Background: Tramadol, a synthetic opioid analgesic, is associated with reproductive toxicity and testicular oxidative damage following prolonged exposure. Amaranthus viridis (green amaranth), a medicinally valued tropical vegetable, possesses antioxidant and anti-inflammatory properties that may offer protective effects. This study investigated the protective potential of Amaranthus viridis leaf extract against tramadol-induced testicular toxicity in adult male Wistar rats, focusing on oxidative stress biomarkers, reproductive hormones, and inflammatory cytokines. Method: Twenty-five adult male Wistar rats were randomly assigned into five groups (n=5). Group 1 received distilled water (control); Group 2 received 200 mg/kg tramadol (toxic control); Groups 3, 4, and 5 were administered combined doses of tramadol (150, 100, and 50 mg/kg, respectively) and Amaranthus viridis extract (100, 200, and 300 mg/kg, respectively) for 21 days via oral gavage. Testicular tissues and serum samples were evaluated for histology, oxidative stress markers (SOD, GPx, MDA), reproductive hormones (LH, FSH, testosterone), and inflammatory cytokines (IL-1, IL-6, TNF-α, TNF-β). Results: Tramadol administration significantly disrupted testicular histoarchitecture and caused a marked reduction in LH, FSH, testosterone, SOD, and GPx levels, along with elevated MDA and TNF-β levels (p<0.05). Co-treatment with A. viridis extract, especially at 300 mg/kg, significantly restored LH, FSH, testosterone, SOD, and GPx levels and suppressed TNF-β expression, although MDA levels remained elevated. Histologically, A. viridis treatment attenuated germ cell necrosis and improved seminiferous tubule integrity. Conclusion: A. viridis extract demonstrated a dose-dependent protective effect against tramadol-induced testicular toxicity by enhancing antioxidant defenses, restoring hormonal balance, and suppressing proinflammatory cytokines-highlighting its therapeutic potential in male reproductive health.
Papillon–Lefèvre syndrome (PLS) is a rare autosomal recessive genodermatosis caused by pathogenic variants in the CTSC gene. The condition is characterized by the coexistence of palmoplantar keratoderma and early-onset, rapidly progressive periodontitis. Here, we present a 21-year-old female patient in whom a previously unreported homozygous CTSC variant, c.872G>A, was identified.Since childhood, the patient had marked hyperkeratosis on the palmoplantar regions, early tooth loss, and the need for oral prostheses. A family history of individuals with similar dermatologic features and consanguinity between the parents supported an autosomal recessive inheritance pattern. The identified variant was evaluated in conjunction with the clinical phenotype and was classified as likely pathogenic according to the American College of Medical Genetics and Genomics (ACMG) criteria.Systemic retinoid therapy was recommended but could not be initiated due to patient preference. This case contributes to the expanding genetic spectrum of PLS and highlights the crucial importance of early diagnosis, a multidisciplinary approach, and treatment adherence in determining disease prognosis.
Effective communication in neonatal intensive care units (NICUs) is central to Family-Centered Care (FCC), shaping how parents understand their infant’s condition, engage in shared decision-making, and form therapeutic partnerships with the healthcare team. Grounded in communication theory, this narrative review explores the triadic interaction among families, healthcare professionals, and infants, emphasizing how information exchange, relational communication, and emotional attunement influence clinical processes and parental experiences. The review synthesizes international and national literature to highlight recurrent communication challenges, including fragmented information flow, limited parental inclusion in care discussions, and variability in professional communication skills. Drawing on FCC principles, we identify evidence-based strategies that strengthen communication effectiveness, such as structured communication tools, routine family meetings, digital information platforms, parent-reported experience measures, and nurse-led relational support. These interventions enhance parental empowerment, reduce anxiety, and contribute to improved continuity and quality of care. The Turkish NICU context is also considered, underscoring the cultural and systemic factors that shape family engagement and communication expectations. Overall, this review demonstrates that communication is not merely a clinical task but a relational process that underpins FCC and supports the emotional well-being of families navigating the NICU environment. Strengthening communication pathways can promote safer, more collaborative, and developmentally supportive neonatal care.
Objective: Although magnesium (Mg) is integral to numerous metabolic and immunological processes, its influence in Hashimoto’s thyroiditis (HT) has not been fully elucidated. The present study sought to examine the effects of oral Mg supplementation on thyroid function and thyroid autoantibody in hypomagnesemic, euthyroid individuals with HT who were receiving a stable levothyroxine (LT4) regimen.Methods: In this retrospective observational analysis, adult patients with HT who were euthyroid and had documented hypomagnesemia were evaluated after receiving oral Mg supplementation for a minimum of two months, during which LT4 dosing remained unchanged. Serum thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG), and Mg levels were measured both prior to and following supplementation. Pre- and post-treatment values were compared using paired statistical methods.Results: A total of 45 patients (82% female, mean age 49.3 ± 15.7 years) were analyzed. All patients received oral Mg oxide equivalent to 365 mg elemental Mg daily. After two months of Mg supplementation, serum Mg levels increased significantly (p = 0.04). Serum TSH levels also showed a statistically significant increase (p = 0.03), while remaining within the euthyroid range. No significant changes were observed in fT4, fT3, anti-TPO, or anti-TG titers.Conclusion: In hypomagnesemic euthyroid patients with HT on stable LT4 therapy, short-term Mg supplementation was associated with a modest but significant increase in TSH without alterations in thyroid hormone levels or autoantibody titers. These findings suggest that Mg replacement may influence biochemical thyroid regulation without short-term effects on thyroid autoimmunity.
Cafe coronary syndrome is a term used to describe cases of sudden death during a meal in healthy individuals without any asphyxia, respiratory distress or neurologic symptoms. It is usually fatal without timely intervention. The causative factor in café coronary syndrome is almost always food. In most cases, predisposing factors such as fast eating, alcohol consumption, underlying neurologic diseases or senility are observed. In this case report, we aimed to present a case who was found dead alone in his home and autopsy revealed Cade coronary syndrome with food in the respiratory tract and to make a forensic and clinical evaluation.
Objective: ASD; It is a neurodevelopmental disorder whose symptoms persist throughout life. There are many studies investigating ASD in childhood, but there are few studies examining the adulthood of ASD patients. The aim of this study is to examine the psychiatric diagnoses received in adulthood by patients diagnosed with ASD in childhood.Method: To work; Between 2006 and 2023, 28 patients who applied to the child and adolescent mental health and diseases outpatient clinic and were diagnosed with autism, and who applied to the psychiatry outpatient clinic in adulthood and were diagnosed, were included.Results: When the diagnoses received by the patients in adulthood are examined; %35.6 of the patients had mental retardation (MR), %21.4 had childhood autism and MR, %7.2 had atypical autism and MR, %7.1 had atypical autism, %7.1 had MR and psychotic disorder, %7.1 with pervasive developmental disorder, %3.6 with pervasive developmental disorder and mild MR, %3.6 with anxiety disorder, %3.6 with childhood autism and anxiety disorder, %3.6 were diagnosed with conduct disorder, %3.6 with mild MR and attention deficit and hyperactivity disorder (ADHD), and %3.6 with autism, moderate MR and ADHD, It was found that.Conclusion: ASD is a disorder whose symptoms continue into adulthood and is often accompanied by other psychiatric disorders. Clinical problems and diagnostic features of patients in adulthood vary. For these reasons, it is thought that investigating the adult symptoms and clinical course of these patients will be useful in determining the most appropriate and effective treatment programs for the patients.
Objective: This study aimed to examine trends in health inequalities by place of residence and household welfare using data from the Turkey Demographic and Health Survey. Methods: Absolute and relative inequalities were calculated using the methods recommended in the WHO Health Inequality Monitoring Handbook, which focuses on low- and middle-income countries. Absolute inequality is the difference between the two subgroups and relative inequality is the ratio between the two subgroups. Inequalities in the field of child, reproductive, and women's health were measured using simple measurement methods recommended in the WHO Health Inequality Monitoring Handbook. To examine changes in health inequalities across household welfare levels and rural-urban residence, we used data from the 2008, 2013, and 2018 Turkey Demographic and Health Surveys. Results: Living in rural and low-income areas has been found to be predominantly disadvantaged. Increased inequality in child vaccination and the use of modern contraceptive methods has been seen by wealth level. Increases in inequality were found in indicators such as adolescent pregnancy, violence against women, years of education for women, and low birth weight, both by wealth level and by residence. However, inequalities in prenatal and postnatal care and the percentage of children receiving all basic vaccinations by residence have decreased, and rural areas have even become more advantaged. Conclusion: Policies targeting rural areas and low levels of welfare are needed to reduce health inequalities. While addressing disadvantaged groups to reduce inequalities is necessary, urban areas are at higher risk for childhood obesity and exclusive breastfeeding. Interestingly, these groups have higher wealth levels and should be selected as the target group for intervention. The findings suggest that the programs implemented in our country are effective in reducing inequalities in some indicators.
Objective: This review examines the applications of Artificial Intelligence (AI) in HIV diagnosis, treatment optimization, and epidemiological modeling. It explores how AI enhances early detection, personalizes antiretroviral therapy (ART), and supports public health strategies while addressing ethical and accessibility challenges. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science for peer-reviewed studies published between 2010 and 2024. Relevant policy documents from WHO and UNAIDS were also reviewed. Studies on AI applications in HIV diagnosis, treatment, and epidemiology were included, while non-peer-reviewed, non-English, and unrelated studies were excluded. Selected studies were categorized into key thematic areas. Results: AI has significantly improved HIV diagnosis by enhancing accuracy in early detection through machine learning models. In treatment, AI-driven models assist in optimizing ART regimens and predicting drug resistance patterns. Epidemiological modeling has benefited from AI's ability to analyze large datasets, informing targeted interventions. However, challenges such as algorithmic biases, data privacy concerns, and limited AI adoption in low-resource settings remain barriers to implementation. Conclusion: AI has transformed HIV management by improving diagnosis, treatment, and epidemic control. Future research should focus on refining AI models, increasing data inclusivity, and ensuring ethical and equitable AI integration into global healthcare systems to maximize its impact.
Thrombocytosis is a condition that is often detected incidentally and can be seen both in the course of myeloproliferative diseases (MPD) and as a reactive condition. Ankylosing spondylitis (AS) is a chronic multisystemic inflammatory disease that mainly affects the spine. Mild to moderate thrombocytosis may occur secondary to the course of AS. In the treatment of AS, tumor necrosis factor inhibitor (anti-TNF) treatments are actively used as first-line therapy. The number of cases of MPDs occurring in the course of AS reported in the literature is limited. Although the exact effect of anti-TNF treatment on the MPD process is not fully known, there are publications stating that caution should be exercised in cases of MPD. By this case, we wanted to share our experience of using anti-TNF therapy in a patient diagnosed with ET in the course of AS. The 35-year-old male patient had been diagnosed with AS for 11 years and had been followed up by hematology with the diagnosis of essential thrombocytosis (ET) since 2010. When there was no response to indomethacin and sulfasalazine treatments, the patient was first given etanercept, and after secondary unresponsiveness, infliximab and adalimumab treatments were given. Despite the use of multiple anti-TNFs, no hematological deterioration was detected in terms of ET. Clinical and laboratory responses were also obtained in terms of AS. The patient has been stable and in remission in terms of both AS and ET since 2016.
ABSTARCT Objective: The tick-borne encephalitis virus (TBEV), a flavivirus transmitted by Ixodes spp. ticks, can cause a clinical picture characterized by nonspecific symptoms, as well as more specific conditions such as encephalitis and myelitis. Most patients admitted and followed with a preliminary diagnosis of Crimean-Congo hemorrhagic fever (CCHF) are from regions with a risk of tick exposure. The aim of this study is to determine the epidemiology of TBEV. Material and Method: A total of 272 adult patients admitted with a preliminary diagnosis of CCHF between April and September 2021 in the Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, XXX University, were included in the study. The diagnosis of CCHF was defined using the criteria established by the CCHF Scientific Committee of the Turkish Ministry of Health. To determine the seroprevalence of TBE, TBEV-IgG antibodies were investigated in patient serum samples using the ELISA method (Anti-TBE Virus ELISA (IgG), Euroimmun, Germany). The results were evaluated by calculating the ratio of the extinction value of the patient sample to the extinction value of calibrator 2. Ratios below 0.8 were considered negative, between 0.8 and 1.1 were considered borderline, and greater than 1.1 were considered positive. Patients with no detected antibodies against TBEV in their serum samples were considered seronegative. Results: The mean age of the 272 patients included in the study was 49.46 ± 17.48 years (Range: 18-98 years), with 181 (66.5%) being male. All patients' TBEV antibody levels were evaluated as negative. The provinces of residence of the patients were Sivas, Giresun, Tokat, Yozgat, and Erzincan. A history of tick exposure was found in 204 (75%) of the patients, with 143 (79%) of male patients and 61 (67%) of female patients reporting tick exposure. Conclusion: In this study, the absence of antibodies against TBEV indirectly demonstrated the absence of TBEV in the tick population. However, no study has been conducted to detect the presence of TBEV in the tick population in Sivas province, and our study is the first to address this issue. Nevertheless, further seroepidemiological studies are required.
Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of autoimmune-mediated disorders. One of the most important developments in recent years regarding IIMs is the clinical use of myositis-specific antibodies and myositis-associated antibodies. The identification of anti-cytosolic 5’-nucleotidase 1A (anti-cN1A), one of the myositis-associated antibodies, represents significant progress in understanding inclusion body myositis (IBM), with research focusing on its role in predicting survival, diagnostic potential, clinical phenotype, and histopathological correlations. With the increasing use of autoantibodies in recent years, it is essential to understand their specificity and sensitivity properties. We presented two cases of dermatomyositis with positive anti-cN1A antibodies, which are known to have high specificity in IBM. One of the cases is a male patient, and IBM was included in the differential diagnosis because of anti-cN1A antibody positivity and resistance to first-line immunosuppressive therapy. The other case is a female patient diagnosed with dermatomyositis twelve years ago, with a myositis antibodies panel performed during a disease flare revealing anti-cN1A antibody positivity.
Sexual development is one of the significant stages of the embryogenesis. In this process, the gonadal differentiation taking place on a genetic basis (sex chromosomes) determines the sexual identity of the individual. Initially, the gonads are considered bipotential because the gonadal primordium can turn into a testicle or ovary through the activation of certain genetic elements in the subsequent period. When there is a disruption at any phase of this period, various clinical conditions called disorders of sexual development (DSD) arise. These conditions, often accompanied by various mutations or sex chromosome abnormalities, may include gonadal dysgenesis and result in a male (46, XY) or female (46, XX) sex reversal. DSD with 46,XY usually contains ambiguous condition, or the presence of female external and/or internal genitalia depending on whether Müllerian tissues are present. On the other hand, different enzyme defects, again, on a genetic basis can lead to disorders of sex development in both males (e.g. 5α-reductase) and females (e.g. aromatase). Congenital adrenal hyperplasia is a relatively common, autosomal recessive enzyme defect, especially in 46,XX DSD cases. A number of syndromes lead to a certain degree of inadequate sexual development in males or masculinization in females. Patients also have some characteristic physical symptoms accompanied by mental problems. Gonadal dysgenesis can be caused by various mutations, mainly in the SRY gene (e.g. Swyer syndrome) or sex chromosome disorder (Turner syndrome). In cases of 46,XY DSD, mixed gonadal dysgenesis, and some other conditions, prophylactic gonadectomy may be considered because of the malignancy risk.
Objectives: This study assessed the prevalence of dyslipidemia in pediatric patients with type 1 diabetes mellitus (T1DM) at diagnosis and after one year, examining the effects of glycemic control on lipid levels. Material and methods: A retrospective analysis was conducted on 56 T1DM patients (30 males, 26 females) aged 10-18 years. These patients were monitored every three months for at least one year. Data on lipid profiles and glycemic control were collected at baseline and after one year. Results: Dyslipidemia prevalence significantly decreased from 60.7% at baseline to 26.8% after one year (p < 0.001). At follow-up, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL), and triglyceride (TG) levels were significantly lower compared to baseline (7.95 ± 1.73% vs. 13.45 ± 2.45%, 84.07 ± 27.55 mg/dl vs. 94.84 ± 27.87 mg/dl, and 78.75 ± 29.93 mg/dl vs. 105.98 ± 58.95 mg/dl, respectively) (p < 0.001, p = 0.007, p = 0.001). Total cholesterol (TC) also decreased, though the difference was near significance (151.20 ± 25.55 mg/dl vs. 159.79 ± 29.78 mg/dl, p = 0.05). High-density lipoprotein (HDL) levels increased significantly (55.60 ± 11.10 mg/dl vs. 49.63 ± 13.46 mg/dl, p < 0.001). Females had higher HDL levels than males (60.08 ± 12.37 mg/dl vs. 51.71 ± 8.24 mg/dl, p = 0.004). HbA1c levels showed a positive correlation with TC, LDL, and TG, and a negative correlation with HDL. Conclusion: This study highlights a significant reduction in dyslipidemia in pediatric T1DM patients after one year, linked to improved glycemic control. Effective HbA1c management is crucial for better lipid profiles and reduced cardiovascular risk.
ABSTRACT Schizophrenia is a chronic disorder that affects 1% of the population and causes serious impairment in functioning. If symptoms associated with schizophrenia begin before the age of eighteen, it is called early-onset schizophrenia (EOS), and if it starts before the age of thirteen, it is called very early-onset schizophrenia (VEOS). Although there are many studies on the prevalence and risk factors of schizophrenia in the adult population, there are not enough studies yet on VEOS. Although the number of studies on this topic is limited, it is known that these cases have a more severe course than adult-onset schizophrenia. In very early-onset schizophrenia, it has been determined that the loss of gray matter continues from the onset of the disease, which accelerates during adolescence. Early diagnosis of cases and early initiation of treatment are critical, as neurocognitive deterioration is more rapid and severe. Also, treatment resistance is not uncommon. Considering its side effects, the use of clozapine, which we do not prefer to use in the pediatric population, should be considered in these cases. In this paper, we will present the successful management of a 10-year-old boy with schizophrenia using clozapine. The patient was brought to our clinic by his family. His symptoms were persecutory delusions, grandiose delusions, self-talk, disorganized behaviors, decreased communication, negativism, and agitation. He was hardly speaking to his family; he could not go to school. Since schizophrenia started at a very early age in this patient, neurocognitive deterioration was rapid and severe, and the symptoms didn't improve with three previously used antipsychotics, so we switched to clozapine. There were no serious adverse events after clozapine therapy, and the patient's psychotic symptoms significantly improved. There was a significant enhancement in the patient's daily functionality. Very early-onset schizophrenia is more severe, and resistance to treatment is commonly seen. It would be useful for clinicians to keep in mind clozapine, which is not a frequently used agent in the child-adolescent population, as a treatment option in treatment-resistant VEOS cases.
ABSTRACT Objective: The purpose of this study was to examine the relationship between 2D:4D digit ratio and aggression and impulsivity in manic patients (BP) with and without a history of criminal behavior. Materials and Methods: The study included a total of 106 subjects, which included 41 healthy individuals, 34 bipolar (BP) patients with a history of criminal behavior (CBP) and 31 BP patients who had not engaged in criminal activity (NCBP). All participants were administered a socio-demographic data form, the Buss-Perry Aggression Scale (BAQ), Barratt Impulsiveness Scale-11 (BIS-11) and the Young Mania Rating Scale (YMRS) and 2D:4D ratio measurement. Results: The right hand 2D:4D ratios of BP patients included in the study were significantly lower (p: 0.007) compared to the control group. Moreover the BAQ scores of BP patients were higher compared to the control group. In CBP patients, both the right hand 2D:4D (p: 0.007) and left hand 2D:4D (p: 0.036) were significantly lower when compared to the control group. Furthermore, the BIS-11 score (p: 0.046) and YMRS (p: 0.008) of CBP patients were significantly higher when compared to NCBP. Conculusion: Based on results, we predict that in the future, the lower 2D:4D ratio in the right and left hand of bipolar manic patients who commit crimes compared to the control group, will guide in advance whether individuals prone to bipolar manic disorder will be involved in criminal activities, utilizing anatomical data (2D:4D) as the gold standard.
Objective Earthquakes are one of the most significant natural disasters, causing physical damage and psychological stress among victims. One of the major mental health issues that can arise after earthquakes is Posttraumatic Stress Disorder (PTSD). Our study aimed to investigate the prevalence of PTSD and PTSD risk factors in the eleventh month following the February 6, 2023 earthquakes in Turkey. Methods Our study was conducted between Dec 19, 2023, and Jan 2, 2024. All participants were given the Personal Information Form and, PTSD Checklist for DSM-5 (PCL-5). The Personal Information Form consists of three parts: survivors' characteristics, the characteristics of the trauma, and the post-trauma characteristics of the survivors. Results The study involved a total of 886 participants, aged between 18 and 65 years. Among the participants, 55.4% (n=491) were considered to have PTSD. The likelihood of receiving a diagnosis of PTSD is 2.95 times higher for male individuals, 2.07 times higher for injured individuals, 2.30 times higher for those who feel unable to escape their situation, and 2.03 times higher for individuals experiencing excessive fear or panic. Additionally, it is 1.65 times higher for individuals whose family member or close friend is injured, 1.82 times higher for individuals who lose their job after the earthquake, and 1.67 times higher for individuals experiencing economic problems after the earthquake. Conclusion Male gender, feeling trapped, experiencing extreme fear or panic, witnessing the injury of a family member or close friend, losing one's job after the earthquake, and facing economic problems after the earthquake are risk factors for PTSD.
Background Chronic itch is often associated with pain due to its complex nature. Neuropathic pruritus is defined as a debilitating form of chronic itching, about which not much is known to date. This condition may develop as a result of various neurological events and is associated with damage to the somatosensory nervous system, accounting for approximately 10% of chronic itching cases. Syringomyelia, transverse myelitis, radiculopathies, thoracic spine masses, brain tumors, strokes, and abscesses are among the conditions associated with neuropathic itching to date. Case presentation A 65-year-old female patient, with no known diseases and no regular medication usage, presented with a complaint of itching that had been ongoing for the past two years. Itching initially started in approximately five cm areas on the bilateral below-knee flexor surfaces. The patient, whose complaints persisted, was referred to the internal medicine outpatient clinic by dermatology. On physical examination, erythematous excoriated papules were observed in the areas affected by itching. The patient's blood sugar, liver and kidney function tests, complete blood count, erythrocyte sedimentation rate, thyroid function tests, urinalysis, stool parasitology were all normal or negative. The patient reported a sensation of coldness in the same area, was referred to neurosurgery to investigate the etiology of possible neuropathic itching. The patient's spinal imaging, revealed a spinal mass. She underwent surgery performed by a neurosurgeon, during which the spinal mass was completely removed. She reported that her itching had completely disappeared post-operatively. Conclusions The concept of itching as a variant of pain is not very new. Any damage occurring in the central nervous system or peripheral nervous system that affects the neurons responsible for transmitting and processing itch can lead to neuropathic itching. Focusing on spinal cord pathologies, any condition that damages the spinal cord may cause itching, depending on the level of damage. In cases of itching with dermatomal localization, where pain, hot or cold sensations, and paroxysmal itching are present, additional imaging methods or investigations for etiology should be performed.
Background: Closed reduction and pinning is the gold standard in the treatment of displaced pediatric supracondylar humerus fractures. With different methods of pinning available, iatrogenic nerve damage is one of the most common complications of this technique. In our study, we aimed to test the preventability of radial nerve injury in the ultrasound-guided lateral cross pinning technique. Methods: The study included 30 patients who were admitted to our clinic between September 2019 and September 2020 due to supracondylar humerus fractures and underwent closed reduction with the lateral cross pinning technique under ultrasonography. Demographic and clinical data of the patients including age, gender, fracture type and side, arm diameters of the fractured and contralateral sides, the distance between the lateral condyle and the radial nerve (LCRN), the distance between the proximal K-wire and the radial nerve (PWRN), duration of surgery, and postoperative complications of the nerve were retrieved from the patient files and recorded. Results: Fifteen (50%) of the 30 patients included in the study were girls. The patients’ mean age was 59.2±33.9 months. While 3.3% of the patients had flexion-type injuries, 30.0% had Gartland Type 2, 40.0% had Type 3, and 26.7% had Type 4 injuries. Eighteen patients (60%) had fractures in their left extremities. Type 4 fractures exhibited the biggest difference among all fracture types in comparison of the arm diameters of the fractured and contralateral sides (17.1%±5.5%; p=0.013). In the comparison of the PWRN to LCRN distance ratio, the difference was the highest in Type 2 fractures (23.3%±8.0%; p=0.027). None of the patients encountered postoperative iatrogenic radial nerve injury. Conclusion: In pediatric patients with supracondylar humerus fractures, the swelling of the extremity increases with the severity of the fracture. This situation decreases inversely with the distance of the proximal K wire from the radial nerve. The ultrasound-guided lateral cross pinning technique is a reliable method in terms of ease of application and the determination of the nerve line to create a safe zone, especially in elbow injuries with excessive swelling.
Purpose: In this study, we investigated the clinical characteristics and survival outcomes of patients diagnosed with special types of breast cancer who presented to our clinic. Material and Methods: The demographic, clinicopathological, and survival characteristics of all rare, histologically special subtype breast cancer patients who applied to Cumhuriyet University Oncology Center between 2010 and 2020 were retrospectively reviewed. Results: The records of 1198 patients with invasive breast cancer were examined, and 104 of them (8%) were identified as having other histological special subtypes. Of these, 19 (8%) had apocrine cancer, 19 (8%) had mucinous type, 17 (7%) had invasive cribriform, 15 (6%) had invasive papillary, 11 (4%) had metaplastic type, 9 (4%) had invasive micropapillary, 6 (2%) had neuroendocrine, 3 (1%) had tubular type, 3 (1%) had microinvasive type, and 2 (1%) had undifferentiated carcinoma. The majority of these patients, 102 (98%), were female, with a median age of 52 years (range 26-82). Of the women, 60 (59%) were postmenopausal, and 42 (41%) were premenopausal. The ECOG Performance Score (PS) was 0 in 79 (76%) patients, 1 in 17 (16%) patients, and 2 in 8 (8%) patients. Upon evaluation, 50 patients (48%) had comorbid conditions, and 26 patients (25%) had a family history of breast cancer. At diagnosis, 25 patients (24%) were stage I, 50 (48%) were stage II, 26 (25%) were stage III, and 3 (3%) were stage IV. Histopathologically, 75 patients (72%) were estrogen receptor (ER)-positive, 69 (66%) were progesterone receptor (PR)-positive, and 26 (25%) were HER2-positive. An intraductal component was detected in 54 (60%) patients, and multicentricity was observed in 15 (16%) patients. A modified radical mastectomy was performed on 56 (54%) patients, while breast-conserving surgery was performed on 45 (43%) patients. Adjuvant chemotherapy was administered to 76 (73%) patients, hormonal therapy to 73 (70%), and radiotherapy to 72 (68%). The median follow-up period was 54 months (range 1-201). During follow-up, metastasis was detected in 13 patients (13%), and recurrence was detected in 7 patients (7%). The 5-year and 10-year overall survival rates were 86% and 77%, respectively, while the 5-year and 10-year event-free survival rates were 79% and 70%, respectively. Conclusion: In our study, the majority of patients with special type breast carcinoma were non-metastatic, and histopathologically, they were hormone receptor-positive with low grade. There was no statistically significant difference in 5-year and 10-year overall survival or event-free survival among the special types.
Cardiorenal syndrome is a complex clinical condition affecting both the kidney and the heart. It is divided into 5 different subgroups according to various clinical features. However, in most clinical settings this is difficult to determine because the pathophysiology is complex and the pathways are poorly understood. Given this complex clinical situation, many challenges arise in the management of both acute and chronic cardiorenal syndrome. In this review, the definition, classification, pathophysiology and treatment of cardiorenal syndrome are examined.
