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Coronavirus disease (COVID-19) caused by a new coronavirus, SARS-CoV-2, , has become a serious health problem throughout the world. Although COVID-19 primarily presents as an acute respiratory tract infection, many neurological findings have also been described in patients. Neurological findings are classified into three groups as central, peripheral nervous system and musculoskeletal system. The most common central nervous system symptom is headache. Encephalitis, encephalopathy, seizures, acute ischemic stroke are also seen. The most common symptoms in the peripheral nervous system are loss of smell and taste. Myalgia, myositis and rhabdomyolysis also can be seen in musculoskeletal system involvement. Awareness of the neurological symptoms by physicians will be beneficial in early diagnosis and treatment of the disease., Yeni bir koronavirüs olan SARS-CoV-2’nin neden olduğu koronavirüs hastalığı (COVİD-19) dünya genelinde ciddi bir sağlık sorunu haline gelmiştir. COVİD-19 öncelikle akut solunum yolu enfeksiyonu şeklinde kendini gösterse de hastalarda pek çok nörolojik bulgu da tanımlanmıştır. Nörolojik bulgular santral, periferik sinir sistemi ve kas-iskelet sistemi olarak üç grupta sınıflandırılır. En sık görülen santral sinir sistemi bulgusu baş ağrısıdır. Ensefalit, ensefalopati, nöbet, akut iskemik inme de görülmektedir. Periferik sinir sisteminde en sık görülen bulgular koku ve tat kaybı iken kas-iskelet sistemi tutulumunda miyalji, miyozit, rabdomiyoliz görülebilir. Nörolojik bulguların hekimler tarafından bilinmesi hastalığın erken tanı ve tedavisinde fayda sağlayacaktır.

Hepatitis-associated aplastic anemia (HAA) is a form of acquired aplastic anemia (AA) in which bone marrow failure develops after an acute attack of hepatitis. Bone marrow failure leading to AA is generally severe in cases of HAA and fatal if left untreated. This retrospective multicenter study investigated clinical and laboratory characteristics, possible causes, treatment, and outcome of HAA in children. Twenty patients from 8 centers were included in the study. Aspartate aminotransferase and alanine aminotransferase were 10×ULN in 16 patients. Acute liver failure developed in 5 (29%) patients. Pancytopenia was simultaneously present in 6 of 20 (30%) patients. Eleven of the 20 patients (55%) were alive, in remission and transfusion free. Those who were alive either had undergone hematopoietic stem cell transplantation and/or immunosuppressive treatment, except 1 patient who had received no treatment. Patients with the diagnosis of acute hepatitis should be evaluated and followed up carefully for presence of cytopenia, so that definitive treatment of AA can be initiated in a timely and appropriate manner when needed. Copyright r 2021 Wolters Kluwer Health, Inc. 34669357

Background/aim This study aimed to analyze the serum melatonin levels and changes in sleep patterns in pediatric patients with coronavirus disease 2019 (COVID-19). Materials and methods This study was designed as a descriptive, cross-sectional study. Serum melatonin levels and sleep parameters of children with the diagnosis of COVID-19 who had mild and moderate disease (i.e., COVID-19 group) were compared with those of children admitted with non-COVID-19 nonspecific upper respiratory tract infection (i.e., control group). The sleep disturbance scale for children (SDSC) questionnaire was applied to the participants› primary caregivers to analyze their sleep patterns at present and six months before symptom onset and to investigate the impact of COVID-19 on sleep patterns. Results The entire study cohort consisted of 106 patients. The COVID-19 group included 80 patients, while the control group consisted of 26 patients. The mean serum melatonin levels were 136.72 pg/mL and 172.63 pg/mL in the COVID-19 and control groups, respectively (p = 0.16). There was no significant difference between the groups in terms of 6 subcategories of the SDSC questionnaire regarding the present time and 6 months before symptom onset. The total SDSC scores were also similar in two different evaluation time points described above (p = 0.99). Conclusions We conclude that COVID-19 did not impact the sleep parameters of children. Serum melatonin levels of all patients were higher than the reference range; however, they were higher in the non-COVID-19 patient group than the COVID-19 group. Since serum melatonin levels were higher than the reference values in children with COVID-19, and this disease is significantly less morbid in children, melatonin may have protective effects against COVID-19.

Solar PVs are mostly built on uncultivated land. However, the increase in land values due to the increasing world population, the lack of suitable areas for potential PV plants, especially in the land-scarce countries, and the increasing energy need led researchers to seek new solutions. At this point, floating solar power plants emerge as a good alternative with their advantages such as not occupying land area and reducing water evaporation by covering the water surface. In this study, a floating photovoltaic power plant with 120 kWp installation power was installed on Buyukcekmece Lake, and the effect of the microclimate data on the produced energy of the system was investigated. Since the energy produced by PV panels is highly dependent on climate effects and there may be many climatic variations depending on the geographical conditions, experimental measurements have been made annually in this study and the results have been analyzed in order to contribute to the researches in this field. From the obtained results, it is seen that the most important factor that positively affects the energy produced is solar irradiance, while specific humidity, wave loads, and module temperature have a negative effect.

Aim:Hypercalcemia (HCM) is a common clinical problem characterized by a serum corrected calcium (cCa) level of >10.7 mg/dL. Primary hyperparathyroidism and malignancy are mostly (90%) involved in the etiology. In this study, we aimed to determine the relationship of cCa and phosphorus (P) levels, cCa/P ratio and gender with the etiology of HCM and one-week mortality.Methods:Records of HCM patients older than 18 years of age who were hospitalized between January 1, 2017 and December 31, 2018 were retrospectively reviewed. Age, gender, cCa and P levels, HCM etiology and one-week survival status of the patients were recorded. Subsequently, the patients were divided into two groups according to whether the etiology of HCM was benign or malignant. Then, the groups were compared statistically in terms of gender, biochemical values and one-week survival.Results:The median level of serum cCa was found to be significantly higher in males (p

This research deals with the impact of the microclimate on historical wooden buildings exposed to open sea streams. The Florya Ataturk Marine Mansion in Istanbul, erected on the sea, totally defenceless to weather and sea effects, has been selected as representative case study for many other buildings located in Bosphorus line. In order to address the effect of the environment on the building exposed to open sea streams microclimatic data were collected for one year. The synergistic effect of the sea-salt aerosol and microclimatic conditions were discussed for the assessment of the impact of the marine environment on the durability of the Mansion, identifying the more vulnerable parts of the building as well as the more critical periods. The results indicate that while moisture content changes from 20.9% to 36.7% and temperature changes from 14.1 degrees C to 28.7 degrees C, thermal conductivity coefficient changes from 0.18 W.m(-1)K(-1) to 0.26 W.m(-1)K(-1), according to the facade of the building and the season as similar to previous studies.

Aim: Mastocytosis is a rare disease characterized by clonal mast cell proliferation in one or more organs. It can lead to different clinical manifestations and has no definitive treatment. in this study, we aimed to evaluate the clinical and laboratory characteristics of our patients diagnosed with mastocytosis in our clinic. Materials and Methods: Thirteen patients that were followed up with the diagnosis of mastocytosis at the Pediatric Hematology Clinic, in the Ege University Faculty of Medicine between November 1999 and April 2016 were retrospectively analyzed. Results: Seven of patients were female (53.8%) and six were male (42.6%). the mean age at diagnosis was 20 (3-68) months. At the time of diagnosis, complete blood count and peripheral smear were found to be compatible with the anemia of iron deficiency in three patients. Other parameters were normal. Mean tryptase level was detected as 5.9 (3.6-16.6) ng/mL, and only one tryptase level was found as slightly increased. the median level of total IgE was 91.1 (4.47-362) IU/mL. Mast cell proliferation was not detected in bone marrow aspiration and biopsy material of any patients. All of the cases were evaluated as cutaneous type mastocytosis. Conclusion: the possibility of mastocytosis in systemic form in childhood is very rare and bone marrow examination may be necessary in selected cases.

The use of a cold storage plant for reducing perishable food losses is insufficient in developing and underdeveloped countries because of required infrastructure and investments. For this reason, many producers continue to store foods with traditional methods, which can lead to considerable food loss. At this point, the relationship between the financial loss due to perishable foods and the costs of cold storage plant (construction, refrigeration equipment, operating) should be evaluated. In this study, the profitability of both the modern cold storage plant and the traditional potato warehouse in Turkey were compared with the data collected from a potato producer and an experienced refrigeration company. The subject is handled with the Monte Carlo simulation method. The results show that a modern cold storage plant provides a return on investment in a short time. Probability of profitability for a cold storage plant is 51.0%, 74.8%, 89.7% and 96.6% for the 1st, 2nd, 3rd and 4th years, respectively.

BACKGROUND Cystic fibrosis (CF) is an autosomal recessively inherited disease. Clinical findings vary by age of the patient, the organ systems involved, and the severity of the CFTR gene mutation. Pancreatic and liver involvement is prominent and exocrine pancreatic insufficiency is observed in the majority of patients. Point shear wave elastography (pSWE) is a non-invasive method that can quantitatively determine tissue elasticity and stiffness. In this study, the morphological evaluation of the pancreas was performed using the pSWE technique in pediatric patients diagnosed with CF. The effectiveness of this method for early detection of pancreatic insufficiency was investigated. METHODS Fifty-five patients with CF (24 girls, 31 boys) and 60 healthy children (29 girls, 31 boys) without any chronic diseases and who were suitable for the pSWE examination were included in the study. RESULTS The mean value of pSWE was 1.12±0.16 in the healthy group and 0.97±0.16 in the patients with cystic fibrosis. There was a statistically significant difference between the two groups (p

Objective: Congenital neutropenia is a rare disorder. The survival and quality of lives of these patients were improved with avoidance of infections, GCSF usage and appropriate usage of antibiotics in infections. In this study, the precautions for infections and the treatment compliance, the level of knowledge about the disease and the reasons that may affect the different behavior and compliance in our patients and caregivers were planned to be determined. Case report: Questionnaires prepared in order to determine how the social, cultural and economic conditions of the families of children with Congenital Neutropenia could affect their behavior and knowledge levels were filled in one-on-one video interviews with the caregivers. Methodology: Behaviors and attitudes of families were questioned, their level of knowledge about the disease was evaluated with a system defined over 40 points, and they were evaluated as very good (40-35), good (34-30), moderate (29-25), bad (25-20) and very bad (

Introduction: Cytomegalovirus (CMV) infections in developing countries are experienced at an early age. This study was performed to investigate the frequency of reactivation and risk factors of infection acquired at an early age of nontransplant acute lymphoblastic leukemia (ALL) patients receiving immunosuppressive therapy with weekly monitoring of CMV levels in Turkey. Materials and Methods: This was a retrospective, single-center study of 172 pediatric patients (102 boys and 70 girls) with ALL. All patients were monitored routinely for CMV-DNA at the initial presentation of leukemia and twice a week during chemotherapy. The CMV immunoglobulin (Ig)M/IgG titers were measured at admission. Results: CMV seropositivity at baseline was 90,11%. The overall prevalence of CMV infection (viremia) was 70.34%, 116 of whom were seropositive for CMV IgG and 5 of whom were negative for CMV at the time of ALL diagnosis. Reactivation was more common than de novo CMV infections (P=0.000). CMV seropositivity at the beginning of the leukemia diagnosis was found to be an independent predictor for developing CMV infection (P=0.001). A total of 60 CMV infection episodes were treated with antivirals. Four of these included organ involvement. The duration of CMV-DNA viremia episodes was longer in patients with CMV-DNA >= 1000 copies/mL (n=45) than in those with lower CMV-DNA levels (P=0.002). Infection was shown not to be associated with chemotherapy phase. Conclusion: This study suggests the importance of monitoring for CMV infections in developing countries because of frequent reactivations in seropositive ALL patients. It should be kept in mind that low CMV-DNA levels may also lead to organ involvement.

Background: Fibromyalgia (FM) is the most common cause of chronic generalized musculoskeletal pain and it is generally accompanied by the other nonspecific common symptoms. The etiology and the pathophysiology is still not clear but also there are some studies that show a relationship between FM and thyroid diseases. So, in this study we aimed to determine the frequency of FM in patients with hypothyroidism and the variables that may affect this frequency. Methods: This is a cross-sectional, single center and prospective study. A total of 180 patients -who were applied to internal medicine outpatient clinics- included in the study and the patients who described the generalized musculoskeletal pain were consulted to the physical medicine and rehabilitation outpatient clinics. We have evaluated demographic data, laboratory, presence of thyroid disease and FM, and Beck Depression Questionnaire (BDQ) and FM Impact Questionnaire (FIQ) for FM patients.Results: 39.4% (n = 71) of the patients had FM and 60.6% (n = 109) of them did not. There was a positive corelation between FIQ score and age at diagnosis and disease duration. As the age at diagnosis and duration of disease increased, the FIQ score increased by 37.3% and 25.7%, respectively. In addition, as BDQ increased, the FIQ score increased by 44.8%. Conclusion: Signs and symptoms of hypothyroidism is similar to signs and symptoms of FM, and approximately 40% of patients with hypothyroidism could have FM concomittantly. Therefore, all patients with hypothyroidism should also be examined for FM.

BACKGROUND Increased left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) are independent predictors of adverse cardiovascular events. However, little is known regarding the association between coronary circulation and LVMI. We aimed to investigate the association between coronary dominance and LVMI, and to demonstrate the impact of coronary dominance pattern on the emergence of LVH. METHODS In total, 367 consecutive patients without known cardiovascular disease and significant obstructive coronary artery disease who underwent diagnostic coronary angiography were prospectively included in the study. Patients were divided into three groups according to coronary dominance pattern. Patients with right dominance (RD), co-dominance (CD) and left dominance (LD) patterns were compared regarding echocardiographically detected LVMI. Additionally, the association between coronary dominance pattern and LVH was investigated. RESULTS The frequency of RD, CD and LD patterns was 70.3%, 19.1% and 10.6%, respectively. LVMI was significantly higher in patients with CD pattern compared with those with RD and LD patterns (P

Amaç: Her yıl Dünyada 0-19 yaş arası yaklaşık 300.000 olgu kanser tanısı almaktadır. Gelişmiş ve gelişmekte olan ülkelerde çocukluk çağı kanserlerinin dağılımı ve sağ kalım hızlarında belirgin farklılık bildirilmektedir. Bu çalışmada amacımız merkezimizde kayıtlı olan çocukluk çağı kanser olgularının epidemiyolojik özelliklerini ve sağ kalım hızlarını değerlendirmektir.Gereç ve Yöntem: Merkezimizde 1992-2017 tarihleri arasında 0-19 yaş arasında kanser tanısı alan 4602 hastanın verileri Ege Üniversitesi Kanserle Savaş ve Araştırma Merkezi kayıtları kullanılarak geriye dönük olarak değerlendirildi. Yaşa, cinsiyete, yıllara göre tümör dağılımları ve genel sağ kalım hızları değerlendirildi.Bulgular: Olguların %55,3’ü erkek, %44,7’si kız ve erkek/kız oranı 1,23/1 idi. Olguların ortalama tanı yaşı 5,6 yıl idi. Merkezimizde en sık lösemi (%25,6), ikinci sıklıkta santral sinir sistemi tümörleri (%23,4), üçüncü sıklıkta ise lenfomalar (%14,2) görülmekteydi. Olguların ortalama izlem süresi 41,4 ay (0-316 ay) idi. Tüm olgular için beş yıllık genel sağ kalım hızı %74 saptandı.Sonuç: Merkezimizdeki kanser tiplerinin dağılımı ve genel sağ kalım hızları literatür ile benzerdir. Ülkemiz verileri ile karşılaştırıldığında genel sağ kalım hızlarımızın daha iyi olduğu görülmüştür. Bu sonuçlar sağ kalım hızlarının bölgeden bölgeye değiştiğini, bu değişimde hasta ve hasta yakınının farkındalık düzeyinin, gerekli tedaviye ulaşabilme imkanının ve multidisipliner merkezlerin varlığının önemini düşündürmektedir., Aim: Approximately 300.000 children between the ages of 0-19 diagnosed with cancer every year in the world. The distribution and survival rates of childhood cancers are significantly different in developed and developing countries. The aim of this study to evaluate the epidemiological characteristics and survival rates of childhood cancer cases registered in our center.Materials and Methods: Recordings of 4602 patients diagnosed with cancer between 0-19 years of age at our center between 1992 and 2017 were evaluated retrospectively using the registry of Ege University Cancer Control and Research Center. Distribution of cancer groups and overall survival rates were evaluated according to age, sex and years.Results: Median age was 5.6 years. 55,3% of the cases were male, 44,7% were female and the male/female ratio was 1.23/1. Leukemias (25.6%), central nervous system tumors (23.4%), and lymphomas (14.2%) were the most common tumors in our center. The median follow-up period was 41.4 months (0-316 months). The 5-year overall survival rate for all patients was 74%.Conclusion: The distribution of cancer types and overall survival rates in our center are similar with those reported in the literature. Compared with the cancer registry of our country, our overall survival rates were found to be better. These results suggest that survival rates vary from region to region, and the importance of awareness of the patient and his/ her relatives, access to the treatment and the presence of multidisciplinary centers.

Aim: Despite improvements in diagnosis and treatment, infections are still major cause of morbidity and mortality in children with febrile neutropenia (FN). in these patients, due to inadequate inflammatory response and subtle clinical symptoms, to determine the source of infection can be challenging. Therefore, it is important to distinguish infections from other non-infectious causes, for both to choose appropriate antibiotic and to reduce the redundant antibiotic use. Materials and Methods: in this retrospective study, we aim to evaluate serial procalcitonin (PCT) levels for predicting bacteremia particularly caused by Gram-negative microorganism. Results: Among FN episodes caused by Gram-negative microorganism, the median level of second PCT sample obtained between 48 and 72 hours PCT 2 was found to be significantly higher when compared to infections caused by Coagulase-negative Staphylococcus or culturenegative confirmed infections, p value was 0.003; however, fever onset PCT 1 and C-reactive protein (CRP) 1 values showed no significant difference (p>0.05). the area under curve values demonstrated by receiver operating characteristic (ROC) analysis for CRP 1, CRP 2, PCT 1, PCT 2 were 0.664, 0.748, 0.504 and 0.842, respectively. Conclusion: This study showed that initial PCT levels were not significantly correlate with culture-confirmed bacterial infection. Therefore, initial PCT values do not help the clinicians in terms of administering or postponing empirical antibiotics at the time of fever onset. However, third day PCT levels present as a good diagnostic marker due to a higher sensitivity and specificity when comparing them to the initial values. Determination of serial PCT may enhance the diagnostic value of PCT diagnostic marker in FN episodes caused by Gram-negative bacteria with a high sensitivity (87.5%). This study also demonstrated that PCT could be used to rule out bacterial infections particularly caused by Gram-negative bacteria.

Aim: Erythrocyte sedimentation rate (ESR) is a simple and inexpensive laboratory test that is often desired in clinical practice. Normal range of ESR; 2-5 mm in men, 7 mm in women, in the first hour and 9 mm in men,12 mm in women in the second hour. Excessive elevation of ESR (≥ 100 mm/h) is often associated with serious diseases. Material and Method: Records of patients who applied to University of Health Sciences Dr. Sadi Konuk Education and Research Hospital internal medicine outpatient clinics, in 2016-2018 years, with an ESR value of 100 mm/hour were reviewed retrospectively. The age, sex, hemogram, biochemistry and diagnosis of these patients were recorded. For each variable considered in the study, normality tests were performed, and Kolmogorov-Smirnov and Shapiro-Wilk tests were applied. Mann-Whitney-U test was used for 2 groups, Kruskal-Wallis test was used for 3 groups and above. Analyzes were made with SPSS 22.0 version and the significance level was taken as 0.05. Results: A total of 397 patients, 160 male and 237 female were included in the study. The Median ESR value was 113 mm/hour. Patients were divided into five diagnostic categories: infection (18.6%), malignancy (25.1%), inflammatory/connective tissue diseases (9.5%), renal diseases (12%) and other causes (34.5%). In cases where etiology was found, most frequent cause was malignancy in females and infection in male patients. Conclusion: However, since the most common etiologic factors in the persistence of high ESR are malignancy and infection, it will be helpful first to screen patients from these angles.

WOS: 000461043500001, PubMed ID: 30473482, Gaucher Disease (GD) is the most common lysosomal storage disorder has traditionally been classified into three clinical phenotypes. Type 3 GD is characterized by neurological involvement but neurological symptoms generally appear later in life than in type 2 disease. Neutropenia is much rarer than other hematological manifestations in GD and has not been scrutinized adequately. Severe congenital neutropenia (SCN) is a rare disease entity which is characterized by a paucity of peripherally circulating neutrophils with arrest of neutrophil maturation at the promyelocyte stage and consequent increased susceptibility to severe and recurrent infections. We report a patient who presented in the first year of life with visceral involvement and severe neutropenia in whom the propositus had a unique coexistence of Gaucher Disease and severe congenital neutropenia associated with a mutation in HAX1. In contrast to his expired siblings he had experienced no severe infections. These clinical observations suggest that enzyme replacement therapy may display a modulating factor with respect to the clinical course of SCN. Synopsis: Our patient is the only report of the combination of Gaucher Disease and Kostmann Syndrome in the literature. The clinical course of our patient is not severe when comparing with exitus siblings and other Kostmann Syndrome patients. But when considering the patient's only clinical difference is ERT, this case is very important to emphasise the role of enzyme replacement therapy in bone marrow.

Objective: This study aims to investigate the demographic, clinical features of children and adolescents with headaches which is one of the most common reason for referral to pediatric neurology clinics in addition to elucidating the frequency of primary and secondary headaches as well as their management. Material and Methods: We retrospectively reviewed the medical reports of children and adolescents who were referred to Ankara City Hospital, Department of Pediatric Neurology between December 2019 and December 2020.Results: During the study period, 236 (86.8%) children, and adolescents were diagnosed with primary headaches and 36 (13.2%) were diagnosed with secondary headaches. Tension headaches were the most frequent (71.2%) type of primary headaches while headache or facial pain attributed to disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure were the most frequent (38.8%) type of secondary headaches. All patients with secondary headaches had at least one red flag while 23 (63.8%) patients had 2 or more red flags. Magnetic resonance imaging was diagnostic in 58.3% of the patients while EEG was diagnostic in 6% of the patients.Conclusion: Pediatric patients presenting with headaches should be carefully examined to diagnose and treat the causes of secondary headaches which can be life-threatening and require urgent treatment. On the other hand, accurate diagnosis is very important in primary headaches which constitute more than 80% of all headaches and have detrimental effects on life quality as a result of refraining from daily activities., Amaç: Çocuk Nörolojisi polikliniklerine en sık başvuru yakınmalarından olan baş ağrılı çocuk ve adolesanların, demografik, klinik özellikleri yanısıra primer ve sekonder baş ağrısı sıklığı ve yönetiminin ortaya konulması amaçlanmıştır.Gereç ve Yöntemler: Aralık 2019-2020 tarihleri arasında Ankara Şehir Hastanesi, Çocuk Nörolojisi Kliniği’ne başvuran çocuk ve adolesanların tıbbi kayıtları retrospektif olarak değerlendirildi.Bulgular: Primer baş ağrısı tanısı alan 236 (%86.8), sekonder baş ağrısı tanısı alan 36 (%13.2) çocuk ve adolesan olduğu; primer baş ağrısı grubu içinde en sık gerilim tipi baş ağrısı (%71.2), sekonder baş ağrısı için baş, boyun, göz, kulak, burun, sinüsler, diş dudak veya diğer yüz veya servikal yapılardan kaynaklanan bozukluklara bağlı baş ağrısı grubunda (%38.8) hasta başvurusu olduğu saptandı. Sekonder baş ağrısı tanısı alan hastaların tamamı en az 1 kırmızı bayrak bildirmiş olup 23 hastada (%63.8) 2 ve daha fazla sayıda kırmızı bayrak saptandı. Her iki grupta da en sık bildirilen kırmızı bayrak; lokalize baş ağrısıydı. Hastaların %58.3’ünde MRG, %6’sında EEG tanısal özellik göstermiştir. Sonuç: Baş ağrılı pediatrik hasta popülasyonun hayatı tehdit eden ve acil tedavi gerektiren sekonder baş ağrısı nedenlerinin tespiti için hastanın ilk değerlendirmesinden itibaren klinik özelliklerinin dikkatle yönetilmesi ve değerlendirilmesi önerilir. Diğer taraftan; hayat kalitesini olumsuz etkileyen, günlük aktivitelerden çekilmeye neden olan ve hastaların % 80’den fazlasını oluşturan primer baş ağrıları için tanı büyük önem taşımaktadır.

Background In December 2019, a novel type of coronavirus infection emerged in the Wuhan province of China and began to spread rapidly. In this study, we aimed to determine the differences between COVID‐19 disease and Influenza. Methods This retrospective study included 164 children with COVID‐19, as well as 46 children with Influenza. The two groups were compared with respect to clinical and laboratory parameters and the rates of intensive care and mechanical ventilation requirement. Results In both groups, the most common admission complaints were fever and cough. As compared to the COVID‐19 group, the Influenza group had significantly higher rates of cough (37 [80.4%] and 38 [23.2%]), fever (31 [67.4%] and 34 [20.7%]), muscle pain (34 [73.9%] and 31 [18.9%]), vomiting (13 [28.9%] and 8 [4.9%]) and tachypnea (32 [69.6%] and 3 [1.8%]) (P

A nine year-old girl, having high temperature and stomach ache symptoms, was diagnosed with primary haematophagocytic lymphohistiocytosis. During the treatment, she had neutropenic fever, dyspnea and bronchospasm. Laboratory tests revealed a 7,189,566 cytomegalovirus (CMV)-DNA copies/mL. Ganciclovir therapy was started for CMV pneumonia. At the second infusion of ganciclovir, she had dyspnea, bronchospasm, tachycardia and urticaria. Adrenaline, antihistamines and corticosteroids were administered for anaphylaxis. Treatment was replaced with valganciclovir but there was no clinical or laboratory regression. Because valganciclovir was ineffective and foscarnet could not be provided, we decided to apply desensitization with ganciclovir without performing skin tests because the reaction was anaphylactic. Total dose was 350 mg, for the patient's weight of 35 kg, according to 10 mg/kg daily dose. A (1/1000 dilution), B (1/100 dilution), C (1/10 dilution) and D (no dilution) solutions were prepared. Desensitization began with a 1/10,000(e) of the therapeutic dose, followed by 14 administrations of increasing doses every 30 minutes and lasted 6.5 hours. There was no reaction during desensitization. Patient was subsequently treated with ganciclovir every day without any problem for 21 days. After the treatment, clinical symptoms resolved and CMV-DNA copies were found < 31 IU/mL. In conclusion, we present a rare case of ganciclovir hypersensitivity (allergic or non-allergic?) and a novel protocol of ganciclovir desensitization. (C) 2021 Elsevier Masson SAS. All rights reserved.

BACKGROUND: Hepatitis-associated aplastic anemia (HAAA) is a rare complication that presented with bone marrow failure after acute hepatitis. HAAA usually occurs in adolescent men within 1-6 months following hepatitis. Most of HAAA’s etiology has non-A-E viral hepatitis. METHODS: Our retrospective study included patients with acute fulminant hepatitis who had been treated in Ege University Pediatric Gastroenterology, Hepatology and Nutrition Department and İzmir Kent Hospital Clinical, laboratory, and epidemiological data of the patients were collected from the files. RESULTS: In this study, 499 children underwent liver transplantation (LT) in two pediatric transplantation centers. Sixty-eight (13.6%) out of 499 patients, underwent liver transplantation due to fulminant hepatic failure (FHF). Therefore, a total of 64 patients (34 girls, 30 boys) with a diagnosis of FHF have included in the study. Thirty-two (50.0%) of 64 FHF were due to non-A-E hepatitis and 4 out of the 64 patients (6.2%) with FHF developed HAAA. All of the patients received prednisolone as immunosuppression treatment after LT. Three patients were also given Tacrolimus and 1 received an additional mycophenolate mofetil. One of the patients was given prednisolone and cyclosporine treatment without tacrolimus. Bone marrow transplantation was performed in 1 patient (25.0%). Two of the patients received immunosuppressive treatment including rabbit-derived anti-thymocyte globulin, cyclosporine, and initially prednisolone. CONCLUSION: In children who underwent liver transplantation for non-A-E FHF are at high risk to develop aplastic anemia. The clinicians should be alert after orthotropic liver transplantation patient could develop aplastic anemia and early treatment with immunosuppressive therapies result in a more successful outcome.

Dear Editor; Often during routine gastroenterology examinations, ulcers and strictures in the colon and small intestine are encountered in patients. Differential diagnosis of ulcers in these patients may not always be easy. Graft-versus-host disease (GVHD) is a serious complication that can be life-threatening after allogeneic bone marrow transplantation (1). Since the introduction of modern immunosuppressive treatment regimens, clinical symptoms, radiographic and histological findings are rarely seen in chronic graft-versus-host disease (CGVHD) (2). However, CGVHD patients often present with various gastrointestinal symptoms such as esophageal reflux, dysphagia, bloating, weight loss, and diarrhea (2). Edema, erythema, diffuse polypoid lesions, multiple ulcers, and strictures in the mucosa can be observed in the endoscopic examination of intestinal GVHD (3). We present a patient who was diagnosed with CGVHD in a colonoscopic examination performed for iron deficiency anemia. A 52-year-old female patient was referred to our gastroenterology outpatient clinic for endoscopic examination after the laboratory tests revealed iron deficiency anemia. The patient's medical history revealed that she had undergone autologous stem cell transplantation in 2012 and allogeneic stem cell transplantation in 2016 with a diagnosis of Non-Hodgkin lymphoma. A hysterectomy had been performed due to myoma. When the patient's complaints were questioned, there were no gastrointestinal complaints such as bloating, constipation, diarrhea, or abdominal pain. Physical examination revealed multiple psoriasis colored rashes on the skin on the neck and nape (Figure 1). White blood cell count in laboratory tests: 8920 x103/μL, platelet: 470 x103/μL, Hgb: 10.9 g/dl, aspartate aminotransferase: 47 U/L, alanine transaminase: 39 U/L, alkaline phosphatase: 99 U/L, total bilirubin: 0.56 mg/dl, albumin: 4.2 g/dL, serum iron: 115 u/dl, total iron-binding capacity: 274 u/dl, ferritin: 12 u/L, vitamin B12: 353 ng/L were detected. The colonoscopic examination showed that, in the ascending colon, the lumen was narrowed fibrotically, not allowing the endoscope to pass proximally (Figure 2). In addition, multiple ulcerated lesions extending perpendicular to the lumen, covered with white exudate, causing shrinkage in the mucosa, and approximately 5-6 mm diameter were observed in the ascending colon, transverse colon, and descending colon (Figure 3). In the pathological examination of the biopsies taken from the lesions, the patient was diagnosed with CGVHD after intense inflammation in the lamina propria. Apoptosis in the crypts was observed, and cytomegalovirus (CMV) was excluded (Figure 4). Endoscopic images of GVHD-induced gastrointestinal involvement vary, and the involvement of lesions may be focal or diffuse (4,5). Various lesions such as mild mucosal erythema, edema, prominent ulcers, lytic mucosal lesions can be seen in the upper and lower gastrointestinal tract (GIS) in endoscopic evaluation. The demonstration of apoptosis is very supportive for diagnosis. The diagnosis of gastrointestinal GVHD is made by endoscopic examination and mucosal biopsy, in the endoscopic biopsy (3). Other causes of apoptotic colopathy, especially CMV, should be considered in the differential diagnosis. Thus, chronic GVHD should be considered in the differential diagnosis of strictures and ulcers in a colonoscopic examination.

Widespread construction of cold storage buildings is important to ensure sustainability of the agricultural industry and reduce food loss. However, the number of cold storage buildings in most developing countries is insufficient because of financial difficulties. Currently, the most critical factor for encouraging investors to finance such projects is the payback period. In this study, the power consumption and profitability of cold storage buildings were investigated based on their capacities using data from selected cold stores in Turkey. The optimal storage capacity was calculated by simulation, and the relationship between the payback period and the capacity of cold stores was analysed using the obtained results. It was found that the amount of power consumed per unit volume for stores with capacities from 100 to 2100 t of apples was 63.8% while that from 2100 to 10000 t was 33.3%. Additionally, the optimal cold storage capacity was determined to be 3500 t with a two-year payback period. © 2020 The Author(s).

Objectives Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI. Methods Extremely rare IFI collected in the FungiScopeⓇ registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales. Results Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScopeⓇ. Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales. Conclusions Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens.

Introduction and Background: There is an increased fall risk in chronic obstructive pulmonary disease (COPD). But there is little data about comparisons of higher and lower risky patients’ physical and spirometric values. Aim and Objectives: The aim of this study was to compare COPD patients spirometric and physical function according to fall risk. Methods: Groups divided according to Berg Balance Test’s cut-off value and grouped into higher (Berg score Results: Dyspnea (p=0.032), quadriceps muscle strength (0.027), handgrip strength (p Conclusions: Fall risk assesment is an important factor about COPD and lots of other functions are different according to fall risk. Further studies must conduct about fall risk and determinants of this risk. Detecting determinants may be preventive for falls, fractures of COPD subjects.

Although sideroblastic anemias (SAs) may be associated with different etiologies, deterioration of mitochondrial heme biosynthesis in bone marrow erythroid cells is a general abnormality. Congenital SA associated with immunodeficiency, periodic fever, and developmental delay is because of loss-of-function mutations in the TRNT1 gene. We report a patient with a novel homozygous mutation in the TRNT1 gene presenting with anemia with siderocytes, hypogammaglobulinemia, hepatosplenomegaly, and brittle hair but without periodic fever or developmental delay. The patient was presented to emphasize the power of reverse phenotyping in the differential diagnosis of primary immunodeficiency patients with atypical features and to raise awareness for TRNT1 disease in case of coexistent SA and hypogammaglobulinemia.

Aim: Bloodstream infections are serious conditions that can cause significant morbidity and mortality. Early recognition of the bacteria and targeted early treatment play an important role in prognosis. the Verigene Gram-negative blood culture nucleic acid test (BC-GN; Nanosphere, USA) is a new method that can accurately identify both Gram-negative bacteria and resistance genes within 2 hours. in this study, we aimed to determine the accuracy of this assay for the rapid identification of certain Gram-negative microorganisms in children with bloodstream infections and to compare with the conventional culture method. Materials and Methods: A total of 30 patients (, Ege University Scientific Research FundEge University, This research was supported by Ege University Scientific Research Fund.

Aim: Hyponatremia is a common electrolyte abnormality in hospitalized patients. Administration of isotonic maintenance fluids is recommended to prevent hyponatremia. the present study was conducted to evaluate the frequency and severity of hyponatremia in children with acute lymphoblastic leukemia (ALL). Materials and Methods: the frequency, severity and possible causes of hyponatremia in children with ALL throughout their entire intensive treatment were retrospectively evaluated. All children in this study received isotonic fluids as maintenance IV treatment during the hospitalization period. Results: in a five-year period, 618 hyponatremia episodes seen in 92 children with ALL (median age 59 months), treated with ALLIC 2002 protocol were entered into the study. the median number of hyponatremia episodes per patient was 6. All patients had at least one hyponatremia episode of which 83.2% were classified as mild, 13.2% as moderate, 2.9% as severe and 0.6% as very severe. the median duration of hyponatremia episodes was 5 (range between 1-43) days. the total duration of all hyponatremia episodes of each patient varied from 6 to 138 days with a median of 30 days. in 241 episodes of 68 children, there was inadequate salt intake secondary to oral feeding intolerance, nausea, vomiting and oral aphthous stomatitis. in four patients, seizure was seen during the hyponatremia period and thought to be secondary to hyponatremic encephalopathy. No patient developed central pontine myelinolysis. Conclusion: Hyponatremia is very frequent in ALL patients. Despite the use of isotonic IV fluids, it seems it cannot be completely prevented.

Severe Congenital Neutropenia (SCN) is a rare inherited disease characterized by an absolute neutrophil count (ANC) lower than 500/mu L. Genetic heterogeneity and biallelic CSF3R mutation has rarely been identified as an underlying genetic defect in SCN. the majority of SCN patients respond to granulocyte colony stimulating factor treatment; however, in patients with inherited CSF3R mutation, ANC cannot generally be increased with granulocyte colony stimulating factor treatment. in such cases, granulocyte macrophage colony stimulating factor presents as an effective treatment option. Herein, we report a case of a 5-year-old SCN girl with homozygous c610-611 del ins AG (p.Q204R) mutation in the CSF3R gene, who was successfully treated with granulocyte macrophage colony stimulating factor.

BACKGROUND: Postural control allows performance of daily and sports activities. The previous studies show that postural sway inceases in orthopaedic injuries such as osteoarthritis and total knee arthroplasty. OBJECTIVE: To compare postural sway, risk of falling and function between individuals with and without patellofemoral pain syndrome (PFS). METHODS: This study included 22 subjects with patellofemoral pain syndrome, age-matched pain-free 22 females serving as a control group. Visual anolog scale and Kujala were used to evaluate the pain. Posturographic assesment was performed by Tetrax posturographic device. Biering Modified Sorenson test for extensor endurance and sit-up test for flexor endurance were used for the evaluation of trunk endurance. Timed get-up and go test was used for lower extremity function. The Student's t Test was used to compare variables between the groups. The Pearson correlation coefficients were calculated to examine correlation between the quantitative variables. RESULTS: Postural sway included eyes open without pillow, eyes open on pillow, eyes closed on pillow, risk of falling, function and postural stabilization included flexor endurance, extansor endurance are impared in patient with patellofemoral pain syndrome when compare to controls. In subjects with PFPS increased postural sway significantly associated with body mass index (r= 0.52), pain duration (r= 0.43), postural control (extansor endurance) (r= -0.50) and risk of falling (r= 0.62) on pillow with open eyes. In addition we found function significantly related with postural control (extansor endurance and flexor endurance) (r= -0.59 and r= -0.59) and risk of falling (r= 0.77) CONCLUSIONS: Decreased neuromuscular control of the trunk core and increased postural sway and falling risk were found in patients with PFPS. Patients may be evaluated for deficits in postural control and falling risk before treatment. Language: en

WOS: 000396430900009, PubMed ID: 28002785, Turkey has experienced a wave of demonstrations in the summer of 2013, called Gezi Park Demonstrations. Between 31 May and 30 August, 297 people who had been subjected to trauma by several methods of demonstration control and Riot Control Agents applied to the Human Rights Foundation of Turkey Rehabilitation Centers to receive treatment/rehabilitation and/or documentation. 296 patients except one 5-year-old child were included in the study. Of the 296 patients; 175 were male, 120 were female, and one was a transgender individual. The highest number of applications was received by the Istanbul center with 216 patients. The mean age of applicants was 33.85, and the age range was 15-71 years. While 268 of applicants (91%) stated that they had been exposed to Riot Control Agents, 62 patients suffered only chemical exposure who had no other traumatic injuries whereas 234 patients suffered at least one blunt trauma injury. Blunt trauma injuries are due to being shot by gas canisters in 127 patients (43%), by plastic bullets in 31 patients (10%). 59 patients (20%) were severely beaten, and 30 patients (10%) were injured by pressurized cold water ejected by water cannons. Thirteen patients (4.4%) suffered injuries that caused loss of vision or eye. Psychiatric evaluations were carried out for 117 patients while 43% of them were diagnosed with Acute Stress Disorder. Post Traumatic Stress Disorder and Major Depressive Disorder followed this diagnosis. This study includes the medical evaluation of injuries allegedly sustained during Gezi Park demonstrations in 2013 as a result of several methods of demonstration control and/or by being exposed to Riot Control Agents. The aim is to discuss different types of injuries due to those methods and health consequences of Riot Control Agents. (C) 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

WOS: 000396425800003, PubMed ID: 27815226, Objectives: Invasive aspergillosis (IA) is an important cause of mortality and morbidity in children with hematological malignancies. The monitoring of serum galactomannan (GM) antigen is considered useful in the diagnosis of IA. The aim of this study was to determine the utility of serum GM monitoring in the early diagnosis of IA and the role of positive antigenemia in the management of children with acute lymphoblastic leukemia (ALL). Methods: The cases of 141 children who were being treated for ALL in the Division of Pediatric Hematology of the Medical School of Ege University between January 2006 and February 2015 were reviewed retrospectively. Cases of proven and probable IA were defined according to the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria. Results: The incidence of proven and probable IA was 3.5% (5/141). The incidence of positive GM antigenemia among 3264 serum samples was 5.5% (n = 179). Of the cases detected, 21.7% were truepositive, 52.1% were false-positive, and the remaining 26.1% were classified as 'undetermined.' An increase in the incidence of true-positive tests and induction of antifungal therapy was determined through multiple consecutive positive tests. Conclusions: GM may be detected in the serum before the clinical signs of IA appear, but its sensitivity and specificity are variable. False-positivity is a significant disadvantage, and consecutive positive GM must be taken into account in the case of clinical and imaging findings that are relevant to IA. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Introduction: Growth retardation (GR) and pubertal disturbances are the earliest consequences of iron toxicity resulting from the pituitary iron deposition in children and adolescents with thalassemia major (TM). It is suggested that adequate transfusion regimens together with appropriate management of iron chelation with timely initiation and dose tailoring by close monitoring using surrogate markers of the iron load may achieve a normal pattern of complication-free survival in TM. Objectives: The purpose of this study was to evaluate the fact that the current approach to the management of the disease has provided a normal growth progression and sexual development in patients (pts) with TM. Methods: We recruited male (M) and female (F) TM pts born after 2000 and followed-up (FU) in Ege University Thalassemia Center. The pts. with an acute or chronic illness that may interfere with growth and development or stem cell transplantation recipients were excluded. The Committee of Clinical Investigation at Ege University Hospital (19.02.2020, 20-2.1T/2) approved this study. Height (H) and weight (W) assessments were performed by using the Harpenden stadiometer and puberty was evaluated by Tanner staging at 3 monthly intervals. H-standard deviation scores (h-SDS) were calculated. Target-H based on mid-parental-H for M & F pts was estimated. All pts. were evaluated annually for bone mineral density (BMD) using dual-energy X-ray absorptiometry (Hologic QDR-4500W, USA) after 8 years (y) of age. The mean SDS of the lumbar spine (L1-4) BMD between -1 and -2.5 was defined as osteopenia and Transfused pRBC units (U) and average pre-transfusion hemoglobin (Hb) per year were recorded. Serum ferritin (SF) was monitored at monthly intervals. Myocardial (T2*) and liver (R2) iron were assessed by a 1.5 Tesla magnetic resonance imaging (MRI) machine (Siemens, Symphony Vision 16034 scanner) after 8 y. Annual median SF, prescribed chelator(s), mean chelator doses were recorded by reviewing pts' records. Transfusional iron intake (TII) was estimated as the total amount of pure RBCs (each U, 250 ml with 57% Hct) transfused in a y (ml) x 1.08. Daily TII was expressed as annual TII (mg)/ mean kg b.w./days of the y. Results: We recruited 30 TM (28 β/β, 1 β/δβ, and 1 non-deletional HbH) pts (13 F and 17 M). Demographics for the population are summarized in Table1. All pts maintained annual mean pre-transfusion Hb> 9 g/dl. Twenty-two of 24 pts maintained Deferasirox (DFX) chelation during 9 ± 3.6 y (median 9, range 2-13 y) and achieved optimum SF levels at all times (Figure a). The dose tailoring of DFX found parallel to the changes in TII during FU (Figure b). Liver iron concentration (LIC) and myocardial T2* (mT2*) in 22 pts on DFX chelation were between 0.9-5.4 (2.1 ± 1.3 SD) mg Fe/g d.w. and 19.4-43.5 (28 ± 6.7 SD) ms, respectively, in all assessments. The only pt with mT2* of 19.4 ms revealed mT2* of >20 ms on FU scans. The puberty initiated at 12.8 ± 1.1 y in M (n=12) & 11.2 ± 1.3 y in F (n=12) and progressed without hormone replacement in all, regardless of the chelator. Overall, growth reduced compared to the non-thalassemic population after 8 y with clear evidence of growth catch-up by the introduction of puberty. h-SDS detected Conclusions: Puberty was the main determinant of growth and bone maturation in TM. Despite, puberty has achieved within physiological limits in M & F pts, a slight delay was observed compared to the non-thalassemic population. The relative delay in pubertal spurt may lead to overdiagnosis of growth and bone-maturation failure and unnecessary intervention in adolescent TM pts. This hypothesis as well as the appropriateness of current management guidelines remains to be elucidated. Disclosures No relevant conflicts of interest to declare.

Objective: In recent years, the rates of marriage and pregnancy are increasing in patients with thalassemia major. The aim of the present study was to investigate the fertility rate of thalassemic patients and the course of pregnancies in terms of mother and infant health. Materials and Methods: In this observational study patients with major hemoglobinopathy were evaluated regarding marital status, the need for assisted reproductive techniques, fertility rate, iron status, and pregnancy complications. Results: Seventeen female patients gave birth to 21 healthy infants. About one-third of the patients needed assisted reproductive techniques. Thalassemia major patients showed increased serum ferritin levels from 1203±1206 µg/L at baseline to 1880±1174 µg/L at the end of pregnancy. All babies are still alive and healthy. Conclusion: Pregnancy in patients with thalassemia can be safe for the mother and newborn with close monitoring and a multidisciplinary approach., Amaç: Son yıllarda, talasemi majör olgularının evlilik ve gebelik oranları giderek artmaktadır. Bu çalışmanın amacı, talasemi hastalarının fertilite oranlarının araştırılması ve anne ve bebek sağlığı açısından gebelik sonuçlarının değerlendirilmesidir. Gereç ve Yöntemler: Bu gözlemsel çalışmada; majör hemoglobinopatili hastalar; evlenme ve çocuk sahibi olma oranları, yardımcı üreme tekniklerine gereksinimleri, demir statüleri ve gebelik komplikasyonları açısından değerlendirilmiştir. Bulgular: On yedi talasemik kadın hasta, toplam 21 sağlıklı bebek doğurmuştur. Hastaların üçte biri bebek sahibi olabilmek için yardımcı üreme tekniğine ihtiyaç duymuştur. Talasemi majör olgularının serum ferritin değerleri hamileliğin başında ortalama 1203±1206 ug/L saptanmış olup, hamileliğin sonunda 1880±1174 ug/L seviyesine yükselmiştir. Tüm bebekler halen hayatta ve sağlıklıdırlar. Sonuç: Talasemi olgularında hamilelik süreci yakın takip ve multidisipliner yaklaşım ile beraber güvenli olarak geçirilebilecektir.

Aim: Pancytopenia is a clinical problem which has a wide differential diagnostic spectrum and may occur with various mechanisms. In this study we aimed to determine the most common etiologic causes in patients with pancytopenia. Materials and Methods: The records of patients aged 18 years and older, who applied to the Health Sciences University Bakirkoy Dr. Sadi Konuk Training and Research Hospital between 2012 and 2017 and who were diagnosed with pancytopenia according to World Health Organization (WHO) criteria were retrospectively reviewed. Statistical Method: Mann-Whitney-U test was used for 2 groups and Kruskal-Wallis test was applied for 3 and more groups. Since no normal distribution was provided as a descriptive statistic, median and change interval values were given for continuous data. Results: A total of 766 patients, 475 (62%) women and 291(38%) men, were included in the study. In these patients, non-hematologic causes were found in 77.7% and hematologic causes in 22.3% of patients with pancytopenia. Hematological etiologies were 72.2% benign and 27.8% malignant. Non-hematological causes were divided into groups as renal diseases (6.05%), rheumatological diseases (2.3%), infective diseases (10.7%), endocrinological diseases (3.8%), hypersplenism (14.4%), immunosuppressive drug use (17.4%), solid organ cancers (10.7%) and unidentified reasons (34.2%). Conclusion: Pancytopenia should be evaluated carefully and the etiology should be detected quickly and corrected by appropriate treatment. It is an appropriate approach to exclude, firs the non-hematological causes (especially immunosuppressive drug use, hypersplenism, infection and solid organ cancers) and the benign causes of hematological reasons., Amaç: Pansitopeni, çeşitli mekanizmalarla ortaya çıkabilen ve geniş bir ayırıcı tanı spektrumuna sahip klinik bir problemdir. Bu çalışmada pansitopenili hastalarda en sık görülen etiyolojik nedenleri belirlemeyi amaçladık. Gereç ve Yöntem: Sağlık Bilimleri Üniversitesi Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi’ne 2012-2017 yılları arasında başvuran ve Dünya Sağlık Örgütü kriterlerine göre pansitopeni tanısı alan 18 yaş ve üstü hastaların kayıtları retrospektif olarak incelendi. İstatistiksel Yöntem: İkili gruplara Mann-Whitney-U testi, 3 ve daha fazla grubun olduğu karşılaştırmalarda ise Kruskal-Wallis testi uygulandı. Tanımlayıcı bir istatistik olarak normal dağılım sağlanmadığından, sürekli veriler için ortanca ve değişim aralığı değerleri verildi. Bulgular: Çalışmaya 475 (%62) kadın ve 291 (%38) erkek olmak üzere toplam 766 hasta dahil edildi. Bu hastaların %77,7’sinde hematolojik olmayan nedenler, %22,3’ünde ise hematolojik nedenlerin pansitopeni etiyolojisinde rol oynadığı görüldü. Hematolojik etiyolojilerin %72,2’si benign, %27,8’i ise malign hastalıklardan oluşmaktaydı. Hematolojik olmayan nedenlerin ise; renal (%6,05), romatolojik hastalıklar (%2,3), enfektif hastalıklar (%10,7), endokrinolojik hastalıklar (%3,8), hipersplenizm (%14,4), immünsupresif ilaç kullanımı (%17,4), solid organ kanserleri (%10,7) ve tanımlanamayan nedenler (%34,2)’den oluştuğu görüldü. Sonuç: Pansitopeni dikkatlice değerlendirilerek etiyolojisi hızlı bir şekilde tespit edilmeli ve uygun tedavi ile düzeltilmelidir. Öncelikle hematolojik olmayan nedenlerin (özellikle immünsupresif ilaç kullanımı, hipersplenizm, enfeksiyon ve solid organ kanserleri) ve hematolojik nedenlerden de benign hastalıkların dışlanması uygun bir yaklaşımdır.

While Timber–Concrete Composite (TCC) construction has been intensively studied in terms of structural behaviour, there is little research on the risk of corrosion of the used metallic shear fasteners in different exposure environments. Due to the marked differences in chemical environments of wood and concrete, however, it can be expected that the fasteners are subject to galvanic corrosion. This was experimentally studied in the present work. TCC specimens were fabricated for electrochemical testing and exposed to two different exposure environments, that is, 95% relative humidity and immersion in water. The moisture content in the wood, the difference in electrochemical potentials and the galvanic current were monitored over 2 months. Two types of fasteners were tested, namely zinc galvanized steel fasteners as well as browned fasteners that have been widely used in the TCC construction industry since 2013. It was found that the fastener parts in the wood generally act as an anode, while the remaining parts in the concrete act as a cathode. However, significant galvanic currents were only observed upon immersion in water. For practical applications in structural engineering, it is concluded that the mass loss of metal of the studied fasteners cannot present a severe risk for structures, especially not at the service classes 1 and 2 according to EN 1995-1-1.

EgeUn###, Background:Invasive fungal infections, including hepatosplenic fungal infections (HSFI), cause significant morbidity and mortality in children with leukemia. There are not enough data to support for the best approach to diagnosis of HSFI in children, nor for the best treatment.Procedure:In this multicentric study, we assessed the demographic data, clinical and radiologic features, treatment, and outcome of 40 children with leukemia and HSFI from 12 centers.Results:All cases were radiologically diagnosed with abdominal ultrasound, which was performed at a median of 7 days, of the febrile neutropenic episode. Mucor was identified by histopathology in 1, and Candida was identified in blood cultures in 8 patients. Twenty-two had fungal infection in additional sites, mostly lungs. Nine patients died. Four received a single agent, and 36 a combination of antifungals.Conclusions:Early diagnosis of HSFI is challenging because signs and symptoms are usually nonspecific. In neutropenic children, persistent fever, back pain extending to the shoulder, widespread muscle pain, and increased serum galactomannan levels should alert clinicians. Abdominal imaging, particularly an abdominal ultrasound, which is easy to perform and available even in most resource-limited countries, should be recommended in children with prolonged neutropenic fever, even in the absence of localizing signs and symptoms. © 2018 Wolters Kluwer Health, Inc. All rights reserved.

This paper presents the results of an investigation on internal stress progression and the explicit dynamics simulation of the bruising behavior of potato tubers under dynamic mechanical collision. Physical measurements, mechanical tests, advanced solid modeling, and engineering simulation techniques were utilized in the study. The tuber samples used in the simulation were reverse engineered and finite element analysis (FEA) was set up to simulate the collision-based bruising behavior of the potato tubers. The total number of identical tuber models used in the simulation was 17. The numerical data of the FEA results revealed useful stress distribution and mechanical behavior visuals. These results are presented in a frame that can be used to describe bruise susceptibility value on potato-like agricultural crops. The modulus of elasticity was calculated from compression test data as 3.12 MPa. Structural stresses of 1.40 and 3.13 MPa on the impacting (hitting) and impacted (hit) tubers (respectively) were obtained. These stress values indicate that bruising is likely to occur on the tubers. This research paper provides a useful how-to-do strategy to further research on complicated bruising investigations of solid-like agricultural products through advanced engineering simulation techniques. Practical applications: This research aims to simulate realistic dynamic deformation of potato tubers during mechanical collision, which is very hard to achieve through physical or analytical expressions. This is attractive because related food processing industries have shown their interest in determining the physical properties and bruising behavior of food/agricultural products using experimental, numerical, and engineering simulation methods so that it can be used in their food processing technology. Very limited data have been found available in the literature about the subject of FEM-based explicit dynamics simulation of solid-like agricultural crops such as the self-collision case of potato tubers (which is very important for indoor or outdoor potato processing). Comparative investigations on determination of modulus of elasticity are very limited as well. Most of the research focused on single calculation theory and linear static loading assumption-based FEM simulation solutions. Here, we report a “how-to-do” case study for dynamic self-collision simulation of potato tubers.

"Objectives: The aims of this study were to translate the Pelvic Girdle Questionnaire (PGQ) to Turkish and to assess its test-retest reliability and validity in pregnant women. Materials and Methods: One hundred and thirty-five pregnant with pelvic girdle pain were recruited in the study. Visual analog scale was used to evaluate pain intensity, PGQ for condition-specific health related quality of life, Nottingham Health Profile for health-related quality of life, Oswestry Disability Index for disability level, The guidelines for cross-cultural adaptation in PGQ was used. Results: A total of 135 pregnant with a mean age of the 30±4.77 years included in the study. Interclass correlation coefficient score for test-retest reliability was 0.972 (95% CI= 0.968-0.977) for PGQ activity subscale, 0.910 (95% CI=0.905-0.915) for PGQ symptom subscale and 0.979 (95% CI= 0.975-0.983) for PGQ total. Conclusion: The study demonstrated that Turkish version of PGQ is a valid and reliable tool for measuring both disability and symptom and good psychometric properties in Turkish speaking pregnants with pelvic girdle pain." Amaç: Bu çalışmanın amacı gebe kadınlarda Pelvik Kuşak Anketi'ni (PKA) Türkçe'ye çevirmek ve testtekrar test güvenilirliği ve geçerliğini değerlendirmekti. Materyal ve Metot: Çalışmaya pelvik kuşak ağrısı olan 135 gebe alındı. Ağrı şiddetini değerlendirmek için görsel analog skalası, duruma özel sağlık ile ilgili yaşam kalitesine için PKA, sağlıkla ilgili yaşam kalitesi için Nottingham Sağlık Profili, özürlülük düzeyi için Oswestry Özürlülük İndeksi, PKA'da kültürlerarası uyum için kılavuzlar kullanılmıştır. Bulgular: Çalışmaya yaş ortalaması 30 ± 4,77 olan 135 gebe dahil edildi. Test-tekrar test güvenirliği için sınıflar arası korelasyon katsayısı puanı, PKA aktivite alt boyutu için 0,972 (% 95 CI = 0,968-0,977), PKA semptom alt boyutu için 0,910 (% 95 CI = 0,905-0,915) ve PKA toplam için 0,979 (% 95 CI = 0,905-0,915) olarak bulundu. Sonuç: Çalışma, pelvik kuşak ağrısı olan Türkçe konuşan gebelerde PKA'nin Türkçe versiyonunun hem sakatlığı hem de semptomu ölçmek için geçerli ve güvenilir bir araç olduğunu ve iyi psikometrik özelliklere sahip olduğunu göstermiştir.

Objectives: The psychosocial factors that may affect the prognosis of patients with low back pain are generally disregarded. The StarT Back Screening Tool can help clinicians to analyze prognostic indicators and the risk associated with outcome by examining physical and psychosocial factors. The aim of this study was to investigate the psychometric properties of the Turkish version of the StarT Back Screening Tool, including cross-cultural adaptation, internal consistency, test-retest reliability, and construct validity. Methods: In this study, 120 patients with non-specific low back pain were included. The Roland Morris Disability Questionnaire, Oswestry Disability Index, Beck Depression Inventory, Tampa Scale for Kinesiophobia, and the StarT Back Screening Tool were administered. One week after the initial testing, the same examiner repeated the tests. Results: The mean age of the patients who participated in the study was 35.54 +/- 12.45 years. Cronbach's alpha coefficients in the analysis of scale reliability were 0.747 for the overall scale and 0.738 for the psychosocial subscale. The test-retest reliability of StarT Back Screening Tool (intraclass correlation coefficient: 0.90-0.93) was found to be excellent. Pearson correlation coefficients for the correlations between the overall StarT Back Screening Tool and the other measures were very good (r=0.678; p

WOS: 000478208700001, PubMed ID: 31321910, Background Severe congenital neutropenia is a rare disease, and autosomal dominantly inherited ELANE mutation is the most frequently observed genetic defect in the registries from North America and Western Europe. However, in eastern countries where consanguineous marriages are common, autosomal recessive forms might be more frequent. Method Two hundred and sixteen patients with severe congenital neutropenia from 28 different pediatric centers in Turkey were registered. Results The most frequently observed mutation was HAX1 mutation (n = 78, 36.1%). A heterozygous ELANE mutation was detected in 29 patients (13.4%) in our cohort. Biallelic mutations of G6PC3 (n = 9, 4.3%), CSF3R (n = 6, 2.9%), and JAGN1 (n = 2, 1%) were also observed. Granulocyte colony-stimulating factor treatment was given to 174 patients (80.6%). Two patients died with infectious complications, and five patients developed myelodysplastic syndrome/acute myeloblastic leukemia. The mean (+/- mean standard error) follow-up period was 129.7 +/- 76.3 months, and overall survival was 96.8% (CI, 94.4-99.1%) at the age of 15 years. In Turkey, severe congenital neutropenia mostly resulted from the p W44X mutation in the HAX1 gene. Conclusion In Turkey, mutation analysis should be started with HAX1, and if this is negative, ELANE and G6PC3 should be checked. Because of the very high percentage of consanguineous marriage, rare mutations should be tested in patients with a negative mutation screen., Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK); Turkish Pediatric Hematology Association, This study was supported by Scientific and Technological Research Council of Turkey (TUBITAK) and the Turkish Pediatric Hematology Association.

The role of IL-25 and IL-33 in the aetiology and pathogenesis of nasal polyps has been controversial in the literature. The objective of the study is to detect serum and tissue levels of IL-25 and IL-33 in patients with (CRSwNP) or without (CRSsNP) nasal polyps using enzyme-linked immunosorbent assay (ELISA). Study group consisted of 20 CRSwNP and 20 CRSsNP patients. Control group comprised of 20 volunteers who had been operated with septum deviation without any additional sinonasal pathology, allergy, systemic disease, or medication use. All groups preoperatively underwent paranasal CT examinations and sinonasal pathologies were recorded based on Lund–Mackay radiological staging system. IL-25 and IL-33 levels in serum and tissue samples were analyzed using the ELISA method. Serum IL-25 and IL-33 levels in CRSsNP, CRSwNP, and control groups did not differ statistically significantly (p = 0.345 and p = 0.338). Any statistically significant difference was not detected in mean tissue IL-25 levels among CRSsNP, CRSwNP, and control groups (p = 0.698). Mean tissue IL-33 level in the CRSwNP group was statistically significantly lower when compared with those of CRSsNP and control groups (p

Objective Silent sinus syndrome (SSS) is a clinical syndrome that occurs as a result of chronic maxillary sinus atelectasis (CMA) and is seen with progressive enophthalmos and hypoglobus. The aim of this study was to investigate the correlation between radiological findings and clinical findings in patients with radiologically asymmetrical reduced maxillary sinus volume. Material and method A comparison was made of patients with CMA through evaluation of paranasal sinus computed tomography, magnetic resonance imaging examination of maxillary sinus volume of the CMA side and the contralateral side, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, middle concha diameter, and calculation of the change in location of the inferior rectus muscle. Results The study included 16 patients. Although a statistically significant difference was determined between the healthy and the pathological sides in respect to maxillary sinus volume, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, and middle concha diameter (p = 0.00, p = 0.002, p = 0.020, p = 0.020, p = 0.007), no significant difference was determined in respect to the change in location of the inferior rectus muscle (p = 0.154). A positive correlation was determined between the increase in sulcus depth and maxillary sinus volume and inferior orbital bone curve (p Conclusion In CMA patients suspected of having SSS, radiological maxillary sinus volume analysis, determination of retroantral fat thickness, measurement of the infraorbital bone curve, and measurement of the uncinate process lateralisation can be used as objective tests. However, it should be kept in mind that radiological findings may not always be compatible with the ophthalmological examination findings.

Objective To determine the hearing levels of participants of a randomized group using a smartphone hearing application and to compare these results with the results from a pure-tone audiogram. Materials and methods A heterogenous group consisting of both normal-hearing and hearing-impaired participants were included in this study. Pure-tone audiogram thresholds were measured from 250 Hz to 8000 Hz, while smartphone measurements were obtained with a Samsung Galaxy GT-19500 S4 with a bundled headphone running the Hearing Test™ software (e-audiologia.pl), which was downloaded from the Google Play Store as a free application. We compared these results with those obtained from pure-tone audiograms performed by an audiologist as a reference. Results Validity analysis indicated that the results for each ear and each frequency were excellent (>0.75). We assessed the mean difference between the pure-tone audiogram and the smartphone hearing test results and found the absolute difference to be less than 8.8 dB. Conclusion Smartphone hearing test applications are providing alternative tests that present low-cost solutions. Using the hearing application test may decrease the demand for audiological services in underserved areas. The study suggests that smartphone hearing test results are comparable to pure-tone audiometry results.

WOS: 000377868800001, PubMed ID: 26937339, Invasive fungal infections are most commonly seen in immunocompromised patients and usually affect the respiratory system. Gastrointestinal system involvement of mucormycosis and invasive aspergillosis is rarely reported in childhood. Here we describe a 5 year old boy with acute lymphoblastic leukaemia who developed invasive fungal infection particularly affecting the lower gastrointestinal system to emphasise the difficulties in diagnosis and management of invasive fungal infections in immunocompromised patients. (C) 2016 The Authors. International Society for Human and Animal Mycology. Published by Elsevier B.V.