Aim: Fournier gangrene (FG) is a rare, rapidly progressing and life-threatening disease of the genital, perianal and perineal regions. We aimed to evaluate etiological parameters, accompanying diseases, current treatment methods and factors affecting mortality in patients with FG. Method: The medical records of 38 patients who were operated by the same team with a diagnosis of FG from December 2015 to January 2021 were retrospectively reviewed. Those patients were divided into two groups: survivors (Group 1), and non-survivors (Group 2). Comparisons were made regarding clinical and demographic features; comorbid diseases; leukocyte count at first presentation; etiological factors; treatment outcomes; and mortality rates. Results: Female gender, septic shock, necrosis, abdominal wall and lumbar region involvement, chronic renal failure, FG development secondary to postoperative complications and ostomy rates were higher in non-survivors. There were no significant differences between the two groups regarding leukocyte count at first presentation, number of debridement, dressing methods, reconstruction methods, and length of hospital stay. Conclusions: Female gender, presence of septic shock and necrosis on physical examination, involvement of the abdominal wall and lumbar region in addition to the perianal region, chronic renal failure, disease secondary to postoperative complications and the necessity of ostomy play an important role in mortality.

Aim: To construct a perfusion circuit for experimental open hyperthermic intraperitoneal perfusion (HIPEP) and to evaluate the antitumor effects of regional hyperthermia in a model of advanced syngeneic high-grade ovarian carcinoma in vivo. Method: 24 mature female Wistar rats underwent intraperitoneal transplantation of ascitic ovarian tumor 1×107 cells per rat. 48 hours after transplantation the animals were randomized into two groups: I. NIPEP group (12 rats) – normothermic intraperitoneal perfusion (NIPEP) with normal saline at room temperature during 45 minutes; II. HIPEP group (12 rats) – open hyperthermic intraperitoneal perfusion (HIPEP) with normal saline (40.5-41.5 ?) during 45 minutes. Endpoints included overall survival (OS), the total peritoneal cancer index (PCI), ascites weight and the grade of ascites hemorrhage. Results: In both groups all animals survived the procedure, in the HIPEP group one rat died due to infectious complications on day 32. Compared with NIPEP group HIPEP with normal saline significantly increased the median OS from 19 to 39 days (log-rank test, P=0.0013), reducing the risk of death by 68% (HR=0.32; 95% CI 0.13-0.82). The open HIPEP without a cytostatic was associated with significantly lower total PCI (14 vs 5 points, P=0.0155). In the HIPEP group 3 of 12 animals had intrathoracic tumor spread with malignant pleural effusion without signs of peritoneal carcinomatosis and ascites. Conclusion: The transplanted syngeneic tumor is a valid model that allows to quantitatively assess antitumor activity of intraperitoneal perfusion therapy. Our preclinical data confirmed the role of regional hyperthermia in the treatment of peritoneal carcinomatosis in ovarian tumors.

Aim: To investigate the position of the heart after pneumonectomy and, also to find out how the changes in the electrical axis of the heart contribute for the possible electrocardiographic and echocardiographic changes. Methods: Ninety-eight patients with pneumonectomy were included to this observational study. To calculate the rotation of the heart and angle measurement two perpendicular lines, one septal and another atrioventricular, were drawn on the images acquired from thoracic computed tomography. Thoracic CT were taken at every 3 months for the first two years. On electrocardiograms net QRS vectors, amplitudes of p waves, findings of right and left ventricular hypertrophy, and other possible changes were recorded. Results: The mean age of all patients was 55.51 ± 8.9. Right pneumectomy was performed in 40 (57%) and left pneumonectomy in 30 cases (43%) cases. There was no significant change regarding both the angle of rotation and the amount of pleural effusion between the findings of the second and first year after the operation. The QRS shift was significantly more pronounced in patients with left pneumonectomies than right pneumonectomies. On echocardiography these cases showed right ventricular hypertrophy and increased pulmonary artery pressures in the second year when compared to the preoperative period. Conclusions: The current study showed that many significant changes occurred in the electrocardiographic and echocardiographic parameters of the heart after pneumonectomy.

Aim: To evaluate the effect of vitamin D replacement on carpal tunnel syndrome (CTS) symptoms and signs in CTS patients with low vitamin D levels. Methods: This study was designed prospective observably. The patient population was admitted to the EMG (electromyography) laboratory in a tertiary hospital’s Physical Medicine and Rehabilitation Department between 1 January and 31 July 2018. Initially, 55 patients were included in the study. The patients were categorized into two groups as group 1 (<10 ng / ml) and group 2 (10-20 ng / ml) according to the vitamin D levels. A total of 39 patients and 63 wrists, 17 patients in group 1 (28 wrists) and 22 patients in group 2 (35 wrists), were included in the analysis. Results: There was a statistically significant decrease in visual analogue scale and quick arm-shoulder-hand disability score in two groups when compared before treatment. In two groups, there was a significant improvement in grip and pinch strength after treatment. At the same time, after treatment we showed that there was a statistically significant increase in median nerve sensory amplitude in two groups. The increase in median nerve sensory velocity was significant in group 2 whereas it was not statistically significant between group 1 vs group 2. Conclusions: Vitamin D replacement can improve symptoms, functional status and electrophysiological findings in CTS patients with low vitamin D levels.

Aim: To evaluate the possible effects of SARS-CoV-2 infection on retinal nerve fiber layer (RNFL) and ganglion cell complex layer (GC-IPL) thicknesses. Method: Patients who had been infected by SARS-CoV-2 and hospitalized because of severe pneumonia were found out from the database of COVID-19 pandemic hospital and formed the patient group. The control group was composed of non-COVID-19 age-matched subjects. The mean and fragmented RNFL and GC-IPL thicknesses were measured by optical coherence tomography (OCT), and compared between two groups, statistically. Results: Patient group 34 eyes of 34 subjects (18 male, 16 female) and 31 eyes of 31 subjects (14 male, 17 female) in the control group were enrolled. The mean age and gender were not statistically different between groups (p:0.56, 0,57, respectively).A statistically significant difference was not found between groups in terms of mean, superior, inferior, temporal, nasal RNFL thicknesses and mean superior, inferior, temporal, and nasal GC-IPL thicknesses. Conclusion: The mean and fragmented RNFL and GC-IPL thicknesses measured by OCT were not statistically different in patients who had moderate disease course and recovered from COVID-19 infection.

Aim: To evaluate the predictive roles of biochemical and complete blood count parameters in the diagnosis of febrile seizures by comparing these between patients with simple febrile seizures and febrile patients without seizures. Methods: One hundred fifty-two children (66 girls and 86 boys), aged 6-60 months presenting with fever symptoms presenting to our hospital’s pediatric emergency department between January 2015 and January 2020 were included in the study. Demographic data, complete blood count parameters and biochemical parameter levels were compared between the two groups. These were divided into a patient group with simple febrile seizures (n = 74) and a febrile control group without seizures (n = 78). Results: Comparison of biochemical parameters revealed significantly higher glucose, CRP, and ALT levels in the febrile seizure group, while Ca and Na were significantly lower. Comparison of complete blood count parameters revealed significantly higher white blood cell (WBC), neutrophil, red cell distribution width, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) values in the febrile seizure group, while hemoglobin, hematocrit, mean corpuscular volume, lymphocytes, and mean platelet volume were significantly lower. Conclusions: We think that in addition to markers such as WBC, leukocytes, and CRP for evaluating inflammation in patients with febrile seizures, simple, easily available, and inexpensive tests such as NLR and PLR can also be useful for assessing inflammation.

Aim: The triglyceride / HDL cholesterol (TG/HDL-c) ratio is increased in a variety of diseases including, coronary heart disease and type 2 diabetes mellitus. However, its role in non-alcoholic hepatosteatosis is not well understood. In present study, we aimed to compare the TG/HDL-c levels of the patients with nonalcoholic hepatosteatosis to those of the healthy subjects. Methods: Medical data of the patients with non-alcoholic hepatosteatosis whom presented to the outpatient internal medicine clinics of our institution were retrospectively analyzed. Healthy subjects whom admissions to our clinics were due to check up were enrolled to the study as control group. TG/HDL-c of the groups compared. Results: TG/HDL-c level of the liver steatosis group (5 (2-22) %) was higher than the control group (2.7 (1- 8) %), (p<0.001). TG/HDL-c was significantly and positively correlated with fasting blood glucose (r=0.31, p<0.001), C - reactive protein (r=0.25, p<0.001) and LDL-cholesterol (r=0.3, p<0.001) levels. A TG/HDL-c value greater than 3.1% has 91% sensitivity and 77% specificity in detecting hepatosteatosis. Conclusions: We suggest that TG/HDL-c ratio could be a useful marker of non-alcoholic hepatosteatosis due to its inexpensive and easy to assess nature.

Aim: In this study, the serological values of our patients followed up with a diagnosis of migraine were compared with the results of healthy controls in terms of possible association with intracellular pathogens, Toxoplasma gondii and Borrelia burgdorferi. Methods: Fifty patients with migraine, randomly selected among migraine patients without any additional disease, who applied to Bolu Abant Izzet Baysal Training and Research Hospital between January 1, 2015 and August 31, 2019 were included in the study. Fifty subjects without headache were included as control group. The history of infectious diseases of the patient and control groups (Toxoplasma gondii, Borrelia burgdorfericausing Lyme disease) was determined by serological diagnostic methods. Results: The study group consisted of 64 women with a mean age of 45.5±13.1 (15-76) years. Migraine and control groups were found to be similar in terms of age (p=0.059) and gender (p=0.211) distributions. The frequency of Toxoplasma gondii positivity in the migraine group was 28% (n=14) and 10% (n=5) in the control group. The frequency of Lyme was 19.6% (n=11) in the migraine group and 14.3% (n=8) in the control group. The frequency of Toxoplasma gondii positivity was statistically significantly higher in the migraine group (p=0.022), while the frequency of Lyme was found to be similar in the migraine and control groups (p=0.450). Conclusion: The results of our study suggest that there are statistically significant differences between migraine and control groups only in terms of Toxoplasma gondii positivity rates, not Lyme. However, we believe that larger sample studies are needed to determine the detailed relationship between migraine and Toxoplasma gondii infection.

Aim: Couple of pneumonia cases were reported in a short period in Wuhan, China. The cases were revealed to be associated with a different coronavirus type was named SARS-CoV-2 and the disease was identified as Covid-19. It is known that the disease occurs in all age groups. We aimed to evaluate the differences in clinical and laboratory features between adult and pediatric patients. Method: The study is a retrospective cross-sectional study and consists of 206 patients with a definitive diagnosis of Covid-19 confirmed by a positive real-time reverse-transcriptase polymerase chain reaction (RTPCR) testing for SARS-CoV-2. They hospitalized in health institutions connected to City Health Administrative of Bolu, Turkey between 11.03.2020 and 19.04.2020. The number of the pediatric patients (0- 17 age group) was 106, that of the adult patients (18 and above age group) was 100. Data concerning the patients consisted of age, symptoms, laboratory parameters such as hemogram, biochemistry, coagulation. Results: The mean values of platelet (PLT), platocrit (PCT), percentage of monocytes (MONO %) and MONO in the “0-17” age group were found to be significantly higher than the mean values in the “18 and above” age group. The hemoglobin (HGB) mean value of the “0-17” age group was significantly lower than that of the “18 and above” age group. The mean C - reactive protein (CRP) value of the “0-17” age group (4.55; min: 1.20 – max: 11.80) was significantly lower than that of the “18 and above” age group (5.35; min 1.25- max: 19.77) with no statistically significance. In pediatric group, the most common symptoms were other symptoms like diarrhea, vomiting and joint pain whereas the adult patients had fever and cough often with statistically significant. Conclusion: Clinical findings and laboratory abnormalities in Covid-19 are less common in children. Although it seems that Covid-19 is less symptomatic in children, they are also affected by the disease. Performing RT-PCR test based on the contact history of the children may help to minimize morbidity with an early diagnosis. Multicenter studies with more numbers of patients should be performed.

Aim: Knee osteoarthritis is a very common joint disease in the community. However, some meniscus lesions are asymptomatic. Studies show that a significant number of individuals with knee pain without radiographic osteoarthritis findings show meniscus injury on magnetic resonance imaging (MRI). Our study aimed to evaluate the relationship between meniscus lesions and the presence of radiographic knee osteoarthritis in individuals over 50 years of age with knee pain complaints. Methods: Radiographic and MRI results of two hundred and forty patients who applied to our hospital with the complaint of knee pain between August 2018 and January 2020 were analyzed. Radiographic grading for knee osteoarthritis was performed using the Kellgren Lawrence scale. Classification of meniscus lesions in MRI was made as per the criteria defined by the British Knee Meniscus Surgery Association. Intergroup results were evaluated statistically. Results: Osteoarthritis was detected in 110 (45.8%) of 240 knee radiographs. In 78.3% of all cases, meniscus lesions were detected in 96.4% of those with osteoarthritis and 63% of those without osteoarthritis. In patients with osteoarthritis, the prevalence of surgically targeted and possible target lesions was found to be significantly higher than those with no arthritis findings. Conclusions: According to our study results, meniscus lesions were found quite common in individuals with knee pain, especially those with osteoarthritis. Particularly in patients with radiographic osteoarthritis findings, surgical targets and possible target meniscus lesions were more common than those without osteoarthritis findings. Therefore, MRI, in addition to direct radiography, should not be overlooked when determining treatment.

Aim: To evaluate the dual inhibitory effect of epigallocatechin gallate on Alzheimer’s pathogenesis. Methods: Cholinesterase inhibition studies were performed by kinetic Ellman methods and also the inhibitory effect of molecule on amyloid fibrillation is determined by dye binding thioflavin T method. Results: Epigallocatechin gallate inhibited both types of cholinesterases and amyloid fibrillation. The inhibition of acetylcholinesterase indicated an uncompetitive inhibition whereas butyrylcholinesterase inhibition had an unique pattern. Compound inhibited butyrylcholinesterase with two types of inhibition in a dose related manner. Fibrillation destabilization is also observed by the compound. Conclusion: Our results indicated that epigallocatechin gallate may be accepted as a candidate molecule as the dual effective drugs for neurodegenerative diseases.

Aim: We visually and quantitatively investigated the success of using 2-deoxy-2-[fluorine-18] fluoro-Dglucose integrated with computed tomography ( 18F-FDG PET/CT) and magnetic resonance imaging (MRI) [Dynamic contrast enhancement (DCE) and diffusion weighted imaging (DWI)] separately and together in detecting axillary lymph node metastasis in patients with newly diagnosed breast cancer. Methods: One hundred and thirteen patients who underwent 18F FDG PET/CT were evaluated, 102 patients of these patients had also MRI (DEC + DWI). Primary tumour size (Tsize), SUVmax of primary tumour (SUVmaxT), short diameter of largest axillary lymph node on PET/CT (LnDPET/CT), SUVmax of axillary lymph node (SUVmaxLn), metabolic tumour volume of the primary tumour (MTV), short diameter of largest axillary lymph node on MRI (LnDMRI), the presence of fatty hilum absence and apparent diffusion coefficient (ADC) were evaluated. Results: In visual analysis, sensitivity and specificity values of 18F FDG PET/CT, MRI and MRI+18F FDG PET/CT were 78.85, 94% – 72.27%, 96.15 – 83.87%, 98.04%, respectively. In the quantitative evaluation, ADC=1.2 x 10-3 mm2 /sec (OR = 6.665, p = 0.001, 95CI%: 2.181–20.370) and LnSUVmax> 2 (OR = 15.2, p<0.001, 95CI%: 4.587–50.376) were independent predictors in detecting axillary lymph node metastasis. Conclusion: LnSUVmax >2 and ADC = 1.2 x 10-3 mm2 /sec can be used as independent predictors of detecting axillary lymph node metastasis in patients with newly diagnosed breast cancer.