Incidental diagnosis of ochronosis by aortic valve replacement.

Alkaptonuria is a rare inherited metabolic disease caused by homogentisic acid oxidase enzyme deficiency. Homogentisic acid formed during phenylalanine and tyrosine metabolism cannot be further metabolized and accumulates due to this enzyme deficiency. Some of the homogentisic acid that cannot be removed by metabolism is excreted with urine, some of it causes this accumulation known as ochronosis, which is characterized by dark pigmented color change in tissues. The classic clinical triad of the disease is darkening of the urine color, degenerative arthritis in the joints and dark colored pigmentation in the connective tissue. Herein, we present a case of ochronosis detected incidentally during aortic valve replacement with the diagnosis of aortic insufficiency.

Evaluation of Tobacco Product-Selling Websites Accessed Using Search Engines.

OBJECTIVE: Although the sale of electronic (e)-cigarettes and "I Quit Ordinary Smoking" (IQOS) is completely prohibited in Turkey, it is observed that tobacco products are sold on the internet. MATERIAL AND METHODS: This descriptive study was conducted between February 11 and 15, 2019, using three search engines (Google, Yandex, and Yaani) in Turkey. All combinations obtained with the keywords (wrapping tobacco, cigarette, hookah, pigtail, cigar, pipe, e-cigarette, snuff, and IQOS) and appendices (sale, price, and shipping) were searched; 2,160 links were scanned. The contents obtained from 130 different URLs were evaluated. RESULTS: The most sold product was e-cigarettes (41.2%) and the least sold one was cigarettes (2.5%). Websites contained 500 phone numbers (79%), live support (32.8%), e-mail addresses (67.2%), and postal addresses (42.9%) for communication. Approximately half of the sites had routing tabs to social media. These websites offered some payment facilities (credit card/debit card, 64.7%; money order/electronic funds transfer (EFT), 37.8%; payment at the door, 54.6%) and contained encouraging texts (61.3%) and misinformation (42.9%). More number of websites selling e-cigarettes or IQOS had the campaign sales (89.3% vs 63.6%; p=0.001), possibility of shipping (98.7% vs 86.4%; p<0.05), and false information about the harmlessness of the tobacco products (61.3% vs 11.4%; p<0.001) compared with websites selling other products. CONCLUSION: This is the first study to show that the tobacco industry is breaking the laws, and the websites which sell tobacco products are easily accessible to the internet users. It is necessary to strengthen the electronic commerce monitoring and control in Turkey.

Chronic Total Uterine Inversion in a Young Adult Patient.

BACKGROUND: Chronic uterine inversion is a very rare and life-threatening disease. It requires emergent treatment. CASE REPORT: We present the case of a 17-year-old patient with chronic uterine inversion. A fragile, bleeding, and soft mass, which filled the entire vagina, was seen during vaginal inspection. There was also a hard and tight cervical ring palpated behind the mass. She was operated on with Haultain technique. She was treated in the first postpartum year. She had normal menstrual bleeding and normal sexual intercourse after 1 month of outpatient control. CONCLUSIONS: Immediate diagnosis and treatment of isolated chronic inversion decreases maternal morbidity and mortality.

Association of G1057D variant of insulin receptor substrate-2 with endometriosis.

OBJECTIVE: To investigate whether the insulin receptor substrate (IRS)-2 G1057D polymorphism is associated with the risk of endometriosis, and to evaluate potential correlation of IRS2 gene polymorphism with the stages of endometriosis. DESIGN: Case-control study. SETTING: Gynecology clinics in university hospital. PATIENT(S): Women with (n = 135) or without (n = 135) endometriosis. Afterward, the women with endometriosis were divided into two groups according to the stage: group 1 included 63 women in stages I-II, and group 2 included 72 women in stages III-IV. INTERVENTION(S): Genotyping by polymerase chain reaction-based restriction fragment-length polymorphism method. MAIN OUTCOME MEASURE(S): Genotype distribution of the G1057D polymorphism in the IRS2 gene. RESULT(S): The genotype distribution of the IRS2 G1057D polymorphism in the endometriosis group was significantly different from that of the control group (GG/GD/DD rates were 43.0%/39.3%/17.7% and 55.6%/36.3%/8.1% for the endometriosis and control groups, respectively). Further subgroup analyses according to the stage of endometriosis also revealed a positive association between the IRS2 DD genotype expression and stage III-IV endometriosis patients in the population studied. CONCLUSION(S): These results suggest that the IRS2 G1057D polymorphism may be associated with an increased risk for endometriosis.