Kronik hepatit B’li hastalarda karaciğer fibrozunun teşhis edilmesi için non-invaziv bir yöntem olarak portal venöz debinin değerlendirilmesi

Objectives: This study aimed to evaluate the relationship between portal venous flow (PVF), which could be measured non-invasively with Doppler ultrasound, and the degree of fibrosis obtained by biopsy in patients with chronic hepatitis (CHB). Materials and Methods: The study included 133 patients with CHB. During the Doppler evaluation, PVF was calculated in addition to routine measurements. The patients were divided into two groups according to the degree of fibrosis based on the biopsy results: F0 and F1 (first group) and F2, F3 and F4 (second group). The Doppler ultrasound findings obtained from all patients were compared with the pathology results. Results: The mean PVF was measured as 688.38 +/- 608.2 mL/ minute. An inverse correlation was detected between PVF and liver fibrosis degree (p<0.0001, Spearman's correlation coefficient 0.47). In the receiver-operating characteristic analysis, the area under the curve was 71.1% (95% confidence interval: 55.6%-83.6%). The cut-off value for PVF was calculated as 480 mL/minute, at which it had a sensitivity of 57.8% and specificity of 100%. Conclusion: We considered that the decrease we showed in PVF in our study could be used as a non-invasive evaluation method in the differentiation of mild and significant fibrosis in non-cirrhotic patients

Giant problem of our era: childhood obesity

Vücutta artmış yağ miktarı olarak tanımlanan obezitenin sıklığı ırk, yaş, cinsiyete göre değişiklik gösterir. Çocuk ve adölesanlarda obezite prevalansı dünya çapında artış göstermektedir. Bu artışın en önemli sebebi ise, gelişen teknoloji ile birlikte çocukların hareketliliklerin kısıtlanması, beslenme alışkanlıklarının ve besin tercihlerinin değişmesidir. Obezite etyolojisinde kalori alımı ve kullanımı arasındaki denge bozukluğu olsa da monogenik obezitede olduğu gibi genetik faktörler, endokrin yıkıcılar olarak bilinen yüzlerce çevresel faktör, barsak microbiatasındaki değişiklikler ve hormonal faktörler de suçlanmaktadır Çocuklarda obezitenin tanısında basit, uygulanabilir, ucuz ve güvenli bir yöntem olan vücut kitle indeksi (VKI) kullanılmaktadır. Erken dönemde ortaya çıkan obezite tip 2 diabetes mellitus, non alkolik hepatosteatoz, hipertansiyon, hiperlipidemi ve kardiyovasküler hastalıklar gibi ciddi komplikasyonlara neden olmaktadır. Çocuklarda obezite tedavisinin temel basamağı yaşam tarzının düzenlenmesi olmasına rağmen ciddi obezite komplikasyonları varsa farmakoterapi veya cerrahi tedavi de önerilebilirThe prevalence of obesity, defined as increased amount of body fat, varies according to race, age, and sex. Obesity prevalence in children and adolescents increases worldwide. The most important reason for the increase is, along with developing technology, limitation of activity, and alterations in nutritional habits and food preferences of the children. Although there is imbalance of calorie intake and utilization in the etiology of obesity, genetic factors as in monogenic obesity, hundreds of environmental factors known as endocrine destructors, changes in intestinal microbiota, and hormonal factors are also accused. Body mass index (BMI), a simple, practical, cheap, and safe method, is used in the diagnosis of obesity in children. Obesity occurring in early period causes serious complications such as, type 2 diabetes mellitus, non-alcoholic hepatosteatosis, hypertension, hyperlipidemia, and cardiovascular diseases. Although the basic step in the treatment pf obesity in children is life-style regulations, pharmacotherapy or surgical treatment are also recommended, if there are serious obesity complication

Fungal Infections in COVID-19 Intensive Care Patients

Opportunistic fungal infections increase morbidity and mortality in COVID-19 patients monitored in intensive care units (ICU). As patients’ hospitalization days in the ICU and intubation period increase, opportunistic infections also increase, which prolongs hospital stay days and elevates costs. The study aimed to describe the profile of fungal infections and identify the risk factors associated with mortality in COVID-19 intensive care patients. The records of 627 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files. The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Opportunistic fungal infection was detected in 32 patients (5.10%) of 627 patients monitored in ICU with a COVID-19 diagnosis. The average APACHE II score of the patients was 28 ± 6. While 25 of the patients (78.12%) died, seven (21.87%) were discharged from the ICU. Candida parapsilosis (43.7%) was the opportunistic fungal agent isolated from most blood samples taken from COVID-19 positive patients. The mortality rate of COVID-19 positive patients with candidemia was 80%. While two out of the three patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward. Opportunistic fungal infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided

C-reactive protein level and obesity as cardiovascular risk factors in polycystic ovary syndrome

Objective: To investigate the role of C-reactive protein(CRP) level elevation and obesity for the increased cardiovasculardisease risk in polycystic ovary syndrome(PCOS).Methods: A hundred and nine patients with PCOS and 30age matched healthy volunteers with regular menstrualcycle are involved in the study. PCOS group is furthersubdivided into three subgroups according to the bodymass index (BMI). Subgroups included 54 with BMI<25,22 with BMI 25-30, and 33 with BMI>30. Blood samplesfor glucose, insulin, uric acid, and CRP were collected inthe morning after overnight fasting (12 hours). Homeostasismodel assessment-insulin resistance (HOMA-IR)was calculated. Results: Fasting blood glucose, insulin,and HOMA-IR was significantly higher in PCOS group(p=0.02, p=0.01 and p=0.02). CRP level was higher insubgroup with BMI>30. High CRP level in PCOS wasfound to be independent from BMI (p<0.001). HOMA-IRand insulin level was higher in the subgroup with BMI>30.When compared with the control group high insulin levelwas the only to be statistically significant in obese PCOSpatients (p=0.005). HOMA-IR was higher in PCOS subgroupwith BMI>30 when compared with controls and thePCOS subgroup with BMI<25 (p<0.001, p= 0.003).Conclusion: Obesity, hyperinsulinemia, and high CRPlevels are seemed to be related and potentiating eachother in PCOS. Struggling with obesity is one of the mostimportant issues for preventive medicine.Key words: PCOS, CRP, obesity, cardiovascular ris

The epidemiology, Clinical Manifestations, radiology, microbiology, treatment, and prognosis of echinococcosis: Results of NENEHATUN study

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 +/- 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important

Fibromyalgia and Thyroid Dysfunction

Fibromyalji sendromu sık rastlanan bir romatizmal hastalıktır. Fibromyaljide tanımlanan bulgular ile otoimmun tiroid hastalıkları ve özellikle de hipotiroidi arasında yakın benzerlik bulunmaktadır. Fibromiyalji sendromu ve tiroid hasta- lıkları arasındaki fizyopatolojik bağlantıyı açıklayacak daha ileri araştırmaların yapılması gerekmektedir.Fibromyalgia syndrome is a common rheumatologic disorder. Symptoms of fibromyalgia and thyroid diseases espe- cially of autoimmune thyroid disorders are closely similar to each other. Pathophysiological relationship between fibromyalgia syndrome and thyroid diseases that further research is required to explain

COVID-19 pneumonia with cavitation

The World Health Organization officially named the disease as Coronavirus Disease 2019 (COVID-19), which was caused by a new type of coronavirus that leads to viral pneumonia on 11 February 2020. Typical computed tomography findings of the disease are ground-glass infiltrations in both lungs. Atypical findings include lung cavitation and pleural effusion. A 43-year-old female patient was admitted to the emergency room with complaints of dry cough, fatigue, and joint pain for three days. Bilateral peripherally localized multisegmented ground-glass infiltrates were present in the first thorax tomography. A combined nasopharyngeal swab was taken from the patient and favipiravir and hydroxychloroquine treatment was initiated and she was sent home with the recommendation of isolation for 14 days. Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) test performed on the same day and confirmed COVID-19 diagnosis. She was admitted to the hospital again with an increase in complaints five days after the first presentation and her oxygen saturation (SpO(2)) was found to be 90%. On the fifth day of her hospitalization, the patient was discharged because of clinical improvement. Two weeks later, she was brought to the emergency room with deterioration in her general condition. On thorax tomography of the patient, an area of necrotizing pneumonia with cavitation in the lower lobe of the right lung was observed. The patient was followed up in the intensive care unit for five days. After being followed up in the COVID service for five days, she was discharged because her respiratory distress, cough and C-reactive protein (CRP) was decreased. Lung cavitation due to COVID-19 pneumonia is rare, and most cases are self-limiting. Although the last rRT-PCR test of the patient is negative, the cavitary lesion in the lung can maintain contagiousness even if it is at a low level. Therefore, the extension of treatment and isolation time should be considered in such patients

Our cases with familial hypocalciuric hypercalcemia

Ailesel hipokalsiürik hiperkalsemi, ılımlı hiperkalsemi, idrarda kalsiyum atılımının az olması ile giden ve kalsiyum duyarlı reseptörlerde mutasyonlardan kaynaklanan benign bir hastalıktır. 2010 Ocak ile 2015 Haziran ayları arasında İç hastalıkları polikliniğimize başvuran altı hasta klinik ve biyokimyasal parametrelerle değerlendirilmiştir. Olgularımız, 21 ile 86 yaş arasında, dördü kadın olmak üzere toplam altı hasta idi. Beş olgumuzun çocukları ve bir olgumuzun ebeveynleri poliklinik ortamında değerlendirildi. Olguların değerlendirmesinde ılımlı hiperkalsemi, sınırda yüksek parathormon düzeyleri ve idrarla günlük kalsiyum atılımının belirgin düşüklüğü nedeniyle ailesel hipokalsiürik hiperkalsemi olabileceği düşünüldü. Beş erişkin hastanın çocuklarında ve bir genç hastamızın da annesinde kalsiyum metabolizmasında benzer laboratuvar bulguları saptanması ve hiperkalsemi yapan diğer nedenlerin dışlanması üzerine tanı doğrulandı.Familial hypocalciuric hypercalcemia is a benign disease caused by mutations in the calcium-sensitive receptors, with moderate hypercalcemia and of calcium excretion in the urine leading to less. Six patients was evaluated in our internal medicine polyclinic with clinic and biochemistry parameters between 2010 January and 2015 June. Our cases were six patients including four women between 21 and 86 old. We evaluated in our polyclinic five cases childs and one cases parents. The results of evaluation of the patients were thought to be familial hypocalciuric hypercalcemia because of moderate hypercalcemia, borderline high parathormone levels and marked impairment of urinary calcium excretion. The diagnosis was confirme exclusion of other causes of hypercalcemia and the childrens of five patients and mother of one patients detected in calcium metabolism in the laboratory findings are similar to

Late onset congenital adrenal hyperplasia with incoming hirsutism

Konjenital adrenal hiperplazi adolesan dönemden sonra daha az görülmektedir ve bu geç başlangıçlı olan vakalar daha çok oligomenore ve hirsutizm nedeniyle araştırılırken tanı almaktadırlar. Özellikle polikistik over sendromu nedeniyle poliklinikte araştırılan kadın hastalarda bu tanının da göz önünde bulundurulmasına dikkat edilmelidir.Congenital adrenal hyperplasia are less frequent after the adolescent period and late-onset cases that are mostly diagnosed in the course of investigating for oligomenorhea and hirsutism. Female patients who evaluated in the clinics for especially polycystic ovary syndrome should be taken into account this diagnosis in with consideration