A case of May-Thurner Syndrome: An old anomaly but, a new suggestion: A case report

May-Thurner syndrome (MTS) is an anatomical condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine. MTS is rarely diagnosed because diagnostic workup is seldom continued once the diagnosis of a deep vein thrombosis (DVT) has been established. Furthermore, patients with DVT generally have several well-known confounding risk factors. We report a 16-year-old girl with a history of left leg swelling who was incidentally diagnosed with MTS. We hope that our case report will create awareness of vascular abnormalities in sports medicine and suggest that routine venous Doppler ultrasound screening may help to detect MTS or associated anatomical prior to the formation of early thrombosis

One of the Main Problems of Infants: Bronchiolitis

Acute bronchiolitis, which is the most common acute lower respiratory system disease, is resulting in significant morbidity and mortality in children less than 2 years. Respiratory syncytial virus (RSV) is the most common causative pathogen for over 30 million new acute lower respiratory infection episodes in children under 5 years of age. Rhinovirus, adenovirus, influenza virus, parainfluenza, and other respiratory viruses also cause acute bronchiolitis as the sole pathogen or as coinfection with or without RSV. Cardiovascular disease, chronic pulmonary disease, immunodeficiency, and premature birth are important risk factors for hospitalization and increase the risk of acute bronchiolitis-associated respiratory failure or even death. Bronchiolitis is a clinical diagnosis that varies from mild illness to severe respiratory failure. The severity of bronchiolitis is evaluated with several parameters including wheezing, retraction, respiratory rate, and general situation. However, the most important clinical finding is the presence or absence of hypoxemia and whether the patient can tolerate respiratory distress. Fluid support and oxygen supplementation by nasal cannula, face mask, or head box are critical for the treatment of bronchiolitis. Commonly used bronchodilators, corticosteroids, ribavirin, and antibiotics have not been shown to be effective in improving the clinical course of the bronchiolitis

Human Cytomegalovirus Infection: Biological Features, Transmission, Symptoms, Diagnosis, and Treatment

Human cytomegalovirus (CMV), a member of the human herpesviruses, is a deoxyribonucleic acid virus that is ubiquitous in the world. After primary infection, CMV develops a latent state; however, when the defense of the immune system decreases in a host, it can reactivate. Human cytomegalovirus infections are acquired via several ways. CMV is spread through contact with infected bodily fluids in humans, whereas it occurs in pregnant women through close contact with young children or through sexual transmission. The clinical manifestations consist of non-specific symptoms or clinical findings. However, the patients with acute CMV infections are generally asymptomatic. Congenital CMV infection (present at birth) occurs via intrauterine transmission of the virus that is thought to be transferred to the developing fetus. The common clinical manifestations of congenital CMV infection are sensorineural hearing loss, petechiae, jaundice at birth, and hepatosplenomegaly. The vast majority of healthy children and adolescents infected with CMV infections are most often asymptomatic. Treatment is recommended to initiate to the infants who have a symptomatic infection or primary immunodeficiency or asymptomatic infection with an isolated hearing loss. The diagnosis of congenital CMV infections should be considered when it is detected in the newborns with signs and symptoms consistent with congenital CMV disease or with abnormal neuroimaging consistent with CMV or newborns who have documented sensorineural hearing loss

Çikolata Endüstrisinde Bulanık AHP Yöntemi ile Tedarikçi Seçimi

Alternatif tedarikçiler arasından en uygun olana karar vermeyi sağlayan tedarikçi seçimi problemi, tedarik zinciri performansını ve işletmenin başarısını artırmada etkili olan bir karar verme sürecidir. Tedarikçi seçimini değerlendirmede, kalite, fiyat, teslimat, performans, etkileşim gibi faktörler ve alt kriterlerin çok sayıda olması karmaşık bir yapı oluşturur. Bu çalışmada, bir çikolata üretim işletmesinde tedarikçi seçiminde önemli kriterleri belirleme amacıyla, Bulanık AHP Yöntemi kullanılmıştır. Veri toplama sürecinde, hazırlanan ikili karşılaştırma anketleri, işletmede görevli dört uzman ile yüz yüze görüşülerek doldurulmuştur. Verilerin analiz edilmesi sonucunda en iyi tedarikçi sıralaması tedarkçi3, tedarikçi 2 ve tedarikçi 1 olarak ortaya çıkmıştır. Tedarikçi 3, 0,4862 değeri ile en iyi tedarikçidir

Lymphadenopathies: An Annoyance or Not?

Aim:The aim of this study was to evaluate the cases hospitalized with lymphadenopathy in terms of demographic and clinical characteristics, lymph node involvement regions, infection markers and their diagnoses.Materials and Methods:The medical records of 56 children with lymphadenopathy between 2014 and 2017 were reviewed retrospectively at Ege University, Children’s Hospital, General Pediatrics Unit. Demographic characteristics, clinical findings and accompanying complaints of the cases were examined. Laboratory tests including complete blood count, sedimentation rates and other biochemical parameters were measured. Lymph nodes were assessed via ultrasonographic examination in terms of distribution, number, size and structure. Lymph node regions were described as anterior or posterior cervical, supraclavicular, submandibular, axillary, epitrochlear, inguinal or popliteal. Laboratory results, microbiological studies and histopathological examination results of the patients were evaluated.Results:Among the 56 patients enrolled in the study, 31 (55.4%) were male, 25 (44.6%) were female and the median age was 3.7±7.1 years. The most frequent involvement location of the enlarged lymph nodes was the cervical area. Others occurred in the axillary, inguinal or supraclavicular regions. The median results of the white blood cell, C-reactive protein and erythrocyte sedimentation rates were 13.670±9760/mm3, 1.9±5.4 mg/dL and 42±51 mm/h respectively. Ultrasonographic evaluation showed that lymph nodes were diagnosed with reactive hyperplasia in 69.6%, suppurative lymphadenopathy in 23.2% and suspected malignancy in 7.1%. Most of the cases with lymphadenopathy resulted from a benign condition.Conclusion:Lymphadenopathy is a common complaint of childhood, mostly benign. The etiology should be elucidated using full history, careful physical examination, follow-up, laboratory and imaging methods. A good physical examination and follow-up of the clinical features of the lymph node are more important than the laboratory and imaging methods. If there is no change in lymph node size in the follow-up, further studies should be performed

Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics

Objective: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. Methods: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. Results: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. Conclusions: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised

A Rare Cause of Diplopia: Idiopathic Orbital Myositis

Orbital myositis is an entity affecting the ocular muscles, especially the medial rectus. These cases are usually referred to clinics with complaints such as diplopia, orbital/periorbital pain, limitation in ocular movements, increased pain with eye movements, proptosis, swelling of the eyelid and/or hyperemia in the conjunctiva. Orbital myositis is usually idiopathic and autoimmunity is often suspected in etiology. In this article, we present a 15-year-old girl who presented with diplopia, pain in both eyes, anomalous head posture, periorbital edema and was diagnosed with idiopathic orbital myositis through history, clinical findings and imaging methods

Seasonal Variation of Vitamin D via Several Parameters in Adolescents

Aim:Vitamin D in adolescents reveals that subclinical vitamin D deficiency is continuously increasing worldwide. The aim of this study was to investigate the prevalence of vitamin D and subclinical vitamin D deficiency and risk factors among adolescents in the summer and winter seasons in İzmir.Materials and Methods:The medical records of 90 adolescents were reviewed regarding their vitamin D status in the summer and winter seasons. Blood samples were obtained from 90 adolescents at the end of summer and the end of winter. These samples were assessed for calcium (Ca++), phosphorus, magnesium (Mg), parathyroid hormone, alkaline phosphatase and 25-hydroxyvitamin D concentrations. The subjects were divided into two groups; the first group consisted of the patients who were assessed for vitamin D levels and the other laboratory measurements at the end of winter (n=46), the second group consisted of the patients who were assessed for the same laboratory features at the end of summer (n=44). The two groups were compared in terms of demographic, clinical and laboratory characteristics.Results:Among the 90 patients enrolled in the study, 41 (45.5%) were males and 49 (54.5%) were females. The median age was 11±4 years. Vitamin D deficiency percentages of the study group for the end of the winter period was 60.8% and for the end of the summer period was 6.8% but this was not statistically significant. Vitamin D insufficiency percentages of the winter group were higher than the summer group (93.2% vs. 39.2%, p>0.05). There were no differences between the groups in terms of laboratory findings concerning Ca, Mg and the other bone parameters.Conclusion:Contrary to the expected, we did not detect a seasonal difference in vitamin D levels in adolescents. Although laboratory findings were not found to be statistically significant in terms of vitamin D levels, we can state that the level of vitamin D in the winter season might be lower than the summer season. Therefore, it should be kept in mind that vitamin D insufficiency is more frequent at the end of the winter season and seasonal differences in the adolescent population should be considered during measurement

Diagnostic Value of the Mean Platelet Volume in the Prediction of Respiratory Syncytial Virus in Acute Bronchiolitis

Aim:Respiratory syncytial virus (RSV) is a viral pathogen that causes lower respiratory system infections in childhood. The purpose of this study was to examine whether mean platelet volume (MPV) changes are significant in the prediction of RSV bronchiolitis.Materials and Methods:One hundred and eighty-four infants who were diagnosed with acute bronchiolitis were divided into groups based on being RSV positive and other respiratory viruses positive. Using the receiver operating characteristic (ROC), diagnostic accuracy was evaluated according to the areas under the curves (AUC) for the diagnosis of bronchiolitis. A p value of 0.05) and other viruses. ROC curve analysis indicates that the MPV level cut-off point for making the diagnosis of single RSV bronchiolitis was 6.63 fL with a sensitivity and specificity of 55% and 63% respectively. The median AUC was 0.384 for the MPV (95% CI 0.270-0.499, p=0.04).Conclusion:Volume of MP may be a useful marker to provide a prediction on single RSV bronchiolitis. However, the measurement of MPV might not be correct and sufficient to provide a prediction on the types of respiratory viruses in bronchiolitis

Global respiratory syncytial virus–related infant community deaths

Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). Conclusions We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines