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Background & Objectives: Diabetes Mellitus is a metabolic disorder in which lacking of control and suitable care lead to disability and mortality. American Diabetes Association (ADA) has emphasized the medical care of diabetic patients and has suggested several objectives to increase survival and improve health outcomes with low complications by controlling the glycemic, lipids, nerupathy and hypertension as well as foot care, nutritional therapy and screening of cardiovascular disease. The aim of this study was to evaluate the quality of care in diabetic patients from Ardabil and its concordance to the standards recommended by ADA. Methods: In a cross sectional study, 100 diabetic patients referring to a clinic of diabetes in Ardabil (2005) were randomly selected and enrolled. The study was conducted according to a questionnaire with 90 questions and physical examination and Final lab tests. Data were collected and analyzed with Spss version 12. ANOVA test was used to compare groups. Results: The 12 months recorded lab tests for diabetic patients were as follows: Hb A1C in 33%, MicroAlbuminuria in 16%, HDL in 58% and LDL in 55% of patients had been checked. Foot and peripheral pulses exams were only recorded in 9 and 5% of patients respectively. In final lab tests, 24% of patients had favorable FBS level (90- 130mg/dl). 46% of patients had suitable Hb A1C and 32% patients had MicroAlbuminuria. Aspirin was recommended to 45% of patients over 50 years old. Only 10% of patient for three lab tests (FBS, LDL cholesterol, Hb A1C) achieved the intended aims. According to ADA recommendations 22% of patients for three risk factors (BP, LDL cholesterol & Total cholesterol) were in optimal level. Conclusion: There is a high difference between current diabetes care in our clinic and ADA goals.

Abstract Background The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries. Methods Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions. Results The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis. Conclusion Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients.

Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed. [ABSTRACT FROM AUTHOR]

Background: The prevalence of metastatic colorectal cancer (mCRC) is increasing and is linked to poor overall survival (OS). Previous studies have aimed to determine the predictive value of scores and laboratory tests for OS in mCRC patients, but their findings have been inconclusive. In this research, we focused on determining the prognostic significance of the fibrosis-4 (FIB-4) index, the aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), the albumin-bilirubin (ALBI) score, and the gamma-glutamyl transpeptidase to PLT ratio (GPR) with respect to OS in treatment-naïve mCRC patients., Methods: This retrospective study included treatment-naïve mCRC patients. The FIB-4 index, ALBI score, APRI, and GPR were calculated for each participant, and their mortality dates were recorded. The clinical importance of these scores for survival outcomes was evaluated via the Cox regression model, Kaplan-Meier method, and log-rank test., Results: The study enrolled 123 untreated mCRC patients. Univariate Cox regression analysis demonstrated that sex and AST/PLT and ALT/PLT counts were not associated with OS (p > 0.05 for all). However, a higher FIB-4 index (p = 0.025), ALBI score (p < 0.001), GPR (p < 0.001), and AST/ALT ratio (p < 0.001) were all associated with poor OS. Additionally, multivariate Cox regression analysis indicated that age (95% CI: 1.009-1.053, p = 0.006), ALBI score (95% CI: 1.234-2.983, p = 0.004), GPR (95% CI: 1.442-2.701, p < 0.001), and AST/ALT (95% CI: 1.193-2.911, p = 0.006) were independent prognostic factors for OS., Conclusion: The affordable and easily accessible ALBI score, GPR, and AST/ ALT have prognostic value in untreated patients with mCRC., Competing Interests: Declarations. Ethics approval and consent to participate: The Clinical Research Ethics Committee of Health Sciences University Gazi Yaşargil Research and Training Hospital approved the study protocol (approval date and number: 2024- 111). Because the study was retrospective, participants were not asked to provide written informed consent when enrolled, and the need for consent to participate was waived by The Clinical Research Ethics Committee of Health Sciences University Gazi Yaşargil Research and Training Hospital. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background/aim: NAD(P)HX epimerase (NAXE) gene mutations have been associated with early onset progressive encephalopathy. We present three patients with NAXE gene mutations and different initial manifestations., Cases: Patient(P)1 was a 30 month-old boy whose neurological regression started after an infection and progressed, ultimately leading to death one year later. His brain magnetic resonance imaging (MRI) findings were suggesting metabolic stroke. P2, nine year-old sister of P1, had mild developmental delay since birth, seizures after age 5 years and pellagra-like skin lesions. P3 was a 15 year old female presenting multifocal neurological signs progressing over months and leading to respiratory insufficiency. Her initial MRI was normal but inflammatory lesions appeared three months after the onset of symptoms. Laboratory investigations including biochemical, serological and metabolic tests, and brain biopsy were unrevealing. Clinical presentation of P1 and P3 initially suggested autoimmune neurological disease, but no response to immunotherapy was obtained. Two different types of variants c.641T > G; p.Ile214Ser and c.128 C > A, p.Ser43* were detected in NAXE in these patients' two unrelated families. All patients were given mitochondrial cocktail including niacin., Discussion: NAXE plays an important role in the electron donors for the mitochondrial respiratory chain. Mutations result in accumulation of toxic metabolites, disruption of energy production, and possibly cell death. P1-3 displayed different ages of onset, different clinical courses and MRI findings unreported previously, suggesting immune-mediated encephalitis and metabolic stroke in P1, and an inflammatory process in P3. NAXE mutations should be considered in progressive central nervous system symptoms., Competing Interests: Declarations. Ethics approval and consent to participate: For a series of 3 cases, we think that ethical approval is not necessary. Informed consent form was obtained from the parents of the patients and we think that this will be sufficient. Informed consent: The parents of the all patients provided informed consent for the publication of their children's data and photographs. Competing interests: The authors have no relevant financial or non-financial interests to disclose., (© 2025. Fondazione Società Italiana di Neurologia.)

Objective: Fibromyalgia, which is becoming increasingly common today, affects the quality of life of those affected. The aim of this study was to investigate the relationship between diet and pain, disease severity and biochemical parameters in fibromyalgia., Design: Cross-sectional design using validated questionnaires., Setting: Fibroyalgia patients with Traditional and Complementary Medicine clinics., Subject: 84 patients with Fibromyalgia (FM), which was diagnosed by a rheumatologist., Methods: The cross-sectional study was conducted with 84 fibromyalgia patients in Turkey. The Dietary Inflammatory Index (DII) was calculated by a 24-hour diet recall. Self-reported pain levels and disease severity were evaluated by the Visual Analog Scale (VAS) and a Revised Fibromyalgia Impact Questionnaire (FIQR), respectively. Antropometric measures and biochemical parameters associated with inflammation were also evaluated., Results: Linear regression analysis revealed that the VAS pain score [β (%95CI)=1,72 (0,90-2,55), p < 0,001], FIQ-R [β (%95CI)=5,62 (0,14-11,09), p < 0,001] and uric acid/creatinine ratio [β (%95CI)=0,21 (-0,10-0,52), p < 0,001] were positively associated with the DII after adjustments for BMI, body fat, fat free mass, cholesterol, fiber, caroten, iron, magnesium, vitamine C reported by the patients with FM., Conclusions: A pro-inflammatory diet was associated with higher pain, disease severity and uric acid/creatinine ratio in patients with FM., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.)

Background: Occlusal trauma has become a common phenomenon among individuals today. Its primary source is bruxism, which involves unusual activities such as clenching and grinding during the day or sleep. The hypothesis is that with 5% dextrose neuroprolotherapy, both the trigger points and affected nerves will be healed, and the muscle will be relieved by eliminating the pain., Methods: This study aimed to compare the short-term ultrasonographic results of patients treated with occlusal splint and 5% dextrose neuroprolotherapy for bruxism. Patients were divided into two groups: the dextrose neuroprolotherapy group and the occlusal splint group. In the first group, patients were administered 5% dextrose three times at one-week intervals using the dextrose neuroprolotherapy method. Impressions for both jaws were made using a high-viscosity irreversible hydrocolloid impression material in the second group. An occlusal splint was tailored to fit the upper jaw. Patients were assessed for masseter muscle thickness and strain ratio using ultrasonography before and 3 months after the treatment., Results: No statistically significant differences were found between the two groups for all measures. Statistically significant differences were observed in the strain ratio of the left musculus massetericus in the resting position and the thickness of the left musculus massetericus in the contracted position exclusively in the neuroprolotherapy group (p=0.001, p=0.011, respectively). Differences in the strain ratio of both sides of the contracted musculus massetericus were demonstrated in both groups (neuroprolotherapy group: right side p<0.001, left side p=0.007, splint group: right side p=0.005, left side p=0.012)., Conclusion: This study demonstrates that 5% dextrose neuroprolotherapy is an effective treatment comparable to an occlusal splint. Objectively visualizing changes in the masseter muscle through ultrasound provides clear results in the context of occlusal trauma and bruxism.

Purpose: The current study is intended to investigate the effect of new organ involvement on overall survival (OS) and modify the Response Evaluation Criteria in PSMA Imaging (RECIP) by including new organ involvement to RECIP 1.0., Materials and Methods: This retrospective study includes 114 patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC) between September 2017 and June 2022 who had received docetaxel treatment and had baseline and post-treatment prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) images. The inclusion criteria were patients with pre- and post-treatment [ 18 F]FDG PET/CT images and whose [ 18 F]FDG PET images were negative. Those whose data were unavailable, who had additional malignancy, or who received abiraterone, enzalutamide, or Lutetium (Lu)-177 treatment were excluded. Age, Gleason score (GS), TPSA (total prostate-specific antigen) levels, surgical history, and OS information were recorded for each patient., Results: The 114 patients herein had a median age of 72.5 (51-91) years and a median GS of 8 (7-10). New lesions were observed in 59 patients (51.7%) and new organ PSMA uptake was observed in 14 patients (12.2%). In the multivariate Cox regression analysis, volume-based treatment response (vTR)-total lesion PSMA (TLP), RECIP PSMA-VOL, modified RECIP (mRECIP) PSMA-VOL, and mRECIP TLP were independent prognostic factors for mortality (p < 0.001, p = 0.006, p = 0.003, and p = 0.003, respectively). The median OS of patients with new organ involvement and new lesion with PSMA uptake was 9.3 months (95% CI 2.1-16.5 months) and 11.8 months (95% CI 7.4-16.2 months), respectively., Conclusion: The study concluded that new organ involvement had a shorter OS than new lesion involvement. In the mRECIP that we developed, unlike RECIP, we demonstrated that both PSMA-VOL and TLP value were independent prognostic factors for mortality., (© 2024. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.)

Introduction: Healthcare-associated infections (HAIs) are common in intensive care unit (ICU) patients and may cause devastating consequences. However, the prevalence of HAI and its effects on in-hospital mortality among critically ill COVID-19 patients is ambiguous. We determined the prevalence of HAI and the rate of mortality in critically ill COVID-19 patients and compared it with pre-pandemic ICU patients., Methodology: This retrospective study was conducted with adult ICU patients admitted to Gazi Yaşargil Training and Research Hospital (Diyarbakir,Turkey) in April-November 2019 (defined as the pre-pandemic period) and in April-November 2020 (defined as the pandemic period). All patients in the pandemic period had COVID-19, while none in the pre-pandemic period did. Patients diagnosed with HAIs during the in-hospital follow-up period were recorded., Results: Of 4596 enrollees, 3386 (73.7%) were pandemic-period patients and 1210 (26.3%) were pre-pandemic-period patients. HAI prevalence was significantly higher at 5.9% (n = 71) in the pandemic-period patients and 2.7% (n = 91) in the pre-pandemic-period patients (p < 0.001). Comorbidities including hypertension (63.4% vs 14.2%, p < 0.001), diabetes mellitus (39.4% vs 8.8%, p < 0.001), and coronary artery disease (30.9% vs 10.9%, p = 0.002) were significantly more frequent in pandemic-period HAI-positive patients. The most common HAI was catheter-related bloodstream infection in both groups, with similar frequency (p = 0.652). In-hospital mortality rate was 85.9% versus 65.9% in pandemic- versus pre-pandemic-period HAI-positive patients (p < 0,05)., Conclusions: The prevalence of HAI and the in-hospital mortality rate was significantly higher among pandemic-period patients., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 İhsan Solmaz, Şeyhmus Kavak, Songül Araç, Hakan Akelma, Bilgin Bahadır Başgöz, Sedrettin Koyun, Şafak Kaya.)

This awareness study aimed to determine the ultrasound (US) examination rates in relation to US-confirmed metabolic dysfunction-associated fatty liver disease (MAFLD) diagnosis in internal medicine outpatients with type 2 diabetes (T2D) across Türkiye. A total of 6283 T2D patients were included in this multicenter retrospective cohort study conducted at 17 internal medicine clinics across Türkiye. The presence and indications for US performed within the last 3 years were recorded along with US-confirmed MAFLD rates, laboratory findings on the day of US, and referral rates. Fibrosis-4 (FIB-4) index was calculated to estimate the risk of advanced liver fibrosis (FIB-4 index ≥ 1.3). Overall, 1731 (27.6%) of 6283 patients had US examination, which revealed MAFLD diagnosis in 69.9% of cases. In addition, 24.4% of patients with US-confirmed MAFLD were at risk of advanced fibrosis (FIB-4 index ≥ 1.3), and the referral rate was 15.5%. In conclusion, our findings emphasize an insufficient MAFLD awareness among clinicians and the likelihood of most of T2D patients to be at risk of living with an unknown status regarding their MAFLD and advanced fibrosis risk.

Introduction: The elderly population is unique and the prognostic scoring systems developed for the adult population need to be validated. We evaluated the predictive value of frequently used scoring systems on mortality in critically ill elderly sepsis patients., Methodology: In this single-center, observational, prospective study, critically ill elderly sepsis patients were evaluated. Sequential organ failure evaluation score (SOFA), acute physiology and chronic health evaluation score-II (APACHE-II), logistic organ dysfunction score (LODS), multiple organ dysfunction score (MODS), and simplified acute physiology score-II (SAPS-II) were calculated. The participants were followed up for 28 days for in-hospital mortality. Prognostic scoring systems, demographic characteristics, comorbid conditions, and baseline laboratory findings were compared between "survivor" and "non-survivor" groups., Results: 202 patients with a mean age of 79 (interquartile range, IQR: 11) years were included, and 51% (n = 103) were female. The overall mortality was 41% (n = 83). SOFA, APACHE-II, LODS, MODS, and SAPS-II scores were significantly higher in the non-survivor group (p < 0.001), and higher scores were correlated with higher mortality. The receiver operator characteristics (ROC) - area under curve (AUC) values were 0.802, 0.784, 0.735, 0.702 and 0.780 for SOFA, APACHE-II, LODS, MODS, and SAPS-II, respectively. All prognostic scoring models had a significant discriminative ability on the prediction of mortality among critically ill elderly sepsis patients (p < 0.001)., Conclusions: This study showed that SOFA, APACHE-II, LODS, MODS, and SAPS-II scores are significantly associated with 28-day mortality in critically ill elderly sepsis patients, and can be successfully used for predicting mortality., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Bilal Tekin, Jehat Kiliç, Gürhan Taşkin, İhsan Solmaz, Onur Tezel, Bilgin Bahadır Başgöz.)

Objective: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic., Material and Methods: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded., Results: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%)., Conclusion: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.COVID-19, intensive care, intensive care unit, pandemic, follow-up

Background: Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory disorders of the central nervous system (CNS) mostly presenting as optic neuritis and acute myelitis. NMOSD can be associated with seropositivity for aquaporin 4 antibody (AQP4 IgG), myelin oligodendrocyte glycoprotein antibody (MOG IgG), or can be seronegative for both. In this study, we retrospectively examined our seropositive and seronegative pediatric NMOSD patients., Method: Data were collected from all participating centres nationwide. Patients diagnosed with NMOSD were divided into three subgroups according to serology: AQP4 IgG NMOSD, MOG IgG NMOSD, and double seronegative (DN) NMOSD. Patients with at least six months of follow-up were compared statistically., Results: The study included 45 patients, 29 female and 16 male (ratio:1.8), mean age 15.16 ± 4.93 (range 5.5-27) years. Age at onset, clinical manifestations, and cerebrospinal fluid findings were similar between AQP4 IgG NMOSD (n = 17), MOG IgG NMOSD (n = 10), and DN NMOSD (n = 18) groups. A polyphasic course was more frequent in the AQP4 IgG and MOG IgG NMOSD groups than DN NMOSD (p = 0.007). The annualized relapse rate and rate of disability were similar between groups. Most common types of disability were related to optic pathway and spinal cord involvement. Rituximab in AQP4 IgG NMOSD, intravenous immunoglobulin in MOG IgG NMOSD, and azathioprine in DN NMOSD were usually preferred for maintenance treatment., Conclusion: In our series with a considerable number of double seronegatives, the three major serological groups of NMOSD were indistinguishable based on clinical and laboratory findings at initial presentation. Their outcome is similar in terms of disability, but seropositive patients should be more closely followed-up for relapses., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Claude syndrome is a rare midbrain stroke syndrome characterized by ipsilateral third cranial nerve palsy and contralateral hemiataxia. So far, only a few cases have been reported in childhood. We present two children with Claude syndrome at 9 and 15 years of age. The typical clinical picture was consistent with brain magnetic resonance imaging findings. A thorough investigation regarding the underlying etiology revealed no definite diagnosis but clues suggestive of probable neuro-Behcet disease. Awareness of pediatric neurologists on arterial ischemic stroke has been increasing over the past decades, enabling timely diagnosis and appropriate management of rare childhood cases with midbrain stroke., Competing Interests: None declared., (Thieme. All rights reserved.)

Aim: To investigate the demographic, clinical and radiological findings associated with treatment success after interlaminar epidural steroid injection (ILESI) in radicular pain induced by cervical disc herniation., Material and Methods: In this retrospective study, the data of patients who received cervical ILESI between January 2017 and June 2021 were screened. Of 223 patients, 92 with unilateral radicular neck pain due to cervical disc herniation were included. Demographic data, symptom duration, and numerical rating scale scores at baseline, at three weeks, three months, and six months after treatment were collected from the medical records of the patients. Disc herniation level, cervical axis, disc height, presence and degree of spinal canal and neural foraminal stenosis, vertebral endplate signal change, and definitive presence of uncovertebral and facet osteoarthritis were evaluated using cervical spine magnetic resonance imaging. Treatment success was determined as ?50% reduction in pain scores at six months compared to baseline., Results: Data of 92 patients (27 men, 65 women) were included. The mean age was 50.82 ± 10.22 years, and the median symptom duration was 12 (4.25 to 20) months. At six months after ILESI, treatment was successful in 58 (58.7%) patients and unsuccessful in 34 (41.3%) patients. Multivariable logistic regression analysis was performed to identify the factors associated with treatment success at six months post-injection. In the final model, neural foraminal stenosis (non-severe vs. severe) and spinal canal stenosis (non-severe vs. severe) were significantly associated with the treatment success (OR=3.02, 95% CI=1.40?10.95, p=0.009; OR=5.31, 95% CI=1.77?15.85, p=0.003)., Conclusion: Treatment success of cervical ILESI at six months is favorable. However, the presence of severe neural foraminal and spinal canal stenosis is associated with a reduced likelihood of treatment success.

Background: Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) are associated with acute demyelinating syndromes and only rarely detected in multiple sclerosis (MS). As MOG-Ab associated disease is common in childhood, we speculated young patients might be more likely to produce MOG-Ab and investigated the frequency of MOG-Ab seropositivity in pediatric onset MS (POMS)., Material and Methods: Patients who experienced their first acute demyelinating event before age 18 years and were diagnosed with MS during follow-up were included in this single-center study. Patient data were retrieved from clinical records. Serum samples obtained and frozen at clinical visits were analyzed for MOG-Ab by a live cell-based assay (CBA) measuring delta mean fluorescence intensity (MFI) and MFI ratio. The control group consisted of patients referred to pediatric neurology for headache or vertigo and who had no neurological disorder (n = 48). Another control group consisted of patients with systemic inflammatory disorders systemic lupus erythematosus (n = 17) and juvenile idiopathic arthritis (n = 13) diagnosed in the rheumatology clinic., Results: The patient group (n = 122, F/M: 90/32, mean age 17.8 ± 2.6 years) were initially diagnosed as: MS, 62/122 (50.8%), clinically isolated syndrome, 43/122 (35.2%), radiologically isolated syndrome, 9/122 (7.3%), and acute disseminated encephalomyelitis 8/122 (6.5%). All received the final diagnosis of POMS. Serum was sampled 22.4 ± 29.2 (0-132) months after the first episode. None of the control groups had MOG-Ab positivity while 2/122 (1.6%) POMS cases had MOG-Abs, and a third patient had positive MFI and a MFI ratio slightly below the cut-off. These three patients' initial and final diagnoses were MS, their annualized relapsing rates (ARRs) were 0.4-0.6, and most recent Expanded Disability Status Scale was 0., Conclusion: Low titers of MOG-Ab can be detected in a small number of POMS patients at similar frequency with adult MS. Our POMS cases with MOG-Abs presented brainstem-cerebellar findings or seizures and had low ARR. Further series and longer follow-up will define whether these cases differ significantly from MOG-Ab negative POMS cases., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Authors declare no conflict of interest., (Copyright © 2022. Published by Elsevier B.V.)

Background: The pathogenesis of multiple sclerosis (MS) involves immune-mediated mechanisms, and disease-modifying therapies (DMTs) administered in MS have immunomodulatory effects. The concern about MS patients' susceptibility to coronavirus disease 2019 (COVID-19) has prompted several studies based on clinical observations and questionnaires. Information about COVID-19 in pediatric-onset multiple sclerosis (POMS) is scarce. The objective of this study was to collect information on the experience of POMS patients with COVID-19 during the pandemic., Methods: This cross-sectional study was conducted with POMS patients diagnosed at Hacettepe University Pediatric Neurology Department and under 23 years of age between October 1 and December 31, 2021. Those who experienced COVID-19 or had a history of contact and were found seropositive for COVID-19 were evaluated for the severity of COVID-19, disability, treatment status, and comorbidities., Results: Among the 101 POMS patients, 13 reported having had COVID-19 and five were exposed and seropositive but clinically asymptomatic. Of these 18 patients, 14 were ≤18 years of age at the time of the study. All 13 patients (72%) reported mild symptoms without hospitalization or respiratory support. Four of 18 had a neurological disability (Expanded Disability Status Scale [EDSS] scores ranging between 1 and 7.5), while the remaining had a score of 0. The outcome of COVID-19 was not affected by DMTs, neurological disabilities, and comorbidities., Conclusions: In this single-center POMS series, the small subgroup of patients who had contacted the SARS-CoV-2 virus or developed COVID-19 had reported no or mild symptoms. This may be partly related to the infrequent use of rituximab in this group. Our results corroborate those in adult-onset MS where no increased risk is reported for patients whose EDSS scores are <6 and who are not on B cell-depleting DMTs. Although less frequently than in adult MS, immunosuppressive DMTs may be needed in POMS; therefore, the importance of appropriate vaccination is to be underlined., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Clinically isolated syndrome (CIS) may be the first presentation of pediatric onset multiple sclerosis (POMS). We retrospectively evaluated the clinical and laboratory data of pediatric CIS (pCIS) patients who were diagnosed with POMS upon followup for any predictive variables. We also reviewed the literature concerning the management of pCIS., Methods: This single-center study involved patients who had pCIS in childhood that converted to POMS during followup between 2011 and 2021. Sixteen patients were included in the study. The data were evaluated retrospectively and analyzed with descriptive statistics., Results: The majority of the pCIS patients were female (F/M: 10/6, 62/38%), and the first pCIS attack was at 13.3 ± 2.6 years old (mean ± SD). Mean follow-up was 3.1 ± 1.4 years; 6 of the patients relapsed within 1 year and 6 within 2 years. The time from the first pCIS attacks of the patients to the diagnosis of POMS was 15.75 ± 11.07 months. The annualized relapse rate (ARR) was 0.9 ± 0.7. The majority (68%) of the patients had a monosymptomatic onset, optic neuritis (ON) being the most common initial presentation (44%). Cerebrospinal fluid (CSF) oligoclonal bands (OCBs) were found in 9/12 (75%) and the immunoglobulin G index (IgG index) was elevated in 5/11 (45%). An autoimmune disorder was reported in the 1st or 2nd degree relatives of 6 patients: four (25%) MS, one ulcerative colitis, and one Hashimoto's thyroiditis. Our pCIS patients did not receive any disease-modifying treatment (DMT) for their first attack. When the diagnosis changed to POMS, most (68%) were started on interferons. The Expanded Disability Status Scale (EDSS) increased in one patient during follow-up (EDSS: 3) while in the others it was 0 at the last visit. The literature is reviewed in order to compare results for suggestions regarding the management of pCIS., Discussion: The presence of OCBs in the initial episode, MS in the family, and monosymptomatic onset may increase the possibility of developing POMS. Whether DMTs given at the pCIS stage are effective in preventing relapses and disability needs to be evaluated in longitudinal follow-up of large cohorts.

Background: Metabolomics has the potential to provide putative biomarkers and insights into the pathophysiology and diagnosis of pediatric multiple sclerosis (pMS), which is an inflammatory demyelinating disorder of the central nervous system with a broad spectrum of clinical manifestations. In this study, we aimed to investigate serum metabolomics in pMS to help elucidate the pathophysiology of MS., Methods: An untargeted approach was applied using the quadrupole time-of-flight liquid chromatography/mass spectrometry (Q-TOF LC/MS) method to study plasma metabolites in patients with pMS (n = 33), patients with unclassified central nervous system demyelinating diseases (n = 6), and age-matched healthy control subjects (n = 40). The patient and control groups were compared for metabolites and the normalized peak areas differed statistically (p < 0.05), showing at least a 1.25-fold change between groups. Bioinformatic tools combined with a clinical perspective were employed for the identification of the putative metabolites. In addition to the untargeted metabolomics approach, targeted LC-MS/MS metabolite analysis was employed to compare the pMS group with the control group., Results: Significant differences between the patient and control groups were noted for tyramine, 4-hydroxyphenylacetaldehyde, sphingosine/3-dehydrosphinganine, prostaglandins/thromboxane A2, 20-hydroxy-leukotriene E4, 3α,7α,12α-trihydroxy-5β-cholestan26-al/calcitriol, pantetheine, ketoleucine/3-methyl-2-oxovaleric acid, L-arginine/D-arginine, coproporphyrinogen III, (S)-reticuline, carnosine, cytidine, and phosphoribosyl pyrophosphate. Additional tests for sphingosine 1-phosphate, sphingophosphocholines, ceramides, oxysterols, and calcitriol levels yielded significant metabolomic differences for the pMS group compared to the control group. The metabolomic data of 3/6 patients with unclassified demyelinating disorders matched the pMS group; their follow-up verified the diagnosis of pMS., Discussion: In general, plasma metabolites related to sphingolipid metabolism, myelin products, inflammatory pathways, mitochondrial dysfunction, and oxidative stress were found to be altered in cases of pMS. The method applied in this study, combining untargeted analysis with a targeted approach, can be applied to larger series of cases of pMS and other demyelinating disorders for further validation.

Background: Disease modifying treatments (DMTs) for multiple sclerosis include injectable drugs (iDMTs) like interferons (IFNs) or glatiramer acetate (GA), and newer agents (nDMTs) in oral and intravenous forms. nDMTs are usually applied in escalation and less frequently as initial treatment in pediatric-onset (POMS)., Objective: We intended to evaluate the effect of nDMTs in comparison with iDMTs by retrospective examination of our patients with POMS., Method: Clinical records of POMS cases who received nDMTs either as escalation or initial treatment and who had at least 12 months' follow-up in our clinic were examined in two groups: patients who were started on iDMTs and later switched to nDMTs (Group A), and those who received nDMTs from the beginning (Group B). Presenting symptoms, annualized relapsing rate (ARR), recent Expanded Disability Status Scale (EDSS), lesion load and presence of contrast enhancing (CE) lesions on magnetic resonance imaging (MRI) were compared., Results: Total 43 patients were included: 33 in Group A and 10 in Group B. Age at onset, female/male ratio, duration since disease onset and duration under nDMT were similar in both groups. Initial involvement was predominantly brainstem and cerebellar in Group A and sensorial, brainstem/cerebellar, and optic nerve in Group B. The most frequently used nDMT was fingolimod in Group A (n = 17, 51.5%) and teriflunomide (n = 6, 60%) in Group B. Median ARR before any treatment was 2 in Group A and 1.5 in Group B (p > 0.05); it decreased to median 1 under iDMTs in Group A and to 0 under nDMTs. Mean follow-up was 6.7 ± 5 years (1-19, median 6 years) in Group A and 3.9 ± 3.7 years (range 1-12, median 2 years) in Group B. At the latest follow-up median EDSS scores were 1 in Group A and 0 in Group B. ARR had increased and lesion load on MRI went up progressively in both groups during follow-up. However, the rate of patients with CE lesions diminished in Group B., Conclusion: This single-center study of POMS shows the ARR decreases under any treatment, more markedly under nDMTs, and nDMTs reduce the rate of patients with CE lesions on MRI without a clear effect on lesion load. The ARR tends to increase after the first 2 years of both iDMT and nDMT, suggesting a re-evaluation at that time. The ARR decreases shorty after treatment is changed from an iDMT to a nDMT., (© 2022 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society.)

Current and advanced breeding tools are being used to improve economically important horticultural crops to meet the consumers' needs and preferences. Genotyping-by-sequencing (GBS) is an extremely useful tool in the investigation and analysis of the genetic diversity of different cultivars. Based on a broad range of genetic backgrounds like single nucleotide polymorphism (SNPs), GBS is known as a novel technique to facilitate the detection of quantitative trait loci (QTL) regions robustly linked with interested traits compared to genome-wide association study (GWAS) and QTL. GBS has gained popularity among breeders in recent years and it is also employed in cucumber breeding programs. Cucumbers (C. sativus L.) are monoecious, gynoecious and some of them are parthenocarpic species. Cucumber is one of the most economical and essential crops in the Cucurbitaceae family. For time immemorial, cucumber has been produced and consumed all over the world like other cucurbits. To a large extent, cultivated cucurbits are beneficial to human health for providing necessary minerals and fibers.Therefore, this review portrays the current status of advances made by using GBS and its combination with other tools in various studies of cucumber such as the use of GBS and single nucleotide polymorphism (SNP) markers, GBS and GWAS, also with QTL and marker-assisted selection (MAS) are applied to display and detect explicit genetic architecture complex traits in crops and chromosome rearrangements.Cucumber breeding programs have undoubtedly benefited from genotyping-by-sequencing. Using the GBS method, research discovered lots of new candidate genes that control various traits including spine color, fruit stalk-end color, and disease resistance in cucumber lines., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Inflammatory demyelinating diseases of the central nervous system (CNS) in childhood include clinically and radiologically defined diseases such as acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD). Differentiation between these phenotypes can be difficult and cases not meeting established diagnostic criteria may remain without any specific diagnosis for months. Laboratory markers can assist in the diagnosis and management of these diseases. Previous studies suggest serum kynurenine-tryptophan pathway products and serum neopterin as biomarkers for CNS autoimmune diseases. Because urine is a reliable and repeatable source for analysis of these products with the additional advantage of easy sampling, we measured neopterin concentrations in serum and urine samples, urinary biopterin and serum kynurenine-tryptophan levels in autoimmune demyelinating diseases of CNS: pediatric multiple sclerosis (pMS, n = 27), MOGAD (n = 10), NMOSD (n = 5) patients and a control group consisting of healthy children or children with non-inflammatory diseases (n = 13), total 55 children. Methods were high performance liquid chromatography (HPLC) for neopterin, biopterin and creatinine in urine and kynurenine and tryptophan in serum; ELISA was used for serum neopterin. Comparison for biomarkers between all diagnostic groups showed urinary neopterin values were significantly higher in the pMS group (p = 0.002). The cut-off point determined by ROC analysis indicated urinary neopterin >167.75 µmol/mol creatinine could distinguish the patients from the controls with a sensitivity of 71% and specificity of 90%. The most significant difference was between the pMS and control groups (p = 0.002) while no difference was observed between pMS patients who were in relapse or stable state. Therefore, urinary neopterin appeared as a potential marker that could differentiate pMS from other demyelinating patient groups MOGAD and NMOSD as well as from controls. The fact that pteridine pathway products had not been studied in urine and serum in children with demyelinating disease before highlights the novelty of this study. If further research in larger samples confirm the present results, these molecules might assist the differential diagnosis of pMS from other demyelinating CNS diseases., (Copyright © 2022. Published by Elsevier B.V.)

Background: Knowing the risk factors for patients in intensive care units (ICUs) facilitates patient's management. The goal of this study was to determine the risk agents that influence our medical ICU mortality., Patients and Methods: This 11-month retrospective trial was managed in the medical ICU. In this study, 340 patients who were followed up for at least 24 hours in ICUs were accepted. The clinical data on patients were recorded retrospectively, and the mortality-related factors were analyzed. A regression analysis was also performed to determine the independent risk factors for ICU mortality., Results: The median age was 73 (53-82) years. The death rate was 23.8%. Length of stay (LOS) in ICU was 3 (2-5) days, and APACHE-II (acute physiologic and chronic health evaluation) score was 19 (13-25). The prevalence of chronic diseases was not dissimilar except acute and chronic renal failures among survivors and deceased patients ( p >0.05). Acute and chronic renal failures were higher in deceased patients than in survivors and were statistically important [107 (41.3%) vs 47 (58%), p = 0.008] and 38 (14.7%) vs 22 (27.2%), p = 0.01], respectively. In the binary logistic regression analysis, age, APACHE II score, need for invasive mechanical ventilation (IMV), decreased serum albumin levels, and increased creatinine levels were established to be independent risk factors for death [(OR (odds ratio): 1.045 (1.009-1.081), p = 0.013, OR: 1.076 (21.008-1.150), p = 0.029, OR: 19.655 (6.337-60.963), p = 0.001), OR: 2.673 (1.191-6.024), p = 0.017, OR: 1.422 (1.106-1.831), p = 0.006)], respectively., Conclusion: The most significant risk agents of death were determined through high APACHE II score, decreased serum albumin levels, and increased creatinine levels., How to Cite This Article: Kalın BS, Özçaylak S, Solmaz İ, Kılıç J. Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital. Indian J Crit Care Med 2022;26(1):49-52., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2022; The Author(s).)

Background: Prolotherapy (PrT) is an increasingly popular regenerative injection treatment for the management of musculoskeletal injuries. The diagnostic injection is a method for selecting suitable patients to apply PrT using subcutaneous 5% dextrose solution., Objective: The study aims to assess the PrT usage and modifications in the treatment of chronic low back pain and lumbar disc herniation and to define diagnostic injection procedure for PrT., Method: Two thousand three hundred and eighty-two patients with low back pain or lumbar disc herniation were evaluated at the Traditional and Complementary Medicine Practice Center in Ankara, Turkey. Six hundred fifty-four patients were included in the study. Diagnostic injections were performed on all patients who were thought to be eligible candidates for PrT indications. A 4-or-6 week interval was allowed between treatment sessions., Results: Xix hundred and fifty-four patient treatments were completed. The Visual Analogue Scale (VAS) scores decreased to 5.1 ± 1.4 while 7.2 ± 1.1 before the diagnostic injection (p< 000.1). The VAS scores decreased from 7.2 ± 1.1 before the treatment to 0.9 ± 0.9 after 52 weeks of the treatment (p< 000.1). Thirty-four patients' treatments resulted in poor clinical results (5.2%), and 620 of the patients' pain improved (94.8%)., Conclusion: PrT can be regarded as a safe way of providing a meaningful improvement in pain and musculoskeletal function compared to the initial status. Diagnostic injection is an easy way to eliminate patients and may become a favorite treatment modality. 5% dextrose is a more simple and painless solution for PrT and also has a high success.

Childhood is a period where most vaccines are administered in order to build-up immunological memory, and immunization against vaccine-preventable diseases is an essential part of child care and health. The administration of vaccines to children with inflammatory diseases is a frequent point of concern for parents and physicians. Published information on the relation between vaccines and autoinflammatory diseases of the central nervous system (CNS) consists of case and cohort studies and reviews, in great majority on adult patients. Vaccines do not have any established causative or triggering effects on these diseases. Another issue is the immunization schedule of patients with autoinflammatory CNS diseases, specifically the interactions between the disorder, the clinical status, the treatment and the vaccine. In this review, we summarize the existing information between autoinflammatory disorders of the CNS and vaccines in childhood and underline the points to be considered under various treatment regimens., Competing Interests: Declaration of competing interest Authors declare no conflict of interest., (Copyright © 2021 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)

Aim of the Study: Vitamin D deficiency is known to be associated with disease severity, unresponsiveness to treatment, and morbidity among patients with chronic viral hepatitis B and C, autoimmune hepatitis, and alcoholic hepatitis. This study aims to research vitamin D levels in patients suffering from cirrhotic and non-cirrhotic phases of hepatitis D., Material and Methods: 170 individuals in total were included in the study in the form of two groups: the first group of 100 patients with chronic hepatitis D (CHD), 30 of whom had cirrhosis, and the second control group of 70 individuals with similar characteristics to those of the first group in terms of age, type, and seasonal sampling. Levels of 25-hydroxy vitamin D [25(OH)D] were measured in the serum collected from patients and the control group., Results: The lowest 25(OH)D levels were identified in patients with cirrhotic CHD. When these levels were compared with those of the control group, they were found to be significant (15.30 ±6.92 and 18.90 ±8.30 ng/ml, respectively, p = 0.04). 25(OH)D deficiency (< 10 ng/ml) was detected at significantly higher rates in patients with both cirrhotic and non-cirrhotic CHD compared to the healthy controls (30%, 25%, and 8.5%, respectively, p = 0.01). A significant correlation was established between 25(OH)D levels and bilirubin in patients with CHD ( r = 0.252, p = 0.012). Multivariate analysis showed that chronic hepatitis D (odds ratio [OR] = 3.608, 95% confidence interval [CI]: 1.31-9.89, p = 0.013) and age (OR = 1.04, 95% CI: 1.00-1.08, p = 0.033) were associated with vitamin D deficiency., Conclusions: Frequency of 25(OH)D vitamin deficiency is higher in patients with CHD. The identification of vitamin D levels and the replacement of any deficiency may create a positive effect on disease progression, morbidity, and mortality levels., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Clinical and Experimental Hepatology.)

Turkey ranks second in watermelon (Citrullus lunatus L.) production globally and the highest production is witnessed for Çukurova plains the country. Although watermelon is extensively cultivated in the Çukurova region, studies on optimum nitrogen (N) and boron (B) doses for watermelon cultivation are quite limited. This study, evaluated the impact of increasing N (0, 90, 180 and 270 kg ha-1) and B (0 and 2 kg ha-1 B) doses on nutrient uptake in rind (exocarp) and flesh (endocarp) of watermelon fruit. Grafted watermelon variety 'Starburst', widely cultivated in the region was used as experimental material. The concentrations of different macro and micronutrients were analyzed from fruit rind and flesh. Individual and interactive effect of N and B doses significantly altered macro and micronutrients' uptake in rind and flesh. Higher amounts of macro and micronutrients were accumulated in rind than flesh. Nutrients' uptake was increased with increasing N doses, whereas B had limited impact. The accumulated nutrients were within the safe limits for human consumption. The N concentrations of rind and flesh increased with increasing N dose. Similarly, B concentration in rind and flesh and N concentration in rind significantly increased, while N concentration in flesh decreased with B application. It was concluded that 270 kg ha-1 N and 2 kg ha-1 B are optimum for better nutrient uptake in watermelon fruit. Thus, these doses must be used for watermelon cultivation in Çukurova plains of the country., Competing Interests: The authors have declared that no competing interests exist.

Objective: The aim of this study was to determine the prevalence of the causative agents of multi-drug resistant bacteria in pneumonia and also evaluate their mortality rates in the intensive care unit (ICU)., Methods: This study included all the cases of hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) in the ICU between the period of January 2018 and December 2019., Results: Seventy-four patients in pneumonia were included. Mortality rate was 45.9%. In patients with HAP had higher length of stay days in hospital and ICU, the use of sedative agents, sepsis rate and mortality rate as compared in patients with CAP (for all P < .05). Microorganism was identified in 27 (36.6%) of the patients. Respiratory samples were positive in 25.4% of patients with CAP and 60.8% of patients with HAP. Acinetobacter baumannii and Klebsiella pneumoniae were the most frequent aetiologic agents (40.7% and 22.2%, respectively). Acinetobacter baumannii was not susceptible to the third generation cephalosporin, piperacillin-tazobactam, carbapenem, fluoroquinolone and trimethoprim/sulfamethoxazole. Amongst gram-positive bacteria, the most common isolate was Staphylococcus aureus. The frequency of methicillin-resistant Staphylococcus aureus was 75% but these isolates were susceptible to vancomycin and tigecycline., Conclusion: The predominance of gram-negative agents was observed in pneumonia patients and because of the high resistance to antibiotics, treatment strategies need to be reconsidered in order to improve the poor prognosis., (© 2020 John Wiley & Sons Ltd.)

Aim: The aim of this study was to investigate the ABO and Rh blood group distribution and clinical characteristics in patients with COVID-19., Materials and Methods: The clinical characteristics and blood groups of 1667 patients who were hospitalised because of COVID-19 (with a positive PCR test) between 16 March and 10 July were reviewed cross-sectionally., Results: When blood groups of patients diagnosed with COVID-19 and control group were compared, it was observed that there was an increase in the number of COVID-19 patients with blood groups A and AB, decrease in the number of COVID-19 patients with blood group O, a statistically significant increase in the number of individuals with blood group A in COVID-19 patients compared with healthy individuals, and almost significant increase in the number of COVID-19 patients with blood group AB and a very significant decrease in the number of COVID-19 patients with blood group O., Conclusion: Our study has found that having blood group O may be protective, that blood group A may have greater susceptibility to the disease, but this does not affect the course of the disease and is not associated with mortality., (© 2020 John Wiley & Sons Ltd.)

Aim: As the COVID-19 pandemic has been spreading rapidly all over the world, there are plenty of ongoing works to shed on light to unknown factors related to disease. One of the factors questioned is also to be the factors affecting the disease course. In this study, our aim is to determine the factors that affect the course of the disease in the hospitalised patients because of COVID-19 infection and to reveal whether the seasonal change has an effect on the disease course., Methods: Our study was conducted on 1950 PCR test positive patients who were hospitalised for COVID-19 disease between March 16 and July 15., Results: As the seasonal temperature increases, decrease in WBC, PLT and albumin levels and increase in LDH and AST levels were observed. Risk of need for ICU has been found statistically significant (P < .05) with the increase in the age, LDH levels and CRP levels and with the decrease in the Ca and Albumin levels., Conclusions: It is predicted with these results that, seasonal change might have affects on the clinical course of the disease, although it has no affect on the spread of the disease. And it might beneficial to check biochemical parameters such as LDH, CRP, Ca and Albumin to predict the course of the disease., (© 2020 John Wiley & Sons Ltd.)

Objectives: Current treatment protocols in acute lymphoblastic leukemia (ALL) are associated with high remission rates and long life expectancy, enhancing the importance of quality of life and prevention of treatment-related complications in patient care. As osteoporosis is a frequent complication in patients under chemotherapy, we investigated the effect of vitamin K2 (100 mcg menaquinone-7) and vitamin D3 (10 mcg calcitriol) on bone metabolism in children with ALL., Methods: Twenty-nine consecutive patients recently diagnosed with B precursor ALL (B-ALL) and treated according to the Turkish Acute Lymphoblastic Leukemia Berlin Frankfurt Münster 2000 protocol were randomly assigned into study and control groups. The study group (n=15, M/F: 8/7, age 1-14.5 years, mean 6.5 years) received vitamin K2 and vitamin D3 with their chemotherapy, while the control group (n=14, M/F 9/5, age 2-17 years, mean 7.1 years) received chemotherapy only. Serum calcium, phosphorus, magnesium, alkaline phosphatase, bone-specific alkaline phosphatase, uncarboxylated osteocalcin (ucOC), tartrate resistant acid phosphatase 5b, carboxyl terminal procollagen propeptide (PICP), osteoprotegerin (OPG), and receptor activator nuclear kappa B ligand (RANKL) were measured and bone mineral density (BMD) was determined at baseline and first, second, third and sixth months., Results: The study group had higher serum OPG/RANKL ratio and lower ucOC levels compared to the control group at the first month; PICP levels were higher in the study group at second and third months., Conclusions: These results suggest an early beneficial effect of the combination of vitamin K2 and vitamin D3 on BMD in ALL patients especially during the period of intensive steroid therapy in the first months., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Doubled haploid (DH) technology is very advantageous in plant breeding. This technique is beneficial for reducing the time required to obtain pure lines and contributes to the selection efficiency. Using this technique, 100% homozygosity can be achieved in a single generation, while the development of stable lines using the traditional self-pollination method takes from 6 to 8 years. It has long been used in diverse crops including cucurbits. DHs can be obtained via parthenogenesis (pollination mostly with irradiated pollen), gynogenesis (in vitro culture of ovules and ovaries), and androgenesis (in vitro culture of microspores and anthers). All these methods have been used for over 30 years to develop haploid and DH lines in cucurbit crops. Nowadays, many researchers benefit from these techniques routinely. However, there are still many limits for using DH technology in watermelon breeding programmes. The number of developed DH lines is still very low.In this chapter, we present a protocol based on the different studies on haploids and DHs induced in watermelon through irradiated pollen technique, unfertilized ovule/ovary culture and anther/microspore culture. According to the results of all these studies, it is crucial to develop an efficient protocol for haploid embryo induction to enhance the frequency of obtaining haploid embryos in watermelon., (© 2021. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Developing drought-tolerant crops is an important strategy to mitigate climate change impacts. Modulating root system function provides opportunities to improve crop yield under biotic and abiotic stresses. With this aim, a commercial hybrid tomato variety was grafted on a genotyped population of 123 recombinant inbred lines (RILs) derived from Solanum pimpinellifolium , and compared with self- and non-grafted controls, under contrasting watering treatments (100% vs. 70% of crop evapotranspiration). Drought tolerance was genetically analyzed for vegetative and flowering traits, and root xylem sap phytohormone and nutrient composition. Under water deficit, around 25% of RILs conferred larger total shoot dry weight than controls. Reproductive and vegetative traits under water deficit were highly and positively correlated to the shoot water content. This association was genetically supported by linkage of quantitative trait loci (QTL) controlling these traits within four genomic regions. From a total of 83 significant QTLs, most were irrigation-regime specific. The gene contents of 8 out of 12 genomic regions containing 46 QTLs were found significantly enriched at certain GO terms and some candidate genes from diverse gene families were identified. Thus, grafting commercial varieties onto selected rootstocks derived from S. pimpinellifolium provides a viable strategy to enhance drought tolerance in tomato., Competing Interests: The authors declare that they have no conflict of interest.