Aim: We aimed to investigate the effects of balneotherapy on knee osteoarthritis in present randomized controlled single blind clinical trial. Methods: Patients with knee osteoarthritis according to ACR criteria whom admitted to our institute were randomly assigned to two groups, 22 patients in each. Balneotherapy group received a total of 24 mixed thermo mineral baths at 37-38 ° C for 20 minutes in a schedule of 2 weeks, 6 days a week, 2 times a day in Gönen Spas. Patients in the control group were received medical treatment and monitored as outpatients. Study population were administered to pain (VAS), The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and The Health Assessment Questionnaire (HAQ) evaluation before treatment, post treatment and on 4th week after treatment. In addition, 10 step ladder-up and 15 meter walking time was calculated. Results: Significant improvement in Pain (VAS), Pain (WOMAC-A), joint stiffness (WOMAC-B), joint function (WOMAC-C), The Health Assessment Questionnaire (HAQ) and in 10 steps ladder up and down tests achieved in balneotherapy group compared to pretreatment values. 15 meter walking time was improved at 4 week compared to baseline measurements. In control group, there was no significant improvement in the evaluated parameters at 4th week compared to pretreatment evaluation. Conclusion: We conclude that balneotherapy may be effective in improving pain and functional status in patients with knee osteoarthritis.

Aim: To achieve homogenization, one of the most important factors to overcome during platelet-rich plasma (PRP) is standardization phases. Method: We used BD vacutainer ACD-A tubes which consisted of ACD-A. 3 tubes blood was collected from healthy volunteers from 20 to 40 years. All tubes were centrifuged. Then ml PRP was collected from just the level of buffy coat. Results: Platelet concentration decreased from buffy coat to top of PPP as expected. If any counting done before homogenization the results will be misleading. Conclusion: When we sample 3 cc PRP homogenized with shaker at 3 point from 3 different point, we see that they are close to each other. It is important that the PRP to be used in the studies must be homogenized before any measurement.

Aim: Celiac disease (CD) is a common immune-mediated enteropathy caused by gluten. These patients may apply with many different clinical forms. The aim of this study is to determine the association of serological tests and type of anemia in CD. Methods: Totally117 biopsy proven CD patients aged between 1-17 years were included. Serological and hematological parameters of all patients were studied. Results: Anemia was identified in 71 (60.7%) cases. Patients with anemia were diagnosed earlier than other patients (5.2±4.5 vs. 15.3±33.8 years, p=0.012). Among CD patients with anemia 39 (54.9%) were having iron deficiency, 22 (30.9%) were having folate deficiency and 10 (14%) were having vitamin B 12 deficiency. In patients with tissue transglutaminase (tTG) seropositivity serum iron levels and ferritin levels were significantly lower compared to anti-gliadin antibody (AGA) or anti-endomysium antibody (EMA) seropositivity (35±23.5 vs. 57.5±33.3, p=0.007 and 12.4±21.9 vs. 24.2±18.5, p=0.026, respectively). Low serum folate levels were more frequent in the presence of tTG seropositivity compared with AGA+EMA seropositivity (81.8% vs. 25%, p=0.015). Conclusions: Anemia is an important cause of admission in CD. These patients are diagnosed earlier as a result of anemia. Alone tTG seropositivity is more valuable to demonstrate anemia associated with iron or folate deficiencies.

Aim:Irritable Bowel syndrome (IBS) is a common gastrointestinal disease worldwide with a broad spectrum of symptoms. In present retrospective study, we aimed to compare mean platelet volume to platelet ratio (MPR) and red cell distribution width to platelet ratio (RPR) values of IBS patients to those of healthy subjects. Methods:Patients whom followed up in internal medicine clinic of our institution between 2014 January to 2018 January were enrolled to the study. IBS subjects divided into constipation dominant or diarrhea dominant IBS groups. Healthy individuals visited our outpatient clinics for a check-up were enrolled as control group. Results:Median MPR of the constipation IBS, diarrhea IS and control groups were 0,034 (0,02-0,06), 0,034 (0,02-0,06), and 0,028 (0,01-0,05), respectively. The difference between groups was statistically significant (p=0.004).Conclusion:We think that elevated MPR in a patient with typical symptoms of IBS could be helpful in the diagnosis of the disease. Therefore, we suggest automatic calculation of MPR in hemogram assays.

Aim:Hepatosteatosis confers increased lipid accumulation in the hepatocytes which is associated with inflammation. Hemogram parameters, such as mean platelet volume (MPV) and MPV to platelet ratio (MPR) are proposed as novel inflammatory markers in recent studies. We aimed to compare MPR of subjects with hepatosteatosis to those in healthy controls.Methods:Patient admissions to our clinic with a diagnosis of hepatosteatosis were retrospectively analyzed MPR values compared to those in healthy controls. Results:Mean MPR of hepatosteatosis group (0,04 ± 0,01fL/mm3) was significantly higher than the MPR of control subjects (0,03 ± 0,01 fL/mm3) (p=0.04). A Pearson’s Correlation analyze was revealed significant correlations between MPR and fasting plasma glucose (r=0.26, p=0.004) and between MPR and LDL-cholesterol (r=0.19, p=0.04).Conclusion:An elevated MPR should alert physicians for hepatosteatosis in otherwise healthy subjects. Therefore, calculation of MPR by automatic hemogram analyzers is advised.

Aim: To compare hemogram-mediated inflammatory markers such as mean platelet volume (MPV), red cell distribution width (RDW), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), MPV to platelet ratio (MPR) and RDW to platelet ratio (RPR) in predicting outcome in the intensive care units (ICU) population. Methods: After obtaining approval of intuitional board the patients whom were treated in the Anesthesiology and Reanimation ICU of Bolu Abant Izzet Baysal University Hospital between March 2017 and December 2018 were evaluated retrospectively and enrolled to the study. The abovementioned laboratory parameters of the deceased and survivors were compared. Results: The PDW, MPV, C-reactive protein (CRP), RPR and MPR values were significantly different between deceased and survived subjects. Moreover, MPV and PDW values were significantly and positively correlated with serum CRP level. Conclusion: We suggest that PDW, MPV, MPR and RPR could be used in determining the severity of the disease in ICU patients along with CRP. Since these hemogram results could be obtained in a much shorter time period compared to CRP, they could be useful in this population; in which hours and even minutes are important in the treatment in ICU.

Aim: To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating enlarged cervical lymph nodes due to tularemia and metastatic tumors. Methods: We evaluated 59 patients with cervical lymphadenopathy (LAP) (32 patients with tularemia, 27 patients with metastatic tumors), retrospectively. We analyzed contrast enhancement patterns of LAP in postcontrast fat sat T1WI. We evaluated T2, DWI, and ADC signals of LAP in a 5-point scale system. Moreover, the mean ADC values of solid and necrotic LAP in both groups were quantitatively measured and compared statistically. Receiver operating characteristic curves of quantitative ADC values were obtained to determine the diagnostic performance. Results: There was no difference between solid and necrotic LAP enhancement patterns in two groups. Solid LAP and peripheral parts of necrotic LAP showed diffusion restriction, whereas central parts necrotic LAP had high ADC and low DWI signal in both tularemia and metastatic groups. Signal characteristics were similar in two groups. In solid LAP, there was no significant difference between ADC values in two groups. In necrotic LAP, total, central, and peripheral quantitative ADC measurements were higher in the metastatic group than in the tularemia group. Conclusions: Conventional MRI findings were not sufficient to differentiate metastatic LAP from tularemia. DW-MRI was not helpful in solid LAP; however, ADC values of metastatic necrotic LAP were significantly higher than tularemia. Microagglutination tests would be useful for differentiation; however, DW-MRI might also be useful for differentiation and may expedite the diagnosis.

Aim:To determine the frequency of the development of anxiety and depression in asthma patients who attended an outpatient clinic during the COVID-19 pandemic, whether these rates were higher than those of the healthy population, and whether there is a possible relationship between asthma control levels, anxiety, and depression.Method:A total of 112 patients with asthma and 81controls, whose mean ages and genders were matched, were included in the study. Demographic data of the two groups and general information about their asthmatic conditions were recorded. Asthma control tests (ACTs) were performed to determine the level of asthma control. The Beck Depression Inventory and Beck Anxiety Inventory were administered to the asthma patients and controls. The groups were compared in terms of their Beck depression and anxiety scores and asthma control. We investigated whether there is a relationship between asthma control level and anxiety and depression scores.Results: Of the asthma patients, 78.6% were found to have anxiety, and 48.2% reported depression, while 32.1% anxiety and 12.3% depression were foundin the control group. Depression and anxiety scores were significantly higher in asthma patients than in the control group. It was observed that 59% of the patients had very poorly controlled asthma, and as the ACT levels of the patients worsened, depression and anxiety scores increased.Conclusions: To reduce the frequency of anxiety and depression in asthma patients, it is essential to provide accurate information about COVID-19 and to effectively control asthma. Therefore, asthma patients should be informed about COVID-19 and advised to engage in regular outpatient examinations