68Ga Prostate-specific Membrane Antigen Uptake in Metastatic Medullary Thyroid Carcinoma.

We present the case of a 58-year-old man with advanced medullary thyroid carcinoma who had a treatment history with different types of modalities. In the follow-up, the patient had rising calcitonin and CEA levels. Metastatic lymph nodes, liver, and bone metastases with varying degrees of uptake were detected on 18F-fluorodeoxyglucose (FDG) and 68Ga-DOTATATE positron emission tomography/computed tomography (PET/CT). 68Ga prostate-specific membrane antigen (PSMA) PET/CT was performed to explore whether the patient might have a chance for PSMA-targeted radionuclide therapy, and increased PSMA expression was noted in most of the metastatic lesions, even some of which have higher PSMA uptake than 18F-FDG and 68Ga-DOTATATE.

Investigation of MIF gene promoter variations and their haplotypes in the Alzheimer disease in Turkish population.

In Alzheimer's disease, which is characterized by amyloid plaques and neurofibrillary tangles in the brain tissue, many components such as acute phase proteins, cytokines, and proteases contribute to the progression of the disease or are part of the pathological process. The macrophage migration inhibitory factor (MIF) gene encodes a cytokine, which is secreted by lymphocytes, and has a role in the pathogenesis of autoimmune/inflammatory diseases such as rheumatoid arthritis. The purpose of this study to investigate the association between Alzheimer disease and MIF gene promoter polymorphisms. The 205 patients with Alzheimer disease (AD) and 130 age-sex matched healthy individuals were investigated in terms of MIF -173 G/C and MIF -794 CATT polymorphisms. The genotyping of MIF -173 G/C was determined using the RT-PCR method. MIF-794 CATT polymorphism was analyzed using PCR and DNA Sequencing. In terms of binary genotypes and haplotypes, the 5/5-GC (p = 0.004), 6/7-GG (p = 0.02) and, 6/6-GG (p = 0.026) binary genotypes, and 5-C (p = 0.003), 7-G (p = 0.026) and 6-G (p = 0.025) haplotypes were differed significantly between the patients and the controls. This is the first study investigating the relationship between AD and MIF in terms of different genotypes, haplotypes and, alleles. The fact that the binary genotype and allele distributions are significantly different between the patient and control group, suggests that this MIF variants may play a role in the pathogenesis of AD.

Unexpected Symmetrical Uptake of 18 F-FDG of Distal Peripheral Bones in a Patient With Diffuse Large B-Cell Lymphoma.

ABSTRACT: A 74-year-old woman was referred for 18 F-FDG PET/CT scanning to investigate an underlining etiology due to recently developed unexplained bone pains and lack of walking capacity. On the initial PET/CT scan, we have noted a highly symmetrical and apparent intramedullary FDG uptake of the distal parts of appendicular skeleton system including the bilateral elbows, wrists, and foot ankles in addition to a lymphadenomegaly in the right groin. The excisional biopsy from the lymph node of right groin revealed a diagnosis of diffuse large B-cell lymphoma.

Evaluation of perioperative risk factors in pediatric patients with left ventricle outflow tract obstruction.

Introduction: Left ventricular outflow tract obstructions (LVOTO) presents as complex cardiac diseases accompanied by other cardiac anomalies in the pediatric age group. Postoperative complications, especially cardiac, pulmonary, and renal complications, that may develop after pediatric cardiac surgery can become life-threatening. If the perioperative risk factors for these complications are known in pediatric patients with LVOTO, anesthesiologists and surgeons may take precautions to eliminate undesirable outcomes. Aim: To evaluate the perioperative risk factors that may contribute to the development of postoperative complications in pediatric patients operated on for LVOTO in a pediatric cardiac surgery clinic. Material and methods: The study retrospectively investigated 58 patients who were operated on for LVOTO in a pediatric cardiac surgery clinic. The patients were divided into two groups, those with and without postoperative complications. Preoperative laboratory test results, anesthesia time, operation time, aortic cross-clamp time, cardiopulmonary bypass (CPB) time, postoperative inotropes, first postoperative laboratory tests, intraoperative and postoperative complications, mechanical ventilation time, intensive care unit stay, and hospital stay were recorded. Results: The most common postoperative complications were endocrine complications, followed by hepatic complications. The preoperative lymphocyte count was significantly higher (p < 0.05), and the neutrophil-to-lymphocyte ratio (NLR) was significantly lower (p < 0.05) in the group with postoperative complications. The postoperative pH, glucose, creatinine, and aspartate aminotransferase (AST) levels were significantly lower (p < 0.05), and the postoperative calcium level was significantly higher (p < 0.05) in the group without postoperative complications. Intraoperative platelet transfusion rate was found to be significantly lower (p < 0.05) in the group with postoperative complications. Conclusions: It is critical to identify predictive factors to prevent postoperative complications in pediatric patients undergoing surgery for LVOTO. Preoperative NLR, intraoperative platelet transfusion, and postoperative calcium, glucose, pH and AST levels may help in the prediction of complications.

Diagnosis and Management of Classical Hodgkin Lymphoma During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has brought life to a standstill globally. Intermittent quarantines were applied to control the pandemic and reduce contamination. During the pandemic, patients with hematological malignancies were among the most vulnerable population. Our aim was to compare in terms of demographic data, disease-related factors, symptom-to-diagnosis interval, diagnosis-to-treatment interval , and interim and end-of-treatment response in classical Hodgkin lymphoma patients diagnosed during the pandemic and in the pre-pandemic periods. A total of 90 patients were included, of which 65 and 25 were diagnosed in the 2 years before the pandemic and the 12-month period during the pandemic, respectively. Demographic features were comparable in both groups. Although the percentage of patients with advanced-stage disease was higher during the pandemic (64% vs 53.8%), this difference did not reach statistical significance (P = 0.384). The median symptom-to-diagnosis interval was significantly longer during the pandemic than was observed within the pre-pandemic era (16 weeks vs 8 weeks, P = 0.042). The median diagnosis-to-treatment intervals was similar in both groups (13 days vs 15 days, P = 0.253). In the pre-pandemic and pandemic periods, 85.2% and 72.7% of the patients had complete response at end-of-treatment evaluation, respectively (P = 0.208). We found that symptom-to-diagnosis interval was significantly prolonged during the pandemic. Higher percentage of patients with advanced-stage disease during the pandemic might also be due to this delay, nevertheless, this difference did not reach to a significant difference regarding treatment response in both groups.

Metformin with Versus without Concomitant Probiotic Therapy in Newly Diagnosed Patients with Type 2 Diabetes or Prediabetes: A Comparative Analysis in Relation to Glycemic Control, Gastrointestinal Side Effects, and Treatment Compliance.

BACKGROUND: To evaluate the impact of concomitant use of probiotic BB-12 in metformin-treated patients with type 2 diabetes or prediabetes on glycemic control, metformin-related gastrointestinal side effects, and treatment compliance. METHODS: A total of 156 patients (mean [standard deviation] age: 50.9 [9.9 years], 74.4% females) with newly diagnosed type 2 diabetes or prediabetes were randomly assigned to receive either metformin alone (n = 84, MET group) or metformin plus Bifidobacterium animalis subsp. lactis (BB-12) probiotic (n = 72, MET-PRO group). Data on body mass index (kg/m2), fasting blood glucose (mg/dL), blood lipids, and glycated hemoglobin (HbA1c) levels were recorded at baseline and at the third month of therapy. Data on gastrointestinal intolerance symptoms and treatment noncompliance were also recorded during post-treatment week 1 to week 4. RESULTS: MET-PRO versus MET therapy was associated with a significantly higher rate of treatment compliance (91.7% vs 71.4%, P = .001), greater reduction from baseline HbA1c values (0.9 [0.4-1.6] vs 0.4 [0-1.6] %, P < .001) and lower likelihood of gastrointestinal intolerance symptoms, including abdominal pain (P = .031 to <.001), diarrhea (P = .005 to <.001) and bloating (P = .010 to <.001). Noncompliance developed later (at least 15 days after the therapy) in a significantly higher percentage of patients in the MET group (P = .001 for 15-21 days and P = .002 for 22-28 days). CONCLUSION: In conclusion, the present study proposes the benefit of combining probiotics with metformin in the treatment of patients with T2D or prediabetes in terms of improved glycemic control and treatment adherence rather than correction of dyslipidemia or weight reduction.

Difficult Ventilation in an Infant After Successful Intubation.

Manufacturing defects in the connector of the endotracheal tube are not frequently encountered in emergency and planned intubations. In cases where they are encountered, however, they may cause partial or complete airway obstruction in sick infants with limited reserves, giving rise to a life-threatening situation following the intubation. For this reason, endotracheal tubes must be checked carefully before use. To this end, a stylet can be passed through the tube to check for a defect in the tube lumen or tube connector as part of a routine check of an endotracheal tube. This report features a patient who experienced a complete airway obstruction following intubation due to a manufacturing defect in the connector of the endotracheal tube.

The effect of using tablet computer on surgical stress: A single-blinded randomized controlled trial.

INTRODUCTION: The purpose of our study was to evaluate the effects of tablet computer method on children with and without anxiety. The study was designed as a prospective single-blinded randomized controlled trial. MATERIALS AND METHODS: The population of the study were 300 patients between the ages of 4 and 10 years old who were scheduled for their first elective surgery for phimosis-inguinal hernia-hydrocele-undescended testis-hypospadias. The initial anxiety scores of the patients were evaluated using modified-Yale Preoperative Anxiety Scale (mYPAS). Group-Midazolam, Group-Tablet, Group-Control were formed by applying randomization to the patients. The anxiety levels of the patients were evaluated in the waiting room using mYPAS after 0.5 mg/kg midazolam or tablet computer. Patient anxiety about separation from their families was evaluated with Parental Separation Anxiety Scale (PSAS), and reactions to the anaesthesia mask were evaluated with Mask Acceptance Scale (MAS). Also, the time spent by the patients in the Post-Operative Care Unit (PACU) was evaluated. Post-Hospitalization Behavior Questionnaire (PHBQ) scores of the patients were determined by the anesthesiologist one week after the surgery. RESULTS: The study compared the anxiety levels in groups. There were significant differences in the post-anxiolytic-mYPAS-scores and percentages of decrease from the preoperative baseline measurements (p < 0.001 and p < 0.001). There were significantly more children who were easily separated from their parents (PSAS-Score 1) in Group-Midazolam (p < 0.01). The children in Group-Midazolam also accepted the masks more readily (MAS-Score 1) than other (p < 0.001). Differences in the duration of the recovery time and mean PHBQ-scores between the groups were also significant (p < 0.001 for each). For children with anxiety, the recovery time for those in Group-Midazolam was significantly longer than other. For children without anxiety (p < 0.001), the duration of the recovery time in Group-Midazolam was also found to be significantly longer than other. The PHBQ-scores of the children in Group-Control with anxiety and without anxiety were significantly higher than other (p < 0.05 for each). Also, there were significant differences in the distribution of the PSAS-scores between the children with and without anxiety. Anxiety had no impact on the distribution of the MAS-scores (p = 0.045 and p = 0.100). CONCLUSION: Playing tablet-based games in the preoperative period enabled pediatric patients to be more comfortable while waiting in their rooms, leaving their families, and applying an anaesthetic mask. In pediatric patient with and without anxiety, midazolam separation from the family and accepting the anesthesia mask is easiest in midazolam, second in those who are given a tablet computer.

Long-term efficacy and safety of repeated botulinum toxin a applications based on function and anesthesia type in children with cerebral palsy.

PURPOSE: This study evaluates the motor development of patients undergoing three or more repeated Botulinum toxin A (BoNT-A) applications in a tertiary pediatric hospital as well as the safety of three different types of anesthesia. METHODS: Seventy-five children who underwent BoNT-A applications at least three consecutive times at six-month intervals and a total of 320 procedures were examined. Gross Motor Function Classification System (GMFCS) was employed in motor development evaluation. The three anesthesia methods (sedation analgesia, anesthesia with larengeal mask [LMA] and inhalation mask) were compared in terms of sedation, procedure, recovery, and total operation room time. RESULTS: Following the procedures, significant motor development was observed in 60 (80%) patients. In sedation analgesia group during the first three procedures, the recovery time was seen to be significantly shorter, while there was no difference between the anesthesia methods of any procedures following the fourth. Regardless of the type of anesthesia, the recovery times of those having undergone six or more procedures were longer than those with less than six procedures. CONCLUSIONS: As repeated BoNT-A application provides motor step progress, it can be applied safely and effectively under anesthesia. Sedation analgesia provides an easier recovery compared to LMA and mask only within the first three applications. However, recovery time increases with four or more repeated applications, specifically increasing as the number of applications increases. LEVEL OF EVIDENCE: III.

The effect of the duration of the procedure on the risk of complications during pediatric cardiac catheterization.

BACKGROUND: This study aims to evaluate the frequency of and associated risk factors for adverse events caused by cardiac catheterization procedures in pediatric patients. METHODS: Between January 2009 and January 2012, a total of 599 pediatric patients (320 males, 279 females; mean age 5.4±4.7 years; range, 1 day to 21 years) who underwent cardiac catheterization in our cardiac catheterization laboratory were retrospectively analyzed. Demographic and clinical data of the patients including the duration of the procedure, management of anesthesia, the American Society of Anesthesiologists class, and Catheterization Risk Score for Pediatrics, and procedure-related serious adverse events were recorded. RESULTS: The incidence of procedure-related serious adverse events was 9.18%. Potential risk factors associated with serious adverse events were identified as interventional heart catheterization, high scores obtained from the Catheterization Risk Score for Pediatrics, the use of endotracheal tube in airway control, and prolonged procedural duration. CONCLUSION: Our study results suggest that prolonged duration of catheterization is a potential risk factor for procedure-related adverse events and the duration of the procedure needs to be included as a variable in the Catheterization Risk Score for Pediatrics scoring system for predicting procedure-related adverse events.

TiO2 nanoparticles and C-Nanofibers modified magnetic Fe3O4 nanospheres (TiO2@Fe3O4@C-NF): A multifunctional hybrid material for magnetic solid-phase extraction of ibuprofen and photocatalytic degradation of drug molecules and azo dye.

Accurate sensitive analysis of drug ingredient substances in biological, pharmaceutical and environmental samples and removal of drug ingredient substances in environmental samples owngreat importance for sustaining viability. The realization of these processes using a single material offers significant advantages in terms of cost, time and ease of use. In this study, TiO2 nanoparticles and C-Nanofibers modified magnetic Fe3O4 nanospheres (TiO2@Fe3O4@C-NFs) synthesized as a multifunctional material employing a simple hydrothermal synthesis method. This innovative material was exploited in the magnetic solid-phase extraction (MSPE) method for the preconcentration of ibuprofen and photocatalytic degradation of antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and azo dye. To our knowledge, no studies have been previously conducted using the same material as magnetic solid-phase extraction adsorbent and magnetically separable photocatalyst. The characterization of TiO2@Fe3O4@C-NFs was carried out by XRD, FE-SEM, EDX and Raman techniques. The main analytical parameters affecting MSPE performance of ibuprofen such as pH, sorbent amount eluent type and volume and sample volume were optimized. The optimum values of the method were determined at the following parameters: pH 4.0, adsorbent amount 150 mg and eluent 2 mL of acetone. Ibuprofen analysis after MSPE was carried out using a high-performance liquid chromatography diode array detection system (HPLC-DAD). The photocatalytic degradation efficiencies of TiO2@Fe3O4@C-NF hybrid material for probe-analytes reached 80-100% and the complete degradation attained within the range of 8-125 min under UV irradiation. Simple preparation, practical isolation from solutions, high efficiency, reproducibility, and sustainability are the main advantages of the TiO2@Fe3O4@C-NFs for MSPE and photocatalytic degradation applications.

Bulging fontanel during a measles infection.

INTRODUCTION: Introduction Causes of a bulging fontanel in children include viral/bacterial meningitis, encephalitis, hydrocephaly, intracranial bleeding, psedotumor cerebri and central nervous system tumors. A less well-known cause of acutely-developing fontanel bulging is transient intracranial hypertension. CASE REPORT: A 7-month-old female was brought to our hospital with fever, cough, watery nasal secretion and bulging fontanel for the last 3 days. The cranial ultrasound examination and cerebrospinal fluid examinations were normal. The patient's irritability and fontanel bulging improved the day after admission but a maculopapular rash developed. The measles Ig M was positive. Measles PCR was positive from urine and nasopharyngeal swab samples. The signs of intracranial hypertension of the patient recovered completely the day after admission and did not recur during the follow-up. The patient was discharged on the 5th day of admission. DISCUSSION: Transient intracranial hypertension is thought to result from a transient increase in the quantity of the circulating cerebrospinal fluid but the pathogenesis is not clear. CONCLUSIONS: Based on this case, we report that transient intracranial hypertension could develop during a measles infection.

IL-1ß and IL-1Ra Variant Profiles in Turkish Patients with Diabetic Peripheral Neuropathy.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is one of the most common complications of Type 2 diabetes mellitus (T2DM). This study was conducted to investigate the possible association between interleukin-1ß (IL-1ß) rs16944 /IL-1 receptor antagonist (IL-1Ra) VNTR variants and genetic susceptibility to DPN in a Turkish cohort. METHODS: A total of 200 subjects were enrolled in this study, 98 patients with DPN and 102 cases of age and sex-matched healthy controls. Genotyping was performed for all individuals using PCR-RFLP analysis. RESULTS: IL-1ß rs16944 CC genotype had a 3.20-fold increased risk for DPN (p=0.0003, OR=3.20, 95% Cl:1.72-5.96). IL-1ß rs16944 CT genotype was higher in healthy control than patients (p=0.004). IL-1ß rs16944 C allele was higher in the patient group compared to controls while T allele was lower in patients than controls (p=0.003). IL-1Ra VNTR a1/a1 and a2/a2 genotypes were lower in DPN patients while a1/a2 genotype was higher in patients (p=0.045). The patients carrying a1/T haplotype had decreased risk of DPN than control groups (p=0.004). The patients carrying a2/a2 genotype had lower HDL level (p=0.039). The subjects carrying a2/a2 genotype had higher total cholesterol level while the subjects carrying a1/a2 genotype had lower total cholesterol (p=0.026 and p=0.037, respectively). IL-1Ra a1 allele was associated with higher HDL level (p=0.041). CONCLUSION: Findings of this study indicated that the IL-1ß rs16944 and IL-1Ra VNTR variants are probably to be associated with susceptibility DPN risk in a Turkish cohort.

Code Blue evaluation in children's hospital.

BACKGROUND: True alarm rate of the Code Blue cases is at a low level in the Dr. Behçet Uz Children's Hospital in Izmir. This study aims to analyse the use of the Code Blue alarm cases in the children's hospital. METHODS: This retrospective clinical study evaluated the age and the gender of the cases, the arriving time of the Code Blue team, the date and time of the Code Blue Call, the reasons of the Code Blue Call, and the verification which were all obtained from the Code Blue forms of the hospital dated between January 2014 and January 2015. The data of 139 Code Blue cases' forms were investigated and was divided into two groups: before and after the education containing 88 and 51 cases, respectively. RESULTS: Conversive disorder (26% to 13%, P<0.01), syncope (21.5% to 19.6%, P<0.01), convulsion (17% to 13.7%, P<0.01), hypoglycemia (4.5% to 3.9%, P<0.01), anxiety (4.5% to 1.9%, P<0.01), head trauma due to syncope (4.5% to 0%), cardiac arrest (1.1% to 0%), respiratory difficulties (2.2% to 1.9%, P<0.01), suspicion of myocardial infarction (2.2% to 1.9%, P<0.01), fall from stairs (2.2% to 0%) and agitation cases (1.1% to 0%) were reduced, however, the hypertension cases were dramatically increased (3.4% to 29.4%, P<0.01) owing to the hospital staff's education. The Pearson's correlation coefficient before and after education was 0.837. About 97.8% of the Code Blue cases were false calls with female greater than male (P<0.01). CONCLUSION: The results of this study show that more education is required for the hospital's staff and a new color code that is to say pre-diagnosis team should be formed.

Honey shows potent inhibitory activity against the bovine testes hyaluronidase.

The purpose of this study was to investigate the anti-hyaluronidase activities of honeys from different botanical origins honeys in order to determine their anti-inflammatory properties. The total phenolic contents, total flavonoids and total tannin levels of six types of honey, chestnut, oak, heather, pine, buckwheat and mixed blossom, were determined. Concentration-related inhibition values were tested turbidimetrically on bovine testis hyaluronidase (BTHase) as IC50 (mg/mL). All honeys exhibited various concentration-dependent degrees of inhibition against BTHase. Inhibition values varied significantly depending on honeys' levels of phenolic contents, flavonoid and tannin. The honeys with the highest anti-hyaluronidase activity were oak, chestnut and heather. In conclusion, polyphenol-rich honeys have high anti-hyaluronidase activity, and these honeys have high protective and complementary potential against hyaluronidase-induced anti-inflammatory failures.