Serum lipids in Turkish patients with β-thalassemia major and β-thalassemia minor

It is well-known that β-thalassemia is associated with changes in plasma lipids and lipoproteins [1,2,3]. To our knowledge, no data are available on lipid profiles in Turkish β-thalassemia major (TM) and β-thalassemia trait (TT) patients together. The aim of this study was to evaluate lipid profiles in two groups of patients with β-TM and β-TT and to compare them with healthy controls. The study included a total of 311 subjects. Group 1 included 131 β-TM patients (mean age: 16.3±7.58 years). Group 2 included 68 β-TT patients (mean age: 7.25±4.43 years). Group 3 consisted of 112 age- and sex-matched healthy controls (mean age: 9±4.7 years). Serum ferritin level was 2487±1103 (range: 661-5745) ng/mL in Group 1. In comparing the correlation between ferritin and lipid parameters, while a significantly negative relationship was detected between ferritin and highdensity lipoprotein cholesterol (HDL-C) (p=0.000, r=-0.602), a significantly positive relationship was detected between ferritin and triglyceride (TG) levels (p=0.02) in TM patients. Serum lipid profiles of the 3 groups are shown in Table 1

Examination of the sub-text questions in the Turkish lesson primary school 4th grade book according to the Bloom’s Revised Taxonomy

Bu araştırmada Türkçe ders kitabındaki metin altı sorularının Yenilenmiş Bloom Taksonomisine göre göre incelenmesi amaçlanmıştır. Bu amaçla 2021-2022 eğitim-öğretim yılında Türkçe dersi ilkokul 4. sınıf kitabında yer alan metin altı soruları incelenmiştir. Bu inceleme nitel araştırma yöntemlerinden doküman incelemesi yöntemiyle gerçekleştirilmiştir. Verilerin analizinde nitel veri analiz tekniklerinden betimsel analiz kullanılmış, veriler Yenilenmiş Bloom Taksonomisinde belirlenen basamaklara göre değerlendirilmiş ve sınıflandırılmıştır. Araştırmada ders kitabındaki temalar ekseninde bilgilendirici, öyküleyici ve dinleme/izleme metinleri incelenmiştir. Yapılan analizler sonucunda 376 metin altı sorunun yaklaşık olarak %41’i hatırlama, %15’i anlama %33’i uygulama, %2’si analiz, %3’ü değerlendirme, %6’sı yaratma basamağında olduğu tespit edilmiştir. İncelenen ders kitabında hatırlama ve anlama basamağı gibi alt düzey bilişsel becerilere ilişkin sorulara Yenilenmiş Bloom Taksonomisinin son üç basamağındaki üst düzey becerilerin gelişimini amaçlayan sorulardan daha fazla yer verildiği tespit edilmiştir. Üst düzey becerilere ilişkin sorular problem çözebilen, olaylara eleştirel bakabilen, yaratıcı düşünen, duygudaşlık kurabilen bireyler yetiştirilmesine yardımcı olduğundan bu basamaklardaki soru sayılarının daha fazla olması gerektiği önerilmiştir.This research aims to examine the reading comprehension questions in the Turkish textbook in the revised Bloom’s Taxonomy. For this purpose, comprehension questions in the 4th-grade Turkish textbook in the 2021-2022 academic year were examined. This study was conducted with the document analysis method, one of the qualitative research methods. In the analysis of the data, descriptive analysis, which is one of the qualitative data analysis techniques, was evaluated and classified according to the steps determined in Bloom’s Taxonomy. In the research, informative, narrative, and listening/monitoring texts were examined within the frame of the themes in the textbook. As a result of the analysis, it was determined that approximately 41% of the 376 comprehension questions were at the stage of knowledge, 15% of comprehension, 33% of application, 2% of analysis, 3% of the evaluation and 6% of creation. In the examined textbook, it has been determined that low-level cognitive skills such as remembering and understanding are more than the questions aimed at development of high-level cognitive skills in the last three steps of Bloom Taxonomy. It has been suggested that the questions related to high-level skills help raise individuals who can solve problems, look at events critically, think creatively, and sympathize, so the number of these kinds of questions at these steps should be greater

A hemophagocytic lymphohistiocytosis case with newly defined UNC13D (C.175G>C; p.Ala59Pro) mutation and a rare complication

Hemophagocytic lymphohistiocytosis (HLH) represents a severe hyperinflammatory condition with cardinal symptoms of prolonged fever, cytopenias, hepatosplenomegaly, and hemophagocytosis by activated, morphologically benign macrophages with impaired function of natural killer cells and cytotoxic T lymphocytes. A 2-month-old girl, who was admitted with fever, was diagnosed with HLH and her genetic examination revealed a newly defined mutation in the UNC13D (c.175G>C; p.Ala59Pro) gene. She was treated with dexamethasone, etoposide, and intrathecal methotrexate. During the second week of treatment, after three doses of etoposide, it was noticed that there was a necrotic plaque lesion on the soft palate. Pathologic examination of debrided material in PAS and Grocott staining revealed lots of septated hyphae, which was consistent with aspergillosis infection. Etoposide was stopped and amphotericin B treatment was given for six weeks. HLH 2004 protocol was completed to eight weeks with cyclosporine A orally. There was no patient with invasive aspergillosis infection as severe as causing palate and nasal septum perforation during HLH therapy. In immuncompromised patients, fungal infections may cause nasal septum perforation and treatment could be achieved by antifungal therapy and debridement of necrotic tissue. © 2015 Turkish Society of Hematology. All rights reserved

Hemophagocytic syndrome due to leishmania infection diagnosed with immunofluorescence antibody test

Leishmaniasis is a reticuloendothelial system disease that mostly observed before the age of 5. Visceral infection causes long-standing fever, weight loss, weakness, pancytopenia, and hepatosplenomegaly. Leishmania infantum is responsible for visceral leishmaniasis (VL) in Turkey. We present a case of hemophagocytic syndrome due to Leishmania infection diagnosed with an immunofluorescence antibody test (IFAT). Leishmania amastigotes were not observed on bone marrow aspiration. We consider that IFAT is very important for parasite detection in the diagnosis of VL in children, particularly when amastigotes are not obtained on bone marrow aspiration

Çocuklarda Epstein-Barr virüsüyle ilişkili akut enfeksiyöz mononükleozun klinik ve laboratuvar özelliklerinin değerlendirilmesi

Amaç: Epstein-Barr virüsünden kaynaklanan enfeksiyöz mononukleozun değişik semptomları, ayırıcı tanıda hekimlerin aklını karıştırabilir. Bu çalışmanın amacı semptomatik çocuklarda bu hastalışın klinik ve laboratuvar bulgularının değerlendirilmesidir. Hastalar ve Yöntemler: Bu çalışma akut Epstein- Barr virüs eneksiyonu olan 52 olgu (31 erkek, 21 kız; ort. yaş 5.4±3.4; dağılım 1-13) üzerinde retrospektif olarak yürütüldü. Klinik ve laboratuvar bulgular, şikayetler başladıktan sonraki başvuru zamanı (?5/>5 gün) ve yaş gruplarına (?2/>2 yıl) göre değerlendirildi. Bulgular: Major semptomlar klasik triadda yer alan ateş, lenfadenopati, tonsillofarenjit idi. Ayrıca asit, artrit ve şiddetli abdominal ağrıyla başvuran atipik olgular da tanımlandı. Hiçbir olguda kötü bir prognoz gözlenmedi. En sık rastlanan laboratuvar bulgu lenfositozdu. Major semptomlar başvuru zamanı ?5 gün olan grupta daha sık iken, atipik lenfositler başvuru zamanı >5 gün olan grupta daha yüksek bulundu. Bu tür farklılıklar yaş grupları arasında saptanmadı. Sonuç: Epstein-Barr virüsüne bağlı enfeksiyöz mononükleoz, çocuklarda iyi prognozlu bir hastalıktır. Hastalık özellikleri başvuru gününe göre değişkenlik gösterebilir, tanıda bu durum göz önüne alınmalıdır.Objectives: The various symptoms of infectious mononucleosis associated with Epstein-Barr virus may confuse physicians in differential diagnosis. The aim of this study is to evaluate the clinical and laboratory findings of this disease in symptomatic children. Patients and Methods: This study was retrospectively performed on 52 cases (31 boys, 21 girls; mean age 5.4±3.4 years; range 1 to 13 years) with acute Epstein-Barr virus infection. The clinical and laboratory findings were evaluated according to admission time after initial complaints (≤5/>5 days) and the age groups of the cases (≤2/>2 years). Results: The major symptoms were fever, lymphadenopathy and tonsillopharyngitis in the classical triad. Moreover, atypical cases who had ascites, arthritis and severe abdominal pain were defined. No case had a poor prognosis. The most frequent laboratory finding was lymphocytosis. While the major symptoms were more frequent in the group “admission time ≤ 5 days”, the count of atypical lymphocyte were higher in the group “admission time > 5 days”. However, these differences could not be defined between age groups. Conclusion: Infectious mononucleosis due to< Epstein-Barr virus is a disease with good prognosis in children. The features of the disease may vary according to admission time, and this fact should be taken into consideration in the diagnosis

Evaluation of visceral leishmaniasis diagnosis using indirect fluorescent antibody tests in 4 pediatric patients.

Visceral Leishmaniasis (VL) in infancy is mostly seen between the ages of 2-4,and visceral infection causes long standing fever, weakness, weight loss, hepatosplenomegaly and pancytopenia. Leishmania infantum is responsible for VL in Turkey. In this study, 4 pediatric cases of VL were analysed retrospectively. Bone marrow aspirate was obtained in two cases and Leishmania amastigotes were not obtained in these cases. Leishmania antibodies by the indirect immun fluorescent antibody test (IFAT) were positive in all cases. We consider that IFAT was a suitable alternative to parasite detection in the conclusive diagnosis of visceral leishmaniasis in pediatric patients when strong clinical suspicion is present

Mikofenolat mofetil ile remisyon sağlanan steroide dirençli otoimmün hemolitik anemi

Autoimmune hemolytic anemia (AIHA) is a disease that is seen in 1/10.000 people and characterized by forming antibodies against red blood cells and degradation of these red blood cells in reticuloendothelial system. Even autoimmune diseases can accompany, it is seen usually idiopathic. Paleness due to anemia, jaundice, tachycardia, darkening in urine color, hepatosplenomegaly are frequently seen clinical findings. Clinically normochrome and normocytic anemia, reticulocytosis, polychromasia in peripheral smear, spherocytes, indirect hyperbilirubinemia and increased lactate dehydrogenase are seen. Direct coombs test is the diagnostic test. Steroids are the first line drugs in treatment. The dosage and the treatment duration is formed according to patient's clinical situation. The treatment is checked by complete blood count, reticulocyte and Coombs test. Immunosuppressor treatments are given to patients that don't respond to treatment in 4-6 weeks or less patients who has recurrence at the time of decreasing the treatment dosage of corticosteroids. In few patient, that did not respond steroids, immunosuppressive treatments are used. Here, we present a patient, who is diagnosed with AIHA that we couldn't manage remission by steroid treatment, and no response to rituxumab as an immunosuppressor, but treated successfully with microphenolat mofetil

Dyadic Death Series from An Autopsy Center: Femicide-Suicides Cases

Objective:Dyadic death is a term generally used to describe cases in which the murderer committed suicide, usually after a murder, or cases where two people committed suicide together. In the cases that underwent autopsy in Muğla, between 2013 and 2021, the crime scene and dead examination reports were retrospectively analyzed, and those with dyadic deaths were evaluated and these cases were discussed. We believe that creating a database where dyadic deaths are recorded across the country, will shed light on understanding the dynamics of dyadic deaths.Methods:The crime scene analysis and dead examination reports of autopsies carried out between 2013-2021 in Muğla Forensic Medicine Branch Office were analyzed retrospectively.Results:In our case series, all 11 bilateral deaths were femicide-suicide and 9 of them used firearms for murder. In one of the cases, femicide occurred with a penetrating tool, and in the other case, it was caused by blunt head trauma.Conclusion:There is a partner relationship in all of the murders. Except for one case, all of those killed were women and all were spouses/partners or ex-partners. These data in our case series show that dyadic deaths are an indicator of the violence against women in our country

Abdominal ultrasonographic findings in patients with thalassemia

AMAÇ: Bu çalışmanın amacı, Denizli Devlet Hastanesi Talasemi Merkezinde izlenen talasemi major ve talasemi intermedia hastalarının rutin abdominal ultrasonografik incelemeleri seyrinde görülen hepatosplenomegali dışındaki abdominal solid organlar ile ilgili bulgularını değerlendirmektir. GEREÇ veYÖNTEMLER: Bu çalışmaya, 73'ü talasemi major, 5'i talasemi intermedia olmak üzere, yaşları 2 ile 30 yıl arasında, 40 kız, 38 erkek hasta alınmıştır. BULGULAR: Safra kesesinde taş ve çamur (%8.9) en sık görülen bulgu idi. Aksesuar dalak 6 hastada (%7.7), karaciğerde ekojenite artısı 2 hastada (%2.6), karaciğerde hemanjiom 1 hastada(%1.3), portal ven trombozu 1 hastada(%1.3) saptandı. Bir talasemi major hastasında, bilateral renal kist ve sag renal tas ve beraberinde safra kesesinde taş görüldü. SONUÇ: Talasemi hastalarında abdominal ultrasonografik inceleme, komplikasyonların önlenmesi ve etkili klinik izlem için düzenli aralıklar ile yapılmalıdır.OBJECTIVE: The aim of this study was to evaluate the type and prevalance of abdominal ultrasonographic abnormalities except hepatosplenomegaly in patients with thalassemia major and thalassemia intermedia. MATERIAL and METHODS: Seventy-eight patients; 73 thalassemia major, 5 thalassemia intermedia followed in Denizli State Hospital Thalassemia Center were included in the study. The patients' ages ranged from 2 to 30 years, with 40 females, 38 males. RESULTS: The most frequent ultrasonografic findings were cholelithiasis (8.9%), accesory spleen (7.7%), hepatic grade I-II echogenity (2,6%), hepatic hemangioma (1.3%) and portal vein thrombosis (1.3%). One case was diagnosed with polycystic kidney disease with coexisting nephrolitiasis and cholelithiasis. CONCLUSION: Abdominal ultrasonographic imaging of patients with thalassemia patients should be done regularly to prevent complications and for effective clinical observation

The seroprevalance and vaccination status of Hepatitis B in children 1-6 years of age in Denizli Province

AMAÇ: Bu çalışmanın amacı Denizli ilinde, 1-6 yas arası çocuklarda, HBsAg seroprevalansı, anti-HBs sıklıgı ve hepatit B aşılanma durumunu araştırmaktır. GEREÇ ve YÖNTEM: Çalışmaya alınan çocukların hiçbirinde kronik hastalık ve immun yetmezlik yoktu. Hepatit belirleyicileri (HBsAg, anti-HBs, anti-Hbc) 545 çocukta ELISA yöntemi ile tarandı. Ayrıca çocukların anne ve babasının Hepatit B infeksiyon durumu sorgulandı ve kayıt edildi. BULGULAR: Çalışmamızdaki 545 çocuğun 314 (%57.6)'sı kız, 231 (%42.4)'i erkek olup, ortalama yas 3.9±1.2 (2-6) yıl idi. 475 (%87.1) çocukta anti-HBs pozitifliği, 58 (%10.6) çocukta HBsAg ve anti HBs negatifliği, 12 (%2.3) çocukta HBsAg pozitifliği saptandı. SONUÇ: Tüm çocuklar içinde aşılanma oranı %84.9 olarak bulundu. Sonuçta, 1-6 yas arası çocukların aşılanmasının önemine dikkat çekilmiştir.OBJECTIVE: The aim of this study was to investigate seroprevalence of HBsAg and frequency of anti-HBs positivity and hepatitisBvaccination status in children, 1- 6 years of age, in Denizli province. MATERIALS and METHODS: None of the children had chronic diseases and immun deficiency. In 545 children, Hepatitis markers (HBsAg, anti-HBs, anti-Hbc) were screened by ELISA method. We questioned Hepatitis-B infection of parents. RESULTS: Of 545 patients, 314 (57.6%) were male, 231 (42.4%) were female, mean age was 3.9±1.2 (2-6) years. We found anti-HBs positivity in 475 (87.1%) children. 58 (10.6%) children had anti-HBs and HBsAg negativity. 12 (2.3%) children hadHBsAg positivity. CONCLUSION: The rate of vaccination in all children was found 84.9% (463 children). Importance of vaccination of 1-6 years of age was emphasized