemia. A 26-year-old female patient was brought to the internal medicine polyclinic by her mother with complaints of consuming a bowl of raw rice (200 gr) every evening. The patient was treated with parenteral ferik hydroxide + sucrose complex (2700 mg) for 5 days. After 15 days, when she came to control her will to eat raw rice had been lost completely. As a result, the attention of doctors and family members for pica due to treatable causes, such as anemia, will prevent many probable complications.Publication Open Access An Overview of COVID-19 Medicines in Current Guidelines(2020-12-01T00:00:00Z) GÖKÇE, MUSTAFA; GÜLER, ERAY METİN; GÖKÇE, MUSTAFA; GÜLER, ERAY METİNAn acute respiratory disease caused by a new coronavirus (Severe acute respirotary syndrome-coronavirus-2, previously known as 2019-nCoV), coronavirus disease 2019 (COVID-19), appeared in December 2019 and then has spread rapidly throughout the world starting from China, Japan and South Korea. As of January 30, 2020, the World Health Organization has officially declared the COVID-19 outbreak. Considering the clinical symptoms of COVID-19, it has many symptoms such as high fever, cough, and fatigue. It is reported that this disease is very severe and causes serious consequences such as cytokine storm and acute respiratory distress syndrome in the elderly and those with chronic diseases. Currently, scientists are trying to find a specific antiviral treatment strategy. Various medications such as hydroxychloroquine, lopinavir/ritonavir, ribavirin, remdesivir and favipiravir are currently being applied in clinical trials to test their efficacy and safety worldwide in COVID-19 treatment, and some promising results have been achieved so far. In this review, agents with potential efficacy against COVID-19 are presented in summary.Publication Open Access An Overwiev of the Neural Crest Cells and Tumor Metastasis(2016-08-01) Bayindir, NİHAN; Esrefoglu, MUKADDES; BAYINDIR, NİHAN; EŞREFOĞLU, MUKADDESNeural crest cells (NCCs) derived from neuroectoderm are multipotential cells. NCCs leave the neuroepithelium and migrate to various tissues by epithelial-mesenchymal transition. In this areas NCCs differentiate to variety of cells including melanocytes, glia cells, chromaffin cells. Cancer is a complex process which involves a dinamic interaction between tumor cells and surrounding micrenvironment. Cancer cells similar to neural crest cells leave their own environments and metastasize into a different tissue. The development of the neural crest and that of cancer progression share paralel morphological and molecular characteristics. Many signalling pathway and transcription factors are mutual for both processes. To investigate neural crest developmental mechanisms will provide a better understanding for cancer development, progression and metastasis.Publication Open Access Anesthesia Management of a Parturient with Generalized Psoriasis Who Underwent Planned Cesarean Section(2014-09-01T00:00:00Z) Basaranoglu, Gökçen; Umutoglu, Tarik; Bakan, Mefkur; Topuz, Ufuk; Idin, Kadir; SALİHOĞLU, Ziya; BAŞARANOĞLU, GÖKÇENPsoriasis is the most common chronic and inflammatory skin disease. The anesthetic approach may be regional or general. In this case, we described the anesthetic management of a parturient with generalized psoriasis who underwent a planned cesarean section.Publication Open Access Anxiety, Depression and Health Profile in Mothers with Children in the Pediatric Intensive Care Unit(2020-04-01T00:00:00Z) Cabuk, Burcu; KOSTANOĞLU, Alis; KOSTANOĞLU, ALİSObjective: The aim of this study was to investigate, anxiety, depression and health profile among mothers of patients at pediatric intensive care unit (PICU) and pediatric inpatient service (PIS). Methods: The sample consisted of a total of 40 mothers, including mothers with children in a PICU (group I) and PIS (group II). The mothers’ quality of life was measured with the Nottingham Health Profile (NHP), anxiety was measured with the State- Trait Anxiety Inventory (STAI), and depression levels were measured with the Beck Depression Inventory (Beck-D) for the all mothers. Results: The mean age of the mothers was 31.5 years for group I and 31.25 years for group II. The mean total NHP score of the mothers was 279.0 for group I and 113.33 for group II. The mean total STAI-S score of mothers was 37.1 for group I and 36.65 for group II. The mean total of STAI-T score of mothers was 46.9 for group I and 47.75 for group II. The mean total Beck-D score was 39.7 for group I and 18.5 for group II. There was a statistically significant differences in the levels of anxiety, depression and health profile between the mothers with children in the PICU and those with children in the PIS (p<0.001). Conclusion: This study showed that having a critically ill child at a PICU unit has negative 17 effect on mothers' depression levels, state anxiety levels and health profile.Publication Open Access Approach to Trichobezoar Cases in Children: Literature Review(2014-03-01T00:00:00Z) Kilincaslan, Huseyin; AYDOĞDU, İbrahim; Kucukkoc, Mehmet; Osmanoglu, Nurcan Keskin; Karacanoglu, Dilek; AYDOĞDU, İBRAHİMTrichobezoar is a mass found trapped in the gastrointestinal system formed from the ingestion of hair. They are mostly localized inside the stomach, and they can occasionally extend from the pylorus into the duodenum and small intestines. At the same time, they are almost always associated with trichotillomania, trichophagia, and other psychiatric diseases. Trichobezoar can be easily confused with other diseases characterized by abdominal pain and vomiting. Removal of the mass with laparotomic, laparoscopic, and endoscopic interventions is an available treatment approach. Among them, the laparotomic approach is the most effective treatment modality. Herein, we present a case and reviewed the literature from a general outlook in order to emphasize current, updated approaches to the pediatric cases with trichobezoar.Publication Open Access Assessing and Managing Delirium in Surgical and Internal Medicine: an Overview(2016-12-01) Kirpinar, Ismet; KIRPINAR, İSMETDelirium is most common neuropsychiatric disorder that affects patients in surgical and internal medicine clinics. It is defined as a transient, usually reversible organic mental disorder that has a rapid onset and fluctuating course. Clinically, delirium is an acute or subacute organic mental syndrome that is characterized by a disturbance in attention (reduced ability to direct, focus, sustain, and shift attention), awareness (reduced orientation to the environment), and other cognitive abilities (e.g., memory deficit and disorientation) and is not better explained by preexisting, established, or other evolving neurocognitive disorders. Studies have found that between 10% and 20% of all adult inpatients are diagnosed with delirium and that it occurs in up to 50% of elderly inpatients. Delirium itself is not a disease but rather a clinical syndrome, which results from an underlying disease. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a physiological consequence of an underlying medical condition, substance intoxication or withdrawal, use of a medication, or a toxin exposure, or it is a combination of these factors. Accurate identification of underlying causes and risk factors is essential in early stage diagnosis and treatment. Treatment of delirium requires the treatment of the underlying causes. Psychotropic medications are used to comfort patients or enable better patient management. This study aims to review the clinical characteristics, etiological and risk factors, and different methods to obtain an accurate diagnosis and treatment of delirium.Publication Open Access Asymmetric Blepharospasm Treated with Botulinum Toxin-A: Case Report(2019-01-01T00:00:00Z) Baran, Gozde; Deniz, Cigdem; GÜRSOY, Azize Esra; BABACAN YILDIZ, GÜLSEN; DENİZ, ÇİĞDEM; GÜRSOY, AZIZE ESRA; BABACAN YILDIZ, GÜLSENBenign essential blepharospasm (BEB) is a focal dystonia that causes involuntary occlusion of the eyelids as result of bilateral contraction of orbicularis oculi muscle. A 51-year-old female patient evaluated at the outpatient clinic with complaints of contraction and closure of the left eye for about 11 years and the same complaints of light cyc for 10 years. Cranial magnetic resonance imaging was normal and blepharospasm was diagnosed based on the clinical and neurological evaluation. The patient underwent a botulinum toxin-A injection and was called for control 2 weeks later. BEB is a disease that seriously affects the quality of life of the patient, sometimes it can cause functional blindness. The time between diagnosis and treatment may be delayed in atypical cases. For this reason; differential diagnoses of atypical cases should be done well.Publication Open Access Bilateral Complete-type Medial Discoid Meniscus(2015-12-01T00:00:00Z) Uzer, GÖKÇER; Yildiz, FATİH; PULATKAN, MEHMET ANIL; Elmadag, NUH MEHMET; UZER, GÖKÇER; YILDIZ, FATİH; PULATKAN, MEHMET ANIL; ELMADAĞ, NUH MEHMETDiscoid meniscus is an uncommon congenital anomaly, and it is rarely seen in the medial compartment of the knee. Literature about bilateral medial discoid meniscus pathology is also limited because one of the knees is usually asymptomatic, although the pathology bilaterally exists. The incidence of bilateral cases should be more than that in current literature because of a number of non-diagnosed cases. In this study, we discuss the approach for a patient with one-sided symptomatic bilateral medial discoid meniscus and present partial meniscectomy as a treatment method.Publication Open Access Bilateral Thalamic Infarction(2015-04-01) HALAÇ, Gülistan; Tektürk, Pınar; Deniz, Çiğdem; Kolukısa, Mehmet; OZCAN, Muhammet Emin; Asil, Talip; DENİZ, ÇİĞDEM; KOLUKISA, MEHMET; ASİL, TALIPBilateral thalamic infarction is a rare cerebral vascular disease. The most common findings are acute impairment of consciousness, vertical gaze paresis, cognitive disturbances, and abnormal behavioral symptoms. In this paper, we report a case of bilateral thalamic infarction that resulted in abnormal behavior.