Association of Vogt Koyanagi Harada Syndrome and Seronegative Rheumatoid Arthritis

Background: Vogt Koyanagi Harada (VKH) Syndrome is a rarely-seen multi-systemic, autoimmune and inflammatory disease. It observed frequently with neurologic, auditory and skin manifestations and characterized with bilateral, chronic and diffused granulomatous panuveitis. It generally affects women in young-adult period.Case: A 57 year-old female patient applied to a special center one year ago with a complaint of decrease in the sight acuity of the right eye. The right eye was operated on with cataract diagnosis. Uveitis was developed firstly in the right eye and then in the left eye after the operation. Having complaints about uveitis, tinnitus and hear loss, the patient was diagnosed with VKH syndrome. The pains started to be felt in small hand joints and both of the two ankles. The pains were increasing especially in the mornings and during rest. The duration of morning stiffness was two hours in hand and foot joints. The patient had had lumbar pain with mechanic characteristic for five years.Conclusion: Being diagnosed with seronegative rheumatoid arthritis (RA), our case is presented because VKH syndrome is rarely seen in Turkey, and the joint findings are at the forefront.Keywords: Seronegative Rheumatoid Arthritis, joint involvement, Vogt Koyanagi Harada Syndrom

Cardiovascular disease risk factors among children of different socioeconomic status in Istanbul, Turkey: Directions for public health and nutrition policy

OBJECTIVES: The aim of the current study was to examine the influence of socioeconomic status (SES) on physiological (lipid profile, obesity indices) and behavioral (dietary habits, physical activity) cardiovascular disease (CVD) risk factors among primary schoolchildren in Istanbul. DESIGN: Cross sectional study. SETTING: One private school and two public schools from different SES districts in Istanbul. PARTICIPANTS: 510 randomly selected children aged 12 and 13 years old (257 boys, 253 girls). RESULTS: The prevalence of overweight (15.2%) and the energy intake (p < 0.001 and p < 0.05 for boys and girls respectively) were found to be higher for the middle/ high SES group for both genders. Regarding biochemical indices, middle/ high SES children had higher values of High Density Lipoprotein-cholesterol (HDL-C) (p < 0.001 and p < 0.05 for boys and girls respectively) and lower values of TC/HDL-C ratio and LDL-C/HDL-C ratio (p < 0.05 and p < 0.001 for boys and girls respectively). This could be attributed to the higher physical activity levels observed for middle/ high SES children (p < 0.001). CONCLUSION: The findings of the current study revealed a coexistence of both overweight and higher energy intake in middle/ high SES children, as well as a coexistence of underweight and lower physical activity levels in low SES children. These observations should guide the public health policy in developing appropriate intervention strategies to efficiently tackle these health and social issues early in life

Efficacy of c-arm scopy-guided erector spinae plane block (ESPB) in postoperative pain control and reduction of opioid side effects in spinal instrumentation surgery

Background: Spinal instrumentation surgery causes significant pain in patients. As a result, patients are exposed to excessive opioid use and the associated side effects, as well as prolonged hospital stay, resulting in economic burden. Local anaesthetics can help both reduce postoperative pain and minimize the side effects associated with systemically administered opioid analgesics. Objective: The aim of this retrospective study was to investigate the effect of erector spinae plane block on analgesia in spinal instrumentation surgery and to reduce the side effects of excessive opioid use. Materials and Methods: We reported a retrospective study. Thirty patients, who underwent spinal instrumentation surgery from 2017 to 2018, were chosen from the hospital records. We performed spinal instrumentation and decompression by laminectomy to all patients under general anaesthesia. While 15 of these patients underwent erector spinae plane block, these patients received patient-controlled analgesia postoperative period. The other 15 patients received only patient-controlled analgesia postoperative period. We analyzed patients' data for differences in preoperative and postoperative visual analogue scores, nausea vomiting scores, constipation life quality scale, patient-controlled analgesia shot count and mean opioid consumption of patients. Results: The data of 30 patients undergoing lumbar spinal instrumentation surgery were retrospectively analyzed. There was no significant difference in the age, preoperative VAS, preoperative ODI and sex between the two groups (p?0,05). In addition, there were statistically significant differences in postoperative VAS, postoperative ODI, Nausea Vomiting Score, Constipation Life Quality Score (CLQS), petidin consumption and PCA shot count (p &lt;0.05). In all variables with significant differences, the values ??in the block group were lower than the non-block group. Conclusion: ESPB provides effective analgesia and reduces side effects due to excessive opioid usage

Association of platelet count and platelet indices with cranial meningioma

Introduction and Objectives: In this study, we aimed to investigate whether platelet count (PLT) and platelet indices included mean platelet volume (MPV), platecrit (PCT), platelet distribution width&nbsp; (PDW) values can be used as diagnostic markers in cranial meningiomas. Materials and Methods: The study included results of 29 patient and 47 healthy contributors. Based on pathologies, the patients were divided into two groups. The first group included meningioma patients and the second one included healthy individuals. Healthy contributors named control group. Platelet count and platelet indices were determined using Sysmex XN 550 haematology analyzer. The preoperative platelet count (PLT) and platelet indices included mean platelet volume (MPV), platecrit (PCT), platelet distribution width&nbsp; (PDW) values were recorded from the routine laboratory tests. Results: There was no statistically significant difference in PLT between the meningioma and healthy groups (p = 0.217). There was a statistically significant difference in PCT between the meningioma group and the healthy group (p = 0.002). There was a statistically significant difference in PDW between meningioma group and healthy group (p = 0.001). In terms of MPV, there was a statistically significant difference between meningioma group and the healthy group (p = 0.001) Conclusion: Platelet count and indices are easily available in the routine blood tests. Despite the retrospective design and small sample size, our findings suggest that altered MPV, PDW and PCT levels might serve as potential biomarkers for the diagnosis of meningiomas

A rare complication of tuberculosis: Acute paraplegia

Background: Tuberculous radiculomyelitis(TBRM) is one of the complications of neurological tuberculosis and includes cases of arachnoiditis, intradural spinal tuberculoma or granuloma, and spinal cord complications of tuberculous meningitis (TBM). Here, we report a case of TBRM which presented with acute paraplegia.Case Details: Neurological examination on admission revealed flaccid paralysis, bilateral extensor plantar responses, and exaggerated deep tendon reflexes. Cerebrospinal fluid analysis showed xanthochromic fluid that contained 600 cells/mm3, 98% lymphocytes, protein 318 mg/dl and glucose 51 mg/dl (blood glucose 118 mg/dl). On thorax CT, calcified lymph nodes that were sequelae of primary tuberculosis infection was detected. Antituberculosis and intravenous corticosteroids treatment was started. Seven weeks from the onset, on-control spinal MRI myelomalacia was determined, and there was no leptomeningeal enhancement. After six weeks of rehabilitation, lower limb total motor score was increased from 0/50 to 15/50.Conclusion: Tuberculous radiculomyelitis is a complication of TBM. It is rarely seen.Keywords: Tuberculosis, Paraplegia, Tuberculous radiculomyeliti

Computed tomography-based morphometric measurements of the atlas (C1) posterior arc

Study design: Single-center retrospective study Objectives: This study is performed to determine the anatomic feasibility of the C1 posterior arc screw and help select an optimal screw trajectory in treating patients with craniovertebral junction pathologies. Material and Methods: We reported a single-centre retrospective study. Forty patients (20 male and 20 female) who underwent cervical computed tomography (CT) were chosen from the hospital records. Based on CT images, we measured left laminar length (LLL), right laminar length (RLL), left laminar angle (LLA), right laminar angle (RLA), left laminar axial thickness (LLAT), right laminar axial thickness (RLAT), left laminar coronal thickness (LLCT), right laminar coronal thickness (RLCT), and craniocaudal angle (CCA) of the C1 posterior arc. Results: The mean values and standard deviations (SD) for nine parameters at the C1 posterior arc were determined. LLL, RLL, LLCT, and RLCT were statistically longer in men than women. RLAT was bigger in men but there was no statistical difference. RLA was statistically wider in women than men. LLA and CCA were wider in women but there was no statistical difference, LLAT was bigger in women but there was no statistical difference. There was no statistical difference in measurements by age. Conclusion: &nbsp;The results of this study are important to avoid neurovascular injury and pedicle breakage because of choosing large screw while performing C1 laminar screw fixation

The efficacy of adalimumab on experimentally induced spinal cord ischemia-reperfusion injury

Objective:&nbsp;Paraplegia is a dangerous complication of thoracoabdominal aortic surgery. Various studies have been conducted on the prevention of this complication and some spinal cord protection methods have been proposed. However, there is not any modality that prevent the development of paraplegia certainly. In the I / R period, primary injury triggers secondary injury due to increased inflammation, apoptosis and free radical formation. In this study, we evaluated that the neuroprotective effect of adalimumab in spinal cord ischemia-reperfusion injury.&nbsp; Materials and Methods:&nbsp;In total, 24 adult New Zealand rabbits were divided into three groups: Group 1, control; Group 2, ischemia-reperfusion by infrarenal aortic clamping; Group 3, adalimumab treated followed by ischemia. Tissue and plasma tumor necrosis factor alpha, interleukin 6, interleukin 10, thiobarbituric acid reactive substance, total oxidant status and total antioxidant status levels were analyzed as a marker of inflammation and oxidation. Histopathological evaluation of the tissues was performed, and apoptosis was evaluated by TUNNEL method. Results:&nbsp;I/R injury significantly increases plasma and spinal cord tissue at TNF alpha, TOS, TBARS, IL6 levels and reduces plasma and spinal cord tissue to TAS and IL10 levels. Adalimumab treatment significantly reduces plasma and spinal cord tissue to TNF alpha, TOS, TBARS, IL6 and increases plasma and tissue to TAS and IL10 levels. Conclusion:&nbsp;Adalimumab treatment significantly reduces the spinal cord neuronal damage score and the number of apoptotic cells. This paper aims to demonstrate the important neuroprotective effects of adalimumab on rabbit spinal cord I/R injury

Familial Mediterranean fever: Health-related quality of life and associated variables in a national cohort

Objectives: This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients. Patients and methods: This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale. Results: The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT. Conclusion: Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale

Growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula in infants with cow’s milk protein allergy

ObjectiveTo evaluate growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula (eHCF) in infants with cow’s milk protein allergy (CMPA).MethodsA total of 226 infants (mean ± SD age: 106.5 ± 39.5 days, 52.7% were girls) with CMPA who received eHCF comprising at least half of the daily dietary intake were included. Data on anthropometrics [weight for age (WFA), length for age (LFA) and weight for length (WFL) z-scores] were recorded at baseline (visit 1), while data on infant feeding and stool records, anthropometrics and Infant Feeding and Stool Patterns and Formula Satisfaction Questionnaires were recorded at visit 2 (on Days 15 ± 5) and visit 3 (on Days 30 ± 5).ResultsFrom baseline to visit 2 and visit 3, WFA z-scores (from −0.60 ± 1.13 to −0.54 ± 1.09 at visit 2, and to −0.44 ± 1.05 at visit 3, p &lt; 0.001) and WFL z-scores (from −0.80 ± 1.30 to −0.71 ± 1.22 at visit 2, and to −0.64 ± 1.13 at visit 3, p = 0.002) were significantly increased. At least half of infants never experienced irritability or feeding refusal (55.7%) and spit-up after feeding (50.2%). The majority of mothers were satisfied with the study formula (93.2%), and wished to continue using it (92.2%).ConclusionsIn conclusion, eHCF was well-accepted and tolerated by an intended use population of infants  ≤ 6 months of age with CMPA and enabled adequate volume consumption and improved growth indices within 30 days of utilization alongside a favorable gastrointestinal tolerance and a high level of parental satisfaction

Volume CXIV, Number 4, November 7, 1996

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespa