Review of a Challenging Clinical Issue: Acute Biliary Pancreatitis During Pregnancy

Acute pancreatitis is an inflammatory condition of the pancreas most commonly caused by gallstone. Approximately 70% cases of acute pancreatitis during pregnancy are secondary to gallstones or sludge. Acute pancreatitis is a rare complication with a reported incidence of one per 1.500-4.500 pregnancies. Gallstones cause bile duct obstruction and pancreatic hyperstimulation. These processes lead to increased hydrostatic pressure, trypsin reflux and activation of digestive enzymes within the pancreas and cause autodigestion of pancreas, followed by local inflammation. During pregnancy, the steroid hormones of pregnancy affect the gallbladder motility and bile content. Progesterone induces gallbladder smooth muscle relaxation and estrogens increase bile cholesterol level, enhancing bile stasis. The clinical symptoms include pain in the right upper abdominal area and/or epigastric area, which can radiate to the right flank, scapula and shoulder, anorexia, nausea, vomiting, dyspepsia, low-grade fever and sinus tachycardia, hyperventilation and smell of acetone in the breath. The diagnosis of acute pancreatitis in pregnancy is confirmed by laboratory investigations and imaging methods. The management of acute biliary pancreatitis during pregnancy is similar on a large scale

Prenatal Diagnosis of Twin Reversed Arterial Perfusion (Trap) Sequence: A Case Report

Twin reversed arterial perfusion (TRAP) sequence is a rare condition of monochorionic twin pregnancy. It has an incidence of 1:35.000 pregnancies and constitutes 1% all monochorionic pregnancies. The etiopathogenetic mechanisms are not well defined. There is co-existence of a normal pump twin and an acardiac recipient twin. A 22-year-old nulliparous woman was referred with TRAP sequence. The prognosis in TRAP sequence is lethal for acardiac twin and the fetal mortality of the pump twin is very high due to the cardiac failure. The obstetrician should be aware of TRAP-sequence in twin/multiple pregnancies

Prenatal Diagnosis of a Rare Type of Conjoined Twin, Cephalothoracoomphalopagus: A Case Report

Conjoined twins are a rare outcome of a monoamniotic and monochorionic gestation. We present a case of cephalothoracoomphalopagus conjoined twin diagnosed by prenatal ultrasonographic examination. A 26-year-old gravida 2, para 1 woman was referred to our perinatology unit for evaluation because of suspected conjoined twins at 24 weeks of gestation. Her medical history was unremarkable. There was no family history of genetic abnormalities. The diagnosis of conjoined twins was confirmed by prenatal ultrasonographic examination. Conjoined twins occur when two identical individuals are joined by part of their anatomy and share their vital one or more organs. The incidence of conjoined twins ranges from 1:50,000 to 1:250,000 live births. We present a case of male cephalothoracoomphalopagus conjoined twin, which is extremely rare type of conjoined twins. A prenatal diagnosis of shared organs dictates pregnacy termination or possible surgical separation strategies

Single-center Experiences of Ovarian Sex Cord Stromal Tumors

Objective:The aim of this study is to examine the sex cord stromal tumors of the ovary operated in our clinic in the last 4 years and to contribute to the literature on this rare tumor.Method:The clinical and laboratory findings of 34 patients with pathological diagnosis of ovarian sex cord stromal tumor, who were operated in our obstetrics and gynecology clinic between 2016 and 2020, were evaluated retrospectively. Pathological diagnoses were classified and other accompanying pathologies and complaints were evaluated for each type.Results:Ovarian sex cord stromal tumors usually attract attention with the peripheral effects of the hormones produced by the tumor tissue. They rarely come to very large sizes. They are mostly benign. When the hormone estrogen is produced, accompanying endometrial pathologies should not be overlooked. Hormonal complaints in patients improve dramatically after surgery both clinically and laboratory. Oncological follow-up is required following diagnosis in some malignant types.Conclusion:If ovarian sex cord stromal tumor is suspected, preoperative blood androgen levels, inhibin A, and alpha feto protein (AFP) should be evaluated. In addition, ultrasonographic and, if necessary, endometrial histopathological evaluations are important for patient follow-up as well as diagnosis. The patient's fertility desire and age should be considered during treatment

The effect of 10 weeks of karate training on the development of motor skills in children who are new to karate

This study investigated the effect of a 10-week karate training program on the motor skill development of 5-7-year-old children new to karate with two different test batteries. A total of 28 participants were included in the study: 18 in the Karate group and 10 in the control group. The karate group was subjected to a fundamental karate training (kihon) program consisting of 90-minute sessions four days a week for ten weeks in addition to physical education classes at their schools. In contrast, the control group did not participate in any sportive activities except physical education classes in their schools. Data were collected using the Eurofit test battery and the TGMD-2 test. In the pre-post test comparison of the anthropometric measurements of the karate group, no significant difference was found in the control group. In contrast, a significant difference was obtained in height, body mass index, and body fat percentage. In the post-test analysis of the two independent groups, there were statistically significant differences in favor of the karate group regarding height and body fat percentage (p < 0.005). In the pre-post analysis of the Eurofit test and the TGMD-2 for the karate group, all parameters showed statistically significant improvements (p < 0.001), while the control group showed no statistical difference. After comparing the karate and control groups, the Eurofit Test and TGMD-2 post-test results showed significantly higher scores (statistically significant differences) in all parameters for the karate group. In conclusion, the study shows that the 10-week karate training program positively affected the motor development of the participating children

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

İslam, Batı ve terörizm

Bu çalışma, 21-22 Şubat 2002 tarihinde Prof. Dr. Yasin Ceylan'ın (ODTÜ- Felsefe Bölümü) Turkish Daily News'te "Islam and Terrorism" başlığı altında ingilizce olarak yayınlanmış bulunan çalışmanın Türkçe'ye çevirisidir.12. yüzyılda Bağdat ve Kurtuba'da yaşayan müslümanlar için İslam adıyla çağrılan kendi dinlerinin sekiz yüzyıl sonra onun kendi izleyenleri arasında nefreti ve fanatizmi telkin eden bir inanç sistemi olarak tanımlanması ve yine onların diğer dinlere mensup insanlar tarafından insanlığa karşı her türlü gaddarlığı ve vahşeti gerçekleştirebilecek potansiyele sahip olmaları bakımından korkuluyor olması tahmin edilmesi son derece güç bir şey olacaktı. Fakat geçmişte bizzat onların yaşadıkları topraklar üzerinde birbirinden farklı birçok inanç, barış içinde yaşayabilmiş ve kendi düşüncelerini hiçbir soruşturma ve eziyet korkusu olmadan ifade edebilmişlerdi

Polisitemia Vera Olgusunda Okluziv Vaskülopati

GİRİŞ VE AMAÇ:Polisitemi vera (PV) tanılı hastada görülen oklüziv vaskülopati bulgularısunulmaktadır.YÖNTEM:Mart 2021’de sağ gözde kızarıklık, bulanık görme şikayetiyle başvuran PV tanılı 29yaşından erkek hastanın oftalmolojik muayene, sistemik değerlendirme ve fundus floreseinanjiografi(FFA) bulguları incelendi.BULGULAR:8 yıldır PV tanısı ile aylık flebotomi yapılan hastanın başvuru muayenesinde;görme keskinliği (GK) sağ 0.05, sol 1.0, biyomikroskopisi normal, göz içi basınçları (GİB)12/13 mmHg, fundus muayenesinde sağ vitre içi hemoraji (VİH) nedeniyle fundusseçilemedi,Sol periferik seyrek yuvarlak hemorajiler ve retinal neovaskülarizasyonlar (NVE)mevcuttu(Resim 1). Sağ ultrasonografi VİH ile uyumlu görüldü (Resim 2). FFA’da sağ VİH ileuyumlu blokaj, bilateral periferik hipoksi-iskemi ile uyumlu hipofloresans ve venlerde boyanma,sol NVE’ler ile uyumlu hiperfloresans saptandı (Resim 3). İskemik alanlara lazerfotokoagulasyon (LFK) tedavisi uygulandı. Hematolojiye konsülte edilen hastanın sistemikdeğerlendirmesi ve hemogram, koagülasyon, hemoglobin elektroforezi tetkiklerinde patolojisaptanmadı. Hastanın 3 ay sonraki kontrol muayenesinde; GK sağ 0.8, sol 1.0, biyomikroskopinormal, GİB 10/14 mmHg ve fundusta VİH ve NVE'lerin gerilemiş olduğu ve bilateral periferikLFK skarları görüldü.TARTIŞMA VE SONUÇ:Polisitemia vera tanılı hastalarda hiperviskoziteye bağlı retinal okluzivvaskülopati gelişebilmekte olup görme keskinliğini önemli bir şekilde etkilemektedir. PV tanısıvarlığında sistemik ve laboratuar tetkikleri normal de olsa, gelişebilecek oküler komplikasyonlarnedeniyle düzenli oftalmolojik muayene yapılması önerilir