Tip 2 Diyabetli Bir Hastada Linagliptine Bağlı Lokalize Ağrılı Döküntü

The number of patients with type 2 diabetes using dipeptidylpeptidase-4 (DPP-4) inhibitors is increasing across the world.Although this class of antidiabetic medications is generallysafe and associated with less side effects compared to otheroral antidiabetic medications, they could also cause some sideeffects such as skin rashes. Herein we report a case of type 2diabetes patient who developed a painful maculopapular rashinduced by linagliptin, a widely used DPP-4 inhibitor.A localized painful maculopapular rash developed on thepalmar faces of the patient’s hands almost 1 day after theinitiation of the drug. The patient was using intensive insulintherapy before linagliptin was started. There was no eruptionon the other body parts except the palmar faces of the hands.Following the discontinuation of the drug, the rash disappearedin about four days. The patient had no history of urticaria anddid not use an ACE inhibitor. As far as we know, this is the firstcase report of a skin rash induced by linagliptin in the Turkishliterature. This case report highlights a rare and lesser knownside effect of linagliptin, a new member of DPP-4 inhibitors.Dipeptidil peptidaz-4 (DPP-4) inhibitörleri kullanan tip 2 diyabet hastalarının sayısı dünya genelinde artmaktadır. Bu antidiyabetik ilaç sınıfı genelde güvenli olmakla birlikte diğer oral antidiyabetik ilaçlarla karşılaştırıldığında daha az yan etki ile ilişkili olsa da, deri döküntüleri gibi bazı yan etkilerle ilişkili olabilirler. Burada yaygın olarak kullanılan bir DPP-4 inhibitörü olan linagliptin ile indüklenen ağrılı makülopapüler döküntü gelişen tip 2 diyabetli bir hastayı sunuyoruz. Linagliptin başlandıktan 1 gün sonra hastamızın ellerinin palmar yüzünde lokalize ağrılı makülopapüler bir döküntü gelişti. Linagliptin başlanmadan önce hasta intensif insülin tedavisi altındaydı. Vücudun diğer bölgelerinde herhangi bir döküntü yoktu. Linagliptin kesildikten sonra 4 gün içerisinde döküntü kayboldu. Hastanın ürtiker öyküsü yoktu ve Anjiyotensin dönüştürücü enzim inhibitörü kullanmıyordu. Bildiğimiz kadarıyla bu, Türk literatüründe Linagliptine bağlı deri döküntüsü geliştirdiği rapor edilen ilk olgudur. Bu olgu sunumu, DPP-4 inhibitörlerinin nadir görülen ve daha az bilinen bir yan etkisini vurgulamaktadır

Ectopic opening of common bile duct into duodenal bulb and gastric antrum and its importance

Background: Ectopic opening of the common bile duct (CBD) is extremely rare, and its importance has not been adequately defined. The aim of our study is to present the characteristics of patients with this abnormality. Methods: This retrospective study was conducted in a tertiary center in Dicle University Hospital, Diyarbakır, Turkey, between October 2008 and December 2020. We present clinical, laboratory, endoscopic and cholangiographic features as well as the success rate of therapeutic interventions of consecutive patients with this abnormality undergoing endoscopic retrograde cholangiopancreatography (ERCP). Results: Ectopic opening of the CBD was identified in 29 (21 men; mean age 62) out of 3872 (0.74%) patients. There was a history of cholecystectomy in 14 (48%) and recurrent acute cholangitis in 20 (69%) patients. We found peptic ulcer in 13 (45%) and duodenal deformity associated with apical stenosis in 21 (72%) patients. Opening site was seen as abnormal in all patients, and it opened into the antrum in 2 (6.8%) and into the first part of the duodenum in 27 (93%) patients. Copious amount of bile and/ or bile sediment in the stomach were seen in all patients. We observed dilatation in both intrahepatic and extrahepatic bile ducts together with tapered narrowing and a hook-shaped distal end of CBD in all patients. There was bile stone in 26 (89%) and sludge in 3 (10%) patients. Sphincterotomy was not performed in any patients because there was not enough incision distance. Balloon dilatation was performed for extraction of stone and sludge in all patients. Complete stone extraction was achieved in only 7 out of 26 (27%) patients. Conclusion: Ectopic opening of CBD is usually associated with gastroduodenal and bile ducts disease. Endoscopic treatment is unsatisfactory in most patients with this abnormality

Oxidative stress of crystalline lens in rat menopausal model

Purpose: To evaluate lenticular oxidative stress in rat menopausal models. Methods: Forty Wistar female albino rats were included in this study. A total of thirty rats underwent oophorectomy to generate a menopausal model. Ten rats that did not undergo oophorectomy formed the control group (Group 1). From the rats that underwent oophorectomy, 10 formed the menopause control group (Group 2), 10 were administered a daily injection of methylprednisolone until the end of the study (Group 3), and the remaining 10 rats were administered intraperitoneal streptozocin to induce diabetes mellitus (Group 4). Total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) measurements of the crystalline lenses were analyzed. Results: The mean OSI was the lowest in group 1 and highest in group 4. Nevertheless, the difference between the groups was not statistically significant in terms of OSI (p > 0.05). The mean TOS values were similar between the groups (p > 0.05), whereas the mean TAC of group 1 was significantly higher than that of the other groups (p < 0.001). Conclusions: Our results indicate that menopause may not promote cataract formation

Investigation of prognostic factors in patients with a diagnosis of pancreatic cancer

Amaç: Pankreas kanseri oldukça kötü prognozlu bir hastalık olup, insidansı giderek artmaktadır. Bu hastalıkta birden fazla prognostik belirteç bulunmaktadır. Bu çalışmadaki amaç kliniğimizde pankreas kanseri tanısı alan hastaların yaşam süresini etkileyen prognostik faktörleri saptamaktı. Yöntemler: Kliniğimize Ocak 2011-Haziran 2020 tarihleri arasında başvuran ve pankreas kanseri tanısı konulan 127 hastanın demografik ve klinik özellikleri, laboratuvar sonuçları, kontrastlı abdomen tomografisi bulguları ve tedavilere cevapları retrospektif olarak değerlendirildi. Bulgular: Hastaların 85’i (%67) erkek 42’si (%33) kadın olup, yaş ortalaması 62,6±12,5 (27-90) yıl, ortalama sağ kalma süresi 11,6±1,3 ay; 1 yıllık ortalama sağ kalım oranı %31 ve 5 yıllık ortalama sağ kalım oranı %0,9 idi. Pankreas kanseri prognozu ile cinsiyet, tümör çapı, tümör lokalizasyonu, DM varlığı, patolojik LAP varlığı, vasküler invazyon, kemoterapi alınması, serum CA 19-9 ve CA125 seviyesi arasında anlamlı ilişki saptanmazken, ileri yaş (p=0.01), karaciğer metastazı (P=0.016) ve yüksek serum CEA düzeyinin (p=0.013) kötü prognostik faktör ve cerrahi rezeksiyon yapılmasının (p=0.039) iyi prognostik faktör olduğu saptandı. Sonuç: Pankreas kanseri tedavisi sırasında hastalığın prognozunu etkileyen faktörlerin göz önünde bulundurulması faydalı olabilir.Objective: Pancreatic cancer is a disease with very poor prognosis and its incidence is gradually increasing. There are more than one prognostic marker in this disease. The aim of this study was to determine the prognostic factors affecting the survival of patients diagnosed with pancreatic cancer in our clinic. Methods: The demographic and clinical characteristics, laboratory results, contrast-enhanced abdominal tomography findings and responses to treatments of 127 patients who were admitted to our clinic between January 2011 and June 2020 and were diagnosed with pancreatic cancer were retrospectively evaluated. Results: 85 (67%) of the patients were male and 42 (33%) were female, the mean age was 62.6 ± 12.5 (27-90) years, the mean survival time was 11.6 ± 1.3 months; The 1-year mean survival rate was 31% and the 5-year mean survival rate was 0.9%. There was no significant relationship between pancreatic cancer prognosis and gender, tumor size, tumor location, presence of DM, presence of pathological LAP, vascular invasion, chemotherapy, serum CA 19-9 and CA125 levels. Advanced age (p = 0.01), liver metastasis (P = 0.016) and high serum CEA level (p = 0.013) were found to be poor prognostic factors, and surgical resection (p = 0.039) was found to be a good prognostic factor. Conclusion: It may be beneficial to consider the factors affecting the prognosis of the disease during the treatment of pancreatic cancer

Our experience in repairs using the native esophagus such as the Foker and Gazi methods in the management of patients with long-gap esophageal atresia

This study aimed to share our experience with infants with repaired long-gap esophageal atresia (LGEA) using the native esophagus and Foker and Gazi methods. We retrospectively analyzed the medical records of 10 patients with LGEA (six with pure esophageal atresia [EA], and four with distal trachea-esophageal fistula [TEF] + EA). The mean length between the esophageal pouches was 5.9 cm (4–9 cm). Five Foker methods, three Gazi methods, and two delayed primary repairs after a daily bougie were performed an average of 19.3 days after the first surgery and 26.4 days after the final esophageal anastomosis. For the Foker technique, it was 36.1 days. Their first oral intake was 10.2 days, and their transition to full enteral food was 26.2 days. An esophageal leak was detected in six patients. Fundoplication and dilatations were performed for three and four patients, respectively. For good results, LGEA patients should be operated on at least under the supervision of an experienced surgeon in specialized centers, and the team should be familiar with the techniques for using the native esophagus.departmental bulletin pape

Post-operative Dressing for Paediatric Hypospadias Repair

The optimal dressing is still unclear, despite hypospadias being one of the most prevalent surgical operations. Children’s dressing for hypospadias surgery was searched on PubMed as “dressing for hypospadias,” “postoperative dressing for pediatric hypospadias,” and “dressing AND hypospadias.” Experimental studies, animal studies, reviews, letters, and repetitive publications were excluded from the study. By evaluating these reviewed publications, factors affecting hypospadias dressing, such as surgeon, country, dressing type, characteristics, and why it is preferred, will be revealed. As a result, 17 articles were examined, and the advantages of each were established by examining the results. The type of hypospadias, the surgeon’s choice, and its ease of removal stand out as the crucial factors in treating hypospadias in children, along with the degree of development of the nation

Diagnostic Value of Sodium, White Blood Cell, Neutrophil Levels; White Blood Cell/Sodium and Neutrophil/Sodium Ratios in Appendicitis in Pediatric Patients

Objective: Acute appendicitis is one of the most common causes of abdominal pain requiring surgical intervention in children. Although clinical and imaging modalities play a central role in disease diagnosis, laboratory markers, such as white blood cell (WBC) count, neutrophil count, and electrolyte disturbances, particularly sodium levels, have been explored as potential indicators of disease severity. This study aimed to evaluate the relationship between serum sodium levels, WBC and neutrophil counts, and their respective ratios with the diagnosis and severity of appendicitis. Methods: This retrospective analysis included 176 pediatric patients who underwent appendectomy. Patients were divided into three groups based on pathological findings: Group 1 (non-appendicitis, n=59), group 2 (acute appendicitis, n=82), and group 3 (perforated appendicitis, n=35). WBC, neutrophil, and sodium levels were recorded. ANOVA and post-hoc Tukey’s tests were used to assess differences between groups. A logistic regression model was employed to evaluate the combined ability of WBC, neutrophil, and sodium levels to distinguish group 1 from groups 2 and 3, and the model’s performance was evaluated using the area under the ROC curve (AUC). Results: Significant differences were observed between group 1 and groups 2 and 3 regarding WBC (p<0.001), neutrophil (p<0.001), and sodium levels (p<0.001). Group 3 had the highest WBC count (17,123±4,491 cells/µL) and the lowest sodium levels (132.5±1.4 mEq/L), whereas group 1 had the lowest WBC count (10,660±3,804 cells/µL) and the highest sodium levels (137.5±2.6 mEq/L). Logistic regression analysis of the combined WBC, neutrophil, and sodium values obtained an AUC of 0.703, indicating moderate diagnostic utility. Conclusion: This study demonstrated that WBC count, neutrophil count, and sodium level, as well as their ratios, can aid in diagnosing appendicitis in pediatric patients. Although sodium levels were significantly lower in patients with appendicitis, no significant difference was found between acute and perforated appendicitis. The WBC/sodium and neutrophil/sodium ratios could be valuable in clinical practice, especially for distinguishing between appendicitis and non-appendicitis cases. Further research is warranted to explore their utility in larger populations

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The possibilities of increasing estrous in the out of season by using exogen hormons at the private farm engaged awassi sheep breeding.

TEZ9145Tez (Yüksek Lisans) -- Çukurova Üniversitesi, Adana, 2013.Kaynakça (s. 55-62) var.xi, 63 s. : res. (bzs. rnk.), tablo ; 29 cm.Bu çalışma, Adana İli Çukurova ilçesi Salbaş Beldesinde özel bir koyunculuk işletmesinde yürütülmüştür. Denemede, yetiştiriciliği yapılan 45 baş ivesi ırkı şişek koyun kullanılmıştır. Araştırma, asezonal dönemde koyunların kızgınlığa gelmesini sağlamak, doğum oranını ve çoğuzluğu olumlu yönde arttırmak amacıyla yapılmıştır. Denemede kızgınlığı sağlamak amacıyla iki farklı progesteron uygulaması (MAP ve CIDR) yapılmış ve bir de kontrol grubu oluşturulmuştur. Her grupta 15 baş koyun kullanılmıştır. Deneme, istatistiki olarak Oranların Farkına Ait Hipotez Testi kullanılarak analiz edilmiştir. Yapılan istatistik analiz sonucunda; kızgınlık oranı, MAP ve CIDR uygulamalarında % 100,0 yani iki gruptaki 15’er koyunun hepsi kızgınlığa ulaşmış ancak kontrol grubundaki koyunların hiçbirinde kızgınlık görülmemiştir. Gruplarındaki doğum oranı sırası ile MAP % 33,33 ve CIDR % 40,00 olarak bulunmuştur. istatiksel olarak doğum oranları üzerine bir farkın olmadığı ancak CIDR’ın etkisinin daha fazla olduğu belirlenmiştir. Gruplardaki çoğuz doğum oranları ise MAP % 40,00 ve CIDR % 16,66 olarak bulunmuştur. İstatistiksel analiz sonucuna göre çoğuz doğum oranı üzerine MAP’ın etkisinin daha fazla olduğu tespit edilmiştir (p<0.05). Sonuç olarak asezonal dönemde İvesi koyunlarına eksogen hormon uygulamasının kızgınlık, doğum ve çoğuzluk üzerine olumlu etkilerinin olduğu tespit edilmiştir.This study was carried out in a private sheep breeding farm in Salbaş Town of Çukurova District of Adana City. A total of 45 Awassi ewes were used. In the trial the aim of the study was to provide the estrous out of season, to increase the birth rate and multiple births. Two different types of progesteron applications (MAP and CIDR) were applied to provide estrous and a control group was created. 15 Awassi ewes were used in each group. This trial statistically analyzed by using Hypotesis Test of Rates Differences. According to results of statistical analyses; estrous rates were % 100,0 observed in MAP and CIDR groups, this means all 15 ewes have showed estrous in each groups but none of the ewes have showed estrous in control group. The birth rates of MAP and CIDR applied groups were found; % 33,33 and % 40,00 respectively. Statistically CIDR’s effect on birth rate is detected higher. In MAP and CIDR groups multiple births were observed as ; % 40,00 and % 16,66 respectively. As a result of statistical analyse, MAP’s effect on multiple birth rate wasfound higher (p<0.05). Consequently; the application of exogen hormone has positive effects on increasing of estrous out of season, birthrate and multiple births